Aging and Disability Community Budget
(Part of the People’s Budget Coalition)
Proposals for the San Francisco City Budget Process 2007-2008
Sponsoring Organizations Include: Community Alliance of Disability Advocates (CADA) Coalition of Agencies Serving the Elderly (CASE) Healthcare Action Team Independent Living Resource Center, San Francisco Mental Health Association of San Francisco Older Adult Reintegration Services (OARS), Family Service Agency of San Francisco Openhouse Planning for Elders in the Central City San Francisco Adult Day Services Network Self-Help for the Elderly Senior Action Network Seniors Organizing Seniors St. Francis Living Room Foundation For more information, call Meg Cooch at Planning for Elders at 415-703-0188.
Table of Contents
Proposals Summary of Requests Statement of Need Cost of Doing Business Housing Modification Fund Shallow and Deep Rental Subsidy Program Eviction and Homeless Prevention for Hoarding & Cluttering Individuals Eviction Prevention Legal Services Money Management to Pay Rents Pilot Patch for Board and Care Living Share of Cost Pilot Expansion Homecare Expansion for Non IHSS Users New Home Fund for One Time Only Items Consumer Support/Check In Program Long Term Care Consumer Rights Senior Housing Socialization Program LGBT Senior and Disability Support Services Additional Home Delivered Meals Pedestrian Safety/Safe Streets Initiative Naturalization Services Expansion Appropriate Language Access Program Taxi Script Expansion Escorts/Transportation Homeless Senior Drop In Program Peer Support Summit LGBT Cultural Competency and Access Training Disability Know Your Rights/Cultural Responsiveness Trainings Department of Aging and Adult Services Proposals 11 12 13 14 15 16 17 18 20 21 23 24 25 26 27 28 29 30 31 33 34 Page 3 6 7 8 9 10
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Aging and Disability Coalition Budget Proposals (Part of the People’s Budget Coalition):
Summary Categories of Funding Requested Housing Access and Eviction Prevention Access to Homecare and Healthcare Healthy and Safe Living Immigrant Services and Language Access Transportation Other Subtotal Cost of Doing Business Increase at 6% for all contractors Total Total Request Per Category $2,028,000 $910,338 $640,000 $600,000 $627,675 $826,987 $5,608,000 $16,000,000 $21,608,000
Cost of Doing Business Increase of 6% (totaling $16,000,000) for all nonprofit contractors to address workers’ wages and health/workers comp increases. The first principle of the Aging and Disability Coalition is that no cuts should occur to services that help seniors and adults with disabilities remain in the community. Nonprofit service providers in San Francisco are facing a crisis in funding, which will result in cuts to services if the City does not address the increasing cost of labor and health care with a 6 percent cost of doing business increase to contracts. This MUST be done in order that seniors and adults with disabilities do not see a decrease in service provision. Category Housing Access and Eviction Prevention Proposal Housing Modification Fund for Rental and Owned Units (average $1666 each person) Shallow Rental Subsidy Program (avg $250 per month per person) Eviction and Homelessness Prevention for Compulsive Hoarders and Clutterers Eviction Prevention Legal Services (2 lawyers) Money Management to Pay People’s Rents # Served 150 Individuals 300 Individuals 550 Individuals 520 Individuals 500 Individuals Cost $250,000 $1,000,000 $250,000 $225,000 $175,000
Pilot Patch for Board and Care Living Access to Homecare and Healthcare Expand the Share of Cost Pilot Program Expand Homecare for Individuals Who Do Not Qualify for IHSS Create New Home Fund for One Time Only Items (approximately $100 per person) Consumer Support/Check in for Homecare Long Term Care Consumer Rights Initiative Healthy and Safe Living Senior and Disability Housing Socialization Program LGBT Senior and Disability Support Service (including activity groups, phone connections, service connection) Additional Congregate and Home Delivered Meals ($7.35 per meal) Pedestrian Safety/Safe Streets Initiative Immigrant Services and Language Access Transportation Expanded Naturalization Services (including legal assistance and naturalization classes) Appropriate Language Access Outreach Program Expanding Taxi Script Program, especially for hospital discharges and medical visits ($11.36 avg cost per ride, 4 rides per week for 52 weeks) Accompanied Transportation for Medical Appointments, Shopping and Other Activities Other Drop-In Program for seniors and adults with disability in the Tenderloin Peer Support Summit LGBT Cultural Competency and Access Training Disability “Know Your Rights” and Cultural Responsiveness Trainings for Consumers and Providers Psych Social Worker and Clerk for Conservator Dept ($135,037 total/$81,022 general fund) 4
8 Individuals 81 Individuals 160 Individuals 350 Individuals 750 Individuals 1500 Individuals 200 Individuals 220 individuals 40,816 meals 2000 individuals 700 individuals 2000 individuals 200 individuals (more than 41,600 rides) Approx 35,416 rides per year 350 individuals 200 individuals 800 individuals 1500 individuals
$128,000 $300,000 $230,000 $35,000 $95,000 $250,338 $40,000 $20,000 $300,000 $280,000 $350,000 $225,000 $302,675
$325,000 $135,000 $20,000 $20,000 $350,000 $81,022
Public Guardian /Public Conservator Expansion ($368,276 total/$220,965 general fund) Subtotal Other Important Advocacy Efforts
$220,965 $5,608,000
IHSS Expansion – use realignment dollars (no general fund) - $382, 858
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AGING AND DISABILITY COMMUNITY BUDGET PROPOSALS Statement of Need One out of every four people in San Francisco is over the age of 65. One out of ten people over age 65 in the City live alone. Furthermore there are over 170,000 Medicare beneficiaries in our community and this number includes over 120,000 seniors and people with disabilities. This large section of our population faces many problems including ever increasing risk of eviction and homelessness, income limitations, high utilization rates of medical and drug prescription services, mental health and substance abuse issues, access to homecare, and healthcare, isolation, linkage to services, safety, food insecurity, pedestrian safety and transportation. Additional barriers are faced by members of the LGBT community regarding access to culturally relevant services and programs. Similarly, international community members who speak languages other than English face a variety of barriers around language access, culturally relevant services and immigration related issues. All groups are in need of more education regarding their legal, civil and human rights. These rights include the right to advocacy and the right of access to the physical environment. Given the high level of need these vulnerable populations - seniors and people with disabilities – have demonstrated, and considering the stated community goal of preventing institutionalization among these groups, several budget proposals have been crafted to address some of the problems experienced by the target populations. It is imperative that people with disabilities and seniors receive all the care they require and are entitled to. The following proposals are the result of a series of five community forums that were comprised of service providers, consumers, advocates, city and county officials, and stakeholders at large. The aging and disability community, in concert with the Peoples Budget Coalition presents recommendations that address critical issue areas for ourselves and our constituents.
