>> if you -- this is not what you are looking at, leave the room, ok? [laughter] and the secretary call, do the roll call. [roll call taken] >> please note executive director is present. at this time we ask you silence all sound producer devices. >> motion to approve the agenda. >> so moved. >> seconded. done. new business. review of the data fiscal year

19- 19-20 and 20-21 budget. thank you, daniel. >> enough of a microphone? so, as we have done in past years, i will talk to the first part of our presentation and sharine will pick up and both answer questions. so, this is the first of two presentations, and this is really the one during which we set the ground work, we review the current year budget, we review the financial context in which we are making a new budget, and we acquaint you with some of the issues we are facing as an agency and as a department and to some extent, some of the issues we are facing as well, moving forward. then over the next two weeks we are going to finalize our

proposal and we will be back, i think it's on the 15th, to present our proposal and ask your approval on it. so, today's meeting is not an action item meeting, it's information that's preliminary to hearing our proposal in another two weeks. so, we typically look at our budget in three different ways. the first one is on the first slide and it is the way, it's the money that we have in the program, and we break it out by sources, and what you will see is that about a quarter of our budget in daas is funded by federal money and then we have labelled 18% as coming from state. now, state is a little more complicated because there are really three major sources of state money on this chart.

there's what's labelled as state, and then there's also 1991 realignment money and 2011 realignment money. and it's called realignment money because there were realignment laws passed in 1991 and 2011, and dedicate a percentage of the sales tax and percentage of the vehicle licensing fee on the state level to count these for social services programs. there are other programs that are nonsocial services programs realigned as well. public health programs, mental health programs, and in 2011, there were public safety programs as well. so, the portion of realignment we receive is social services realignment and it covers a number of programs in the human services agency.

most of them are on the department of human services side of the agency and they include cal works, cal fresh and eligibility and many of the child welfare-related programs. on the daas side of the human services agency, one big program realigned, that's the 1991 realignment of ihss costs. and 2011, most affected child welfare, but it also affected adult protective services. and so that's why we have a big slice of 1991 realignment revenue and smaller slice of 2011 realignment revenue, and they fund respectively a portion of the ihss program and portion of the a.p.s. program. so federal money, you know, goes

to find ihss administration, ihss health benefits. public service administration, a piece of the adult services program, contract mode program, and then there is time studying by a number of c.b.o.s which also draw down federal money under what's known as the county services block grant and this money, federal money that's available for connecting clients up with health benefits of various sorts. then we have another big piece of money, the general fund share, which is money that is primarily available for, well, a big part of it's available for the ihss m.o.a., a county

expense for the ihss program. and also money available for c.b.o. contracts. there is some money in the a.p.s. program. we have the dignity fund, in 18-19 was $47 million and if you remember the dignity fund started out with a base of $38 million and we added 6 million in the first year and then 3 million in the second year. year two is 18-19, to get us to the 47 million, and we will be adding $3 million a year for some time now. and then there is money that goes into the community living fund, and then there are small bits of other money as well. so if we go to the next view, it's the program view. and as you can see, daas is

comprised of a large number of programs, from an expense point of view are not usually expensive individually, and then it's got about 70% of its money in the ihss program, so sort of the bottom, the bottom 70% of this pie chart is really different pieces of the ihss program, starting on the right side from ihss contract mode, and then going through the ihss m.o.e., maintenance of effort payment, and then payments through the public authority to buy health benefits for ihss workers, and then an administrative cost for the ihss public authority, and then lastly, there's about $20 million in ihss program management. and those are primarily staff of

daas who work on the program. and then the next really big piece is the office of aging, which is where we have the lion's share of our contract budget, and a large portion of that $63 million is in fact dignity fund money. and then the third view is sort of what kinds of things are we buying with that money, and there again, you see that 65% goes to what we call aid payments and those are again, another way of looking at the ihss programs, so the money we put out the door that supports the ihss program is in this age bucket, and the only ihss expense that's not in this aid budget is money for the staff, ihss administration at daas.

