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California Master Plan for Aging Long-Term Services and Supports Subcommittee Meeting #10

March 10, 2020

Captioners Transcript (2:51pm – 3:54pm)

... GRETCHEN, WANT TO DO -- THAT SOUNDS GREAT.

>> WOLF. THANK YOU, EVERYONE, GRETCHEN, WITH THE SCAN FOUNDATION, I'M DEEPLY HONORED TO BE ON THE RESEARCH SUBCOMMITTEE FOR THE AGING PROCESS. I'M HAPPY TO EBB JOINED BY GOAL ONE COLLEAGUES, KATHY LINE, KATHY AND DONNA. WE WILL GO CRUISE OUR TEAM. MY JOB TO SETO GIVE YOU AN OVERVIEW WHAT WE HAVE BEEN UP TO AS A RESEARCH SUBCOMMITTEE, HOW WE THOUGHT ABOUT THE PROCESS. WE RECEIVED A LOT OF QUESTIONS ABOUT HOW WE'RE THINKING ABOUT MIRRORS, AND DIFFERENT WAYS, AND WE NEED TO TAKE REFLECTION TIME. WHAT'S THE INTENT LAID OUT IN THE EXECUTIVE ORDER, AND THEN PUSHING BEYOND THAT, WHAT IS THE SPIRIT OF WHAT OUR, THAT WILL SERVE THE MASTER PLAN PROCESS NOW WELL AS WELL AS THE MEASUREMENT OF PROGRESS OVER TIME AT YOUR ONE, YEAR THREE, OVER THE TEN YEAR WIDOW, HOW DO WE THINK ABOUT WHAT THE MOVEMENT IS IN WAYS THAT GETS US TO ADDRESS THE GOALS OF THE MASTER PLAN AS WELL AS THE, HOWEVER THE RECOMMENDATIONS MAY EVER COME OUT ULTIMATELY AT THE FINAL MASTER PLAN DELIVER IN OCTOBER? WE'RE MINDFUL THAT OUR COMMITTEE SUCH AS YOURS, SUCH AS THE SAC, ARE DEEPLY ROOTED IN ADVISORY COMMITTEES, TO ULTIMATELY, THE CABINET LEVEL WORK GROUP. OUR GOAL IS TO GIVE AS MUCH DIRECTION AND HOW WE THOUGHT ABOUT THE PROCESS, AND A SAMPLE SET OF MEASURES. WE ARE DELIVERING THIS TO YOU ALL OF THE IT'S A MEASURE OF FRAME SET THAT'S FOR ALL THE GOALS, NOT JUST GOAL ONE. AND I WILL LAY OUT CONSIDERS AND I'M HAPPY TO TAKE REAL TIME QUESTIONS BEFORE WE GO INTO SOME OF THE RECOMMENDED MEASURES THAT FIT UNDERNEATH THE GOAL ONE BANNER. BEFORE I START, ANY CLARIFYING QUESTIONS IN THE ROOM OR ON THE PHONE? ALL RIGHT, WE WILL JUMP IN. GOAL ONE, PARTICULARLY FOR THE CONVERSATION TODAY, WE'RE FOCUSED ON GOAL ONE, AND I DON'T NEED TO ARTICULATE ANY OF THE DETAILS ON THAT. WE THINK ABOUT MEASURES RELATED TO BOTH OBJECTIVES IN THE GOAL. GOAL ONE, THINKING ABOUT THE LTSS SIDE, THAT CONNECTS WITH THE PERSON AS WELL AS ON THE FAMILY CAREGIVERS END.

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MOVING FORWARD, WE THANK YOU FOR THE OPPORTUNITY TO PEEK AT THE GREAT WORK YOU'VE BEEN DOING THOROUGH THE PROCESS SO WE CAN BE MINDFUL OF THE CRITICAL OBJECTIVES THAT ARE PART OF THE REPORTSREPORT WE REVIEWED EARLIER. NEXT SLIDE, THE RESEARCH COMMITTEE BEING WHO WE ARE, PEOPLE WHO SIT INSIDE THE ROCH WORLD, THOUGHT ABOUT THE METHODOLOGY OF BRINGING FORWARD IDEAS FOR KRIS. WE THOUGHT ABOUT THE NUMBER OF RECOMMENDATIONS COMING OUT OF THIS GROUP, WHICH IS VERY VALUABLE, AND THOSE WILL BE SERVED UP TO THE CABINET LEVEL WORKER FOR CONSIDERATION AND THEY WILL MOVE FORWARD HOW THEY SEE FIT. OUR CHARGE IS ABOUT MEASURING AT THE GOAL AND OBJECTIVE LEVEL FOR THE MASTER PLAN AS OPPOSED TO MEASURING AT ANY PARTICULAR RECOMMENDATION AT THIS POINT. THERE MAY BE DIFFERENT PERSPECTIVES ON THAT BUT WE FELT WAS THE MOST PRUDENT CHARGE TO MOVE FORWARD IN TERMS OF WHAT WE'RE SEEKING TO DELIVER TO THE CABINET LEVEL WORKERS. THAT'S GETTING TO THE SPIRIT ABOUT WHERE ARE WE MEASURING AT, AND I WILL GO TO THE LAST POINT FIRST. SOMETHING WE USED AT THE SCAN FOUNDATION, WE THOUGHT ABOUT THE DIFFERENTIAL BETWEEN WHAT'S A PERSON CENTERED MEASURE. HOW DOES SOMEBODY'S LIFE ACTUALLY IMPROVE IN VARIOUS WAYS AS OPPOSE SYSTEM DRIVERS THAT ARE KEY CONTRIBUTORS TO MOVING THE MEASURE FOR THE PERSON? A PERSON LEVEL CORE MEASURE MIGHT BE SOMETHING, USING SOMETHING DENINE, DOES MY WELL BEING IMPROVE, HOWEVER I RANK THAT, OVER TIME. IT'S TALKING ABOUT ME, MY PARTICULAR REFLECTION AND WE WOULD TAKE EVERYBODY'S SENSE OF WELL BEING THROUGHOUT THIS MEETING AND PUT IT AS AN AVERAGE THAT. WOULD BE THE WELL BEING MEASURE OF THIS GROUP OF PEOPLE IN THIS ROOM, AS OPPOSED TO, WAS THERE SNACKS, THE TEMPERATURE OF THE ROOM, WAS THERE GOOD ENOUGH LIGHT IN THE ROOM? THE MEASURES THAT ARE ABOUT THE SYSTEM ENVIRONMENT, HOW WELL DID ZOOM WORK, THOSE KINDS OF MECHANICS OF THE SYSTEM FRAME THAT ALLOW FOR HOW PEOPLE PERCEIVE THEIR SENSE OF WELL BEING. SO WE THOUGHT A LOT ABOUT THAT DISTINCTION. AND BEING CLEAR ABOUT THAT IN TERMS OF OBJECTIVE ONE, PEOPLE GIVING THEIR -- AS WELL AS THE EXPERIENCE OF THE FAMILY CAREGIVER. THEN, THAT MOVES US TO THE PLACE OF SAYING WITHIN THE SPIRIT OF PERSONAL LEVEL CORE MEASURES, HOW WE DEFINE IT, VERSUS SYSTEM DRIVER MEASURES, THINGS THAT FACILITATE THE ENVIRONMENT. WHAT ARE THOSE MEASURES THAT EXIST TODAY OR WILL VERY SOON THE SABLING. KATHY LINE WILL TALK THROUGH THOSE IN THE CALIFORNIA HEALTH INTERVIEW SURVEY. WE WILL TRYING TO ACCURATE AND FREE IN THIS DISCUSSION THERE. ARE THINGS AVAILABLE NOW THROUGH THAT INTERVIEW SURVEY, THINGS THAT WILL BE SOON BE AVAILABLE TO REPORT OUT ON. WE DID NOT, IN THIS CONVERSATION, INCLUDE ANY MEASURES IN WHAT WE CALL THE LAND OF DREAM, THAT WE

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WISH WE HAD THAT MEASURE AND PUT IT ON THE DASHBOARD. THIS IS FOR 1.0, ABOUT WHAT EXISTS TODAY. THAT'S VERY IMPORTANT. CONTEXTUALIZE, WE'RE MEASURING AT THE GOAL AND OBJECTIVE LEVEL FOR MASTER PLAN, LOOKING AT PERSONAL LEVEL AND SYSTEM DRIVER MEASURES THAT EXIST OR WILL SOON EXIST. ANOTHER EXAMPLE IS, WE TALKED A LOT ABOUT THE SCORECARD THAT AARP NATIONAL DOES. THERE WILL BE A 20 14-6D 20 SCORECARD ON JUNE 25, NORPGHT THE MEASURES FROM THAT FRAME. MOVING TO THE NEXT SLIDE, TO GIVE YOU A SENSE OF ALL THE AMAZINGLY SMART PEOPLE WHO PROVIDED CONTEXT TO THE RESEARCH SUBCOMMITTEE ABOUT VARIOUS WAYS TO THINK ABOUT, YES, LYDIA, THAT WAS QUITE A DAY GETTING YOU THERE. WE HAD A LOT OF INCREDIBLE INPUT FROM REALLY THOUGHTFUL FOLKS FROM ALL SORTS OF PERSPECTIVES ABOUT MEASURES THAT EXIST TODAY. TOUCH POINTS ACROSS ALL THE GOALS, WE WILL BRING FORTHED IDEAS TODAY ABOUT IDEAS FOR MEASUREMENT FOR GOAL ONE. ONE WONDERFUL THING THAT CARRIE AND KIM AND TEAM HELPED ORGANIZE FOR THE SUBCOMMITTEE IS BRINGING THOUGHTFUL PEOPLE, HOW TO MEASURE LARGER LEVEL FROM, THE EXPERIENCE OF PEOPLE AND SYSTEM DRIVERS AND THE INTERACT BETWEEN THE TWO. IT'S BEEN AN AWESOME EXPERIENCE. I LEARNED A TON THROUGH THE PROCESS, AND ALSO, WE HAVE BEEN, WE HAVE AN INCREDIBLE PARTNER WITH THE DEPARTMENT OF PUBLIC HEALTH AND -- THIS V BEEN REALLY VALUABLE. VERY LUCKY TO HAVE GREAT PARTNERS. WE CONTINUE TO HAVE THE PARKING LOT WHAT ARE THE THINGS WE WOULD LOVE TO MEASURE AND WHAT WOULD BE VALUABLE TO HAVE OVER THE TEN YEAR WIDOW AND HOW TO THINK ABOUT THE CONSTRUCTION. THOSE ARE IDEAS WE WILL SHARE TODAY AND IT WILL BE PART OF THE LARGER REPORT. WE'RE NOT JUST FOCUS AGO WHAT WE HAVE. WE'RE SEEKING A VISION TOWARDS ADDITIONALLY WE COULD MEASURE OVER TIME. SOME OF THAT WILL BE VALUABLE IN TERMS OF THE FEEDBACK, FROM THE GROUP AND THE TFNING PROCESS, AND ALSO THE GET LEVEL WORKER, HOW THE MASTER REPORT COMES OUT AND HOW WE WOULD MEASURE THOSE RECOMMENDATIONS. THAT'S TOP OF MIND FOR US. NEXT SLIDE, OUR JOB IS PROPOSE A VERY SMALL SET OF EXISTING MEASURES FOR A DASHBOARD 1 POINT 0, YOU CAN SEE I'M SETTING AN EXPECTATION WITH YOU, THIS IS A VERY SMALL SET. THE SPIRIT IS THAT YOU BEGIN MEASUREMENT WITH WHAT YOU HAVE IN A WAY THAT'S CLEAR AND DEFINABLE, KNOWING WE WITH ALWAYS GROW. WHEN WHAT WE HAVE NOW IS A SMALL SET OF MEASURABLE INDICATORS. NOTE, KATHERINE WILL SHARE A PROPOSED SET OF MEASURES WE MAPPED UP AGAINST THE FIVE OBJECTIVES THAT ARE IN YOUR REPORT. WE WANT TO MAKE SOME SYNERGY BASED ON ALL THE WORK YOU DID. YOU MAY DISAGREE AND SWITCH THAT AROUND, WHICH IS OKAY. WE'RE OPEN TO LOTS OF FEEDBACK. IT'S IMPORTANT TO CONSIDER HOW YOU THOUGHT ABOUT THE OBJECTIVES. NEXT SLIDE, DATA SOURCES,

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YOU WILL SEE PRIMARILY A COUPLE IN THIS PRESENTATION TODAY, BUT CONSISTENTLY ALIGNED WITH THE MASTER PLAN FOR AGING GOALS AND BEING, REALLY THOUGHTFUL ABOUT THAT CONTRIBUTION ABOUT POPULATION LEVEL DATA VERSUS PROGRAMMATIC DATA. PLEASE, KNOW THAT FOR EVERY MEASURE, ESPECIALLY THE PERSON RELATED MEASURES, ABOUT PEOPLE'S EXPERIENCE, ARE, OUR INTENT IS THAT THERE'S AN OPPORTUNITY TO DISPLAY THE INFORMATION IN ALL SORTS OF WAYS YOU POSSIBLY CAN, NOT JUST STATE OF CALIFORNIA, BUT WITH ALL OF THE APPROPRIATE KIND OF EQUITY LENSES WE TALKED, AND WE WILL SHOW SOME OF THOSE. WE THOUGHT ABOUT MEASUREMENT IN TERMS OF DIFFERENT WAYS TO THINK ABOUT THE CONSTRUCTION OF AGE FOR A MEASURE, BUT IF YOU'RE WONDERING WOULD WE DO IT BY RACIAL STATUS, SEXUAL ORIENTATION, ABSOLUTELY, TO WHAT'S AVAILABLE BY DATA. WE HAVE A GREAT RESOURCE IN THE CALIFORNIA HEALTH INTERVIEW SURVEY THAT ALLOWS US TO DO A LOT OF DIFFERENT CUTS. TO THE EXTENT THE DATA ALLOWS, WE WOULD ASK, WOULD PUSH FORWARD THAT VISIBILITY FROM ALL SORTS OF ANGLES. THE SPIRIT OF THE MEASURE IS ABOUT, IT IS DIRECTIONAL, SO YOU KNOW THAT UP MEANS SOMETHING, VERSUS DOWN. AND MAYBE YOU CAN SEE THAT, SO THINK ABOUT DIRECTIONALITY MATTERS, AND YOU CAN MEASURE CHANGE THERE. IT'S NOT JUST ABOUT A MEASURE THAT'S, A FEW OF THE -- VIEW OF THE LANDSCAPE FROM A PERSON LEVEL MEASURE. BUT IF YOU CHANGE THE SYSTEM DRIVERS, EVEN IF THEY WEREN'T DIRECTLY MEASURED, YOU'D SEE IMPROVEMENT, WHATEVER, MAYBE IMPROVEMENT MEANS HIGHER NUMBER OROR LOWER NUMBER, BUT YOU'D KNOW CLEARLY WHAT IMPROVEMENT MEANS FOR PEOPLE, TAKING INTO TO THE SPIRIT OF 9 MASTER PLAN. WE ALSO TOOK THE IDEA OF AGING, CALIFORNIANS, VERY SERIOUSLY, MEANING THIS IS NOT ABOUT A PARTICULAR AGE 65, IT IS ABOUT THE EXPERIENCE OF AGING ADULTS IN OUR STATE AND THERE'S DIFFERENT WAYS WE COULD CUT THE DATA IN CIRCUMSTANCES TO GIVE PROFILES OF DIFFERENT POPULATIONS. ALL THIS TO SAY, WE THOUGHT A LOT ABOUT THE INTRICACIES, AND ARE HAPPY TO SHARE MORE AS WE LOOK AT ACTUAL MEASURES. IT'S BEEN IMPORTANT TO TAKE A PHILOSOPHICAL FRAME AND APPLY IT AS WE LOOK AT CREATING RECOMMENDED MEASURES ACROSS EACH GOAL SO CONSISTENCY IN WAYS WE'RE PUTTING FORTH HOW WOULD THE STATE MEASURE HOW WELL WE'RE DOING. I WILL TURN IT OVER PARTICULARLY TO KATHERINE AND KATHY, TO TALK ABOUT OBJECTIVES 1.1 AND 1.2, AND THEN TURN IT OVER TO DONNA. AT THE END, WE WILL PROVIDE SUMMARY COMMENTS AND RECOMMENDATIONS. KATHERINE, TAKE IT AWAY.

>> THANK YOU. GREAT TO BE HERE AND MEET EVERYBODY IN PERSON, KNOWING YOU'VE BEEN TOILING AWAY AND IT'S GREAT TO HAVE THE OPPORTUNITY TO BRING THE DATA PIECE TO YOUR ATTENTION AND TAKE INSPIRATION FROM ALL YOUR WORK. GRETCHEN, KATHY, DONNA, HAPPY TO

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TALK ABOUT WHAT WE CAME UP WITH SO FAR. GRETCHEN, GREAT JOB OF PROVIDING THE FRAMEWORK, THIS IS A STARTER SET. I DON'T HAVE TO SAY IT'S 1.0. BUT BOTTOM LINE, THESE ARE REALLY INITIAL RECOMMENDATIONS. WE KNOW THEY'RE SUBJECT TO CHANGE, ADDITIONAL STAKEHOLDER INPUT AND WE EXPECT THAT, BUT WE HAVE A STARTING POINT AND A TEMPLATE THAT WE CAN WORK WITH, WITH THE DIFFERENT GOALS. I GET TALK ABOUT CONCRETE MEASURES, WHICH IS FUN. OUR FIRST WHAT WE'RE CALLING PERSON CENTERED CORE MEASURES, REFLECTS A PRIORITY TO GET A BETTER HANDLE ON OR UNDERSTAND THAT THE SCOPE AND PREVALENCE OF CALIFORNIANS WHO HAVE LTSS DIFFICULTIES, WITH DAILY ACTIVITIES. THEREFORE, WE RECOMMEND A MEASURE OF REPORTED DIFFICULTIES WITH ROUTINE CARE NEEDS, WITH CONCENTRATION AND DECISION MAKING, AND REPORTED DIFFICULTIES WITH PERSONAL CARE NEEDS. ROUTINE CARE NEEDS CORRESPOND GENERALLY WITH ACTIVITIES OF DAILY LIVING LIKE CLEANING, COOKING GETTING TO THE STORE AND DOCTOR. AND THE PERSONAL CARE NEEDS ALIGN WITH ACTIVITIES OF DAILY LIVING, PERSONAL CARE, BATHING, DRESSING, AND BY PUTTING THEM AS A COMPOSITE MEASURE WE CAN GET A MORE COMPLEX MEASURE OF THE DIFFICULT. NOT JUST SOMEONE WITH PERSONAL CARE NEEDS. THEY MAY HAVE COGNITIVE AND PERSONAL CARE NEEDS AND SO ON, SO WE RECOMMEND A COMPOSITE DIFFICULT SCORE. THEY'RE ASKED, 40,000 PEOPLE WITHIN, OVER A TWO YEAR PERIOD. THE QUESTIONS WILL BE ASKED AGAIN IN, CURRENTLY BEING ASKED IN THE SURVEY, AND WILL BE ASKED AGAIN IN 2023-2024. WE WILL HAVE A ROBUST SAMPLE TO GENERATE STATE WIDE ESTIMATES, LOOK AT REGIONAL DIFFERENCES, IN TERMS OF THE LEVEL OF DIFFICULTIES THAT CALIFORNIA ADULTS, 18 YEARS AND OLDER. MOVING ALONG TO THE NEXT, AS IMPORTANT AS IT IS SO IDENTIFY THE DIFFICULTIES, IT'S ALSO VITAL TO UNDERSTAND THE UNMET NEEDS. WE'RE ALSO RECOMMENDING A COMPOSITE UNMET NEEDS SCORE AND THIS IS USING DATA FROM A FOLLOW UP SURVEY TO THE CALIFORNIA HEALTH INTEARKS A 15 MINUTE FOLLOW ON FOR PEOPLE WHO SCREEN POSITIVELY FROM THAT FIRST SET OF DIFFICULTIES QUESTIONS, THEN ASKED TO PARTICIPATE IN THE FOLLOW OPEN, IN THE FIELD, A NUMBER IN THE ROOM WERE PART OF THAT PROCESS. I'D LIKE TOE CALL THAT OUT. AND DEVELOP THE QUESTIONS, AND VERY QUESTIONS WE'RE TALKING ABOUT. IT'S DESIGNED SPECIFIC TO GET INFORMATION FROM THE CONSUMER PERSPECTIVE GOING BACK TO THE PERSON LEVEL MEASURES, ABOUT PEOPLE'S EXPERIENCES WITH NEEDS FOR LTSS, UNMETS NEEDS AND THEIR USE OF SERVICES.

>> I WANTED TO OFFER A PERSPECTIVE ON WHY A COMPOSITE MEASURE, AND WHY BUILD ALL THIS INFORMATION TOGETHER INTO ONE SCORE. THE SPIRIT OF THAT IS YOU CAN ALWAYS AGGREGATE IT. EACH OF THESE ITEMS, PER CENT OF ADULTS WITH UNMET ROUTINE CARE NEEDS IS ONE MEASURE, SAME WITH PERSONAL NEEDS, THERE'S, EACH ONE IS ITS OWN DISTINCT

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LINE. IF YOU WANT TO SEE THAT PARTICULAR ITEM, IT'S ALWAYS AVAILABLE BECAUSE IT'S COMING OUT OF CHIS. THE SPIRIT OF A COMPOSITE MEASURE IS THAT WE SEE THE DASHBOARD, MEASUREMENT DASHBOARD, AS BEING A REALLY PERSON FRIENDLY DOCUMENT. IT'S NOT ABOUT THE RESEARCH UNIVERSE TALKING TO THE RESEARCH UNIVERSE, IT'S ABOUT USING DATA AND CONVERTING IT INTO INFORMATION FOR POLICY MAKERS, FOR STAFF, NEWS MEDIA, LOCAL LEVEL PLANNING. IT'S TRULY TAKING THE INFORMATION AND MAKING IT ACCESSIBLE. AND IF WE THINK ABOUT THE BROAD UNIVERSE OF FOLKS OUTSIDE OF ALL THE EXPERTS PARTICIPATING ON THE PHONE, AND IN PERSON, MOST PEOPLE KIND OF JUST WANT TO HAVE A SENSE OF HOW MANY ADULTS HAVE THIS KIND OF NEED. THEY CAN ALWAYS GO DEEPER, CAN GET BACK TO THE INDIVIDUAL LEVELS. BUT THE DASHBOARD IS A CHECK ABOUT HOW WELL CALIFORNIA IS DOING. BY BUILDING COMPOSITE MEASURES, BECAUSE WE KNOW, MOST PEOPLE DON'T JUST HAVE DISCRETE NEEDS, THERE'S DEFINITELY PEOPLE WITH PERSONAL CARE NEEDS, AND, OR ROUTINE OR COGNITIVE IMPAIRMENT NEEDS. SO, THIS IS ABOUT SHOWING A PICTURE ABOUT HOW FOLKS ARE DOING AND BEING ABLE TO BENCHMARK, AND GET THE NEEDS ADDRESSED. PEOPLE MAY HAVE NEEDS, BUT THEY MAY BE ADDRESSED BY SUPPORT AND SERVICES IN THE PRIVATE OR PUBLIC DOMAIN. SO WE'RE TRYING TO SHOW THE PICTURE ABOUT HOW CALIFORNIANS ARE. SO IS IT, IT'S ABOUT SERVING FOR MESSAGING PURPOSE. SARAH, IF YOU HAVE A QUICK QUESTION?

>> OKAY. WELL SAID. THE NEXT MEASURE WE'RE RECOMMENDING IS LOOKING AT THE EXTENT TO WHICH PEOPLE WITH LTSS NEEDS REPORT THEY'RE GETTING THEIR NEEDS MET, WHETHER COMPLETELY, SOMEWHAT, NOT AT ALL MET, ET CETERA. IT'S NOT JUST DO YOU HAVE UNMET NEEDS. IT'S, IF YOU'RE GETTING SOME SORT OF ASSISTANCE, WHAT'S THE LEVEL, DOES IT MATCH WHAT YOU NEED? NEXT, ALSO IMPORTANT TO UNDERSTAND THE SEQUENCES OF UNMET NEEDS. WE'RE EXPLORING THAT BY TAKING TOGETHER A SERIES OF QUESTIONS IN THE LTSS FOLLOW ON SURVEY, SEQUENCES, LIKE NOT GETTING OUT OF 9 HOUSE, GOING WITHOUT BATHING, ET CETERA. THE NEXT SLIDE, OUR OWN -- EVALUATION -- GENERATED THESE RATHER STARK AND INFORMATIVE METRICS OF THE CONSEQUENCES OF UNMET LTSS NEEDS. THAT'S JUST TO GIVE YOU A REAL DATA EXAMPLE. THANK YOU, CARRIE. FOR THAT.

>> TALKING QUICK, YOU HEAR PEOPLE TALKING ABOUT UNMET PERSONAL CARE NEEDS OR ROUTINE NEEDS. WHEN YOU GET INTO THESE QUESTIONS, ASKED OF PEOPLE WITH THOSE NEEDS, IT GIVES A PICTURE OF WHAT IT LOOKS LIKE TO LIVE WITH THAT. IN THE LAST TWO MONTHS, DID YOU NEED A BATH AND COULDN'T GET ONE. 57% OF PEOPLE WITH UNMET NEEDS IN CALIFORNIA ACKNOWLEDGED THAT WAS HAPPENING THEIR LIFE. IT'S ALSO REALLY ACTIONABLE TO HAVE TO BROKEN DOWN LIKE THAT A. OKAY,

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PEOPLE HAVE UNMET NEEDS. WHAT DO WE DO, TO ADDRESS THAT? OKAY, THERE'S THIS MANY, 20% OF PEOPLE GO WITHOUT GROCERIES, A SPECIFIC ACTION YOU CAN TAKE FOR THAT. IT GETS DOWN ACTIONABLE DATA THAT CAN BE USED FOR PROGRAM DEVELOPMENT. THAT'S WHAT I LIKE ABOUT THESE QUESTIONS.

