status or address the fear they have releasing information to the federal g do you have thoughts to overcome the immigration concerns especially in an era even in the obama administration there have been deportations so the fear is real. >> right. i hope there will be a profile in the paper of a family receiving aid and the parents aren't documented and the children are and addressing in a palpable way what the anxieties are. maybe with a spanish speaking immigrant, somebody cantonese speaking and the anxieties are different between the groups. we're in a tricky situation because according to the lawyers i have spoke with we can't make the promise we won't share information and we might be

required to and if a handout goes out and the next day the government says you have to share information so it's tricky. i am told by those in the field with folks that if the city could have some proclamation or a letter that went in the paper, some bold statement that was on letterhead, that would be very helpful. >> thank you. >> any other questions? thank you so much. >> thank you. >> thank you and now we will hear from linda lowl and improving food security for seniors and adults with disabilities. >> good afternoon everyone. i

the nutritionist with the department of aging and adult services. i wanted to give you an overview of the major nutrition programs our department supports and how we can address part of the food insecurity issues so our mission is to promote the well being and self sufficiency among individuals, families and communities in san francisco, and we have three major nutrition programs that do that. first is the meals program and the home delivered meals program and also we have the home delivered grocery programs. while today we won't go into details on the congregate program but it's helpful to get an overview and how it supports food insecurity with these groups so the meal program is

supported with federal and state money as well local funds. we currently fund 43 different centers throughout san francisco. many are in senior centers, some churches, some housing facilities that are also open to the public, seniors coming in from the outside, and a number of different places. i think we have one -- some say rec and park facilities so we make it accessible in having different places in the city and we provide 10 different ethnic meals including of course the american type of meal, chinese, filipino, japanese, kosher, latino, russian, we have southern and samoan and vegetarian so this is very unique and we're proud we're the only city and county that does is that. other counties do not

provide that diverse cuisines to meet the needs of the different paint apts in the city. we recognize the diversity and that's why we have the different meals -- >> supervisor campos has a question. >> quick question what is the latino one? is it mexican, central america? >> it's a diverse one and i think there are different kind of latino meals. i'm not an expert but they're one of our new providers of course and their meals are popular. >> now you're just getting me hungry. thank you. >> so the meals are nutritious because they have to meet the dietary reference intakes and what that means is the intake levels -- the nutrition requirements are set by the national -- by the u.s government in terms of the

medicines and other -- the american dietary requirements to help seniors not only stay healthy but prevent chronic health conditions. the other important part of all the new programs is that the participants are given the opportunity for -- participate in activities, socialize and also they can donate toward the meal so what are the eligibility requirements? they just need to be as a senior 60 years or older or their spouse or partner of a senior, regardless of age, they can participate at the senior meal program at the suggested donation rate. there is nutrition education provided at the site four or more times a year. many sites provide weekly nutrition education and partner with the city college of san francisco. their adult education instructors go to the

site and provide weekly nutrition education for them. the adults with disability need to be 18-59 with disability and again we target low income participants, but it's not means tested. however when we look at statistics the majority of clients are low income and currently we serve about 3400 meals daily to those groups. this is more than a meal. different senior centers offer activities including health promotion finance programs. of course we have computer classes. some of you may have heard about that. there are pantry sites at the senior centers and other social activities and the idea really is offer these activities, keep the seniors engaged, keep them healthy so we can keep them healthy and not

go to the next higher level of care that is needed. now the home delivery meal program is sort of for seniors and also adults with disabilities that have inability to travel to a site because they're home bound or have difficultly going out because of physical or mental disability and currently one or two meals are delivered daily five or seven days a week and we have seven agencies that contracts with offering the ethnic meals. of course the american meal, chinese, filipino, kosher, japanese, russian and modified diets. we don't necessary offer modified meals here because it's a little more expensive. nutrition counseling is offered to clients that need the

additional assistance in order to adhere to their doctor's proscribed diet and with this one meals are delivered and meet 1/3 of this for adults and we serve about 290 meals daily. for the seniors meals we serve close to 4200 meals daily. in terms of eligibility earlier i mentioned they need to be disabled either mental or physical disability. another part is that these people don't have or really have -- don't have enough support for safe healthy alternatives for meals. of course nutrition education is provided and nutrition counseling is available for participant oses modified diets

and for whatever reason if they didn't get the counseling from their provider a dietician is available to provide that to them, and again we target the service to low income consumers and when we looked at all of the data last year the majority of them are under 100% fpl which is quite low and the participants are given an opportunity to donate. in addition all of the participate aptds receive at least one annual assessment which is in home and they receive quarterly assessments to see what their needs are to see if they continue to be eligible for the program. some people are there because of a very acute illness and need the program for a short period of time so they graduate and referred out to another program for other activities and services. we also have emergency meals and this is

