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 retain the relationship with those buildings. and if we moved them out, we would probably move them into a dah, building, one of them, and sometimes the people, and in and the people that were in a dah building and the things really settled for them and we would move them out of the building into a more independent and we also, ran into some problems, and we a

couple of people that we set them up in really nice apartments and really nice buildings and these were folks, both of them had been homeless for a very long time, and they really had trouble with adjusting to being in the whole apartment and in that kind of a setting, and we ended up moving them into sro buildings. >> i saw that. >> and they, you know, they did really well. there was, and they had a level, and so, you know, we had our own and we wanted to put them in a nice place and that worked for us and it did not work to them and so, it is, it is, it really opened our eyes to really looking at what is that person is saying, and how can they best cope,? what do they need? and, you know, our focus is maybe, like somebody should stop drinking but that is not realistic but how do we allow them to live in the community

and carry on and have the choices of how they want to live. >> one more thing is that we also found that people had a lot and we were surprised at how much mental health issues, were a problem. it has made a difference in the terms of the case managers knowing how best to deal with the people, but also, to be able to make a connection with them. and allowing the people to live, how they want to leave and for us not to be judge mental, and just learning.

>> yeah. >> and if i can hole the mic for one more, and i am going to try to combine a couple of things in one question partly i think that it relates to the peer mentor program that is tabled for a moment, but it also, it might relate to some of the demographic profiles that are trends, like, you know, 77 percent male, and a little bit younger, than i might have expected the population to be. and the ethic diversity patterns don't seem to match perfectly to the general, ethic diversity stats of the city. and so, i am wondering, you know, what is the thought? peer mentorship seems like a really lynch pin concept. and depending upon how this works and i am wondering if some of the demographics are working against that? or not? >> so i just say, that the peer mentor program out of the ihs public authority, is where they

primarily someone, who is disabled is going to be leaving laguna honda hospital or thinking about it any way. the public authority would match them with the peer who has a disability, and who lives in the community, to talk to them about how, and just how it is. to live in the community. and how it is to get around. and how... >> and actually take them out. >> how do you go to the bank? how do you do this and ride muni? >> right, so it is a very practical, and so, i think that what we are seeing, at laguna honda is that this younger population, is primarily caucasian, yes, there is some diversity but a lot of disabled middle aged, or younger, white, males. and so, i think that whenever we look at our dem graphics, you know, i am always asking, what kind of out reach are we doing? are we making sure that we are getting? and i think that if you look at this program, over almost, ten

years now and not quite, but close, you will see that there were years when we had you know the greater diversity and now, we are, and we have got, kind of this population that we are looking at. >> and does that give you some... >> okay. >> thank you. >> thank you. >> could we... >> yeah. >> and okay. >> thank you. when the veterans and so we have a third piece of the report. >> i don't see mine. >> it is stapled into this. >> okay. >> and so, i think that again, this is a report, that rose johns was a graduate student at the time that they did it now on the staff prepared for us, and i would just ask her to share some highlights with you, because i think that this gives you a deeper look into both (inaudible). >> good morning, commissioners.

so, as... >> you might want to pull the mic up. >> yeah. >> and so anne has the report that i completed when i was in graduate school and uc berkeley public policy and social master's program and now i am with the hsf planning as six weeks ago and i think that you actually started pulling from some of the data in my report in what you were just talking about because it is stapled to the back of the six-month report that you received. >> yes. >> but just to highlight a couple of key points, i think, what linda and i really were interested in or noticed, in the data was that the population that i was focusing on, which is those consumers served by both clf, and the dsip deversion and we noticed that they tend to be middle aged and male. and that is notable, because often the people think about seniors, and when we are talking about taking people out

of skilled nursing facilities, but this population does tend to be younger. which means that they have a lot more time ahead of them that we can help them live more fully, in the community. part of this project was looking at this clf purchase, services. and what i found was that services both in terms of the total dollars spent and the number of purchases tended to be clustered around the discharge and they were primarily related to setting up a home. for these individuals, who are leaving laguna honda and had not lived in the community for a long time and so a lot of the purchases were things like putting in a stair lift. or, putting down a rental subsidy. and or excuse me, a rental deposit. and i think that something that we are pleased to see is that based on my attempt to do a cost calculation that was more comprehensive and i looked at the costs as well as housing costs and through the meals

through the office on aging what we found is that the cost of putting these people, pulling them out of laguna honda and to support them, appears to be much lower than the cost of living in honda for a year i think. i calculated the cost of supporting someone in the community is $32,000 that is not a comprehensive cost estimate, a lot of these consumers are accessing other services through the department of public health that i didn't have data on. this cost, 32,000, is much lower than the projected cost in the year in laguna honda, which is $32,000 for one year. >> and those are the highlights, any questions or do you want to move on with the agenda today? >> i heard you say that you wanted to move on. >> and no in questions, for the..., okay.

>> other than to say thank you for doing the work. >> yeah. >> it was quite enjoyable. >> thank you. >> it says the veteran history project. >> right. >> yeah. >> okay. >> good morning, commissioners president james, and director hinton thank you so much for having me here this morning, my name is gabriel ledeen and i am an attorney here in san francisco and i am going to talk about a federal initiative called the veteran's history project. and ask for your help in reaching senior veterans here in san francisco. >> you looking at two. >> and i know that and thank you for your service and i am also a veteran and i served in the marine as an officer for four years and that is why this project is so important to me. >> okay. >> the pro-yekt and a product of the federal statute and congress directed the library of congress to establish the program in 2000.

and since then, they have collected, a stories of over 90,000 american veteran and they have archived them and made them publicly available through the library, and on-line, data base and also, physically and in dc through the archives. the library relies on the volunteers for these stories of veterans and the volunteers like myself, go out and find, the set ran and interview them, and record those interviews and then submit them along with the required paperwork to the library of congress, where they are archived. and now the library has encouraged us to focus our efforts on senior veterans, particularly world war ii, because the population is rapidly dwin delling and way nt to capture those while they are still here and available for interviews and now. the most difficult part of this process