Well, I haven't met every senior yet. So it's hard to say. But, but I would say I would say those in the lowest those in the lowest income brackets are going to be the ones that hard to get the most tension made, mainly because they're not going to put themselves out there as much because they can't afford to.


Let's see. I would say, reflecting on the list that you provided, I would say the emotional well being is probably one that's been overlooked a little bit. Is I think it's easy for senior, it's easier for seniors to feel lonely. You know, which, as in, you know, their kids get older than their kids are raising their own kids. And so it's easy for, you know, for a grandma or grandmother and grandfather to kind of spend more time by themselves, especially if they're if they're widowed and spend more time by themselves and they would have expected Yes, I think I think that I think that if if you know if neighbors took a more kind of proactive, proactive role and trying to make put themselves out there to some of their older neighbors a little bit more of our even do or even little things of offering to go hey, can I can I take your trash cans down for you like little, little personal acts of service like that will go a lot or go a long way. I've seen Yeah, seniors having that emotional well being, in a sense, that sense of belonging somewhere and making them feel like they didn't, you know, they don't want to age out of the society they grew up in or they don't want to age out of a belonging to a community and trying to try to minimize that would be important because that's something that people aren't going to talk about very often, especially, especially see, I noticed that senior men are a lot more closed off in saying anything that remotely relates to feeling lonely or forgotten about things like that. That you know, that could also be You know, in some ways be characterized as elder abuse, if it gets really to the if it gets, you know, really to the extreme. But yeah, I would say I would say, I would say the emotional well being, and maybe even even a sense of respect and feeling seen and heard, is important, because we've we've had, we've had members here before, who will, you know, they'll bring up, they'll bring up a concern, a concern to, you know, to a staff member. And, you know, depending on how the staff member addresses it, or how proactive they are about whatever that concern is, I've had, I've had Mara swallow me before saying, hey, you know, I brought this I brought to someone's attention. I felt kind of brushed aside and I didn't, I felt like I wasn't being heard. And that's and that's a really, that's a really big deal. When someone doesn't feel heard. You know, younger folks are better at expressing their discontent with that. Older folks. They feel that they struggle to get to get those thoughts and feelings out there. So, yeah, I would say emotional, emotional well, being and respected.


Yeah, thank you so much for all your input and wisdom. So this concludes our interview. I want to thank you for your time. If you have anything more to share, please feel free to reach out and I'm gonna stop the recording now.


Okay, primary goal today. Sure. I'm always nervous, just want to make sure that that that is working. That is the primary goal today is to identify what needs you think are most important to the older adult population that you serve. Those who are 60 and older, we want you to think as broadly as possible, taking into consideration the older adults, caregivers, families, and very community. I'm going to share my screen so you can see a list of common issues and concerns impacting older adults. Now, I'd like you to take a few minutes to read through this list. And let me know when you are ready to begin.


And I tried to It looks small because I tried to fit on one page, but let me know if I need to move it down or enlarge or anything like that just


If you take as much time as you need to go through this list Okay.


Sure. So I am the Human Services Manager senior with In Home supportive services with the county of Orange. And so my role is to oversee our Office of almost 200 staff. And so I have two managers under me. And then we have supervisors and social workers. And then of course, you know, the rest of the administrative staff and clerical staff. So my job is to make sure that we are following our policies and procedures, not only with the county policies and procedures, but also our state mandates to make sure that we are providing the services for eligible older adults to stay safely in their homes. So making sure that our social workers are going out within the 45 day mandate that they're required to go out to assess clients, making sure that we are meeting with the clients once per year, as that's also a state mandate. And then making sure that you know, we are providing resources for the families or the individuals that we're seeing that we're giving them information for any other services that we provide such as CalFresh. You know, any of the additional services that the county provides as far as basic services, and then making sure that we are sufficiently staffed in order to provide the services that we are mandated to provide for our community. Okay,


just thinking about all right, thinking Orange County and looking at the list of some of the common issues and concerns impacting older adults. Um,


this is a pretty good list. I would say we probably see all of these. When I was looking through I was like, Oh, yes, that one for sure. Definitely. I don't I just looking through it. I think this is a pretty comprehensive list as far as what we see, a lot of times, you know, we'll have to call Adult Protective Services APS because of you know, self neglect, food insecurity, different things, you know, where they're, you know, they don't have the means to provide, you know, basic necessities for themselves. So I think a lot of these issues that you have listed cover at all, I can't think of anything that is missing from here


after needs, and this list is ranked at top three that you feel are the most important. Okay,


I would say behavioral and mental health for sure.


and probably for us, I would say caregiving, because that's a huge issue for us with the lack of caregivers that we have.


i Sorry, that's okay. Go ahead. Okay. So I will ask this ask you a set of questions based on the three areas that you identified.


I think a lot of times, what we see when our social workers are going into the home is that a lot of them either don't have family around, or they have isolated themselves from the people who do want to help them. You know, it seems like there may be some of these things happening. So I think that's probably why it's a big issues, because there's really nobody seeing some of these behaviors or these health issues.


I think, barriers to seeing improvement. They, you know, a lot of older adults don't think that they need help, you know, they think that they're fine, and everything's fine, because, you know, they've been getting along this, this long for with what they have. And I think, you know, a lot of times there's access to medical care, whether they don't have transportation to get there, they need accompaniment to get to and from their medical appointments. I think those two barriers of, you know, not really thinking you need it. And then, you know, if you do think you need it kind of getting to those places, and kind of figuring out where you need to go and how to ask for help, I think are probably the biggest two.


Yeah, alright. They are different experiences for different groups of older adults from different backgrounds, for example, where they live, their disability status, income, education level, etc.


I think so for sure, I think, you know, it all makes a difference. You know, if you are someone that has a lot of family around and maybe higher income where you'd have more access to people and resources, compared to if you have less family around and you have less access to people and resources, then I think that is going to make a difference. You know, where you who, who you go to for help, how you ask for help, who sees that you may need some help and maybe make suggestions. All of those things are kind of factors that would contribute to it. You know, and definitely, those would be different if you're in lower income. or higher income areas, as far as you know, education and stuff like that, I think that does play into it too. Because if you are educated on these are kind of some of the symptoms of anxiety or depression, or these are things that you know, I think, think this may not be right, you know, not feeling right. So I think some education plays into that as well. So I do think there are differences, when you're talking about, you know, the, where you live, how you live, your economics, all of that,


Good question. I think that, you know, the first thing would be making sure that older adults are getting into their doctors, you know, at least once a year, twice a year or as needed, depending on you know, what's going on with them, I think that's the first step is making sure that they are getting the care that they need, and that they are getting, you know, transportation to and from all of those things. So I think that would be the first step is making sure that they're they have access to medical care, and that they're actually utilizing it if they do have that access.


So the second issue, you identify economic security, again, how or why are older adults struggling with this issue.


I think a lot of times, with the older adults, when it comes to, you know, a lot of most of them are retired, they don't work, but the cost of living has increased. And they're, you know, whatever they're living off of whether it's social security or retirement, a lot of times that is not changing. So it's not fluctuating with what they need in order to pay their rent, get food on the table, pay their bills, you know, so a lot of times, what we see is that these older adults are not getting the food that they need, are not keeping up with the medication that is required to manage their different, you know, issues that they have. So I think, though, for economic security, you know, we do see a lot of the cost of living and being able to afford basic needs, and that includes food security.


And so what barriers exist to see improvement in this area.


As far as you know, like I said, a lot of times, these individuals are not eligible for other services, because of their income, whether they're getting, you know, some kind of retirement, they may not be, you know, eligible for, you know, food, you know, like CalFresh, or something like that. Or they may not know where to go to get those services or apply for them. And they really need help, and someone to kind of walk them through the steps in order to apply for these services. You know, and I think that, you know, some of the time, they just think, Well, I've been getting by this long, so it's fine, I don't need anything additional. So I think, you know, getting them to understand why it's good for them to apply for different services and benefits, so that they can afford basic needs and food and all of that.


Yeah, I mean, definitely, obviously, if you you know, if you are, you know, of a higher income, and you don't have to worry about, you know, your money, and you're comfortable, you probably have enough money to afford basic needs and food every month. You know, the long term you know, how long will this last me if somebody's gonna take me shopping, you know, I have to make this last for a week because the next time isn't going to be for another week. So I think that is a lot of you know what Our older adults tend to look at


I think, you know, I know we have CalFresh. And I know that there's food banks and stuff, but a lot of times, and we have, you know, Meals on Wheels, and we do have some of these different food, you know, services. But I think, again, just educating the older population on what's available to them, when they can get it, you know, providing transportation if needed. So really kind of making it more well known what is out there, and what's available for them. Because I think that lacks, especially for older adults, a lot of things, focus on families and children. Because, you know, they have lack of, you know, a lot of the same issues that struggling families and children have.


