program which were primarily in the case management programs and also had the ability to buy services and other goods that people might need. lots and lots of restrictions on those programs, but nonetheless, that is the format, and the design of those programs was pretty eloquent in its origins. and we also looked at a program in philadelphia where they do something similar. and with it and we looked at the information that they had and so the program that you have in the community living service design based on the three, programs, so, it has court and in the case management and the case managers have very small case loads, anywhere from ten to 20 ten to 15, and which is not the norm, and the norm is more like 40. and again, the case managers can buy, goods and services that they and the client have worked together, and believe that are important to put in place. and they only do this, after

all of the other resources have been exhausted. and so first of all the case manager has to go and look for those things and other places because many things do exist. and then, again, if they don't, they can purchase them. >> so what you see, we are directed, ordinance for this program, and it says that there will be, an annual plan that will be designed out of our office, and in addition to that, there will be a 6 month report, on what has happened with the consumers that have been served and the dollars that have been served and spent and so on. and so what you see in the annual plan, is really a report that comes to you not for vote but for your review, it also goes to the department of health, and it will go to the board, of supervisors, and of course, the mayor's staff, as well. and i would just i think, that i highlighted a few portions of the report, itself. but, i would go to page 4, and just talk a little bit about

anticipated budget and policy considerations. so, you may remember that about a year or so ago, we were successful in negotiating with the san francisco health plan, for dos to be the central point, of for new and consumers who were looking to be joined with the (inaudible) health program, and we had and so we are the initial intake and the folks that were here today and that were coming to them. and then, we pushed those referrals out to the community partner which is the institute on aging and they sent a nurse and social worker because that is the model for review before you can get to the adult to help and they send a team out, that review and if they qualify, then they are referred to the appropriate health center whether that is the one in the bay view or the downtown area, wherever they might be. and so that will be continuing.

i thought that it was interesting, in and within the noting and in this write up, that we are now working with, and we have been working with laguna honda services all along, but now we are looking at helping the folks in the civil and the city college and initiating the services with the vocational rehab services and the community based adult services and so clearly what we are finding as people are being discharged from laguna is that we have a number of people who are cap able of work and want to work, and you know, if this many years later, there is many opportunities for people and so there is work going on in that area as well. and which is very, exciting, i think. go on to page 5, you will see, under the data collection, we evaluate this work that we are doing, on a regular basis. but we have added two new out

come measures, and this year, because we were meeting and exceeding the other ones that we had and so we have added two. and this one, is the first one is that percent of care problems are resolved on the average after one year of enrollment. and we are looking for at least an 80 percent success in that and the second one is that the percent of clients will have readmissions and admissions to acute hospitals within six months. and we are looking for an 80 percent, on that and so that will be and those will be new measures for us. and we have an advisory council and we have had from the very beginning of consumers, and community folks, to initially it was to help us as we are designing the program to make sure that we got it right in terms of what consumers were problems for consumers and you know, we think that our thinking is great but you know, not always, and so, and now, we

use the advisory council, really to do and evaluate, and things and so that continues. and i think that that is all in that part of the report. and in this particular report. and so, i would entertain any questions, from this one, and certainly, linda is here to answer any questions on this one and then we will go to the 6-month report if you like. >> permission to see them. >> under the consumer input category there is an anonymous yearly survey and it did not address the response rates and i did not see the data that was related to the events and i was just curious about the end of that story. >> it is a periodic report and so it will be with the next six month report. >> i see. >> can you generally comment about the response rate? is it high? >> you know, it is not bad, it

is around 30 percent, usually, but that is actually. >> that is good. >> that is good. and we have been changing around how we have been doing it to try and pull in more... >> and well, i just have one other question, under anticipated expenditures in the add back process, they received a one time funding to hire a consultant and i wonder if it is hired yet and if so, who it was. >> it is not hired yet. >> it is not hired yet. >> thank you. >> any other questions? >> yes, you mentioned about 300 percent of the parts of the line, and i, okay, give me the basic, what is the... go, part... >> so it is the federal. it is the federal poverty level. and it is near the income? >> it is, i do believe that it is around 15,000. >> okay. >> so, it is up around 40,000.

