hoping is that some of those folks will go into a dull day care, if they need, without a higher level provisions that they can switch into. programs that are actually lower cost. we are looking to put together an assessment team to assess the adult day health, moving into lower cost programs. keeping the adult day centers open, to try to work with that the state to figure out if there is a way to drive down the federal match and working with those health officials to pay for some of this. we are asking for this to help us by some time. we realize that in seven months there will be a core group of people who need an analog to the

service that we have. we have not had time to have adequate conversations about the health plan with the state and ask about what might be possible. supervisor chu: i know that one quick question i have is that the cut we are expecting in the local area is from capital and that local establishing funding. i wonder, if we were to allocate this $3.4 million, would we be able to receive any kind of federal matching? >> what the state did when they cut this, they cut it out of the health plan. likely not. we are hoping that there are conversations going on at the state with another drawdown on the federal funds. these are folks who are eligible for services. certainly, they are eligible for health care and they are getting it in one place, of which you

would think would be more expensive to get those in different ways. that is what we are going to be doing over the next few months. supervisor? supervisor mirkarimi: was a the state that initiated these cuts? it seems very drastic to me in the way that it denies us the federal match. the way that i interpreted how this came, it could have been executed in another manner. is that not correct? >> i would agree with that. supervisor mirkarimi: i have not heard any analysis as to why the state did it this way. >> obviously, the state is looking for ways to cut services. particularly in southern

california. there has been a lot of talk of fraud by an adult day health. we know that we have a very high acuity level and we believe that they really need those services. in other parts of the state, sometimes people have not felt that strongly about the need for this service. the state is also looking at ways to push metical's folks into managed care. that is something that we will see with a lot of services for the people that we serve. supervisor chu: but -- supervisor mirkarimi: the population that benefits from these adult daycare centers in san francisco is what, approximately? >> between 1215 hundred right now. supervisor mirkarimi: per day? >> that is the total census.

supervisor mirkarimi: it seems loath to leave. i have visited many. i am surprised. >> -- it seems to me. i have visited many. i am surprised. i noticed that some of the features of adult day care, there are people on staff, volunteers on staff, that actually help these seniors. people without the ability to help manage their own funds, their own personal finances. without having to resort to a public guardian, this sort of service center seems like it really helps people maintain a certain level of independent lifestyle, if they need to.

>> money management programs. right. bayview hunters point, and i think some of the others, have this. helping people to pay their bills. supervisor mirkarimi: i think it is an invaluable service. with the aging population of san francisco, this is a complete step in the wrong direction. i wholeheartedly support this move today. supervisor chu: thank you. another question. can you explain and break out the usage of the 3.4? >> sure. basically, this is somewhat arbitrary, but we were looking at some of the senate bill totals for each year.

so, rather than look at that cost, we are looking at bringing down the census a little bit. moving people to other programs. we look at things a few different ways. we realize that if we went too low, it would not take into account people that need to pay for facilities and staffing costs. we were looking at 75% as the overall cost. that is where most of the money would go. annualized, it would be about $1 million for center. we are looking at seven months. that is -- sorry, i have it here -- that is the majority of

the cost. we were looking at 300,000 of that analyzed for the assessment team. the way things work well, we have a community fund, moving people into a lot of different services. basically, they have the ability to assess an individual and of what they would need to live in the community. we would be adding staff to see if they can handle this extra population. it would be money for a successful social worker team. money for supervision. also, money for occupational therapists. also, a position where we could do the writ -- initial screening in dos.

every service that is coming through that intake, if they thought that people were appropriate for adult health care, they would move for a vigorous assessment. for that part, weekend time the study, which draws down about $78,000 from the federal government. supervisor chu: of the $3.3 million going to the community living fund, we talk about administrative purposes. for the remaining balance, is the idea to spread that evenly amongst providers? or be more sensitive to the numbers served? >> it would be spread out, based on the numbers served.