07-08 AGING AND DISABILITY COMMUNITY BUDGET PROPOSALS Cost of Doing Business Since the Fall of 2006, seniors, adults with disabilities, service providers and advocates have been meeting to discuss the unmet needs and gaps in services present in the home and community-based long term care system. The first principle of the Aging and Disability Coalition is that no cuts should occur to services that help seniors and adults with disabilities remain in the community. Nonprofit service providers in San Francisco are facing a crisis in funding, which will result in cuts to services if the City does not address the increasing cost of labor and health care with a 6 percent cost of doing business increase to contracts ($16,000,000). This MUST be done in order that seniors and adults with disabilities do not see a decrease in service provision.
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07-08 AGING AND DISABILITY COMMUNITY BUDGET PROPOSALS Housing Access and Eviction Prevention Proposal Name: Housing Modification Fund Amount Requested: $250,000 Department: Department of Aging and Adult Services Statement of Need, including Target Population: This would allow adults with disabilities and seniors to pay for reasonable modifications to their rental units so as to allow them to retain access to their housing units, remain in these units, and avoid displacement or institutionalization. Brief Description of Program/Service To Be Funded: At a minimum, the fund would cover labor and materials and would provide assistance and referrals regarding access issues related to the qualified individual’s building and unit. Potential Number of Persons Served: This would depend largely on the amount of modifications required to make the unit legally accessible, but if average cost is $1,666.00, then at least 150 people could be served. Expected Savings and/or Dollars Leveraged: Considering the cost associated with placing seniors and adults with disabilities in dangerous or compromised housing, the savings far exceed the expenditures. People with disabilities or health conditions living in housing that is not fully accessible are at risk for injury or falls related to their medical conditions. The cost of emergency services, hospital treatment and possible litigation for one person can easily exceed the requested amount of $250,000. Contact Person for this Proposal: James Chionsini 415.703.0188 X 304, james@planningforelders.org
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07-08 AGING AND DISABILITY COMMUNITY BUDGET PROPOSALS Housing Access and Eviction Prevention Proposal Name: Shallow Rental Subsidy Program Amount Requested: $1,000,000 Department: Department of Aging and Adult Services Statement of Need, including Target Population: Seniors and persons with disabilities are at ever increasing risk for homelessness, especially when living in non-rent controlled units. This proposal would help preserve housing for people who are often on fixed incomes. Housing preservation is critical to ensure folks are not homeless while waiting to access affordable housing. Seniors and persons with disabilities face unique obstacles when they become homeless including a shelter system that is not designed to accommodate their special needs. Brief Description of Program/Service To Be Funded: This would provide funding for seniors and persons with disabilities who are at risk of losing their housing due to income restrictions. Shallow subsidy means that the program would pay for about $250 in monthly subsidies for folk who can pay the rest. Potential Number of Persons Served: At least 430 individuals per year Expected Savings and/or Dollars Leveraged: Eviction prevention can be quicker in response and cheaper than waiting for affordable housing to be built for all low income seniors and adults with disabilities. It is a practical way to save money on the expense of homelessness. Contact Person for this Proposal: James Chionsini, 415.703.0188 X 304, james@planningforelders.org
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07-08 AGING AND DISABILITY COMMUNITY BUDGET PROPOSALS Housing Access and Eviction Prevention Proposal Name: Eviction and Homelessness Prevention for Compulsive Hoarders and Clutterers Amount Requested: $250,000 Department: Department of Public Health Statement of Need, including Target Population: Compulsive hoarding and cluttering is known to be among the most common causes of eviction among seniors, people with disabilities, and lowincome individuals in San Francisco, especially those marginally housed in single room occupancy (SRO) hotels. Compulsive hoarding and cluttering is related to several psychiatric disorders including obsessive compulsive disorder, major depression, dementia, and schizophrenia and is typically challenging to address. A task force to coordinate city departments and community agency efforts on compulsive hoarding would lead to improved coordination and maximization of existing resources, as well as the identification of gaps in the current systems. In addition, the provision of a city-wide support group and treatment group for people at risk of eviction for compulsive hoarding would provide an alternative to eviction for those at risk and a mechanism for tenants to negotiate a reasonable accommodation with a landlord threatening eviction. With adequate resources outlined here, there would be a decrease in evictions and subsequent homelessness in San Francisco due to compulsive hoarding. Brief Description of Program/Service To Be Funded: Establish a city-wide public policy task force on compulsive hoarding, that would bring together and coordinate the various city departments and mental health, housing, legal services, and community providers and develop understanding of the roles of each of these organizations, design best practices and procedures for managing compulsive hoarding situations, minimize duplication of services, leverage existing resources, and coordinate efforts to prevent eviction of people who compulsively hoard and clutter. Offer a peer