>> commissioner? commissioner and chair katie loo? commissioner tedi vriheas? commission wallenberg? can i have a motion to approve the agenda. >> so move, seconded. >> moved, second. so we have the business list the consideration and possible action regarding the proposed budget for fiscal year 2018-19 and 2019-20. thank you. >> are you in control? >> i'm in control of the -- >> ok. >> here we go. for the record, for the record, i'm dan kaplan.

i am the deputy director of the human services agency for administration. and i guess i'd like to start off by talking about our process and where we are in the process and then we will go into the substance of this presentation. so, the department of aging and adult services is of course part of the human services agency. and the human services agency has within it a sort of a large support staff area. it does a number of things, but one of the things we do is we develop the budget for the agency, of course, we do that in cooperation with shireen mcspadden and deputy directors like cindy and joe, and program directors throughout the agency.

and we do it with a budget staff and emily gibb and tiffany wong are two of the members who have worked on the daa is budget this year. we reach out to the program offices throughout the agency to ask them to identify areas of new need, changing regulation, changing law. changes in the patterns of consumption of services. and then potentially innovations to make in program areas. and we collect all of that. we begin to analyze it, we begin to cost things out. and then we do this in the late autumn typically. we start then. and then in december, right at the beginning of december typically, the mayor's office

provides budget instructions and the mayor's budget instructions typically are based on forecasts of city revenues and city expenses. and they are sometimes based on special areas of focus that the mayor wants agencies to take. those agencies, those areas of focus often tend to be at the instruction phase, very broad. and you know, in the mayor's office gets to specific things that the mayor is actually interested in him or herself as we move through the process. and then at the beginning of january, what happens is the governor issues a budget. and the governor's budget is very important to us, because of course, a great deal of our funding is federal, a great deal is state and the rest is local. so the state budget that comes out in the second week of january typically helps us

refine our notion of the revenues we'll be working on. and because the hsa is an agency that comprises three operating departments, our budget and the money availability is really affected by what is happening in a whole bunch of different areas. i will come back to the one that is the largest impact on daas during this presentation, which is changes in the ihhs program at the state level. but you know what happens in the cal works program, in the cal fresh program, what happens in the medi-cal program have influence on the amount of money that hsa has to work with, which effects the budgets in each of

the operating departments. at this point, we've seen the governor's budget and we're really at the point in the process where we are trying internally to fit together a budget proposal. and so, this is the first of two meetings we're going to have. this one is one that we hope to set the context and talk about some of the things that are affecting the budget and then when we come back in several weeks, we will be sharing with you what our actual proposal to you is for the daas budget. and then we'll make that proposal sometime after that. probably a week after that. and then we will go into a long period of discussion, with the mayor's office, about what the shape of the hsa budget and its operating departments' budget are for the next year.

and then the mayor will propose a budget herself on june 1st. so then we'll go into the board phase. so, if we can -- just to describe the daas budget. we're going to describe it three ways. the first way we typically describe the budget is we call it sources. that seems to be the san francisco term, but it's really where does the revenue come from? and as you can see, the daas budge is comprised of a number of slices.

working our way around the pie chart there -- >> can you repeat that, the last point? >> to the federal revenue is primarily associated with, or what is in this slice of federal revenue is primarily associated with the ihhs program or the adult services program. there is another little pot of federal money i'll talk about in a little bit. >> sure. thanks. >> the state money, the 60.5 million dollars, is money that also supports ihhs program, primarily. and that is, you know, parts of the ihhs program so the health benefits, contract mode costs,

and daas staff and public authority administration. we call realignment too. this is a little bit perplexing in the context of daas alone. the realignment revenue source at the state level, refers to a series of revenues and program responsibilities that were realigned from the state to count these. it happened on two occasions, one in 1991. and in our descriptions of the budget, we call that realignment one. and then the second one is realignment two. which is what appears here in the amount of $4 million. that occurred in 2011. and what realignment does, it says to counties, you are responsible for a set of costs. but we're going to create a revenue stream for you.

