So the primary goal today is to identify what needs you think are most important to the older adult population who served. That is those who are 60 years 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 list of common issues and concerns impacting older adults. So please take a few minutes to read through the list and let me know when you're ready to begin. I will share that now


So feel free to take a few minutes to review and let me know when you're ready.


Okay, great. So starting off for our records, can you please tell us your role and how you interact or engage with older adults.


As I'm a branch manager with Orange County Public Libraries, I work with adults, while the general population directly I'm currently working in Laguna Woods, which is a 55 and better population for the city so I do interact on a daily basis with older adults Prior to working at Laguna Woods I have also worked in Laguna Hills and Irvine while also working for the county of Orange


thank you and thinking about Orange County and looking at the list of common issues and concerns impacting older adults is there anything missing from the list


it don't think so. I was just going to it might be on here I was just looking for mental health but that's probably included with emotional well being and health care so no, I was just looking for that specific term but it looks like it's included


Okay, thank you and have the needs on the list including mental health Please rank the top three that you feel are most important


oh now I see mental health is up there under behavioral mental mental health sorry about that um, so yes transportation and mobility


probably disability is by your definition with vision hearing loss cognitive decline and


Thank you for your patience while I look. No rush


and I looking for I guess it would fall under respect. A big concern that I hear is dignity. Yes, I would say respect and a lot of that has to do with cultural differences. And for you know language barriers and cultural there, so let's say respect.


Okay, thank you. So for the next few questions, we will go, we will be going through each of these areas that you have identified.


Well, specific to Orange County and even more specific to South Orange County, I see where it's largely an area where people are used to commuting and driving themselves. And often as they become older, they are not able to have that same amount of freedom due to either physical ability, doing vision, hearing, just mobility issues, or cognitive decline, and often a combination of both. So I see with transportation as there's a loss of independence. And then there's looking for options where I see people that are learning how to find other options for transportation, and trying to learn other options can be confusing and complicated. Plus, there's also how that affects someone having that bit of independence and taken away from them and a lifestyle change where they're used to be able to drive themselves independently, most often. And I realize not everyone drives, but in southern california, car culture, I do see and hear from people saying, Oh, I can't get to you as easily. I don't know how specific you want information. I don't know. Or if you just want more broad terms.


Yeah, as much as you feel comfortable sharing, okay, would be great as well.


I work at city of Laguna Woods where the library is located. And one of the options they have for Laguna Woods residents is they can get what's called taxi vouchers, or discounted vouchers for Uber taxi type of transportation. And they do have that program through city of Laguna Woods, I'm sure there's other cities, similar programs, but I see on a daily basis, residents coming in and by residents, I mean of Laguna Woods, because you have to be a resident of Laguna Woods to be able to qualify for the discounted transportation passes. So I do see that there are folks that are looking for those options to get to grocery store run errands most often to doctor's appointments, where they used to be able to drive and they're no longer able to drive themselves. So I see that need for services being addressed in Laguna Woods. And I know that's not unique to the area. But that is something that I'm able to see on a daily basis, that concern with transportation and looking for options to get to places that they have to go such as doctor's appointments, or just grocery store, or just places for fun. So I see the change of having to navigate that as an older adult, how that affects and takes energy can be confusing and just generally having to learn something new sometimes. It's a process sometimes we'll see. There are folks that all of a sudden they have a physical injury that happens where they need to immediately completely change their transportation methods that they have been used to for decades and decades. And now all of a sudden, they have to learn something new while possibly also dealing with recovering from a physical ailment, a loss of a spouse or life partner. So for transportation, I do see that as being a negative a big concern. Also, personally, I know family members who are dealing with that. So I know it's just not unique to the residents of the area where I work, but transportation is a concern and there's a lot of concern for loss of freedom. And also, I don't know if it's fear, possibly more just strong concern with how will I be able to get to the places I need to go, if I can no longer often drive, which is a big issue that I see changing, I have family members alone, they just downsized from my in laws just downsize from two cars to one. So they're also dealing with that, we're still able to drive, but they are dealing with the psychological effects of loss of independence, to not have their own vehicle available 24 hours a day, seven days a week. So that, for transportation, I, that's what I see is something that is affecting the local population.


Thank you for sharing, and what barriers exist to seeing improvement in this area of transportation.


A lot of it just has to do with the, you know, the car culture in Southern California, but there is not a great infrastructure for public transportation. So that is definitely a barrier even with even if the individuals have the money are able to get bus passes or vouchers of some sort, the infrastructures not great.


I think so there is the economic difference. But I do also see, just cultural there are there's a large population that I work with that are English language learners, that are either recent or long term immigrants where they are they have been here for a long time. And while they are able to get by day to day learning something new and perhaps is more challenging when English is not the first language. And I my experience with that is just literally having people ask for help because of the confusion and filling out forms and paperwork.


Well, you know, long term would be better infrastructure for public transportation. But in the short term, really, I think, you know, more options for explaining or more venues for explaining what the options are and having staff that can assist. Because it can be confusing a lot of times this is an individual that is how also having some cognitive decline. Or if English isn't their first language. I, I've had people come to me looking at trying to look up things on the internet or fill out forms. And it's confusing to me, there's terms and options that it's not simple. So perhaps provide having, you know, places or ways to have more help and understanding. If I need to switch to other transportation.


Thank you. And now moving on to the next issue that you have identified of disability. So thinking of disability, how are Why are older adults struggling with this issue.


Just being able to continue life as they were used to as far as getting to places they want to without it being as difficult oftentimes ending up not oftentimes, but sometimes ending up kind of in a caregiver shut in situation where they're just not able to get to things they have to depend on someone else to do it. And then that, in turn, has to do with you know, affecting mental health and even physical health and losing some of the social interaction some of the routine the security of having a change in life. With Disability I see On a daily basis, individuals that are using mobility aids, such as wheelchairs, more often canes and walkers. And just by it, I looking at things differently because I realized, wow, there are a lot of places that are really difficult to walk around and get to and access with a disability. That I can understand people feel insecure, it's physically difficult, they need somewhere to stop and take a break, before, you know continuing on trying to move from one spot to another concern with just I guess, I know all of these things tie in together and aren't completely independent. And if I cannot, can I use public transportation, I noticed from personal and then also professional, and just from being in the community that the option for curbside services is often very helpful for individuals who either temporarily or permanently disabled such as recovering from a surgery or injury, or having a permanent disability, I see the curb size, curbside services are definitely helpful, and letting individuals navigate access to everything, you know, food. I work in a library library, but just having the options of having someone come to you instead of trying to get out of a vehicle and navigate an area where they're afraid they may become injured if they even have the option of moving.


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


Honestly, this one might sound a bit strange, but this is something that I do see, I hear people express their concern over I don't know the correct terminology for it. But when there's accessibility at the end of a curb, such as at a corner, where there's those raised, often yellow bumps, I do hear individuals and I have heard individuals say they fall in because working with an assistive device such as a cane, or a walker, or just unsteady feet, and it's very easy to lose your balance and trip over those bumps. I've also heard from individuals that maybe aren't disabled but just or you know, have small children whose toes catch on those bumps, or someone pushing a stroller that I understand the purpose of those is to assist individuals who may have visual impairment with knowing when they're entering or leaving a curb. But I know I've had people expressed to me that fear of falling is tripping on those yellow bumps. I know that's very, very specific, but that is something that I do hear individuals say often is a concern. They understand that to help folks with vision loss, but i i even encountered that when I had a family member with a temporary disability and was on crutches and was really having difficulty getting over those yellow bumps without ending up falling.


Um, I don't know that. As far as mobility other disability again, maybe perhaps cognitive or language but as far as just strictly physical. I don't know that there's necessarily anything different there unless it's paired with an additional thing as such as cognitive decline or language barrier. I haven't noticed anything specific to just purely physical disability.


Well, I just think, can continue. Enforcement and evaluating access as far as physical access is, is a big thing. And I know that happens in an ongoing basis when different buildings are renovated or updated, making sure they follow code. So just continuing to enforce that would be helpful.