staffed semi-monthly support group and also a separate professionally staffed treatment group for people at risk of eviction due to compulsive hoarding. Hold annual Hoarding and Cluttering Conference that brings together hundreds of providers, clinicians, landlords, city department staff, hoarders and others. Potential Number of Persons Served: The support and treatment groups would serve 500 duplicated and 50 unduplicated tenants The task force would benefit an estimated 500 additional tenants at risk of eviction in San Francisco due to compulsive hoarding. Expected Savings and/or Dollars Leveraged: Savings would include reduction in need for shelters and other emergency housing, legal services for eviction defense, and other expensive costs associated with eviction and homelessness. Contact Person for this Proposal: Belinda Lyons, Executive Director, Mental Health Association of San Francisco, 870 Market Street, Suite 928, San Francisco, CA 94102, (415) 421-1882 10
07-08 AGING AND DISABILITY COMMUNITY BUDGET PROPOSALS Housing Access and Eviction Prevention Proposal Name: Eviction Prevention Legal Services Amount Requested: $225,000 Department: Department of Aging and Adult Services Statement of Need, Including Target Population: Since the dot com boom, seniors and adults with disabilities have been at significant risk for home owner move ins and other evictions partly because they usually have significantly rent controlled apartments. Consumers also have very limited incomes usually, so fighting eviction becomes even more critical. Yet the eviction process can involve legalese and confusing letters. Legal aid would significantly help consumers traverse this confusing process and potentially keep them in their apartments or at least receive significant moving payment to cover their costs. Brief Description of Program/Service To Be Funded: When eviction becomes imminent, it is critical to have a lawyer be able to help seniors and adults with disabilities advocate to prevent the eviction and file documents in the appropriate time. Lawyers can help mediate to avoid eviction or at least help advocate for significant payment for moving costs. Potential Number of Persons Served: Approximately 520 individuals Expected Savings and/or Dollars Leveraged: Savings would include reduction in need for shelters and other emergency housing, legal services for eviction defense, and other expensive costs associated with eviction and homelessness. Contact Person for this Proposal: .Meg Cooch, Planning for Elders, 703-0188, meg@planningforelders.org
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07-08 AGING AND DISABILITY COMMUNITY BUDGET PROPOSALS Housing Access and Eviction Prevention Proposal Name: Money Management Amount Requested: $175,000 Department: Department of Aging and Adult Services Statement of Need, including Target Population: One of the reasons seniors and adults with disabilities are evicted from their apartments is because of unpaid rent and related issues. There are not enough free or very cheap money management programs that help consumers pay their rent and other bills. Brief Description of Program/Service To Be Funded: Money management would decrease the number of evictions because of unpaid rent by ensuring that the individual’s rent and other bills are paid before anything else. This would provide no cost or low cost money management, which is the only type of money management most very low income folks can afford. Potential Number of Persons Served: 500 individuals Expected Savings and/or Dollars Leveraged: Savings would include reduction in need for shelters and other emergency housing, legal services for eviction defense, and other expensive costs associated with eviction and homelessness. Contact Person for this Proposal:. Meg Cooch, Planning for Elders, 703-1088, meg@planningforelders.org
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07-08 AGING AND DISABILITY COMMUNITY BUDGET PROPOSALS Housing Access and Eviction Prevention Proposal Name: Pilot Patch for Board and Care Living Amount Requested: $128,000 Department: Department of Aging and Adult Services Statement of Need, including Target Population: Board and Care housing provides individuals with disabilities a group setting with some service on site such as 24 hour management. Individuals can receive homecare on site and address other service needs such as meals. It is a critical part of the continuum of housing and services for seniors and adults with disabilities as they age or become disabled. Unfortunately due to the funding limitations, any reimbursement board and care homes receive for serving low income elderly and adults with disabilities is far too low to maintain the housing. Therefore, throughout the city, but especially in places like the Bayview, board and care homes are closing and people are being put into institutions or out on the street. A monetary patch for board and cares to take care of low income consumers would help them remain open and provide more opportunity for individuals to live in the community. Brief Description of Program/Service To Be Funded: The patch would be per individual and would require the individual to pay 30% of their income to rent. The patch would fill in the remaining cost of the individual to live there. Ed Harrington, the controller, estimated that it would cost $1600 per bed per month to house someone in a board and care so this patch would serve as a pilot project to address about 8 individuals’ needs. In a year it should be re-evaluated to see if there is a better way to serve folks who need this level of care. Potential Number of Persons Served: approximately 8 individuals, perhaps more depending on the rental cost sharing. Expected Savings and/or dollars leveraged: Savings would include reduction in need for long term care beds, use of shelters and other emergency housing, legal services for eviction defense, and other expensive costs associated with eviction and homelessness. Contact Person for this Proposal: Meg Cooch, Planning for Elders, 703-0188.
