do a lot about jeans, we can through planning, public policy, funding, funding decisions, a program designed impact in the influence the second and third. the lifestyle and environment. i think we often tend to think that lifestyle and environment are things we have a lot of influence over, and we do to some extent. we know that type 2 diabetes is cost from obesity, so we have the ability to think that through and try to figure out, is that where we are going or not going? and are certainly other things we have choices about. but then there are other things, that have come up already in the comments, such as fixed low income, frailty, isolation, which impact our environment and lifestyle in ways that provide us with fewer choices. all of this is further compound it when you add discrimination

and being marginalized and having other things that go on in our society around us. all of these things are part of lifestyle and environment. older adults are really just like any other population of people. we are all different. we have things in common, things that we share, things that we hold dear to us, things that make us have a successful life, but we are all different. i think it is important to remember this, especially when we think about our public policies, what are we going to fund and what are we going to do. the population, as supervisor campus mentioned, the older adult population is growing. the boomers are taking over the world and the day now, and that is certainly true for lgbt seniors as well.

the whole population is growing. are we ready for that? no, i don't think anyone is ready for that. it has our public policy caught up with the fact? we talked about all of the events that take place in our community, but, no, we have not been able to, especially in these difficult economic times, to think about what is going to happen in our community and across the country as this population explodes. we know we will have a growing population of folks with disabilities. we know that if you have a chronic disease in your 50's you will take it with you probably in your sixties, seventies, and 80's if you are lucky. what have we done to try to maximize the dollars we have and to think about the future? i was struck by the comment about the plans to get done, but they did not get worked on. but i will comment on that. the department has for many, many years funded programs

within the community that the they're particularly targeted lgbt seniors for, as part of their mix of people that were serving lgbt seniors. all other programs, such as the center for alders, the institute of aging, case management programs, these are all things we kept an eye on and were aware of. about 10, 12 years ago it became part of a 16-committees around the country that form the community partnerships for older adults and young adults with disabilities. this really opened a door for us and away we have not had before. as part of that war, we formed a communications workgroup and lgbt partnership group. the lgbt partnership group, just as the other groups that were meeting, put together a plan and put to other ideas and things they thought or durable within

an environment where the money was. there was a lot of money, but what could we do? they came forward to our commission, give a very interesting report. part of that report was a request that we as a department found about $20,000 for an education program they had been running and had just lost their funds for. we were pleased to be able to do that, because it is very clear, especially talking about issues of discrimination and march solicitation, that if you don't educate the people around you, if you always have the expectation that people just know and will do the right thing, we have missed the boat. that was our first experience pushing that out. the idea was a mixed to educate seniors, but more importantly at that point was to educate community providers, senior centers and other places, so if somebody walked into a senior

center, that could be assured of being feeling like home, or at least know that people in the center had been trained and educated and so on. things we have done since then include the oldtimers strategic plan, -- the old-timers strategic plan, which is a plan because we know that alzheimer's disease is an escalating crisis in our community and across the country. but now the fastest-growing age group is the 85-plus group, and want out of every two has dementia. we know that there are a number of things -- we know there are certain chronic diseases that can have a bearing on what you have diabetes, thyroid disease, tumors, and aids. what are we going to do in our own community? this is a 10-year plan, we have an oversight committee, and they're working and moving ahead, so it is something to keep an eye on and make sure

that we are covering our basis. we also want to make sure to mention that in the preceding years and subsequent years, we have been funding an open house. at what the way about a year or so ago. open house stepped into that void and really took on the center with the walls, the nimbleness to move around the community and do the things that need to be done with various groups of people who may not feel comfortable in coming to the senior center. at the same time, we have been funding the castro senior center, which is a more integrated setting, although a much smaller environment. we have introduced a public occasions campaign to make sure that people know where to go to find information related to services.

the conversations of putting pictures on the wall and tried to determine whether or not that was enough, we are interested in our offices. it was easier to identify some of the populations. but it was done, and it was done with the kind of sensitivity and i think the new onslaught and the need that we recognize in the community. -- it was done with the nuance and the need that we recognize in the committee. we have been making sure that people all across our committee have access to the communication things that will be needed, that are needed in the new age. i am certainly available to take a questions, but i know that you have a full house and another room that is probably packed by now of people who want to speak today. supervisor farrell: thank you so much, --