and that revenue stream for both realignment one and two, is largely sales tax money but to a smaller extent vehicle licensing fee money. and those two streams of money are combined and then they are allocated out to counties on a formula. and the formula for realignment two, 2011, was set at the time of realignment based on state revenues, allocated to each county. and what happened over time, is the amount of sales tax that flows into the realignment pots and vehicle licensing, these are grown. so our revenue from that source has grown over time. but we get the same percentage that we did from the beginning. so, the 2011 realignment program

that is in daas is adult protective services. and so we have what is in essence sales tax and vehicle licensing fee money that would offset what would have in the past been the state share of adult protective services costs. so at this point -- or in the current fiscal year that's about $4 million. ok, then we get to federal, state and local grants. this is mainly area agency on aging federal money. so under the older americans act, there are a set of programs that in this county or this city are administered through the office of aging. the city of san francisco has added a great deal of local money to sort of the standard list of older americans act

programs, but those older american act programs exist in every county. and every county gets allocation for there is a pot of money we

call general fund aid. that is money that funds the ihhsmoe. i'll come back to that later. there is general fund operating money which is fund staff and professional services within the department and then there is what is called work order recovery and the term work order recovery in san francisco means money that is paid to an agency. in this case daas or hsa, by another agency. in this case the department of public health. and this amount represents the historical general fund share of the ihss benefit program. one of the things that we do,

just to sort of take a side step about the ihss program, the ihss program has a number of major components. we pay wages to ihss workers. and we have in our budget an amount of money that approximates the general fund share of that. we pay for the staff that administers the program. we also pay for the contract mode services and we pay for health benefits for independent providers. and any given time we pay 12,000ish independent providers health benefits. and we pay that through a contract that we have with the ihss public authority who then buys services through a provider of health care. so what the department of public

health does, they work order to us the amount of money that is equal to the general fund share of the cost of the health benefits. this is a second view of the budget. this is sort of the cost side of the program. so if we start at the top, you can see again, we have the office of aging at $53 million. these are -- for the most part, there is a small amount of staff in the office of aging, which is -- whose costs are here too, but the lions share of this slice of the pie is made to

community organizations that provide services to elderly or disabled within city of san francisco under daas's various programs. then we have lots of other slices of the pie. so again, i think you're familiar with all of these, but we have a program support group which is staff and intake, and ir, within the daas program we have the community living fund program. we have the adult protective services program, which as you know, investigates and intervenes in cases of abuse or neglect for elders and people with disabilities. and then we have sort of going in the other direction, we have the representative payee.

and then the bottom -- i don't know -- two-thirds to three quarters of the pie is ihss in one form or another. so we have the ihss consortium, we call it here. which is really a contract we have with an organization called home bridge. we've called it that for a long time. there actually used to be an entity called the ihss consortium, but now it's home bridge. this is contract mode ihss services. we have independent provider wages or the ihssmoe. this is a payment that we make to the state of california which then covers the cost of wages to ihss workers and pays for them through its payroll system. we have the public authority which administers the health

program -- health benefit program for independent providers and then maintains the registry. handles collective bargaining for ihssi providers and advocacy services. and then we have the ihss county staff. so these are the major components of the daas budget. and you know, as you can see, a great deal of it is associated with the ihss program, which is a program that serves 20,000 clients. and has 18,000-ish independent providers and the home bridge program in it. i.o.c.