Just their experience another, you know, chapter in their life change, just as you know, children become teens and adults. And just transitioning to another period in your life where you notice there's a lot of changes as far as you may need to move your physical, and cognitive health might be different, you may no longer to be able to drive, just respecting that this is another stage in life. And that's I think we're hearing about it more, because the population, the aging population is growing. So I think there's a need for more attention. And I think individuals are trying to demand that because the range for what's considered older adults, depending on the definition can be started at 50,55, 60, 65. But still, it's possible to be considered an older adult for 40 or 50 years of an individual's life. So seeing the access and equity to existing services is important. And I think people are right to want that either for themselves, or seeing that they have someone else they know, that is part of the aging population. Well, we're all part of the aging population, but part of the senior population to realize, Wow, how hard is this for my neighbor, my family member, it's just the stranger I see on the street that going, Wow, how, how are they able to do this, I wouldn't want to have to try to navigate certain things. And so the respect, just I think there's needs to be more attention to another stage in life that's going to be lasting for possibly decades and decades, as opposed to seniors, it's a short, short period of one's life where there's a good chance it could be the majority of one's lifetime is as a senior and having, you know, respect for that is important. Just, you know, general, I guess all of those things being considered is responsibility to take part of take care of this part of the population that's aging, just as like there's so many I feel like protections and considerations for children. Everything from car seats, you know, age restrictions, free lunch at school, all sorts of different things, just respecting seniors are also another part of the population. And I realize there are options for free lunches and transportation issues, but the respect is not like oh, you're a senior, you're an accept exception to the population, you're now the majority of the population. So that needs to be addressed and respected.


Um, let me see. Let me think about that. I painted such a broad picture now let me think about it.


I guess perhaps. I'm gonna go back to cultural like respect as being seen as something different possibly depending on what culture came from originally. You know, that type of attitude that a Um, historically has been part of, I would say, culture in the United States where there hasn't been a senior's necessarily known as a segment of the population that's respected and seen as wise and has a lot important place in society. Instead, it's seen more as, oh, you've retired, you're no longer contributing to society, you're a burden, financially and everything else. As opposed to celebrating that, okay, your survivor, oftentimes, military experience, most often come through some kind of having lived through moving to a different country learning a new culture, major changes, veteran status, so forth all I think all of those things demand respect, and they do get some, but not enough considering the huge amount of population that are seniors. How to fix that. That's a little harder, because it's not something that just say, I will change this and make this more accessible. I don't know, I guess just I think part of what you're doing for a little bit, I understand is definitely listening to the voice of the aging population and seniors making sure that they have a say that any changes are I know you're serving some through your project. And I think that's very important. Because it's one thing for me to say, I'm looking at this, how I see someone else and what they're telling me they might be feeling or what I think they're feeling. I think letting them know that their opinion matters for issues that directly affect them. is important. Probably more important than my own.


There are I think, a large one has to do with what we see in Southern California, that economic barriers can prevent someone from having access to pretty much every thing that could be available to them, you know, in a different side, from any cognitive language, so forth. I've seen individuals while they're waiting to try to get a caregiver, because now they found they need one. And while they're waiting for approvals and things to go through, sometimes individuals are able to have themselves or have friends or family where they can pay for a temporary solution till they have a longer more affordable one. Where for individuals that don't have that economic security of having their own money or friends or family, that is more difficult, and that can lead to more problems while they're waiting for assistance. So economic access, because I do see individuals that let's say maybe can't drive anymore need to figure out options, but if they're able to financially, get someone else to drive them, that's a totally different situation than not being able to put money towards something to find at least a bridge till there's a more permanent solution for often caregiving transportation, so forth.


Thank you. And I know you already touched on this a little bit, but there's anything you want to add.


Thank you. And there's a few more questions. But that's it for the list. So I will go ahead and stop screen sharing.


Can you please describe how accessible and adequate, accessible and adequate


Often, it's transportation and time, that's the issue as far as how quickly someone could get an appointment, and then what their options are for getting there. But I think the care is adequate, just from what I've heard, personally.


Thank you. How accessible or adequate would you say that it's,


for long term care, the I would say, the bigger problem is just cost, it's very prohibitive not knowing cause long term could mean anything from six months to 30 years or more. So the problem is, it's less accessible and adequate, because realistically, someone's not going to come up with a long term care plan, and then not have to have changes to that plan, either because they require a different level of care, or because it's not affordable, or the provider has changed, it changed for long term. And then that's a whole other thing where someone has to get used to it, now I need to work with someone else in my home or move to another facility, and all of them can be quite expensive. And it's hard to gauge that not knowing is long term, six months, a year, two years, 20, 30, 40 years. I mean, I I've come in contact with individuals that are in their 90s and, you know, have very little need for long term care, some that have had long term care for decades. So I can't even imagine as far as organizing that for yourself or a family member, how you go about knowing well, what's long term.


i Well, I do think just you know, making sure that there are I see individuals that are on a lot of medications at the facility where I work in city hall that is currently at the end of June expired and no longer needed medication Drop Location, where I'm at, I know there's changes and it's gonna be switching to I believe local pharmacies, but right now in Laguna Woods, they they're a location where individuals come and they can drop off items. And I see it's amazing that when someone loses someone, then someone else brings in the medication that's no longer needed. The amount just the sheer quantity is a lot. To me, I'm I'm sometimes shocked just the amount of sharps and pills and medications that thing oh my gosh, this individual really had a lot and I I just wonder like, how often is it reassessed because instead of just adding more and more and I you know, I don't have a medical background, but just the sheer quantity of medications that I see are brought in for drop off when they're no longer needed is quite shocking to me personally. And I don't know if these are medications for like, physical health, mental health, because I don't have access to that, and I don't want it. But just looking at what are perhaps other ways of treating health other than medications. And I do realize, yes, there may be some that are necessary, but I feel like gosh, there's there really had there are other options that are explored that the health insurance would cover that possibly wouldn't require someone to take so many medications on a daily more than a daily basis multiple times a day often. So I would just like to see more looking at options that aren't just in prescription pill and liquid sharps form.


Um, let's see, I don't entirely have as much contact with that. I think the bit that I do see is feeling that. And this could just be a matter of impatience, but just how long it takes to when you are, you know, someone who might need help to get social services can be difficult. Because I don't know, it's, if that's oftentimes you don't see it. I don't have the perspective to know what this person considers an emergency. I have seen, you know, individuals where there's concerns that are immediate than they call the non emergency police line as far as the if there's concern of elder abuse, neglect, a welfare check, and that police will respond, but I don't see what happens beyond that. So I don't know as much. I do know, like the immediate, like, non emergency police lines responsive, but I'm not sure what then happens with social services and human services to address concerns like that.


It sorry, it faded out a little bit. Oh,


I do think there's a wealth of information, knowledge that older adults have. So definitely make it sure they're part of the conversation. Just the government really needs to tap into that knowledge, I think is a good starting point.


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


Trying to think of the different resources, and I know some are addressed, I have seen just thinking out loud, I've seen a lot of help for folks that do have language barriers, get it from their cultural groups, their church groups, I see that is coming, there's still a much greater need, because if someone's not part of some kind of cultural or religious group, then they wouldn't have access. So language is a concern. And not just language, just like cultural difference. So I'm going to go with yes, those individuals who have immigrated to the area, you know, at some point in the lives, it could be very recent, my next door neighbor just came here from Ukraine a year ago, she has a language barrier, she is living with family members, so they are able to assist her. But I also you know, have other neighbors with similar situations from different countries where they've been more of a refugee situation. And so I will have to go with language and cultural because a lot of times individuals, there might be help and options, but they may not even know that because perhaps from their experiences and the culture they came from, that's not something that we offered so they wouldn't even know to look for certain types of services or assistance because that would not have been provided in their experience where they came from either due to you relied on multigenerational families to take care of yourself or it you just came from a place of political unrest where that just hasn't even been an option so lack of knowing so again the culture and language thing I would say that can cut across all different economics just as far as getting the word out there to know there is there are some services and options and places to get questions answered.


Yeah, thank you and thinking about all the issues facing older adults in Orange County what issue is being overlooked


tried to address a lot let me think of what being what's being overlooked.


Good, I feel like counties doing a good job of trying to identify


I don't know maybe I maybe I just haven't heard about it. But I hear a lot of confusion with possibly how to Prepare for when you or someone you know who's older will need to transition to needing more caregiving, just where to start getting more information. And it may be there. And I'm just not aware of it, which I guess could possibly mean it's overlooked. Just understanding where to start. Perhaps for my age, I'm, you know, the sandwich generation of children in college, I have parents in their 80s. And just trying to figure out well, how does one prepare for when more help is needed, as far as often like caregiving are not able to live independently understanding the process to set up a good plan for individuals.


Thank you. And in addition to what we've already talked about, we can dive a little bit deeper into the topic of bridging the digital divide.


