there was always an educational component but they were working meetings for people working in the areas across our city would pick a topic they were interested in and in all the five subsequent meetings would work to develop short and long-term goals so by the end of the final session we had these recommendations in place, and you will hear through the -- christine's presentation that the recommendations are actually moving forward and work is being done on them. a number of people from the long-term care council and in the audience were part of the discussion. one of the beauts was bringing all of us together and a first in the community at least on this subject. i learned a tremendous amount and i am internally grateful to the folks who participated and are continuing to work on this so christine i

will hand it over to you and have you walk the commission and the audience through the process and the recommendations. thank you. >> [inaudible] >> i cannot hear you. >> is it on? can you hear me now? >> yes thank you. >> thank you to president james and to the commission for giving us this opportunity to tell you a little bit about the proceedings of the task force. it was really an amazing and productive time that we had together and as you heard from anne this was a program or issue that was cosponsored by the department of public health and the department of aging and adult services and it was really in response to this recognition that there are opportunities in our community to improve access to palliative care and improve the conversation around care for people who have serious illness so sort of with that back drop to get everybody on the same page about what the definition

is for palliative care because as a palliative care provider i can say many people have different perspectives or understandings of what palliative is. palliative care is a form of care that is person family centered really around individuals who are experiencing some serious or life-threatening illness that unlike hospice it can and should be provided at any age and stage of an illness along treatment so it's not an either/or phenomenon and it's about providing the extra layer of support to individuals who are experiencing high illness or treatment burden as a result of a serious illness and provided ideally by a professional team and delivered in all settings where people find themselves so both in the hospital, in the community, in long-term care settings, at home, so our

project team and task force is comprised of the following individuals. i had the great privilege of [inaudible] with anne. it was a great pleasure. we had an incredible team project team and then a number of task force members that represented our community and really i think represented at least over 30 community agencies in the city and county of san francisco. it was a very strong collaboration between the department of public health and daas and a great opportunity for people that really care about this issue to come together and learn from each other about really what is happening and not is happening in our community. so our structure was fairly intensive one as was noted. we had five meetings that spanned over the time frame of may and august of last year, and anne mentioned to you our funding

sources -- we pretty had the first meeting and getting everyone on the same page around the definition of why we were all there, our goals and objectives, what our deliberatables would be and broke into work groups around system issues, quality and community engagement and financing and people worked very hard during the sessions to really come up with key recommendations for our city and county. we defined three deliverables and they meant defining palliative care for us in our community, creating inventory of palliative care services and there is a lot things going on in the community but not well coordinated or understood by each other and developing a list of short of and long-term palliative care recommendations aimed at improving access to quality palliative care, so first of all our definition so the definition

of palliative care emphasized a few things and i will briefly touch on those. first in our definition for our community we wanted to emphasize the person who is experiencing that serious illness and their relevant community and loved ones as an important part of the team and part of communication and coordination, and those services again should be available along side disease modifying or curative or life prolonging care and we're focusing on making sure that patients and families desire for peace and dignity on their terms are respected throughout their course of illness so that was the additional emphasis that the task force put on the definition of palliative care. our second deliverable is talking about the target population. we talked about it in two different ways. the first was sort of long-term that frankly all of us and i will touch on this at the end

benefit from learning about palliative care and what it can do for us and for our loved ones so from that standpoint our long-term target population is all of us that we're all educated about palliative care but in the shorm term we're focusing our energy about those individuals who are experiencing high illness burden and high levels of suffering not relieved and the persons in the last two years of life. our recommendations came along those four different work groups that you heard about. although i have to say there was a lot of overlap around the recommendations, both short and long-term and i will emphasize the big picture ones. if you're interested in looking at all of the recommendations they're on the department of public hate reb. >> >> website and promoting palliative care in the