you can see again we spend about $63 million on c.b.o. contracts. most of these are in the office of aging, some of this is in the c.l.f. program or long-term care operations. you know, and we have things in there like support at home and the rental assistance demonstration programs, but most of it is the office of aging programs that this commission spends a lot of its time looking at. and then of course, you know, the other big area that we have in here is essentially staffing, salaries and fringe benefits. ok. so, one of the things that the mayor's office and the controller's office and some extent the budget and legislative analyst's office

work together on each year is an analysis of the current law costs of city programs going out five years into the future. and this has a lot of uses. one of the, you know, one of the uses is longer term financial planning, and sort of understanding the larger city financial context. in the shorter term, we look at just the upcoming by -- bienium, between city costs and expected revenues and the budget making process is balancing that budget or bridging that gap in a way that delivers the best programmatic response for the city. so the way to read this is in

the budget year 19-20, we are anticipating a revenue increase from basic tax sources of $182 million. and we are also expecting expenditure increases that are larger than that by about $107 million. and in doing this analysis, the mayor's office and the controller's office break these cost increases into several large categories. the largest is salary and benefits. and city workers are mainly working, well, almost entirely working under contracts of one sort or another, and those are normally negotiated for a multi-year period. we are at a point now where negotiations are just commencing

for all unions except for police and fire. police and fire were renegotiated last year. so, in doing this work they have made an assumption that the salary increases in the new contracts will be equal to the c.p.i., which you know, may be right. and then the second big bucket is -- is baselines and reserves, and i think as we all know, the city of san francisco is ardent in its use of dedicated funds compared to, well, compared to every other municipal in california, actually. and so in daas, the big dedicated fund is the dignity fund. in another part of h.s.a. we

have a dedicated fund that supports childcare and there are many, many other dedicated funds supporting parks, supporting transportation, supporting programs for children, etc., etc., throughout the city. and so the point here is that when revenue grows, those funds all get a piece of that growth. so, in doing this, what the mayor's office and all are saying is we have $55 million that is going to go into city services. it's not going into the general fund, it's going into special funds of one sort or another. and then the next bucket is departmental costs and in the budget year, this is actually not an area of growing cost, it grows relatively quickly after that, being and about three fifths of the growth in the bubt over the long-term is the great

of the ihss program under current law. so, when you go to a meeting of c.f.o.s in the city you hear about every other minute that the ihss program is really driving costs in a big way, and everyone looks at me. you know, the point here is that the ihss program has gone through a number of different financing models. the most recent that has been enacted was sb-90 of 2017, and that shifted a lot of costs from the state to the counties, and really caused a rapid growth in the ihss costs in this program. now, we have done things locally, which i think we would all say are good things to have done, but they have also increased the costs of the ihss program rapidly, and those are around the minimum wage law and more recently, the minimum compensation ordinance.

i'll talk a little bit about those in a few more slides. but that's why we get mentioned so much here. and then the city-wide uses are basically various motions of inflation and capital investment that need to be made. so i guess the unbelievably short summary of the mayor's analysis is that revenues are growing slower than expenses and so when we look at each of the next five years, without different from what we are doing now, there is a growing deficit, that city workers are having salary costs grow and that's the biggest cause of those deficits. and, and then there are other decisions we have made to this point, which also cause deficits

to grow. so, basically we have what you would call a structural deficit. that's what people always use. so, that's where we start off and the question is what do we do to get into balance. and so we have all received instructions about reductions of general fund use. they are relatively small in the h.s.a., and these numbers are for all of h.s.a., not just daas. and typically when we balance the budget we do it across all of h.s.a. so, across daas, office of early care and education, department of human services, and h.s.a. administration, which is also a big expense area. but across all of those against our almost $1 billion budget are