The third topic, caregiving, so how and why are older adults struggling with this issue.


So what we normally see is, you know, especially with caregiving, one, they don't have friends or family around, or available to provide the care that they need. So that would be the first line. And then the second one is, you know, our public authority in Orange County provides caregivers, for the recipients on our program, referrals, you know, they give referrals, but we are so short on eligible providers, and, you know, we just don't have the amount of providers that we need in order to provide to our clients. So lack of caregiving, lack of caregivers, and then you know, lack of friends or family member who are able to provide services as well. So I think with those two, it's, it's unfortunate, because the needs of the recipient and of our older adults are not being met, because there isn't anybody to provide these services.


And what barriers exist to see improvements in this area,


I would say the first barrier is, especially for IHSS, the amount that the providers get paid, you know, at minimum wage, or a little bit over minimum wage for the amount of work that they're doing. You know, not a lot of people are going to want to get paid minimum wage to clean and bathe someone and prepare food. And, you know, it's a pretty intensive amount of work that you have to do, depending on what the client has, you know, that they need help with. So I think that is the biggest barrier is the rate of pay, for sure. And then it's just recruitment and retention of the providers, you know, whether it's, they only want to do certain services, so you can't refer them out to a lot of people. You know, sometimes you have difficult clients, so they're hiring and firing providers regularly. So there's, there's quite a dip, you know, there's quite a number of different barriers and issues. But, you know, just trying to make sure that we're providing as much as we can, you know, as far as the caregiving aspect that was a hard one.


I'm sure there are, you know, but I think with caregiving, I think you run into the same issues. It's barely enough to live on.


I think that's pretty much it. I think it would, I think it would be the same. You know, you'd see the same things across a lot of different cultures, then socioeconomic status, probably.


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


ah, I mean, definitely increasing the the rate of pay for caregivers who are, you know, paid. Well, this is what you're going to be limited to, you know, if you want to stay in your home, whereas if you maybe go to a skilled nursing facility or something, you know, which is the other alternative, you know, then you will have access to all of these things. So, I think, you know, educating people on what their, what their options are, and then also what's, what caregiving entails. Because I don't think a lot of people realize, you know, oh, I've got to take care of my mom or my dad, and then you realize, like, it is a 24/7 job a lot of times and, you know, they may need more help than you originally anticipated.


So that's the end of the sub questions for that. So moving on to the next one. The first one is geriatric care.


Um, I think we're talking about like medical care. Well, sorry.


No, perfectly fine. I'll read the definition based on our survey, so geriatrics, the sub branch of health care that focuses on our unique needs as we age. Just as pediatricians specialize in health needs of children. geriatrician, and fellow geriatric health professionals specialize in the health needs of older people. Okay.


I think they're fairly accessible. I think, you know, there are a lot of programs that cater to older adults, you know, Cal Optima and some of the other programs that really focus on older adults and getting them the care that they need. So I do think, but I just don't think that a lot of people know what resources are out there for them. So although it's out there, and it's accessible, you know, again, educating people where to go, how to sign up, what services to look for, all of those things are important.


Our definition of long term care is 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. Okay. There are


different, you know, programs for long term care. They're pretty accessible. I just don't know, you said accessible and adequate, adequate. Okay, I don't know how adequate they are. You know, I think in our experience, we've seen where people are put in long term care and then removed or they're only put there for a certain amount of time until whatever it is that they were put in there. You know, is finished. So I just don't know how adequate it is. Especially when you hear about you know, all the horror stories of different you know, programs and they leave their clients and don't check on them and all of those things so accessible. Yes, adequate. I'm kind of on the fence on that one.


I think there's been a lot more focus on behavioral and mental health, you know, especially when you look at kind of like Alzheimer's, dementia, those types of things. So I think, again, it is accessible, I just don't know that a lot of people know where to go, or what to look for, especially older adults, and substance abuse. We have had a lot of clients that have substance abuse, and I haven't really seen a lot of programs that are focused on older adults. So I think that would be an area that could definitely be improved upon. Because I'm not sure how many programs there are that caters specifically to older adults, when it comes to like drug and alcohol addiction.


Yeah, so I know that we have, we have Cal Optima who provides a lot of services for our older adults. There's Alzheimer's OC there's trying to think of what else I mean, there's so many different programs that maybe touch on it. Those are the only two that kind of come to me right now. But I know that there are a few other ones that might be Cal Optima related CalAim, and Pace and some of those other programs that are, you know, geared towards older adults, and encompass behavioral and mental health.


How Sorry, I'm gonna get the question is,


if you could describe how accessible or adequate in Orange County Oh,


okay. Accessible again, I think it's very accessible. If you're technology savvy, you know, you can do everything online, and you know, apply online. But again, you have to know how to navigate the technology and how to do that, or have someone help you navigate. So as far as accessibility, you can go into the office, you can do it online, you know, you can call and get services. So I do think it is very accessible, I just don't know that, you know, a lot of times the older adults know what to do, or where to go, they need a little bit more help. And, as far as you know, if they're adequate. I think we could improve upon maybe how we provide services to that older population, again, a lot of times, you know, they're very old school, and they want something in writing, they just want to be able to talk to someone and, you know, so I think, you know, being sensitive to kind of where they're at and navigating them through, I think is important.


I think for sure, technology, I think we're already seeing that, you know, technology has posed an issue for a lot of older adults, because pretty much everything is done online now. You know, so if you're used to writing checks and sending in payments, you know, a lot of things are done online now. So you really do have to know how to navigate the computer and do a lot of things online. So I think technology is going to be a big barrier. And then I think that, you know, as the cost of living continues to increase, I do think we're going to continue to see older adults kind of struggle financially, you know, because they're on a set income, and they're not able to really do anything to make more income, you know, especially if they're disabled or they have other issues that prevent them from, you know, doing a lot of things. I think, you know, definitely economic security and technology.


I think the government just really needs to pay attention to what is going on and realizing that our older adult population is increasing. We have continued to see an increase in just the amount of clients that are applying for services for us. So, you know, over the past five years, our applications have increased, like, you know, 20 to 30%. You know, and every year, it's like seven to 9%, that we're seeing an increase.


Oh, good question, the least amount of attention.


I don't know, that's a good question. Um, you know, I think that people who maybe aren't on social services benefits, or, you know, they, if, if we don't know about you, we can't help you type of mentality. So you know, we know, we can help the people who are on some of the benefits, services, so whether they're getting CalFresh, or they're receiving medical, or, you know, different things like that we know about them. Maybe they don't know that they're eligible for things. So I think you're missing probably a very large population of older adults who really do need assistance and need resources, but they just haven't been able to access them, or nobody's told them about it, they don't know where to go. And so you're missing a whole population.


Um, I think a big issue that is overlooked is, you know, kind of them being able to take care of themselves. I think, you know, you see older adults who are alone in their homes, maybe they don't have any family, they don't have anybody around. And so I think that is probably a big issue.


I just lost my train of thought. Tell me a question again.


Oh, yeah. Okay. Yeah. So I think, I think really, older adults being able to take care of themselves, you know, as they get older, you know, you think, Oh, well, they can take care of themselves. They've been doing it for this long, you know, and, you know, as you get older, there's less and less things you can do. Or maybe your mobility is not like it used to, you start to forget things. And so I think that a lot of people overlook that, that, you know, yes, my, my mom has been living by herself for you know, however many years, but as they get older, they may need help with more things. Oh, that was a little weird. Like, you know, catching little things that they forget that are, you know, they're repeating things or they're not remembering things. So just being, you know, a little more proactive and seeing what types of help our older adults need because they're change. They're, their needs change, they could change every couple of months, every couple of years, every year, you just don't know depending on you know, what kinds of things they have going on. So I think being really mindful of, you know, their changing needs.


Okay, moving on to our last last section. More questions to go. So, in addition to what we have already talked about, we just want to add dig a little deeper into your area of expertise. So thinking about in home supportive services, right care, care, caregiving, what are some ways that this area is working or not working for older adults in Orange County.