>> this is a focus of a what categories we spend to. character is a category of expenditure. and you can see some of the major categories on the sheet. a big piece of what we've got here are called aid payments and these are payments that support again the ihss program, it's our moe payment, public authority payment, our benefits. to ip workers in the contract mode. then there are contract services which are cbo services. this is mainly what comes through the office of aging and the clf program. there is a small materials and supply budget. there are some work order services where we buy services from another agency. there is the salaries and

benefits of the staff of daas. and then there are some professional services that we buy, which you know, clf falls -- some services fall under there. some computer programs that we buy. some dignity fund consulting services. so that's a mix of services that are not direct client services, but they are services that support the operations of the agency. so those are three angles on what the daas budget looks like. >> maybe before you continue with the 18-19, i wonder if any of the commissioners have questions? on 17-18, that was then just

presented, any questions? >> i do. just one minor question. on the sources portion of the presentation. the state money. do you have a sense of where that is coming from, the source of it? just taxes? >> so, yes, i mean their federal taxes, state taxes and on the local level, they are property, business, hotel taxes. so it's really those basic sources. >> very good, that's it. >> thank you. any comment from the public? hearing none, we continue. >> ok. so changing our focus to 18-19.

so as i said at the beginning of this, the city does a forecast and it's actually part of the five-year forecasting process that gets updated on a regular basis. and you know, we do that as a city for purposes of being financially responsible. we say in essence what is happening with our costs? we have a bunch of labor agreements. we pay for employee benefits. we make pension contributions. weer looking at -- we are looking at increases, or some cases not increases, in social services benefits costs. we are looking at the operations of our public health system. we are looking at the operations of our parks, et cetera, et cetera. and so we look to the future. and we say, so what is happening on the cost side? and then we make an economic forecast on the revenue side. and you know, one of the

purposes of that is to allow us to say, are we likely to be able to cover our costs going forward? and so, what happened this year and happened in many years in fact, we say, ok, we are a little bit out of balance. we've added a lot of staff over the time since the last recession. we have labor agreements that, i don't know if you call them generous, but they're what they are. so we know what our cost growth is going to be going forward. and you know, we have information about the economy and we can make a look at what our revenues are. and we can estimate a gap. so, to this work -- this work is done in cooperation between the mayor's budget office, the controllers office and the budget and legislative analysts

offices. and basically what they have estimated at this point is that we will see a revenue increase in the upcoming year of $190 million. and we will see an expenditure increase in the upcoming year of $278 million. for a gap of $88 million. and then if we don't do anything about that, that gap will grow in the budget year plus one, and i didn't include the budget year plus two and the budget year plus three, but the gaps grow even more. i think we get up to about $700 million four years out. and so what will happen obviously, is we will collectively do things to eliminate that gap, because we need to put together what --

with high probability -- will be a balanced budget. there are things that could happen on the tax side and there are things that could happen on the expense side, there are things that could happen in terms of maximizing revenues. so, agencies are asked to look at all those things and some of those things are done centrally as well. so, the mayor's office typically then says, ok, so if we're going to close the gap, how much of this do we want to come from agencies? and what they've said this year is, we basically want about 2.5% to come out of every agency's discretionary general fund budget. so for hsa, it comes to $1.3

million. that's a relatively low number and the reason it's relatively low, there are a few fairly big pots of local money at the hsa that are in set-aside fund. so they're not discretionary in the sense they can't be used for anything but those particular set-aside fund purposes. the large one in daas is the dignity fund, which as i said, this year, was $44 million and that has to be used on a set of services that are in the legislation for it. and the amount is fixed by the legislation as well. and then we have a childcare fund which is a set-aside in the office of early care and education and typically we don't include aid money or entitlement money in the calculation. so it's really the remaining

general fund money within the hsa budget that is subject to the calculation. so in summary on that, as i said, revenues are growing slower than expenses. and an important thing to think about, too, there are some cost areas that are growing relatively rapidly. and one of the cost areas that is growing relatively rapidly in the city is the ihss program. so i will come back to that as well. so for now, we have a target to reduce general fund costs by $1.3 million in the upcoming budget year. and by a further $1.3 million or a total of $2.6 million in the budget year plus one.

we've also been directed by the mayor's office not to grow our head count. as i said before, head count has grown a lot since the end of the recession. now, for good reasons. but it has grown a lot. and part of balancing the budget, or part of the strategy for balancing the budget that the mayor's office has directed is not to grow city staff more. so what that means for us, in essence, when we're building the budget, we have to look at our agency head count and say are they in the right place? do we have not enough in some place and can we shift people from other places? are they in the right classifications? can we take a position that we don't need as much in one area and shift it to another area?