19-20 target is about $753,000. so relatively small and then it doubles in the next year. and part of the reason our target is relatively small is we don't include dedicated funds in the base of funds which we take 2%. we don't consider outside revenues, federal, state, realignment, and don't include money spent on aid. so in the case of the daas budget, the general fund on the i.h.s. program are not part of the calculation. and this year we have been asked to identify a contingency reduction of a further 1%, which we will do.

so, we develop a budget, i guess -- i guess what i've said is obvious, or i'm about to say is obvious. because we have so much state and federal revenue, obviously the state and federal context is very important for us in building a budget. so, there are a number of concerns with regard to money from the federal government at the moment, and some of them are general broad economic concerns, you know, we have been in a "recovery" for ten years now. it's getting to be a very long time. and there's been good economic growth throughout that period. you know, we don't necessarily expect a recession like the last recession, but it's reasonable to assume that growth will slow at some point.

that's just out there. you know, the other things, the current administration is doing things that has caused a lot of volatility in the stock market, and may begin to have sort of general economic consequences so that's out there as well. more recently we have been looking at the impacts of federal shutdown. we don't really have serious impacts within the daas program. we have had two impacts within h.s.a. that we have been concerned about, and one of them is the impact on the cal works program. so far it's theoretical and re-authorized through the rest of the state fiscal year at least, so we are getting ready to worry about next fiscal year. with regard to cal fresh or food stamps, there was an impact

during the shutdown that just recently ended, and we ended up issuing food stamps much earlier than we would have. we pushed the issue in state up by 15 days. and the reason we did that is budget authority for food stamps ran out on january 20th. so, the state of california at the request of the usda issued early. now we have the government open 'til february 15th, and so as we get close to that date, if there's no resolution to the budget, the impending budget shutdown, we will probably have to issue food stamps benefits early again, which actually doesn't have a fiscal impact on the agency, but it's bad for our clients. when you, when they get a monthly benefit, two weeks or

three weeks early then it's got to stretch out over a longer period of time, which is confusing. that is not an issue at the present time for most daas clients, or any daas clients, really. it will become one as we move into, into the next fiscal year, i'll explain why in a moment. and then there's another federal issue that is also in another part of the h.s.a., but actually has a fairly significant fiscal impact in the long run, and that's the end of what we call the 4e waiver, i won't go into detail what it is, except it's a child welfare financing mechanism that ends on september 30th of 2019 and it has delivered to us about $4 million a year more than we would have gotten without it.

so, as it ends, that's a revenue source we don't have and we need to deal with it. and so that puts pressure on the whole budget. so, when we get to state concerns, the first item is really not a concern, it's a good thing. the governor, governor newsom has proposed a change again. this change is actually very beneficial to counties, and in san francisco we are estimating that this change, assuming it's enacted, will put us $11 million to the good in the budget year and $20 million in the budget year plus one. so, that's great. it's done in a combination of ways that are sort of technical

to the m.o.e., i won't go into them here. but -- but this is a good thing and this is the governor or the governor's office or both, reacting to huge concern from counties about the growth of costs of the ihss program. there have been a number of other things that are good news in the governor's proposal. he has proposed raising cal works grants rather steeply. we also have a new program that's coming online starting in june, which i think we are still looking for a better name for, but at the present time, we are calling it the s.s.i. cash out reversal. so, which is descriptive, but not catchy. the -- so, in california for 30

plus years, people who are on s.s.i. have not been eligible for the program that is currently known as cal fresh and once upon a time known as food stamps. and in lieu of that benefit, they have gotten an additional state grant of $10 a year. and what many people have noted over the years is, as the cal fresh benefits have changed, they would do much better being on cal fresh if they qualified for cal fresh. and we are estimating, there are about 42, being 43,000 folks in san francisco who are s.s.i. recipients, we are estimating about 13,000 of them will actually be eligible for cal fresh. and for those folks who are, they will receive an average grant that's probably around $80