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07-08 AGING AND DISABILITY COMMUNITY BUDGET PROPOSALS Access to Homecare and Healthcare Proposal Name: Expand the Share of Cost Pilot Project Amount Requested: $300,000 Department: Department of Aging and Adult Services Statement of Need, including Target Population: There are increasing numbers of seniors and person with disabilities who need homecare to live safely in their own homes, but who are not able to afford it. By the year 2020, one in every six people will be over age 65. The largest growth will be seen in the “old-old,” those over 85 years. Although individuals may be eligible for “share of cost” IHSS, often they are unable to afford to pay the out of pocket cost of the services because housing and other necessary living expenses are not included in the calculation of the share of cost. People are left with the impossible choice of paying their rent or having necessary homecare services. Usually they go without the care they need to remain healthy and safely in the community. The target population includes low income seniors and person with disabilities whose maximum countable income may be above the state Medi-Cal income guidelines, who do not have subsidized housing, and who are not able to afford homecare services or access subsidized housing. Brief Description of Program/Service To Be Funded: The Share of Cost Pilot Program currently funds approximately 81 seniors and people with disabilities who would otherwise be unable to pay their share of cost. Increased subsidies would offer more people opportunities to receive the care they need while being able to pay for such necessities as rent, food and medications. This increase would also provide funding for the development of a sliding scale within the pilot program that would make allowances for basic expenses like medicine and rent when tabulating share of cost. Potential Number of Persons Served: At least 81 people. Expected Savings and/or Dollars Leveraged: Research shows that, when homecare services are not available, there is an increase in the use of emergency rooms and other acute services that cost the city and county money. More people are forced to go into institutions rather than remain in the community, and institutional care is often more expensive than community based services. There would be other savings in city/county healthcare costs because uninsured persons would access Medi-Cal when they receive IHSS services. Contact Person for this Proposal: Meg Cooch, Planning for Elders, 703-0188.
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07-08 AGING AND DISABILITY COMMUNITY BUDGET PROPOSALS Access to Homecare and Healthcare Proposal Name: Expand Homecare for Those Who Do Not Qualify for IHSS (including sliding scale short term and long term homecare) Amount Requested: $230,000 Department: Department of Aging and Adult Services Statement of Need, including Target Population: IHSS state eligibility requirements limit the assets of an individual who wants to access IHSS and Medi-Cal to $2000. This asset limit has not changed since the 1980s and means that individuals who have saved even a little in pensions or IRAs can not receive the care they need. These consumers can be making below the income limit, but with more than $2000 in the bank, they are automatically excluded from accessing IHSS and potentially cannot afford private pay homecare. The target population is low income seniors and adults with disabilities who do not qualify for IHSS due to asset limit issues or who are waiting to get on the share of cost pilot project. Brief Description of Program/Service To Be Funded: Sliding scale homecare would help those people who, because of asset limits, cannot access IHSS or the SOC program. The sliding scale would be based on the person’s income and expenses and would allow individuals who need critical homecare services to receive them despite the state asset limit. In addition, emergency homecare currently funded through DAAS also would address the needs of those who do not qualify for IHSS but are still low income and serve them on a short term emergency basis. Potential Number of Persons Served: 160 individuals Expected Savings and/or Dollars Leveraged: Access to homecare can decrease the number of folks who need emergency services because they are doing activities such as cooking and cleaning that they should not be doing. The sliding scale can help leverage dollars from those individuals who can pay a greater amount to cover those who can only pay a little. Contact Person for this Proposal: Meg Cooch, Planning for Elders, 703-0188, meg@planningforelders.org
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07-08 AGING AND DISABILITY COMMUNITY BUDGET PROPOSALS Access to Homecare and Healthcare Proposal Name: Create a New Home Fund Amount Requested: $35,000 Department: Department of Aging and Adult Services Statement of Need, including Target Population: Homecare workers often visit apartments where individuals have recently returned from the hospital or who were formerly homeless. They find that these individuals need basic one time only items such as towels, sheets and cleaning supplies that they can not afford to provide. At times workers will buy the needed goods themselves because of the dire need. The target population is low income seniors and adults with disabilities who receive homecare services. Brief Description of Program/Service To Be Funded: This fund would be administered by the adult services division of the Department of Aging and Adult Services and would help purchase those small one time only items identified by homecare workers and social workers. Average cost estimated at $100 per person. Potential Number of Persons Served: 350 individuals Contact Person for this Proposal: Meg Cooch, Planning for Elders, 703-0188, meg@planningforelders.org.
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07-08 AGING AND DISABILITY COMMUNITY BUDGET PROPOSALS Access to Homecare and Healthcare Proposal Name: Develop a Follow-up/Check-in Program for New and/or Struggling Homecare Consumers Amount Requested: $95,000 Department: Department of Aging and Adult Services Statement of Need, including Target Population: IHSS and homecare can be complicated for consumers who are new to the homecare system. Confusion about process and misunderstandings over how to manage workers can cause stress, frustration and issues with receiving services. A program to follow-up with new and/or struggling consumers of IHSS and other homecare services could potentially decrease the turnover of workers, conflict between consumers and workers and strengthen the service delivery process. The target population is low income seniors and adults with disabilities receiving homecare services. Brief Description of Program/Service To Be Funded: This program would follow-up with new IHSS consumers to problem solve any initial problems with the program and to ensure the consumer has the support needed to manage their worker and get what they need. Potentially, this program could use peer to peer support to make sure consumers are getting what they need out of the IHSS program and remain safely in their homes. Potential Number of Persons Served: 750 individuals Contact Person for this Proposal: Meg Cooch, Planning for Elders, 703-0188, meg@planningforelders.org.