Okay, well, I do. I see all different levels of digital use and access, both on a personal and professional level. Where I work in the library's pretty much every year after Christmas, I'll have individuals that are given e readers, by family members, they'll come into the library and schedule a one on one tech help with setting up their Kindle or other e reader. The age ranges from in their, I would say 50s to 90s. And these are individuals that have gone from regular print book to large print, to now need to and sale the large print books too heavy, I need an e reader. So I see there's it's not one size fits all, as individuals that very much are super tech savvy, you know, whip out the smartphone, the e reader have an Amazon account. So not trying to think it's a one size fits all for seniors is important. Then I also think of my own father who never used a computer in his life and never intended to so would still go and do banking at the bank and doesn't have doesn't use an ATM card. So I think just recognizing that digital divide, it's I know it may not be cost effective, but keeping different options where there are individuals that don't want to or you know, have a computer that prefer to call and speak to someone one on one for anything. I get a lot of individuals that will call at the library. And even if they have a computer, perhaps, you know, it's something they were told to do you know, for a mental health call and interact socially with someone. So the digital divide is, I guess, providing options because while that may not be cost effective to have a live person who can answer or you know, a chat bot or you know, online help, and everything, just understanding and respecting that I see all different levels of, you know, ability with technology. And then that's and that's just talking about the ability of wanting to use technology, not if there's an economic barrier. That's a whole other thing in itself. I just mean the desire to use technology and respecting that. Perhaps still need to have all different levels of options. I do like the idea of there's an I hear individuals say they like being able to do stuff from their smartphone or computer because if they don't have transportation or mobility, but they have the cognitive ability, and the economic ability to have Wi Fi a computer or smartphone. That is great. Everything's more accessible through technology for them, but then there are individuals that either don't want to because they don't want to adopt technology or have even been told. Go out and interact socially with people and be aware of those, you know, scams and Brought, don't put your information into a computer, if you're not 100% Certain, so just respecting that the digital divide is it's varied, it's not just a divide, it's like all up and down and roller coaster of different levels. So that's, that that's problematic, but but I see it all the time.


Thank you, and what new or revised policies are needed


language accessibility is a big one. I see a lot of individuals that are very sharp, you know, no cognitive decline to speak of retired professionals highly educated, but might not have the command of the English language. So having options in different languages, because it is very different for someone to be able to have conversation on day to day going grocery shopping type of interactions, as opposed to filling out tax firms and dealing with legal language is a whole different level of fluency. So language barrier.


I don't know. Because that's, I honestly don't know. That's difficult. I mean, I almost feel like that's complicated. Because I want to say, you know, someone that ways to translate items without being unbiased, but how I don't even know how to third party check on translations, if once they're, you know, able to vet them that it's not biased in some way. Perhaps I'm just reaching there. That's very complicated.


I do look at the local census. Numbers, demographics for the area I work at. And that's what I use for planning. I also direct observation, and then I will, you know, I'm a librarian, so I research stuff. Census data is helpful. But I realized not everyone does the census. But that is helpful. As far as seeing some some areas where it could perhaps go to focus, this is a bigger trend, where I work directly, so I need to focus more on one thing instead of another.


I, I do, I work with the seniors or I work in Laguna Woods senior community library. But we also have a Senior Services Committee, which I am a part of, but there are two co chairs that recently led the May 2023 Older Americans Month events for Orange County public libraries. So they would have a lot of direct, you know, information based on the direct experiences up to planning and success and interactions with individuals. I know, they said, we had some different things from craft to making some recipes to just telling about libraries, vendors from, you know, perhaps health care agencies and so far, so it was like a I say like a health fair or job fair, but it was for older Americans during the month of May. And I know the response was that it was very welcomed that individuals who attended are happy to see something and commented, there's usually nothing for us. You know, while it's great, there's stuff for kids preparing for kindergarten and different things. There's not as much the other end of the spectrum and They were happy to see that they're being given a place and respected and so but I yeah, I do have two individuals I don't know if you want me to tell you you know how their names or how to contact them or email, what would be the


Yeah, sure. I can definitely get their names and emails or if you'd be able to connect me with them that would be amazing to hear. Yeah,


whatever your preference is because our email through the county is quite long. So, but they, but their names are Isabelle Stevens and Josh Hartel. And I will send you that information. Okay, but they were, you know, chair and co chair of Senior Services Committee and instrumental in preparing, planning and executing the different activities we had last month.


Okay, that'd be great. Thank you. Yeah. I would love to hear from them as well. Yeah, okay. And


they both work for OC public libraries, but they work in different cities than I do in Garden Grove and Seal Beach. So they're, while I'm in Laguna Woods, so their experiences, I'm sure there's going to be some a lot in common, but they also work in different cities. So I'm sure they'll have some different things to say.


Sounds great. Yeah. Thank you. Yes. Yes. Great. Thank you. So that concludes our interview. I will stop recording now.


Okay, so the primary goal today is to identify what needs you think are the most important to the older adult population that you serve, which those are, who are 60 and older. Okay, so we want you to think as broadly as possible, taking into consideration to older adults, caregivers, families and their communities. So, right now I'm going to share my screen. So you can see a list of common issues and concerns impacted or the adults condition is simply now


Yes. So take a few moments and go over it and the following questions will go from this table, okay.


thank you. So, the thinking specifically about the older adult population in Orange County, for records, can you please tell us your roles and how you interact and engage with older adults.


Yeah, so I am I oversee many volunteer programs at One OC, who serves the entire Orange County community. And one of our programs is the RSVP programs. So that's a retired and Senior Volunteer Program where we specifically work with older active adults in and placing them in volunteer roles and positions. So we have a full program and we actually have that program for San Bernardino County as well. But I guess for the purpose of this we'll focus on the Orange County program


I don't think so. Not from my experience and working with with that, I think they're very covered on here.


perhaps the I would see this as one in the same so I would kind of say and this is what maybe we specifically work towards so maybe I'm a bit biased and skewed here but we work really specifically with the emotional well being and the behavior and mental health because those are areas that volunteering and being connected to your community can really help support um, it also helps you know, identify other things on this list earlier if you aren't connected and everything so I would say those would be if I can do a tie for first or maybe that's just my first and second and then I think from what I see maybe


I would say personal care management or disability


Personal care. Okay, so number one. Number one.


I guess I was kind of seeing them as I guess I was trying to do too is this number one because I kind of see them as interacting a lot that behavior on mental health and emotional well being.


So behavioral and mental health would be you One. Okay. Yeah. And then the other one is for number two will be your well being


Oh, yes. For number one you say So for number one, I have behavioral and mental health. Yes. Is emotional well


so when you think about all the things that you mentioned, like top three that you mentioned. So now I'm going to go ahead and ask like, a few questions, for each of those things.


I think because of, I mean, many of these go into the other ones, but I think just in the world that we're in right now, many have been, you know, either isolated in some way or, or scared of going out during COVID. And I think the recovery after that, I think in many different fields, are seen sort of the effects of that. So I think it's maybe top of mind and probably encompasses some of these other issues and concerns. So if they're just beginning memory loss, or forgetfulness, if they're starting to worry about meeting a caregiver, and not possibly being able to afford one, if it's perhaps their first time struggling with mental health, again, induced perhaps by the pandemic, I just think it's top of mind for most of our population, but I think it hits the older population in a different way, because they may not be able to access all of the


available programs that could support them, they just might have more barriers to access for support in this area.


Thank you, and what barriers exists are seeing improvements and behavior on mental health.


Um, for that, I think some of the things that are listed on here, I mean, the technology piece of it, if they're just even trying to identify where they could go for that. Then on top of that, depending on if they have transportation or anyone to help them access those things, and it could also be an economic piece if they're older and no longer have health insurance through their work, because they're retired or otherwise.


Yeah, I definitely think based on, obviously, your economic picture, but also different cultures have different, you know, if you don't speak English, it might be harder to access services. Depending on how culturally you live, if you're living with, you know, your kids or your grandchildren that might be able to support you that might give you more support than maybe if culturally, you're a part of a culture that where you are living more alone and isolated. So I definitely think there are different groups that just have very different experiences with it.


The best way to address it, I think it's really taking into account you know, all of the barriers and designing programs and community support around that. I also think there's a piece of it that's preventative so understanding that. I guess understanding and for and empowering and giving people tools to address these things, even before they reach being an older adult is if you've access programs before, if you've gone to therapy, if you have identified, you know, resources, where if you're realizing that you're forgetting things or things like that, I think there's a preventative aspect to this where we could educate the general community before they're getting to that place.


Thank you for sharing that. And so now I'm going to go ahead and ask the same questions for the second issue that you mentioned. So how and why are older adults are struggling with emotional wellbeing. Yeah,


I think a lot of the same points there, but maybe really focusing on the fact that their life may look very different than it did maybe when they were working and had, you know, a lot of tasks and families family around a lot of obligations. And I think it's a really big change for people when perhaps they lose their partner, or perhaps their kids move away, and they're feeling more isolated, if they haven't ever had the time or experience to get involved with their community or make new connections. Again, this could go back to a cultural background of feeling comfortable doing that.


that we are definitely seeing, and I don't think this is a new one, I think that it might be exasperated by the pandemic, but I definitely think this has been a


piece of of aging, unfortunately, that you do feel more isolated and more lonely.