>> thank you so much, anne. i like to thank you for calling this hearing. and thank you, supervisor farrell, for chairing this important meeting. open house was founded in 1998 to enable san francisco lpg seniors to overcome the unique challenges they face as they age. our goal is that every lgbt senior be able to live in a safe and stable housing that is affordable to them, at whatever their income level may be. we want them to be welcome and appropriately served, and we want them most importantly to be engaged in their committees of choice, which is such a key to healthy aging. 25,000 lgbt seniors live in san francisco. the baby boomers are coming. that will only increase. it is important that we have a strong housing and aging services infrastructure that is

open and welcoming to this large and growing population of lgbt seniors. kellen to talk about three general areas -- housing, community services, and partnerships, key to growing need. in 2003, there was a need assessments done by the human rights commission, and again and 2006 there was a report that identified affordable lgbt welcoming housing as one of the most important priorities for lgbt seniors. lgbt seniors arctic to the vulnerable in this regard because they're much more likely than heterosexual peers to live without partners or children or support from their families of origin. the circumstances create enormous is challenges come economic challenges, which forced many lgbt seniors to leave behind their friends and families of choice in san francisco. but supervisor olague and wiener

mentioned this, see news or face with the untenable choice of wanting to stay in their community are being forced to leave to the east bay, fresno, back to their families, places that may not be as welcoming or have the community that have relied on. many lgbt seniors are subject to the ellis act defections. we get many calls about that. those choices are all too often extraordinary. we managed to place about 70% of the seniors that we work with, either in housing or on a wait list for future openings, but when it will ever be picked from those waitlists is anybody's guess. we have a job to do to organize the lgbt senior community to be far better represented in the lotteries that determine who will get access to this incredibly scarce resource of

affordable housing in san francisco, that requires outreach, education, resources, money, and it is a top priority at open house. open house is built in 110 units of senior housing that will be welcoming to lgbt seniors or low income. with significant support from the mayor's office of housing, we're moving forward with all of the pre development work, and we anticipate having final approval from the planning commission sometime later this year. with the elimination of the redevelopment agencies and the deep, deep cuts at the federal level and affordable housing, we have no idea what will be happening with the program next year. the city funding must be prioritized for this project with the next few funding years. literally, our ability to get funds relies on the paper, to get from lines on a paper to the shovel and the ground depend entirely on the city's decision

to prioritize this critical project. i want to talk about services. our goal is not only to provide housing but the services and resources needed such that those who move into those buildings will be up to remain healthy and independent and in their new home for as long as they choose. this is also our goal for lgbt seniors who may live in a market rate senior housing or other affordable housing facilities or their own home in the caster. again, supervisors talked about this. it is really important that we have the services in place that will ensure that lgbt seniors have the access to the committee-base services that support health, and pundits, civic engagement, and quality of life. the services have to be readily available so that lgbt seniors can live in their own homes, where that may be, and in their communities of choice. the research is unmistakably clear that lgbt seniors are much less likely to participate in

general committee activities and access the service they need because they feared judgment, rejection, and compromised care. as a result, they did not disclose their sexual orientation or gender identity, and at even greater risk to their health and well-being, there remained isolated without access to import and community services, and we have to change this dynamic. the open house committee served 600 lgbt seniors next year, and we expect that number to grow if not double. for active lgbt seniors and for those who are at risk for social isolation, we organized hundreds of intellectually stimulating activities and opportunities for civic engagement for lgbt seniors who may have other needs or at our risk for unnecessary hospitalization or premature institutional is asian, would provide a broad range of social services to assist them in maintaining their health and independence.