>> THEY'RE REALLY POWERFUL QUESTIONS. SO, IN ADDITION TO PERSON LEVEL DATA, THE POWER OF GENERATING THIS POPULATION LEVEL DATA, GOING BACK TO THE SYSTEM DRIVERS, WE ALSO NEED TO KNOW ABOUT THE SERVICES, WHO THEY'RE SERVING, WHAT PERCENTAGE OF THE ADULT POPULATION IN CALIFORNIA ARE GETTING IHSS, ARE GETTING OCCUPANT BASED ADULT SERVICES. I'M TRYING TO DEACRONYMIZE A MINUTE. NEXT, AGAIN, WE LOOK AT, MEASURES OF SYSTEM DRIVERS, WE SNEEZE TO KNOW WHAT PROGRAMS ARE AVAILABLE. THESE ARE EXAMPLES OF PROGRAMS, NOT AN EXHAUSTING LIST, BUT SPAN CARE SUPPORT PROGRAMS AND OTHERS. WE WILL GET TO THAT OBJECTIVE 1.2 IN THE NEXT MOMENT. QUESTION?

>> SARAH HAD A QUESTION.

>> I HAVE A QUESTION, THIS IS AMAZING, ALLY EXCITING. THE PROGRESS YOU MADE THINKING THROUGH THIS. THE QUESTION IS, ABOUT TALKING ABOUT THE SCOPE AND PREVALENCE OF THE CALIFORNIA RCHESZ WITH DIFFICULTIES IN ROUTINE CARE NEEDS, ET CETERA, THAT'S A GREAT BASE LINE. TO MEASURE THAT CONSISTENTLY. BUT I'D THINK IT HAS TO BE FRAMED IN A WAY THAT, THAT NUMBER ON ITS OWN IS NOT USED, A NEGATIVE CATER IN MEASURING THE STATE'S PROGRESS FOR, IN THE MASTER PLAN BECAUSE HAVING THE NEED IS NOT THE PROBLEM. IT'S THE FACT THAT THEY'RE NOT BEING MET, THAT'S THE PROBLEM. INITIALLY, THAT WAS MY THINKING BUT I ASSUME IT WILL BE FRAMED IN A WAY THAT THE EMPHASIS IS NOT ON THE NEED, BUT ON THE FACT THAT THEY'RE NOT BEING MET.

>> I THINK THE FIRST QUESTION, THE DIFFICULT, THAT'S A QUESTION, HOW MANY PEOPLE HAVE DIFFICULTY WITH THESE. THE UNMET NEED GOES INTO WHAT YOU SAID, THERE'S ACTUALLY NOT A PROGRAM THAT ADDRESSING THIS NEED OR PERSON OR CAREGIVER.

>> YOUR POINT IS IMPORTANT. THE WAY THE DATA WILL BE FRAMED THAT WILL MAKE THE DIFFERENCE. IT SHOULD NOT BE A MIRROR OF DIFFICULTY YEAR AFTER YEAR. THAT'S NOT AN ASSESSMENT OF CALIFORNIA'S PROGRESS IN MEETING THEM. SO ABSOLUTELY, THAT'S WHY WE'RE MIGHT BE THE UNMET NEED QUESTIONS AND ADEQUACY OF WHICH THEY'RE BEING ADDRESSED. IT'S PUTTING THESE TOGETHER AS A PROFILE, RATHER THAN LOOKING AT IT AT A SINGLE DATA INDICATOR. IT'S IMPORTANT TO BE ABLE TO

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SAY HERE'S THE NUMBER OF CALIFORNIANS WITH DIFFICULTIES. POLICY MAKERS NEED TO UNDERSTAND THE LEVEL OF THE PREVALENCE.

>> STEPPING BACK, WE'RE IN A PROCESS DEEPLY INVOLVING STATE PARTNERS, IN A STATE BUILDING RIGHT NOW AS WE TALK, BUT IT'S GOOD TO REMEMBER THAT THE MASTER PLAN FOR AGING IS FOR CALIFORNIA AS A WHOLE, AND THERE ARE A LOT OF PRIVATE SECTOR PLAYERS INVOLVED IN THE PROCESS. AND WE NEED TO BE INVOLVED, IN THE IMPLEMENTATION OF MOVING THE RECOMMENDATIONS FORWARD AROUND LEARNING FROM THE MEASUREMENT FRAMEWORKWORK. SO I COULD THINK, IF THERE'S A MEDICARE ADVANTAGE PLAN SERVING THE STATE OR CALIFORNIA, AND THEY, THEIR HEALTH RISK ASSESSMENT MEASURES DID NOT COMPORT WITH THE DIFFICULT, YOU SAY CALIFORNIANS HAVE THIS PERCENTAGE OF DIFFICULTY AND THEY LOOK AT THEIR ASSESSMENT MEASURES AND THEY'RE WAY OVER OR UNDER, THAT MAY BE SOMETHING, THE PLAN COULD SAY, WHAT'S HAPPENING HERE, THAT WE'RE ABLE TO BENCHMARK AGAINST WHAT WE KNOW AS A WHOLE, OR LOOKING AT UNMET NEEDS, WE, MAYBE WE NEED TO MEASURE BECAUSE WE'RE SAYING HIGH HOSPITALIZATIONS IN THOSE GROUPS OF PEOPLE, AND WE HAVE NOT ASKED DEEPER LEVEL QUESTIONS ABOUT THE IMPLICATIONS, BUT SEEING PEOPLE COME IN WITH LOTS OF PROBLEMS ASSOCIATED WITH THOSE CATEGORY. IT STARTS SETTING THAT PROFILE FOR MANY PLAYERS IN THE MARKETPLACE TO THINK ABOUT HOW, WHAT'S THEIR ROLE AND CONTRIBUTION TO MINIMIZING UNMET NEEDS, IN ADDITION TO HOW TO BEST USE RESOURCES WITHIN THE STATE AND VARIOUS PROGRAMS FOR PEOPLE WHO ARE ELIGIBLE, TO BETTER MEET NEEDS OR MAKE SURE WE HAVE WAYS OF SCREENING PEOPLE FOR ELIGIBILITY FOR SERVICES TO ADDRESS UNMET NEEDS. IT CREATES THE PROFILE THAT SETS THE BASE LINE. I AGREE, IT'S ABOUT WHAT IS THE WAY IN WHICH YOU DISPLAY THAT. YOU COULD MAKE A NUMBER THAT IS, THE AMOUNT OF PEOPLE WITH UNMET NEED DIVIDED BY THE AMOUNT OF PEOPLE WITH DIFFICULTY, SO THAT GIVES YOU A RATIO, AND YOU WANT TO SEE THAT RATIO CHANGE. THERE'S DIFFERENT WAYS OF PUTTING IT TOGETHER. PEOPLE WILL HAVE DIFFICULTIES. WHAT CAN WE DO AND HOW DO YOU PUT THAT INFORMATION AROUND, AND I ACKNOWLEDGE, DURING THE PROCESS OF THE LONG TERM CARE COMMISSION IN WASHINGTON, D.C., IN 2013, THERE WERE A LOT OF QUESTIONS, BECAUSE WE DID NOT THAT DATA INTRODUCES ALL SEGMENTS OF THE LTSS POPULATION TO SAY HOW MANY PEOPLE ACTUALLY HAD DIFFICULTY, FEDERAL DATA DOES NOT HAVE ENOUGH INFORMATION ABOUT THE UNDER 65 POPULATION. SO WE'RE VERY, VERY GRATEFUL IN CALIFORNIA BUT WE HAVE A SURVEY THAT CAN CRACK THE NUT TO SEE THE UNDERLYING DIFFICULTIED AND WHAT ARE WAY TO ADDRESS THAT AS A SOCIETY.

>> PATTY IS ON THE PHONE. CAN YOU UNMUTE?

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>> I'M UNMUTED.

>> WE CAN HEAR YOU.

>> HOW DID YOU DISTINGUISH BETWEEN TEAM CARE NEEDS AND PERSONAL CARE NEEDS? THAT'S ONE. SECOND, WHEN YOU GET INTO SYSTEM DRIVER, I'M ONE OF THOSE, RURAL AREA, ALWAYS TALKING ABOUT A BASIC SERVICE MIX THAT NEEDS TO BE IN EVERY COUNTY OR AT LEAST REGIONLINGLY FOR PEOPLE. MANY OF THE REGIONS, PEOPLE CAN'T GETS SERVICES BECAUSE THEY DON'T EXIST IN THE, RURAL CALIFORNIA. WHEN WE TALK ABOUT THIS IS A PLAN FOR ALL OF CALIFORNIA, IT MEANS THE RURAL AREAS, URBAN RICH AREAS. HOW DO YOU DISTINGUISH BETWEEN ROUTINE CARE, AND PERSONAL CARE NEEDS?

>> THANK YOU FOR THE QUESTIONS. THIS IS KATHERINE. IN THE SURVEY, WE ASK ABOUT ROUTINE, WE USE THE LANGUAGE, ROUTINE CARE NEEDS. IT CORRESPONDS WITH THE TRADITIONAL CLASSIFICATION OF INSTRUMENTAL ACTIVITIES OF DAILY LIVING, THEY PROVIDE EXAMPLES TO THE PEOPLE RESPONDING TO THE SURVEY. IT'S REALLY ABOUT CLEANING, COOKING, GETTING OUT OF THE HOUSE, GOING TO THE DOCTOR, ET CETERA. PERSONAL CARE NEEDS ARE HANDS ON BATHING, DRESSING, ET CETERA. DOES THAT HELP?

>> I KNOW THE DIFFERENCE BETWEEN ADLS. I JUST DIDN'T UNDERSTAND ROUTINE VERSUS PERSONAL CARE NEEDS. THANK YOU FOR THAT. THE SYSTEM DRIVER ISSUE IN TERMS OF. LIMITED SERVICES AVAILABILITY, THAT'S GOING TO BE HUGE.

>> RIGHT. I AGREE. IT'S HUGE. THAT'S PART OF THE POINT OF LOOKING AT SYSTEMS. LOOKING AT WHERE THE DISPARITIES HAPPEN ACROSS THE STATE, AT THE DIFFERENCE IN WHAT'S AVAILABLE IN RURAL POCKET OF THE COUNTY VERSUS URBAN AREAS, OR HAVE WITHIN AN URBAN AREA IN ONE NEIGHBORHOOD, NOT ACROSS TOWN. THAT'S THE INTENT GETTING TO THIS COMPOSITE MEASURE. GETTING THERE IS SOMETHING WE HAVE A LOT OF TO TALK ABOUT, HOW TO GET DATA FROM ALL THE DIFFERENT PROGRAMS BY GEOGRAPHY. GRETCHEN, YOU CAN ADD TO THIS.

>> ABSOLUTELY. I AGREE. WE FELT STRONGLY THAT DASHBOARD 1.0 SHOULD EFFECTIVELY SURVEY THE LAND STAPLE IN TERMS OF ACCESSIBILITY, IN TERMS OF PHYSICALLY HAVING A PROGRAM PRESENTS AVAILABILITY, ABOUT THESE SERVICES. SO WE CAN SEE WHERE WE HAVE IT IN THE STATE AND WHERE WE DON'T AND WHERE DO WE HAVE SOME THINGS, AND NOT OTHERS. WE'RE WORKING THROUGH HOW THIS COMES OUT, MAYBE AT THE MAP, THAT SHOWS A SHOT SPOTTING, WE'RE PLAYING WITH THE VISUALIZATION OF THIS AND ULTIMATELY IT WILL BE UP TO OUR DATA PARTNER. WE'RE GIVING AS MUCH GUIDANCE ABOUT HOW 20 REPRESENT

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WHERE SERVICES EXIST AND WHERE THEY DON'T, ESPECIALLY TO YOUR POINT THERE ARE MANY AREAS INCREDIBLY UNDERSERVICED.

>> KAREN KIETZMAN. KAREN?

>> HI. THIS IS KAREN. I APPRECIATE THE COMMENTS YOU JUST INSTEAD ABOUT NEED TO DRILL INTO THE SPECIFIC PROGRAMS TO FIGURE OUT THE TERMS. I REACTED IN MY BRAIN WHEN YOU USED THE TERM, UNMET NEED. SOCIAL WORKERS ARE REQUIRED TO DOCUMENT UNMET NEED, AND THEN, IF THERE'S AN ACROSS THE BOARD CUT, THAT UNMET NEED FACTOR CAN BRING DOWN WHAT THEIR POTENTIAL CUT WOULD BE. SO IT HAS REALLY SPECIFIC MEANING IN OUR PROGRAM. CONVERSELY, THE JOINT LEGISLATIVE AUDIT COMMITTEE JUST APPROVED AN AUDIT REQUEST TO LOOK AT THE GAP BETWEEN AUTHORIZED AND PAID HOURS, AND FOR COUNTIES, IT SOUNDS LIKE THE THEORY IS THAT THE GAP SOMEHOW IS MEANINGFUL IN MEASURING UNMET NEEDS. I COULD TALK A WHILE ABOUT WHY THAT'S NOT A MEANINGFUL MEASURE, BUT IT MAY TAKE TIME, YOU'RE REALLY GOING TO NEED TO DIVE INTO EACH FROM FIGURING OUT HOW, WHAT THE MEANING IS, OF THOSE TERMS WITHIN THE PROGRAM CONSTRAINT, AND THEN FROM THERE FIGURE OUT THE COMMON DENOMINATORS.

>> THAT'S A GREAT COMMENT FOR US TO CONSIDER ON HOW TO INTERSPERSE THE PERSON LEVEL CORE MEASURE, WITH WHAT'S AVAILABLE WITHIN THE SYSTEM CROSS THESE VARIOUS PROGRAMS. AND RECOGNIZING THAT THE SPIRIT OF THE PERSON LEVEL MEASURES IS AT THE MACRO CALIFORNIA LEVEL THOUGH WE CAN DRILL DOWN IN DIFFERENT WAYS. IT'S MAKING ME THINK ABOUT LANGUAGE IN THE DISPLAY. I APPRECIATE THAT, KAREN, IN TERMS OF THE SPECIFICITY OF WHAT THAT MEANS. WE WILL CONSIDER THAT.

>> JEFF, YOU'RE ON THE LIST. SUSAN IS NEXT.

>> THANK YOU BOTH IN THE ROOM AND THOSE ON THE PHONE. I'VE BEEN CURIOUS AND HAPPY TO HEAR 1.0 AND THIS MACRO. THE DASHBOARD WILL BE USED BYSON MORE AUDIENCES, GIVEN THE DIRECTION YOU'RE TAKING. I WAS A LITTLE FEARFUL IT WOULD BE AN EIGHT FOOT CATALOG, NOT USEFUL FOR ALL THE AUDIENCES YOU DESCRIBED. SO THANK YOU. AT THE BEGINNING, WHEN YOU SAID THE FIRST TWO SLIDES WHERE WE USED COMPOSITE, AND ONE WE INCLUDED MEMORY, DECISION MAKING, AND SECOND ONE WE DIDN'T. TO ME, THOSE SEEM LIKE THINGS, THE NEED AND UNMET NEED, THEY WOULD GO HAND IN HAND. WHY WAS THAT DROPPED FOR THE SECOND ONE?

>> SURE. THAT'S A FUNCTION OF THE WAY THE SURVEY IS DESIGNED. THE DIFFICULTY QUESTIONS ARE ASKED INDIVIDUALLY SO WE CAN REPORT INDIVIDUALLY, OR AS A COMPOSITE. WHAT COMBINATION OF THE THREE

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DIFFICULTIES DO YOU HAVE. REMEMBERS DOING IT AFTER THE FACT. THEY'RE ASKED IF THEY HAVE DIFFICULTIES IN THREE AREAS. I UNDERSTAND YOUR CONCERN ABOUT UNMET NEEDS, PERSONAL CARE AND ROUTINE CARE NEEDS. IT DOESN'T MEAN WE CAN'T CROSS THAT WITH PEOPLE WITH MEMORY AND DECISION MAKING ISSUES. THAT WILL DEFINITELY BE ONE OF THE ANALYSES WE DO. LOOKING AT WHAT AS A RESULT OF WHETHER PEOPLE HAVE COGNITIVE DIFFICULTIES, PHYSICAL, HEALTH CAMPGROUNDS, FUNCTIONAL LIMB TAKINGS, AS A RESULT OF THE WHAT ARE YOUR UNMET PERSONAL OR ROUTINE CARE NEEDS. DOES THAT HELP? DOESN'T MEAN WE DROPPED OUT, TO LOOK AT PEOPLE WITH COGNITIVE DIFFICULTIES.

>> GREAT. THAT WILL BE PART OF THE QUESTIONS, TO DETERMINE, IF THEY HAVE AN UNMET NEED. OKAY. THEN, ON THE SLIDE

DISPLAY, YOU'RE GIVING AN EXAMPLE OF SERVICES, IS THIS THE COMPLETE LIST, OR ARE YOU USING, IS THERE A LINKS THAT EXISTS? WE HAVE SOME IN THE REPORT.

>> CURIOUS, WHAT THE STANDARD IS. I'M NOT SAYING I KNOW WHAT IT IS.

>> WE'RE THUNDER AND LIGHTNING THAT DID YOU HAVE A LIST -- DELIGHTED YOU HAVE A LIST. THE SPIRIT IS WANT TO GATHER AS MANY DIFFERENT WAYS OF THINKING ABOUT THE SERVICE FRAMEWORK THAT'S DRIVEN, OR REGULATED. BY STATE ACTION. THAT'S PART OF IT. THINKING ABOUT, RIGHT NOW WE'RE NOT EVEN SURE HOW WE GET ALL THE INFORMATION TO FEED THE DENOMINATOR ON THIS. SO, WE WILL TAKE, AS MUCH GUIDANCE ON THAT AS HUMANLY POSSIBLE. ESPECIALLY THINKING ABOUT, PER ONE HUNDRED, SORRY, ONE THOUSAND CALIFORNIANS, OVERALL, WE COULD SAY DIFFERENT AGE BANDS, AND WE'RE HAPPY TO CHANGE THE BANDS, WE'RE FLEXIBLE ON THIS. WHAT IS THE SACHS OF AVAILABILITY OF PROGRAMS AND SERVICES THAT NEED LTSS NEEDS, THAT HAVE EITHER DIRECT FUNDING FROM STATE AND FEDERAL SOURCES OR DIRECTLY REGULATED FROM THEM. SPEAK TO THE LONG EXTENSION ARM OF THE STATE INFRASTRUCTURE, TO AFFECT THE AVAILABILITY, SERVICES, HOW MUCH OF THAT EXISTS PER ONE THOUSAND CALIFORNIANS. THE COMPOSITE, WE'RE OPEN TO THAT. PART OF IT IS THINKING ABOUT HOW, INCLUDE HSS, IHSS IS ABOUT PEOPLE HAVING ACCESS TO IT BY VIRTUE OF THE FUNCTIONAL NEED AND THEY COULD HAVE A FRIEND CAREGIVER, ALL SORTS OF CAREGIVERS, NOT A PHYSICAL LOCATION, LIKE A DAY CENTER. WE STRUGGLE HOW TO MAKE IT COME TO LIFE BUT THAT'S THE INTENT. TERRY IS PUSHING A CARD -- WE'RE DOING A LOT OF DIGGING. WE DON'T HAVE TIME FOR ALL OF THAT TODAY BUT WE WELCOME IT. YOU CAN EMAIL US, CARRIE, YOU HAVE THOUGHTS ON HOW 20 CONSTRUCT THE AVAILABILITY FRAMEWORK.

>> JEFF?

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>> I WANT TO ASSOCIATE MYSELF WITH KAREN'S COMMENT ABOUT WHAT UNMET NEED IS AND ISN'T. FOR EXAMPLE, IF YOU'RE PROVIDING TRAINING ON USING AN IPHONETO SOMEONE WITH VISION LOSS, IF YOU GIVE THREE HOURS OF TRAINING FOR ONE PERSON, THAT MIGHT BE ENOUGH, AND FOR OTHERS, MATING TAKE 15 HOURS. SO WE MUST LOOK BEHIND NOT JUST THE HOURS OF SERVICE, BUT WHAT EXACTLY IS ACHIEVED. I HAVE A QUESTION. WILL YOUR REPORT AND WHAT YOU PRODUCE IDENTIFY SORT OF THE GAPS AND PROBLEMS THAT STATE AND OTHER ENTITIES FACE IN TERMS OF ENGAGING, GATHERING ISSUES, WHETHER PHYSICAL ISSUES, INFRASTRUCTURE, WHATEVER, SO THAT WHEN THEY DECIDE TO HOPEFULLY UPGRADE THESE DATA GATHERING EFFORTS, THEY WILL KNOW WHAT PROBLEMS THEY NEED TO HANDLE?

>> WE'RE DEFINITELY OPEN TO YOUR CONSIDERATION ON THOSE TOPICS. I'D SAY WE DEFINITELY ARE NOT EXPERT ON ALL OF THE ELEMENTS FOR THOSE CONSIDERATIONS. WE WELCOME YOUR FEEDBACK IN THAT AREA. OUR DATA GAP REPORT DEFINITELY IS TO SPEAK TO WHAT DOESN'T EXIST THAT SHOULD, AND WHAT ARE THE MECHANISMS, FOR GATHERING THAT INFORMATION. ADDITIONAL CONSIDERATIONS TO BE ADDED, WE WELCOME.

>> WE HAVE KATHERINE AND THEN ELLEN OF THE THEN WE WILL MOVE TO THE CAREGIVER SIDE.

>> I THINK THIS IS REALLY INTERESTING. MY QUESTIONS, SOME OF THEM MAY HAVE BEEN ANSWERED, BUT IN SOME SYSTEMS, HOW MUCH WAS AUTHORIZED VERSUS HOW MUCH WAS UTILIZED. I THINK THE DISCREPANCY BETWEEN THOSE TELLS YOU SOMETHING ABOUT THE AVAILABILITY OF SERVICES AND OTHER BARRIERS. I THINK THERE'S A WAY TO DO THAT WITHIN THE SYSTEM, AND I KNOW THERE'S A WAY TO DO IT WITHIN THE DEVELOPMENTAL DISABILITY SYSTEM. DATA IS ALREADY TRACKEDDED BY PURCHASE OF SERVICES, A LOT OF REALLY GOOD DATA IN THE SYSTEM ABOUT THAT. THE SECOND IS, YOU HAVE THE LIST THERE, AND IT'S JUST TO THINK WHEN YOU'RE COMPARING, ARE THERE OTHER DISABILITY SPECIFIC SERVICES THAT SHOULD BE WITHIN THAT, AND WHAT WOULD IT LOOK LOOK AND HOW BEST TO GET THE DATA? THEY'RE NOT NECESSARILY GROUPS, THE SAME SURVEY. THE LAST, THERE'S A QUESTION ABOUT NOT JUST THE DIRECT SERVICES PEOPLE GET, BUT THE AVAILABILITY STATE WIDE ABOUT INFORMATION AND REFERRAL AND ALL OF THOSE THAT, WOULD BE, IF NOT BEING DONE SEPARATELY, AN INTERESTING OVERLAY OF THE DIRECTION.

>> THANK YOU. THIS, THE SPIRIT OF WHERE WE WERE PLANNING TO GO WITH OUR RECOMMENDATION OF DASHBOARD 1.0 MEASURES WAS DEFINITELY AT THE MACRO LEVEL. NOT PROGRAM SPECIFIC MEASURES. ALTHOUGH I LIKE WHAT YOU ARTICULATED ABOUT THE DIFFERENTIAL BETWEEN AUTHORIZED AND, NOT RECEIVED, BUT, YOU TOTALLY COULD DO

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THAT. WHAT I'D LOVE IS THAT THE WORK MASTER PLAN FOR AGING PUTS FORTH IN TERMS OF CONCEPTUAL FRAME, THAT THERE ARE PERSON LEVEL MEASURES AND SYSTEM DRIVER MEASURES. THAT COULD BE A TEMPLATE THAT ANY AGENCY, ANY DEPARTMENT, COULD MAKE THEIR OWN DASHBOARD ALREADY PROGRAMMED, AND THAT WOULD BE SPECIFIC TO THEIR INFORMATION SYSTEM THAT WOULD START ARRAYING DATA IN A WAY THAT SPEAKS ABOUT PERSON LEVEL IMPACTS AND THE SYSTEM CAPACITY AVAILABILITY UNDERNEATH TO DRIVE THAT FORWARD. IT WOULD RADICALLY CHANGE THE WAY STATE LEVEL INFORMATION IS PUT OUT, TO BE ABOUT THE PERSON IN THE CENTER AND HOW THE SYSTEM SUPPORTS THAT. THAT COULD BE A RECOMMENDATION THAT ANYONE COULD PUT FORWARD.

>> NINA?