Yeah, and What barriers exist to see an improvement, and on this issue emotional wellbeing.


And so I think that's all all very, can be cultural dependent, which would split it up into groups within Orange County. Definitely.


This I think, honestly, we see this addressed so much through the programs that we offer. Volunteering is a really fantastic way for people to feel like they have a purpose like they have, you know, something coming up, they have something on their schedule, there's something that they can or shouldn't be doing. Even if it's from their home, if they don't have the transportation piece. There are a lot of opportunities that even without technology, older adults can can volunteer from their homes now it could be making meals or birthday cakes for foster youth or like some really cool programs that that really just gave us a sense of purpose and have that connection to the community even if it's just for a brief few minutes of someone coming to pick up something that you made for someone else. So I think that's a really, really fantastic way to address this.


on to the next issue, like you mentioned, I just want to clarify.


I think disability, one, figuring out how to adjust your life for a disability. But I think the examples of vision or hearing loss are things that we know happen to older adults, no matter what no matter what cultural background you are, or anything like that, it kind of unequivocally happens across the board biologically. And those things we know can be incredibly isolating. And can really affect your whole way of life, you can feel like you're not participating in life anymore, which can lead to the cognitive decline and, and can really have some horrible, horrible consequences for the way that you spend the, you know, the end of your of your life. So I think disability and really understanding and being equipped to, to adjust to a disability is a big thing.


Yeah, I think a lot of this goes to like, the insurance piece being able to get into doctors getting the equipment like hearing aids and, and things like that can be very expensive, it can be very hard if they need to be fitted multiple times, if you lose one, I think really accessing the medical care around these things can be one of the biggest barriers, I would say. In our


lives difference, different experience for different groups of older adults, and for different from different backgrounds. Regarding this issue.


Some may feel more or less comfortable asking for help in these areas. There may be from a cultural perspective, more or less shame, depending on your background and asking for these things. But I think, as I mentioned, biologically, we know that a cognitive decline or hearing and vision loss, but it's just it happens across all groups.


lot, as I said, with the first one, I think, a lot of education.


preventive education, I guess, but also, again,


with the knowledge of what is included in Medicare of what is, you know, where can they go for doctors that specialize in working with older populations, and ones that have, you know, a proven track record of really caring for their patients. So I think it goes to both available health care available medical care, as well as the knowledge around what that medical


Thank you so much for answering that. Those questions and the following question won't go based on this table, so I'm going to start sharing my screen. Okay. The first one is geriatric care.


I guess I don't have personal experience with enlisting geriatric care. I do feel like even as someone who's not a caregiver of someone who's in need of Geriatric Care at this moment, I do know of places that I would go in Orange County for that. So I would say that it is least at least prevalence. I don't know how the economics work into that. I don't know how accessible it is from an economic standpoint, but I do know that there are a lot I have resources in Orange County for that.


Thank you so much. How accessible and adequate


the Council on Aging on some projects. So I definitely know there are a large number of long term care facilities in Orange County. Again, the ability to get into those depending on your background or your economic status I'm not aware of but once again, I know there are many of them. I also, though, know that we have an ever growing older population. So I am not sure if that is on par with the need in the county. I'm just aware that there are a great number of long term


Say I kind of have the same answer for that I once again, I'm aware of a number of resources for those things in Orange County, through the numerous hospital systems that we do have here. And through nonprofits in Orange County as well that work to get those services out. I don't know how it meets the full need of what is in Orange County right now. So they're there, it feels like there's knowledge about them, but I'm not sure if it's fully meeting the need.


So working with different organizations, there's Mariposa, there's Nowruz. There's a good number of clinics that really focus on specific populations. And those are more towards, for instance, Nowruz focuses on Persian populations of all ages, but they're very focused on that. I know. Mariposa specifically focuses on women at any age, and they have programs specifically for older women as well. And then I know you've been working with Kaiser, they have resources for that as well. I know through Laguna Woods, their care coordinators at some of the levels of living are very good at arranging those services as


What about humans, social services, have adequate accessibility in those services are.


know, again, not having access to them for my personal family in Orange County. I'm not sure what the process is for going through those.


So much. Now we're going to move to the next question. And the next 10 years


the next 10 years did you say it's I would guess,


housing, maybe one of that affordable housing, as people as we know that housing prices continue to escalate here. And we know that people are living longer, but also perhaps having more needs that they're addressing as well, both medically and mentally. So I think I think housing need might be one that is a big piece of it. In Orange County specifically, I guess.


I continue. Like I said, I think that behavioral mental health will continue to be that just because also we'll have older adults, people who are over 60, who both need care themselves, but are becoming caregivers as well. And I think that will continue to


be a huge need for both them needing care


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


in Orange County. I think making mental health


and healthcare services as accessible as possible and as affordable as possible, would be government's role in that


attention and support. I think perhaps, I think of and this is just,


I think of newer refugee groups that are coming over the Afghan refugees that had come over recently. Yeah, I think a lot of those groups and also, I guess, I would throw into here, undocumented people that are here, I'm, obviously are not getting access to those services, the caregivers of those who are undocumented. That would probably be the least represented group


that I would think of. Thank you so much.


I really do think that connection piece is a huge one. I think there are many groups that advocate for different for different physical illnesses for dementia and Alzheimer's. And absolutely, those things need to be taken seriously and really need to be planned for because of the level of care that they require. But I do think that perhaps being overlooked is just the emotional well being and the


It seems to be very once you get to a certain age seems to be very physically focused.


The resources, I guess, that are available. Thank you so much.


Now we're going to move to different questions like focus more on your on your topic of expertise.


There are a lot people who are still living very, very active lives. So what's working is giving them still, you know, things to do. They're very, they're experts in a lot of areas, they've done amazing things, they have a lot of experience. They can be fantastic mentors, they can be fantastic trainers, they're, you know, helping nonprofits, they're helping their communities, they're able to outreach to others and be caregivers. So I think what's working is not treating every older adult as if they need help, like part of what can help them and give them purpose is actually understanding that they can give help, still they can. They're still very adequate. And they might have now some different barriers physically or even mentally, like we talked about. But I think that there are volunteer roles that fit for any different kind of person. If they don't speak this language, there's a ton of things that they can do to help their own community and being you know, speaking in their own language, but still making awareness of resources and and doing that. So I think what is working is having a huge variety of ways that people can volunteer and be connected and feel that sense of purpose and meaning.


working, is thinking that volunteering just looks kind of like going into like a food bank and packing a box, or kind of the maybe a traditional or typical or older way of thinking about volunteering, connecting with your community and supporting and everything doesn't have to be a physical act, it doesn't have to happen outside of your home, it doesn't have to happen, it can be whatever you want it to be. So I think it could do some updates as far as like, what people think is available in that way.


when new or revised policies are needed.


to necessarily be a policy change or anything around it. Perhaps there's some sort of initiative or some sort of incentive for organizations to offer volunteer opportunities, or varied volunteer opportunities. That would be the only thing that I think could possibly cross over into policy, but I don't know, perhaps some incentive piece for organizations that can come can have volunteers and come up with roles for people to be involved and connected and


Like, I think local government like city governments and things like that. And maybe hospital systems. So some private companies, I guess, as well, but I think I don't think it's necessarily like someone needs again, I don't think policy needs to be created. But I think the help in spreading the word of the benefits of that and spreading that there are these different opportunities. I think that local governments and even again, hospital systems and things like that could do better at that being a solution sometimes that sharing that and that making that connection for people or sharing those resources.


there's different I know, we work with Americorps is who's who's one of the funders for our RSVP program. And so they have data on how having older active adults, you know, involved in their communities, and everything does help their well being does help their quality of life. And so that's the data that we go off of, and I would venture to guess that there's quite a bit more data about how staying just socially connected, really helps cognitive function and other things that older adults also are concerned with as well.


I can't off the top of my head, I can send you some of those.


The Council on Aging, I think is a fantastic resource in the Orange County community as well. They're very passionate about it. We work with them to get long term care ombudsman, volunteers. The Council on Aging, aging. Yeah, they're fantastic. They are super passionate about the work that they do. And I think they would have even more talk about data being driven and the programs that they do and trying to really address you know, the physical, mental and just quality of life aspects. There are really fantastic organization.