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07-08 AGING AND DISABILITY COMMUNITY BUDGET PROPOSAL Access to Homecare and Healthcare Proposal Name: Long Term Care Consumer Rights Initiative Amount Requested: $250,338 Department: Department of Aging and Adult Services Statement of Need, including Target Population: San Francisco has significantly increased its home and community based long term care services over the past 10 years because: It is the most flexible, cost-effective way to meet growing need It is city policy It is required under the Olmstead decision of the Supreme Court It is overwhelmingly what consumers would prefer Currently, there are significant increases in: the IHSS Program Adult Day Services Assisted living and supportive housing Individuals eligible for Medi-Cal Waivers Other long term care resources, like the Community Living Fund. The proposal would support and coordinate existing efforts as well as augment where needed to assure individuals understand their rights and get appropriate support in the areas of dispute resolution, hearings, and other grievances. Similar programs operate in the arena of mental health, housing rights, nursing facilities, homeless shelters with public funding. Brief Description of Program/Service to Be Funded: Long Term Care Consumer Rights Center would provide an independent, consumer-focused entity to do training, outreach, and provide hands-on support for advocacy, included but not limited to Medi-Cal Fair Hearings. The Center could either provide these services directly or through sub-contracts with other community-based organizations. The Center would: Offer independent, multi-lingual access to information and advocacy support to consumers. Provide referrals to appropriate mediation and legal services to help resolve issues Provide supplemental funding to help provide these services if not currently available Help identify system issues that need to be addressed Help maximize state and federal dollars to support local long term care consumers. The Center would also work with hospital discharge planners to assure patients have access to funded home and community-based Medi-Cal and other services. Potential Number of Persons Served: 2400 individuals Expected Savings and/or Dollars Leveraged: Programs which protect and advance individual rights in the area of home and community-based benefits can help prevent more costly hospitalization and institutionalization Empowering individuals is shown to have a direct impact on their feelings of well-being and sense of having control of their lives.
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Increasing eligibility means increasing access to state and federal dollars by providing coverage of health and long term care services.
Contact Person for this Proposal: Marie Jobling, 821-1003
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07-08 AGING AND DISABILITY COMMUNITY BUDGET PROPOSALS Healthy and Safe Living Proposal Name: Senior and Disability Housing Socialization Program Amount Requested: $40,000 Department: Department of Aging and Adult Services Statement of Need, including Target Population: Target population: seniors and adults with disabilities living in public housing where socialization/activity programs are infrequent. According to the 2006 DAAS Community Needs Assessment, 40% of seniors in public housing report a social opportunity less than once a month. According to the lead analyst of the Needs Assessment, social isolation was an undercurrent of all the discussions. Research shows isolation has significant health risks. Brief Description of Program/Service To Be Funded: Building on the current services connection pilot project, this project would be expanded to four senior housing locations. A peerbased socialization program will offer group activities once a week on site, in a highly visible location, such as a lobby. Staff will include a specialist in group work and peers. During the first three months, natural group leaders within the senior housing will be identified and gradually empowered to lead programming. The specialist in group work and the peers will then convert to providing assistance as needed. A continuing program would offer similar programs in smaller congregate housing, such as board and care residences. Potential Number of Persons Served: 200 individuals Expected Savings and/or Dollars Leveraged: Expected savings include important health benefits from reduction of social isolation as well as an increase in health monitoring. Contact Person for this Proposal: Cathy Spensley, Family Service Agency, Tel: 474-7310.
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07-08 AGING AND DISABILITY COMMUNITY BUDGET PROPOSALS Healthy and Safe Living Proposal Name: Lesbian, Gay, Bisexual and Transgender ( LGBT) Senior Cultural Competency Integration- Phase Two Amount Requested: $20,000 Department: Department of Aging and Adult Services (DAAS) Statement of Need, including Target Population: The number of underserved lesbian, gay, bisexual and transgender ( LGBT) seniors living in San Francisco is huge and growing. According to calculations based on data from DAAS and the California State Plan on Aging 2005-2009, there currently are more than 25,000 LGBT San Franciscans 60 years or older. That number is expected to surge to over 35,000 by 2010, just barely three years from now. Fewer than 400 of those seniors attend LGBT – specific programs. Even a tenfold increase in LGBT senior programs would leave 80% of San Francisco’s seniors unassisted. And it would be unsustainable. New models are desperately needed to serve hard-to-reach populations with subpopulations that present even more outreach challenges. San Francisco is fortunate to be rich in high-quality mainstream social services for the aging, conveniently decentralized into every neighborhood throughout the city. LGBT organizations here could not hope to duplicate the efficient transportation, nutrition, in-home care, recreation, and many other services that are already available everywhere our seniors live. However, LGBT seniors are not integrated in the city’s senior care system. Because of discrimination, LGBT seniors go back into the closet to feel safe enough to access senior housing services, or they do not access these services at all. As a consequence they are at risk for poor health and quality of life issues due to the long term care system being neither welcoming nor responsive to their needs. Brief Description of Program/Service To Be Funded: To meet overwhelming needs with few LGBT resources, we must now increase LGBT accessibility to mainstream support services that already exist. We need to reach out to both the mainstream providers and the hidden LGBT seniors to bring the two groups together in mutual trust and understanding. This is not an easy task, and needs a focused, long-term commitment and the know-how to do it successfully. Mainstream aging services will need to reshape their programs to become fully responsive and welcoming to the senior LGBT community. This will need the expertise of a competent LGBT aging provider and at least one year of technical assistance The target of the major focus of the program will be at two senior centers to create a sea of change in the cultures and direct services of those two agencies (who have the highest concentration of LGBT senior residents), and then to more mainstream organizations providing health, aging and housing related support to thousands of seniors throughout San Francisco. The agencies will be shown how to go into the community on a continuing basis and bring in LGBT seniors one by one, group by group, providing individual reassurance, building their own responsive outreach programs, and gradually setting up careful mixes of diverse participants before isolated seniors and their friends begin to trust the agency.