also, looking at each individual and their actual needs. particularly if there is a dual license to see if they can serve in another way. generally speaking, we would be spreading it out, taking into account that they have totally different populations at this point. children's family services, at this point, has two ships. taking all of that into account. supervisor chu: this is the same question that i had for the previous supplemental. the fact that we're using a onetime state reserved. and what it is that we will be doing going forward with the state reversing their action. given that, this is a deliberate

effort to take and evaluate each case for services elephant -- elsewhere, or if it could be accommodated by the programs we currently have in the city. we might still have a population of individuals that need these services and would not be accommodated by other services that we have currently. how do you see this going forward? >> we really are looking at this as a onetime solution. like has said, we are having this conversation on the health plan and in a preliminary sense they said they are interested in talking to us about looking at papers for managed care. we are hoping that this is one time only, that we will have other solutions.

but, there are no guarantees to that. supervisor chu: there was the 240 that was willing to be used on the administrative agency costs and 145,004 the administrative panel. are those also going to be lifetime costs? why would that be? >> we will still have the need to go through the system, they will still need to be assessed for the various programs that they do have. we do not to the population, you know -- the population is not going to get any less. we will have services for people in the quality fund who could

qualify for alzheimer's day care resource centers. supervisor chu: why don't we go to the budget analysts report? >> members of the committee, if the proposed supplemental appropriation is approved by the committee, the fund that you previously appropriated in the 11-12 budget, the city revenue loss fund, would be reduced by $3,700,001, there would be a balance left. we pointed out on page 5 of our report in the supplemental that there is funding that is continued. the estimated annual cost would be $5,730,000.

at the bottom of page 5 of the report, based on december 2014, if you approve the proposed supplemental appropriation, that would be about 2,824,000 below current state and federal funding levels of $5,833,000. supervisor chu: thank you. let's open this item for public comment. i have two cards. >> thank you very much, supervisors.

i am the associate executive director of jewish family children's services. we operate the high end adult family day care center that serves 250 frail, primarily modeling will speaking elderly in our city every year. -- modeling will -- mono bling will -- and will -- lingual speaking elderly and our city every year. the dramatic reduction in funding that we use -- that we receive, the population that will serve, they are basically kept basically in the community because of the coordinated medical services under one roof.

as in the that -- the other adult day care centers. social work, nursing care, occupational therapy, all in one place. truly, they are kept out of nursing homes. without this program, there really is -- there are no beds in the city to accommodate them. truly, we do not have enough alternative services to provide for their care. they're very appreciative of the possibility of this funding. if they could give us breathing room to enable us to maintain some of the services, while we work with you and the state to put together alternative funding to keep this program going. thank you very much. supervisor chu: thank you.

>> good morning, supervisors. i am the executive director for stepping stone. we administer four of the adult day care health centers in san francisco. as gayle mentioned, these services are critical for a frail population of seniors that are at risk of going into nursing. it would be designed to keep people in their homes, keep their independence, and it has worked very well. i would just like to underscore the consequences that we are looking at. when we discharge people into the community without adult day health, we serve almost 400 people per year. of those people, we are looking at about 75% in six months going into some kind of institutional care. that is a lot of people that are

going to need hospitalization or skilled nursing. at a great cost to the city. one hospitalization is estimated at $9,600. that is one year of adult day health. so, you can quickly see the cost to the city, and the state, for discharging this many people so suddenly from a program that has allowed them to stay independent, living in the community, which is what we want as we age. thank you so much, a city of san francisco, for your commitment. thank you. supervisor mirkarimi: next speaker, please. >> goodman -- good morning. i am the executive director of the adult day services network of san francisco. those presented today are members of the network, the

regional members back in the late 1980's, early 1990's, when it was the cutting edge trend to provide services for low-income seniors and adults with disabilities. as a collaborative for for all of these years, we have worked with the city's stakeholder partners who know our responsibility for help with this. we have identified other revenue streams and other ways to collaborate and preserve this model in the city. with behavioral health in mental health populations. it gives us more time to do

strategic planning for huge reliance on city funds. supervisor chu: thank you. supervisor mirkarimi: next speaker, please. >> good morning, supervisors. i am the executive director of the community living campaign. i want to thank you for your support and leadership on this issue. we want to thank you in advance, we hope, for your approval today, and your continuing compassionate care for our neighbors that are older and that risk, who want more than anything else to remain in their own homes and neighborhoods. this is one of the critical pieces needed to provide. thank you so much.