that's part of the process that we are going through right now. but we are working very hard on having a budget proposal that doesn't add staffing. and then of course, the third point is to maintain client services which we will also do in whatever proposal we come up with. just to mention, we obviously build budgets based on local concerns, state concerns, and federal concerns. so, when we look at the federal budget at this point obviously with the current administration, we have seen a lot of thrashing around about programs that might eventually affect the work that we do in daas and we do in the hsa and other parts of the hsa.

at this point not much of anything has actually come through, but i think there are obviously last year, we had a huge amount of discussion about the affordable care act and medicaid expansion, that didn't result in changes which is a good thing. this years at the end of 2017, we had quote unquote, federal tax reform as you know. which will open up a large hole in federal revenue over a 10-year period. and the extent to which congress will have to balance that might affect a number of programs that are important to our clients. and you know, we have the potential for welfare reform, which would certainly affect the

program which in california is the cal works program. we have a farm bill for reauthorization over the next several months. part of that is the snap program. supplemental nutrition program. which in california is the cal fresh program, or food stamps more generally known. we have the medicaid program which is very important to many of our clients and certainly to all of our ihss clients. we have the medicare program which is important to many -- well not all, but most of our daas clients. so those are out there and you know, there are risks around all those things with the current administration. we also have a set of concerns that come from the state budget. so as i said, in the state

budget, we have seen some impacts in the cal works program. which in this case, probably reduce our revenue by about $1.5 million. it's not a daas program, but as i said before, all of the hsa programs are to some extent connected by their general fund. so if we lose revenue in one place, we have to figure out what we're doing there. and if we're that increases the need for general funds in the program. that's how these are all affecting each other. think we're losing a little bit of revenue in the cal fresh program, probably about $3-400,000, not huge, but not nothing.

we also have issues, ongoing issues around the ihss program. and the good news is we've seen some improvement in 2011 realignment revenue, which offset some of the other losses. so let me talk for a moment about ihss. so, at the end of the 2017 legislative session, the legislature passed senate bill 90 and that really significantly changed the way that the ihss program is funded. and so let me take a step back and talk about how it was funded over the period from 2012

through 2016-17. so, basically what happened in 2012 session was that governor brown proposed a new program that would integrate physical health, mental health, and long-term services for californians. and would ultimately develop a cap tated payment for all of those services. this is a complicated sort of program affecting upwards of half a million people in the state. and the state's plan was to roll it out in a series of waves. the first wave was meant to include eight counties, of which san francisco was not one. but at the time the bill was put together, counties said, well,

if there is a cap tated payment, the people who are receiving that cap tated payment will have a great incentive to make more use of in-home and in-community care and less use of more expensive nursing care. and counties said at that time, that's a good thing, but we're on the hook for the cost of in-home care and we're not on the hook for the cost of nursing facility care, so this will be a shift in cost to us. and the state said, yeah, that's probably right. so you probably don't like that idea as counties. so we're going to agree to a maintenance of effort payment instead of a county share for in-home supportive services. and the terms of the maintenance of that payment were these. take a look at what counties

actually spent in fiscal year 11-12 on in-home supportive services and grow it by 3.5% a year, and if counties negotiate changes in wages and benefits from the unions representing independent ihss providers, then there would be an adjustment to take that into account as well. and ultimately, what is going to happen is counties will start to become coordinated care initiative counties and as they do, responsibility for labor relations will shift to the state and so counties will just pay an additional 3.5% a year on top of their ihss. and so we went along for a number of years under that general set of rules. and what happened was the state said, we are actually absorbing

more and more of the costs of the in-home supportive services, because the case load side, the number of hours of service being delivered are growing faster than 3.5% a year. and so, this past legislative session they did a computation and they said, originally, we are estimating that we have picked up $623 million of what would have been county costs under the previous way of funding the ihss program and we'd like to go back to that way. and counties said, 623 is a lot of money to absorb, especially all at once, we can't do it. and so throughout the session, there was conversation about how do we handle this situation? and we, california, ultimately came up with a compromise.