hospitals and there are many opportunities to do this and a national initiative to do a better job at palliative care in the hospitals and we wanted to do that locally and require that palliative care is part of the quality matrixes that they are supporting and then promoting palliative care training for all members of care provision staff including front line workers. in terms of finance again trying to make sure that people understand what the business case is for palliative care especially around its ability to both right size care so it's more cost appropriate while at the same time improving quality of life and many studies suggest prolonging survival and use data to current understand the utilization patterns here in the community for this population so we can see where our real gaps are; that we promote understanding of improved

outcomes if san franciscans had broughter care around. >> >> broader care. >> >> and have a board working along with the council and so the recommendations wouldn't be on a shelf and get moving and try to address them in an aggressive way. with respect to systems we recommended again more collaboration across systems really trying to minimize the bear areas that many of us and you have experienced in accessing palliative care services and creating a data base that is accessible to providers and updated and dynamic and standards for advanced care planning and documentation so people's preferences about their care are communicated across settings and not lost when someone goes from one setting of care to the next. to integrate

palliative care into the management programs that are in existence in the community. again so there was a more robust support and integration of those services for all that needed them. and then finally from the standpoint of community engagement to really create a public campaign around the conversation of what people -- what do we want if we in the future are facing serious illness to really help people feel comfortable about communicating the care preferences so we can respect people's wishes when they become seriously ill and we're a conversation competent community unlike some other communities in the country that have tried to aggressively help their citizens be more informed about their opportunities for self determination. a really happy thing and sort of as a result of

this task force a natural sort of transition occurred of the task force recommendations under the long-term coordinating council and the long-term coordinating council happily voted to create a palliative care work group and committee and now moving the recommendations forward and already we have met i think at least three times, had three meetings. the committee again looking carefully at those recommendations trying to figure out which ones we should be addressing most aggressively for the short of run but trying to pay attention to all of the recommendations including the long-term recommendations so we're very excited this has transpired and grateful for the support we received from the department of aging and adult services and public health and enthusiastic what it will mean

for improving quality of all right for our citizens with serious illness and april 16 is national health care decision day and if you haven't had the opportunity to tell someone you love what is important to you about your treatment decisions please use that day as an opportunity to communicate that because that will only help you and hopefully help those that you love down the road and i am happy to answer any questions. >> commissioners? >> thank you dr. richie that was informative and encouraging. i am curious are there any state laws that can conflict with the goals of the task force in terms of what it wants to do in san francisco? do we need any legislative action in sacramento? >> wow that's a great question. i could probably spend a lot of time on that but i will say there are a few things happening that are encouraging and

specifically sb104 which actually requires that palliative care be fully integrated into one -- medi-cal and the challenge is making sure that the providers are educated and having the competencies to provide and offer good palliative care services and those services are across the continuum and not limited to hos -- hospice alone but wherever they're experiencing the service and around the state legislation that is encouraging providers to be more explicit when someone has a terminal illness and know what their treatment options are including palliative care. that has become particularly relevant around the issue of dementia

and alzheimer's disease and when they are diagnosed with alzheimer's disease aren't told it's a progressive condition and i think there are opportunities when we get into the nitty-gritty supporting our legislature to more thoughtfully integrate palliative care services into the health care community, and then finally i think there are opportunities from the standpoint of reimbursement to encourage inter-professional care in a way that currently isn't supported in most spheres and they're in a different world and only certain providers can bill for services and others can not and i don't know anne if you want to add to that. >> as a follow up is medicare recognizing the difference of the palliative care that you have outlined here and hospice

care? >> yes, medicare recognizes that palliative care is a special medical service that is actually has specialty certification associated with it and certain competencies associated with it and should be available to people across their life continuum if they have a serious illness. however philosophy of palliative care and inter-professional care is not supported through many of the mechanisms of medicare. >> thank you very much. >> commissioner simms. >> thank you. i wanted to add my support and appreciate the hard work on the topic i am curious how to do this with the work and because san francisco is a diverse community there are cultural differences in the way people think about the conditions and the scenarios that they bring about. how