Um, so as far as it working, I think that, you know, it does allow older adults to stay in their home, which is where they feel comfortable, they, you know, some of them have been in their home for a long time. And that allows them to do some things for themselves, instead of going into a skilled nursing facility or some type of assisted living, where everything is done for them, they really don't have a whole lot of autonomy in making decisions or doing things for themselves. So I think it provides a really great service for individuals to stay in their home. You know, but I think the other problem is, the problem is, is that being in your own home, if you don't have somebody to help you with the daily functions, like I said, our care, you know, we don't always have caregivers to go out or, you know, they may be in between getting, you know, one quit, and now they need a new one. So I think that is where we see a lot of issues where, you know, there is no nobody providing services. How is their house, all of those questions come into play. And that's usually when we see APS reports is because there's some self neglect, there's few food insecurity, maybe there's, you know, cleanliness issues throughout the house. So although it provides a great service for you to stay in your home, it also provides some challenges to make sure that everything is done the way that it should be done for you to stay safely in your home. And that's like, a big thing is, yes, you're in your home, but are you safe, you know, especially if you don't have a caregiver, which is, you know, an ongoing issue that we've seen,


and what new or revised policies are needed. Um, gosh.


I don't I mean, I don't know if there's any new or revised policies that are needed, I think we just need really, you know, if we want to provide the best service to our clients, you know, we really need to get more caregivers, and have adequate staff to go out and see our clients. You know, so I think that is a big problem is, you know, like I said, recruiting caregivers, getting them to stay. And then making sure that we have the staff sufficiently staffed, in order to see the rising number of, you know, clients that we're seeing every month, every year, and being able to assess those clients and make sure that we're going out and visiting the home, you know, within a year, maybe, maybe there needs to be some wellness checks in between those, you know, because like I said, there may not be anybody else, besides the provider coming in and out of the home. So we, you know, we have seen, where, you know, there hasn't been a provider for a long time. And now there are issues, you know, with the client


I think the state, I think the state really has to recognize the need to make sure that our older adults are safe in their home, you know, they obviously created this program for a reason and to keep older adults in their home. But they haven't recognized that, that takes money. That takes staff, you know, across the state we're seeing where, you know, not just Orange County, but every IHSS program is increasing in the amount of clients that they're seeing. And the state is not giving us additional funding to hire new staff. You know, so I think that's a it's a big issue that has to come from the state down to really make it a priority so that we can provide the services that the state wants us to provide sufficiently, you know, not just the minimal but, you know, if they adequately gave us, you know, the funding for staffing, maybe we could do a little bit more so that you know Our clients aren't being referred to APS we're not seeing the issues that we have, you know, and our staff wouldn't be, you know, overwhelmed by their growing case loads.


Yeah. Do you find relevant to your work in the family and friends caregiving arena, um,


we really use a lot of internal data, you know, to see kind of, you know, what, how many, you know, applications were receiving, we have reports that we run to see who hadn't had a caregiver at a certain amount of time. So we use a lot of internal data just to monitor for our own program. But then we also get data from the state that kind of compares us not kind of done. It gives us all the numbers, you know, the case loads, and providers and all of that information for the different IHSS programs across the state. So that you can look at, you know, a large county, which is what we're considered, you know, how are the other programs doing compared to you, you know, what are their caseload looking like, you know, different factors that, you know, obviously contribute to us providing a service. So that is nice, because, you know, we really get to see how we're doing in relation to the other programs across California. Let's call them, you know, some follow up needed. So I think those would probably be the biggest two sources of data or internal, and then, you know, the state data that kind of looks at all the IHSS programs.


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


um, since this is just for Orange County, I mean, APS, I think APS is a good resource. Adult Protective Services, you know, we, we work a lot together. Like I said, you know, whether they go out to a home visit, and then refer, you know, the person to HSS, or the other way around, we go out to the home, and then we have to make an APS referral, because of, you know, the condition or something's going on. So I think APS has a lot of good insight as well to the needs, in fact, maybe more so than we do, because they have, you know, different criteria that they have to meet. And sometimes they're doing more follow up with their clients than we are with ours, because, you know, we're only state mandated to see them every year, whereas APS may have to go out, you know, 2 3 4 times before the case is closed. So they have a better, you know, better indication of what's going on with the, with their client.


Sure. All right. I didn't expect you to say no, so at this interview, thank you so much for your time, you have been incredibly helpful to our research. Now. If you find that you have more to share, please feel free to reach out to us. Our contact information is available on our website@www.sec.com and you can leave an anonymous voicemail on our telephone line anytime. And then of course, I tell everyone, you can always reach out to me with any additional to add. Okay, let me just stop the video. Now.


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


Like, hit a couple of button. Yeah, let me know if I need to just enlarge this, because that will try to wake up here. But everything on one page, I can also do this. Well, in fact, a little bit better.


Because it seems like it's missing a lot of big stuff. It's not a good list.


well. I haven't memorized it, but I've read it.


No, I'm just gonna leave it up here. So we can refer to that.


Sure, in a couple of ways, our primary mission is access to legal services, particularly focused on vulnerable communities that need a different type of legal services than the traditional one because we're able to go to them in a way that traditional ones aren't. So that ends up meaning a lot of communities that are unhoused and older adults, people with disabilities. And so kind of in our work through providing legal services, we really do kind of a wraparound, a wraparound perspective on how to do that. So we're helping with everything from end of life planning type legal services, estate planning for lower income families, we do have an income limit. But But estate planning for lower income families to help ensure they can keep their home that's not recovered by Medicaid, to disputes with shelters if a older adult is being exited from a shelter, to access to mental health or substance use programs. A lot of assisting individuals with challenges with their vehicle and their license. So kind of with a wide range of ways in which seniors need assistance from lawyers. Often it's kind of more of a wraparound perspective.


Yeah, parts of this list seem to be more like a list of conditions than concerns. But I think in terms of resources that are needed, though, so housing and homelessness is certainly number one, and it says housing and homelessness, but then it goes on to define housing as affordability and options and care which what seems so there's also like, safe and stable right that like habitability conditions. So we have a lot of and and I'm not sure how much whether you mean for that housing to include facilities. So if


I can interject, so on the right hand side, the right column, right, these are examples. Yeah. So we're, you know, not I totally understand more of like a broader right. Yeah.


Yeah. So that like as recently as this morning, I got a call about people being evicted from an assisted living, so couldn't get a lawyer. And so kind of the big picture of like housing and homelessness, legal services is clearly missing from this list. And there's certainly particularly leading into a lot of the things on this list that impact health that impact capacity. There's a huge amount of autonomy that people can have by being empowered to make their own decisions by having powers of attorney and medical directives and kind of having the support they can get from lawyers. Before these things happen to ensure that they have control over the choices that come up in their life. Stuff as simple. If you offer psychiatric health care directives, like those are all pieces that fall under legal services, which are not listed here at all.


I think there's let's see you have behavioral mental health, which is certainly a component


I'm not sure if that would, because, like stuff like IHSS


probably fall on falling under the fourth one caregiving, right.


But once you get approved for that county program, getting a person who's able to take the job is nearly impossible, if you don't have a family member who's willing to do it. Yeah.


I know, there's a lot more out a lot more


I don't see anything related to finances.


There's economic security. And I see what you're saying,


in terms of like, yeah, I guess, I guess for me, that's definitely part of what I think it was finances, economic security, and the rest, just kind of like the support and avoiding scams and financial management and financial planning and kind of, for older adults who are kind of on the cusp of being our clients or not, there's places where that kind of financial support can help with preventing the economic security need.


I'm not sure if it's meant to be in one of them, but just kind of so you like, you know, the data centers or whatever, like the social component.


emotional well being right. We have loneliness, inclusion and quality of life.


Yes, that's probably falls in there. Okay. Yeah, I think that's I think they all kind of fall under those kind of like the financial independence, the living independence, like the stability and housing, and then the biggest one that is not there. It's obviously the one that I see, which is legal.


Okay, so, so of all attorneys on this on this list, including those that you have suggested, Please rank the top three that you feel are the most important.


I think it would be housing, health care, and legal


aid. So I am going to ask you a set of questions based on each of the three that you just mentioned. Alright.