which is not great for counties and probably not great for the state in the short run. and the compromise was this. that the additional cost that the state said would have been county cost will get rebased to the counties and will be part of their maintenance of effort payment. but in the first year, the state will offset that amount by $400 million. and in the second year, the state will offset that amount by $330 million and then going forward, the state will offset the amount by $150 million a year. but the state also said, we need to increase the rate of inflation of the maintenance of that payment. it used to be 3.5% a year, and the state said, ok, so we need to go to 5% inflation in 18-19.

and then to 7% inflation each year after that. and that's more in line, they said, with what the growth in the ihss program has been. now, there were two other things that happen that really affected san francisco and only san francisco. and this is the change in the law, two changes in the law. one related to wage increases that occurred as a result of of minimum wage ordinances, local minimum wage ordinances. and the previous law had said, the moe would only be adjusted upward on negotiated changes. as you know in san francisco we had a minimum wage ordinance that increased the wage of all workers, but ihss workers among them. and when those wage increase happened, we said we didn't

negotiate these, these are actually part of a local ordinance passed by the voters and whereas we think it's a good thing that the wage is going up, we didn't negotiate it. and we shouldn't be responsible for it in the sense that it shouldn't affect the moe. and we prevailed on that argument so we didn't pay an increase on the moe based on the minimum wage ordinance. the other thing the original law didn't have was anything in that would trigger changes in the moe based on changes from contract mode cost. if you look at contract mode hours in san francisco, they represent between 2-3% of the total number of hours delivered. they tend to be provided to the highest-needs clients, the clients who have the most difficulty self-directing and

have the least family and friend involvement in their cases. but they're a very small number of the whole. san francisco hat largest contract mode program in the state. so statewide, contract mode is a very small piece of the whole. it was not addressed at all in the original legislation. so the new legislation addresses changes in contract mode costs as well. so those two changes have a big impact in san francisco and nowhere else. when we built the 17-18 budget, all of this was kind of in a time where the impacts were not really clear. and the mayor's office working with the hsa and daas decided to add money to the daas budget to pay for what we assumed would be increased costs in the ihss

program. and we added $7 million of city general funds to the program and we added some additional realignment money because we believed, this turned out to be true, there would be a shift of realignment money from public health agencies to social services agencies to partially offset cost increases in ihss. so there was an addition of $11 million in total to the daas budget. when we got the final rules -- we don't really yet have the final rules -- but when we got the rules that have been developed, it became clear that a larger share of cost increase was going to come so san francisco. and so this sheet that you have on here, describes a supplemental appropriation that the mayor's office proposed and that the board approved for the

ihss program. so in total, we incurred about an additional $10 million of costs because of the last minimum wage increase. we incurred about $10 million of costs because of the rebasing of the maintenance of effort and the shifting of close to $600 million of maintenance of effort costs to the counties. we're anticipating picking up about $3.7 million in additional costs for our share of the minimum wage increase that happened last july. we're anticipating $2.5 million of additional costs associated with rising costs in the

contract mode program. because there are now caps on administrative costs, we think that a good estimate is $3.7 million of additional costs that will come to the city for the administrative part of the program. so all of that together comes to about $20 million of additional costs, and as i said before, the mayor's office at the time that we were building the budget anticipated that we would have extra costs and added in $11 million, so the amount that was appropriated in the supplemental appropriation was an additional $8.8 million. so to make a long story short, we underestimated the impact of senate bill 90 on san francisco and in the supplemental appropriation, we added enough money to cover the actual costs of the program. one of the things you should note about the changes in the