does the task force contemplate delivery and operationalizing some of these kinds of priorities in the community? >> this is one of the most exciting things to me in doing the work in san francisco is really learn from all of the communities as many different types both cultures and ethnicities to actually guide us so one of the things we're working on through the long-term coordinating council is really thinking what it means to do a needs assessment in the community and the particular concerns in the community that are culturally relevant so we're thoughtful and sensitive communicator on what palliative care can offer and [inaudible] is put forward as one of the poster children for having the conversation out there for people becoming comfortable

talking about their wishes for the future if they become seriously ill. laacross is a very homogeneous community and we want to look at what it looks like and reduction of the illness burden and suffering in our community which is more diverse. we're taking this on with a lot of fervor i should say in the work group because it's so important to be attentive to the issues here in san francisco. >> bravo. >> any other questions? >> yes. i'm a senior. it won't be long because i need medical care, so walk me through -- well, if i have an accident, fall, you know, i cannot walk, and i'm -- i sign up with the

kaiser now and i heard that eventually kaiser will -- am i going to end up with kaiser take care of me forever. >> well, our hope is kaiser and all the health systems throughout our community will be increasingly attentive to the fact that people when they're going through some kind of serious illness or crisis in the case of a fall or an accident have access to a supportive group of individuals who are well trained in reducing suffering and improving quality of life number one, and number two making sure your wishes about how your future unfolds is listened to, heard and actually -- and then followed through on, so that's not just -- it should be something available to people regardless whether they're in

kaiser or through anthem or any other payer that we have in our community, and right now i will say that palliative care services for the most part are most available in hospitals. they're not as available in the community. again getting back to the issue of reimbursement and that's something we really want to explore for two angles and one how can we support payers to provide the services in the community number one, and number two, how do we actually train all of our providers who are on the front line to have enough information to make sure people are getting access to palliative care. anne, do you want to add to that? >> i wanted to add something about one of the last sessions but you answered the commissioner's question. >> okay. i have a follow up question. when kaiser going to -- we have done everything what

we can do for you and [inaudible] transfer into the general hospital in san francisco. >> yeah, and again -- >> [inaudible] >> i always want to be careful about speaking for a particular payer. that being said i am aware that kaiser actually has many close relationships with hospices throughout our community if that is a choice and if hospice was not somebody's choice there are other opportunities to engage in palliative care through kaiser and i am sure kaiser -- many of the health care systems has that available to their patients. >> having heard from you i will sleep better. >> okay. >> commissioner. >> just one final comment. could we have a copy of your presentation? >> happily. >> thank you. >> i will make sure you get it.

>> i am happy to send it to bridget. >> i wanted to say -- we both mentioned that we use the successions as an opportunity not only to set goals and get hard work done but as a teaching and learning opportunity as well. in the last session the teaching and learning experience was i think very powerful. we had three people speak to us -- actually three women who had love ones that had access to palliative care services or had them themselves. one woman was from the chinese community and very much spoke to the cultural aspects of caring for her mother, and how hard and how many falls her being mother took before she just realized she couldn't do it anymore and went into a palliative care program at laguna honda and what kind

of team support her mom got as well as her from the folks there. the second woman that presented was from the african-american community here in the city and she too had her siblings were taking care of her mom and she spoke just eloquently about her experience of care giving, both at home and then with the palliative care team that she worked with, and i have to say she had knowledge of palliative care because she worked in that world, so she had a little leg up on some of the rest of us and the third person that spoke was a caucasian woman like myself who had experienced palliative care team support herself because she had had a tremendous illness that affected her, and i have to say that those three relatively short presentations spoke so eloquently to the folks in the room and it was

wonderful i think for everyone to see how much their experiences actually ended up in this document because so much of the richness of the recommendations really was around this idea of team, team support and good quality of care that we would all love to have no matter when in our lives so i learned a lot, and i just thank the folks that participated. >> thank you. >> commissioner. >> how many are on your community and it's not a ad hoc committee. it's a continuation committee. isn't that right? >> do you want to answer that question? >> currently there are 15 to 18 people that came off of the original committee that expressed interest and have participated in the meetings. these meetings are open as all of the long-term coordinating