The there's kind of two, two pieces of that. One is just the simply the cost of housing or that, particularly in Orange County, we have a lot of tenants and the cost of rent is going up exponentially. And then there's homeowners who are kind of over housed but can't reduce their housing because the cost of housing has gone up exponentially. So they're left in a precarious place where they can't quite cover their costs and they also can't quite move. And then the other of course, is it income and assets that people are outliving their planned retirement savings, particularly women. And this is why women older women are the fastest growing homeless population is they cannot maintain housing off their Social Security, it's less than their husbands was their, you know, partner passes away. And then they have lower social security, whether that's because they were paid less or worked less or took time off for breast cancer. But whatever series of activities led to it, their income has gone down. And they plan to live to 70 or 80. And that's really young now. But at the time when they started planning that didn't sound so young. And so now they're, you know, 85, and could easily live to 100, except that they would need a place to do it. So they get the kind of two of the biggest drivers are that that the availability of affordable housing and the availability of funding for it. And the third is that as, as our community particularly in Orange County is really shifting more and more toward significant rentals, particularly the housing that's available to older adults is often rentals like mobile homes, the lower cost apartments, the access to legal services that when there are bad actor landlords when there are facilities, like the one I got a call about this morning, that are improperly evicting people that are creating not habitable conditions, that whether it's because of their assets, or because of fear of scams, that that often those older adults are less able to get lawyers to step in and prevent the bad actor landlords from pushing them out of their housing.


think the number one is political will, that in order to build how they're built housing, there will always be some community pushback. I mean, things as simple as you know, the ongoing situation in Anaheim where they wouldn't let Grandma's House of Hope expand. It's literally grandma's house of hope it's for older women who are seeking help for their mental health needs who are living in a community. And yet still, the neighbor said, We don't want that hear so loudly that the city listened. And so I think that kind of the political will to simply approve the developments and to approve the programs and to ensure that when funding is available, because there is state and federal funding available right now for particularly for vulnerable groups, like older adults, to ensure that every time that money is available, that Orange County is taking the money and using it and building and not letting money pass us by and go to other counties because we didn't ask for it if we didn't have the political will to use it.


Definitely, I mean, particularly language, right, there's language barriers. 100%. with Santa Ana, which has significant older adults, Vietnamese speaking population was not translating their meetings to Vietnamese until very, very recently. And only then it was because someone who organized the community to show up to the meeting and to call in to the meetings to get public comments, and they brought their own translator who clearly was a person who was bilingual, but not a translator, and really struggled to adequately convey the message that we should the seniors, he was fighting to get rent control for their community. So I think we, you know, we see very clearly that, particularly for older adults, particularly in non English speaking communities, it's very easy to be left out of the decision making process completely. But yeah, when it comes to, you know, disability access when it comes to immigration status, right, that even as we have some of these, we, Orange County has, regardless of how you feel about it, Orange County has a large community of older adults who are undocumented. And unless we want to lead these folks to die in our streets, we have to provide support. And they're less, you know, the lot of the federal programs are not going to qualify for. And so ensuring that we're coming up with some type of plan to make sure that inside of our community that everyone has access to kind of safe and stable housing can age in the community they're in, definitely requires looking at the needs of each group based on you know, income based on immigration status based on language based on disability. Like there's, there are a lot of buildings in Orange County where there may be available units, but they're on the second or third floor and the elevator doesn't work. We have we have we have one right now we've been working on for a long time where the building is used by the county funded by HUD, permanent supportive housing for people with disabilities, but the elevator hasn't worked in 10 years. So people who get placed on the second or third floor have to be mobile, and if they have an accident or as they're aging, they just lose some mobility and they can't walk the stairs anymore, then they can't carry their groceries up the stairs. So I think that definitely each of the things you listed plus them are factors and access


It's really simple. Like there's not, like, I know, like we act like it's very complicated. But it's really not complicated. Like we know, there just needs to be the political will to just decide to build the housing. You know, we built 1000s of units every year in Orange County, we build high end, you know, million dollar condos. I see buildings go up in a matter of months. The fact that we're not putting up buildings that are affordable and accessible for older adults is a choice, not a necessity.


We on to the second issue oh, gosh, I can't read my own writing. Well, wait a second. Wait. The Yeah, yes, yes. Yes. Yes. Healthcare.


Right part of part of it is, is the housing and the transportation that you know, housing and health care are pretty inextricably intertwined. And so when you don't have housing, it's hard to take care of your health care when you don't have stable housing, that when older adults have to choose between paying for their medication or paying their rent, they pay their rent. And that means they're not taking their medication. That there's, this is kind of another one of those. It sounds complicated, but it's not that complicated. People need more money to pay their rent and their medicine, people need transportation to get to their doctors, people need, you know, adequate access to communicate with, you know, even when there are transportation programs, they're not super reliable. They don't always show up on time, they don't always show up at all. And so really kind of just the physical and geographic access, and the impact of not having enough finances or housing to get it.


And what barriers exist to see improvements in this area.


It's expensive, taking care of people costs money. And so in order to increase access to have reliable transportation to ensure that everyone who's trying to get health care, can engage in the best way possible, which includes having stable housing, we would have to invest in infrastructure and housing and resources, we'd have to make sure that if you know, a 65 year old who's been on house for years with seeking mental health or substance use treatment, that when they walk in that there is a door they can walk in, because right now there's not the only door is the ER, and that when they walk in the door that we have those services available. And at the same time, if there's a 85 year old, who's about to lose their housing and can't get to the doctor's appointment today, because the sheriff is coming to lock them out that there is a phone number, they can call of someone who's going to help make sure they have a lawyer to prevent the lockout, and that they have the money to pay the rent to stay there and that they can get to the doctor's appointment today. Right. But like, those pieces are just so intertwined, that the barriers that they all require investment. And while they would save money in other areas, that we wouldn't be paying the sheriff to go lock the senior out of their apartment, if we prevented the lockout, we wouldn't be paying the sheriff's to go pick people up off the park bench where they, you know, often died if we kept them inside in the first place. So it's different. I don't know, it's not more expensive, but it's different expensive, and it would require restructuring how we're spending our money on the front end.


Definitely, I think that's a lot of the same answers as to the housing one that you know, coming into healthcare in general that that there's that healthcare as a as a whole is kind of reckoning over the past decade with its long history of bias and racism and you know, assuming that older adults don't know what they're talking about, so ageism. And so I think that is a thing that healthcare is just kind of starting to look at and think, Okay, how can we get appropriate diversity of age, race, language, all of these things so that we can provide better health care, but we're not there now. So there's definitely disparate treatment and where do they end up and what type of service they get. And even things as simple as what health insurance they have. There are some resources like we know, the Orange County, I think is the largest county in California that doesn't have a county health care like kind of hospital we don't there is no county hospital, like LA has a county hospitals in Orange County kind of sort of acts like UCI is supposed to be the county hospital but UCI is very clear that it does not view itself as the county hospital. And so we don't have kind of that place of last resort that is government funded to ensure access to health care.


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


Like, even if your phone is already turned off, that there should be a door in every city, we only have 34 cities, it's not that many doors that someone can go knock on and say, hey, you know, I need help today with these things, and a structure in place that they don't walk out without a plan about where they're going to sleep that night, and how they're gonna get to the doctor that day, and how they're going to make sure that they're Medicare's in place.


Um, the third area you mentioned, which is legal services, so how and why are older adults struggling with this issue.


When the legal services - that for older adults who can afford legal services, there's a fear of the scams of lawyers can't be trusted if not knowing where and how to find a lawyer who's going to do the things that they want. And for those who don't have the resources to hire lawyer is the thought that they can't get a lawyer, they can't hire a lawyer, therefore, they can't have things like an estate plan, like someone to represent them, when their landlord is speaking about after so many of like these HOA problems. So people who, you know, hoard everything they had into their mobile home or their condo, and now the HOA is coming for them. And HOAs can be aggressive and expensive. And so there's their kind of access to lawyers for everything from the pre crisis planning to the mid crisis solutions, you know, when they're, if they're CalFresh, that their food stamps is being reduced, that they are much more likely to be successful, appealing that if they have a lawyer to help them. And that is unfortunate, it'd be great if we had a system where people didn't need a lawyer for those things. But between here and there, access, you know, adequate access to get legal advice for everything they need, even if they can't afford it is is kind of banned by the combination of fear from the private bar and funding for the public bar.


Mostly money, which I said to answer most of these, but it's you know that we have four different legal service providers in Orange County. So there's the Community Legal Aid of SoCal, the Public Law Center, our office, the elder law and Disability Rights Center, and the Veterans legal Institute. And between the four of us, we cover most of the areas of law that older adults need. We do estate planning, others don't. Vets legal does VA benefits, Others don't. ya know. Legal Aid does eviction defense, I think really the biggest thing that is not covered it all is a lot more support in licensed facilities, whether it's room and boards or assisted livings, but there's almost no no free support in assisted livings. The problem is that even though we all cover these areas of law, we're also underfunded that we don't have enough staff to help the majority of calls we get. So Community Legal Aid runs a whole hotline, where they have a roomful of people who are answering phones and giving the most kind of triage style crisis advice that they can, because only a tiny fraction of those cases are going to make it through to having a lawyer represent them, not because they don't need it not because the other side isn't doing something wrong. Simply because there just aren't the resources to meet the need.