>> WHAT I LIKE ABOUT IT IS, AT LEAST AT THE BEGINNING, EASY TO UNDERSTAND. WE'RE LOOKING AT, I THOUGHT OF THIS AS PROBLEM, SOLUTION. HERE'S OUR PROBLEM. AND WE HAVE DATA ON, SAY, ALL THE UNMET NEEDS. THEN, KIND OF A SOLUTION ON A BROAD LEVEL, BUT WHAT'S GOING IN BETWEEN IS MY QUESTION, WHAT ARE THE FROM EACH PROGRAM THAT WILL REAL ATTUNE TO THE NEED -- ON TUNE TO THE UNMET NEED. WHEN MY MOTHER WENT INTO HER DECLINE, HAD SO MANY UNMET NEEDS. BOY, IT LED TO FARTHER DECLINES. THERE WEREN'T THE APPROPRIATE, NOBODY WAS REALLY CHECKING, LIKE, OH, BECAUSE SHE'S TAKING THIS MEDICINE, AND TOILETING NEEDS, THAT WEREN'T BEING MET, THAT LED TO FURTHER DEPRESSION. AND EARLY DEATH. SO AT LEAST BEING ABLE TO MATCH WHAT'S AN UNMET NEED, SERVICES THAT ALSO, THE APPROPRIATE INTERVENTIONS IN BETWEEN, WE HAVE BEEN TALKING ABOUT UP STREAM, HAVING THAT DATA OF UNMET NEEDS. THAT'S THE UP STREAM. OH, LAST WEEK, THIS PERSON DIDN'T HAVE ENOUGH FOOD. WE KNOW ALL THE PROBLEMS THAT COME FROM MALNOURISHMENT. AND FOOD INSECURITY.

>> I'D LIKE TO HEAR MORE ABOUT IN TERMS OF EVIDENCE BASED INTERVENTIONS.

>> NOW, WE HAVEN'T GOTTEN THERE. I DON'T ESTIMATE THAT WE WILL IN DASHBOARD 1.06789 IN MANY WAYS, IT'S ABOUT THE COMMUNITY OF SERVICE PROVIDERS AND LEADERS AND POLICY MAKERS TO SAY HOW DO WE WANT TO MOVE THE NEEDLE ON ADDRESSING UNMET NEED AND THE ADVERSE CONSEQUENCES. IT COULD COME FROM LOTS OF ANGLES. THERE'S ALSO A WAY EACH PROGRAM, SERVICE LINE, WHETHER STATE FUNDED OR NOT, COULD MICK A CONTRIBUTION STATEMENT ABOUT HOW THEY'RE ADDRESSING UNMET NEED THROUGH THE WORK THEY DO. IT'S MORE ABOUT HERE IS WHERE WE ARE AS A STATE, AND THEN CALLS THE QUESTION TO SERVICE PROVIDERS OF ALL TYPES, WHAT ARE YOU DOING TO ADDRESS

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UNMET NEED? I DON'T SEE THAT RIGHT NOW IN THE SPIRIT OF DASHBOARD 1.0.

>> THANK YOU SO MUCH. I'M ENJOYING THIS. I'VE BEEN LOOKING FORWARD TO HEARING ABOUT THE MEASURES A LONG TIME. I'M GUESSING IT IS NOT POSSIBLE, LOOKING AT AN INDIVIDUAL RESPONDING TO THE CHIS QUESTIONS, TO KNOW IF THEY'RE RECEIVING SERVICES OR ANY OF THESE AND STILL HAVE AN UNMET NEED S THERE A WAY TO CORRELATE, OR IS THAT ASKED? SECOND QUESTION, WHAT ARE YOUR ASPIRATIONAL MEASURES? YOU HAVE DREAMS ABOUT WHAT YOU'D REALLY LIKE TO SEE IN 2.0.

>> THAT'S A LONG CONVERSATION. WE WILL TABLE THAT. KATHERINE WILL DO ABROGATE JOB ANSWERING YOUR FIRST QUESTION.

>> IN THE FOLLOW UP SURVEY WE ASK ABOUT PEOPLE GETTING, WHAT KIND, BE IT'S NOT PROGRAM NAME SPECIFIC. IT'S ABOUT WHETHER PEOPLE GET PERSONAL CARE, GO TO A COMMUNITY CENTER, THOSE TYPES OF THINGS. WE WILL BE ABLE TO CROSS WALK THOSE WITH UNMET NEEDS.

>> ALSO, ASK ABOUT HOW SERVICES WITH PAID, WHETHER PAID OR NOT PAID AND HOW.

>> WE SHOULD PROBABLY HAND IT TO KATHY TO TALK ABOUT MEASURES THAT ARE PART OF OBJECTIVE 1.2. KATHY? ARE YOU READY?

>> I WILL SET THIS UP.

>> WHILE SHE'S WAKING UP, WE WILL TALK ABOUT NEEDS AND EXPERIENCES. MEASURES THAT LOOK AT THOSE, OF CAREGIVERS. I'LL TALK ABOUT A COUPLE MORE CHIS MEASURES WE CAN USE AND RECOMMEND. WHAT'S INTERESTING IN WHAT KATHY WILL PRESENT, LOOKING SIDE BY SIDE, POPULATION LEVEL AND PROGRAMMATIC MEASURES. SHE WILL PROVIDE DATA GIVEN AT THE CAREGIVER RESOURCE CENTER AND HOW WE CAN CROSS WALK THOSE SETS OF DATA. HOW CAN WE USE THE TWO MEASURES TO GET THE STORY. THE COMPLETE STORY. SHE WILL TALK ABOUT CAREGIVER PROFILES, CHARACTERISTICS AND SERVICES. BRIEFLY, I WILL SAY IN THE CURRENT 2019-2020, WE HAVE A CAREGIVER MODULE. INSTEAD OF QUESTIONS ASKED OF STARTS WITH ARE YOU PROVIDING CARE QUESTION, EVERYBODY IN THE 40,000 SAMPLE IS ASKED THAT QUESTION. IF THEY SAY CONFESS, THEY'RE ASKED A SERIES OF 12 QUESTIONS WHICH YIELD A ROBUST SET OF INFORMATION. WE RECOMMEND ON THE NEXT SLIDE, THE ABILITY TO REPORT ON THE PREVALENCE OF CAREGIVING. WE CAN GENERATE ESTIMATES OF WHO'S PROVIDING THE CARE IN THE LAST 12 MONTHS, AND THOSE CURRENTLY PROVIDING CARE. THOSE ARE THE TWO TIME LINES FOR WHICH WE CAN PROVIDE A COMPOSITE MEASURE. FOLLOWING UP, NEXT SLIDE, WE HAVE A MEASURE OF CAREGIVING

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CONVENTIONS, INDIVIDUAL QUESTIONS THAT RELATE TO PHYSICAL, MENTAL HEALTH CONSEQUENCES, FINANCIAL STRESS AND CHANGES IN EMPLOYMENT. SO WALKING THROUGH THOSE FOUR DIMENSIONS, WE CAN CREATE AGAIN AN ACCESSIBLE COMPOSITE MEASURE. CAREGIVER CONSEQUENCES. AS GRETCHEN POINTED OUT YOU CAN SEE THEM INDIVIDUAL IS THERE A QUESTION? WE HAVE SUSAN.

>> THIS IS SUSAN WITH THE ALZHEIMER'S FOUNDATION.

[ 3:54 PT ]

>> DO WE SEND IT VIA E-MAIL? WE ARE OPEN TO IDEAS AS TO HOW WE PRESENT THEM? KATHRYN?

>> TWO THINGS. I THOUGHT THEY WERE GETTING THE REPORT FOR THE FATAL FLAW REVIEW. IF THEY HAD A FATAL FLAW, A DECISION WOULD BE MADE AS TO HOW TO HANDLE THEM. I HAD A HANDFUL OF COMMENTS EARLIER TODAY. THERE ARE TWO I THINK WE SHOULD CLEAN UP BEFORE SENDING IT TO THE EQUITY GROUP.

>> ONE OF THE COMMENTS, BEFORE WE FORGET, TERMINOLOGY, WE WERE TRYING TO BE CONSISTENT. I WANT TO BE SURE WE ARE ON THE SAME PAGE. IS THIS THOSE WITH DISABILITIES OR SENIORS?

>> I MAY HAVE USED "SENIORS."

>> I WANTED TO BE SURE YOU WERE OKAY WITH THAT.

>> I WASN'T TRYING TO COMMENT -- SIGN LANGUAGE IN ADDITION -- WE DEFINE. IT SAYS NOW SPOKEN LANGUAGES. SIGN LANGUAGE IS NOT SPOKEN, AND WE DIDN'T USE SPOKEN ANYWHERE ELSE. WE LISTED CHARACTERISTICS OF DIVERSITY IN CALIFORNIA. THEY ARE NOT EXACTLY THE SAME AS IN THE REPORT. WHEN YOU OMIT A GROUP -- IT'S REALLY JUST TECHNICAL KINDS OF CLEAN UP WITH THAT. I DID NOT INTEND TO CHANGE THAT.

>> I DIDN'T TAKE IT THAT WAY.

>> CAN I FOLLOW UP ON THAT, CARRIE? CAN EVERYONE PAY ATTENTION TO THE DEFINITION SECTION? THAT IS NEW. I WANT TO BE SURE WE ARE ACCURATELY REPRESENTING THE ACRONYMS AND DESCRIPTIONS. THAT IS NEW, IF PEOPLE CAN TAKE EXTRA TIME ON THAT AND GET US FEEDBACK, WE APPRECIATE IT.

>> I THINK FATAL FLAW REVIEW IN THE NEXT 48 HOURS FROM THIS COMMITTEE. AFTER THAT, WE'LL INCORPORATE THE EDITS, SEND IT OUT,

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SAY, IF EVERYONE IS OKAY WITH THIS VERSION, THIS GOES TO SACS. EARLY NEXT WEEK SENDING IT TO SAC.

>> EARLY NEXT WEEK MEANING?

>> MONDAY, AND EQUITY MEETING ON THE 17TH. HOLD ON ONE MINUTE. SUSAN HAD A GOOD POINT. IF SOMETHING COMES OUT OF EQUITY THAT WE WANT TO CHANGE BEFORE BRINGING IT TO SAC, SO THAT'S A GOOD POINT. BRING IT TO EQUITY WITH THE REVISIONS YOU HAVE. IT WOULD BE THE FOLLOWING WEEK OF THE 23RD.

>> PATTY, YOU ARE UP. THIS IS A FATAL FLAW TO THE ACRONYM. I THINK WE SHOULD BE WITH THE LONG-TERM SERVICES AND SUPPORT. THERE IS NOTHING ABOUT PERSON CENTERED. IF YOU GIVE BOTH DEFINITIONS TO LYDIA. WE HAVE THE STRATEGIC PLANS THERE. HOME AND COMMUNITY BASED SERVICES DOESN'T SAY ENOUGH. REMEMBER WHO THE READERS ARE GOING TO BE WHO DON'T KNOW THE FIELD. WE NEED TO BE CONSISTENT WITH HOW WE DEFINE LONG-TERM SERVICES AND SUPPORT. WE NEED TO ADD HOME AND COMMUNITY BASED SERVICES, ONE SENTENCE OR SOMETHING LIKE THAT. WHEN YOU CONDENSE, IT MIGHT BE LOST IN TRANSLATION. I'M SAYING THAT, THAT'S NOT ENOUGH IN TERMS OF WHAT YOU HAVE IN THE ACRONYMS -- DEFINITIONS.

OKAY, ARE WE READY TO MOVE ON? ACTION READY ITEMS AND FOLLOW UP DISCUSSION? CLAIRE, YOU CAN PLEASE JUMP IN. I'LL INTRODUCE IT, CLAIRE, AND THIS IS SOMETHING YOU PUT YOUR HEART AND SOUL INTO. YOU TOOK THE ACTIONABLE ITEMS ON THE ONE PAGER SUBMITTED TO SAC. YOU SEE THE GRID WE TALKED ABOUT A BIT. SINCE THE LAST TIME THIS WAS PUBLISHED, CLAIRE ADDED THE COLUMN ALIGNS WITH PRIORITIES AND THE NOTES COLUMN WHICH WAS SKIMPY TO BEGIN WITH. WE WOULD HIKE TO HAVE PEOPLE TAKE A LOOK AT THAT, AND GIVE US FEEDBACK GIVEN WHAT WE TALKED ABOUT EARLIER WHERE THE GRID MIGHT LIVE AND ITS ABILITY TO CHANGE OVER TIME. I WOULD LIKE TO TURN THAT OVER TO YOU -- FOR DISCUSSION.

>> I HOPE PEOPLE HAVE HAD A CHANCE -- IT SOUNDS LIKE PEOPLE HAVE HAD A CHANCE TO LOOK AT THE ACTION READY ITEMS, THE ONE PAGER TRYING TO CONDENSE ALL OF THE MANY RECOMMENDATIONS INTO ONE, EASY -- HOPEFULLY EASY DIGEST FORM. AS ELLEN SAYS, WE AGREED THAT THESE WERE NOT THE MOST IMPORTANT RECOMMENDATIONS. THEY WERE THE RECOMMENDATIONS PEOPLE IDENTIFIED AS TAKING FORWARD STEPS ON IMMEDIATELY OR IN THE NEAR FUTURE. THIS IS THE ULTIMATE DECISION THAT LTSS FELT THIS WAY AND SAC AGREED, NOT TO HAVE TO WORK TOWARD WINNOWING DOWN THE LIST, THAT IT WAS OKAY TO HAVE A LONG

17

AND ROBUST LIST. I THINK THERE ARE POSITIVES IN THAT BECAUSE IT MEANS THAT THOSE THINGS MIGHT BE THINGS THAT CAN BE PULLED UP BY LEGISLATORS INTERESTED IN AGING ISSUES. I KNOW THIS IS DONE BY MEASURE, NEXT TERM BUDGET ITEMS. THERE ARE A LOT MOVING FORWARD ALREADY. IT GIVES PEOPLE THE PLACE TO SAY, HEY, THIS IS IMPORTANT. HERE IS ANOTHER PIECE OF EVIDENCE TO SHOW IT'S IN THE MASTER PLAN AND IT SHOWS ACTION READY BY THE ACTION PLAN. THAT PARTICULAR LIST ISN'T GOING TO KEEP EVOLVING IN TERMS OF CONTENT RIGHT NOW. I'M SORRY, I CAN'T HAVE MY SOUND TURNED OFF AND TALK TO YOU, SO I APOLOGIZE IF YOU HEAR THE BINGING IN THE BACKGROUND. AS A LIVING SET OF WORK WE NEED TO DO WITHIN THE REPORT, MY HOPE IS THAT AS WE PROGRESS FORWARD, SOMETIME NECKS YEAR, WE CONTINUE TO IDENTIFY THINGS LIKE A B & C, TEEING UP DEF AND STAGE THINGS THAT WAY. THAT'S THE THING ABOUT THE ONE PAGER. THE GRID, I'M HOPING IT'S FUNCTIONAL FOR PEOPLE. IT DOES HAVE A NOTE SECTION AS LYDIA MENTIONED. MY HOPE IS THAT PEOPLE WILL ADD THINGS TO THE NOTE SECTION.

WE TRIED TO MAKE BASIC COMMENTS, AND IF WE KNEW BILLS OR BUDGET ITEMS WERE ATTACHED TO THE ACTION ITEMS, WE WERE TRYING TO IDENTIFY THEM. IT'S POSSIBLE WE DIDN'T CATCH THEM ALL. IT MAY BE THAT THERE ARE ACTIVITIES HAPPENING AROUND AN ISSUE WE WERE NOT AWARE OF. THOSE ARE THE THINGS WE WERE HOPING YOU STARTED TO POPULATE THE NOTE SECTION WITH. I DON'T THINK THERE IS A NEED FOR THE NOTE SECTION TO BECOME 75 PARAGRAPHS PER ITEM. THE IDEA OF, HEY, YOU KNOW, THIS HAS A BILL NUMBER. IT'S ALSO A BUDGET ITEM. I HAVE GOT INTEREST FROM -- YOU KNOW, THE GOVERNOR AROUND THESE ISSUES, OR SOMETHING, THOSE ARE GOOD KINDS OF NOTES TO PUT IN. WE CAN DEFINITELY TALK ABOUT THOSE THINGS TODAY. WE CAN PUT IT IN A WAY PEOPLE CAN E-MAIL THIS SAYING, LET'S ADD THIS TO NOTES OR IF THEY WANT TO ADD IT TO THE GRID, WE CAN KEEP A MASTER COPY, PUT IT ON GOOGLE SHEETS SO IT'S UNIVERSAL ACCESSIBLE. I DON'T WANT IT TO BECOME A MESS AND PEOPLE CAN USE IT, AND IT'S STILL HELPFUL.

I'LL STOP TALKING KNOW. WHAT KIND OF THOUGHTS OR ADDITIONS DO PEOPLE WANT TO TALK ABOUT NOW?

>> I LOVE THE GRID. WE TRIED TO BASICALLY IDENTIFY -- A LOT OF THINGS IN THEORY HAVE A BUDGET ASK ASSOCIATED WITH THEM. YOU CAN DO NOTHING ALMOST TOTALLY FREE. WE TRIED NOT TO OVERDO THAT. THE RECOMMENDATION WAS ABOUT INFRASTRUCTURE RELATED TO REORGANIZE THIS DEPARTMENT. THERE MAY BE BUDGET ASSOCIATED AT SOME LEVEL.

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THAT DIDN'T SEEM LIKE A BUDGET ITEM. HOWEVER, WE TRIED TO BE THOUGHTFUL. A LOT OF THINGS THAT ARE LEGISLATIVE ASKS ASSOCIATED. WE TRIED TO CLICK BOTH WHEN APPROPRIATE. I THINK IT'S ANOTHER PLACE TO LOOK ON THE RECOMMENDATIONS THAT THEY SUBMITTED THEMSELVES OR IN THEIR OWN WHEELHOUSE, AND WERE TOTALLY OPEN IF THEY MISIDENTIFIED SOMETHING OR WE DIDN'T CLICK ENOUGH BOXES.

WE WERE THINKING IN TERMS OF ADMINISTRATIVE, THAT INCLUDED REGULATIONS BUT ALSO ACTION ITEMS BY AN ADMINISTRATIVE AGENCY. THE DEPARTMENT OF LABOR IS LOOKING TO PUT TOGETHER A TASK FORCE, THAT COULD BE ADMINISTRATIVE AS WELL. LEGISLATIVE AND BUDGET IS CLEAR. INFRASTRUCTURE WAS THE HARDEST THAT WAS NOT WELL CAPTURED BY THE OTHER THREE. AGAIN, THERE IS NO -- NO EGO-OR HURT FEELINGS IF PEOPLE SAID IT WAS THIS, BUT IT WAS ACTUALLY THAT. IT'S IMPORTANT TO LOOK TO SEE THAT THEY ARE THE RIGHT CATEGORIES. ALMOST EVERY BUDGET ITEM NEEDS ADMINISTRATIVE ACTION TO IMPLEMENT. WE DIDN'T CLICK EVERY ITEM TO HAVE ADMINISTRATIVE ACTION. IT DIDN'T SEEM WHAT THE ACTION THAT NEEDED TO HAPPEN WAS. WHAT ARE THE SIMULTANEOUS THING THAT IS HAVE TO HAPPEN TO MAKE THIS WORK AS OPPOSED TO CLICKING EVERYTHING THAT HAD TO HAPPEN RELATED TO THAT ITEM.

>> OKAY. NEXT IS KATHRYN -- SORRY, THAT WAS FROM BEFORE. YOU MAY SKIP OTHER ME.

>> KAREN KIEFER ON THE PHONE.

>> HI, THIS IS KAREN. QUESTION OF CLAIRE AND OTHERS. SOME OF THE THINGS ON THE ACTION READY LIST DON'T HAVE BUDGET REQUESTS OR LEGISLATION MOVING, SO FOR EXAMPLE, IN THE HOMELESSNESS, THERE IS THE RECOMMENDATION TO REDUCE BARRIERS, AND IT RELATES TO THE GOVERNOR'S AGENDA. THERE WERE SPECIFIC RECOMMENDATIONS LIKEWISE ON EMERGENCY BACK UP, GETTING THE STATE TO PAY FOR CRIMINAL BACKGROUND CHECKS FOR IHS PROVIDERS AND OTHERS. IS THERE A RECOMMENDATION ON HOW TO FRAME AND NOTE THE WAY THAT THE -- PEOPLE WHO ARE BEHIND THE PROPOSAL -- THE ORIGIN OF THE PROPOSAL, HOW THEY HAD CONCEIVED THEIR PROPOSAL AS BEING ACTION READY. FOR EXAMPLE, IF WE HAVE A PROPOSAL AND THERE IS NOT A BUDGET ASK OR PIECE OF LEGISLATION WITH THE FRAMERS THINKING THERE SHOULD BE A BROAD LANGUAGE TO SAY, SET UP A TASK FORCE OR DO SOMETHING TO MEET THIS GOAL BY A CERTAIN DATE?

>> I DON'T THINK IT WAS THAT RIGOROUS. PART OF THE LIST IS VERY MUCH A CONSENSUS DOCUMENT IN THAT -- MAYBE THAT'S THE WRONG WORD. VERY

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MUCH LIKE WHAT DID PEOPLE WANT TO SEE ADDED THAT THEY BELIEVED WAS ACTION-ITEM READY? WE TRIED TO PUT PARAMETERS AROUND, BUT I THINK THERE WAS A REAL SENSE OF LIKE, THERE WAS NOBODY BEING A GATE KEEPER. IT WASN'T FOR ANYONE TO SAY, THIS ACTION ITEM IS ACTION READY, AND THIS ONE IS NOT. WE ARE PLAYING GATE KEEPER ON THAT. I KNOW SOME THINGS ARE POSTURES AND THINGS ARE LIKE, IF THE LEGISLATURE AND GOVERNOR SAID YES, THEY ARE GOING TO HAPPEN. OTHERS MAY BE MORE, THOUGH THEY ARE ON THE ACTION ITEM LIST.

THAT IS HOW QUICKLY THE IDEA GATHERING WAS. I THINK IT'S POSSIBLE, FOR EXAMPLE, ON THE HOMELESSNESS ONE, THERE HAS BEEN WORK GOING ON IN TERMS OF GETTING -- THAT WAS AROUND ADMINISTRATIVE WORK THAT THE DEPARTMENT PUT OUT GUIDANCE AROUND FOR COUNTIES IN HOMELESSNESS AND OWN HOME STUFF. I KNOW THERE IS HOPE THAT WE CAN BUILD ON THAT WORK TO DO ADMINISTRATIVE THINKING WITH CDS AROUND THE ISSUES, NOT THAT THERE IS A BILL ON THE SECOND, THOUGH I WOULD LOVE FOR THERE TO BE SOMETHING NEXT YEAR. I THINK PEOPLE HAD DIFFERENT THOUGHTS. WE CAN PUT OUR IDEAS IN. BECAUSE SOMETHING DOESN'T APPEAR DOESN'T MEAN IT'S NOT POTENTIALLY ACTION READY, OR THIS LIST IS EVERYTHING IMPORTANT, BECAUSE IT'S NOT. I THINK IT'S A STARTING PLACE.

>> I THINK IT'S A REALLY GREAT LIST. I'M WONDERING IF WE CAN PUT OUT A REQUEST TO OUR COMMITTEE FOR SOMETHING -- FOR EXAMPLE, READING SERVICES. SOME OF THESE THINGS, IF THERE WAS FUNDING OR STATUTORY AUTHORIZATION WOULD NOT BE DIFFICULT TO IMPLEMENT. THE IMPEDIMENT HAS BEEN FUNDING. I WONDER IF WE CAN STRENGTHEN THE THINGS WHERE THERE IS NOT YET A SPECIFIC BUDGET ASK OR PIECE OF LEGISLATION TO RECOMMEND THAT IT BE RECOMMENDED FOR THE MAY REVISE OR SOMETHING LIKE THAT.

>> THAT'S A GREAT QUESTION. IF WE WANT THAT DONE THIS YEAR, THAT'S THE ACTION THAT HAS TO HAPPEN. A GROUP OF STAKEHOLDERS HAS TO COME TOGETHER. IT MIGHT BE WITHIN THE GROUP OR EXTERNAL. IT'S GOT TO BE A QUICK TURN AROUND. THAT'S WHY I WOULD LIKE US NOT TO HAVE TOO MUCH WORK WHEN IT'S NOT THE WORK WE NEED TO TURN OUR ATTENTION TO, WHO WANT TO GET OUR STUFF PASSED THIS YEAR, YOU KNOW?

>> OKAY, GRETCHEN.

>> THANK YOU. AGAIN, I LOVE THIS GRID AND A COUPLE OF THINGS AS A COMPLETELY FRESH READ OF THE DOCUMENT, I LIKE THE DESCRIPTIONS THAT YOU OFFERED, CLAIRE, IN TERMS OF THE CATEGORIES. I THINK THAT'S

20

VALUABLE TO HAVE A GLOSSARY IN THAT FRONT MATTER OF THIS SPREADSHEET ABOUT WHAT YOU PARTICULARLY MEAN, RELATIVE TO ADMIN ACTION VERSUS INFRASTRUCTURE AND WON'T GIVE FOLKS NOT FAMILIAR WITH THE DOCUMENT A SENSE OF WHAT THE CATEGORIES MEAN. HOWEVER, THEY MIGHT COME OUT IN THE FINAL PRODUCT. THERE IS CONSIDERATION ABOUT WHAT THE DOCKETS MEAN AT THIS POINT. THE OTHER THING, AND I REALIZE THIS MAY BE DIFFICULT TO OFFER AS A CONSIDERATION, IS THERE ANYWAY TO HAVE A THREE TO FIVE WORD STATEMENT ABOUT EACH ONE OF THESE? AGAIN, AS A FRESH READER, YOU HAVE TO GET THE ESSENTIAL GIST. THE CHALLENGE OF THAT, REDUCTION TO THE MEAN OF THE TITLE FOR THE RECOMMENDATIONS. IF YOU HAVE IT.

