be dumped out of county i am the director of the services and we are the contract mode, of the ihs program here in san francisco, and we basically served the most challenging consumers and we all want the programs, and that was talked about that, and we will be rolled under the managed care essentially. and this is a very exciting time, and in terms of the healthcare field and it is a challenging time and you know, all of us, i think on the and not to change the program and not to be proactive and to do that, it is going back into the 200,000 that we need in terms of managed service organizations and what the hope

is that it will help the non-profit community to be able to be competitive in the market place. they will be purchased by the managed care organizations and the hospital and the group and now everyone is pdsing that the only way that they can have an effective cost healthcare system, is to integrate

>> there needs to be much more funding for the ages and the workers and i know that a lot of care givers live in our district, especially in the richmond and a lot of the patients or the people that they serve are in our districts too, but what more supports do you need from the city? >> well, what is going to happen, i think, is you know, say, that the ihs program and we don't know what is going to happen, but the expectation is that, in many changes are happening. and if you look at the... and if you look at the federal, and new regulars in terms of over time for our ihs workers, and what the government proposals are, and not to pay over time.

the >> we are fortunate in the san francisco, that the dos has funded a very large, training, yet, program for our ihs workers, we are trying to stay ahead of the curve and we do know and we believe that ihf and ann was talking about how it has to change how it operate and we want to be the people who is to come up with those ideas. >> and i also just wanted to ask you, i know that some labor and community groups here had supported, a federal effort called caring across generations, to increase the

number of care givers especially from low income communities and i am wondering does that compete with or is it complimentary to what the ihs system does here. and i don't know that that program specifically, but, i would imagine that it is complimentary. i mean, the need to expand the direct care workforce is a huge challenge. and nationwide. and in california, and in the san francisco. we do not have the cohort, that we used to have, and in the nation. and then in the number of you know females between the age of 24 and 45, has decreased in the nation, and that has been the group that has gone into the home care, workforce, looking

now, at we have helped that population to become more nraout in english and it is a challenge and we don't have the funds and at this point, san francisco to work with that in terms of, vocational, and esl programs and but these are going to be the critical pieces in the long term is to have that workforce available, and so it is a big issue nationwide. >> and i just wanted to thank you for constantly advocating for the strongest possible program here for the ihs system and it is such a economic benefit when people can stay in their homes longer and not be institutionalized and i strongly agree with you that the workers deserve a living wage and to be treated as professionals. and we are hoping that the mayor's minimum wage proposal will go through and we hope

that it will be applied, and that the ihs workers and that they won't carve out that workforce. it is a bunch of money and we understand that. but, i mean that these workers are so under paid and their jobs are so tough. so, i mean we are really, optimistic, at this point. and it is to get the additional funds in. so thank you very much, supervisors. >> good morning, supervisors my name is donna and i am the executive director of the ihs public authority and i wanted to pick up on the themes that i have heard and emphasize that the changes that we are talking about are not just systems, and it is really a mentality and an approach, and i think one of the concerns of consumers is ihss is very much a social services program. and even though there are

healthcare die mentions, not only can they not make a meal or do the laundry or so on and which does not involve a medical issue but it is an important program that can delay, or prevent hospitalization or institutionalization to get care, and managed care organizations themselves, recognize that they don't fully understand the provision of social services. and so i think that that is part of the reason that the group here in san francisco has been so important is because it is broad based and trying to convey how it could change the notions of what medical care is, and that the low level services really do keep the people out of institutional

care and settings and then picking up on ihss and that a lot of people in california have not understood how it is in the united states. and the issues around the wages, and no one would argue, with these workers being paid what they deserve for the hard work. there is a cut in services and i would poind out that, that 60, or about 60 percent of the program here, in san francisco, is family members state wide they say that it is 70/72 and i am mentioning that to say that there are unique aspects that are not like other employment areas. and if we don't for sure, press for funding, of the wages

increases that are being entertained, it is a cut on services and also a cut on the worker's wages but it is a complex issue and a complex dynamic and if our society does not step forward to fund the decent kind of home care, and assistance to help the people move into the community and go to school and work and not just be taken care of in their homes, we will literally be falling behind on what our society i think should be provided in this area. >> thank you. >> considering the data and do you have any comments on that?