ihss program is they actually have nothing whatsoever to do with the services that clients get. so clients are eligible for service in exactly the way they were before. the number of hours of service that are allocated is done exactly the way it was done before. this is all been a discussion about what share of the nonfederal costs does the state pay and what share of the nonfederal costs does the county pay? anyway, that's the ihss program. we will incur additional costs next year. the minimum wage is going up again on july 1st, it goes to $15 an hour, so ihss providers will be paid $15 an hour and in subsequent years it will rise with the cpi, so that should be

additional 40 to 50 cents a year delling on what the -- depending on obviously what the cpi is. that is a good thing to raising wages of ihss workers, but there is impact on the costs in the budget that will be felt in subsequent years. i want to turn this over to shireen to talk about program changes and program accomplishments. and then we can take questions and talk a little bit about schedule going forward.

ok, that's better, thanks. good morning chair loo and members of the finance committee. so one of the things that we don't have usually in the first hearing is all of the level of detail in the budget that is going to go to the mayor. so it's a good opportunity to hear about some of the things that dan and his team are working on and get the level of detail they have so far, but it's also a good opportunity to talk about what we're doing with the dollars in the daas budget. so i wanted to take a little bit of time to talk through a few things, just to give you an overview of what we're doing in the various programs, what the case loads look like and other initiatives we're working on.

the first slide is daas case loads. so, i just want to start and go through the programs here. but i want to start by saying that daas serves close to 60,000 clients annually. which is about a quarter of the city's older adults and people with disabilities, adults with disabilities in the city, so 25% and we think impressive. adult protective services received 7400 reports of abuse and neglect in 16-17 and that was 25% increase over the last five years, which is alarming on one hand because the numbers are going up, but it's a good thing because we're doing good outreach to let people know to make reports. county veteran service office is located at 2 goff, which is great because it brings our services together so when people

come in together for services for veterans, it's also a good way for them to link them to other services, also if they come in for other services first and we find out they're a veteran, we can link them to the veteran services. we worked with 2800 clients and filed 5700 claims and helped clients access $4 million in retroactive benefits. in-home supportive services. we have 25,300 unduplicated clients in the program, which is amazing. san francisco has the highest penetration rate, so the number of people receiving ihss per population is highest in san francisco. higher than any other county. on average, clients get 98 home care hours per month. in the private market that's $3,000 per month benefit, so we think that's amazing, too.

it's amazing what ihss does for people in san francisco. moving onto daas integrated intake and referral. we received about 20,700 calls last year and completed 14,000 intakes, home delivered meals, adult press conferencetive services. the office on the aging, we have about 34,000 clients in the programs. as you know office on the aging is the office that contracts with most of our community-based organizations. that's where most of that work happens. and we had almost 10,000 more unduplicated clients than five years ago in office on the aging. that means a growth in some of what we call our main stay programs like congregate meals and community service centers, but it's because of new services, home delivered

groceries and connected. >> director mcspadden: so, thank you. so, just highlights of what we've done in the programs, adult protective services, we have the high risk unit. i think jill nielsen who is the deputy director but was head of aps envisioned it being able to help with eviction prevention. we have a lot of people at risk of eviction because of unhealthy behaviors they have. and our staff are able to get in and work with them if necessary to help them figure out ways to alter those behaviors so they can stay at home. one is hoarding. we have staff who are really trained well and able to work with clients to make sure that they're able to live at home

safely, mitigate some of the effects of -- some of the dangerous effects of the behaviors they have so they're not at risk of eviction anymore. in-home supportive services. ihss social workers are now screening all clients for food insecurity and referring to food resources as appropriate. this is something that we didn't do until recently. and it's been really helpful. to date over thousand clients have been enrolled in the home grocery delivery program. it's another way of getting food into households. as you know, department of aging and adult services takes nutrition services seriously. it's the biggest part of the dignity fund. third of it. this is another way to ensure that people get the food that they need. public conservator.

