>> good morning and welcome to the commission of aging and adult services. good morning again and welcome to the commission on aging and adult services commission meeting. could we have the roll call. >> president ed that james. >> present. >> vice president gustavo seriina. >> here. >> commissioner katie loo. >> here. >> commissioner samer itani. commissioner ow. >> present. >> commissioner roy. >> present. >> and please note that secretary badasow is present.

>> please note that we're going to table the nominating committee and could we have approval of the agenda with that change. >> so moved. >> second. >> it's been moved and seconded that we approve the agenda as printed except item 3 the nominating committee report. all in favor? >> aye. >> aye's have it. next item approval of the consent agenda. >> so moved. >> second. >> it's been moved and seconded that we approve the consent agenda as printed. all in favor say aye? >> aye. >> opposes? the motion is carried. can we have approval of the march 4 meeting minutes except that we have a change there commissioner katie loo had a change in the minutes which

says --in. >> should be congresswoman. >> okay. could i have a motion to approve the march 4 meeting minutes with that correction. >> so moved. >> second. >> it's been moved and seconded that we approve the march 4 meeting minutes with the correction. all in favor say aye? >> aye. >> opposes? the aye's have it and the motion is carried. public comment. you have three minutes. general public comment at this time. any general public comment? three times. moving on. thank you. reports. employee of the month. department of aging and adult services commission and executive director anne hinton

will recognize renee beaupre legal assistant for the public guard an, public administrator. [applause] >> [inaudible] >> oh it's both. we're both going to get it right now. congratulations. >> thank you. >> for those that have been to one of the commission meetings before this is an opportunity to honor renee because the staff she works with nominated her for employee of the month but it gives me a chance to talk about the wonderful work that you do in the context of the programs that you're involved in which are the public guardian and the public administrator. is that correct? >> yes. >> so well first of all who is

here from those two programs? you need to stand up and wave your hand. there you go. [applause] for those that don't know the work that renee does and her colleagues is all about serving people who can no longer serve themselves in the best way possible. it's also serving people that have died and need someone to follow through with what their wishes would have been if we know that, but frequently we don't know that so staff in these departments are constantly searching i think i like to say who this person was; right? because we might not have known them before they came to us so it's a lot of work that the people in the department do, investigation, digging deep, trying to understand someone,

trying to find family trying to do all these things so that's a huge piece that hamgz in the programs but the other piece is what i call the "i" dotting and what you're responsible for and making sure that every dollar is accounted for, that expenditures are made in the most appropriate way. this is the handling of someone else's estate and dollars and assets in a way that we want someone handling ours and someone that doesn't know us and in this case we do that, so it's important as all that front end work do and the work that you do renee and you're just wonderfully described in this short paragraph -- not limited, but short paragraph says you're smart and talented. you can be counted on which of course is extremely important in the work that you do. she prepares the

accounting for program programs and it says that you're thorough and accurate and colleagues seek your guidance and you seek answers to questions that seem impossible to answer and given the outline i gave you you can understand how it's difficult but it gets done so congratulations. i believe we have a gift for you. like to give these and you really get to read what people said. it also said she's very calm and i am thinking that is another good quality to have doing this work so on behalf of commission thank you and i think we need a picture while she's back there already taking pictures. marianne an are you getting one?

>> thank you very much. >> you're welcome. [applause] >> >> well thanks again renee for your hard work because it's sometimes lonely out there doing that kind of work. next we have the director's report, executive director anne hinton and we welcome back. >> thank you. thank you. so i was in chicago last week for the american society on aging conference and primarily was there because i was asked to do a presentation with kate hopkey

from the san francisco foundation on the public partnership that we have with the villages here in san francisco. the session went well. it was parked with people really interested in the work that gets done in san francisco and i think truly a lot of comments about how innovative san francisco is in its supportive programs like the villages but also the innovations that we participate in. i had the opportunity to meet at the conference with foundation folks from different foundations around the country and again i heard from people from other states about what is happening in san francisco. it was a great foundation to smooth away foundation support for activities going on in our community. the other thing that became an opportunity thanks to

marie jobling and community living campaign was to meet with a counter part at microsoft the civic engagement person. they're a member of the technology council that has been formed in this city, and so we had this opportunity to meet with the woman there who is a counter part to one of our members here and really talk about what they have done in chicago. interestingly enough they want to learn from us as much as we want to learn from them because we have taken different roads and opening technology paths to members of our communities so that was pretty exciting and on the last day there was a three hour session on social and health disparities in nonwhite populations of older adults across the country and it was enormously interesting as there were at least three panels of folks who spoke specifically on specific populations of people,

some of whom you're familiar with. a researcher from washington state who did a lot of work in the city related to lgbt seniors was there, a woman from san francisco state showed about research she oofs doing related to asian pacific islanders. someone we don't know but who had a very interesting presentation and i think partly because there is so little done in this area with native eskimos and native americans and hawaiians so that was interesting for me. there was a call to action at the end of that session around poverty and these social determinants that are such a problem within certain communities, and so that was actually quite interesting and hopeful in a way. i think there surely will be pressure for next year to be at the beginning of the conference so

it sets the tone during the week instead at the end of the conference. there was a fair amount of conversation in different sessions about what really can be done to educate -- especially older americans around the things happening in congress that seem to be a threat to things like social security and medicare and medicaid, and president james i think you will be very interesting there is an activity going on right now -- i believe it's in the senate side -- no, it's the house, to form a committee and made up of republicans and it's to look at social security and try to fast track major changes in the plan. there will be no public input to the process. it's just what it is. now i have to say knowing how congress works and things have to make the way to the president and there are checks and balances i have to say it to myself i don't believe this

could happen. on the other hand i think we have seen any number of things happen like major impact to adult day health here in the state, sequestration, the lost of funding for nutrition and other programs and it makes you wonder what might be in store so i think for those of you that don't know president james is quite a speaker when it comes to promoting social security, not just for would r older adults but thinking about our children and their children and whether the program will be there for them or not and again i think it's a call to action for us in our community about how do we make sure that people understand what is happening and what's possible, both the good and the down side of that. cathy greenly the secretary was also i was able to get to a session she spoke in and i

think one of the things that captured me about her comments is where she talked about longitudinal solutions and i think of that when i think of some of the work that we do here in san francisco. we know so much now about mental health and hospital starts in younger agents and we see examples of that. >> >> cluttering and hording is inn an example of that and abuse she was talking about and could start at earlier ages and that was one session and she was right on the mark in the call to action how do we hopefully think about these programs and services and the people who eventually come to our attention and are served by them. the primary part of my report today though is going to be a presentation on the work that the palliative care strategic

planning group did. excuse me. when i was in chicago i think the snow and the cold i had a really good voice. now i am back with no rain and i can hardly talk again so bear with me. you may remember my mentioning some months ago that a gentleman the then hospice came to speak to me about what was going on and not going on in the world of palliative care in san francisco, and what was to happen within the next few months the san francisco health department and the department of aging and adult services were doing things and staff support was brought in and we both had staff and its was a lot of work and today i'm not going to present part of that

presentation except to set the stage for you because dr. christine ritchie is here and christine if you would come up that would be great. we were co-chairs of the palliative care task force. christine is with the department of medicine at ucsf in the division of geriatrics and center on research of aging and works at the jewish home -- san francisco jewish home. i have to say we only had i think five or six meetings. the first one was only two hours. after that they were three. we set these meetings up so 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