a month. so, it's the difference of $10 and $80. not gigantic, but good to have. that change is going into effect in june, and the state has funded additional money for doing that eligibility work and working with those clients. as always in the state budget, allocated go up and allocations go down. most of them are tied to case load. so, money in the calworks and calfresh program, other than the s.s.i. cashout reversal are going down. medical going up, ihss admin allocations are going up. so there are puts and takes there. the last thing i would like to talk about before turning this

over to sharine, is ihss -- obviously an interest to us in paying a decent wage to ihss workers, we would like them to be able to live in and around the city, first of all. we would like them to think of this as a good job. we would like them to be able to keep doing the job. and because we have 20 thousandish ihss workers, any change in the wage has a very big fiscal impact. so, we have been over the last year going through a labor negotiations process and then that process bridged into a process of a new minimum compensation ordinance, which affects ihss workers, the largest fiscal impact on ihss, is from ihss workers, and also

c.b.o.s. and what the new minimum compensation ordinance says is that this friday, the ihss wage will go from $15 an hour to $16 an hour, and then in july it will go to 16.50, a year later to 17.50, and a year later to 18 and then after that, to 18.75, and it will grow with the c.p.i. after that. and so we are estimating that that will get the ihss wage to about a dollar 75 an hour above the minimum wage. which in san francisco is high, compared to other places. and then at the bottom of this chart we have estimated that this will cost the city $6.2 million this year and then another 7.3 million next year, because it affects the

ihss m.o.e. turn it over at this point. >> thank you, dan, for that overview, that's really helpful. and good afternoon, commissioners. as you know, this is usually the meeting, finance committee where we discuss kind of the budget instructions and as dan has talked about also concerns we have are just kind of things we need to be aware of as we are building the budget for next year and we like to talk about the highlights that we have with each of our programs and give you an idea of how many people we are serving and things like that. so, you can see from the, i guess i should go stand over there. should i stand over there? >> you want me to just -- >> or can you just flip the slide for me? >> you want the case load slides, right? >> yeah, thanks. >> thanks, dan. so, so basically you can see

from the case load slides that we are serving particularly i want to point out, in home supportive services and office on the aging, because those are kind of our two biggest areas that we serve people. we had 25, over 25,000 clients in fiscal year 17-18 for in-home supportive services, and we served over 34,000 people in the office on the aging in 17-18, so those are generally i think we estimate that we serve over 60,000 people annually, which means serving a quarter of the eligible population in san francisco that we could serve. and moving on to the next slide. so, adult protective services you know the mandate of adult protective services is to investigate allegations of abuse and neglect, including self-neglect. and a couple highlights here, biggest one here, landed a big

grant from the state called home safe, eviction prevention pilot program. department of social services at the state is providing over $770,000 over three years to really look to see if there are ways to really improve eviction waits for victims of abuse and neglect. and so we were really excited to get this and our team worked very hard to get the grant proposal, work closely with the department of homelessness and supportive housing to identify people who are in supportive housing at risk of eviction due to abuse or neglect,s and basically it helps us provide services, wrap around services for them through community living fund, so that we can ensure that they stay safely at home and do not get evicted. so a number of people, i know you have heard the stories, we

often have people that were, who are at risk of abuse or who are self-neglecting, having, they have behaviors that really don't allow them to live safely in the house, in their supportive housing environment, things like hoarding and hoarding behaviors and sometimes bedbugs and just general things that are not helpful for them, when they are living in a community environment like this. so this really allows us to work with them to prevent that eviction. so, it's exciting and we, a.p.s. has been doing a lot of that work but we have not really had a funding stream to really help with that support that's needed. so, this is going to be great. and of course, we'll be evaluating the program as we go along. in-home supportive service, one of the things we launched recently, and commission through our contract mode, contractor, which is home bridge, just to remind you, the contract mode is