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


Definitely, I think that the kind of again, one of the biggest discrepancies is is language and culture that having kind of culturally appropriate responses people, especially when it comes to folks who can afford to hire attorneys, being able to find someone who they trust who speaks the same language they speak, is often a barrier because because they there's often, you know, like, cultural needs that not every, you know, Orange County, white man will be prepared to respond to. And most of the lawyers are white men, just the reality of who the lawyers are. And so I think there's both kind of all the disparities we talked about in the other categories with financial access and economic and age and kind of race, gender language, citizenships status, but also because it is that you know, the housing and healthcare definitely have some of the components of it, but legal services are like 100% service from the person and so the kind of culturally appropriate response is even more important when it comes to legally legal services.


Oh, no, what do you suggest is the best way to address this issue or need


Yeah, there's always my wish I had a different I wish there was an answer that was not more money. I mean, a little bit of it as community education right. If we had like, for for all three of these, if we had, you know, more education, maybe there'd be more access to landlords more, you know, trust in lawyers through certain referral services, maybe more senior center referrals to help that some senior centers do clinics for legal services which do quick advice, which at least gives people like when we do a clinic at the Huntington Beach Senior Center, it's often folks who wouldn't necessarily qualify to retain us, maybe over income. But by having this 20 minute consult with us, they're empowered with the language. They know what they're asking for. They feel confident, they know like what the range of cost should be. And so when they go and talk to private lawyers, they're not as worried about being, you know, victim of a scam, because they know what they're asking for and what words they should expect to hear. A little bit of education, but a lot of it is just, it just costs money to take care of our community.


Right, thank you. Moving on to the next set of questions.


I simply meant health care. But if you mean something different than


I'll just read it anyway. So geriatric is the branch of health care that focuses on our unique needs as we age, just as pediatricians specialize in the health needs of children, geriatrician, and valid geriatric health professionals specialized in the health needs of older people. So the question is, if you could describe how accessible and adequate this care is in Orange County,


for the groups of people that have higher level insurance and can afford it, it seems like it is relatively accessible and adequate. for the group of people that are on Cal optima and cannot afford it. It seems to be much less accessible and adequate. for uninsured people aren't for people are uninsured. It's also Yeah, leaving out the uninsured.


And I'll just read that off. So long term care is the variety of services which helped me both the medical and non medical needs of people with a chronic illness or disability who cannot care for themselves for long periods.


Insurance about the same that for those who have the means to pay for it. Those who have long term care insurance, that that is often accessible and effective. And for those who don't, there is no long term care.


Next one, is mental behavior, health, substance use treatment.


This, that for the people who have better insurance, and that means that it's kind of medium level, I wouldn't say it's as accessible as the other two. But there is some of those things available for those who have the insurance. And that means for those who have, you know, medicaid Cal Optima or no insurance, I would say mental health and substance use treatment is completely unavailable, like not just inadequate, just like barely there at all.


So yeah, there's there's a few there's, you know, the I think the primary one that works with the folks we work with, that is focused only on older adults is Oasis, because they get the FSP contract from the state. But I wouldn't necessarily say their level of care is adequate, then there's a few that focus on people with HIV and AIDS. And they have, they also keep older adults. And so they're they're probably a little better at services. And then there's some of the kind of broader mental health programs countywide that are not focused on older adults. And so they don't necessarily prioritize the special needs of older adults, but they do provide services. And then the net with this with the HomeSafe funding is kind of a unclear lot like the way HomeSafe funding has funneled through adult protective services. They're basically funding mercy house to act as case managers for older adults who qualifies engaged in self neglect, who, who need assistance, Mercy house as a generic homeless service provider, this is their first time doing a project that was focused on older adults and so far, I have no reason to think they have developed necessarily the specialized experience, but maybe they'll get there


and the last one is human or social services. You know, such as, you know, basic needs, shelter, food, things like that. And


I think for people who are housed with income, certainly there's like, increasingly accessible kind of delivery services in different programs for people are housed and low income, there's kind of moderately accessible, kind of companionship programs and, and food services, usually not quite enough to meet the full needs. But more than for people who are unhoused are kind of on the risk of being unhoused or who are in congregate settings, that there's really not there is there is no emergency shelter that's exclusively for older adults in Orange County that doesn't exist. There, you know, they're sent to the same congregate shelters as the 20 year olds, which often for older adults who feel more vulnerable is too scary, so then they just don't go. Um, so in terms of kind of like emergency wraparound services of case management, shelter, housing for folks who are either unhoused or living in their car or at risk of being unhoused, there's very, very little that is particularly focused on this population and accessible to this population.


All right, moving on to our last set of question. So we're almost done. Now. So in addition to what we have already talked about, let's dig a little deeper into your area of expertise. So thinking about your area, which we have listed under protection from abuse, neglect, or exploitation in one way, or what are some ways that this area is working or not working for older adults in Orange County.


So I think right in this year, in Orange County, probably the biggest thing that is both working and not working is the HomeSafe program, that the state sent $4 million of 2022 money to be passed through APS to serve those that that population that was APS qualified, because of self neglect or abuse. But usually it's self neglect. That was kind of a wraparound whatever it takes funding to pay for motels, housing, food, case management, and that it took us until nearly 2023 To start using it at all. And so we are using it now. And in some ways our program is way ahead of what other counties are doing with that pot of state money. In other ways, our program is still so non responsive that when a person calls in with an emergency and asks to be matched with home safe, that they are told local, they'll get an interview in a couple of weeks from an APS worker, who will then determine if they qualify, and who will then send them over to Mercy house who will call back in a month or two and three or four months from now, when they've already been evicted, there will be rental assistance available. And so it is like there are some ways in which it is doing great work. Once a person gets enrolled in it, I think our Home Safe Program is ahead of those counties who are getting getting access to kind of this like well functioning wraparound program. But getting enrolled in it is really a barrier. And for our most vulnerable older adults, when we have this pot of millions of dollars that's intended to catch these catch those people and to keep them home safe, that sort of thing, right to keep them safe and stablely homed, we're really struggling to get get it out. And sure like it's not that much money, it'll be gone at some point. But hopefully that will put us in a position to go back to the state and say, Hey, we helped all these seniors, we need another pot home safe money.


Okay, yeah, so it's 4 million allocated for 2022. That is still being spent. So there hasn't been any new 2023 money because we haven't gone back because we haven't spent the 2022 money. And so the Yeah, I think that's kind of an area where there's both great success and great failure in different pieces of the same program. I think overall that the you know that we have a pretty robust system of like senior centers that are there and available. And some of them have like really amazing resources and connecting people with different programs and having a lot of city specific things. But we really don't have the cohesiveness as a county. So if you know, if a person, you know, who particularly an unhoused person walks into one senior center, they only know what's happening in the, you know, the four mile radius of them. They can't tell you anything beyond that. So if that person, you know, happens to actually be from the next town over and just couldn't find the right city or something, they didn't have a phone, they didn't have a car, they went where the bus took them, that there really is no cohesive system of care to connect people with resources county wide and really is this kind of like every city for themselves. And, you know, either the city does it or doesn't and some cities do and some cities don't. And that just is how it is. And kind of forget that people cross City Lines every day for every you know, for lunch for work, and that we can't pretend that older adults, particularly those who have needs like medical and housing and food are not going cross the city line. So we need to come up with some way to be more cohesive in kind of a system of care where if a person walks in, that it doesn't matter if they , you know, are a San Clemente resident who walked into a Mission Viejo door that they're still a way to communicate with each other and find a place to make sure they can still get to their doctor in San Clemente, but that they get to sleep inside tonight


know what new or revised policies are needed.


I mean, I think the two, at least in the main priorities that would make a really big difference would be more housing protection. Whether that's extending some form of, of rent control, or rent stabilization, whatever people want to call it. But we see in like, San, I think it's in San Juan, they have a senior mobile home park, and they have rent control for this senior mobile home park. And people there thrive like they've been people have lived there forever, their houses, their their house values maintain, they're able to continue to live out their lives there. For the rest of the county, where there's no protections for mobile homes, they're kind of the place where seniors dump all their money thinking they're going to live the rest of their life and suddenly find themselves dying, trying to hold on to their home. And so we saw, you know, we saw it up in Anaheim, Fullerton, and that Park was bought, and they went all the way to the state begging for help and came back with basically nothing. And so we see kind of over and over where there's the lack of protections for tenants, particularly older adults, and puts them in a really vulnerable position. And so having some type of whether it's county wide, or every city, even mobile home specific, but broadly kind of housing wide, right to counsel or protection on rental increases would definitely go right, because the right to counsel piece, which is a really a national movement that is happening in a lot of states has a right to counsel and housing related things where attorneys are funded to provide services for housing related things. Or, you know, rental assistance, like all the kind of the range of policies that could from like, right to counsel to rental assistance to protections that could keep keep people stablely housed. And it would all go a long way toward letting us work on the healthcare and everything else.