Thank you so much. Yeah. May may follow up with you if necessary. Yeah, of course. There's so much yeah. So this was the end of the questions or the interview. So thank you so much for your time. It was very helpful for research. And please LIKE if you feel that you want to share something else, I mean, dismissed They're like saying that right now just like just to confirm that to me my email or like send it to the website I wouldn't accept sharing right now


once again we saw the primary goal today is to identify what needs you think are most important to the older adult population you serve the population user who are 60 years and older we want you to think as broadly as possible taking into consideration the older adults, caregivers families in their community. I'm going to share my screen so you can see a list of common issues and concerns impacting older adults


so please take a few minutes to read through this list and let me know when you are ready to begin and take as much time as you need and let me know what this is a one page document I'm trying to fit it out into one screen but let me know if I need to enlarge it or you know move around so just feel free to let me know what you need


Yeah, sure if you can enlarge it I would appreciate that


Yes Yeah. There we go. Thank you so much course.


Let me know when you need me to scroll down okay


Okay, all right. I will just leave this page up on the screen and we can move up and down however you like.


Yes, so my my role with with the elderly adults would be more on the housing side. And what type of emotional well being, you know, are they are they incurring, you know, on a daily basis because of, of, of anything having to do with with homelessness or you know, disability and like diet, mental health, emotional health as well as you know, addictions alcoholism and just basically, you know, being you know, their emotional health and their and their welfare


state You're thinking about Orange County, and looking at the list of common issues right that I have on the screen and concerns impacting older adults.


It looks like there there's culture. I don't I don't think I seen anything in regards to let's see access to culturally and linguistically appropriate care. Oh, there we go. That's under health care access and delivery. I'm sorry, I didn't see that one. But yeah, it's it does say access to culturally, culturally and linguistically appropriate care so that's in their ultimate abuse neglect


Okay. Um, I don't see anything. Maybe in regards to


Like, I know, even you know, I know that our elderly sometimes do want to be have some sort of, you know, they want to feel like they, they, they still are a part of the society and that they're not just forgotten. And some of them do love, you know, do like to volunteer or they do like to, you know, kind of have like a be a part of if they don't have their own family be a part of like a, an adopt an adoptive family, like an adopted elder sort of deal. Where were families or even just in general, maybe, you know, businesses or schools or, you know, people like, like nursing, like you know, I get nursing homes where you know, people go out to visit them or play cards with them or take them you know, a pet to go see them, you know, just to kind of like brighten their day. I don't think I've seen anything in regards to that


I mean, it says, you know, loneliness, including quality of life, life satisfaction, community support from work, family, or Church Age Friendly neighborhoods, but I don't see anything in regards to having you know, those type of resources for somebody or


health care and everything like that, that's, that's good, but like as far as you know, people going to see them too whereas they need like PPE or you know, things like that. I don't think I've seen that. I mean, it might fall underneath the health care, access and delivery


that's fine. So but it doesn't really say anything in regards to you know, get getting out you know, things like that to them.


Please rank the top three that you feel are the most important.


The top three, definitely. One would be behavioral and mental health.


Think that the second would be the disability


let me scroll down the second half, two.


And then the third would be the the health care access and delivery.


Now I'm going to ask you some specific questions about each one of the three.


Probably will, I think, number one, because of


not, you know, it's hard enough as adults or as children to, to receive help for for those types of, you know, of issues. But for elderly, for elderly, you actually have to have somebody who is willing to, to take you to a doctor who's willing to take that time, you know, to schedule all those appointments for you and to differentiate if it is either from you know, Alzheimer's, or if it is actual mental health, and behavioral issues. Because sometimes, a lot of you know, a lot of times, people don't, they aren't able to differentiate, you know, from from that, like, I know, especially like if, if, if there is an elderly person, like say, in a, you know, like a, a nursing a nursing home, or a nursing care, or if they were like if they were to fall and like breaking her hip, and then they need to go get surgery, and then they stayed in aftercare for a while. If they started to become depressed, or, you know, they didn't have enough people to come visit them, or their family members were, you know, like they, they can sometimes get into like a battle, you know, between legalities or who's going to do this, or who's going to do that for them. It can cause them a lot of serious issues. You know, and they, a lot of people don't tend to know, like, well, maybe they're just getting old and they're suffering from Alzheimer's or sundowners or what have you. But it can also be the mental health. So yeah, so it's a really, it's a big issue in regards to that. Because not only that, you know, the family, they tend to, to kind of like, not want to believe that there's any type of mental health issues or behavioral health issues with their, like grandma or their mom, or their dad or whoever it is. So there's that. That disconnect right there. And especially with between the families, but not only that, like, you know, say that the, that they're that they had, like, addictions problems for a long time or alcoholism. And that can can, that also can affect their mental health and their ability to, you know, live a good healthy, you know, long life, or, you know, any type of just really, like, yeah, just just have a good quality of life. Not only that, like some of them feel like their burdens on people, and then also that would that can affect their, their mental health, you know, and, like, all of this stuff, I mean, like it, the pandemic, being lonely being, you know, cultural, you know, different different types of cultures, and then like, maybe they're having, like caregivers go in, and they have a lack of communication, because they, you know, they're, they don't speak like if they're not English speakers, and they can't really get like a caregiver provider who can speak to them, then there's that that misquote, you know, that that lack of communication, and that could cause you know, different things where you can't understand if they're, if they're suffering from any type of mental health. Yeah, so


Again, we're talking about the first of the three that you mentioned, the first three or the first of the three, the behavior, mental health or so we're still on this topic.


Well, let's see. One of the biggest barriers I think would be culturally because a lot and you know, a lot of people Um, like, as far as the Native American culture, I know, that it's really hard for people to ask for help. And it's really like, it's kind of like a stigma, you know, like, they're, they tend to not want to even go to a doctor for help. You know, there's systemic racism in healthcare. And they're, like I said, there could be a communication barrier because of non speaking English patients, and not enough interpreters. Or just people basically dropping the ball and not really caring, you know, about our elderly people. And just thinking that, Oh, well, you know, what, they're old. Why, why even bother, at this point, trying to try and to get them any type of help. I've seen, you know, I've seen all kinds of different things or, like, you know, if they're homeless, and they, they're suffering from mental health, or nobody was going to want to, you know, nobody wants to go near them. Nobody wants to touch them, they just based on fear of, of not, uh, being, you know, kind of, like, ignorant to the fact that these people are somebody's, you know, they were somebody's grandmother, they are somebody's grandma, they, you know, or, yeah, there's lots of barriers. Again, you know, travel, getting them to and from their doctors, having that person who, who can drive them to and from, you know, the necessary financial, you know, obligations to people. And, you know, some people don't have that money to go to go get help for to go see a doctor, or even have family members who, who can afford it, or have that time to, you know, so the, that's the biggest barriers is, is to actually have that support, you know, from, from either the community from your doctor from, you know, from your caregiver, and, and your family or your or your friends or your church.


Oh, yeah, definitely. I mean, there can be people who, you know, live on, on reservations, and they don't have that mental health. You know, they don't have that mental health or behavioral health clinic, you know, near them, and then they would have to, like, you know, traveling to the cities. And then the referrals, like in order for mental health and behavioral health referral, you know, sometimes those takes long those those take long, you have to go through like psychiatrists, you have to go suicide, like our, you know, psychiatrists, psychologists, you have to go through different phases of medication to see if the medication is going to be working. You know, in regards to medication, you know, do a lot of people don't don't trust people to other people to come into their homes, and especially, you know, after the pandemic, or during the pandemic. They didn't want people to come into their homes because they were in fear that they would be sick. You know, if they live more in an inner city, you know, area where they only basically have like walking clinics, and there's long waits to see therapists you know, yeah, or if they don't have any type of transportation or they don't know how to navigate, you know, the internet, and let's say if, if the only way to see a mental health therapist or doctor is over, you know, a zoom call or something like that, and, and the elderly and especially if they have mental health, behavioral health issues, and they're, they're not able to, you know, navigate a computer or their phone cell phone. So, you know, that would definitely be one as well.


Now, what do you suggest is the best way to address this need or issue


Of all those people, so you basically find out I mean, that's the only thing that I can think of, like, you know, door to door to door, but that's just like not even, that wouldn't even be that would be way too hard way to take way too long. I guess it would, I guess the best way that you could probably do something like that would be through community, you know, you would host community meetings and figure out what the biggest need was in, in, in, in the elderly community, and or hospitals and or nursing homes, you know, have somebody go out to those places and, and document and figure it out.