for people who are really not able to manage their own worker but still need in-home supportive services. so, home bridge have been struggling with the ability to retain a work force. we think of them as really serving people who are very difficult to serve and of course, even with the increases in pay that ihss workers are going to get, it's a really difficult job. so home bridge came to us and said we would really like to have a way to pay workers more. so with our funding, they launched a program called steps, skills training and employment pathway, what that allows them to do is provide training to their work force and extra training, and then pay them 2 to $3 above the minimum wage. we are in the first year of this, and it's really a pilot. we want to see, does this really help with the retention of the work force, does it help with

quality, and evaluation will not come out until 19-20, just in the first year we have seen some promising results from this. so, we are hopeful that it will help retain that work force that is so important to us. and then moving on to the office of the public conservator, one of the things we have been working closely on with the mayor's office and the department of public health and some of the board members on the board of supervisors interested in this, helping to prepare the sb-1045 implementation. it was conservatorship bill authored by senator wiener and passed by the legislature and what it allows is for, it really helps people on the street who have, you know, behavioral health issues in tandem about substance abuse issues and not able to care for their own

needs. so, it's kind of another tool along with more traditional conservatorship that the city can use to, you know, help people get off the street, get the treatment that they need. and there is also a housing component. so, supportive housing ongoing for people who meet the criteria for sb-1045. a lot of work to do. the board has to accept it, to do it in san francisco, and then get the program up and running. so i think jill neilson has been working hard to get red for that. and the office of the public guardian, you know, conservatorship is really confusing to many people and one of the things we noticed when we are not getting referrals or the right kinds of referrals that we need, there really needs to be a lot of education with health care providers and hospitals that are making the referrals to our office so they better

understand how to get kind of -- how to prepare the referral correctly so we have all the information we need and so they really understand, you know, when somebody really meets criteria for conservatorship and when they don't, and just to get -- so people have education about, you know, other options as well. so they really understand how to get referrals and so we can accept them quickly and move people into the kind of care they need. so, that's something that we are working with a provider with to do some education out in the community, so we are kind of launching this seminar so that people in the health care community can really understand conservatorship and get correct referrals to us so we can do a better job of serving them more immediately than we can right now. moving to the next slide, community needs assessment, talking a lot about at

commission was completed last fiscal year and then our planning staff really did some deeper dives into some of the data that we had, specifically because we realize we wanted to look at communities with what we call equity factors, and whether people know about services, whether they are using them at the rate we think they should be given their proportion within the total population, and so we looked at communities of color and kind of looked at the data we had to see how well we were serving various communities of color, we know people from communities of color are using our services but separated them out, we saw there were differences. and so trying to, you know, understand that so that we can think about how we target our funding and how we target our work in communities to make sure

that we are serving people in the community, and people of color, lgbtq, and people with disabilities and caregivers, so gleaned a lot of information from that that we will use in our service allocation plan that we need to -- that we are developing right now and service allocation plan will guide our allocation of funding over the next four years. and for those of you, the two of you, who really like to read, i know you like to read the stuff that comes out of the department, we will be releasing a draft of the service allocation plan march 1st, looking through it, making comments, we need to make revisions and take it to the mayor's office and have the mayor take a look at it and all of that before we can actually

start implementing the allocation plan. so, there are still steps we have to take and with he want to get that out so the public can read it and make comments on it as soon as we can. so, march 1st plan to read it, it's a friday. office on the aging, we have done a few things with add back money. we got i think $2.8 million in add backs, i believe, or close to, yeah, about $2.8 million. primarily for increasing our meals programs, meals and nutrition program, so, home delivered meals and home delivered groceries did very well, and so we had that process, so experiment some time allocating those colors out to the meals providers. and then we also got some funding through the board to increase employment opportunities for older adults and people with disabilities. we also have the program that