in our community independence project which basically allows them to be on a conservatorship, but still live in the community. we have 47 clients enrolled, 18 active. so conservator -- do you know what that is or means? ok, so then i don't need to go into detail about that. we have a new process where we're working to collaborate with other departments, department of public health, police, the district attorney attorney, and the public defender to think about ways that we can create a better and more seamless system for people, so they don't fall out of the system before they get to the conservatorship that they need. so we're going to be embarking on a new process where the departments are going to come together to discuss cases, peoples' cases to make sure they're really getting served

the way they need to get served and we're not giving up on them before they get the treatment they need. public guardian is revamping the intake and referral process for new clients. this is really important. we've been informed often by hospitals in the community that it's really hard to access that program and they don't know how. so we're trying to make the program more accessible by making the process of intake easier for people. and we're hoping to see an increase in referrals because of that. and then lastly, on this slide, we've also embarked on mobile work. rolling out mobile work for our staff. we started that with adult protective services. we're following with the in-home supportive services. one of the reasons for that, these are staff already out in the field. many of them live out of county, so when they're able to be mobile, when they have a laptop and phone and they're able to work mobile-y, [laughter], then

it saves a lot of resources for the department and saves a lot of stress for staff. you know, keeps them from having to fight traffic from coming in and they're able to do things differently that way, so that's the tuesday noon warning. [sirens] >> moving onto the next slide. so dignity fund, i think everyone knows because we've been talking about this a lot. we allocated the first $6 million -- oh. fighting with the voice outside. we allocated the first $6 million of the dignity fund in this fiscal year. we had expansion of current services and six new requests for proposals of community services. caregiver respite, lgbtq, life planning. technology at home and veteran services.

we have $3 million coming up in the next fiscal year in dignity fund dollars and will be working with the oversight and advisory committee of the dignity fund to allocate those dollars. i think we've been talking about this frequently, but just a reminder we're working on the community needs assessment for the dignity fund. we have retained rda associates. and they're the consulting working with us. we have done 11 forms, community forums, one in each district. we had over 550 at those forums and had 63% older adults and 35% non-english speaking in the participants of those forums. we did survey online, paper and phone and we had over 1300 surveys completed. approximately 70 of those were consumers and about 30% were

providers. and then we had 30 focus groups targeting specific populations, for example, chinese-speaking populations, veterans, faith-based communities. case managers. we had several focus groups with people with disabilities. and others. and then currently rda is working on an equity analysis. which will be evidence-based and take a data driven approach, including identifying equity factors, utilization rates for each factor, identifying resource allocations by district and since sizing those to find needs and gaps. the report, what they're going do do is put together a report for us, needs assessment report and that with will help us start with our formal allocation, service allocation plan that will be completed every four

years. we're going to -- this is a four-year process. we'll be doing the $3 million allocation with the current needs assessment we have, but the needs assessment will help inform the dignity fund allocation process starting the following year. so that will be 19-20. next slide. thanks, bridgett. so i just also wanted to mention -- got lost a little -- know, i want to go back, i skipped one of my pages here. back one more. so i talked about dignity fund, but didn't talk about office on

the aging and one of the things we're doing is enhancing performance measure to focus on outcomes, making sure we're understanding what the impacts of our services are on the people that we're serving. any of that sounds obvious, but it's actually complicated and it means we have to think about the resources we're giving our contractors. you know, whether it's technology, whether it's person, power they need to make sure they're tracking the things we need to know about. and it means asking the right questions, so it's a process every time we do it. one of the things we've taken on over the past couple of years is case management and it's really been interesting. it's been an interesting learning process for the department to go through that process and think about what do we need to know and how do we really understand the impact we're making on people? we also -- we use this information also to think about how we allocate funding.

one of the things we've been able to do i guess in the last year with the nutrition request for proposal, we were able to look at the impact we had on people and start thinking about allocating those dollars a little bit differently and you probably remember we talked about that when linda lou came and presented on the nutrition contracts we had. and then in long-term care operations, we launched the support home pilot to serve older adults who have functional needs tore home care. those unable to buy home care on the private market. and then because that's a pilot, we also have engaged ucsf to conduct a formal evaluation of that program. now we can go to the next slide. so, add