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The program will also identify isolated LGBT elders and connect them with others to build community. In the process LGBT seniors in these high density LGBT neighborhoods will increase their knowledge of and access to services designed to support them in a healthy aging process. As they build networks and connect to services, they will avoid many health problems. Potential Number of Persons Served: 420 units of direct service during the first year as follows: Staff and volunteers at two senior service centers will identify and connect with a total of at least 50 unduplicated, previously underserved LGBT neighborhood residents ages 60 and above. At least 25 of them will be visited individually with at least three follow-up contacts (by visit or phone). Those who are not visited in person will be contacted through at least three phone conversations. The program will provide at least 50 units of service in connecting LGBT seniors to appropriate preventive and primary healthcare services they need (e.g., connecting 50 seniors to one needed resource each, or connecting 25 to two resources each, etc.). Outreach specialists will present a total of at least 12 group activities or workshops (six per site) during 2007 with an average of at least 10 LGBT seniors attending each activity. Every unduplicated LGBT senior who attends an activity will receive at least two follow-up phone calls. Expected Savings and/or Dollars Leveraged: Integration of mainstream and LGBT senior programs will achieve long term sustainable change. This will be accomplished by seeding programs that will serve hard to reach LGBT seniors who are at risk for poor health because of compromised quality of life and isolation. Contact Person for this Proposal: Moli Steinert, openhouse Executive Director, 415 296-8995
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07-08 AGING AND DISABILITY COMMUNITY BUDGET PROPOSALS Healthy and Safe Living Proposal Name: Home Delivered Meals Expansion Amount Requested: $300,000 Department: Department of Aging and Adult Services Statement of Need, including Target Population: There remains a home delivered meals waiting list of at least 100 adults with disabilities and 300 seniors. In addition, the federal government has been cutting back on food support at the local level, so this service becomes even more critical to ensure folks who are home bound can receive food. Brief Description of Program/Service To Be Funded: Home delivered meals expansion will pay for approximately 40,816 meals at an average cost of $7.35 per meal. Contact Person for this Proposal: Meg Cooch, Planning for Elders, 703-0188, meg@planningforelders.org.
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07-08 AGING AND DISABILITY COMMUNITY BUDGET PROPOSALS Healthy and Safe Living Proposal Name: Pedestrian Safety/Safe Streets Initiative Amount Requested: $280,000 Department: Department of Public Health, Injury Prevention Programs Statement of Need, including Target Population: In San Francisco today, one of 4 households, or 25%, have a person over 65, and 1 in 10, or 10%, is a household with someone over 65 who lives alone. In every neighborhood in the City, Seniors and persons with disabilities are impacted far more by traffic than most populations. From 1995 through 2006, approximately 40% of pedestrian fatalities and 85% of pedestrian injuries were seniors. Pedestrians over age 65 are 9 times more likely than younger people to have a fatal injury when hit by a car. Experience in South of Market and Visitacion Valley has shown there are ways this problem can be addressed by residents through a program to advocate for safety improvements. In addition, pedestrian safety improvements to streets and sidewalks for Seniors and persons with disabilities also increases the safety of everyone else living in that particular area. Funding in the range of $50,000 per neighborhood for 4 neighborhoods, or from $200,000 throughout the City, plus DPH staff and contract indirect costs can support an effort to address heavily impacted neighborhoods (home to the “Dirty 30” high injury intersections for example). Brief Description of Program/Service To Be Funded: Safe streets and sidewalks are a major issues for Seniors and persons with disabilities because 1) Seniors comprise over 25% of the households in every neighborhood of San Francisco, and 2) disproportionately represent those killed and injured in pedestrian-motor vehicle traffic collisions. However, pedestrian safety improvements to streets and sidewalks for Seniors and persons with disabilities also increases the safety of everyone else living in that particular area. Experience has show in Visitacion Valley, and now in South of Market that there are ways residents can be empowered to identify issues, develop an agenda of engineering, education and enforcement changes, and carry out the advocacy activities needed to make them a reality. A safe streets and sidewalks program needs from $50,000 per year to operate in a target neighborhood, and funding at $200,000 per year would allow four programs to be carried out at the same time. Additional costs totaling $80,000 include DPH staff time to administer the program as well as contract indirect costs. Each effort will take on the order of three to five years work (even though successful activities will take place throughout the period). Finally, since Seniors and persons with disabilities live in every part of the City, these efforts, and the community groups they create, should be linked together in a City-wide effort. The hallmarks of a successful program consist of the following essential elements: 1) Longevity – experience shows work of this sort take three to five years, even though there are a number of immediate steps to be taken; 2) Community involvement and empowerment – residents must identify the problems, create solutions, build support for them, and carry out the advocacy activities at City Hall, the SFPD and MUNI to make them a reality; 3) A community developed agenda of engineering and enforcement improvements; 4) A whole neighborhood approach; and 5) Outreach and education. Potential Number of Persons Served: 20,000 individuals Contact Person for this Proposal: David Grant, Senior Action Network, 546-1335, david@senioractionnetwork.org. 24
07-08 AGING AND DISABILITY COMMUNITY BUDGET PROPOSALS Immigrant Services and Language Access Proposal Name: Naturalization Services Expansion Amount Requested: $350,000 Department: Department of Aging and Adult Services Statement of Need, including Target Population: The federal government is continuing to impose regulation on immigrant seniors and adults with disabilities, and many need more help through the naturalization process. With the increasing regulation from the federal level which requires immigrants to show significant documentation to access Medi-Cal, there needs to be expansion of naturalization services and help to ensure immigrant seniors and adults with disabilities can navigate the changing system. Brief Description of Program/Service To Be Funded: Services should include both naturalization classes as well as legal help. Potential Number of Persons Served: 700 individuals. Contact Person for this Proposal: Meg Cooch, Planning for Elders, 703-0188, meg@planningforelders.org.