called reserve, that fund community living campaign for and job subsidies for seniors and people with disabilities and are working hard with the non-profit communities to find job placements and do that, but we thought it would be a really good opportunity to work with them, and also to leverage the infrastructure that we have at human services agency through department of human services workforce development programs so we are now working with them to figure out whether they can serve older adults and adults with disabilities and also using community living campaign as the community provider to reach out to new adults and people with disabilities could benefit from their programs. so, that's an exciting thing for us. and then long-term care operations. we are in the evaluation process, looking at community living fund, program impacts and really trying to pay attention

to making sure that community living fund is really focussed on preventing institutionalization, and you know from the evaluations that we have done, that people who are in community living fund really tend to not go back in the hospital as much as people who, you know, as much as if they didn't have those services. we know those services are really helping people stay at home, living safely in community, which is exactly what we want from that program. its flexibility is great, it has case management, case managers are able to help people with other tangible services that they might need and set up their homes to make them safer get them extra meals if they need or extra home care if they need and it's been very successful in keeping people out of the hospital. we are also just completed the first year program evaluation report for the support at home program, if you recall, program aimed at people who have more

income than people on medical, don't qualify without a giant share of cost, and provides subsidies for home care and it's for people who don't need hours and hours of home care but a small amount of home care per week to help them remain at home safely, and this is a two-year pilot and so we need to wait until we see the second year evaluation. the first year evaluation kind of has some promising results, you know, suggesting that the program does help people stay at home safely. and then just the next page is really some things that we are working on and so age and disability friendly in 17-18, we had an aging disability work group that focussed on identifying strengths that the city has with respect to older adults and adults with disabilities, asset mapping,

what are we good at, what are we really good at in san francisco with respect to older adults and adults with disabilities and where could we improve, and what efforts are being done to tag on and say hey, you know, there's an angle for adults with disabilities and older adults here. we came up with 24 recommendations for the city to work on and implementation body led by nicole bon, disability director and kelly deerman who is the head of the san francisco public authority, and they are really kind of leading us forward to finish these recommendations and really there's some exciting work going on there. so you'll be hearing more about that when we come back to report on that. national health care decisions day is april 16th, and the san francisco palliative work group, which i co-chair, palliative

work group is interested and involved in creating some buzz around national health care decisions day. we are partnering with the libraries, so have events, a couple events at the main library, but we are also going to have events throughout the city at some of the branch libraries and ask some of the senior centers in various communities where we don't, are not partnering with the library that day to have advance care planning workshops to have some panel discussions maybe about thinking about preparing for death and chronic illness, you know, how do you handle that, you know, what do you want your choices to look like, you know. how do you plan ahead. and then we are also, we may be showing some films that day, so it's a national day and do something in san francisco. we want to do this well, and probably small, and then hope to do this every year in the future

and maybe build on what we do this year. so, kind of going for some small successes this year and hoping to build it into something bigger and with more communications and marketing focus in the ensuing years. dementia early diagnosis and intersection, working with the aging, optimizing aging collaborative to train staff in our department to, to recognize early signs of dementia, and then we have been working, and then you know, so trained and then report that to our clinical, what's it called, clinical and quality assurance unit so the staff can do follow up and help people get resources. that's something really exciting for us that we were not doing a few years ago and now trained a number of staff to recognize the signs. and then lastly on this page is

the reframing campaign. i have talked to you about that as well a few times, but still kind of plugging along with reframing. right now we are in the process of engaging a creative agency to work with us on messaging to the public and really saying, you know, using the language from the frameworks institute that kind of -- that, you know, shows positive images of aging and things like that, and just trying to figure out how we incorporate those messages into what we are doing in san francisco and two-pronged goal to make sure the public thinks about aging and not just like is getting old and being shut out and isolated and all of that. negative images we often see, but trying to get it so where, you know, we see hey, you know, this is something we all face and you know, how can we do it in as positive way as we can. how do we embrace it as part of life. the other prong of it is to really make sure that older