>> actually,... >> and what is... >> and 11,000 and so it is like, and so, 11,000 a year, for one... >> okay, not 13,000. >> no, 11,000. >> and so, for we do, 300 percent of... >> 300 percent. >> and so it is like, 33,000. >> and if, and the person income whatever source it comes from, it is less than 33,000, and that is... >> she is eligible for them, and for the fund? >> exactly. >> thank you. >> thank you. >> so it is the capture people who are not eligible for medical and have too much money for medical but not enough money to be able to provide for their care. >> okay, and another question. i believe that the funds

started in newsom's term with $3 million dollars a year and every year, it is put in $3 million dollar a city. >> correct. >> and that is enough to cover all of these, even though they caused an increase. >> no. >> we would not want to give the impression that $3 million takes care of everything. because this... >> and this is. >> this is actually, the patient needs. >> and no. >> in order for from the hospital to home. >> no, we know that we have more people who need this service than we can provide a support for. so, we have and we have waiting lists, and in the first two years, we actually spent more than 3 million because of the way that the fund works, you get 3 million each year and you don't spend it, you rolls into the next one and you get another three million, and so in the first year, we did to the spend the whole thing, we did not have the program up and running until december or january and next year we had 5 million dollars to spend and we

spent a majority of it, and so the 3 million dollars, obviously serves the people and it serves very well but it does not serve everyone who needs the program. >> question, so how many people are actually served through the community living fund? and meaning, how many people were taken out of the laguna honda? >> so it is two groups, it is the people who are in the community who are at a risk of being institutionalized and so they are actually like a nursing home level of need, and we try to keep them in the community. >> and a lot of those folks are already, they already have services and case managers, but they seem to have risen to a point where they need that extra help and then the other group are people who are in institutions and who probably are still or could stay in institutions and they have that level of need.

but we bring them out into the community and give them that. and the services. >> actually wh, we get to the 6 month report, we have got, i think more information in there about numbers of people, and class, but, and >> yeah, and there is, and there is a program, and the program over the last, it is from 2006, more to 2007, and so we have got like 7 years or so. and it serves to 2600, just over 2600 people. >> okay. >> and in total. >> right. >> individuals. >> and thank you. >> thank you, i think that it is a very good program. >> it is. >> and commissioners? >> yeah, you know, i have a question. what are the medical home equipment and the special needs in could you give an example of what are the special needs? >> so, is there where it goes? ... is this... >> it sits in the... >> and this is like the generous and stuff. >> second. >> non-... and no. >> and i am wondering

commissioner, and president james if we should just move to the second report and i think that the questions are going into that area and we could cover that real quickly. and then we can cover and because i know that commissioner sims has questions in this area as well. >> i think that we do things for the house, that are not medical, and we might put in a stair lift or a ramp, or you might be remodel a bathroom entrance because a wheelchair cannot fit in to it and the thing that is about this fund that is so great and because it has a flexibility to do what nobody else will pay for. we sometimes will fix somebody's furnace, and they only the house and they, in elderly person has been there forever, and their furnace breaks down and they can't stay there because they have no heat. and so, buzz but that is going

to allow them to stay there and it is just and, it could be, anything, where we are really opened to anything, ha is going to help that person who is, if they didn't get this help, could possibly go into institution. >> the other question is that you got the referrals from the hospital, and the community, and can the person, sell kind of a self-... >> they can, but generally, people are already connected up to all of these services and so somebody who call dos intake and say that i need help with whatever. and if they are not connected enough to regular services case management, food, ihss or anything, and they will connect them up with those services. and in addition, our intake, also looks at the need for community fund, and generally, these are people who already have all of the services, and all of the regular services but they are still falling apart, the circumstances are falling

apart. >> if they have family and is the family involved in the plan. >> yes, of course. and yes, i mean that the plan, and if we are looking at discharging it from laguna and that might take, many months, and because, we are putting together, a whole wrap around plan and we include the family and what their involvement is, and we work closely with the social workers and at laguna, to it, and the resident there. and because, it does not, it does not help if we put together a plan and they don't agree that this is how they want to do it. and so, sometimes, it will take two or three months and sometimes, for somebody who has been living at laguna for 15 years and it might take, up to a year or more and so it is whatever is needed to insure that when that person comes out that they have the best chance of making it the other thing is

that if they need a medical tune-up, we work closely with them and with the staff and then they go back and and get a little tune-up and come out and we hold on to that you are housing and so it is a very, much a community or a collaboration. and >> thank you. >> thank you. >> and yes, i have a question,..., you mentioned a person owned their own home, but they need to repair on the heaters for the heaters, and then, the owner of the house, and have much you know, resources or the value, is beyond the 300 percent poverty. >> and so the, and so, we look at income just bear income and we look at their savings. and so, the their income has to

be under 3300. and but... >> but you are not looking at all of the assets. >> and no, and the savings have to be under $6,000, the medical, limit is $2,000, and so we have 3 times that and so $6,000 and so now somebody, if they have lived in the bay view, but let's say that they have got this old house that is totally paid off and that is, and they don't have any more taj or anything, and they don't have any income or assets, money assets, we don't look at this. >> i understand that. >> their house or their car or anything like that. >> that is perfectly clear now. that is a good system, thank you. >> i would just ask, linda is correct that under medical that is the same rule and they don't look that you can have a car and a home and that is not part of the asset test. >> correct? >> i have a question.