>> WE HAVE TITLE. I THINK WHAT WE CAN DO IS TRANSPORT THE TITLE FROM THE REPORT AND PASTE IT THERE.

>> THAT WOULD BE GREAT. THEN, JUST THE LAST SUGGESTION IS -- I DON'T KNOW IF THIS IS POSSIBLE, AND MAYBE IT DOESN'T MATTER, BUT IF THERE IS A STAGING THAT WOULD BE REQUIRED RELATIVE TO THE ACTIONS SUCH AS -- SOMETHING IS TOTALLY READY AND WHAT IT NEEDS IS A BUDGET ITEM OPPOSED TO THERE NEEDS TO BE POLICY FORMULATION THAT IS INCORPORATED. IF THERE IS ANYTHING THAT IS ABOUT THE STAGING OF THE ACTION READINESS, IF THAT'S APPROPRIATE, MAYBE THAT'S IN THE NOTE SECTION. IT MAY BE BEYOND THE CAPACITY AT THIS POINT, WHICH IS FINE.

>> I THINK THAT'S A GOOD POINT. THIS IS SARAH. I THINK -- FOR THE ITEMS -- FOR EXAMPLE, READING E-MAIL TRAFFIC ABOUT IT BEING CONSISTENT AND ENSURING FOR EACH OF THE ACTION READY ITEMS THAT HAVE AN ACCOMPANYING BILL, WE TRIED TO FLAG THEM. WE MAY HAVE MISSED SOME. IF WE HAVE, LET US KNOW. THOSE ITEMS HAVE BILLS THAT THEY HAVE LEGISLATIVE LEADERS BEHIND. THEY ARE GREAT OPPORTUNITIES. THOUGH WE HAVE A CATEGORY FOR BUDGET, I THINK THERE NEEDS TO BE A WAY TO DISTINGUISH CURRENT LEGISLATIVE BUDGET ACTION ITEMS VERSUS, WE NEED LEGISLATIVE BUDGET TO GET THIS IMPLEMENTED. DO YOU SEE THE DISTINCTION? LET'S HAVE CURRENT ONES.

>> THAT COULD BE INCORPORATED IN THE CODING. MAYBE THERE'S AN "X" BUT ALSO A "C," SOMETHING THAT DENOTES WHERE THINGS ARE. NOT TRYING TO BE OVERLY COMPLICATED, BUT IF THERE IS SOMETHING THAT GIVES TEXTURE TO THE COLUMN THAT OTHERS CAN FOLLOW, THAT GIVES TEXTURE TOO. AS LONG AS IT WORKS IN BLACK AND WHITE PRINTING.

>> OKAY. NEXT IS JEFF.

>> JEFF: SO, LET ME PREFACE MY COMMENT SAYING THAT PERHAPS THIS HAS HAPPENED ON THE FORMAL BASIS. THAT'S GREAT. EVEN IF WE HAVE SOLID RECOMMENDATIONS WITH RESPECT TO THE NEEDS OF THE DEAF AND

21

HARD OF HEARING POPULATION, I WOULD HOPE THAT THIS REPORT IS SOMEHOW VETTED THROUGH THOSE IN THAT POPULATION BECAUSE IT'S REALLY A LENS THAT NONE OF US CAN COMPLETELY SEE THROUGH, SO I THINK THAT'S MY POINT.

>> HMM HMM.

>> NINA?

>> YES. NINA HARWELL. UNDER 41A THERE IS GOVERNOR'S LANGUAGE FOR PAID FAMILY LEAVE EXPANSION. AB196 IS WAGE REPLACEMENT, WHICH WE DIDN'T TACKLE ON THE REPORT. NOT THAT IT'S NOT IMPORTANT, BUT WE DIDN'T TACKLE IT, SO I WOULD STRIKE THE LANGUAGE OUT. I BELIEVE, FB2 IS AB192, LIZ HAMILTON CAN SPEAK TO THAT. I BELIEVE THERE WAS A RECOMMENDATION TO MAKE IT AN ENTITLEMENT. WHERE WOULD THAT FALL ON THE GRID?

>> WE WOULD LOVE IT IF IT WAS ACTION READY. LET'S DO IT THIS YEAR.

>> OKAY, THAT'S AN EXAMPLE, TO ALAN'S POINT, WE CAN'T FORGET POLICY RECOMMENDATIONS THAT ARE -- MAY TAKE A LITTLE BIT OF A LONGER TERM. ALL RIGHT, LYDIA.

>> I WANTED TO SUMMARIZE WHAT I HAVE BEEN HEARING ON THE GRID FOR THE NEXT STEPS. I THINK THE IDEAS THAT HAVE COME FORWARD ARE REALLY GOOD. TO GRETCHEN, ADDING A SHORT TITLE TO EACH ONE, THAT WOULD BE SIMPLE TO DO AND HELP PEOPLE SPOT IMMEDIATELY WHAT THE TOPIC IS. WE DO NEED EVERYONE ON THE SUBCOMMITTEE TO REVIEW THE GRID AND GET US YOUR COMMENTS. WE ARE NOT EXPERTS IN ALL OF THESE AREAS. AS NINA POINTED OUT, A COUPLE OF THINGS THAT WERE MISSTATED THAT WE NEEDED TO CORRECT RIGHT AWAY. IF YOU COULD DO THAT, ADDING THE GLOSSARY FOR THE NAME.

>> IS THAT IN THE NEXT 48 HOURS?

>> YEAH.

>> NO WORRIES. THEN, THE DISCUSSION WE HAVE HAD ABOUT THE CODING AND THE CHECKMARKS, IT DOES FEEL TO ME LIKE EVERYTHING SHOULD HAVE A MARK, AS SOMEBODY SAID. I THINK OUR ORIGINAL THINKING WAS, IT APPEARED IF SOMETHING COULD BE DONE WITH LEGISLATIVE ACTION, IF THAT COLUMN WAS CHECKED OFF, THEY ARE HAVING DISCUSSIONS TODAY AROUND CORONAVIRUS, FOR EXAMPLE. BUDGET -- DEFINITELY NEED BUDGET. DOESN'T MEAN IT'S IN THE BUDGET NOW, BUT IT COULD APPEAR MAGICALLY, AND THE SAME WITH LEGISLATION. INFRASTRUCTURE WAS TO POINT OUT THINGS, I BELIEVE, THAT WERE NEEDED IMMEDIATELY, AND THERE WAS A COUPLE OF RECOMMENDATIONS IN HERE. I KNOW THERE WAS

22

ONE THAT CAME FROM ME THAT IS ONE TIME ONLY FUNDING. THAT WOULD BE A GOOD THING TO HIGHLIGHT TOO. WE KNOW THAT THE LEGISLATURE AND GOVERNOR LIKED THOSE KIND OF THINGS.

IF THERE IS ANYTHING ELSE ON THE GRID THAT COULD BE DONE WITH ONE TIME ONLY FUNDING, LET'S PULL THAT OUT AS WELL AND CODE THAT. IS THERE ANYTHING ELSE FROM OUR IMMEDIATE CONVERSATION I HAVE MISSED IN SUMMARIZING? GRETCHEN?

>> THOSE ARE THE BIG ONES. IT DEPENDED ON WHERE THE CATEGORIES CHANGE OR SHIFT OR ARE TITLED BASED ON THE DISCUSSION. I WAS THINKING ABOUT, AGAIN, NEW READER, WHAT IS THE DIFFERENCE BETWEEN LEGISLATIVE ACTION OR INFRASTRUCTURE. ISN'T IT SOMETHING THAT IS THROUGH AN ADMINISTRATIVE ACTION OR MAYBE NOT. CLARITY, BUT THAT MAY COME IN THE EDITORIAL PROCESS OF FOLKS REVIEWING THE GRID, CONSIDERING, ARE ALL OF THE CATEGORIES NEEDED? CAN IT BE A FEW IF SOMETHING EXPANDED? WHENEVER THAT IS RESOLVED, THAT THERE IS A GLOUCESTER ABOUT WHAT THIS MEANS.

>> FRESH EYES ARE GOOD. CLAIRE, ANYTHING ABOUT THE SUMMARY?

>> THAT SOUNDS GOOD. IN TERMS OF WORKLOADS. I KNOW 48 HOURS ISN'T A HUGE AMOUNT OF TIME. IF YOU ONLY HAVE MINIMAL TIME, LOOK AT THE ONES IN YOUR WHEELHOUSE. THEY'LL BE MUCH MORE HELPFUL TO HAVE 20 PEOPLE WITH TWO EACH THAN TO FEEL LIKE A COUPLE OF PEOPLE ARE SLOGING THROUGH. IF YOU THINK THE WAY THE PIECE WORKS ISN'T LOGICAL, LET ME KNOW. I AGREE THAT YOU CAN CALL SOME OF THE INFRASTRUCTURE STUFF ADMINISTRATIVE.

WE WERE TRYING TO SEPARATE THE IDEA OF THINGS LIKE, CDA COULD TAKE UP THE ACTION AND MAKE REGS OR CHANGE THE GUIDANCE. IT WAS AN INFRASTRUCTURE SORT OF -- GLOBAL SHIFTS, SORT OF MORE TECTONIC SHIFTS HAPPENING IN DEPARTMENT ORGANIZATION OR SOMETHING THAT TAKES A HIGHER LEVEL OF LEADERSHIP AND AUTHORIZATION ALL THE WAY UP TO THE GOVERNOR TO DO. EVEN IF IT DID AFFECT ADMINISTRATIVE AGENCY. SEE IF THE WAY WE CHECKED BOXES MAKES SENSE TO YOU. SEE IF THERE SHOULD BE A FIFTH CATEGORY. WE ARE NOT LOCKED IN. LOOK AT THE ONES YOU FEEL MOST ABOUT AND TARGET AND IF THERE ARE MORE NOTES TO PUT IN.

>> MAY I ASK A QUICK, CLARIFYING QUESTION. I'M LOOKING AT PAGE ONE, 1A, AND 2II. WHAT DOES THAT REFERENCE?

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>> OH, IT REFERENCES THE LARGE REPORT THAT HAVE FIVE BIG OBJECTIVES. THE ONE, TWO, THREE -- THE NUMBERING REFERENCES THAT OBJECTIVE, AND THEN, ALL OF THE SUB STUFF, IF YOU GO TO THE REPORT, YOU WILL SEE THE SUB RECOMMENDATION WITH THE STATEMENT ABOUT WHY THIS IS THE PROBLEM AND WHAT THE RECOMMENDATIONS AROUND FIXING IT ARE?

>> GREAT. I'M THINKING SOME KIND OF NOTATION FOR THAT EFFECT.

>> OR A HYPER LINK.

>> I REALIZE THAT'S AT THE END OR PAGE NUMBER. LET'S ME AS A READER NO WHAT THAT IS.

>> EVEN PUTTING A PAGE NUMBER AND DESCRIPTION AT THE END OF THE DESCRIPTION, WE COULD PUT IN A HYPER LINK TO THAT ONLINE. WE HAVE KATHRYN AND PATTY. KATHRYN?

>> AGAIN. PATTY, YOU'RE UP.

>> GREAT MINDS, KATHRYN.

>> I DON'T KNOW IF THEY EMPLOYEE A PERSON FOR AGING, BUT THERE USED TO BE A LEGISLATIVE ADVOCATE OR COORDINATOR OR WHATEVER THEY CALL THE PERSON WHO COULD FOLLOW AND TRACK BIG BILL AS WELL AS EVERY BUDGET ITEM DEALING WITH AGING. I THINK THAT'S WHO COULD -- YOU SHOULD GIVE THIS TO KIM. SHE COULD DO THAT WITHIN 48 HOURS, OR HER STAFF COULD.

>> I'M GOING TO MAKE NO COMMENT ON THAT. OKAY. MARTY HAS A QUESTION ONLINE TYPED INTO THE CHAT BOX.

>> WE'LL SEE HOW THE GRID IS UPDATED IN TWO BUDGET ITEMS, BILLS. ARE WE RESOLVED --

>> IS THAT THE NEXT SLIDE, BASICALLY?

>> YOU KNOW, IT WAS HARD TO HEAR WHAT WAS SAID.

>> THE QUESTION, CLAIRE, WAS, WHO IS GOING TO BE UPDATING THE GRID AS CHANGES HAPPEN? I THINK THAT'S A GREAT QUESTION. I DON'T KNOW HOW YOU DEAL WITH QUALITY CONTROL. IT'S SOMETHING THAT CAN BE UPDATED ONLINE BY EVERYBODY. IS THAT A GOOGLE DOC? I DON'T KNOW IF THAT'S POSSIBLE. I'M LOOKING AT SCARED FACES.

>> YOU CAN TRY GOOGLE DOC.

>> NOT EVERYONE KNOWS HOW TO USE IT. GOOD QUESTION. ARE YOU VOLUNTEERING, MARTY?

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>> THIS IS CLAIRE. I'LL VOLUNTEER TO UPDATE THE GRID FOR NOW. AT SOME POINT, IT'S A TOOL FOR OTHERS, AND IT'S BEYOND OUR CAPACITY TO KEEP CURRENT ON. IF PEOPLE WANT TO SEND ME THEIR EDITS FOR THE FIRST ROUND, I'M HAPPY TO DO THAT.

>> WE HAVE ONE FINAL COMMENT FROM NINA, AND WE'LL GET TO THE LAST POINT OF CONVERSATION.

>> JUST A QUESTION SINCE I'M WRITING TO THE AREA CAPTAIN. ONE QUESTION FROM THE FOLKS IS MAKING SURE WE KEEP A CONSISTENT VOICE IN THE NEXT ROUND OF WRITING. IF YOU HAVE SUGGESTIONS OR IDEAS, IF WE MIMIC THE STRUCTURE AND VOICE, WE DON'T HAVE TO HAVE THE CONVERSATION NOW. WE CAN HAVE IT OFFLINE. I WANTED TO PUT IT OUT THERE.

>> THE LAST SLIDE FOR THE REPORT IS THE PLAN FOR TRANSMISSION OF STAKEHOLDER REPORT AND ACTION READY ITEMS TO THE ADMINISTRATION. WELL TELL YOU WHAT WE THINK WE HEARD. 48 HOURS FOR ANY FATAL FLAW IN THE REPORT. WHAT'S THAT? FROM 5:00 P.M. FROM 5:00 P.M. TONIGHT, YOU HAVE 48 HOURS. THIS IS ALSO 48 HOURS TO REVIEW THE GRID AND MAKE FATAL FLAW OR RECOMMENDATIONS ON THE GRID. THIS IS THE LTSS SUBCOMMITTEE. WE ARE THEN SENDING THE REPORT -- REVISING THE REPORT AND GOING TO EQUITY TUESDAY THE 17TH. DO WE WANT TO GET THE REPORT TO EQUITY A DAY AHEAD?

>> YES, THE GOAL WOULD BE TO GET IT TO EQUITY THE DAY AHEAD. I THINK THAT'S DOABLE. THE FINAL STEP I DON'T THINK WILL BE TOO HARD. INCORPORATING THAT FROM EQUITY TO SAC ON THE 23RD. HOW DOES THAT SOUND?

>> WONDERFUL. THEN WE'LL HAVE A PARTY.

>> WE KEEP TALKING ABOUT THIS PARTY, SARAH.

>> IT'S GOING TO HAPPEN.

>> WE SHOULD INVITE MARTY FROM HOME OFFICES TOO.

>> THERE WILL BE LESS THAN A THOUSAND PEOPLE.

>> ANYONE HAVE COMMENTS? NINA?

>> SAC GETS IT, AND THAT'S IT, RIGHT? IS THERE ANOTHER TURN AROUND?

>> SAC WILL GET IT ON THE 23RD. WE'LL GIVE THEM A FEW DAYS TO SEND FATAL FLAW. COULD THEY SEND FATAL FLAW IN THE NEXT 48 HOURS. THE CHALLENGE IS WE WANT TO BRING IT TO EQUITY FIRST. WE HAVE MORE CHANGES BEFORE IT GOES BACK TO SAC. WE'LL BRING IT TO SAC AFTER EQUITY FOR THE FINAL, AND HOPE NOBODY --

25

>> FATAL FLAWS ONLY.

>> I BELIEVE SAC WAS TOLD THEY HAVE THE 10TH TO THE 17TH. DOES THAT SOUND FAMILIAR?

>> IT COULD HAVE BEEN.

>> WHAT ARE YOU GOING TO DO WHEN YOU GET CHANGES?

>> FATAL FLAW CHANGES?

>> EQUITY ISN'T TOLD AS MUCH. I THINK IT'S CONFUSING WITH EQUITY WHO IS UNHAPPY WITH THE TIMING. UNHAPPY MIGHT BE STRONG. THEY WANT TO LOOK AT IT THROUGH THE EQUITY LENS AND PROVIDE ADVICE, IS THERE ANYTHING WE MISSED, NOT JUST FATAL FLAW REVIEW. IT SEEMS HARD TO GIVE IT TO SAC UNTIL AFTER EQUITY LOOKED AT IT. THEY MIGHT HAVE ADDED SOMETHING AND THEY HAVE TO GIVE IT BACK TO SAC AGAIN. THAT MAY BE WHAT WAS DECIDED. IT SEEMS HARD TO PULL OFF.

>> I AGREE.

>> YES.

>> OKAY.

>> DID WE GIVE SAC48 HOURS AFTER THE EQUITY MEETING? COULD THE EXPECTATION WITH EQUITY BE THAT ANY CHANGES BE MADE AT THE MEETING, HOPEFULLY WITH THE EQUITY WORK GROUP, THEY'LL MEET AND GET BACK TO US. IT MEANS IT'S IMPORTANT TO GET THE REPORT TO THEM IN ADVANCE.

>> IT NEEDS TO BE NO LATER THAN MONDAY MORNING. THE EXPECTATION THAT PEOPLE REVIEW THIS THE NIGHT BEFORE IS CHALLENGING AND RESULTS IN PEOPLE SAYING, I GOT TO THE MEETING. I HAVEN'T REVIEWED IT. I'LL BE THERE. I'M HAPPY TO BE A PERSON TO TAKE NOTES ONLINE AND MAKE CHANGES IF THAT'S HELPFUL. TO THINK IT'S A LITTLE HARD TO SAY YOU ARE GOING TO GET IT SOMETIME MONDAY, WHICH MIGHT BE 9:00 P.M. AND YOU WILL BE PREPARED BY TUESDAY --

>> CARRIE, QUESTION TO YOU. I HAVE SEEN A DRAFT OF THIS A FEW TIMES. JUST THROWING THAT OUT THERE. THIS IS NOT SEEING IT FOR THE FIRST TIME THE DAY BEFORE.

>> CARRIE, IF WE GET IT FROM EQUITY TO SAC AT THE SAC MEETING, IS THERE A PROBLEM WITH THAT? NEXT QUESTION, HOW IS IT GOING TO BE TRANSMITTED FROM SAC TO THE GOVERNOR?

>> WE'LL GET BACK TO YOU ON THAT ONE. WHY DON'T WE GO BACK AND PUT TOGETHER THIS TIMELINE AND DISCUSS WITH KIM AND LOOK AT THE

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TIMELINE OF THE OTHER COMMITTEES, AND HOPEFULLY FINALIZE SOMETHING BY THE END OF THE WEEK?

>> ELLEN?

>> ARE TALKS ABOUT COMPLETING THE REPORT AND GETTING IT TO THE ADMINISTRATION, DOES IT TRAVEL THROUGH CDA AT ALL FOR ITS JOURNEY FOR FEEDBACK AND REACTION TO THE REPORT AND THE PROCESS THEY HAVE BEEN INVOLVED IN?

>> MY UNDERSTANDING IS THAT THIS DOCUMENT WILL BE A LEGACY DOCUMENT FROM THE LTSS STAKEHOLDER COMMITTEE. ALL RIGHT, NINA, MORE COMMENTS, OR IS YOUR FLAG JUST UP? OKAY, WE ARE GOING TO TAKE A TEN-MINUTE BREAK, AND THEN COME BACK.

>> ALL RIGHT, GUYS. LET'S GET STARTED ON THE SECOND HALF OF OUR MEETING. ALL RIGHT. WE ARE GOING TO PIVOT INTO OUR RESEARCH SUBCOMMITTEE. THE DATA DISCUSSION. SO, JUST LIKE SAC AND OTHER WORK GROUPS, THE RESEARCH SUBCOMMITTEE HAS BEEN MEETING SINCE OCTOBER, I THINK. WE HAVE IDENTIFIED PEOPLE AND PUT PEOPLE IN WORK GROUPS WITHIN THE RESEARCH SUBCOMMITTEE. TODAY, WE ARE INTRODUCING THOSE ON THE SUBCOMMITTEE WORKING SPECIFICALLY ON GOAL ONE LONG-TERM SERVICES AND SUPPORT AND CARE GIVING. TO INTRODUCE GRETCHEN FROM THE SCAN FOUNDATION, KATHRYN KIETZMAN FROM UCLA AND DONNA BENSON, THEY ARE OUR CORE GROUP. THEY HAVE BECOME OUR GO-TO. THEY WERE VOLUN-TOLD. WE HAVE A FOLKS ON THE COMMITTEE, COMMUNITY PURPOSE, STACEY MOORE. WE HAVE JANET FRANK, SHIREEN MCSPAEDEN, FROM THE SAN FRANCISCO COUNTY OF AGING. WE HAVE THE GOAL FOUR GROUP. THE GOAL THREE MEETING WILL BE HELD AT WEST HEALTH IN LA JOLLA, MARCH 19TH. GOAL FOUR, ECONOMIC SECURITY SAFETY MEETING, HELD AT USC APRIL 28TH AND THE FOLK ON THE RESEARCH SUBCOMMITTEE, KAREN LINCOLN, NARI RHEE. ALSO HAVE OTHER FOLKS ON OUR RESEARCH COMMITTEE HERE WHO HAVE NOT YET BEEN NAPPED FOR ONE OF THE WORK GROUPS. ALL RIGHT. OUR RESEARCH SUBCOMMITTEE CHARGE -- OH, TERRY SHAW IS ON THE PHONE. SHE IS WORKING ON THE DATA DASHBOARD AND GAP ANALYSIS. TO REVIEW THE SUBCOMMITTEE CHARGE IS TO ACHIEVE AND MAINTAIN THE CHART FOR ALL CALIFORNIANS. TO CREATE THE EXECUTIVE --

THE MASTER PLAN FOR AGING IS SUPPOSED TO BE EVIDENCE BASED WITH MULTIPLE INDICATORS. THE SUBCOMMITTEE IS LOOKING AT RECOMMENDED DASHBOARD INDICATORS, ALLOWING US HOW OLDER ADULTS AND AGING CALIFORNIANS, WHERE ARE WE NOW? WHERE DO WE WANT TO BE IN TEN YEARS? WHERE DO WE WANT TO BE OVER TIME AND ARE THERE

27

DISPARITIES? THERE IS A SECOND PART TO DEVELOP RESEARCH AGENDA FOR THE MASTER PLAN. THAT'S RESEARCH EVALUATION DATA COLLECTION THAT SHOULD BE INCLUDED IN THE MASTER PLAN. HERE ARE THE RESEARCH SUBCOMMITTEE TIMELINES. AS I SAID BEFORE, AND YOU WERE RIGHT, GOAL THREE MEETING IS MARCH 19TH. THE GOAL FOUR MEETING ECONOMIC SECURITY AND SAFETY IS APRIL 28TH. WE HAVE A MAY MEETING WHERE THE RESEARCH SUBCOMMITTEE REPORTS TO SAC ON PRELIMINARY RECOMMENDATIONS RELATING TO THE RESEARCHERS HERE TODAY.

WE HAVE -- WE'LL BE REVIEWING SAC FEEDBACK AND THE DASHBOARD IN MAY. ALL RIGHT, I WANT TO START OFF, GRETCHEN -- DO YOU WANT TO -- YOU TELL ME.

>> THAT SOUNDS GREAT. THANK YOU, EVERYONE. I'M WITH THE SCAN FOUNDATION. I'M GRATEFUL TO BE JOINED BY OUR COLLEAGUES, KATHRYN AND DONNA. DONNA IS WITH ME AND THE OTHER TWO ARE ON THE PHONE.

THERE'S MORE TO SAY BUT WE WANT TO START, THAT WE'RE PRACTICING FROM OUR LOCAL PUBLIC HEALTH DEPARTMENTS AROUND PERSONAL AND COMMUNAL HAND WASHING, OUR ROOM IS SET UP WITH THE RECOMMENDATIONS ON WIPES AND SANITIZERS AND ALL OF YOU KNOW, I HOPE NOBODY SHOOK THEIR HANDS. WE ALL GREETED EACH OTHER WITH NODS. WE'RE LOOKING AT MEETINGS AND TRAVEL, PARTICULARLY IN LIGHT OF THE NEXT GUIDANCE FROM CITY LAST NIGHT ABOUT OLDER ADULTS AND OTHERS WITH INCREASED RISK. THANK YOU TO THE COMMITTEE FOR SENDING IT OUT. THIS MEETING, WE ENCOURAGE PEOPLE, THE WE CAN ALREADY QUICKLY PIVOT TO EXPLORATIONS WHICH WE DO HERE. WE WILL BE TAKING A CLOSET LOOK AT OUR TWO MEETINGS NEXT WEEK. THERE WILL BE A SUBCOMMITTEE TO CONSIDER TO GO TO ZOOM ONLY. WE WILL MAKE THAT DECISION SHORTLY. WE WANT TO BE SURE EVERYBODY HAS THE INFORMATION AND ENCOURAGE YOU TO PRACTICE, HOLD EACH OTHER ACCOUNTABLE IN KINDNESS TO WORK ON THE HABITS AND IF YOU HAVE INPUT FOR US ABOUT HOW YOUR ORGANIZATION IS DOING IT, WE'RE HAPPY TO BE IN DIALOGUE ABOUT THAT WITH YOU. GOOD NEWS, THE MASTER PLAN, WE, FROM A VERY ORGANIZATIONAL PERSPECTIVE, ARE NEXT LARGE SCALE MEETINGS ARE THE STAKEHOLDER ADVISORY COMMITTEES AREN'T UNTIL MAY 16 SO WE HAVE TIME FORT SUBCOMMITTEE TO WORK ROOM IN WEBINAR WHICH IS MORE ZOOM FRIENDLY. THE WORK CONTINUES, EVEN MORE ON ZOOM THAN USUALLY BEEN. OTHER ORGANIZATIONS ARE WRESTLING WITH IN YOUR MEETINGS. I SAW A MEETING IN ATLANTA WAS CANCELED. WE ALL HAVE THAT WEEK FREE. IT'S A LOSS OF TIME TO GATHER BUT IF THERE ARE

28

ANY OTHER, AGAIN, THE MASTER PLAN IS NOT JUST ANY OLD MEETING. I WANT TO CREATE SPACE TO TALK ABOUT THE OPERATIONAL IMPACTS AND ALSO IF THERE ARE THOUGHTS ABOUT HOW WE COULD OR SHOULD BE RESPONDING. LID?

