and cal fresh, the only income is $813 retirement payment and in july, faced with the negative bank balance and i applied for cal, cash aid linked to medical, and in person, and i requested an assessment, i have yet to be contacted by them. i was given an appointment to apply for general assistance, on august 25th. on the morning of the 26th, because of the cancer operations that i have had to miss the 25th. i arrived there determined to see somebody who could help me. right. and i apologize for this. and so, i was told that a

worker could come to my home and they did, and they on september 11th, while my partner was still in the hospital, and the pointment had taken a long time to get which i was grateful. and he has been operated on the day before and it was awful to have the meeting with the social worker, but i did this and i was qualified for general assistance. we received one payment on the 16th, on the same day we got a notice of action saying that because we received income from ssi, our food stamps were going to be stopped. and that was not true. and had been entered in error by (inaudible), and on this day, i personally had my (inaudible) and was taken to urgent care, vomiting bile, on the 23rd i went to hsa to try to take care of this paperwork and was fingerprinted and gave

over the document and stuff, andvy been taking the emergency anti-anxiety medication, and the worker became annoyed with me and tried to cut off my benefits. she knew that i had these disabling conditions, because she had been to my home, but she said, when i asked for more time to give her the documents, she said that if i should not or could not do it was not her fault. >> okay, >> there is more. >> please, i beg you. >> hold on. just a minute. we usually allow three minutes, and we do have i would like to is it okay, with the rest of the commissioners that we allow because the term is three minutes. >> and i know that you took yours, and she is the second speaker.

so... >> i ask for... unanimous consent that we will continue listening. >> for how much longer? >> another three minutes. >> okay. >> thank you. >> thank you commissioner. >> any objections? >> none. >> okay. >> and so, she told me that it would not be her fault if i could not get the documents to her on time and knew that i was anxious and i had ga unto meet her in person in her office and she turned me away, and greg was discharged from his additional two day admitting on the 25th, and on the 26th i called to ask for help from the ada desk where i thought that i had been helped earlier, and i just through a young woman who explained things and she confused me and i became upset and started crying. she seemed to me to be saying that the benefits had been cut off that the ta would be taken back and it seemed to me that we were going to have to pay

back the money that we didn't have, we had already spent it because we needed it. and that they were taking back our food stamps as well. and he had to step in to deal with this and having only just come home from the hospital. >> okay. >> and now, we get to the crux of it. >> at the close of business last friday, at the very last moment with his last job of the day, i talked to the ga, supervisor about this case. and at this point, it was clear that because i do not receive ssi, nor does rosa, we have never received ssi, there is no record of it. that there was a clerical error at minimum on the part of the general assistance staff. that was going to result in our losing my food stamps.

i asked the supervisor what could be done to remedy the situation caused by his error? his advice was to not file for a hearing, his advice was to supplement the lack of our legitimate benefits, his suggestion, was to get on ihs, and commit fraud. and i spent all day question and morning trying to request a hearing so that our benefits would not be cut today, due to the failers of the state hearing and due to the failures of every single voice mail system in this entire structure i was not able to file a hearing and our benefits are cut. this is the first time i have

been able to find anybody who can do anything about it, and i do not expect to you do so today. but as the... said, this will not stand. after this meeting, we will be finding council, and determining appropriate legal, state and administrative charges. our statements this morning, are being emailed to representative palosi's office and mayor lee's office of disability, i look forward to discussing with them ways to resolve the situation for the benefit not only of us, but for awful the working class and poor people in san francisco who desperately need, not only the services but the hope of the services provide. we did not ask for this. all that we want to do is heal, and to think about the warriors moving to san francisco. every night before we sleep, in the cab on the way over here at every point, we chant together, the huddle chant, we are all

that we have got. we are all that we need. and that is the truth. now if you will forgive us, i need to go home and rest and have my nursing assistant go and clean me up so i can talk to doctors about catheters and whether or not i need chemical cautoriization of my weeping flesh, thank you. >> thank you for your comments. and i am sure, yeah. thank you. >> >> thank you all very much. >> you are welcome. >> have a peaceful and great day. >> thank you. >> thank you. >> is there any old business? any new business and non-action item and no vote required, community on living and annual plan?

>> so, president james and commissioners, i am going to go over the annual plan for 2014, and 2015, with you and then i am going to take you through the 6 month report and just say that rose jones, and linda edelstene are here with us today and so in the packets there is a report that rose put together and so she is here to answer any questions that you might have about this really interesting report and of course, linda is here to help me answer any questions that you might have about the other two documents. and normally, i would go through the six month report, first. but, i think that there is some back ground information in the plan itself, that is helpful for us to review together, and so i am going to start there. >> so, the community living fund, was established, i

believe in 2006. and it is all general fund dollars. and although, we do some time studying with that money so that there is a little bit of federal money there, but it is essentially a $3 million fwund that was created by the mayor, and at the time, and the board, and to help people who are living at home, and wanting to stay at home, but don't necessarily have all of the goods and services that they might need to do that and it was also established to help the people who were in skilled nursing facilities such as in the honda hospital to come back into the community and many of these people are folks who have resided in facilities for year, or 15 years or ten years, so they have lost obviously their home, and the things that would help them come back into the community. and so, the fund was established for that reason. and because this was a locally designed program, we were able

to raise the level of entry into the program, so it is 300 percent of poverty. both on assets and on income. and it is for all adults and so any adult, who meets the minimum requirements is or has access to the fund. >> the program's design was based on work that we had done, people had done here in california. and the msfp and the linkage 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, at 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