But you know, I think the challenge is that when we put local, we put cities in charge of doing it, the political will problem comes up. And so having really having a county wide response, but when we have a county with five supervisors, or each very tied to their own district, you have kind of similarly challenges spending the money in each of the districts. And so having, you know, passing policies that would require some minimal housing that would require protections, like putting money into funds that could be split between rental protection, or, you know, right to counsel attorneys to help people putting money into funds to help people do their end of life planning and kind of empowering them with a medical directives and kind of stop people having to go get conservatorships in the house, in the court system. All of that would would kind of trickle down to having the frontline decision making being the providers. And instead, some some of the hospitals are in a position to help with there's some some of the treatment components that if the hospitals had the adequate funding, they would expand. We saw how the county's attempt to try and expand services by creating be well didn't really pan out the way it was intended. We'll see how the next site goes. But the current site doesn't seem to actually be offering quite the level of service that was promised for all those millions of dollars. So I think kind of the how to get past that political will and who, who is able to get past that political will is really tough in a county that structured the way it is. And that's probably part of why this kind of all 34 cities are saying, oh, that's the one next door. And the county is saying, Oh, we don't want to step on the city's toes. And the cities are saying, Oh, but that's the county's decision. That in some ways, like one of those entities, whether it's, you know, the cities or the county, someone has to kind of take ownership and step up and decide they're going to change the policies, they're gonna put money into solutions. It's going to anger some voters now. And when there are less people dying in the streets, hopefully those voters won't be angry anymore. But how to get from here to there, other than, you know, people just decide to do it. I don't have a good answer for


So we really haven't. But it's just data we've never sought out because we're so unable to meet the need, and that being able to show that need is more than we can imagine, isn't gonna get us any closer to meeting the need. Even stuff like the special needs trust beneficiaries don't have access to any lawyers. But having having the numbers just wasn't, it's just sad when you know, there's no money to apply for. There's no work to


Linda is certainly on kind of like the social services and legal services side, if you haven't already talked to people in the there's there are elder law units at Legal Aid and Health Law Center. Veterans legal doesn't necessarily have an elder law unit, but they work a lot with Vietnam veterans are all older adults. So I think all three of those on kind of the legal services side. And then well, while I'm frustrated with the way in which the HomeSafe program is being administered, I can see there that they are, right that to the county has chosen to put on the front lines right now is that the call comes to APS, if yes, eventually gets the call to Mercy house and mercy house isthe ones out in the street, matching up with the people APS chose as deserving of the program and trying to figure out what it's going to take to get them into housing. And so they're the ones reporting up to the state, hey, we don't have enough training on the housing services and benefits services and how to get so it might be useful to talk to the Department of Mercy house specifically that's working on HomeSafe to hear kind of what are the things that they're seeing and when people do make it to them through APs and when they are trying to get those folks back into or maintaining stable housing.


Sure. Well, this concludes our interview. Thank you so much for your time, you have been incredibly helpful to our research. If you find that you have more to share, please feel free to reach out to us. You know, our contact information is available on our website www.fsoc.com And you can leave an anonymous voicemail and our telephone line anytime and as I tell everyone of course you can reach out to me and you have anything that you thought of afterwards which you stop the sharing


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


I am attacking a let me know if I need to enlarge or move up and down but this is the entire page that I'm showing you.


Alzheimer's cancer caregiving caregiving is a big one for us. communicable diseases, big one and the veteran community.


It's okay. I'm trying to add to that for now. Just go ahead and read through it because I want to ask questions about about this list. Yeah.


Digital Divide Yes. Yes. Absolutely. Not security. Yes. social wellbeing. Yes, environmental. Health healthcare acts almost as housing. Tobacco use transportation. Okay, I got it. Okay.


Okay, so I'm the executive director and co founder of veterans legal Institute, and we provide free legal services to low income and homeless veterans. As you know, Orange County has a large population of veterans. And specifically, when it comes to low income and homeless veterans, there's a contingent of those who served in Vietnam, Korea and world war two that are all over 60 years of age. So we provide very specific services to that population. And it's a population I feel very passionate about serving.


I definitely yes. I think that their legal is missing from the list. I think a lot of older adults need access to low low cost low Bono or pro bono legal specifically when it comes to their estate planning and also their benefits. A lot of elderly people apply for veteran benefits, Social Security, Social Security, disability income, and they have issues they have issues filing for their Medicare, and things of that nature. There's a lot of financial elder abuse that's taking place and regular elder abuse and oftentimes the older adult population cannot afford an attorney.


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


I think caregiver assistance is very important.


Yes. The second one behavior, behavior mental health.


Okay. Now. So I'm going to ask you a set of questions about each one of these.


I think specifically in Orange County, we do not have a lot of affordable options for caregivers. And especially like this includes the homes. I forgot the name of those types of homes. Skilled Nursing. Yeah, nursing homes and in homes where they can really kind of like end of life type of planning folks. There, the semi decent ones are extremely expensive, and unaffordable, only the wealthy can afford them. And so and having a caregiver, first of all it, a lot of elderly need the caregiver, and it's just beyond their financial needs. There are I know, county programs for the super low income, but oftentimes people don't know how to access that program, and how to find a caregiver. And many times also people need 24 hour care. And they're only getting appointed caregivers for like eight hours or 10 hours or 12 hours, it doesn't, you know, match the the amount of care that they need. And so there, they have to rely on their children, if they have some and if they don't, they're kind of on their own in terms of taking care of themselves.


I think we have a lack of affordable skilled caregivers, a lack of affordable nursing homes. And I think there's barriers to information about how to access programs where they can get low cost or subsidized caregivers.


Aarthi Oh, definitely. Oh, sorry, go ahead.


I would also say that a lot of Orange County residents are asset rich and cash poor, meaning they live in their homes, or, you know, 50 years and the home is worth you know, they bought the home for 50,000, the home is now worth 800,000. And that works against them in terms of eligibility for certain benefits. So even though they live off of their social security, which is like $1,200 A month or some minimal amount, so their cash for because they live in that home, they often don't qualify for certain benefits, which is unfair, because it forces the older adult either to put the home in a trust with like a loophole in that system it is borderline fraud and also costs them money, or it forces them to bankrupt the value of the home in order to qualify for services. So makes no sense. No. Sorry.


Sorry. Go ahead. Sorry, I didn't know you were not finished. Go ahead.


I mean, I feel very bad about this. Because, you know, I have, like my grandma died. But this was an issue for that. And you know, a lot of people have like moderate income, but it's a fixed income, and they still they can't afford caregivers. But they don't qualify and ----- on federal guidelines, where people who live in North Carolina, have a significantly less cost of living. So our eligibility has to match, not state guidelines, but county specific guidelines.


Absolutely. I mean, you can separate it, even by veteran versus civilian status. Oftentimes, veterans have different mental health issues than their civilian counterparts due in part to traumatic experiences, from their military experience, so they might have issues, for example, with post traumatic stress, that give them you know, paranoia, or depression or other things that, you know, make them need a different level of care than someone who might not have these issues. Obviously, somebody who is a high wage earner and has money is going to have easier access to a caregiver as well as a caregiving facility because they can afford it. Low income seniors are the ones who really struggle, I think, to access the care that they need, because they're poor.


I suggest that we should have more programs for caregivers as well as skilled nursing facilities. And it should be income based based on an income criteria that suits the median income of Orange County residents. So we shouldn't have to make our seniors go broke to qualify for services.


Housing. Okay, this is there's so much to say on this. This could be like a 30 hour call, by the way, Tammy, I know. Primarily, we have two things with housing in Orange County, because we have a low supply of affordable housing, and lots of demand to live here. And what that causes is people to, you know, either have several people in one house or in one room, which is unhealthy. Or people have to move away and older adults don't want to move away from their children or from where they grew up. It's very difficult or from their health care provider. So the main thing, the main issue when it comes to housing is we lack affordable housing. And there's there's so many other things that tie into this, for example, the social, the rate of Social Security is so low that most people can't survive off of their social security income alone, as well, they have to done some significant planning and have other investments in order to survive and live in Orange County. Right.


I have my PhD dissertation all here for you right now.


Well, that's a very complex question. And one of the barriers is that our local cities don't want to build affordable housing, because they don't want to attract low income people. Because they want to maintain their property values, and they want to keep out low income people that they view as undesirable.