>> THANK YOU FOR THE COMMUNITY TO TALK ABOUT THAT A. I'M NOT DIRECTLY INVOLVED ANY MORE WITH THE STATE ASSOCIATION FOR ADULT SERVICES, BUT I HAVE BEEN PART OF MESSAGE CHAIN, TALKING ABOUT THE NEED TO -- ADULT CENTERS HAVE IN THE COMMITTEE. WE CAN'T LOCK DOORS AND CLOSE PEOPLE OFF FROM THE COMMUNITY. PEOPLE GO HOME TO THEIR OWN FAMILIES. WHILE INFORMATION IN THE DEPARTMENT OF PUBLIC HEALTH IS GREAT APPRECIATED AND WIDING IN THE COMMUNITY, ANY FURTHER GUIDANCE THAT WE CAN GET FROM THE DEPARTMENT OF PUBLIC HEALTH, FROM YOUR DEPARTMENT AND OTHERS, AROUND.THE COMMUNITY BASED PROGRAMS THE LIKE OURS WOULD BE HELPFUL. THERE'S BRAINSTORMING GOING ON AMONG THE MEMBERS OF THE ASSOCIATION ALREADY. SO BESIDES EXTREME INFECTION CONTROL, WHICH THEY WILL BE PERFORMING ANYWAY, TALKING ABOUT THINGS LIKE VISITATION, EDUCATION OF THE PASSIONATES AND FAMILIES, HOSTING OF -- POSTING OF NOTICES, ANY FURTHER ADVICE AND INFORMATION THAT CAN COME FROM OUR STATE PARTNERS WOULD BE VERY, VERY HELPFUL. SOME OF OUR CENTERS ARE IN TOUCH WITH THEIR DEPARTMENTS OF PUBLIC HEALTHY. TOO.

>> THE STATE PUT OUT RESIDENTIAL GUIDELINES AND FOR THE INDIVIDUAL. FIRST PIECE IS COMMUNITY BASED GUIDELINES WE HAVE BEEN IN TOUCH WITH PROVIDERS, ADULT DAY CENTERS, OR MULTI SERVICES, SENIOR PROGRAMS, AND TO GET QUESTIONS, FROM PROVIDERS AND THOSE QUESTIONS ARE CURRENTLY, I JUST SAW THEM TO GET ANSWERS. WE'RE GOING TO PUT OUT FA QS TO THE PROVIDERS, TODAY, ALTHOUGH SOME OF THE ANSWERS MAY, NOT PROMISE, BUT THE QUESTIONS I SAW COME THROUGH, SCREENING INDIVIDUALS COMING, PROTOCOLS THAT, MAICHTING CENTER STANDARDS AND CLOSURE, CENTER CHANGES, LOTS OF OPERATIONAL ISSUES, SO THE IMMEDIATE THING TO DO IS SEND THE QUESTIONS TO THE PROGRAM STAFF AT CALIFORNIA DEPARTMENT OF AGING, ANOTHER CALL TODAY WITH MEDICAID FUNDED PROGRAMS FOR GUIDELINES. WE HAD A NATIONAL CALL YESTERDAY WITH FREDZ, LEARNING IN WASHINGTON, UNFORTUNATELY, BUT ALSO ABOUT THE PROGRAMMATIC OPERATIONAL ISSUINGS. HOPEFULLY, YOU WILL SEE INITIAL FAQ TODAY BUT MORE ANSWERS IN COMING DAYS AS WE GET MORE CLARITY FROM THE STATES AND FEDS.

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>> I KNOW THIS IS NOT UNIQUE, BUT IMPACT OF POTENTIAL CLOSURES ON THEIR FINANCIAL STAT WILL BE VERY HIGH. TOP OF THE LINE FOR EVERYONE.

>> WORKERS WHO WERE THERE AND CENTERS THEMSELVES. SO --

>> HI, IT'S KATHERINE. ON THAT TOPIC, IN CONSULTATIONS, IT LOOKS LIKE THEY HAVE THE AUTHORITY UNDER THIS TITLE 17 REGULATIONS, WHERE A GROUP OF PEOPLE CAN NO LONGER ATTENDED CENTER TO CONTINUE TO -- THE PROVIDER AT THE SAME RATE. I HAVE NO IDEA WHETHER THERE IS SIMILAR AUTHORITY OTHER PLACES, BUT IT SEEMS A FORWARD LOOKING PROVISIONS, SO INDIVIDUALS IN RESIDENTIAL FACILITIES THAT CAN NO LONGER GO TO THE DAY PROGRAM THEIR SPECIALIZED NEEDS, PROVIDERS STILL PAY FOR THAT.

>> I WAS THINKING, KIM, SIMILAR IS TO WHAT WE DID WITH OUR COMMUNITY BASED HEALTH HOME DURING FIRE EMERGENCIES, THE STAFF ARE STILL IN COMMUNICATION WITH FAMILIES, WITH PARTICIPANTS, DOING SURVEILLANCE, THERE ARE A NUMBER OF VERY HELPFUL TASKS AND ACTIVITIES THEY CAN STILL ENGAGE IN, EVEN THOUGHED PERSON HAS BEEN AT THE CENTER FOR FOUR HOURS. THOSE ARE THE KINDS OF IDEAS AND BRAINSTORMING --

>> ON THE CALL, THE CALL WITH THE FEDS YESTERDAY, DHS WAS ON, WE WERE ON THERE, AS WELL, COMMUNITY LIVING FROM THE CENTRAL DEPARTMENT OF HEALTH AND HUMAN SERVICES, AND MEDICARE SERVICES FROM THE SAME AGENCY, THOSE WERE THE KINDS OF QUESTIONS ASKED AND THE ANSWERS RANGE FROM, YOU ALREADY HAVE THAT FLEXIBILITY, CAN BE TAKEN WITHOUT ANY EMERGENCY DECLARATION, THAT'S A PROGRAM FLEXIBILITY, OH, THAT REQUIRES TELLING US, OH, THAT REQUIRES A DLAFERTION DISASTER, IT WAS MAPPING OUT WHAT WAS, WHAT COULD BE CURRENTLY FEDERALLY GRANTED AND WHAT WOULDN'T, THAT'S WHAT PEOPLE ARE LOOKING AT, WHAT NEEDS TO BE DONE TO SIGNATURE SERVICE'S AND -- ENSURE SERVICES. COUPLE OTHERS FOLKS ON THIS. KATHY KELLY, YOU'RE MUTED.

>> OH. THANK YOU. JUST WANTED TO, JUST A MINUTE --

>> ARE YOU OKAY? WE'RE STILL WITH YOU.

>> NO, SHE GOT MUTED.

>> OKAY.

>> SORRY. I HAD TO UNMUTE SOMETHING ELSE. CAN YOU HEAR ME?

>> YES.

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>> WE STILL CAN, KATHY. GO AHEAD.

[LAUGHTER]

>> HELLO?

>> YUP. WE CAN HEAR YOU.

>> OKAY. I WANTED TO MENTION, THERE'S A COUPLE PANELLESTS, ALSO PEOPLE ON THE ZOOM MEETING, MENTIONING THAT FOR THOSE OF US WHO WORK WITH FAMILIES IN THE HOME, THAT WE WOULD LIKE TO HAVE GUIDANCE OR CONSUMER TIPS FOR HOME BOUND INDIVIDUALS AND PARTICULARLY THOSE OF US WORKING WITH DEMENTIA.

>> DO YOU MEAN, HELP ME OUT, WE'RE DEALING WITH SOME OF THESE ISSUES IN THE PROGRAM ABOUT WHEN TO VISIT, PRECAUTIONS, ET CETERA. SOUNDS LIKE YOU'RE SCWG FOR SOMETHING DIFFERENT K YOU CONTINUE?

>> YES. SORRY, NEED TO GET AWAY FROM MY COMPUTER.

>> IT'S ALWAYS A CHOICE FROM THE TELEPHONE AND COMPUTER AUDIO. ONE OR THE OTHER.

>> TIPS FOR FAMILY CAREGIVERS, BEYOND PUBLIC HEALTH TIPS, ARE YOU TALKING MORE ABOUT MANAGING FEAR, ISOLATION?

>> WELL, WE WILL DEAL WITH THE -- ISSUES BUT A LOT OF, HOME ENVIRONMENT, WE'RE DEALING WITH -- NOT CONNECTED WITH MANY FORMAL SERVICES.

>> OKAY. THIS IS A GOOD TIME TO SAY THAT LAST THURSDAY, OUR OFFICE OF EMERGENCY SERVICES, HELD A STAKEHOLDER CALL ON THE VIRUS, AND THE DECISION WAS IT TO BE A WEEKLY CALL. SO THIS THURSDAY, 3:00, IF YOUR ORGANIZATION HAS NOT BEEN INVITED AND WANTS TO BE INVITED, I WILL EMAIL YOU. IT'S A STAKEHOLDER CALL MEANT TO HAVE A TWO WAY CONVERSATION LIKE THIS, I WILL THINK WITH YOU, KATHY, OFF LINE, ABOUT WHAT THAT WOULD LOOK LIKE. WHAT KIND OF, I KNOW A.P.R. IS ALSO INTERESTED IN SIGNIFICANT AWARENESS AND EDUCATION SO WINK THINK ABOUT WHAT THE BEST VEHICLE FOR THAT RESOURCE IS.

>> THAT WOULD BE HELPFUL. THANK YOU.

>> THANK YOU, KATHY, CAN YOU UNMUTE YOURSELF? YOU DID IT. GO AHEAD.

>> OH, I'M DOING BOTH PHONE AND COMPUTER. SO I GET AN EXTRA STAR FOR TWO TECHNOLOGIES. I EMAILED JEN, THAT DEPUTY DIRECTOR AT -- AND DEPUTY THOMPSON, ALSO DEPUTY DIRECTOR, SAN FRANCISCO IS OUR FIRST

31

COUNTY AND PUBLIC AUTHORITY THAT HAS PUT A PAUSE ON THE PROVIDER ENROLLMENT ORIENTATIONS THAT ARE REQUIRED BEFORE A PROVIDER CAN GET THEIR FIRST PAYCHECK. CURRENTLY, THEY PUT A PAUSE ON THAT FOR TWO WEEKS AND OTHER KINDS OF TRAINING AND SO FORTH, SO I GOT A THANK YOU BACK FROM THEM BUT I'M INTERESTED IN CONNECTING WITH THE UNIONS AND OTHER GROUPS TO SEE IF WE WANT TO FIGURE OUT SOME SPECIAL KINDS OF ACCOMMODATIONS, IT'S GOING TO BE TROUBLING AND ALSO, WE HAD OUR FIRST PROVIDER THAT CALLED THE PUBLIC AUTHORITY YESTERDAY AND IS SELF QUARANTINING HERSELF, THERE ARE REAL CONCERNS ABOUT NOT HAVING CAPACITY FOR ENOUGH REGGIE AND EMERGENCY BACK UP PROVIDERS. I DON'T THINK OUR PROGRAM, I ASKED, HAS THE SAME AUTHORITY AS DD'S, PAYING PROVIDERS WHO CAN'T PROVIDE CARE. THE LIMIT ON ONE DAY FOR PAID SICK LEAVE IS NOT SUFFICIENT, IF WE SEE A SPREAD OF THE VIRUS THROUGH THE -- PROVIDER COMMUNITY. INTERESTED IN PARTNERING WITH OTHER ORGANIZATIONS TO SEE IF WE CAN TACKLE THE UNIQUE CHALLENGES.

>> THANK YOU. THIS WAS GREAT. WE WILL, AGAIN, WE'RE TRYING TO ORGANIZE ALL OF US DOING COMMUNITY BASED SERVICES. THIS IS AIE GOOD TEST CASE, BRING THEM TOGETHER, OURSELVES, TO GET DIFFERENT RULES, GUIDANCE AND GET CLEAR GUIDELINES OUT. THANK YOU. LET ME NINA.

>> ACTUALLY, SINCE WE -- PAID LEAVE CARE CAME UP, THIS WOULD BE A GOOD TIME FOR THE EMPLOYMENT -- DEPARTMENTS TO PUT OUT INFORMATION ABOUT PAID FAMILY LEAVE PROGRAM, THAT'S AVAILABLE, PAID SICK LEAVE AND UNDER STATE PROGRAM, RUN THROUGH DD. I HAD ONE OTHER QUESTION THAT CAME UP ON -- AREA. I KNOW THAT IN CHINA, THEY, THERE WERE REPORTS, AND CHINA, FOLKS ARE BEING QUARANTINED AT HOME. THERE'S AN INCREASE IN DOMESTIC VIOLENCE. SO JUST BEING ON THE LOOK OUT FOR THAT. AN APS, ASIDE FROM ISOLATION ISSUE, AS WELL. I DON'T KNOW HOW TO ADVISE PEOPLE TO BE ON THE LOOK OUT, BUT SOMETHING LIKE, I HEARD THAT CAME OUT OF CHINA.

>> IT'S DEFINITELY ON OUR RADAR. PEOPLE ARE NOT GOING TO DAY CENTERS, ALL THE REISES OF ISOLATION -- RISKS OF ISOLATION COME UP. EDD PUT OUT A LOT ON UNEMPLOYMENT. I CAN'T REMEMBER IF IT SPEAK TO PAID LEAVE AND SICK LEAVE AND FAMILY LEAVE. THEY HAVE BEEN OUT THERE PROMOTING THAT FOR LOTS OF FOLKS LOSING WORK TIED TO THIS.

>> IT YOU UNMUTE? PATTY?

>> IT'S DONE. CAN YOU HEAR ME?

>> YES.

32

>> -- CALLED FOR -- WE'RE PLANNING IN TERMS OF WHETHER OR NOT PEOPLE HAVE TO -- STOPPING WITH THE ACTUAL -- MEALS.

>> YOU'RE CUTTING IN AND OUT. IT'S ABOUT MAKING PLANS ABOUT MEALS AND WHETHER THAT COMES HOME DELIVER. THAT'S ON THE MIND, THE KINDS OF CONVERSATIONS WE'RE HAVING. HOPE TO SEE AN FAQ COMING OUT.

>> THOSE WILL BE -- SENT WITHIN THE NEXT COUPLE DAYS TO ALL THE MEAL PROVIDERS?

>> THE GUIDELINES, WE WILL SEND GO TO THE AAA'S FA QSWILL GO OUT WITH WHAT WE KNOW AND WE WILL CONTINUE TO UP DATE. BUT YES, THAT COMMUNICATION TENDS TO BE BETWEEN CTA AND AAA'S. THAT'S A GOOD POINT, USE THEM AS A DISTRIBUTION AS WELL. THAT'S GOOD.

>> OKAY. GREAT. THANK YOU.

>> OKAY. MORE TO COME ON THIS TOPIC. SORRY, ON THE PHONE --

>> HI, JUST WANT RESPOND TO WHAT KAREN, I THINK WHAT'S HAPPENING AND WHAT WILL HAPPEN IS QUITE PROFOUND. I THINK FOR THE PURPOSE OF THE MASTER PLAN GROUP AND YOU SPECIFICALLY, KIM, AS THE DIRECTOR, EVEN THOUGH IT'S NOT RUN OUT OF THE DEPARTMENT OF AGING, I DON'T KNOW IF ANYONE FROM CVVS IS THERE BUT THE PROBLEM WITH BACK UP PROVIDERS AND LACK OF PAID SICK LEAVE TO ME IS LIKE A HOUSE ON FIRE THAT WE'RE ADDING WOOD T IT'S GOING TO KEEP BURNING WORSE. IT'S A VERY RIPE SITUATION FOR WIDE SPREAD CONTAMINATION DUE TO NOT ENOUGH FOLKS WHO WILL BE BEING BACK UP, BACK SUP NECESSARY, OR TAKING TIME OFF, IF THEY NEED TO, BECAUSE THEY CAN'T AFFORD TO DO THAT. I DON'T HAVE THE ANSWERS, EXCEPT INCREASED WAGES, OBVIOUSLY, WHO KNOWS HOW WE COULD DO THAT. I WANT TO RAISE THIS TO THE LEVEL OF THE GOVERNS OFFICE. THE THESE ARE THE PEOPLE AT FRONT LINES WITH NO RESOURCE TO DEAL WITH THIS. I DON'T KNOW WHAT WE DO ABOUT THAT BUT MAYBE WE CAN HAVE A TARGETED DISCUSSION ABOUT THAT. THAT WOULD BE GOOD.

>> YEAH. I APPRECIATE THE URGENCY. AS A MENTIONED, A LOT OF THESE, A LOT OF PUSH TO GET THE GUIDANCE OUT YESTERDAY FOR INDIVIDUALS, ELDERLY, THIS IS WHERE WE'RE HEADED. THIS WAS EXACTLY WHAT I NEED TO GO BACK TO MY DIRECTORS AND PULL TOGETHER. CSS HAS BEEN ON THE COMMUNITY LICENSATION, OO. -- LET'S SEE IF WE CAN GET COLLECTIVE, HOPEFULLY HAVE AN UP DATE FOR SURE AT STAKEHOLDER CALLS THURSDAY.

33

>> THANK YOU.

>> THIS IS SUSAN WITH THE ALHEIMER'S ASSOCIATION. WE TALKED IT HERE, WE HAVE AN 800 NUMBER THAT'S STAFFED BY MASTER LEVEL CLICHES, 24/7, WITH CONCERNS ABOUT HOME BOUND PEOPLE, IF THEY HAVE ALZHEIMER'S OR COGNITIVE IMPAIRMENT, THAT'S AVAILABLE AND ALSO WORKS NATION WIDE SO IF PEOPLE HAVE CONCERNS ABOUT SOMEONE IN ANOTHER STATE OR LONG DISTANCE CAREGIVER, WE'RE HAPPY TO MAKE THAT PRIVATE RESOURCE AVAILABLE.

>> THANK YOU.

>> OKAY. I'M GOING TO BE IN AND OUT TODAY DOING SOME OF THESE THINGS. CARRIE AND AMANDA WILL GET US TO THE WORK OF THE DAY. I WANT TO, AGAIN, SAY HOW EXCITED I AM FOR THE SUBCOMMITTEE ABOUT WHAT HAS BEEN ACCOMPLISHED SO FAR AND WHAT'S BEEN ACCOMPLISHED ON THE CONTENT AND PROCESS SIDES, WORKING WITH SAC TO GET THE REPORT ACCEPTED, TO GET THE ACTION ITEMS. .

[APPLAUSE]

>> I'VE BEEN TELLING EVERYBODY THAT WAS OUR FIRST SET OF RECOMMENDATIONS, COME BACK FOR TWO, THREE, FOUR, EQUITY, I'M EXCITED TO FINISH THAT WORK, AND THEN GOING TO THE DATA INDICATORS AND MEASUREMENT AND DASHBOARD. WE HAVE A GREAT PARTNER, TO HELP LEAD THAT WORK AND ALL THE RESEARCH AND EQUITY ARE MODELING. THERE'S A GREAT AGENDA, I WILL BE IN AND OUT WITH OTHER -- BUT WILL BE HERE AS MUCH AS POSSIBLE.

>> ONE COMMENT, THIS IS GRETCHEN. I COME FROM THE SCAN FOUNDATION. THANK YOU KIM FOR YOUR LEADERSHIP, AND IN THE MIDST OF THIS WORRY AND STRESS ABOUT 19, THERE'S A PART OF ME SO GRATEFUL WE ARE HAVING THIS CONVERSATION BUT IT UNDERSCORES THE VALUE OF THIS KIND OF DIALOGUE AT THE HIGHEST LEVELS IN STATE GOVERNMENT. THINGS HAPPEN BEYOND ALL OUR CONTROL, BUT WITH A STATE THAT'S PLANNING WITH CONSCIOUSNESS OF ITS AGING POLICY ACROSS ALL LEVELS OF FUNCTIONAL NEED. THIS IS THE RIGHT TIME TO BE HAVING THESE CONVERSATIONS. I DON'T KNOW WHAT IT WOULD HAVE BEEN LIKE A YEAR AGO, BUT WHAT I WAS HEARING NOW, THE FLOW OF INFORMATION ACROSS DEPARTMENTS, CENTRAL FOCUS OF AGING AMERICANS OF ALL LEVELS OF NEEDS, IS CENTRAL IN THIS DIALOGUE AND GETTING OUT INTO LOCAL COUNTS. CONGRATULATIONS, FOR ALL THE CONNECTIONS YOU HELPED IN THE LAST SIX MONTHS AND THE HELP OF EVERYONE IN THE COMMITTEES, EVERYONE INVOLVED. THINGS HAPPEN, AND WE RESPONDED WELL. THIS IS

34

A PROCESS THAT'S SHOWING THE STATES ARE RESPONDING WELL TO THIS SITUATION.

[APPLAUSE]

>> THANK YOU. THE LEGISLATOR, WE HAD OUR FIRST BUDGET HEARING ON AGING A MINUTE AGO, THURSDAY MORNING, AND THERE WAS A GREAT DISCUSSION ABOUT THE MASTER PLAN, THE LEGISLATOR, INCLUDING NEED FOR AASSISTANCE, A PROPOSAL TO DO STATE WIDE SYSTEM FOR STOCKHOLDERS. MONDAY, THERE WERE A ROUND TABLE, AND KRISTIN WAS THERE, THE GREAT MPA REPRESENTATION. WE HAD THE DISCUSSION ABOUT THE MASTER PLAN AND 19. IT WAS, THE TABLE WAS SET, THE FRAMEWORK OF THE LTSS, TO SHARE, WE WERE READY TO SHARE IT. OUR NEXT HEARING IS TOMORROW, AT THE ASSEMBLY. THESE CONVERSATIONS ARE REALLY LEGISLATOR, AGENCY, AND STAKEHOLDERS FLOWING TOGETHER. SO THANK YOU FOR, IT'S, YOU ALWAYS WISH YOU WERE MORE READY BUT WE'RE IN A BETTER PLACE THAN A YEAR AGO.

>> ONE COMMENT. AT THE ROUND TABLE, TO JUST, WITH POTENTIAL SLOW DISOWN IN ECONOMY, AND DECREASED -- TAX REVENUES, CONVENTIONS BEING CLOSED, LINES NOT FILLING UP, I'D ARGUE STILL NEEDS TO BE A PRIORITY, COST SAVING MEASURES FOR THE STATE IN THE LONG RUN. WE DON'T ALL MAKE THE FINAL DECISIONS, BUT WE CAN'T LOSS THIS OPPORTUNITY. LOSE THIS OPPORTUNITY.

>> OKAY. CAN I HAND IT BACK TO YOU?

>> SURE. WE HAVE OUR MEETING AGENDA. WE HAVE THE FIRST PART OF THE MEETING, LTSS STAKEHOLDER REPORT, FINAL REVIEW, A FEW THINGS TO GO OVER BEFORE WE PUT THE STAMP ON. IT. WE HAVE A RESEARCH COMMITTEE. WE WILL PLAY BY EAR, AND HERE WE HAD ARE AT MEETING TEN TO REVIEW THE STAKEHOLDER REPORT. LOOKING AT SUBCOMMITTEE WORK. I WANT TO FLOAT OUT THERE APRIL, MAY, JUNE MEETINGS. WE DON'T HAVE TO MAKE DECISIONS TODAY FOR THE LTSS SUBCOMMITTEE. BUT THERE ARE ALSO A LOT OF OTHER PIECES OF WORK GOING ON THAT WE NEED TO MAKE SURE THE SUBCOMMITTEE IS WORKING WITHIN THOSE PRETTY TIGHT TIMELINES. SO, ANYBODY HAVE THOUGHTS ON APRIL, MAY, JUNE MEETINGS, WITH THE IDEA THAT, SO GOAL 2, 3, 4, ARE GETTING THEIR RECOMMENDATIONS IN BY MAY SECOND. SO JUST WITH THAT IN MIND, WHAT IS THE BEST USE OF THE TIME FOR THE LTSS SUBCOMMITTEE IN TERMS OF ACTUALLY MEETING IN PERSON, MEETING ON A WEBINAR, MEETING WITH CROSS, WITH GOALS 2, 3, 4 CAPTAINS ON THEIR MEETING SCHEDULE? THERE ARE SOME THOUGHTS AXED CHOICES TO BE MADE THERE. ANYBODY,

35

ANYBODY HAVE THOUGHTS ON THAT? [THOUGHTS AND CHOICES] CLAIRE, PLEASE UNMUTE YOURSELF.