>> if i misspoke, sorry, it is the provider of it and we get a lot of information since we are following them after the discharge, we have that and what we speak about earlier is that our department does not necessarily know for the vast majority of people who are living in our community, how many of those people say need care or need nursing home because we would not track them and we would track them if it is a public guardian client and we would know it in the program, but, it would have to be within the purview of the data that we are collecting and so yes, we do have that and i think that supervisors you asked for some information that i think that the specific to the guardians office of how many of those people get placed and we can provide you with that. >> that is great. >> and the key, living fund is there to support the people living in our community and not to live in other communiies

>> if they have to go out of county and is there a strategy where you start to think about creating something here so that the people stay locally? >> i think that the biggest issue is that like, and no different than that, the housing issue of people being kind of priced out of the market as i was saying, a lot of the board and care of the facilities were houses, where maybe, five or six residents lived there. and well, the people sold those homes, because the market here is what it is. and they moved to the other places and so to find a board care, that in this, in our community, any more, is benson would say, is pretty, unlikely, and so the people that are going to freemont and in places beyond that. and in terms of smith, or skilled nursing facilities, again, he is right, we are not

building more beds. there has been talk from the council to think about what our, what are they going to do with the patients in the hospital but need that kind of facility but it does not exist and i know that there are services there. and we have been working on a couple of populations and again, it relates to the coordinating councils and our department's interest and the counsel's interest, and the dementia population and a lot of those people don't need a nursing facility but they need a safe environment to live in and in fact many times they do better in a calm group setting than they do by themselves.

>> i would encourage a further conversation on this issue and certainly, maybe, including in the conversation, the mayor's office of housing, because, you know, even with boarding, i mean that... yes. >> i know that i, i certainly feel, i mean, would want to stay in san francisco, and as you age and you know, you spent your life here and to have to go out of county, or somewhere else, you know, just because that is no facility here i think that it is not a good thing. >> right. >> and the rates are low, i mean medical rates were reduced ten percent, under this governor, and a few years ago and so, we saw daycare take that reduction, but the nursing homes took that reduction and

so we just had a facility and, 30 some beds had been there for many years, primarily serving, mono lingual chinese and older adults and all of those have to be sent to beds and some of those folks did go out of county because there were not any folks for them here. >> it is a huge issue for us and if you are for instance a member of the lgbt community there is a reason why you came to san francisco and going out of the county. it creates challenges. >> correct. >> thank you. >> and so, supervisor? >> i am looking for the projections from the boom of the senior population and i think that it is 2006 when the baby boomers turned 60 and the growth from 2000 to 2010, to

the senior and now to 2020, it is a huge, booming population and if we don't address now these strat bys that you are putting forward we are going to pay for it late ner harmful way and could you talk about the senior boom? i am a baby boomer that will be a senior very soon and i have been going to as many conferences and trying to get on to the lists of the people over 50, and how to be as healthy as possible as i age gracefully, but could you talk about the boom? >> so, yes, i heard on the news that there is 10,000 of us every day that turn 65. and this will go on until 2030 when we pique out and that trend changes, but that has enormous consequences and around the workforce and those kinds of things but one of the

things. if you are going to live in the community, and the community living campaign, which you are referring to earlier, that is one of the major things for them, right? but if you are in an institution, or living in the community, the people are staying engaged and so the evidence based programs and the things like the villages and looking at workforce issues and all of those things are the things that we have to do and i think that is also why the business acumen piece of this is so important because we need the people who know the budget matter and have been providing, care service and supports to be able to do that across broader populations, and in our community, we do have people that can buy the services and

you want the people to know enough about what is out there that they will actually do that for themselves and the family members and so on, and thes a huge issue and it is a worldwide issue and we are not in it alone, and we have the people that come to talk to us from all over the world about what are we doing in this area but it is a struggle and it is about the partnerships and it is not that the government is going to do this alone it is just not possible. >> so, i want to thank, eileen and sandy and tracy for coming today and presenting and also the public comments that were made, i think that was, and as i said earlier, the intention here is to really look at what you have done as a group and what has come out is that there is many needs that we have. currently, and moving into the future. and that we certainly don't

have all of the answers right now in terms of solving them but the fact that we are just looking at solution and looking at implementing things that get us closer, is exciting, and the whole notion of integration coordination, and having a central door and so forth, and for it is really important, and i have to take care of my father and my mother and my aunt. and they are all gone, but i have been through many of the issues that you talk about. and as a consumer or a relative of seniors, that struggle with where they are going to be staying and so forth, it was really confusing for me. and one of the things that i am hoping for is that there is a better or a better system, for individuals like myself when i was younger to figure out what is going on and i mean this seems to be a million things going on and i couldn't figure out anything.

and we wherever he went they told me something different and the issue of not having enough from the housing, here, is a big problem. and it is, it is a problem not only for the consumer of that housing, but really it is about the families. >> families. >> you, the last place that where my aunt was staying was in daily city. >> and it was easy for me to get there, but the rest of my family, extended family, they did not have cars, and so, she lost those contacts. and that is important and so, i am glad that we talked about the funding issues, and i think that this is important that you have other opportunities to talk about the funding needs, and i would love it if a group of you would come into my office and talk specifically and explain everything to me because it would be better so

that i can work whether supervisors to help out. and with those issues. and it sounds like supervisor mar well educated and many of these issues. so i am going to rely on him a lot. and to explain many of the things. and but, once again i want to thank everybody for coming and as you move forward, please, continue to dialogue with not only with your group, but with the board of supervisors, thank you very much. >> thank you. >> so supervisor, should we go ahead and file this hearing? >> yes, please. >> do we have a motion to file? >> motion by supervisor mar, could we take that without objection. >> without objection. >> mr. clerk if you call it next item?