the median age is around 50, used to serve the older people, what are you doing with the older, older people. >> i lot of, well, we work with them as well. and a lot of the elderly, when honda was cutting back on its beds, it had been 1200 and they are down to like 780 now, we worked closely with them to bring a lot of people out and there was, and a lot of the elderly, and their situation was easier sometimes, and they, and there were a lot of, there were, and i know a lot, but there were senior housing available, that we were able to move people in, and put the wrap around services on. >> they have a lot of younger disabled folks. >> yes. >> and so we have been working closely with them to bring those people out.

and the housing, issues, are a little or are harder for that group. and because they don't have the same kind of status, and although, they are, and they have been changing that more. and we have had the, we have had subsidies through the department of public health, for the last, five or six years, that has allowed us to lease up scattered site units and to move the people there and so we have been working closely with them with the housing piece from public health, and the services through dos. >> so, we are looking at most of this as rehabilitation, for the younger group. >> it is people of all kinds, it is people who maybe have had injuries or strokes or motorcycle accidents or gun shot wounds or whatever they

are paralyzed for but it is also people who have serious illness, and not related to trauma. >> thank you. >> we will move to the next report. and so if you turn to the 6-month report, and i am just going to walk you through some of the detailed and the dem graphics and the usage of the services and so on here. and i think that the first page is pretty self-explanatory and we just have the overview at the top and the key findings that you will see under the first bullet that 526 clients and received service during this part of the year and that was the highest level that we have seen since 2010. and we have got this is just a little bit more detail there but i think that we want to move to page 2, and again, demographics are highlighted

here, and we and initially we saw if you go back to the reports you will see that initially, it is it heading and there were a lot of old adults referred to the program and at some point that shifted and a greater percentage of younger adults and the older adults now it is starting to even out a little bit again. and we have seen an earlier reports, that there was, and there were more chinese elders being referred and then as the wait list grew longer we did not get as many referrals and i think that is kind of standard of what happens in the community, and you, as long as the referrals point of entry is open, and the people can get into the program, you are going to see a lot more referral and we have a waiting list and some people will stop trying to get on the list when they know that there is a bottle neck and we are continuing to see the zip code, 94116. and which is primarily, laguna

honda hospital as a major place of referrals. and then, of course, tender loin and the haze valley areas as well. and actually 32 percent of our referrals are coming out of laguna honda hospital and in terms of service requests, the highest request, are for case management and inhome support, and housing, always, remains in the top. and there was a time, when we had greater dollars, and then in the dimension when they had access to because money had been set aside in the health department for this program to access the housing particularly for the people leaving the hospital and there was a more fluid operation in terms of housing, but again we don't have any more, mental health and substance abuse and assisted living devices are also high on the request level. the total amount of the program expenditures of $2.8 million, which has been the norm now for

some time, and you will see that something that i am very, interested in, and i am very pleased about, is that the average cost per person is 557 dollars a month and i think that is an extraordinary amount when you think about who is being served in this program. and now clearly we have the people who are much higher than that and the people who are lower and it brings us to the norm, but, when you think about over 500 people, served, and you think about that particular, and i think that is pretty amazing and i think that later in the report you will see that some things align this line are happening in two of the counties and i suspect that is one of the reasons and turning to page 3 looking at systemic changes in the trends that are effecting a clf, you will see, the second bullet there, that, well, yeah, on the second bullet, and that the housing were recently awarded a contract with the health plan