>> CAN YOU HEAR ME?

>> YES.

>> OKAY. TO YOUR QUESTION, CARRIE, ONE THING WE SHOULD BE THOUGHTFUL ABOUT IS HOW MUCH WORK IS GOING TO GO INTO HAVING GOALS 2, 3, 4 DONE, AND I DON'T WANT TO LOSE MOMENTUM ON LTSS, BUT I THINK THE IDEA OF HOW TO SUPPORT THE OTHER GROUPS SEEMS LIKE MAYBE THE PRIMARY FOCUS, AND ALSO, HOW DO WE SUPPORT EACH OTHER'S INITIATIVES ALREADY GOING FORWARD THIS YEAR, SO WE MAYBE CAN GET IMMEDIATE ACTION? WE SHOULD FOCUS THERE IN THE NEXT COUPLE MONTHS, TO NOT OVERWHELM PEOPLE.

>> OKAY. GOOD POINT. ELLEN?

>> HI, MY THOUGHT IS, JUST AS WE SHIFTED SOME ITEMS TO THE OTHER GROUPS FROM THIS GROUP, I WONDER IF THERE WILL BE A SHIFT WITH THE ITEMS THEY'RE PROCESSING BACK TO US? I THINK WE SHOULD BE STANDING IN READINESS TO HELP WITH THOSE NEW CONCEPTS OR IDEAS OR RECOMMENDATIONS THAT COME FORWARD.

>> MM HMM. ANYBODY ELSE ON THE PHONE? BEFORE WE MOVE ON?

>> I THINK OUR GROUP MIGHT NEED A LITTLE BREAK. SPRING BREAK. MAYBE RESUME AROUND THE FIRST OF A, OR, NO, LONGER THAN THAT. THAT'S GOING TO BE HERE BEFORE WE KNOW IT. MAYBE A MONTH OFF, BECAUSE SEVERAL OF US ARE ON OTHER WORK GROUPS, TOO.

>> MANY PEOPLE ARE ON, OR WILL GET PULLED INTO A GOAL 2, 3, 4 WORK GROUP, IF SOMETHING THEY'RE WORKING ON FALLS WITHIN YOUR EXPERTISE. SO, LET'S CONTINUE TO THINK ABOUT THAT. AND ALWAYS WELCOME TO FEEDBACK ON WHAT THE NEXT STEPS ARE THERE.

>> AS A NON-GROUP MEMBER, BUT A MEMBER OF THE RESEARCH SUBCOMMITTEE, I WILL ACKNOWLEDGE THAT GOAL 3 DISCUSSION HAPPENS ON MARCH 19, BE AND GOAL 4 DISCUSSIONS, ABOUT MEASURES, IS APRIL 28. SOMETHING TO CONSIDER FOR THIS COMMITTEE IN TERMS OF, FOR KIND OF LISTENING IN ON THAT DIALOGUE AND THINKING ABOUT HOW ONE WANTS TO WEIGH IN FROM THE VISION POINT OF MEASURES, CONSIDERATION.

>> ABSOLUTELY. YES. RESEARCH IS CONTINUING ON IN MARCH AND APRIL.

>> ALL RIGHT. WE HAVE OUR A.P.R. GUIDELINES, AND ON TIME. I DON'T KNOW HOW WE'RE DOING ON THAT. ONE PERSON SPEAKS AT A TIME. BE FULLY PRESENT, DISENGAGE FROM ELECTRONIC DEVICES, USE RESPECTFUL

36

LANGUAGE AND ASSUME GOOD INTENTIONS. SO, WE'RE GOING TO START WITH OUR LTSS STAKEHOLDER REPORT. WE HAVE LYDIA, SARAH, SUSAN DEMAROIS AND CLAIRE RAMSEY. DO YOU WANT ME TO CONTINUE WITH THE CLICKER? NOT REALLY?

>> CARRIE, IT THIS IS CLAIRE.

>> YES, HI.

>> AM I RIGHT, WE NEVER, I NEVER HEARD US INTRODUCE OURSELVES? IT WOULD BE HELPFUL TO KNOW EVERYBODY IN THE ROOM AND ON THE PHONE. I DON'T KNOW WHO'S THERE.

>> LET'S START IN THE ROOM. I WILL START. I WAS CARRIE GRAHAM, FROM UNIVERSITY OF CALIFORNIA, A CONSULTANT CVA.

>> AMANDA, WITH CVA.

>> SARAH.

>> SARAH STEENHAUSEN, SCAN FOUNDATION.

>> THIS IS ELLEN, ON THE COMMISSION OF -- SERVICES.

>> A.P.R., CALIFORNIA. LINE FOR LEADERSHIP AND EDUCATION.

>> JEFF THOM, COUNCIL OF THE BLIND.

>> GOOD AFTERNOON --

>> GRETCHEN, SCAN FOUNDATION.

>> KATHY LINE, U.C.L.A. POLICY FOR HEALTH RESEARCH.

>> LET'S DO A ROLL CALL AS PEOPLE ON THE PHONE -- I THINK WE HAVE CALIFORNIA DEPARTMENT OF AGING. BRANDI WOLF, CLAIRE RAMSEY, DONNA BENTON, KAREN, KATHY KELLY, ANYONE ELSE ON THE PHONE? MARTY? ANYONE WE MISSED?

>> --

>> CHRISTINE ON THE PHONE.

>> --

>> OKAY. ALL RIGHT. WHO'S TAKING IT FROM HERE?

>> I WILL START. ANY OF MY COLLEAGUES, FEEL FREE TO JUMP IN. WE DECIDED AT THE LAST MINUTE. I DON'T THINK WE WILL HAVE, THE DISCUSSION RIGHT NOW WILL BE MORE ANSWERING QUESTIONS AS YOU LOOK THROUGH THE FINAL DRAFT OF THE REPORT. BUT ALSO A LITTLE BIT OF AN UP DATE ON WHAT HAPPENS IS SINCE YOU LAST SAW THE REPORT.

37

FIRST, I WANT TO THANK EVERYBODY ON THE COMMITTEE, THEY ALL PLAYED A ROLE PULLING THIS TOGETHER AND PROVIDING THOUGHTFUL FEEDBACK ABOUT THE PROCESS, FIGURING OUT HOW TO BRING IT TOGETHER TO TELL A STORY AND SEND A STRONG MESSAGE ABOUT WHERE THE SYSTEM IS AND WHERE WE HOPE IT CAN BE TO MEET THE NEEDS OF OLDER ADULTS AND PEOPLE WITH DISABILITIES. FOR ME, WHAT'S MOST TREMENDOUS ABOUT THIS IS THE PROCESS AND PRODUCT. IN THE PROCESS, WE CAME TOGETHER AS A GROUP AND I THINK WE HAVE DEVELOP THE A VOICE TOGETHER AND THAT'S SOMETHING THAT WILL SERVE THIS ISSUE WELL IN NOT ONLY NOW, BUT MOVING FORWARD AND IT'S CLEAR HOW COMMITTED EVERYBODY IS TO THESE ISSUES. I HOPE WE CONTINUE TO WORK TOGETHER, WHETHER PART OF THIS COMMITTEE OR OUTSIDE OF IT. SO, THANK YOU FOR EVERYBODY'S EFFORTS. ABOUT THE ACTUAL PROCTORS THE FOCUS OF THE LAST ROUND OF EDITS WAS TO TAKE THE E DOTS WE GOT FROM THE STAKEHOLDER ADVISORY COMMITTEE, MEMBERS, WE WEREN'T CHANGING THE CONTENT OF THE RECOMMEND, BUT A LOT OF EDITS WERE CLARIFYING. THE WRITING TEAM OF LYDIA, SUSAN, CLAIRE AND MYSELF LOOKED AT THE EDITS, CONSULTED WITH A LOT OF YOU, REALLY COULD NOT TAKE EVERYTHING BECAUSE IF IT CHANGED THE NATURE OF 9 CONDEMNATION, WE KNEW -- NATURE OF THE RECOMMENDATION, WE KNEW THAT WOULD NOT HAPPEN, WE AGREED WITH YOU. WE LAS THOUGHT IN ADDITION TO TAKING FEEDBACK FROM THE ADVISORY COMMITTEE, WE WANTED TO INCORPORATE THE PERSON THROUGHOUT. SO WE INCLUDED ON THE PICTURE OF PEOPLE WE COULD FIND WITH THE QUOTES ATTACHED TO THE PICTURE. SO EVERY PICTURE YOU SEE IS CONNECTED TO AN ACTUAL PERSON THAT'S QUOTED. I STILL THINK WE CAN USE MORE THROUGHOUT THE BODY OF THE REPORT. I WENT THROUGH ALL THE PUBLIC COMMENTS THAT THEY COMPILED. THERE WEREN'T MANY THAT PROVIDED PERSONAL PERSPECTIVE. A LOT WERE IMPORTANT FEEDBACK, BUT WE WANT THE STORY, SO IF YOU HAVE, PARTICULARLY PICTURES AND QUOTES FROM PEOPLE WITH DISABILITIES, BECAUSE A LOT OF THESE ARE OLDER ADULTS, AND WE ALSO WANT TO MAKE SURE WE REPRESENT THE WHOLE COMMUNITY. WE HAVE PERMISSION FOR THESE PICTURES AND THE QUOTATIONS. LYDIA AND I TALKED ABOUT NOT GETTING IN TROUBLING, THAT WAY. SO, I THINK I WILL PAUSE AND SEE IF, LYDIA, WANT TO -- OH, I WANT TO SAY, LYDIA, SHE PULLED THIS TOGETHER.

[APPLAUSE]

SHE'S AMAZING. SHE TRACKS EVERYTHING ON, CLAIRE DID AN AMAZING JOB PULLING THE GRID TOGETHER, ENORMOUSLY HELPFUL, WE HAVE THE ACTION READY GRID, CLAIRE'S BRAIN CHILD, LYDIA WORKED TO HONE IT, GET FEEDBACK, BUT ACROSS THE REPORT AND ACTION READY ITEMS, WE HOPE THESE ITEMS CAN SERVE AS AN ADVOCACY PLATFORM FOR EVERYBODY.

38

AND I WANT TOE UNDERSCORE THE TREMENDOUS AMOUNT OF WORK THAT LYDIA PUT INTO THIS. WE'RE LUCKY SHE'S RETIRED BECAUSE SHE WOULD NOT HAVE BEEN ABLE TO PUT THE AMOUNT OF TIME SHE PUT IN AND HER EXPERTISE TO BRING VOICES TOGETHER. IT WAS INCREDIBLE. SO THANK YOU. LYDIA, ANY OTHERS COMMENTS, THEN CLAIRE?

>> NO, I ECHO WHAT YOU SAID ABOUT THE PROCESS AND HOW AMAZE EGG IT'S BEEN. IT'S A MOMENT IN TIME, I HAVEN'T SEEN ANYTHING LIKE THIS IN THIRTY YEARS, AND I'M REALLY PROUD TO BE PARTLY OF THIS GROUP AND TO HAVE CONTRIBUTED WITH THE E DOES THING. REALLY, THE WRITING PART WAS DONE BY ALL OF YOU. IT WAS PUTTING ALL THIS TOGETHER IN WORD, WHICH IS FUN, I LIKE DOING THAT, AND DOING THE TABLE OF CONTENTS, WHICH I HAVE TO TEACH MY FRIENDS HOW TO DO. IF YOU CLICK ON THE TABLE OF CONTENTS, IT TAKES YOU RIGHT THERE.

>> THIS IS EXCITING TECHNOLOGY I NEED TO LEARN.

>> WE HAVE SEEN EMAILS WITH COMMENTS, SO WE WILL GET THOSE GOING. I WANT TO THANK SUSAN, CLAIRE, WE WERE LIKE A TAG TEAM. WHEN SOMEONE WAS URGENTLY NEED BE TO DO REAL WORK STUFF, SOMEONE ELSE STEPPED F IT WAS PHENOMENAL. I'M GLAD WE GOT TO DO THIS TODAY. WE WILL SPEND SOME TIME 209 GRID TODAY. WE WANT TONIC THIS BE A FINAL KIND OF PUBLIC DOCUMENT FOR ADVOCACY. ARE THERE OTHER FATAL FLAWSES, SEND THEMTUOUS, THE WRITING TEAM AND THE FINAL DRAFT IS DUE WHEN, CARRIE?

>> WE WANT TO PRESENT IT TO THE EQUITY WORK GROUP NEXT WEEK. ALSO, SEND IS IT BACK TO SAC. SO, IF PEOPLE HONESTLY COULD DO A FATAL FLAWS REVIEW TONIGHT, TOMORROW, GET IT BACK WITHIN 48 HOURS. REALLY FATAL. WE'RE HOPING, IT'S A TYPE OF THING WE COULD KEEP EDITING FOR YEARS. SO IF, THAT'S THE FOCUS RIGHT NOW, FATAL FLAWSES, OR GRAMMATICAL ERRORS. ANY OTHER, IS PATTY ON THE PHONE? CLAIRE? AND JEFF?

>> I HAVE A QUESTION. CLAIRE, I LOVE GRIDS AND LOVED YOUR GRIDS. BUT I DIDN'T SEE IT AS PART OF THE PLAN. I SAW IT AS SEPARATE, BUT DIDN'T GO THROUGH THAT. I JUST GOT A COPY OF THE PLAN, DIDN'T PRINT IT OUT. MY QUESTION WAS INITIALLY GOING TO BE, DID I MISS THE ACTION READY ITEMS BECAUSE THEY, I DIDN'T SEE THEM IN THE PLAN. THOSE WERE SEPARATE IN TERMS OF THE GRID. WHERE'S THE GRID GOING TO HANG? WHY ISN'T IT PART OF THE PLAN?

>> DOES IT BELONG IN THE REPORT, WE SEE THE GRID AS A LIVING, THE REPORT WILL BE A MOMENT IN TIME. WE MIGHT WANT TO UP DATE THINGS, BUT THE GRID WILL BE CONTINUALLY UPDATED, SO THEY THOUGHT IS WITH

39

AN ATTACHMENT TO IT, BUT NOT NECESSARILY A PIECE. THAT'S OPEN TO DISCUSSION.

>> I'D LIKE TO DISCUSS THAT BECAUSE I KNOW HOW THINGS GET LOST AND SEPARATED. SO YOU'RE DEALING WITH A LEGISLATOR THAT REALLY DOES NOT KNOW AGING IN LONG TERM CARE. SO --

>> IT WAS LIKE --

>> KATHY, THIS IS LYDIA. THAT TRIGGERED AND IDEA. THAT MIGHT BE, WHAT SARAH DESCRIBES IS CORRECT, I WONDER IF IT MIGHT BE USEFUL AS AN APPENDIX, TO INCLUDE THAT ONE PAGER AND PEOPLE COULD REVERSE RIGHT BACK INTO THE REPORT. THAT'S JUST ONE PAGE.

>> IT'S FINE. I THINK IT WAS FINE. THAT WOULD BE GREAT. -- COULD BE IN THE APPENDIX. GREAT. THAT CAN BE UPDATED, YOU KNOW -- TEN YEARS BUT -- WILL BE UPDATING THIS. THIS IS, THESE ARE THE ONES WE WANT TO GET DONE NOW. THEY SHOULD BE THERE. APEX APPENDIX IS FINE.

>> WE'RE GOING TO CLAIRE.

>> I'M TRYING TO NOT JUMP AHEAD AND RAISE MY HANDS. IT MAKES SENSE WITH THE ONE PAGER, AND SO PEOPLE KNOW, THE STAFF APPROVED SEPARATING BOTH THE REPORT AND ADOPTED THE REPORT AND ONE PAGER OF ACTION READY ITEMS SO IT'S APPROPRIATE TO PUT THE ONE PAGER AS AN AN APPENDIX, AND CARRIE, COULD THE GRIDLY LINKERS -- LINKED HR SOMETHING?

>> THERE COULD BE A LIVE LINK TO THE GRID ON LINE, I'M HEARING YOU MIGHT NEED TO UP DATE THE GRID, IT COULD BE UPDATED, I CAN'T SPEAK FOR CALIFORNIA DEPARTMENT OF AGING, WHERE IT WOULD LIVE ON LINE WITHOUT IT CAN BEING ON THE ENGAGE WEBSITE, AND IF IT GETS UPDATED, PEOPLE STILL GO TO THE MOST UPDATED VERSION. THE LINK WOULD BE -- READING THE ONLINE VERSION TO LINK TO OR WE COULD PUT A TINE. U RL IN THE REPORT.

>> OKAY. WHY COULDN'T, AGAIN, I THINK IT MAKES IT, WHY CAN'T 9 ONE PAGER BE INCLUDED IN THE -- CONTENT, LISTED OUT, THEN WHAT YOU REFER TO IS BACK TO THE PAGE NUMBER OF THAT PARTICULAR OBJECTIVE. SO THEY CAN TURN BACK, READ THE, BUT I THINK IT HAS TO BE PART OF PLAN.

>> OKAY.

>> WE REVERSE WITH A (INDISCERNIBLE)

>> WE WILL GO TO ELLEN.

40

>> THANK YOU. I WAS THINKING THE SAME THING. ONE PAGER IS POWERFUL. AND HAVING THIS THAT AS PART OF THE EXECUTIVE SUMMARY OR PART OF DOCUMENT, AND ALSO, NOT LET US OFF THE HOOK, THE GRID AND ONE PAGER AREN'T THE ONLY DADS THAT CAN MOVE FORWARD. ALL OF THEM CAN MOVE FORWARD INCREMENTALLY. I'M WORRIED THE MESSAGE WON'T BE POWERFUL ENOUGH, THEY'RE NOT THE BEST RECOMMENDATIONS, JUST THE FIRST OUT OF GATE.

>> YES.

>> ALSO, ALL THE RECOMMENDATIONS EVERYBODY SENT IN, WHERE WILL THEY BE DISPLAYED? HONORING EVERY PERSON THAT STAYS UP ALL NIGHT --

>> I'M WORKING WITH TEAM OF STUDENTS AT U C BERKELEY. WE'RE CATEGORIZING EVERY RECOMMENDATION COMING IN, GOALS ONE, TWO, THREE, AS WELL AS BEING TAGGED WITH MORE TYPICAL, LIKE THIS IS DRESS IS HOMELESSNESS, AND TAGGED WITHING POPULATIONS, THEN IT WILL HAVE A LINK BACK TO THE ACTUAL RECOMMENDATIONS. SO THAT'S BEING WORKED OUT.

>> JEFF, YOU'RE NEXT.

>> I WON'T BOTHER TO REPEAT ALL THE COMMENTS BECAUSE I DON'T THINK THEY NEED TO BE. BUT I WANTED TO TO MAKE A PERJURY OBSERVATION. AS -- PERSONAL OBSERVATION. I'M A NATIONAL ADVOCATE, VISION LOSS COMMUNITY. WITH RESPECT TO SENIORS. THERE'S NO QUESTION IN MY MIND, THE OUTSTANDING DISCUSSION, THE KNOWLEDGE INTERCHANGE AND ULTIMATE PRODUCT THAT WE PUT TOGETHER IS GOING TO MAKE ME A MORE IMPACTFUL AND INSIGHTFUL ADVOCATE AT THE NATIONAL LEVEL. THANK YOU, TO THE COMMUNITY, FOR THAT.

>> THANK YOU. GRETCHEN?

>> THANK YOU. AMAZING BODY OF WORK IN TOTAL. PARTICULARLY, I LOVE THE GRID AND THE ONE PAGER. I WAS THINKING ABOUT STRUCTURALLY, THE CONVERSATION ABOUT OPPORTUNITY FOR ADDING AN APEX OF THAT ONE PAGE SO THERE'S ALWAYS SOMETHING MEMORIALIZED ABOUT THE ACTION ITEM BLOG, AND PLAYING AROUND WITH THE HEALTH AND HUMAN SERVICES PAGE OF THIS COMMUNITY, SUBCOMMITTEE, AND THINKING ABOUT WHERE THERE MIGHT BE AN UP LOADED PDF OF THE REPORT WITH THE ONE PAGER THAT HAS THIS GRID, DOCUMENT WITH A LITTLE BIT OF A HEADER AROUND IT. THAT GIVES IT CONTEXT SO IT COULD LIVE AS ITS OWN FREE FORM DOCUMENT. I LIKE THE DATE ON IT, BECAUSE IF IT'S UPDATED, ALSO, IT'S AN AWESOME RESOURCE FOR ADVOCACY ORGANIZATIONS WHO COULD DOWNLOAD THAT EXCEL AND USE IT FOR THEIR OWN TRACKING OR

41

CALIFORNIA COLLABORATIVE, MANY WAYS, BEING ABLE TO USE IT AS A LIVING EXCEL DOCUMENT. I ENCOURAGE THAT KIND OF PLATFORM, RATHER THAN EASILY PUTTING INTO A PDF BUT THEN IT LOSES IT'S APPEAL, TO REALLY USE THIS AS A WORKING ADVOCACY DOCUMENT IN THEIR OWN RIGHT. THIS MIGHT LIVE IN MULTIPLE WAYS IN ADDITION TO ELLEN'S COMMENT ABOUT HOW WE HAVE A PLACE FOR ALL THE RECOMMENDATIONS THAT COME IN. THAT CAN BE ITS OWN DOCUMENT. IT'S A WAY TO LAY OUT A RESOURCES PAGE INSIDE OF THIS NAVIGATION THAT MAKE IT'S CLEAN ABOUT THE MAIN REPORT ACTION ITEMS AND THE WHOLE UNIVERSE THAT PEOPLE OFFERED.

>> THANK YOU, ELLEN. YOU EXPLAINED, A LOT OF US WORKED HARD ON THE RECOMMENDATIONS. THE RECOMMENDATIONS ON THE REPORT ARE JUST THE FRONT PIECE. THE SUMMARY. SO JUST KNOWING WE'RE GOING TO BE ABLE TO FIND THEM ONLINE. LOOKING FORWARD TO SEEING IT POPULATED ONLINE.

>> LYDIA?

>> WHAT YOU SAID, GRETCHEN, REMINDED ME THAT WE STARTED TO SEE IF WE COULD IDENTIFY RESEARCH OR OTHER DOCUMENTS THAT SUPPORT WHY THAT RECOMMENDATION HAS MEANING BEYOND, IN TERMS OF STATE BUDGET, POLICY AND SO ON. IT WAS ALSO STRIKING ME THAT THERE MIGHT BE SOME, AS A LIVING DOCUMENT, EXPERTISES WITH THE RESEARCH COMMITTEE, HELPING POPULATE THAT COLUMN OF THE GRID, THINKING ABOUT HOW THEY MIGHT INCORPORATE THAT INTO THEIR THINKING AS THEY PUT THE RESEARCH AGENDA TOGETHER, AND THEN, BEING AWARE OF THE OTHER RECOMMENDATIONS, NOT IMMEDIATE ACTIONABLE ONES, WHAT DO WE DO WITH THOSE IN TERMS OF HOW IT TIES INTO THE THINKING OF THE RESEARCH COMMUNITY AND OTHER GOALS. IT FEELS LIKE AS A START TO A LIVING DOCUMENT, THIS COULD GROW AND TAKE ON ADDITIONAL DEPTH AT SOME POINT. JUST A THOUGHT FOR YOU TO THINK ABOUT IT.

>> SHALL WE MOVE ON TO OUTREACH, STAKEHOLDER ADVISORY COMMITTEE AND EQUITY WORK GROUP?

>> THE NEXT STEP IN TERMS OF CALENDAR-WISE, WILL BE MEETING WITH THE EQUITY WORK GROUP. WE REALLY APPRECIATED THEIR INPUT FEEDBACK AGO. WITH WE WANT TO SEE IF THERE ARE MISSING COMPONENTS OR IF THERE ARE AREAS THAT WE MIGHT HAVE INCORRECTLY APPROACHED IN TERMS OF THE EQUITY ISSUE. WE TRIED TO REALLY GO THROUGH AND FIND THE AREAS THAT WE CAN INCORPORATE THOSE IMPORTANTS THROUGHOUT. SUSAN, ANY THOUGHTS ON THE EQUITY WORK GROUP? THAT WAS MY UNDERSTANDING OF HOW IT WOULD WORK BUT THE GOAL IS NOT TO CHANGE THE REPORT CONTENT AND STRUCTURE. JUST TO

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GET FEEDBACK. WITH SAC, I'D LIKE CLARIFICATION ON THE PROCESS OF GETTING IT THROUGH BACK TO SAC. THEIR NEXT MEETING IS NOT UNTIL MAY. ANY FEEDBACK, RESEND BY EMAIL, DO WE HAVE, I GUESS WE'RE OPEN TO IDEAS ON HOW WE PRESENT THEM WITH THAT. KATHERINE?

>> MY RECOLLECTION OF WHAT SAC APPROVED, THEY WERE GOING GET THE REPORT FOR A FATAL FLAWS REVIEW AND THAT MEANT A DEAD LINE BY WHICH ANYBODY WHO HAD ONE WOULD SUBMIT IT AND EFFORTS WOULD BE MADE TO HANDLE T IT'S BEEN APPROVED THANK YOU THEM. I SENT A HANDFUL OF COMMENTS EARLIER TODAY, THERE WERE TWO RELATING TO SOMETHING WE SHOULD CLEAN UP BEFORE WE SEND IT TO THE EQUITY GROUP.

>> ONE COMMENTS, TERMINOLOGY, WE'RE TRYING TO BE CONSISTENT. IS OUR TERMINOLOGY OLDER ADULTS AND PEOPLE WITH DISABILITIES, OR SENIORS?

>> I MIGHT HAVE USED SENIORS.

>> NO PROBLEM.