>> self-help for the elderly has been serving primary chinese speaking population for over seven years. we had a program that just guarded this year. we are petitioning to preserve this model on behalf of all of our participants. this bridge funding allows us to serve our population more effectively and in the past, we thought about different ways, which is why our program [unintelligible] we would like to thank -- take

this opportunity to thank for the support and continue to support this important service, allowing us during this time to think how we can serve more effectively. thank you very much. >> ♪ stayed in bed all morning just to pass the time saved me some money and maybe more of dimes i would give them the moon and it is not too late to say that i care and they cannot wait i do not really try to make it and in bringing its soon won't you they can hardly wait it is not too late to help daycare right now ♪ [applause]

supervisor chu: thank you very much. are there any other members of the public that wish to speak on item number six? seeing no one, public comment is closed. the source of funds would be the state reserve. i know that you have spoken to us briefly about state impact recently. the drawdown here would result in 11 cents left in the reserve. where do you see the state? >> supervisors, we do have a little bit more information that i had last week. a round of the laguna honda hospital, revenues from the state, there is a federal

reduction in that rate, resulting in a $30 million hit that year. for all intents and purposes, i would say that the rest of the state reserve is gone. i do think we have some good revenues in the current year that are likely to be okay without having to do a round of cuts. i am hopeful that that is the situation we are in. between that news and development payments still outstanding, some other news we are tracking -- if we could, i would have -- i think the mayor is supportive of the program and support of of using the state reserve to backfill this program. the timing is unfortunate because it would have been nice to have waited to see where these other issues shake our,

but because the funding was expiring december 1, we were forced to act. that is why the mayor chose to use this portion of the state reserve right now, but again, i think i would not look to use any other parts of the state reserve until we have more clarity on redevelopment and just more news on our current year revenues overall. supervisor chu: so there really is a timing issue with regards to the adhp centers that we are not seeing? on the other hand, we expect our reserve will be fully used because we're seeing almost $30 million in cuts, probably, or revenue loss in laguna honda? >> obviously, there's a lot going up and down.

local tax revenues are looking good compared to budget. more information on that soon. the $30 million could become $15 million depending on whether the federal government has just their portion. if they adjust their reimbursement rate, that could offset that $30 million cost. again, i think we are going to need the rest of that state reserve just for that alone. that is kind of where we are. supervisor chu: i can ask you that when you do find additional information or have more concrete information about the ups and downs of our revenue sources, if some of the cuts you do come back to this committee, and you update us if there are any other changes we should be aware of? >> after the result of the election -- after we know the results of the election, i think it would be good to revisit where we are.

supervisor chu: in terms of a bridge funding source, i am very supportive of that. i think if we did have such of a service stoppage, it would have a very bad impact on many of our most frail residents in the city, so i would be supportive of that. my hesitation on this item is the fact that i am not sure we really are justified in adding staff. that is a total part of the supplemental overall. i will support the item going out of committee today, but what are the light from the department is to come back to the committee over the next week before it does come before the supervisors and provide that information for us, especially at a time when we think we would be cutting additional service. i am loath to add staffing, especially if we are not sure we need it. i would like the department to comeback to share with us how

this would be a temporary usage or how we would be savings in the work load of these individuals. i am willing to support the item going out, but again, i am has a tin to add additional staffing at our department, especially at this time -- view of -- i am has a chance to add additional staffing -- i am has a 10 -- i am hesitant to add additional staffing. propose we send this out with no recommendation to the full board next week. supervisor chu: thank you. i would support that. so long as the department does provide the inspiration to us. i think it would be good information for us to have. we have a motion to send the item forward without recommendation at this time. >> we will do that without objection. supervisor chu: thank you very

much, colleagues. do we have any other items before us? >> that completes the agenda. supervisor chu: thank you. we are adjourned.

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