Gosh, okay. Like, I know, because I come from a smaller community, you know, I come I come from like, a, like a, like, smaller cities, smaller towns, versus versus these, you know, bigger, bigger areas. And


I guess you could actually do it that way, it would take some time. And but it can be done. Because you can, you would have to just treat it like it was a smaller area.


try it, yeah, like try to condense it in some way, shape, or form and then go in and, and and figure it out. There's always there's, there's always information, and it's readily available on the internet, it's readily available. You know, to everybody, like birth certificates, and whatnot. I mean, you know, people who have passed, you know, people who are still alive, you know, births, you know, all of that stuff. So then why would it be hard to figure out, you know,


type of that group with, you know, like that age group, you would be able to figure it out, but it would have to take some time, and it have to take money, and then it has to be, like some sort of initiative, you know, for for, like a city or town to start. And yeah, yeah, I think that I think it can be done. And I think it can be done in that way. You know, you could actually go to doctors offices, or you can go to hospitals, and you can kind of like do surveys and see who wants to be a part of those surveys, because you always have to take HIPAA into account. Right. There is HIPAA, because, because of it mean, you got to be very careful in regards to, you know, the type of information that you're giving out. And you don't want to incur lawsuits and stuff like that. So you have to fight figure out and find a way to kind of get around that. And again, it's it goes straight to, you know, like, like, like government, because the government would have to be definitely be involved in something like that, to that to that extent.


Oh, I'm going to ask you the same set of sub questions. With this issue


with disability there's death, there's like tons of there's, there's tons of reasons for disability. And in and then it's just the number one, of course is natural, you know, natural occurrences, you know, number two would definitely be, you know, not not taking care of themselves, you know, or not enough not enough self care or not enough. doctor's visits, like there's not a whole lot of people, like I said, you know, who have that transportation to be able to go to, you know, their doctor's offices every, like twice or three times a week or whatever is needed. And that would probably, you know, have to do a lot with maybe support community and family as well. And money, you know, that's, that's a big barrier, as well for for people with disabilities, because when you're on disability, you know, you're only making a certain amount of money. And not a whole lot of people can afford to, you know, get caregivers to take them, you know, every few days to go see your doctor and have upkeep and physical therapy and, and the medication be able to afford the medication.


I guess the barriers that would exist, I would think is


again, financial, you know, financial stability, the other barriers that exists for you know, disabilities is called when you when you're like, when when you see it, but you don't take action, or you kind of like, pretend Yeah, it doesn't, it's not there. So then you don't, then there's not that help for them.


And then again, a lot of people you know, they tend not to want to,


they tend not want to not want to ask for help. And also they don't want to be a burden on others. And some don't know how to communicate, you know, like they they won't be able to communicate that there's a form of, of disability or they're called, they like kind of, you know, keep to themselves, or they don't have that outlet or people to support them and help them with what they need.


Oh, yeah, definitely. Again, I'm gonna have to, you know, go back to, you know, being in you know, in smaller, smaller cities, smaller towns, you know, if you're not in an urban setting, where the we're all, you know, like, where you have access to everything, you know, if you're in a place where it's more away from, you know, bigger cities and bigger areas, like say in Orange County, if you're like out more like say, San Juan Capistrano, or you're out more like near Not, not closer to like Santa Ana or Tustin or like, you know, orange or city of orange or anything like that, then yeah, you're gonna have you're gonna have more barriers because there's not as much access to to to bigger facilities that you may You need


So you would have to have like tele, you know, tele tele med like telehealth, you know, probably better to have like maybe go into, like having the community senators and everything like that, where they would offer, you know, some sort of some type of classes for, for elderly people and people with disabilities, and make sure that they had, you know, transportation, make sure that they have, you know, people going in and checking on them and being able to help them get to and from, and to have that education for their families and for the for the community. So you have to have that you have to have that education out there for the community.


Now and again, moving on, again, same set of question.


So for, let's say health insurance, right, when you retire. You know, you have to literally go on, you have to pay for your own health insurance. So if a lot of you know a lot of Merrick, or a lot of elderly people there, they live on a fixed income. And if they qualify for a certain health insurance, you know, possibly some of that won't cover what they need, like, say, you know, they need a wheelchair, and they've already had a wheelchair, they've been disabled for however many years, and that will turn no longer works. You're only allowed to get certain DME products right every three years, or every four years, or every five years or over 10 years. If like, something breaks down on them, or you know, like, say, a scooter or their walker or something like that, and they're not able to afford to get another one, then that's definitely you know, a barrier right there. And where are they going to get the resources to, to be able to, you know, get any type of extra help. So they're gonna need, you know, that's a barrier, because sometimes, you know, those aren't readily available to them. And that goes hand in hand with education. The availability of providers, you know, sometimes like, like I said, you know, they're in short to short supply of mental health therapists and psychiatrists, and psychologists. Whatever, they whatever illness or sickness that they have, it gets, it gets worse because it doesn't, it's not addressed properly and right away. Let's see, some of them don't have access to you know, their, their cultural culture or linguistically appropriate care. You know, there's, again, for Native Americans, there's not a whole lot of people who know how to speak can know their languages. And how, how are they going to get help when somebody, they can't even speak one dialect. And then how are they going to be able to communicate with them, you know, and again, with caregiving. II seen a decline in in caregiving services, especially like, during the pandemic, where you weren't able to go, you know, the caregivers weren't even able to go into the homes, they were only able to drop stuff off at the doors, and they still have safety precautions, when it comes to caregivers, not only that, the cost, the transportation is a barrier, because they, you know, as a caregiver, you don't get paid a whole lot of money. So how are you gonna get to and from if you can't afford to even pay for your gas, or you're gonna, you know, the transportation costs have gone up in buses, or in cabs, and Ubers. Not only that, people don't feel safe using public transportation anymore. So it's like, okay, well, either I'm gonna, you know, go to work and get assaulted on a bus or a train, or I'm gonna stay home, and not. So a lot of people. Not only that, a lot of people are moving out of the state. And so we don't have as much, you know, have as much people that are even working in those types of types of jobs.


So the answer Oh, sorry. No, no, go ahead.


The barriers, you know, for improvements. Ah, you know, what, I think that there will will definitely brought up a lot of those barriers. But I think there can be improvements, but I think the improvements have to start at a level of level inside the home, you know, not a whole lot of families are you know, like, like, so oriented to where


they help each other out, like before, you know, when, when people used to, like, you know, they, they have big families, you know, they they're close and, you know, everybody kind of like takes turns helping one another out. I see more and more people. Especially in Orange County, where they're there. They keep more to themselves, you know, and they look out for Yeah, and then once it's just, it's so it's so random. Like, just for example, I was leaving work one day, and there was this elderly lady and she was in the shade and she had I noticed a big like a tarp over something and it was over her cart. And I just pulled over and I gave her my card. I'm like, you know, if you need any help, looking for a home or looking for a place, you know, give me a call. And she said that she was and that she started to show me like her, her neck and everything like that where she had bites all over, you know, and she was suffering from you know, all this all these ailments and everything like that. And she worked she said, I still work. But I either need another job or you know, some form of help and it was like wow, like you're working you have a job. But you know, you're still homeless because there's no can't afford, you know, she can't afford to, you know, get a proper place. to live off of what she's making. So there's, there's so many different types of barriers you know, for for the elderly, and that don't have that support or family or that care. And the community is just in general, there are some people that care about people. And there's, there's just other people that, like, the guy behind me just honked and wanted me to get out of the way, so he can go on with his life instead of, you know, instead of caring and helping your fellow man.


Yeah, of course, you know, of course there is. You know, you see it every day you see, there's, you know, there's racism, you know, there's ignorance. There's fear. And that could easily cause people not to want to help other elderly people and also responsibility


I think like, one of the biggest things to address something like that would be to again, you know, go to our youth, you know, go into schools go into edgy, you know, educate them educate, like them on how


you know, it would be it would be good for, for our youth to get more involved in planning, you know, a future where they would want where, where they would like to live where they would feel comfortable, when they're older, like, what are some of the things that you can do, to combat you know, homelessness to combat not having the best health care. And to make sure that, you know, there's cultural activities for, for people in, you know, in society, in your area in your community in general, you know, to instill those values back into, you know, back into our youth into and to have like pride and to be able to, you know, have that knowledge because, in reality, elderly people carry all that knowledge, you know, they are knowledge keepers. And so to try, you know, just make sure that we have that, that future planning, instead of not, and then all of a sudden, just like, boom, having to deal with it as it comes. So, you kind of have to Yeah, you definitely have to, you know, like, educate and plan.


Thank you. We're gonna move on to the next question. Can you please describe how accessible and adequate the following care or services are in Orange County, a geriatric care. I'll come back to each one of them the first one here battery care, B, long term care C, mental slash behavior health slash substance use treatment, D human slash, social services. So the first one is here, we actually care and the question is how, if you can describe how accessible and adequate the following here or services are in Orange County.