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07-08 AGING AND DISABILITY COMMUNITY BUDGET PROPOSALS Immigrant Services and Language Access Proposal Name: Multilingual Outreach Efforts Amount Requested: $225,000 Department: Department of Aging and Adult Services Statement of Need, including Target Population: Many communities of seniors and adults with disabilities are isolated from services because lack of awareness and language access issues. The DAAS needs assessment found that multilingual outreach and language appropriate material can increase access to services. Brief Description of Program/Service To Be Funded: Language outreach will vary based on the specific communities’ ways of passing information. Outreach activities include language appropriate material, presentations to neighborhood community groups and outreach to local neighborhood hotspots. Potential Number of Persons Served: 2000 individuals. Contact Person for this Proposal: Meg Cooch, Planning for Elders, 703-0188, meg@planningforelders.org.
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07-08 AGING AND DISABILITY COMMUNITY BUDGET PROPOSALS Transportation Proposal Name: Taxi Voucher Expansion Amount Requested: $302,675 Department: Department of Aging and Adult Services Statement of Need, including Target Population: At least five years ago, due to budget issues, Muni put a cap on the number and types of individuals who could access taxi script. It is the cheaper and preferred way to travel for many seniors and adults with disabilities who cannot wait for paratransit van service. Folks over 80 years old or in a wheelchair can access taxi script, but many other folks with other disabilities can not. Brief Description of Program/Service To Be Funded: This funding would augment the current taxi script program to allow more individuals access to the program than the current limitations allow. Potential Number of Persons Served: 41,600 rides Expected Savings and/or dollars leveraged: The taxi script program is actually cheaper than group van paratransit services. There is potentially cost savings by moving individuals from paratransit van service to taxi script. Contact Person for this Proposal: Meg Cooch, Planning for Elders, 703-0188, meg@planningforelders.org.
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07-08 AGING AND DISABILITY COMMUNITY BUDGET PROPOSALS Transportation Proposal Name: Escort/Transportation for Medical Appointments/Shopping/Recreation Amount Requested: $325,000 Department: Department of Aging and Adult Services Statement of Need, including Target Population: The African American Partnership as well as the DAAS needs assessment identified that transportation and safety are issues within certain communities. Escort needs have been highlighted as key concerns for the southern half of the city. Brief Description of Program/Service To Be Funded: This funding would pay for an escort system to go hand in hand with transportation to ensure people are not isolated in their homes because they cannot safely go to the doctor or grocery store. The program would provide individuals with a person to help them with errands or to go to the doctor’s office. Potential Number of Persons Served: Average $12 transportation ride plus (Approximately 45,416). Contact Person for this Proposal: Meg Cooch, Planning for Elders, 703-0188, meg@planningforelders.org.
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07-08 AGING AND DISABILITY COMMUNITY BUDGET PROPOSALS
Proposal Name: Drop-In Program for Seniors and Adults with Disabilities in the Tenderloin Amount Requested: $ 135,300 annually Department: Department of Aging and Adult Services Statement of Need, including Target Population: There are approximately 3000 under served persons in the Tenderloin. Most are elders and persons with disabilities. Many are homeless. Baby Boomers are increasing the numbers of seniors that are underserved. Brief Description of Program/Service To Be Funded: Building on $47,000 of funding in last years’ city budget process, this program would provide services that will promote quality of life outside of an institution, including but not limited to the following: Community Information, Social Service Referrals, Nutritional Food Service, Health Maintenance, Education, Elder Right information, all in a protected environment with socialization activities. These services will be available five days a week by qualified personnel. Potential Number of Persons Served: 350 individuals annually Contact Person for this Proposal: Christine Morrison 350 Golden Gate Ave, San Francisco, CA 94102, 415 816 5230 or 415 447 9860 or 415 592 2872
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07-08 AGING AND DISABILITY COMMUNITY BUDGET PROPOSALS Proposal Name: A Peer Support Summit Amount Requested: $20,000 Department: Department of Aging and Adult Services Statement of Need, including Target Population: Target population: Peers and staff of peer support programs within the city. As peer support programs increase, often in direct response to RFPs from DAAS and DPH, important issues need addressing in a summit/conference. In addition, peer support staff can be formally recognized for their dedicated contribution to the community. Brief Description of Program/Service To Be Funded: A steering committee made up of staff and peers of community-based peer programs, along with representatives from city departments will organize a one-day summit conference. The conference will include keynote speakers, breakout sessions, and exhibitions. The summit will also include a closing event in appreciation of the dedication of peer support staff throughout the city. Potential Number of Persons Served: 200 individuals Expected Savings and/or dollars leveraged: Expected savings include increased cooperation of peer support programs, exchange of information, and problem solving techniques. As identified in the 2006 DAAS Community Needs Assessment, increased partnership among city departments is needed and this summit provides an opportunity for city departments to work collaboratively, as well as with community-based programs, towards assisting peer support programs within the city. Contact Person for this Proposal: Cathy Spensley, Family Service Agency, Telephone: 474-7310
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07-08 AGING AND DISABILITY COMMUNITY BUDGET PROPOSALS Proposal Name: Lesbian, Gay, Bisexual and Transgender ( LGBT) Cultural Competency Training Amount Requested: $20,000 Department: Department of Aging Statement of Need, including Target Population: Lesbian, gay, bisexual and transgender (LGBT) elders are a substantial and multi-ethnic constituency, estimated to comprise more than 17% of all seniors in the Bay Area. According to calculations based on the data from DAAS and the California State Plan on Aging 2005-2009 there are currently 25,000 LGBT San Franciscans, 60 and older. That number is expected to surge to over 35,000 by 2010. This is a larger population of seniors than Latino and African American seniors in San Francisco combined. Those over 70 have lived most of their lives under the threat of severe discrimination, and they still face huge obstacles to critical services that promote health and wellness while preventing disease and unnecessary costs of long-term care. Fewer than 400 of the 25,000 LGBT San Francisco seniors attend LGBT specific programs and over 98% of San Francisco LGBT elders remain unaware of, unwilling, or unable to access services. If they do access services they do not talk about who they are for fear of judgment, rejection, or compromised care. Brief Description of Program/Service To Be Funded: To make mainstream senior services safer to access, advocacy and education to senior service providers and seniors is needed for removal of barriers such as inhibiting practices in intake and service delivery. A key component of a training would include a multicultural LGBT volunteer panel of elders who share essential parts of their lives. Last year Department of Adult and Aging Services (DAAS) funded the Cultural Competency Trainings in the amount of $10,000 for 9 months and a total of 336 seniors and service providers of aging-related medical, housing and social service agencies were trained. The trainings were so successful that there were many more requests for provider and community trainings than could be accommodated. Although volunteers are involved in the trainings, they still need to be facilitated by a trained staff. Afterwards, most of the agencies called with referrals and questions as issues of LGBT cultural competency arose. Additional training is needed to be able to continue and follow through on these very successful educational efforts. Because of AB 2920, enacted in 2007 there will be many more agencies that will require the LGBT Cultural Competency Trainings to comply with the new legislation. Overall Goals of Cultural Competency Trainings: 1. Raise awareness of the unique health and aging-related issues of LGBT elders 2. Reveal barriers that often jeopardize services to this overlooked and under-served population 3. Show specific ways to overcome those barriers 4. Build partnerships with diverse groups to educate providers, elders and the general community about legal protections (though often violated) for LGBT elders attempting to access health, housing and aging-support services. Potential Number of Persons Served: 800 Individuals including service providers and clients.