100% funded with local money. to qualify for emergency meals the person needs to under 300% fpl and the goal for the emergency meal is clients served within 2-5 days and currently that program is pretty maxed out. i put in reference what this year's the guidance for the federal poverty level for a family of one it's a little over $11,000 and 200% is about $23,000 so if you could imagine it's not that easy to support yourself if you have to pay for this or medication or other things. i wanted to give you just a snapshot of some of the participants in the home delivery program because this is one of the largest programs that our department funds, and these are some clients that are

served by meals on wheels in san francisco and provide two meals a day to the participants and modified diets. lori and she's 106. she's one of 131 clients who are with meals with wheels over 100 years old and we know they're aging in place. in the backup document we provided with the report we have -- give you more details how long the seniors have been on a program and over 50% have been on the program for four years or longer so we are keeping them living in their home. 84 harold is 84 and worked in the shop yard in the -- shipyard and from the mission district. jimmy is

70 and a double apputee and veteran and this lady the kids are out of state so the meals help her. she is unable to travel because of the stairs in the home. being able to go up and downstairs makes it difficult. on the right is harry and sitting down and age 90 and his caretaker partner is 86 years young, and in his building there's no elevator and of course he's pretty much gets around in his home in his walker and rarely leaves outside the building. now the meals for seniors and adults with disability what are the needs? our department conducted nutrition needs assessment and our findings from a 2012 there are -- for seniors 60 and above

under 200% the federal poverty level they're over 126,000 average meals needed and currently we are providing a little over 42,000 meals and this is through both public and private programs, and you can do the math as how many there's a gap there. 1/3 to one fourth of the seniors and adults live under the 200% federal poverty level. a third of the seniors 60 and above there is 38% of those 65 and above and about a quarter of the adults with disability are living under 200% federal poverty level so the numbers are pretty large. >> may i ask a quick question? >> yeah. >> so what happens if we need 126,000 meals but only provide

42,000 what happens to all of the people -- >> that need the meal , what we're doing? well, we can -- our best guess some of the people are buying less nutritious and less expensive food and some of the people even though they're using the community cbos network, pantry sites and the program is not enough. our programs only provide one hot lunch a day for the congregate meal and many of the seniors save a part of that meal and eat it for dinner, so we look at food security and if they're not getting enough and maybe not the right enough of nutritious food to maximize their health. further down we will share with you a little

bit the waiting list for the program and what it costs so right now we have 231 people on our home delivery waiting list. 154 of them are seniors and 77 are adults with disability. and last year just as a fyi our contractors over served the contract by 367,000 meals. this is above and beyond what our department contract for because they're able to fund raise and court things, and currently the waiting time before someone gets served, gets home service is 42 days. the range varies. if you're -- when someone requests a home delivery meal there's intake and assessment done by staff at our department and then depending on what their functional ability or disability is they are prioritized and

they are scored so someone with a higher score and they have -- a space is open in the waiting list let's say in the mission district then home delivery will look at the list and contact the client to see if they still need the meal, and then start the service, so if you have a higher priority -- higher needs you generally get served earlier and people who are a little lower in terms of the needs they wait a much longer. in terms of recommendations to how to address some of the home delivery meal needs the resolution was to serve clients within 30 days and emergency clients within 2-5 days. it would take a concerted effort and one of the recommendation is really develop a city wide campaign to highlight the hungry in san francisco and more

importantly to raise funds from across san francisco to expand food programs. i wanted to make sure that adults leaving san francisco hospital are offered the transitional care program to qualify consumers so this program has been expanded and we're excited about hoping it's part of the emergency needs are met and also we wanted to use more of the community living campaign for emergency meals when it's appropriate. another recommendation is to develop business collaboratives that allows the meals to be purchased for clients and this is in process. actually another important part is advocate for state and federal policy changes that can help promote food security with seniors and

adults with disability. for example the current calfresh policy where if you're on ssi you're not qualified -- seniors are not qualified. well that's something i think needs to be -- there are some legislation looking to change that, and another important recommendation is to report out to the food security task force the average wait for food service on a quarterly basis so we can see how we're doing over time, and the last recommendation is really to do a more indepth analysis to more accurately identify the extent of the home delivery meal needs and this is in conjunction looking at home delivery grocery which we will talk about. if someone is able to still prepare some meals at home but they can't travel out the home delivery grocery could be an

option that is less expensive, and here's -- before i talk about the home delivery grocery what is the cost to serve another 231 unduplicated high risk clients? based on our cost and nutrition budgets it's going to be 1.3 million and this averages out to $3,663 annually per consumer. well it might seem high but if the look at the alternative how much are we saving? there ared is its -- recently the manna study done by a nonprofit group in philadelphia they show the clients receiving adequate nutrition service they reduced overall health care costs by 30%. that means over $12,000 a month and also they reduced the in patient costs by 40% monthly and that's $87,000 a month, so

that is huge savings if we're able to provide home delivery meals to keep people healthy living at home versus them going into a skilled nursing facility that cost a lot more. in addition -- >> can i just ask about that 231 new unduplicated high risk seniors and people with disabilities and the 1.3 million dollars amount. as i recall it was estimated to be much higher before, and i am just trying to think about it. that seems low given the numbers of people who are at risk and i know the report was saying one in four based on different numbers and the 231 -- isn't that only the number on the current wait list? >> you're correct. >> it's no where near the huge need that is there but could you address that? >> sure. you are right. base