So for geriatric care, how how accessible are the services is that


by how, how you know if you know if you have any opinion on any of these so how accessible and adequate the following care or services are hearing on counted in the first one was via TRICARE.


So for geriatric care, you know, there are quite a few hospitals and there are quite a few clinics that that do help and assist with geriatric care. I think, though, that for that, it just, it's all about being able to afford it and the affordability of it and the amount of people who can, again, help and support with them receiving that care.


Long term care. No geriatric care. Oh, sorry. Yeah. I mean, so the next one's long term care. Oh, the


next one, long term care, long term care. And, you know, I'm not, I'm not 100% too familiar with with the long term care, but again, you know, the,


let me read this to you. Because I know, we find that sometimes people aren't, you know, they do ask us what that means. So, a word define long term care as a variety of services, which help me both the medical and non medical needs of people with a chronic illness, or disability who cannot care for themselves for long periods.


So from from what I know, and what I've seen so far, I mean, in Orange County, it's all about, it's all about being able to afford that type of care. You know. And because it's such a high cost of living in that area, it's only, you know, it's only afforded to people who can really navigate the system. And, and, or can't afford it. So, I would kind of, like, do a 5050, it's like, really 5050. You know, you see a lot of elderly people, it's becoming more and more apparent, that, you know, they're there, there's a lot of them that that are being taken advantage of, and that there's a lot more becoming homeless, you know, it's even in the numbers, right. I mean, as far as I know, as Native American, elderly people, they're at the top of the list right now, their percentage of them becoming homeless is higher than have an adult or have an IQ of a child or a teenager.


there's like, yeah, I would say definitely, like, 5050, you're either you either can afford it and have the support or you don't.


And the third one is mental behavioral health, substance use treatment. For older adults, of course.


You know, again, across the board, I don't think that there is a whole lot of a whole lot of adequate services for the elderly, when it comes to mental health and behavioral health. Because again, it takes a lot to differentiate from


dementia, from Alzheimer's from and, you know, to differentiate that from like, if it's either mental health or behavioral health, or if it's just basically them, you know, like getting older and losing, you know, losing that memory and being able to, you know, be in control of your, you know, have your own mind. So, again, a lot of people tend not to want to believe that, you know, their, their grandma or their mom or their aunt or anyone is is suffering from mental health. And


chop it up to you know, to to getting dementia and then sometimes Yeah, they take too long, you know, they kind of let it linger. Because they're, you know, in denial and and then it gets to the point where it gets worse,


you know of any services or programs in Orange County that provide, you know, mental behavior behavior here to older adults.


So, the, I mean, there's just like a psycho psychiatric facilities or, like gym like the I want to say the long like, not the long term facilities, but like for the shorter term facilities, like those type of facilities, they do have mental health and behavioral health you know, access but other than that, just like, like I said, regular psychiatrists offices or, you know, Kaiser or, you know, like, hospitals, facilities that offer those types of services.


So I think that yeah, they definitely have those services available. I think that they're just like, too overcrowded, like, they're just the population is, is so there's just so much people that it's just so hard for, like social services and for them to can keep up with it. And people just get lost in the shuffle and or there's so much burnout from social workers, that they tend to just like, their, their their, their caseload are so high that it's it's easy for an elderly person to get lost in that in that shuffle and not receive any of the services that they need I don't think that APS is like their turnaround time is just so so long that people don't get the help that they that they need nor or deserve. And a lot more people are just too scared to, you know, to take that route into. And just to you know, to help, so, it's few and far between.


And Lisa, I have a few more questions. Do you I'm doing a time check. We're almost coming up to an hour. Do you have some plans to continue or is not we can schedule another time to finish out the rest. I'm going to defer to you one second, I'm sorry.


I actually have another meeting that I have to attend right now.


Okay. All right. Let me stop the recording right now.


Okay. We can definitely pick this up another day. And then we can definitely


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


No, we have a little bit. Now more to go.


Okay. So if you go back up, I'll read down. Okay.


Yeah, when you want me to scroll out and let me know. You scroll down.


Okay, I think we have one more is last issue. Yeah. Okay. I read them. Okay. thinking specifically about older adults in Orange County. For our record, can you please tell us your role and how you interact engage with older adults.


I am the president and CEO of Alzheimer's Orange County. So in that role, I direct the programs and services of a roughly $10 million organization serving particularly frail seniors throughout the county. I also co chair the Orange County aging services collaborative, and supervisory data report for the county the collaborative is 42, Senior facing organizations. And the collaborative itself helps coordinate co joint activities of those organizations.


There could be more specificity to the list. I think the list is reasonably comprehensive. But the breakdowns could perhaps be if you're trying to get to very specific issues, then you could probably break it down a bit more. For example, fitness and diet are not the same thing. Yes, diabetes and obesity are absolutely not the same thing. And they're both significant issues, heart disease and stroke. If you're talking about heart health, and heart disease and stroke would come under them. But other than a lack of specificity. I think you've you've captured everything


up the needs on the list, or any of those that you think might be oh, excuse


So respite could mean everything from adult day centers, to residential care facilities to in home support to ITSF.


Okay. Okay, so I'm making a note of your comments here.


I do. And I mentioned what those are respite and the forms of respite.


That's impossible. There it depends on the individual senior if I'm looking across the county, then transportation is certainly high. I think Alzheimer's or dementia are high partly because of what I do for a living that is that's my forward facing issue. Yes, Alzheimer's. Transportation for sure. Not behavioral mental health, I already get some ton of like, go ahead and scroll down, please. Economic Security. And again, I just want to I'm going to continue to note, economic security is not food security is not housing security, it's different. So my answers might be different.


Yeah, that's understandable. So for when you think of transportation how or why older adults struggling with this issue.


The accessibility of transportation is modest at best, it doesn't help that we're in an octa strike for access today. But the access program only goes where bus routes go or in the equivalent areas, and for seniors in the county, that's not a reasonable quantifier. Because I can get, I can walk myself a mile to a bus stop a senior and wheelchair, a demented senior cannot. So the lack of facilitated Transportation provided by the county is a significant barrier to medical care to socialization to all of it.


County, the county construct the belief by the Orange County Transit Authority and therefore the county itself to the supervisors. That transportation should exist beyond bus routes. And that access. If you look at the quality of access and its ratings, it's horrible, and it's just not addressed. The strike this week is a perfect example of that daycare center participants medical appointments are being missed throughout the county yesterday, today and tomorrow and probably all next week just because they couldn't work out a deal with their union. So I think the funding focus of the county and Octa is inappropriately focused on able bodied and what's easy.


Absolutely. If an older adult has a physical impairment, transportation is even harder to access. If they have a mental impairment, be it mental issues of mental health, drug addiction or Alzheimer's memory loss, etc. All of those issues make accessing public transportation particularly difficult. We talk language barriers in there as well. Oh, yeah.


Invest. Expand the existing one, expand the existing programs for seniors and people with disabilities to more of the county two, actually fund it well enough to correct the issues of competence that are that are easily identified and have been identified with those programs.


Well, it's an incredibly impairing condition. When we figure that people 65 and older are the only growing part of the population. And by our estimates, over 169,000 of them have either mild cognitive impairment on into some form 169,000 It's a huge percentage of the population. It's over a third. So if over a third of the County seniors are facing some form of cognitive impairment, we as a county are not adequately addressing it. county funding is almost non existent. Beyond some for Adult Day and some Meals on Wheels, there's not enough focus, there's not enough discussion in the county.


awareness on the part of our elected officials at all levels state local, county wide and federal and funding. The infrastructure exists to provide supports and services through community benefit organizations of all types, everything from hospitals to organizations like ours. But there's the money to actually provide the needed services does not exist currently.


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


Absolutely. People from different ethnic backgrounds who have a different countries of origin, who have different languages who have different faiths systems have different belief systems, you have different cultural systems, all of them have far more trouble accessing what supports do exist than those who are from the more traditionally, Anglo, Protestant etc. So if you take any of those groups in the community, in Orange County, if you look at the concentration of seniors, they are massive percentages of the population. It's not a White County, but we operate our programs and services as if it was, and I'm not saying the folks who are, who are Anglo don't deserve support, I'm just saying everybody else deserves the same supports.


There needs to be a great deal of community conversation facilitated at the county level on where the gaps in service exist in those communities that needs to be done in the language. folks live their lives in from the cultural perspective they live their lives and and that needs to be integrated into a countywide plan on how we're going to address the issues. And again, that can be done easily through the existing network of community benefit organizations that exist and have those relationships in those different communities.