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Expected Savings and/or Dollars Leveraged: Cultural Competency Trainings will save money and time to all senior programs funded by DAAS by providing the LGBT trainings and technical assistance to each agency that is now required by AB 2920 effective January 1st, 2007. The bill requires that all programs and services provided through the Older Americans Act include the needs of lesbian, gay, bisexual and transgender seniors in their needs assessment and area plans and to provide technical assistance to the Area Agencies on Aging for the training of all program staff, contractors, and volunteers regarding the unique needs of the lesbian, gay, bisexual, and transgender senior. Contact Person for this Proposal: Moli Steinert, openhouse Executive Director, 415 296-8995
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07-08 AGING AND DISABILITY COMMUNITY BUDGET PROPOSALS Proposal Name: Increase access of persons with disabilities to City Services via “Know Your Rights” Training and cultural competency and sensitivity training on disability for city and nonprofit staff Amount Requested: $350,000 Department: Mayor’s Office on Disabilities Statement of Need, including Target Population: Persons with disabilities need training in advocating for their needs, asserting their rights and navigation of the City Service system in order to receive critical services they are eligible for. This is especially true for requesting fair housing rights, reasonable accommodation, assistive technology and alternative formats. In addition, persons with disabilities meet attitudinal barriers from city staff when attempting to access City Services. Training of city staff and nonprofit staff in recognizing Persons with Disabilities as a unique community needing special accommodations will increase the quantity and quality of service provision. Brief Description of Program/Service To Be Funded: “Know Your Rights” trainings throughout the community, but especially in ethnic communities focusing on persons with disabilities in those communities. Information in print and audio format in English, Spanish, Chinese, Tagalog, Japanese and Russian for distribution to persons with disabilities in the community. Creation of training material and protocols to be used with current city staff who serve the public plus mandatory training of all new hires and nonprofit contractors. Potential Number of Persons Served: 1500 individuals Expected Savings and/or Dollars Leveraged: By being able to access the services they need, more individuals with disabilities would avoid becoming homeless, home-bound or institutionalized. Contact Person for this Proposal: George L. Clark, Chief Development Officer, LightHouse for the Blind and Visually Impaired, 214 Van Ness Avenue, San Francisco, CA 94102, 415-431-1481, gclark@lighthouse-sf.org
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Department of Aging and Adult Services Budget Requests The Aging and Disability Coalition supports the Department of Aging and Adult Services Proposals: Serial Inebriate Program Staffing This initiative would provide funding for Public Conservator staff (one 2930 Psychiatric Social Worker and one 1430 Transcriber Typist) to provide assessment services and administrative court support. This program proposes an intensive supportive transitional housing component for homeless individuals struggling with severe alcoholism and will work in concert with DPH and HSA. Approximate FY07/08 cost is: $135,037 - $81,022 in general fund. Public Guardian / Public Conservator Initiative This initiative request is in response to the new State Omnibus Conservatorship and Guardianship Reform Act of 2006, which will increase the workload for Public Guardian attorneys and shorten the required response time for reporting to the Courts. DAAS is requesting a total of 5 new positions for the Public Guardian and Conservator. The five positions are as follows: one 1458 Legal Secretary, two 8173 Legal Assistants, one 1634 Principal Account Clerk, and one 4230 Estate Investigator. The Department is currently proposing to claim these costs to SB90. Approximate FY07/08 cost is: $368,276 - $220,965 in general fund. Disability Access Fund The community supports the need to ensure equal access to services for adults with disabilities as well as seniors. There is about $7,000,000 that is brought down from the federal government for services for 60+. Therefore, significant funds should be allocated to increase access to services currently only funding seniors. Therefore, in an attempt to move toward parity in funding for home and community based services in DAAS, the community wants to allocate $2.5 million for the following activities: employment, employment advocacy, housing, housing advocacy, meals, transportation, services in supportive housing and services currently only provided to 60+ seniors. IHSS Expansion In keeping with the activity of the previous Mayor, the community and the Department of Aging are requesting that $382,858 in realignment dollars sent from the state to address caseload growth be kept in the program to address the increasing need for IHSS services.
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