council work groups and we are still seeking groups to participate who represent key categories of service that aren't at the table, so with this meeting monthly at this point christine and i volunteered to co-chair for the first six months to get it off of the ground but if anyone is interested let me know we will plug you in or if you have someone that you know is interested we can plug you into what is going on. >> when is your next meeting? >> april 10. >> [inaudible] >> which is a friday i believe at 2:00 p.m. >> that's right. >> at 2:00 p.m. >> at the department, yeah up on the fifth floor. >> okay. thank you. >> thank you. >> thank you very much. i just want to add one point to anne's report and i guess it includes your report too is there are four partnerships very

much, african-american partnership, very much active -- want to be active again, the gay lesbian trans partnership and the latino and the asian and they all want to be active and this is where the partnerships can come and speak to and especially on the other items you talked about, so we have been asking for a secretary help. thank you. okay. moving right along. the advisory council report, mr. schmidt. >> good morning president james, commissioners, executive director hinton. the advisory council met on wednesday march 18 and at that meeting we shared some information we received from the white house conference on aging. again i'm going to ask the executive

director henton to give a little more detail on that. >> sure. so the white house conference on aging is going to take place -- we believe there will be an event in washington and happens more and more it will be at white house and not a hotel or convention center so that's very i think wonderful and meaningful. it does mean as they have been saying all along though that there will be very few invitees that are able to attend. for those that have been to the white house these rooms are small so it's not a big event. there will not be delegates and talking to someone to chicago how that event will look, but today is the event in phoenix. there's been one in florida already and i think next week there will be an event -- these are the five regional events -- in oregon. >> yes.

>> and then the other two baltimore and ohio so they're going to be strategic and other parts of the country. we were invited to the one in phoenix and unable to go but people in california and southern california did go so that is great. there are speakers on the four categories that the white house lined up as things they're focusing on and in the afternoon they're be breaking into groups. there has been -- i don't know if jessica is here but i know that senior action network and long-term coordinating council are looking to have an event here in april again to mirror what is happening in the five communities so we have a community conversation about the four key topics again so that's what we know. the white house

-- i heard nora say it and their agenda is really around the four topics in trying to get as much input so people having sessions in their community and submitting communities to the white house is what they're looking for. >> >> they don't have a preconceived outcome but looking for policy initiatives that could be put into place through presidential executive order and put into place by the six key departments that are participating in the work, so is that what you wanted. >> yes thank you. also we -- the council sent letters to support to assembly person tony thermom and senator holly mitchell regarding funding for aps services throughout the state and also to support the [inaudible] program throughout

the state and ms. lawrence who works with commissioner sims will give a detailed report from that point when she follows me. also we continue to seek more members to join us on the council, and i believe there's a new councilmember has been -- not yet. >> still working on it. >> i'm sorry. i spoke out of turn so we're working on that, and an update on the training. our next training from the education committee will be on also april 10 and this time instead of the bethany center it will be at the institute of aging and 130 to 4:00 o'clock. our site visits we continue to do that. the staff was -- rich gave us a new listing update,

the sites that we will continue to visit and we have our sites visit form in place, so hopefully at the next commission meeting i will be able to report on the site visits we're under taking. >> thank you. >> that's my report. thank you. any questions? >> yes. i heard the points for the white house conference. i want the name of the four points -- you mentioned quite a few times. >> so the four points are economic and retirement support and security -- economic and retirement security. there's elder justice is a key -- one of the four points. long-term care, integration and services and supports is the third and the other one i am blanking on. do you remember what it is?

>> oh that's enough. you mentioned more than four points. >> okay. thank you. >> thank you. >> next we have the joint legislative committee report. diane lawrence. >> good morning. i wanted to start off with an action item from our march meeting. commissioner seriina asked if there was a new status felony created under the identity theft for seniors proposed legislation, and the current legislation has -- identity theft has one year penalty attached to it. the proposed legislation and the number is escaping me and extends that for anyone over 65 to two years so takes the current felony legislation on iernt theft and