(inaudible) put together a community living fund and program and i think that is enormously exciting given that when we first started, i remember approach of a foundation, and asking for money to do some research on this program. because i thought that really, do the research when you are starting and not at the end and they said that this could never be replicated any place else, only in san francisco, it is wonderful now to see that other communities have really learned the lessons of what a flexibility fund can do to help people live at home, and also come out of institutions. and then, for the first bullet on page 4, santa clara now is doing the same thing, and both (inaudible) and santa clara are two of the eight counties that were selected for the coordinating care initiative to move into the full service managed care and so we see that santa clara is doing the same thing and i am glad and

appreciative to say that they have worked with both of those counties to help them to be successful in area for work out the details of how this program could be set up, and so on. and i think that the disappointing thing, in this year, that we are in, is that our deversion and community in the integration program, the dcip and essentially, the electronic tool is no longer able to be accessed and this is due to health department concerns are on privacy and so we are working across the departments to try to figure out how are we going to share the data, when it is in the best interest of the people that we are both serving to make sure that they get the best from all of us, and they get the most complete plans and so we are working hard to see that that gets reinstated. but this has been a very important piece to the community living fund, and the work that we have been doing there and so we are working

hard to see what can be done, in that area. the second bullet from the end, you will see the san francisco and the consumer mentor program, xh is housed at the public authority is on hold right now and that is because they are re, really looking at that programming and thinking about a redesign, and so when that is back on, line, we will be back to tell you about it. and then what you see, i think in the last few pages are the charts and i did the quick math and if you take $25 million over the course of the program, and with the, and what that is to say 26,000 people and that is $9,000 per person and i mean, really that is pretty amazing. >> and given that so many of these people have come out of institutional care, where frankly, just the city's portion at laguna honda is $100 a day. and so, we are enormously proud

of this program, and we are glad to take any questions and then, i think that rose is going to spend a little time going over the third report, because this is an incredible analysis of a particular group of people during a particular time in terms of a program's success. so, open to any questions. >> commissioner? >> on the chart labeled is it ior one? labeled one, it says that the number of clf clients served by homecoming continues to increase. and the increase is seen nominal almost slightly up to flat and i wondered if that is

due to funding ceiling that you are maxing out? >> are you looking? >> you know, the bottom chart. >> and the homecoming itself is a separate program, and it is at san francisco senior center and it is money that is set aside for people coming up through transitional care and so the people coming out from the hospital, >> okay. so it is really not. >> it is not part of this and it is less dollars, but it goes and, it goes to it and to a different program. they have access to as much as they actually need, and but, and so the spending each year, and varies, because so, it might be just somebody coming out of the hospital and they can't pay for their medication and we will, and we have an apartment but it could be and we need a grab bar and they didn't have one and it is just like the immediate need and so

that, it kos go*es up and down a little bit based on what the program needs and not our control over it. >> any questions? >> commissioner? >> how long do you follow the clients off of their (inaudible) in the home or, i mean, in the... (inaudible). >> you know as long as we need to. and so, when we first set up the program, especially with the folks coming out of laguna honda, we said that we would follow them at least two years. and we will just see, a lot of times we transfer them to a lower level of case management and the people are doing well and they don't need us any

more, but we, if we go out at a year and two years, just to check and see how they are doing. we do like an oversight, and then if we do or bring them back into the program. >> and we change. >> and the care. >> right right right. and so it is just, it is just, it really is just depends on the individual person and we can't stay in there for as long as they need us, which could be like three or four years, whatever, but generally, i think that we generally we end up staying for a year if somebody needs an ongoing service, and then we are still involved, and we are not as actively involved in terms of the case management, but, there is an over site checking in with them, regularly making sure that they are still stable. >> okay, thank you. >> commissioner sim? >> i would love to hear a little more about the identification of these scattered housing units and one of the reports talked about

some of the very practical problems that could arise, or have arisen, placing some of these at risk patients from the availability of the drugs in the neighborhood or the problems that might come up with the circumstances of the patient in a larger unit and i would love to hear you talk about the mitigation of those issues. >> sure, you know the scattered site program was contracted out to west bay housing, and they, they and their staff worked closely with clf and their case managers and the rest of the team, to when we we would look at what the best what the need was, did they need the scattered site, is that the best way to go, or do they need a unit to direct access to housing which has on site

services and nursing service and they have got a desk clerk, and you know, they can be more tolerant of different kinds of behaviors and so, we would look at that. and for the scattered site ones, and that is our first choice and we would like the people to be out in the community as much as possible. and for the most part, it worked well, with the wrap around services. sometimes issues would arise around screening or behavior or friends, or alcohol, or drugs. west bay housing did a really good job of working with the management in the buildings. and they would, they would get on any issues and we, a lot of time, we bring in the case management and we really try to ease the situation and sometimes we have to move the people out, in order to