as a result of our programs, 84% of the participants last year said there were better able to remain independent as a result of our services, and 82% said they felt much more connected with our community. we are really appreciative of this program. our city contract is significant, but it covers about half the cost of the program. it is certainly subject to the yearly cuts with ever diminishing resources. but the demand and the need on the continues. i just want to point out that research shows that compared with heterosexual peers, lgbt older adults report higher rates of chronic illness from diabetes, asthma, type 2 diabetes, a chevy, and the stigma that many lgbt seniors experience increased these risks. i guess what to close by saying that i know many of our community partners are here to

day, and to ensure that they have access to the broad range of services, these partnerships are critical. just to name a few that open house works with all of the senior centers around the city, we have a terrific partnership with the california pacific medical center to provide critical physical and mental health services, work with the institute on aging, stepping stone, the lgbt community center, the lgbt committee partnership, a critical thing for housing and service providers to discuss how better to serve these populations. we are building that infrastructure that is critically important for this growing population. in these very challenging economic times, it seems timely and appropriate to focus on the need of this particularly vulnerable population and how we can work together to meet the needs being raised here today. lgbt seniors are adaptive,

resilient, some of the strongest people i have ever met, but our community faces. and take challenges and obstacles, and i look forward to working with the supervisors and the human rights commission and how we could put these resources together to confront all of these challenges. thank you. supervisor farrell: ok, so our final two presenters. the director of adult mental- health at the department of public works, and daniel rudman from the national center of lusby legal rights issues. they will each have three minutes or so to%. -- they will each have three minutes or so to present. >> hello, everyone. my name is ed wynn. i have to apologize because our

public health director could not be here today. she's very supportive of this effort, and we are also eager to learn how to improve services to the lgbt population. i come from the committee behavioral health services side, which includes mental health. i want to talk briefly in broadly about the services of the department of public health. it is basically over a billion dollars worth of services located between 3 service delivery centers, one is the san francisco general hospital, the other is a good hospital, and the other is a wide variety of community programs -- the other is laguna hospital, and the other is a wide variety of community programs.

in the department of public health, which is now under the leadership of garcia, we have really embraced integrated care. the care needs to be duly coordinated so that the mind and body and other needs are the best for the clients. and the service delivery and public health. this also includes collaboration with other city departments. in all of our efforts, we have collaborated with the adult probation office, we have cooperated with the adult aging services, human services agencies, and a whole variety of initiatives. within in particular behavioral health, mental health and services, it has a budget of about $200 million, $300

million, and it is mental health and substance abuse treatment across several modalities, ranging from outpatient clinics to residential treatment programs, transitional residential, to acute in patient psychiatric services to day treatment, to vocational organizations, agile services, and also we provide housing through a variety of programs that allow for services in that direction. at we have all of our programs that are able to serve everyone, regardless of age, however, we realize that we also -- hopefully, all seniors will be served.

we still have an older adult programs, assisted health care, his mission is to really serve the senior population. it also, we are aware of it and lgbt issues, and that has been the subject of our training. at prior to the closing of a new leaf, it is also the subject of special laws funding, to have the behavioral health program that best serve the lgbt community. we have tried to make sure that we have reallocated the dollar's to organizations that have cultural competence and sensitivity to the lgbt community, and at some point in time, we may have to look at that, for aspiring providers, to

have the opportunity to serve on the committee. so i think i will leave at that. there are any questions, i will be more than happy to answer. >> thank you very much. mr. redman. >> thank you very much, members of the board of supervisors. it my name is daniel rudman, and i am an attorney. our elders came of age during a time when to even gather as lgbt people was an extraordinary act of bravery. they stood up for us in bill to committee we call home, and now it is our time to stand up for them. today i will speak about the varieties of discrimination that lgbt people face in our city. across california and in san francisco, lgbt elders face

significant discrimination and their families, accessing service, housing, and employment. it is compounded for lgbt elders of color, others who are immigrants or a document, and others with disabilities, and others who are hiv-positive who could comprise the majority of people with hiv in the united states. studies show that lgbt others are more likely to end up in facilities then there street peers. there are disturbing levels of neglect and harassment, and i would like to share two-story specifically from san francisco in our report. johns partner jack was a san francisco skilled nursing facility in 2008. for 16 days, staff members refused to pay him, there were not comfortable helping a gay man to baith. john had to resort to taking check out of the facility and into his apartment for showers. buanother story.