adults and people with disabilities understand that there are services here for them because one of the things we kept hearing in the community needs assessment forums and you know, throughout that whole process, was that people don't know where to go for services. so that's part of the marketing and communications work as well. >> so the last slide is, of course, a schedule, and we are here today and we'll be back in two weeks, and then a week after that we will be submitting our budget. and then, as you know, what really happens after we submit our budget, there are months are work back and forth between this agency and all other agencies and the mayor's office to figure out really what should go into the mayor's budget that happens by june 1st, and then the next six weeks is devoted to the board process, and in about the middle of july the board will pass a budget for the next fiscal year, and the fiscal year

after that. we do a rolling budget. questions for us. >> how much is the daas share of the ihss program? >> so, are you looking for a percentage of costs? is that it? or -- >> so, ihss is sort of complicated these days. before the world of m.o.e., for each hour of service provided there was a local share, a state share and a federal share. federal share was 100%. the state share was 32.5%, up to a cap, and the local share was

17.5% up to that cap. and then when the cost of wages and benefits were over the cap, the local share for the amount over was 50% and the federal share was 50%. when we instituted the m.o.e., happened back in 12-13, the way of doing this changed. and for a number of years the county share actually went down because counties were shielded from case load growth costs, and to some extent, shielded from costs per hour. certainly shielded on the medical benefit side, and in san francisco, because our wages were driven by minimum wage ordinance implementation, we were also shielded on the service cost side. then when sb-90 passed in 2017,

that changed that yet again and the local share started growing rather rapidly, and partly that was because higher inflation factors were put into effect and partly it was because we were no longer shielded from some of the cost increases as we had been in the past. so, if governor newsom's proposal holds, the rate of the growth of the county share will slow compared to what it's been. i'm not sure if that's a good answer to your question, but sort of the way i look at it. on the administrative side, it was also a sharing ratio which was affected by the implementation of the county m.o.e., and the new law basically sets us back to the old way of doing business. so, the federal share for administrative costs is 50%. the state share is 35%, up to a

cap, and the county share, obviously, below the cap would be 15%. and then when we exceed the state allocation, the costs become 50% federal and 50% local. >> yeah. because this is actually really the big portion of the daas budget, you know. >> it's actually -- >> in a way bigger than the budget would suggest because there is a big ihss cost that is paid with several and state money that doesn't hit the daas budget at all, and that is the federal. >> pass-through. >> the federal and state share of ihss independent provider wages. and i think we estimated earlier today because i had a feeling this question might come up, that that is about $325 million. so, it's actually a huge additional amount of cost for the ihss program that's born by

the federal and state governments, but doesn't hit the daas budget. >> thank you, dan. thank you, sharine. comments and questions. daniel in the materials you submitted you said one of the ways that we would be making up the projected shortfall was to tap additional revenue sources and we have been doing that very, very well over the years. which new revenue sources have you found that you think you'll be able to tap? >> well, so, i should say at this point that three of the staff will work on the budget. emily gibbs is the budget director, and principal budget analyst, and -- one of the things we do, and we do this

between now and, and february 21st, is work on a balancing strategy, where we are looking at all of the revenue sources and looking at ways that we can push them as hard as we can aggressively. one of the things that we are, you know, hoping after this year, that -- counties come in -- [inaudible] >> thank you. sharine. i have some questions and comments as well for you.

one, on palliative care, last year a documentary was made called "the end game" and was shown at the castro theater and nominated for an academy award for best short subject documentary, and it's a very, very good film, and perhaps you can get i hold of the documentary and show it around to help people understand what palliative care is and how different it is from hospice care. the two tend to be confused. >> they do, that's right. and we actually talked about showing that film that day, so, that's a possibility. >> and u.c.s.f. has made palliative care a separate division. five years ago started out as a chair, and growing very talented doctors into the palliative care field. >> yes, they are. >> a couple of other things. sb-1045, glad to see passed, did any funding come with that, any