>> I WAS --

[MULTIPLE SPEAKERS]

>> SIGN LANGUAGE. WE DEFINE, IT'S SM SPOKEN LANGUAGES. SIGN LANGUAGE IS NOT SPOKEN.

>> THAT'S AN IMPORTANT POINT. APPRECIATE THAT.

>> OTHER, WE LISTED CHARACTERISTICS OF DIVERSITY IN CALIFORNIA. THEY'RE NOT EXACTLY THE SAME AS THEY ARE IN THE REPORT. REALLY JUST TECHNICAL KINDS OF CLEAN UP. I DID NOT INTEND TO CHANGE ANY OF THE --

>> NO, I DIDN'T TAKE IT THAT WAY.

>> FOLLOW UP ON THAT, CARRIE. COULD EVERYONE ALSO PAY ATTENTION TO THE DEFINITION SECTION? THAT IS NEW, AND I WANT TO BE SURE WE'RE ACTUATELY REPRESENTING THOSE ACRONYMS AND DESCRIPTIONS. THAT'S NEW, IF PEOPLE TO KEY EXTRA TIME ON THAT SECTION.

>> WE MIGHT, ACTION-READY –

>> I THINK THERE IS AN INTERESTING QUESTION ABOUT STATEWIDE GEOGRAPHICALLY ABOUT INFORMATION AND REFERRAL AND THE SERVICES THAT WOULD BE, IF IT'S NOT BEING DONE SEPARATELY -- IT WOULD BE AN INTERESTING OVERLAY IN TERMS OF WHAT THE DIRECTIONS ARE.

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>> REALLY THOUGHTFUL COMMENTS. THANK YOU. THE SPIRIT WE WERE PLANNING TO GO, DASHBOARD MEASURES WAS AT THE MACRO, LEVEL. I REALLY LIKE WHAT YOU ARTICULATED BETWEEN AUTHORIZED AND NEWS RECEIVED.

>> THERE IS NO WAY YOU COULD DO THAT.

>> YOU TOTALLY COULD DO THAT. WHAT I WOULD LOVE IN MANY WAYS, THE WORK THAT MASTER PLAN FOR AGING PUT FORTH IN TERMS OF THE CONCEPTUAL FRAME OF DASHBOARD 1.0, THERE ARE SYSTEM DRIVER LEVELS THAT, THAT COULD BE A TEMPLATE THAT ANY AGENCY OR DEPARTMENT COULD MAKE THEIR OWN DASHBOARD THAT WOULD BE SPECIFIC TO THEIR INFORMATION SYSTEMS THAT WOULD START TO ARRAY DATA IN A WAY THAT SPEAKS ABOUT PERSON-LEVEL CAPACITY AVAILABILITY UNDERNEATH TO DRIVE THAT FORWARD. IT WOULD RADICALLY CHANGE IN WHICH THE WAY STATE LEVEL INFORMATION WAS PUT OUT TO BE MORE ABOUT THE PERSON IN THE CENTER AND THE WAY IT'S SUPPORTIVE OF THAT. IT'S A RECOMMENDATION THAT ANYONE COULD PUT FORWARD AS PART OF MASTER PLAN FOR AGING, AND WE MOVE FORWARD WITH THE POPULATIONS WE CARE ABOUT.

>> NINA.

>> NINA HARWELL, AARP. WHAT I LIKE ABOUT IT, AT THE BEGINNING, IT'S EASY TO UNDERSTAND. I THOUGHT OF THIS AS PROBLEM SOLUTION. HERE'S OUR PROBLEM. WE HAVE DATA ON -- SAY ON THE UNMET NEEDS. THEN, YOU KIND OF HAVE YOUR SOLUTION ON A BROAD LEVEL BUT WHAT'S GOING IN BETWEEN THERE IS THE QUESTION. WHAT ARE THE INTERVENTIONS FROM EACH PROGRAM THAT ATTUNE TO THE UNMET NEED, RIGHT? JUST THINK PERSONALLY, WHEN MY MOTHER WENT INTO HER DECLINE, THEY HAD UNMET NEEDS, AND IT LED TO FURTHER DECLINE. THIS IS A DIFFERENT STATE, BUT BECAUSE NOBODY WAS REALLY CHECKING THAT, OH, BECAUSE SHE'S TAKING MEDICINE AND TOILETING NEEDS NOT BEING MET, THAT LED TO FURTHER DEPRESSION AND EARLY DEATH. AT LEAST MATCHING THE UNMET NEED, SERVICES AND INTERVENTION IN BETWEEN. WE HAVE BEEN TALKING ABOUT UPSTREAM AND HAVING THE DATA ON THE UNMET NEEDS IS THE UPSTREAM. LAST WEEK THIS PERSON DIDN'T HAVE ENOUGH FOOD. WE KNOW ALL OF THE PROBLEMS CAME FROM MALNOURISHMENT. I LIKE TO HEAR ABOUT EVIDENCED SOLUTIONS. HAVE WE GOTTEN THERE?

>> WE HAVEN'T GOTTEN THERE. IT'S ABOUT LEADERS AND POLICYMAKERS TO SAY, HOW DO WE WANT TO MOVE THE NEEDLE ON ADDRESSING UNMET

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NEED AND THE ADVERSE CONSEQUENCES ASSOCIATED WITH UNMET NEED. IT CAN COME FROM LOTS OF ANGLES. THERE IS A WAY THAT EACH PROGRAM, EACH SERVICE LINE STATE FUNDED NEEDS. IT'S MORE ABOUT HERE WE ARE AT A STATE. WHAT ARE YOU DOING ABOUT THAT.

>> WE ARE REALLY ENJOYING THIS. I HAVE BEEN LOOKING FORWARD TO HEARING ABOUT THE MEASURES A LONG TIME, SO THANK YOU. I GUESS IT'S NOT POSSIBLE WHEN LOOKING AT THE INDIVIDUALS TO KNOW IF THEY ARE RECEIVING SERVICES OR IF THEY ARE RECEIVING ANY OF THE SERVICES AND STILL HAVE AN UNMET NEED. IS THERE A WAY TO CORRELATE? THAT'S MY FIRST QUESTION. THE SECOND ONE IS, WHAT ARE YOUR ASPIRATIONAL MEASURES. I BET YOU HAVE DREAM ABOUT 2.0.

>> THAT'S A LONG CONVERSATION, SO WE'LL TABLE THAT. CATHERINE WILL DO A GREAT JOB ANSWERING YOUR FIRST QUESTION.

>> CATHERINE: IT'S ABOUT IF PEOPLE GET PERSONAL CARE ASSISTANCE, THOSE SORT OF THINGS. WE'LL BE ABLE TO CROSSWALK THOSE WITH UNMET NEED.

>> WE ALSO ASK HOW SERVICES ARE PAID, WHETHER THEY ARE PAID OR UNPAID AND HOW THEY ARE PAID, IF THEY ARE PAID.

>> WE SHOULD PROBABLY HAND IT OVER TO CATHY TO TALK ABOUT 1.2. CATHY, ARE YOU READY?

>> CATHY: I WAS GOING TO SET THIS UP.

>> WHILE SHE'S WAKING UP.

>> CATHY: GETTING UN-MUTED. WE'LL LOOK AT THE NEEDS OF CAREGIVERS THROUGH OBJECTIVE 1.2. I'M GOING TO TALK ABOUT A COUPLE MORE CHIS MEASURES WE'LL USE AND RECOMMEND, AND I'LL TURN IT OVER TO CATHY. SHE'S GOING TO PRESENT LOOKING AT SIDE BY SIDE PROBLEMATIC MEASURES. SHE WILL PROVIDE THE DATA GIVEN AT THE CAREGIVER RESOURCE CENTER. WE'LL TALK ABOUT HOW WE CAN CROSSWALK THE TWO SETS OF DATA AS WELL. I THINK IT PROVIDES THE EXAMPLE OF WHAT'S GOING ON AT THE PROGRAM LEVEL AND THE POPULATION LEVEL AND HOW WE CAN USE THE MEASURES TO GET THE COMPLETE STORY. SHE'S GOING TO BE TALKING ABOUT CAREGIVER PROFILES TO THE CRC, DEMOGRAPHICS AND SERVICES. BRIEFLY, I'LL SAY IN THE CURRENT 2019-2020CHIS, WE HAVE A CAREGIVER MODULE. IT STARTS WITH ARE YOU PROVIDING CARE QUESTION. EVERYONE IN THE 40,000 SAMPLE IS ASKED THE QUESTION. IF THEY SAY YES, THEN THEY ARE ASKED A SERIES OF 12 QUESTIONS WHICH YIELDS A ROBUST SET OF INFORMATION. WHAT WE RECOMMEND ON THE CHIS CAREGIVER MODULE IS THE ABILITY TO REPORT ON THE PREVALENCE OF CARE GIVING. WE CAN GENERATE WHO PROVIDED CARE IN THE LAST 12

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MONTHS, AND THEN, AS WELL, THOSE WHO ARE CURRENTLY PROVIDING CARE. THOSE ARE TWO DIFFERENT TIMELINES FOR WHICH WE CAN PROVIDE A COMPOSITE MEASURE OF CARE GIVING.

FOLLOWING UP TO THE NEXT SLIDE, WE HAVE A MEASURE OF CARE GIVING CONSEQUENCES. THESE RELATE TO MENTAL HEALTH, FINANCIAL STRESS AND CHANGES IN EMPLOYMENT. WALKING THROUGH THE FOUR DIMENSIONS, WE CAN CREATE THE ACCESSIBLE COMPOSITE MEASURE OF CARE GIVER CONSEQUENCES. YOU CAN LOOK AT THEM INDIVIDUALLY. IT GIVES US A GLOBAL NUMBER ABOUT CAREGIVERS IN CALIFORNIA. WE'LL TURN IT OVER TO CATHY KELLY NOW.

>> THIS IS SUSAN DEMORRIS WITH THE ALZHEIMER'S ASSOCIATION. WILL THIS QUESTION CONTINUE? ISN'T THIS A ONE TIME -- WILL WE BE ABLE TO MEASURE THE SAME QUESTION GOING FORWARD, OR IS IT A MOMENT IN TIME?

>> THANK YOU. IT'S AN IMPORTANT DISTINCTION. AT THIS TIME, IT'S FROM THE CURRENT CYCLE, 2019-2020. SPEAKING OF ASPIRATIONAL, WE WOULD LIKE THIS TO BE SOMETHING THAT CAN BE MEASURED AND REPEAT, AS THE LTSS SURVEY WILL BE REPEATED 2023-2024, IT WOULD BE IDEAL TO REPEAT THE CAREGIVER MEASURES 2023-2024.

>> I HAVE A QUESTION. I KNOW THERE IS A PAID FAMILY LEAVE MODULE COMING. ARE YOU THINKING ABOUT HOW THAT WILL BE INCORPORATED GOING FORWARD?

>> THERE IS -- TO CLARIFY, THERE IS NOT A MODULE, BUT THERE IS A PAID FAMILY CAREGIVER QUESTION. WE ARE CONVENING A WORK GROUP FOR THE CHIS WITH A GROUP OF EXPERTS TO LOOK AT THAT. THERE IS INTEREST IN THAT. IT IS A POLICY RELEVANT ISSUE, CURRENT AND SO WE'LL SEE WHERE THAT GOES. THE POINT OF THE -- THIS IS THE INITIAL STAGES TO SEE WHAT SHOULD BE MEASURED, HOW IT SHOULD BE MEASURED AND HOPEFULLY, THAT WOULD BE INTEGRATED INTO THE CHIS IN AN IDEAL WORLD. I DON'T KNOW IF THAT ANSWERS YOU.

>> I'M ON A GROUP, SO THANK YOU.

>> ALL RIGHT, CATHY KELLY, ARE YOU UN-MUTED? CATHY? IS SHE CHATTING? CATHY, WE CAN'T QUITE HEAR YOU. WE HEARD YOU EARLIER.

>> HI, THIS IS DONNA.

>> HI, DONNA.

>> HI. I COULD START ON HER SECTION UNTIL SHE GETS ON.

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>> THAT WOULD BE GREAT.

>> CATHY, WE HAVE NOT GIVEN UP ON YOU.

>> CATHY, CHECK IF SHE'S ON THE PHONE AND LAPTOP. HER PHONE MAY BE MUTED, EVEN THOUGH THE BOARD MAY SAY UN-MUTED ON THE INTERNET. JUST A SUGGESTION. GO AHEAD TO THE NEXT SLIDE. ALL RIGHT, IN LOOKING AT WHAT'S BEING DONE IN THE CALIFORNIA CAREGIVER RESOURCE CENTERS WHICH THERE ARE 11, AND THE CENTERS HAVE BEGUN TO START A DATA WIDE PROCESS THAT WILL USE A DATABASE ACROSS ALL 11CRCS TO COVER THE STATE OF CALIFORNIA. THESE WILL BE DATA FOR PEOPLE THAT ENTER INTO THE CAREGIVER RESOURCE CENTER AS CLIENTS. IN OUR DISCUSSIONS, WHAT THIS ALLOWS IS AN IN-DEPTH LOOK AT WHO OUR CAREGIVERS REACHING OUT, OR HAVE BEEN REACHED OUT ARE BEGINNING TO USE PROGRAMS IN CALIFORNIA. WE ARE LOOKING AT A LOT OF PERSON-CENTERED CORE MEASURES WHICH HELPS REFINE THE PROFILE OF PEOPLE SO WE CAN LOOK AT AGE AND THE RELATIONSHIP TO WHO THEY ARE CARING FOR DOWN TO THE ZIP CODE LEVEL.

WE ARE ALSO LOOKING AT EDUCATION LEVEL, LANGUAGE, SEXUAL ORIENTATION, GENDER IDENTITY AND EMPLOYMENT, BOTH CHANGES IN EMPLOYMENT AND CURRENT EMPLOYMENT STATUS. OTHER PIECE FROM THE DATABASE, AND WE ARE HOPING THIS -- BECAUSE WE HAVE THE FUNDING IS BEGINNING NOW, UNTIL 2023, AND THEN THE DATABASE WILL CONTINUE ON WITH OTHER -- HOPEFULLY, CONTINUED FUNDING FOR THE PROGRAM, THIS WOULD AGAIN BE THE BEGINNING OF A PERSON-CENTERED CORE MEASURE FOR THE PROGRAM. YOU CAN GO TO THE NEXT SLIDE. I'M HOPING CATHY GETS ON SOON.

THE NEXT THING WE WANT TO LOOK AT FROM OBJECTIVE 1.2, WE WANT TO UNDERSTAND WHAT ARE THE CHALLENGES AND REWARDS? ONE OF THE THINGS WE WANT TO BE ABLE TO SAY ABOUT CAREGIVERS IS THE POSITIVE SIDE OF CARE GIVING, A LOT OF RESEARCH AND WAYS WE TEND TO LOOK AT SOME OF OUR ISSUES MIGHT BE ON THE NEGATIVE SIDE. WE WANT TO SAY WHAT IS POSITIVE ABOUT THE CARE GIVING EXPERIENCE. ADL, DIFFICULTIES, NUMBER OF HOUR, WE HAVE THE EMOTIONAL AND HEALTH MEASURES THAT CAN TALK ABOUT HOW PEOPLE ARE FEELING IN TERMS OF LONELINESS, DEPRESSION, STRESS. FROM THE CAREGIVER STANDPOINT, DO THEY HAVE POWER OF ATTORNEY, PULSE, WELLNESS. ON THE POSITIVE SIDE, WE CAN SEE IF THE CAREGIVER IS FEELING CONFIDENT BASED ON INFORMATION RECEIVED OR CONNECTION THROUGH SOCIAL SUPPORT BY ATTENDING SUPPORT GROUPS OR EDUCATIONAL EVENTS, FOR EXAMPLE.

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AGAIN, A LOT OF THESE -- ONE OF THE THINGS WE WANTED TO MAKE SURE IS THAT THE DATA IN THE CRC DATABASE WILL LINK UP WITH WHAT'S IN THE CHIS CAN WE WERE TALKING ABOUT EARLIER. SOME OF THE QUESTIONS GO FORWARD. LOOKS LIKE KATHY -- SHE'S ON HER LAPTOP. MAYBE YOU CAN UN-MUTE HER AND SEE IF SHE CAN GET ON.

>> KATHY IS UN-MUTED.

>> YES, SHE IS. OKAY.

>> KATHY: CAN YOU HEAR ME NOW?

>> YES! WE CAN HEAR YOU.

>> THANK YOU, KATHY. I WAS TRYING TO FILL IN, BUT I NEVER DO AS WELL AS YOU DO.

>> KATHY. I HAVE BEEN SITTING HERE FOR HOURS. WHERE ARE WE?

>> I HAVE ONLY MESSED UP ONE OF YOUR SLIDES. GO AHEAD.

>> KATHY: OKAY. I KNOW THAT DONNA TALKED ABOUT WHERE THE DATA COMES FROM. BEFORE I GO IN AND TALK ABOUT ALL OF THE COMPONENTS OF THE DATA WE ARE NOW COLLECTING OR WE ARE IN THE PROCESS OF BRINGING PEOPLE ONBOARD WITH CLIENT RECORD SYSTEM THAT WILL ENABLE US TO HAVE THE DATA MORE READILY AVAILABLE FOR USE IN A VARIETY OF WAYS, IS WHEN, FROM MY PERSPECTIVE, THE DATA AVAILABLE FOR CAREGIVER PURPOSES OF DESCRIBING OR TALKING ABOUT CAREGIVER OUTCOMES IS PRETTY RARE. SITTING ALONG WITH GRETCHEN ON THE LTSS SCORECARD THAT ALP DOES, I'LL TALK ABOUT THE COMPOSITE SCORES LATER. THE FACT OF THE MATTER IS, THERE IS A LOT OF DESCRIPTIVE STUDIES AROUND CAREGIVERS, BUT THERE IS NOT A LOT OF IN-DEPTH DETAIL ABOUT HOW CAREGIVERS ARE FAIRING, PARTICULARLY WITHIN A STATE SYSTEM.

IT DOESN'T HAPPEN. WE HAVE A RARE OPPORTUNITY WITH THE INFORMATION THAT'S FROM THE CHIS SURVEY, A HUGE POPULATION SAMPLE, AND NOW WITH THE EXPANSION OF THE CRC SYSTEM, USING A UNIFORM ASSESSMENT, CHIS HAS 20,000 ON THE QUESTIONNAIRE, AND ALSO 40,000 ON SOME OF THE QUESTIONS INTEGRATED INTO THE CHIS STANDARD SURVEY THAT WE'LL BE ABLE TO PARTICIPATE WITH DATA COMING ACROSS THE STATE, A FAIRLY DIVERSE SAMPLE OF CAREGIVERS WHICH WILL BE 8,000 PLUS ON AN ANNUAL BASIS. WHAT WE HAVE IS A GOLDEN OPPORTUNITY TO SAY, HOW DO WE USE THIS DATA TO DESCRIBE WHAT FAMILIES ARE DOING

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WITHIN THE LONG-TERM CARE SYSTEM. I HAVE A PROBLEM TALKING ABOUT WORKFORCE BECAUSE THEY ARE NOT PAID. BE THAT AS IT MAY, THESE COMPONENTS WILL START TO SET THE BAR FOR DESCRIPTION AND ATTENTION PAID TO THE CONTRIBUTIONS OF CAREGIVERS, AND AS WE MOVE THROUGH, WE'LL KNOW THIS IS A 1.0 EXPERIMENT.

WE'LL START TO REFINE AND UNDERSTAND MORE AS WE MOVE ALONG. SAY IT'S A UNIQUE OPPORTUNITY THAT IS NOT AVAILABLE IN ANY OTHER STATE THAT I'M AWARE OF AT THE MOMENT. IN THE CORE MEASURES, WHEN WE TALK ABOUT THE TYPES OF SERVICES, I THINK, DONNA, CAN YOU GO BACK FOR JUST A MINUTE TO THE -- I WANT TO MAKE A POINT. I KNOW DONNA WENT THROUGH THIS, BUT THERE ARE MANY COLLECTIONS OF IDLS AND ADLS OUT THERE, AND WE COLLECT THAT TOO. WHAT IS NOT COLLECTED UNIFORMLY AND SCANT ATTENTION HAS BEEN PAID UNTIL THERE ARE SURVEYS DONE ON THE MEDICAL TASK IS THAT WE ASK THESE QUESTIONS.

IT GIVES THE IDEA OF COMPLEXITY OF WHAT IS PROVIDED BY AND LARGE NOT TOUCHED BY SERVICES IN THE COMMUNITY. I WANTED TO MAKE MENTION OF THAT AND WHAT OTHER MEASURES THAT WE ARE USING ON THE HEALTH AND EMOTIONAL HEALTH IMPACT. THE DEPRESSION, PHQ9 AND LONELINESS SCALE, UCLA, WHICH WE HAVE MOVED FROM LOOKING AT SOCIAL ISOLATION AND USING THIS PARTICULAR SCALE BECAUSE IT'S IN BROADER USE ACROSS THE ADMINISTRATION FOR COMMUNITY LIVING PROGRAMS AND SO ON. THESE ARE ALL FACTORS THAT WE LOOK AT IN TERMS OF THE IMPACT. IN OUR SCORES BEFORE, WE NOTED 50% OF OUR CAREGIVERS NOTED SOCIAL ISOLATION IN THE CARE GIVING ACTIVITIES. THAT'S A TROUBLESOME HEALTH IMPACT FROM THAT TYPE OF SCORE. CAN WE MOVE AHEAD AGAIN? WE CAN TIE THE DEMOGRAPHICS AND CHARACTERISTICS THAT DONNA TALKED ABOUT EARLIER AND TALK ABOUT WHAT ARE THE INDIVIDUAL SERVICE USAGE FOR THOSE WHETHER IT'S SERVICES FAMILIES MOST LIKELY USE. WE ASK A LOT OF RISK ASSESSMENTS ON THE CALL. WE ARE ABLE TO TAYLOR THE KIND OF RESPONSE. THE CAREGIVER ASSESSMENT I TALKED ABOUT BEFORE, THOSE ARE THE BENCHMARK QUESTIONS WE ARE ASKING ABOUT FURTHER DEMOGRAPHICS AND IMPACT AND FURTHER INFORMATION WE NEED TO DO AN ADEQUATE CAREGIVER PLAN OR ACTION PLAN. CONSULTATION IS ENCOUNTERS WITH FAMILIES. I WANT TO SAY WE KNOW WE HAVE X NUMBER OF NEW FAMILIES THAT COME IN TO THE -- CRC. WE ALSO KNOW 30 TO 40% OF ADDITIONAL CALLS ARE COMING FROM FAMILIES WHO ARE IN PRIOR FISCAL YEARS.

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THIS IS A LONG-TERM ENGAGEMENT, LONG-TERM RELATIONSHIP WHICH HAS BUILT UP OVER TIME WHICH IS UNIQUE IN TERMS OF FAMILIES GOING IN AND OUT IF THEY ARE EXPERIENCING A CRISIS. THERE IS SHORT-TERM COUNSELING WITH THE THERAPIST. NEXT SLIDE. WE DO A LOT OF EVIDENCE-BASED SKILL BUILDING, PROBLEM SOLVING, PSYCHO EDUCATIONAL GROUPS, CONSULTATION, LEGAL, FINANCIAL, GENERAL EDUCATION PROGRAMS ON A BROAD SPECTRUM, OFTEN TIMES DIRECT CARE SKILLS GENERALLY NOT TAUGHT TO CAREGIVERS, AND WE HAVE RESPITE VOUCHER AND SO ON. AT AN AGGREGATE, WE KNOW HOW MUCH IS USED BY CLIENTS WE CAN LOOK AT THE NUMBER OF SERVICES CUT BY DIFFERENT CHARACTERISTICS OF CLIENTS, HOW MUCH IS USED IN RURAL AREAS VERSUS URBAN AND SO ON. NEXT SLIDE.

THIS IS THE CROSSWALK. KATHRYN, DO YOU WANT TO TALK ABOUT THE CROSSWALK? WE WANTED TO SEE HOW MUCH CONGRUENCE WAS THERE BETWEEN THE CHIS DATA AND CRC DATA. WE WERE SURPRISED.

>> THIS IS KATHY'S BRAIN CHILD TO SAY, LET'S SEE WHERE THEY OVERLAP. NOT EACH QUESTION IS ASKED THE SAME WAY BUT THEY LOOK AT DEMOGRAPHICS AND COLLECT INFORMATION ON THE CARE RECIPIENT, NUMBER OF HOURS SPENT CARE GIVING PER WEEK, BOTH CHIS AND CRC. WE CAN ABOUT THOSE NEEDED BY THE CARE RECIPIENTS AND LTSS SURVEY, WHAT THE NEEDS ARE OF ADL, AND IADL. WE DON'T ASK QUESTIONS ABOUT THE MEDICAL SERVICES PERFORMED BY CHIS. THE TWO COMPLIMENTARY DATA SOURCES PROVIDE A UNIQUE OPPORTUNITY TO LOOK AT A BENCHMARK OF POPULATION DATA LOOKING AT CAREGIVERS ACROSS THE STATE OF CALIFORNIA THAT MAY OR MAY NOT BE CONNECTED TO DATA AND THOSE CONNECTED TO SERVICE.

