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 up to the wherewithal of that

formally incarcerated person to seek their own healthcare and luckily for the invention of healthy san francisco and there was that access and it was not compelled and it was not motivated by the in-house staff before and now it would be. and in linking our and it will have nothing but a positive impact on reducing our jail population or keeping people out. because of lowering recidivism rates but i believe that you

will see the strong correlation of the less crime occurring too, because for the most part, san francisco, is progressive in this way, that we do not incarcerate people as much as we used to, and far from it actually, for substance abuse disorders but many people who come into our jail systems have them nonetheless but what we are noticing and what we do need to have, and i think a greater grasp, collectively in the city are the people who are suffering from the mental health disorders and i worry, and we worry that those who get the great care, but it is triage for the most part when they are in our system from when they are released what is to become of them? so if we don't set up that process from incus to post custody and then by linking up i think that more effectively with the department of public health and hsa and then you are

just going to see sort of a status quou and i think that we made a decent dent. >> supervisor yee? >> i really appreciate, this ordinance. and to me, it is a very large goal. approach, and with your same share. and in regards to what you have, and you have the people there. and why let them go, out there to deal with this issue, because we don't know what is going to happen afterwards. and this continue of it and so forth is so important so, i am whole heartedly supportive of this ordinance. >> thank you. >> thank you, sheriff, and i think that i want to join my colleagues and reiterate that, you know, the very positive direction that this is taking us, and really appreciate your work and your staff. and i think that it makes a lot of sense, and i think that in the end not only is it the

right thing to do but it will save the taxpayers a lot of money. i do have a question, do you have a sense of how many of the folks in the jail population may not qualify for the aca? >> we can get you that number, but, not as many as you would think. >> okay. >> not as many as you would think, considering the jail population, and it is almost a very static number that continues to rollover. but, you are talking about a population that is indegent and those needing a medical, cal fresh, you know, level of support, really many of our people are you know, i think, exactly what aca had mind and what a great way to leverage it while they have them and while

we have their attention. >> great. >> thank you. >> and i also want to thank the staff here from my programs and our cfo and the legal in-house counsel and of course our jail health services and they do amazing work inside. thank you. >> thank you all for your work. why don't we open it up to public comment. if there is any member of the public that would like to speak on this item? i don't see anyone here. and so we will close public comment and if we could have a motion on this ordinance? >> do we have a motion by supervisor yee moving this item forward with the positive recommendation? can we take that without objection? without objection? the item passes thank you very much. >> for your good work. mr. clerk, do we have any other business before the committee. >> no more item mrs chair. >> great. >> the meeting is adjourned thank you for the city attorney for being here, thank you. meeting adjourned. thank you. 2:00 p.m.

>> (clapping.) you know, we're surrounding the in this area by a horse shoe drive is the charring allocate and george schultz horse shoe

drive we have this lady that's the director of protocol for the statistical choorlt i want to recognize you thank you so much (clapping.) and i haven't seen him but steven made this project possible is mr. beckal here a big had an for steven he made this thing go. we have mayor edwin lee we're lucky to have him. we have members of the board of supervisors. i've seen one at least do we have any members. thank you all so much. oh, i see scott wiener it's good to have you here and city

attorney herrera. the city administer naomi kelly (clapping) and the department of public works mohammed (clapping.) and the south san francisco arts commission director tom. thank you tom for being here (clapping.) and we're going to ask someone to speak in a minute our senior veteran former secretary of state george b schooulz will you make many racks this morning for us? >> this is a great occasion. and mike has identified people

as he wanted to honor and he give recognition to but let's face it this project got off the dpround when you put a marine general in charge let's hear it for mike (clapping.) that is a memoriam but it's as much about the future as about the pa past. yes memorial has the ring looking back and paying honor to our veterans and we need to do that and we need to give honor to anybody who has served but recognizing people who have been in combat and wounded we want to

pay attention to the mothers and fathers and brothers and sisters to those who have fallen and let them know as a pledge we're with them. one of the causes or the events that i'm particularly interested in mr. and mrs. an organization that raises money for the sole purpose of helping the children of police officers and marines who have fall in the line of duty but they deserve special remembrance and we need to take care of the the children and recognize veterans tangiblely. in my case i was able to complete my education on the