>>ordinance amending the administrative code, to designate the sheriff as the entity to assist county jail inmates with submitting an application for a health insurance affordability program consistent with federal requirements. >> great, thank you very much. and we have the sheriff before us. and welcome back. and former member of the board of supervisors. thank you mr. chair and good morning supervisors and nice to see you, relative to your previous discussion and like you, proud of the work that the presenters have shared with you, we also want to have a more integrated approach in our city's healthcare system by leveraging obama care and the affordable care act, for those inmates who are soon to be formally incarcerated in order to make sure that they have access to health insurance and access to healthcare. and it is the first few weeks after the release from jail or

prison that are the critical time in the possibility of their likelihood to repeat another offense, and in seeing recidivism become elevated and we have a preponderance of data that show that inmates, those that suffer from substance abuse disorders, infection disease and chronic health malties and if they do not have access to healthcare, then, there is great propensity that they are likely to recidivism. and similar to the state as well as our local jail system, upwards to 90 percent of those that are in custody, do not have health insurance and we

believe that in taking advantage of the affordable care act in its front to the states in allowing the county sheriff's departments to assembly and built 720 and then, motivates us to do our part and so working very closely with our own san francisco department of public health. and san francisco human services agency. and others within the city government, and allows us to cast a very sizeable net in making sure that upwards to 30,000 people that come through our jail system that are booked in our jail system a year gives us a greater opportunity to sign people up for affordable care act. and depending on how long their stay may be and what that duration of time is so that we are actually able to approach them. and activation of this

ordinance, then allows our department to then send people already employed by the sheriff's department, detailed, so that they would then get the required training, and as instructed by the federal law, through simply bill 720 so that they then would become officiated so that they could certificate the inmates before the day that they are released so that they would then have the kind of healthcare that normally that they do not. and taking the cues from the san francisco department of public health and assess it and allows us to partner up with them because we are 24-7 operation and so when we can certainly rely on their assistance, that helps us cast a even more thorough approach in signing up people within the

jail system that might be short termers or even more long. to make sure that they are into the reentry for the society and since we are a 24-hour, seven-day a week operation, who are released at non-unconventional times, and that also, that the people do not fall through the cracks that when we are released in the middle of the night or a day that someone may not catch and i think that this is a a precedented move for the state of california and that i have been told that there are not any other state's sheriff department yet that have taken advantage of ab 720 and officially signing up for aca and we are excited about the prospect that, you know, we are

doing, our larger part. and our average daily population right no is 1,310 as i mentioned earlier, our bookings, will and they are going down like our jail population has, could anywhere between 22,000 and upwards to 30,000 a year. and still, a high population considering the fact that high majority of them do not have access to healthcare and this is really what the rub is for many state and local governments since the affordable care act that the uncompensated dollars, that local and state governments have to shoulder, in being able to care for the uninsured, and then you have to look at who that uninsured population is, and in san francisco, and one-third of that population for the most part are people

who have actually had or been involved in the criminal justice system. and so if we are looking at, ways to reduce recidivism and improving public safety, and helping people better their lives and saving tax payer money, because it would be less of a shouldering by the local government and say through the healthy san francisco because now people are shifting to aca and then, we are actually saving tax payers money well too and it is nothing but a win, win, once we are able to start and rolling in the inmates and i am more than happy to answer any questions. >> supervisor mar? >> thank you, sheriff for being so visionary as usual on issues like this, of really supporting the inmate population to make sure that once they leave they have access to a better life and i think that healthcare is critical to that and i want to ask what other counties do they use other entities, besides the sheriff's office to implement

programs like this, and are there other counties using non-profits or what are they using? >> they do, the other counties are a sheriff's departments yet have not enrolled to be officially certificated but they partner up with their either cbos and for example, we have excellent coverage by our jail medical health and jail psychiatric services and through the health right 360 in the jails they would be a likely partner with us to help and then because of the compensation, by the federal government, by the government to those actually signing up we would not be able to receive that as a government entity and it is only non-government entities that will be able to receive, there is a $58 dollar fee for how many applications are successfully signed up. and that may then go potentially to the cbo but that is what a lot of the other county sheriff departments are

doing. >> i wanted to thank you and the chief for walking me around the jail, and meeting some of your health staff, and i wanted to know, if we designate, the sheriff's office as this entity, what kind of assistance would you provide to inmates and you said 90 percent of them are not or don't have access to healthcare, but what kind of assistance would we provide to them as they exit? >> well, when someone is in our custody, or if someone is actually diverted not incarcerated, but is in a diverse program, because we are also responsible for administering a very robust, alternative to the program, they still have access to jail healthcare, or public healthcare ebut with you what we noticed is that the people that have been released it is