a woman in her 80's had gone by the name rusty her entire life. the staff members insisted on calling her hazel, which was her birth name. they also excluded her from activities in the facility because she was a lesbian. and another store, a man witnessed a transgendered resident and one of the facilities he visited being prevented from meeting with other residents. these are not isolated incidents. 80% of lgbt elders reported in this study they would not feel safe to be out in a nursing home. when one man put it, when i'm at the gates of the nursing home, the closet doors will shut behind me. all efforts to mandate cultural competency in lawn care facilities have faltered, san francisco can step in to help facilities train staff. that can step up monitoring of care facilities and quarter made average to residents to let them

know their rights. and there is precedent for this. san francisco haslett on senior issues in the past as well. in conjunction with the city- funded singer care facility, san francisco and implemented a program to stop the unlawful fiscal restraint and drugging of residents. -- physical restraining and drugging of residents. lgbt elders also face complete disregard for their powers of attorney in advance directives. in my own work, i seen this firsthand. in one case, state officials separated the gay couple, stole their belongings, and cut the help the partner from visiting his sick partner. this went on for weeks, and the man died without his partner getting a chance to say goodbye. we assisted in a similar case two weeks ago in another state. it would do something about this as well. activists are currently pushing for the establishment of a kinship residency -- registry and san francisco, allow anybody

to choose from a menu of options to determine who should make decisions about medical care, finance, and other issues. many seniors to not enter into domestic partnerships. this is a strongly to provide a chunk protections. lgbt elders are far more likely to rely on non biological family of choice. lgbt people -- san francisco must take the lead in finding creative ways to ensure respect for all of our families. the board should also focus on employment discrimination. in national survey found over a quarter of lgbt people plan to wait until the 70's to retire. lgbt others are more likely to be in poverty than their st. pierre's, and these numbers will rise. for lgbt elders who are recent immigrants and undocumented, the city has a role to ensure their culture reed caught the tend to work with them and their resources and our rich material are culturally sensitive and

translations are always available. it is incumbent to ensure that all lgbt seniors are included. lgbt elders also suffered from an ability to access services. they fear access to services when did not have documentation, hiv-positive elders have health needs, and city services serving people with hiv must be inclusive of elder sexually. last but not least, many lgbt elders feel pushed out of the city by the availability of affordable housing. these are all issues that must be explored by the board. we need a concerted city-wide pushed to assess this, bring together diverse members of the community to share struggles and suggestions, and invested all of the ways the power of the city can be brought to bear on this issue. the lgbt elders of our city deserve nothing less. supervisor wiener: i just have a

few quick questions. in terms of the cultural competency training, has there been any movement forward locally on offering that to nursing facilities? >> in terms of what is available for cultural competency training, set from open house and other organizations provide competency training. there have been efforts at the state level to mandate them. atin 2008, a law was passed, but that has not been implemented. in terms of what the city can do, the city can assist facilities in obtaining those trainings, and the city can certainly ramp up monitoring to ensure that cultural, take care is being administered. i hope that answers the question. supervisor wiener: and working

together to move that ford, absolutely. -- to move that forward, absolutely. >> i will be very brief. i have a couple of paragraphs about our training program. we have a contract with the city and county to deliver the competency programs. it's a small contract, but it has helped us with training other city contractors. we have trained since 2004 about 1800 individuals from about 170 separate agencies in san francisco, to help them create safe and welcoming environments for the lgbt seniors that currently serve and to the lgbt seniors that they should be serving the seniors are reluctant to seek out those services. we have a very small competency training program, the product of many years of work to cooperate on putting together a good training program, which is enormously effective, but the

demand for the services and the demand for that training just far outstrips our ability to deliver right now. but the demand is certainly out there. i think the interest is out there among service providers and lawn care facilities -- long-term care facilities to get these. we have the material, and we need to put together some resources and the plan to broaden that. supervisor wiener: thank you very much. before we get to public comment, supervisor campos and olague? supervisor campos: thank you, since we are talking about some of the programs about city funded programs, what is the city require in terms of cultural competency? is that part of the requirement of getting a contract? and to the extent that is the and to the extent that is the case, what kind of oversight