state funding? >> no, no funding came with that, and actually considered a pilot this year, only certainly counties got written into the legislation. a movement for clean-up legislation which would take away some of the current barriers built into the legislation and also probably expand it to other counties. and certainly there's been some advocacy from counties to get funding for public guardian conservator administrator work. there is no state revenue stream for that. there is some, i guess going to be a request from the public guardian administrator conservator association fo the state for funding for these services, i'm not sure where that will go. it's been difficult in the past to get any state money for these programs, but we'll see how it works. >> thank you. and then regarding step and home bridge and the additional wages

to be paid, i recognize how difficult the challenge is to retain, get workers and retain workers. will these salaries as they increase, how will they compare with what the ihss workers are getting, and will that create a conflict or tempt ihss workers to work for home bridge. >> right now we are still evaluating how this is going to work, is it really going to keep people working at home bridge if people are getting a couple dollars more. we have had the retention issue for a while. but i think our thinking around this is that many of the home bridge workers are not necessarily family members as most ihss providers are, right? and again, the people who are

served by home bridge are often some of the most difficult people to serve that we have. and so i don't know, you know, if we got people going from other jobs into home bridge, i don't think with he would see that as a bad thing. we definitely want t keep that work force very vibrant and active and engaged and you knee, if they are people who want to work there, that's a good thing. so, i would not see -- and mainly because they are family providers, probably not a huge number of people would be jumping ship from their family to go work there. >> and then the various programs that we have aimed at keeping people in their own home safely, do we fund any programs that make physical changes to their environment. >> we do. >> so if they have stairs, or provide stair steps or things like that to help them stay at home. >> we do, we do it through complunts living fund and also the city funds, rebuilding together san francisco, not through us, but through another

department, and they do a lot of that work as well. so, we do. >> finally, you mentioned earlier that it appears that we are serving about 25% of the eligible population, and how did we arrive at that number, eligible simply in terms of their age or age and resources and income? >> no, just age and disability. so, if we are thinking about there being 200, you know, 225,000 people with disabilities and older adults in san francisco, serving about a quarter of them. >> we don't know if they would be eligible. >> don't know -- don't know if they would need our services. a number of people probably don't, or may later. it gives us. >> ballpark. >> we know we are serving, doing very well at serving people who have limited income. so, you know, when we look at --

we are looking at a quarter of the total population but know we are doing very, very well in serving people who have a limited income, or living in poverty and so it's way beyond that quarter. >> traditionally a big problem with the population that has more resources than would make them eligible for programs, and yet have real fiscal needs. >> right. >> it's important to realize when we look at things like personal assistance services, big problem, ihss program, very definite, hard limits in the program and there are many people who have slightly more resources than would allow them to be made eligible. and it's not as if they can really fund their home care themselves. >> thank you. >> i have a couple of questions for sharine. in the memo, on page five, you

said at the top, provide 2.2 million home delivered meals and almost 1 million congregate meals. i thought congregate meals should be a larger number than home delivery. i don't know. i'm just asking a question. >> you think there would be more because it's a lesser intervention? >> i thought that more people would, the congregate meal would be more than the home delivered. the population is smaller. >> right. i know. i guess not. i mean, i think part of it is we know, you know, only certain places people can get congregate meals. some of the home delivered meals also do two meals, so that might factor into the actual number of meals, people are getting one meal, right, going for lunch -- >> the only thing i figure out, usually the home delivered meal,

especially for the meals on wheels, they deliver two meals. so -- >> that would double, right. so, yeah. >> and sometimes caretakers are allowed to get home delivered meals if it makes it easier for the client to complete, to eat, so sometimes maybe three meals. >> right. >> i haven't thought about that one. the other question i want to ask is the national health care decision day is just one day. event, the whole week, or just one day? >> i think we are planning on the one day. we talked about both, the week and the day and at this point we are talking about most things happening that one day, which is april 16th. >> thank you. thank you very much. >> thank you. we will see you in two weeks. >> any public comment?