Thank you for sharing, when you think of economic security, how or why older adults struggling with this issue,


Orange County has an incredibly expensive place to live. Even for those considered to be of affluent their primary asset may often be their home. If they're not interested, willing or able to sell their home, then they're often reliant on modest savings and or Social Security. When you go to the other end of the spectrum where we're not talking about homeownership. For those who have social security, it is often the only thing they have to rely on, it is not enough to live on in Orange County. And then when you go to that percentage of the population that never qualified for Social Security, everything from undocumented to those who are documented, but with no reliable work history, they have nothing to rely on except family, friends, and are at risk of homelessness. So wherever people fall on the income spectrum, there is great risk for seniors, they are not generating income, therefore, whatever they have is what they have.


What barriers exist to see improvement in this area.


The general lack of awareness of the of the problem. There's also a general public lack of awareness, legislative lack of awareness. And I think there's also a an unwillingness on the part of many seniors to discuss their financial situations in a public space or with those who might be able to offer assistance. There's a stigma.


Yeah. They're different experiences for different group of older adults from different backgrounds.


Yes, and I would go back to my answer to the previous question, where you have everything from folks who are undocumented to entry level documentation to net Social Security to no social security, to affluent but only owning their home, it is markedly different for most individuals situations based on their ethnicity, their financial backgrounds, all of those.


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


we need to start investing more in financial literacy for middle aged and older in and not only providing it but also creating forums that are accessible to provide financial literacy so that folks can come and get a grip on their finances. Going back to the Alzheimer's and dementia space, if if a third of our population has significant cognitive impairments, we need to provide facilitated financial planning for that population. All of those need to be everything needs to be accessible in the same way as I've talked about before, ethnicity, gender specific sexual orientation, culture, ideation, all of those things.


Thank you for your feedback. Can you please describe how accessible and adequate following care and services so first is the geriatric care.


Again, I want to make sure I understand.


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


geriatric care in Orange County is remarkably inaccessible. By inaccessible it doesn't exist in many spaces. We are incredibly short on geriatricians in this county. Physicians specific to senior care are very short. We just don't have enough of them. If you're trying to get into a neurologist, it can be a three to six months wait despite the level of crises you're experiencing. So one, there's a lack of clinical providers in geriatric space, two, There's not enough funding for the geriatric social work experience, which is a big chunk of what geriatric support is. So there's not enough money for people to provide geriatric support for homelessness issues, you need a social worker who understands what seniors face, if you're on the street, and you're homeless, you're geriatric at 50. Biologically, so it's a different world. Each one of the spaces that we deal with food insecurity, dementia, all of those need more resources to address the barriers in their own specific space. Again, it boils down to an issue of money.


Can you please describe how accessible and adequate long term care and services in Orange County,


Long Term Care is more accessible when you get to nursing homes, which is where no one wants to be ever with respect to nursing homes, but because it is federally funded, it is the place people often end up because they have no other options or alternatives. We don't fund residential care facilities. So after a person is no longer able to live at home safely, there is often no place for them to go until they are qualified for nursing home. So that gap means that the caregiver is going to get ill the caregiver is going to hurt themselves, the person experiencing issues of aging, requiring additional assistance is going to harm themselves or wonder. So until we address that gap with some form of in home support or residential care, that is not a nursing home, and a step down level and non medical intervention. And we're going to face those problems and it's going to increase because the aging populations increase.


Can you please describe how accessible and adequate mental health behavioral health or substance use treatment treatment services in Orange County,


it's one of the few areas that has been growing to bewell initiative has actually put some significant resources from the state, local and federal government to play. So out of everything in a strategic plan for aging that I hope is addressed, that's one that I hope they check off and go, there's more to be done. But we're doing the right thing. Now, let's focus our energy and resources. And let's put some of the same level of energy into Alzheimer's disease that we're putting into mental health or into homelessness that we're putting in a mental health. Because that I believe, while not adequately addressed, I do believe that the right moves are being made


to you know, any services or program in Orange County that provide mental health or behavioral care for older adults,


the entire bewell initiative and everything that falls underneath them. So bewell as the umbrella has many, many component parts, working with many different organizations, all of which provide some level of mental health support. So it's dozens of organizations. But the umbrella most commonly recognized is the bewell organization.


So that in and of itself is a question that's, I don't know how to answer actually.


100% transportation is one of them. I think Alzheimer's and dementia specific Orange County is going to be one of them. Alzheimer's, dementia, mild cognitive impairment, forms of memory loss. I think those two and I do think that gap we that I mentioned earlier, that respite in home care and facility based care that's non medical prior to the need for nursing home hospital or hospice, that's not paid for that we're gonna have to figure that out. We've got 10s of 1000s of people living alone, for example, who experienced some form of dementia. At some point, they're not gonna be able to live alone, but they're not gonna need a nursing home. What are we going to do.


If by government, we mean the county, because there's city state, all kinds of difference with let's focus on the county. I think the county has a coordination role. If you look at the county has a role I believe in identifying the gaps in needs and services. Helping formulate a plan to fill those using the existing network. I think the county fails when it tries to do in itself. When the county tries to provide the service. I think that's a weak formula. But when the county figures out where the needs are, and figures out how to access state, federal local funding to cover those needs and then uses the existing network of community support. Again, everything from hospitals, community clinics, CBOs. I think that's the most successful means of actually filling the needed gaps.


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


thinking about all the issues facing older adults in Orange County, what issues is being overlooked,


undocumented, and those people who do not qualify on their face as low income because they have physical assets like a home or car. So believe it or not, I think it's the folks who are at the lowest end of the financial spectrum often and those who are sometimes at the upper end, not the highest of the high, obviously, but you have no cash assets, but their physical assets, keep them from accessing services, and the perception of them is that they don't have need. And on the lower end, they have trouble accessing services often, partly because of language and culture and partly because of fear on their part.


I'd like to dig a little deeper into the respite care that you mentioned, what are some ways that respite care is working or not working for older adults in orange county.


I think the concept of IHHS is solid. I think now that has a little more funding, it's better. But it's hopelessly underfunded. When you offer someone eight hours a week, for example of personal care, and they're a paraplegic or quadriplegic, senior, it's woefully inadequate. The fact that they have to find their own care is not necessarily bad, it can often be a family member, but there's not enough. The infrastructure CalOptima, for example, is not enough to really fully support them in finding those people supervising them vetting them and that sort of thing. No shame on CalOptima there's just not enough money for people. Bottom line, there's not enough money there. So in that form of respite, it needs more resources and some more infrastructure in the middle part of respite, which is residential care facilities, Medicare funded beds funded a level most facilities will never take. So even if we increase the number of Medicare funded Beds in the County, it's not going to fix the problem. I think there has to be a concentrated effort to create living spaces for seniors who have nowhere else to go and can't live at home safely, but who don't require nursing homes, it needs to be managed with the federal funding systems for nursing homes, with the argument that it's way cheaper than a nursing home, and we're gonna have this person in the nursing home tomorrow if we don't figure it out. So I think there needs to be some very creative legislative action happening to access federal funds for those interim living arrangements.


So on that note, what new or revised policies are needed.


We need at the county level, we the city level, they need to keep doing with their ADAs, their mother in law units, allowing more spaces like that, at the city level, like Laguna Woods village, they need to allow roommates in group living situations so that people can afford a space to live at the county level. There needs to be more effort resources in coordinated planning at a very systematic level, instead of just these 123 smaller initiatives needs to be much more global with much more money we're talking many millions, if not billions of dollars need to be invested if we're going to really climb that mountain. So legislatively, it's accessing funds, allocating funds, and creating a system for monitoring them safely and quantifying their return.


So there's a great dearth of data in any area of senior service delivery, and also in Alzheimer's and dementia. So we've just released some figures on county wide prevalence, my organization has just ended last week. There's no other data in the county that's county specific except what we release. And we're looking at it extrapolating that information. So on a general data note, it is the weakest part of planning for seniors that we as a county face, we've Collaborative has released multiple data reports we're about to release another one. No one's collecting comprehensive county wide data on working with the different datasets to aggregate them better to create cross correlations to create ways that we can work better together with those who are collecting data until that's fixed, and that needs a whole that's not just the county, that's a county commission, with hospitals, Cal Optima, everybody's sitting at a table, investing time, effort, money and creating a county wide data collection systems. That has to happen before we're ever going to move the needle on any of this stuff. We don't know for sure how many people really are at risk transportation wise. CTA doesn't know it they only deal with One segment of population. So until we figure out how to get better annual data collection and analysis, we're guessing