Yes, low income people struggle to access safe and healthy housing and secure housing more than people that have money. People with mental health, like elderly with mental health issues, struggle to maintain safe and secure housing, because they have mental health issues that create barriers towards rational and healthy living. For example, if you have Alzheimer's and you are living in your home, you may forget to pay your mortgage and that can lead to foreclosure. If you're on a fixed income, you can't hire an attorney to help prevent that foreclosure. But if you can't afford to go into a skilled nursing home because you live off your fixed income, and your home is, you know, you're only paying $400 A month your mortgage, does it make sense to go to a skilled nursing facility so you really need someone to come in and help manage your affairs. So I would say that people with mental health issues also are at greater risk to be housing insecure.


Vote for me. I can only say this stuff because that you said no one else was gonna listen to it. And it's anonymous. Okay. We can resolve the complex housing issue in our county at 30 minutes, let's talk about that. We would need to have better requirements for cities to have to build affordable housing specifically for seniors. Cities would and the county or the state would have to enforce consequences for cities who don't want to comply with those rules. So oftentimes we have rules in place where cities need to allocate a certain number of units for vulnerable populations, the city then tells the state to go pound sand, and they just don't do it. And then the state doesn't have a lot of teeth. Really behind their their order. So we really need to provide better incentives for cities to provide housing for the elderly, and skilled nursing facilities, things of that nature


So mental health, the decline of mental health post pandemic in the United States is something evident in all ages. But specifically with older adults, there was a lot of isolation alienation during that time. And as a result, they're mental health, a lot of elderly people, there was visible degradation in their mental health, higher levels of depression, people were not getting the treatment they needed for other mental health issues that they may have had.


I think mental health is very taboo. And there's not a lot of education out there on mental health. And I think we need to do a lot conduct a lot of outreach to older adults in need of mental health services. And I think that should should span, you know, lower levels, per se, of mental health issues like depression, anxiety, and go all the way to extreme levels like schizophrenia. And we need to allocate funds and take mental health seriously in older adults, as well as the rest of the American population.


Yes, the key factor here is money. People who don't have money, don't access resources. So, you know, people can pay $250 an hour to see their therapists, or people might have great insurance where they only have to pay $50 an hour to see their therapist. But if you're poor, and you don't have insurance, you might not access those mental health services. If you have to work an incredible amount of hours just to pay your rent, you might not have accessibility based on the hours that you work to access mental health services. So And oftentimes, older adults are so isolated within their own home. They don't have an advocate who lets them know what's available. So they're not even familiar with the resources available to them to assist them with their mental health.


I think there needs to be a stronger campaign. Out there in the forms of media that that older adults tend to use, which I think is print media as well as TV versus just the internet, where, you know, they're not as savvy as their younger counterparts. I think we need to put the education out there. I think we need to, I think older adults that are in more severe situations should be assigned social workers or some sort of advocate to help them navigate what can be very complex and bureaucratic systems so that they are able to access the resources and the benefits out there that they're eligible for. I think we have barriers to transportation for a lot of the elderly, a lot of them are unable to drive because whether it's they don't own a car or they are no longer eligible to carry a driver's license because they might be blind or hard of hearing, or whatever it is. We need to really reach out and find And those older adults and seniors so that they're they don't fall between the cracks.


Right, I'm moving on to the next question.


I don't know if I'm best qualified to answer that question, to be honest with you. I don't want to criticize something that I don't have a full understanding about.


Let me just, if it's helpful, let me just read you the definition we're using for geriatric care. And you know, you can answer or not perfectly fine. So geriatrics is the branch of health care that focuses on our unique needs as we age, just as pediatricians specialize in the health needs of children, geriatricians and fellow geriatric health professionals specialize in the health needs of older


people. I don't know if that's helpful at all. But I mean, so the question is, how


accessible and adequate these services are in in Orange County.


I'm gonna say that they're accessible to people who have money and are of a reasonable mental health. I'd say Geriatric Care is far more difficult for those who lack mental stability, as well as to those who are low income and can't afford, you know, to see a doctor. Also people that are more vulnerable, even if they have their own different, you know, state based insurance systems where they have more accessible health care, they it's so like, the bureaucracy is so complex to navigate, you know, that they they have to go for see a general and then be sent somewhere else. And that the medical system in and of itself, and the insurance system is very broken. So it makes it you really have to fight for your health care, I think in our state, especially if you're poor. And I think that makes it even harder for the elderly.


The next one is long term care. And I will just read to you. Long Term Care is a variety of services, which helped meet both the medical and non medical needs of people with a chronic illness or disability who cannot care for themselves for long periods.


I will say the same answer, I think, long term care for people who have planned ahead or of reasonable mental health or have children or a partner or spouse


don't speak good English, have barriers to transportation, don't understand modern day technology are dyslexic and struggle reading are have poor eyesight and struggle reading I think people that are, you know, like that are more vulnerable struggle to access long term care, and most specifically the poor because they simply can't afford it.


Again, how adequate and accessable inadequate you think.


I believe there there are programs out there but I believe it's it's inadequate, compared to the demand for these types of services.


Yes, I. And I'm sorry that it's gonna have to be veteran specific since the field I work in but the Vet Center, there's one in Garden Grove as well as one in Mission Viejo. They are a subsidy of the VA hospital, and they provide free mental health counseling for veterans, as well as if their veteran has a partner they will do group counseling as well with partner. So that's the one that's the That's the program I'm most familiar with.


I think that that's probably our strongest, okay. I it's inadequate given the demand. However, I really do believe that the, the void left by government in Orange County has been relatively well filled by nonprofits as well as, you know, civilian volunteers, churches, and other groups that are community minded. I do believe that Orange County is very philanthropic and nonprofit minded, and we do have lots of programs in place. No. Partly because there's such a great demand. But also, some of the services needed simply social services, whether it's like going to Social Security, or, you know, the county or the processes are so long and drawn out, it takes up so many hours of someone's time, it's hard to find an advocate for everybody to help each person and.


I think cost of living. I mean, I just think I think economic viability, I think that social security is, you know, there's always been this constant threat that Social Security is gonna go away. And I think that's most older adults, that's their main form of income as they get older. And I think that without that, along with the increased cost of living in Orange County, it's very hard for them to survive, we have a affordable housing shortage, you know, the cost of health care is going up. And so for somebody who's not working, it becomes very difficult for them to, you know, access to really thrive the way somebody who's young and works and has money.


I think the government has an obligation to keep our streets safe and our communities healthy. And part of that is ensuring that older adults Americans needs are met. And that includes making sure that


proper health care that they have, if they have barriers to transportation that they have an advocate who can assist them in accessing the resources that are available to them.


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


out of older adults or out of everybody,


I think all older adults, I think the elderly are are in General ignored. It's not a it's not a gender thing. It's not a citizen status thing. The people who need it more are in terms of accessing resources. No, I think I would say I would actually say all older adults are are ignored. They don't seem to take priority


It's like, oh, protect our elderly, none of them. I mean, it's you look at it. The commercials it's protect immigrants, protect LGBTQ plus, protect veterans, protect cancer survivors protect children. I mean, they're all worthy causes. I'm not saying they're not. But I don't think I've ever seen anything that was like, oh, old people that don't have children like they have nobody visit them. They're alone. What about the suicide rate Amongst the elderly is pretty high.


I would say housing for for, for older adults to make any big one.


Right. So moving on to the last set of questions. Yeah. So, in addition to what we have already talked about, let's dig a little deeper into your area of expertise.


Sure. Well, let me just go back. So in addition to what we've already talked about, let's deep dig a little deeper into your area of expertise in, in this case, inclusion and equity in aging.


Don't know if I fully understand that. Yes.


I would just say that low income and moderate income older adults need more resources. And in general, because of their I'm not I don't I don't I truly believe it's not like you can break it down by like race and ethnicity. But it really comes down to money, those with more money, regardless of whatever shade of you know, skin that they have. If you have money, you're accessing resources. If you don't, you're not. And I would say that we really need to be more inclusive of older adults that have mental health issues and older adults that are low and moderate income to be able to access safe and secure housing.


What new or revised policies are needed.


I can't believe this phone call me like, Gee, I could write like a 300 page novel on this.


I know what what policies let me give you


a one line answer to that. We need to have I'm going to stick with this we need to have more affordable living space for the elderly in every single city. It should be a requirement that each city allocates a certain amount of units to the elderly.


Like to expand, it's completely up to you.


Do I want to expand that. Yeah, and I think that cities that fail to comply and fail to provide affordable housing to seniors. I feel that there should be a consequence. Or let's not even say more positive city, you should be motivated to be in compliance with these these rules.


Okay, well, I guess I kind of know the answer to your next our next question. Again, we're talking about really, either by the inclusion equity agent


I mean, in terms I think each city should be addressing the issues within their city because every city has a different demographic, and also has different you know, some cities have more resources, some cities have less. So I would, I would, I would say that ultimately, state lawmakers should be creating blanket policies that can be tailored to each city to make it feasible for cities to comply. But the cities also have to take it upon themselves


to want to, you know, help out in this way.