the on the other information that we have in terms of number of seniors and adults with disabilities under 200% fpl we think that is the need for home delivered meals is higher than the number on the waiting list. we were being conservative because without -- that's one of the reasons we wanted to do a little more data analysis to really ascertain what is most appropriate, and what would be important to include -- this amount does not include projected growth in the need for home delivered meals so it's a conservative number. >> so i know that the long-term care council and others have estimated the senior population because of the baby boom to be a senior boom in 20-30 years doubling from the period -- i

think over the last five years to project it out, so one thing that would be helpful would be to estimate the need now, but also as the baby boom population turns into senior boom what it will be in the future, and what the cost would be? that would be helpful from dass i think. >> we'll do that as the next step in order to get a better picture of the need. >> it seems like the 1.3 million for the wait list people is miniscule compared to the real need and project the growth of seniors it's going to seem even more miniscule i think. >> thank you. we will certainly do that. the other thing too with the providing home delivery meals we're able to leverage other funding. last year we lever agented 18% of federal and state funding. also the

service providers do fundraising as well as get in kind recruiting volunteers to help and that made up about 51% of the budget in terms of the cost of providing the service, and while we really commend the providers for doing that the 51% is definitely not mandated and it's not sustainable. many of the providers are having challenges year to year to fund raise a lot to support increase in the service in the demand from their clients. we have contributions to the program and other in kind services we're able to leverage because the volunteers would provide visitors to the clients. they help with some of the shopping like getting pet food for the climates that maybe have pets in the home keeping them

company so there are a number of things we're able to leverage because of the program and the cbos that we partner with. for the home delivered groceries this is a community based organizations partnering with the san francisco marin food bank and they provide a weekly or bimonthly supplementary food bank to high risk seniors and adults with disability. we started this program a few years ago as a pilot to see how things go because based on the assessment we found there were unique needs not met so we have three models. one is a weekly supplemental of food delivered to seniors that need the supplemental food and meet the eligibility requirements. the second model is the sro food outreach and this is through partnering with the chinatown community development center at

five sros and utilize volunteers to help the seniors get the groceries into their room because many don't have elevators and to be able to lug 25-30 pounds of food up the stairs is going to be very difficult of these frail seniors. the third model is groceries for food networking program and this is a delivery program and the difference with this the seniors are connected and provided community service connections with the volunteers and with the staff that work with them and we only have this program in the omi park merced and bay view right now. what we did with the home delivery grocery we met with the providers and conducted a survey to assess what the need is and because we don't currently have a lot of information about that, and what we found from the

survey is that about a little over 10,000 adults and this includes 74% seniors and 26% of disabled adults or with disabilities they're identified to be eligible for and need home delivery grocery. the supplemental food bank actually contains always some fruits and vegetables, staple items and protein items so this is a picture of one of the food bags being delivered to a client. the resources and recommendations to expand this program and address the need to do the serve another 10,000 of unduplicated consumers it will cost about 3.1 $7 million and comes out to $316 per year a client and the benefit is that by providing that the clients get actually 6-7 times the

value of the food from the food they receive and one of the reasons this is so cost effective is because volunteers are used for a lot of the delivery and really partnering with the food bank and the pantry sites we're able to do that. the other recommendation is really to for dass work with the cbos to improve the intake and the assessment and referral process to identify those would benefit and have the ability to do something with the food, prepare at home, versus going to the next level and needing home delivered meal. >> can i just ask about the economic benefits of investing in home delivered meals and groceries? i know that the long-term care council and other senior advocates in the room are looking at aging in place

programs and this say critical part of allowing people to stay longer in their homes to be benefits to their communities, but also there is economic benefit not going to a hospital or long-term facility. could you talk about the economic benefits of staying in your home longer to be a independent living person versus institutionalization and the costs involved in that? >> right. when we look at studies that provided additional nutrition service to seniors and adults with disability the mana study that we provide references in the backup document that really provided some concrete data as to how much savings in health care costs it is. 30% reduction in hospital care as well as in patient care is significant, you know. also there is another study, a national study, that found that

the cost of one year of home delivered meals is equal to about one day's stay in a hospital, so any way you look at it yes if we can keep seniors healthy living in the home in the long run it will reduce the health care cost for the city. >> thank you. >> thank you. >> linda and now we will hear from out of school meals i will note it's a while since we had district representation on the task force and we are thrilled to have all of the partnerships we can expand through the involvement in the task force. >> thank you. i just want to know i know this is important stuff. i want to make sure if we don't lose the quorum and we can move it forward. i want to make sure all of the information is provided. >> i am heather and senior

planner for the department of children and families. i will give a quick overview of the meals and the importance of them and a scope of san francisco so we're really talking about after school snack and supper and during the school year and then the other section is summer, and the lunches and snacks provided during that time. i want to make it clear in san francisco we have a different sponsors that provide the meals, and there's a handful of cbos we're working on connecting with so the importance of these meals the cdc said it perfectly in the sense that food and hunger insecurity can affect us in many ways. we know what happens when we don