So I collect a lot of on every client, I collect all their demographic data, their age, their income, whether or not they're disabled, their military service, and I believe all of that is is relevant. But I would say primarily, it's really important to gather data on people about their income, if they are disabled, their household size because if somebody has other people in the house, it means they're more likely to be taken care of their military service because if they are a veteran, then they may have they may have issues related to that military service. So those are some of the types of data that I would suggest people


think you should talk to chase Wickersham.


Chase is a I don't know how to put it. But let's say he's a leader in Orange County when it comes to veteran and older adult issues and mental health. He's 77 years old. He's a military veteran. He's helped put together large projects mhsa funding programs for for the elderly and veterans and he's very well versed in what older adults need.


And I'm gonna follow up with you later about getting in contact with him if it's okay. Yeah, of course, I assume he's retired. He's not, you know, quote, unquote.


He's retired but yeah, he he basically volunteers full time. Okay, on these exact issues. Okay. Okay.


this concludes our interview. Thank you so much for your time, you have been incredibly helpful to our our research. Now. If you find that you have more to share, please feel free to reach out to us. Our contact information is available on our website www.sz.com And you can leave an anonymous voicemail on our telephone line anytime. But as I tell everyone, please reach out to me.


I know Hold on. Let me just um, there we go. Recording


Before we go over the questions, I'm going to explain a little bit of like a goal, which a primary goal today is to identify the needs that you think are the most important to the older adult population that you serve with those who are 60 and older. So we want you to think as broadly as possible. So thinking into consideration the older adults, caregivers, families and their communities. So um, first, I'm gonna go ahead and share my screen. So you can see a list of common concerns and issues of for the older adults. Yes. Just please take a few minutes and go over the list. Based on the list, I'm going to ask the following questions.


And please let me know when you're done.


Okay, okay, so thinking specifically about older adults in Orange County. Yeah. So


my role I work for the University of California, Irvine, as the director of the Sustainability Resource Center, so I work with a large array of folks. The first primary population, our students, which includes traditional and non traditional students, UCI has a large population of non traditional, which essentially means, you know, not your graduating high school and immediately coming into college. So we have folks from, you know, a wide array of ages below 18, all the way, you know, and 98, right. So, I serve a large array of those students, but then we also work with staff and faculty for a lot of sustainability related issues. So that's, again, a large array of folks and then our primary mission with Irvine. And then the community is doing a lot of that outreach work in order to connect students to community organizations to populations in need of service or needs of some kind in order to work with them and provide what we can provide as a university. So again, that's a large array of folks to including, you know, small infants all the way up to older populations of folks, too. So that's a little bit about my role in what we do.


Including, again, the one that's above it, have respiratory conditions and other illnesses and ailments.


homelessness, house lessness, heart disease, all of this is on there. The one thing that I will say as I was reading, right, is that when we talk about sustainability with folks, and especially if we're looking at our older population, there's a lot of crossover that comes with environmental injustices and environmental concerns. Right. So you're looking at the environmental concerns piece and you see drought and wildfires, pollution, right. So a lot of those ailments that are correlated with our environmental concerns. So that's the one thing I'll say is that, even though they're listed as standalone, right, they do correlate and compound with each other, especially for our older population.


well, it's gonna be different for me right then someone else. So what I feel are the most important.


most important for me on this list in terms of trying to address in my work is one the environmental concerns peace, transportation, and mobility. And then well that's hard.


So many of these rights are so interconnected and interweaved.


say, though, is is that how we view our work, too, and I'm seeing Community and Family Safety. If we view, like a family unit and our community as priority, then we're gonna pay attention to a lot of these other things, right, and take more care and attention to things like our transportation issues, like older populations, and having access to certain things, right, like infant care. So I'll say that even though I'm hard pressed to name top three, but that's what I say.


Thank you. For the next question, I'm going to ask, ask you the same questions for each of the needs that you listed. So what like, I'm going to start with the number one that you like mentioned, which is environmental concerns. Yeah.


So what you have listed with environmental concerns, right of drought, wildfires, pollution, emergency preparedness, that list could go on with a whole bunch of other kinds of environmental concerns. What we talked about with vulnerable, vulnerable populations, which, when we're talking about environmental injustice is older populations would fall under, just as right, folks of color or low socio economic status, folks would fall under vulnerable populations. We know that environmental injustice is such as, like, where landfills are placed, where waste treatment facilities are a place where, you know, lower income housing is placed are more commonly correlated for areas that don't have enough services to fight against those don't have enough public services, public goods, right. And then also, with that comes less preparedness to respond to some of these issues like if a wildfire were to happen. Like if drought were to happen, right, there's less public good, less public will towards addressing that need urgently. We're less likely to need to respond with, you know, large campaigns for the rich, commonly white family neighborhoods because they're going to have more resources in order to respond themselves. Right. And so just with that, you can see that when we're looking at an older population, maybe there's less resources in order to respond to those emergencies or to those environmental injustices


the biggest barrier, right is climate change, as the climate continues to change. And as we see more and more intensified natural disasters and natural occurrences, these correlations that I mentioned right are going to intensify as well. So our vulnerable populations are going to continue to experience intensified natural occurrences that impact them. And all we have to do is look at last summer with our two heat waves, right, that lasted a pretty long time when we see things like that vulnerable populations, such as older populations


again, not always equipped with all of the resources in order to respond to that. And so we see that with our students, when we're working with them, we see that with our local nonprofits that are working with vulnerable populations, right. That's Eric, like, how do we respond to that kind of thing. And those natural phenomena and are going to intensify, are intensifying with climate change. And so it's going to be more and more of a concern for our vulnerable populations, as well as it should be for, you know, folks that don't fall under that umbrella.


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


so like I mentioned to right, environmental injustices correlate with so many other socially constructed identities and communities. And that's because of our history of in this country, right of, you know, colonialism, of racism, of capitalism, all of these things compounding in and of itself to create the vulnerable populations, and then vulnerable populations that correlate with even more environmental injustice is, and so it's not necessarily that it's like if you are of a certain like vulnerable population, and you identify as someone who falls under the umbrella, you're going to experience this, that's not what it means. It just means historically, within this country, at least, right because of these different compounding historical happenings, and social constructions that these natural phenomena, like the intensification of certain natural phenomena from climate change, correlate with impacting more vulnerable populations. So we see a higher percentage right of folks of color, and specifically, our Black and African American are indigenous native american folks experiencing more intensification from these natural phenomenon due to climate change, because of that historical context. And then because of the disenfranchisement, by construction of these compounding narratives and social constructions often have less resources in order to combat them. So I mentioned earlier too, that environmental injustice is can include things like where landfills are placed, where we waste treatment facilities or place right. And we see often that gets placed, the burden of those kinds of facilities get placed in predominantly communities of color, predominantly low socio economic status communities, because they have less resources often in terms of time, energy and money in order to fight that. Whereas, you know, more often white higher income communities have more time, money, energy in order to fight that. So all of these things compounds so that are vulnerable populations.


And so that needs to be talked about when we talk about environmental concerns with our vulnerable populations is that communities may feel it more, even within those vulnerable populations.


Thank you for sharing the next one, as the news suggests.


Oh, that's a big question. There's so many things to do. And if we're looking at large, grand scale solutions, right, there's a lot of ways to address climate change that are out there. Right, eliminating greenhouse gas emissions and encouraging, you know, our state, our federal facilities, our municipalities to rapidly start addressing and cutting their greenhouse gas emissions, right, we only have a certain amount of time to bend the curve and our greenhouse gas emissions before we reach higher than 1.5 degrees Celsius in our global warming, which will further intensify climate change. And so we need all governmental units addressing that. But we also need our corporations and businesses to address them as well. And that also will involve right our government to be involved in some way of incentivizing that or, you know, actually putting limitations and restrictions. And, but that's on the grand scale. So on the community scale, right, with something like looking at vulnerable populations in Orange County. One, it means providing the resources to the populations of folks that correlate with these intensified environmental phenomenon concerns, through the form of right, like I said, cooling centers during those times of extreme heat, or like transportation to and from, like, all of these things that are on this list go together in order to help address some of these issues. But really, we're not going to be able to address the local issue of climate change without those larger ones as well. All we can do right now is look at how we can help within our community to provide resources for vulnerable populations, and even like folks that don't fall under that umbrella of vulnerable populations.


Thank you, and now we're gonna move on to the second neighborhood you identified and I'm gonna go ahead and ask the same questions. Yeah,