YOU CAN'T INTEGRATE THE DATA, BUT YOU CAN DEVELOP A PROFILE. THIS IS A GREAT EXAMPLE OF OTHER WAYS WE CAN DO THAT -- I WON'T CALL IT A HARMONIZATION OF DATA. THAT'S A DIFFERENT THING WHERE YOU INTEGRATE MEASURES THAT ARE COMPARABLE. YOU CAN LOOK AT AND DEVELOP A PROFILE. LET'S GET THE LANGUAGE TOGETHER. A PROFILE OF CAREGIVER EXPERIENCE AT THE POPULATION LEVEL AND CAREGIVER SAMPLE. I IMAGINE WE CAN DO THIS WITH OTHER PROGRAM DATA LOOKING AT CH IS AND LTSS. WE HAVE LIVING ARRANGEMENT, MENTAL HEALTH IMPACT OF CARE GIVING. CHIS HAS A VALUABLE SET OF QUESTIONS THE CRC CAN GET AT. IT'S UNUSUAL TO GET THAT TYPE OF DATA. PUBLIC PROGRAMS, CHIS, IN THE GENERAL CHIS, WE ASK IF PEOPLE ARE GETTING

50

FOOD ASSISTANCE, ARE THEY GETTING GENERAL ASSISTANCE, OTHER TYPES OF PROGRAM SUPPORT. I SHOULD SAY THAT'S NOT AN EXHAUSTIVE LIST OF WHAT IS IN CHIS OR CRC DATA.

>> JUST A TIME CHECK. I WANT TO BE SURE IN ABOUT TEN OR SO MINUTES WE GET INTO THE REFERRED RECOMMENDATIONS FROM THE LTSS COMMITTEE TO THE RESEARCH COMMITTEE.

>> THE NEXT SLIDE. OKAY, SO THESE ARE COMPOSITE SCORES THAT COME FROM THE STATE ARP STATE LTSS SCORECARD. AS GRETCHEN MENTIONED, THE NEXT SCORECARD COMES OUT IN JUNE. THERE'S FOUR AREAS WHICH HAVE MULTIPLE SERVICES UNDERNEATH THEM, AND THEY ARE WEIGHTED IN A WAY THAT COMES UP AS A COMPOSITE SCORE. THERE IS A SECTION ON SUPPORTING WORKING FAMILY CAREGIVERS, PERSON AND FAMILY CENTERED CARE, NURSE DELEGATION, SCOPE OF PRACTICE AND TRANSPORTATION POLICIES. NEXT SLIDE. THE SUPPORTING WORKING CAREGIVERS HAS INFORMATION AROUND FAMILY MEDICAL LEAVE. CALIFORNIA SCORES HIGHER, HAS MORE POINTS A LOTTED BECAUSE WE HAVE PAID FAMILY LEAVE AND HAVE HAD FOR 12 YEARS. THE PAID FAMILY LEAVE AND SICK DAYS, EXCUSE ME, FAMILY MEDICAL LEAVE AND THE SECOND ONE PAID FAMILY LEAVE WHICH IS GERMANE TO CALIFORNIA PARTICULARLY, AND PAID SICK DAYS.

YOU CAN SEE UNDERNEATH HERE, THERE ARE A VARIETY OF THINGS THAT ARE RATED ON A SCALE AND COME UP AS A WHOLE COMPOSITE FOR JUST THIS ELEMENT -- JUST THIS CATEGORY OF SUPPORTING WORKING FAMILY CAREGIVERS. THIS HAS BEEN REPEATED EVERY THREE YEARS. I DON'T WANT TO ASK GRETCHEN IF IN ANOTHER THREE YEARS, I ASSUME THERE WILL BE ANOTHER LTSS SCORECARD. THE SCORECARD IN GENERAL HAS BEEN HELPFUL TO STATES TO USE IN IMPROVING THEIR LTSS PROFILE. STATES DO PAY ATTENTION TO THE RESULTS AND SCORECARD BECAUSE EVERYONE IS RANKED ACCORDING TO DIFFERENT ELEMENTS WITHIN THE SCORECARD AND AN OVERALL RANKING AS WELL. THE NEXT SLIDE WE ARE COMPOSING.

>> I'LL SAY THAT WHILE KATHY IS TALKING ABOUT THE SCALE, THE SCALE IS HOW WELL DOES CALIFORNIA DO RELATIVE TO HOW WELL OTHER STATES ARE DOING? CALIFORNIA HAS ONE NUMBER AND IT'S JUXTAPOSE AGAINST HOW WELL IDAHO AND CONNECTICUT DID. DO WE HAVE UNEMPLOYMENT SERVICE OR NOT? WE HAVE A SCORE FOR THAT. THERE IS VARIATION FOR IT TO CHANGE AND SOMETIMES NOT A HUGE VARIATION IF IT'S 0 OR 1.

>> THESE ARE THE PRESENCE OF THE POLICIES IN THE STATE. FOR EXAMPLE, UNEMPLOYMENT INSURANCE, THERE IS UNEMPLOYMENT

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INSURANCE THAT ADDRESSES GOOD JOB LOSS TOO FOR THE DISABILITY OF SOMEONE'S IMMEDIATE FAMILY. I DON'T KNOW IF ANYONE A, KNOWS THAT, OR B, TAKES THAT. IT'S THE PRESENCE OF HAVING THE POLICY IN PLACE THAT HAS THE BEARING ON THE REQUISITE COMPOSITE SCORE. THE LAST ONE IN THIS IS THE STATE POLICY THAT AFFECTS THE DISCRIMINATION.

THAT'S BEING TALKED ABOUT RIGHT NOW IN THE LEGISLATURE. NEXT SLIDE.

>> THIS IS THE FINANCIAL PROTECTION FOR SPOUSES PROTECTION. STATE ASSESSMENT OF CAREGIVER NEEDS. THIS IS THE UNIFORM ASSESSMENT, BASICALLY, ACROSS PROGRAMS. THE CARE ACT WAS IN THERE WHEN IT WAS PASSED IN 42 STATES NOW, AND THE DISTRICT OF COLUMBIA. NEXT SLIDE. THIS IS THE NURSE DELEGATION SCOPE OF PRACTICE. I NOTICE YOU HAVE SOMETHING IN THE RECOMMENDATIONS ON THIS. WHAT NUMBER OF HEALTH MAINTENANCE TASKS ARE DELEGATED TO LTSS WORKERS? THAT IS NOT AN ISSUE IN IHSS BUT IT IS ON THE PRIVATE SIDE AND NURSE PRACTITIONER SCOPE OF PRACTICE. NEXT SLIDE?

>> TRANSPORTATION POLICIES WERE MOLDED UNDER THAT. IT'S INTERESTING, WE HAVE SOMEONE REPRESENTING TRANSPORTATION SERVICES. WE'LL TALK ABOUT HOW THIS -- WHETHER IT STAYS HERE OR STAYS HERE AND THERE'S ADDITION TO TRANSPORTATION CONSIDERATIONS. THIS CONCERNS VOLUNTEER DRIVER POLICIES, COORDINATING COUNSEL, BECAUSE THAT MAKES AN IMPACT ON HOW WELL TRANSPORTATION SERVICES ARE REVIEWED AND APPROVED AND NON-MEDICAID TRANSPORTATION. THESE ARE THE FOUR AREAS THAT REPRESENT THE COMPOSITE SCORES INDIVIDUALLY AND COLLECTIVELY IN THE SCORECARD. NEXT SLIDE. THAT'S IT.

>> DO WE WANT TO TAKE A -- DONNA, DO YOU HAVE A FEW CONCLUDING --

>> IF YOU WOULD GO TO THE RECOMMENDATION SLIDE. REMEMBERING THAT THE GOAL FOR RESEARCH RIGHT NOW IS 1.0 AS YOU HAVE HEARD. THEY ALWAYS SAY REPEAT SOMETHING THREE TIMES TO GET IT THROUGH. THIS IS THE THIRD TIME HEARING THAT ONE. WE KNOW MORE THINGS WILL BE COMING ON FOR LTSS.

WE WANT SOMETHING FOR THE DASHBOARD FOR THE BEGINNING PHASE. WE WOULD LIKE TO SEE FUNDING. IF WE DON'T FUND DATA COLLECTION, WE WON'T HAVE IT, AND WE WON'T BE ABLE TO MEASURE GOALS. THIS IS TO DO WITH FUNDING AND DISINTEGRATION. WE ARE LOOKING AT A MINIMUM DATA SET FOR OUR HOME AND COMMUNITY-BASED PROGRAMS SO WE HAVE A CONSISTENCY OF DATA ACROSS THE STATE THAT CAN BE LOOKED AT. WE WOULD LIKE TO SEE STANDARDIZATION AND HARMONIZATION WHICH IS NOT

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THE SAME AS STANDARDIZATION. IT'S HOW YOU BRING TOGETHER THE INFORMATION ACROSS THE DELIVERY SECTIONS SO WHENEVER POSSIBLE, THIS CAN PUSH DOWN THROUGH ALL LEVELS OF GOVERNMENT AND INCLUDE OTHER COMMUNITY PROGRAM DATA SETS THAT WE CAN ADD ON TO FOR EXAMPLE LIKE THE CRC DATA SET DISCUSSED TODAY.

ASSESSMENT, HAVING A STANDARDIZED ASSESSMENT OF NEEDS AND EXPERIMENTS. IF WE DON'T KNOW HOW THE PERSON IS EXPERIENCING THINGS, WE WON'T GET A GOOD WAY OF MEASURING HOW WE ARE IMPACTING EVEN THE DIVERSITY ISSUES. WE COULD SAY, IT'S AVAILABLE IN YOUR NEIGHBORHOOD. IF SOMEONE CALLS AND DOESN'T FEEL THE PERSON ANSWERING IS MEETING THEIR NEED WITHIN THEIR CULTURE, THEN THAT'S NOT GOING TO BE A GOOD EXPERIENCE FOR THAT PERSON. WE WANT TO LOOK AT THE OUTCOME METRICS THAT LOOK AT THE QUALITY AND EMBODY THE WHOLE PRINCIPLE OF THE PERSON AND TO INCLUDE FAMILY CENTERED CARE IN THESE MEASURES. THAT'S MY WRAP UP. I KNOW NOW WE HAVE TIME FOR QUESTIONS. THANK YOU GUYS FOR LISTENING TO US.

[APPLAUSE]

>> WE'LL TAKE ABOUT FIVE MINUTES FOR QUESTIONS. WE WANT TO MOVE INTO WHAT THE LTSS COMMITTEE IS REFERRING TO RESEARCH. SUSAN AND THEN KATHRYN?

>> I THINK THIS IS A DUMB QUESTION. IN TERMS OF DATA AROUND HOSPITAL UTILIZATION, E.R. VISITS AND THINGS LIKE THAT, IT WOULD SHOW UP UNDER GOAL THREE, CORRECT?

>> YOU ARE WELCOME TO COME TO THE MEETING IN LA JOLLA MARCH 19TH. THERE IS A LUNCH AHEAD OF TIME. WE APPRECIATE THE ENTER PLAY BETWEEN HEALTH MEASURES AND LTSS MEASURES. WE ARE COGNIZANT OF THAT. WE DECIDED TO CLEAVE RESPONSIBILITY AT THIS POINT IN TIME. WE SEE THAT THE DASHBOARD FOR MP4A COULD CONNECT AND MAKE COMPOSITES RELATIVE TO LTSS DIFFICULTY AND REHOSPITALIZATION. YOU CAN DO A LOT OF THINGS BY PUTTING PIECES TOGETHER.

>> ONE COULD GO UP AND ONE COULD GO DOWN. NURSING HOMES COULD BE INCLUDED?

>> WE WOULD THINK ABOUT THAT AS PART OF THE SYSTEM DRIVER COMPOSITE MEASURE UNDER OBJECTIVE 1-1 IN TERMS OF THE SERVICE LANDSCAPE AS AVAILABILITY. THERE WAS A GROUP SERVICE AVAILABILITY SIDE. NURSING FACILITIES PROVIDE SUPPORT, SO WE HAVE TO DECIDE

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WHERE IT LIVES AND HOW YOU REPRESENT THAT AS PART OF THE LARGER CONTINUUM OF CARE.

>> IF WE INVEST IN HOME BASED SERVICES, WE SEE A CORRESPONDING DECREASE IN THE AREAS.

>> OR DIFFERENTIAL USE IN REHAB STATES.

>> NINA?

>> THERE WILL ALWAYS BE A NEED FOR LONG-TERM CARE AND DEFERRED NURSING HOMES BECAUSE NOT EVERYTHING CAN BE DONE BY FAMILY AND COMMUNITY SERVICES.

>> NINA HARWELL, AARP. I KNOW IN THE LTSS RECOMMENDATION, THERE ARE SUGGESTIONS THAT THE CHIS QUESTIONS CONTINUE TO BE FUNDED. IT WAS IN THEIR SOMEWHERE, RIGHT? CALIFORNIA AGING DISABILITY ALLIANCE, DEFINITELY SUPPORT THIS, FIGURING OUT -- I KNOW THE DATA SETS ARE NOT TOO DEFINED, BUT HOWEVER WE FIGURE THIS OUT SO IT'S CONTINUOUS AND WE HAVE GOOD DATA, THE CAREGIVER DATA IS NOT JUST A FEW YEARS. ART STONE IS GENEROUS AND KICKS IN A MILLION DOLLARS. CAN YOU TALK TO ME ABOUT NOT BEING QUANTITATIVE MYSELF. WHAT IS A MINIMUM DATA SET FOR LTSS LOOK LIKE? WHAT DOES THAT MEAN? IT'S STREAMLINING ACROSS THE THINGS THAT ARE CURRENTLY HARMONIZING DATA. IT'S LIKE WHAT WE ARE DOING WITH THE 1.0 IN A WAY. WE ARE TRYING TO GET DOWN TO THE ESSENTIAL MEASURES THAT CAN GIVE US INFORMATION ACROSS SYSTEMS. BY HAVING A MINIMUM DATA SET THAT WOULD -- GETTING THERE IS EASIER THAN I DESCRIBED. IT WOULD BE AN ASPIRATIONAL GOAL.

>> WITH THAT, WE'LL MOVE TO A FEW RELATIONS THAT WE WOULD CALL REFERRED RECOMMENDATIONS THAT LTSS CAME UP WITH IN THEIR REPORT. I'M GOING TO READ ABOUT SIX RECOMMENDATIONS THAT LTSS WANTED TO PRESENT TO RESEARCH SO THEY WOULD BE AWARE OF THEM. HOW MANY ADULTS ARE ON MEDICAL DISABILITY CARE FOR INDIVIDUALS. THE DASHBOARD, WHEN WE TALK ABOUT SYSTEM DRIVERS AND CORE CENTERED MEASURES, THERE IS ANOTHER WAY TO DIVIDE THAT UP. DESCRIPTIVE MEASURES, THERE IS A WHOLE PART OF THE DASHBOARD TO DESCRIBE PEOPLE IN CALIFORNIA. HOW MANY PEOPLE HAVE DIFFICULTY WITH PERSONAL CARE? THOSE ARE IN THE DESCRIPTIVE PART.

>> IF I CAN ADD ON TO THAT, I THINK THERE IS A LOT THAT WE CAN, AS A LARGE KNIT COMMUNITY OF PEOPLE INTERESTED IN THE PROFILES OF OLDER PEOPLE, AGING CALIFORNIANS, BROADLY. HOW DO WE DEFINE THEM IN A VARIETY OF WAYS? THESE ARE PIECES OF INFORMATION THAT AREN'T CAPTURED IN A SIMPLE WAY ANYWHERE IN DASHBOARD. WE CAN

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INCORPORATE THINGS RELATED TO THE HEALTH SIDE. I LIKE THE INTERSECTION BETWEEN AGE, ACCESS TO CARE DELIVERY, INSURANCE COVERAGE WHICH CAN BE EXPANDED ALL SORTS OF WAYS AS WELL AS THE MEDICAL ELIGIBILITY FRAME. WHAT DOES IT MEAN FOR PEOPLE THAT ARE JUST ABOVE MEDICAL ELIGIBILITY, SOMETHING SPOKEN ABOUT A FAIR AMOUNT. WE'LL BRING THESE TO THE HEALTH GOAL THREE.

>> YOU ARE JUST IN TIME FOR THE MARCH MEETING. ANOTHER ONE, DEVELOP A COMMON DATA LINE TO BE SHARED QUICKLY AND SECURELY ACROSS THE PARTNERS. AN EXAMPLE, HEALTH HOME INCLUDING DEVELOPMENT OF A COMMUNITY HEALTH RECORD. COULD WE BUILD SOMETHING LIKE THIS TO INTERFACE WITH MANAGED CARE ORGANIZATION DATABASES?

>> I THINK THIS IS A REALLY INTERESTING PROGRAM IMPLEMENTATION DATABASE. IT'S NOT NECESSARILY THE CHARGE OF THE RESEARCH SUBCOMMITTEE TO HAVE THIS INCORPORATED IN FROM OUR SIDE, BUT IN TERMS OF A RECOMMENDATION THAT COULD COMFORT FOR AGING AS A WHOLE, ABSOLUTELY. OUR CHARGE IS ABOUT THE DATA DASHBOARD ITSELF, MORE OF THE PROFILE AND MEASUREMENT FOR CHANGE. NEXT IS THE DATA BOOK THAT LYDIA PRESENTED AT OUR MEETING, INCLUDING SCRAPING TECHNOLOGY, ZIP CODE LEVEL DATA. OPPORTUNITIES TO SEE WHERE NEEDS ARE AND THIS CAN BE USED FOR DEVELOPMENT AND ACCESS STANDARDS AS THEY ARE DESIGNED. THIS IS SOMETHING ELSE THAT WE CAN BRING 2.0 AND RECOMMENDATION TO THE MASTER MAN FOR HOW WE COLLECT DATA.

>> IF I COULD COMMENT ON THIS. IT'S PROBABLY 2.0 IN TERMS OF MAKING THIS COME TO LIFE, BUT THE SPIRIT OF THE SYSTEM DRIVER MEASURE RELATIVE TO CALIFORNIANS AGING BY DIFFERENT AGE GROUPING, THAT'S THE SPIRIT UNDER GIRDING THAT. COULD YOU DO IT FOR JIO MAPPING? COULD YOU CONNECT? IT WOULD BE CENSUS DATA POURED IN, IN TERMS OF PEOPLE LIVING IN CERTAIN AREAS. THIS IS REALLY THE NEXT LEVEL ITERATION ABOUT HOW DO YOU SHOW WHERE SERVICES ARE RELATIVE TO THE VARIOUS NEEDS EVEN BY THE SIMPLEST CRED, IF YOU ARE OVER 85, YOU ARE GOING TO HAVE NEEDS. YOU CAN'T SAY THAT FOR YOUNGER GROUPS, BUT YOU CAN A LITTLE BIT MORE FOR AGE 85 AND ABOVE.

>> WHAT RESEARCH EXISTS TO SUPPORT RECOMMENDATIONS SAVING TAXPAYER DOLLARS? A LOT OF LTSS RECOMMENDATIONS ARE DESIGNED TO SAVE, IN THE END, LONG-TERM, SAVE TAXPAYER DOLLARS.

>> SOUNDS LIKE PROGRAM EVALUATION AT SOME LEVEL, WHICH I THINK IS USEFUL. I ENCOURAGE THE LTSS RECOMMENDATIONS WHERE IT'S

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APPROPRIATE TO HAVE THE COMPONENT TO IT IF IT'S PART OF YOUR FUNDING ASK.

>> THE FIFTH ONE IS WHAT IS THE PROJECTED NEED FOR DIRECT CARE WORKFORCE WORKERS? AT ONE OF THE LTSS MEETING WHERE THE CWDA CAME --

>> WE RECOGNIZE THAT WE DIDN'T HAVE IN OUR IMMEDIATE BRAIN SET ABOUT A SYSTEM DRIVER MEASURE ABOUT THE CARE DELIVERY WORKFORCE. WE WELCOME ANY RECOMMENDATIONS THAT THIS GROUP HAS ABOUT WHAT WOULD BE A DISCREET SYSTEM DRIVER MEASURE AND WHERE WOULD IT COME FROM? DEPARTMENT OF LABOR MAY HAVE IT, WONDERFUL. WE WOULD LOVE TO KNOW WHAT IS THE DATA SOURCE AND QUESTION TO PORT THAT IN. IF THERE IS CALIFORNIA SPECIFIC, IT WOULD BE VALUABLE.

>> AND REGIONAL.

>> SURE.

>> WHAT RESEARCH EXISTS ABOUT THE IMPACT OF RESTRICTED IMMIGRATION ON THE WORKFORCE? THAT'S A GOOD QUESTION. I KNOW OF STUDIES FROM OTHER COUNTRIES. I DON'T KNOW OF ANY IN PARTICULAR, BUT I THINK THE SPIRIT OF THE DASHBOARD WOULD BE MORE ABOUT THE AVAILABILITY OF THE DIRECT CARE WORKFORCE. THE IMPLEMENTATION OF ANY POLICY ON THAT WOULD PROBABLY BE SOMETHING OUTSIDE OF THE SCOPE OF THE MEASUREMENT DASHBOARD AT THIS POINT. IT COULD BE INCORPORATED INTO POLICY DISCUSSIONS

>> IT CONNECTS TO SOMETHING NINA SAID EARLIER, MAYBE IN ANOTHER MEETING. WE DON'T WANT THE ONLY DESCRIPTORS TO BE HOW NEEDY PEOPLE ARE. IF YOU PAINT A PICTURE THAT SAYS, PEOPLE WITH DISABILITIES, OLDER ADULTS NEED ALL OF THESE THINGS AND THEY HAVE ALL OF THESE HEALTHCARE ISSUES, IT IS GOING TO MAKE IT HARDER TO SHOW THAT YOU, IN THE END, COULD SAVE MONEY BECAUSE PEOPLE CONTINUE TO WORK AND GENERATE TAXES. I WANT TO PLACE A PIN BY THAT DESCRIPTIVE DATA HAS TO BE BALANCED IN THAT WAY OR WE'LL CAUSE OURSELVES DOWN THE ROAD, PROBLEMS.

>> I KNOW WE HAVE TO MOVE ON, BUT THANK YOU FOR BRINGING THAT UP. THAT'S AN IMPORTANT PICTURE TO PAINT, EVEN WHEN SOMEONE IS DRAWING SERVICES, THEY ARE WORKING, CARE GIVING, VOLUNTEERS, CONTRIBUTING TO CHARITY AND SO FORTH. WE HAVE DONE OUR RESEARCH

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SHOWING HOW THE CONTRIBUTIONS OF THE 50 PLUS CALIFORNIANS, AND I THINK STACEY BROUGHT THAT UP DURING RECENT SUBCOMMITTEE. LET'S NOT LOSE THAT TOO.

>> THANK YOU FOR BRINGING THAT FORWARD, BOTH OF YOU, IN YOUR HARMONIZED WAY. STACEY BROUGHT UP GOALS TO COMMUNITY ELEMENTS. YOU WOULDN'T SEE IT HERE. WHAT'S REALLY IMPORTANT IS THAT WE AS A COMMITTEE ARE OFFERING A PROPOSED SET OF MEASURES TO GET A PICTURE OF GOAL ONE, AND WHAT WE WOULD LOVE FOR EACH ORGANIZATION TO DO OR MAYBE THE LTSS COMMITTEE WANTS TO DO IS RELATIVE TO SOME OF THE THINGS THAT WE PROPOSE, THERE ARE GAPS THAT WE TALKED ABOUT SAY THE WORKFORCE MEASURE. IF YOU HAD YOUR FAVORITE MEASURE OUT OF ALL OF THIS, WHAT WOULD YOU PUT FORWARD KNOWING YOU HAVE GOALS LIKE HEALTH. IT SHOWS THAT THERE ARE THOSE WITH EXCELLENT HEALTH OR PEOPLE WITH DISABILITIES EXPERIENCING THEIR DAY WITH EXCELLENT HEALTH BECAUSE THEIR NEEDS ARE BEING MET. IT'S A BETTER PICTURE OF AGING CALIFORNIANS. WE WELCOME YOUR PERSPECTIVE OF WHAT YOU HAVE TO SHOW TODAY.

I THINK THE STORY MATTERS ABOUT WHAT THE DATA DASHBOARD TELLS ABOUT OUR AGING CALIFORNIA.

>> THAT'S A GREAT POINT. I DON'T SEE ANY OTHER FLAGS UP. I DON'T SEE ANY NAMES ONLINE. WHY DON'T WE MOVE -- BEFORE WE MOVE TO PUBLIC COMMENT, I WANT TO THANK OUR RESEARCH COMMITTEE VISITORS WHO ARE HARD WORKING A GROUP AS THE LTSS. WE HAVE AMAZING SUBCOMMITTEES IN THIS MASTER PLAN. THANK YOU FOR BEING HERE. THEY'LL BE GOING TO EQUITY WORK GROUP AND SAC, AND WE'LL BE ROLLING OUT THE MORE TO BE REVEALED.

>> MORE IS COMING. THEY ARE POSTED ONLINE. THANK YOU, CBA TEAM. YOU DON'T HAVE TO COMMENT IN THE NEXT 48 HOURS. I THINK ONE OF THE INDICATORS ARE THAT WOULD BE A RICH BASE FOR OUR SUBSEQUENT MEETINGS.

>> PARTICULARLY ON A SMATHERING OF MEETINGS TO COME OUT TO THE PIECES.

>> I WOULD ADD TO THAT TOO, I'M GLAD THAT YOU MENTIONED ABOUT THE PAID DIRECT WORKFORCE.

>> ALL RIGHT, WE ARE GOING TO START WITH PUBLIC COMMENT IN THE ROOM. ALSO, EVERYBODY WHO IS ON ZOOM SHOULD KNOW THAT THERE IS A LINK TO SUBMIT PUBLIC COMMENT AND MEETING FEEDBACK AS WELL AS ANOTHER LINCOLN THE SLIDE TO SUBMIT DETAILED RECOMMENDATION FOR

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THE MPA. ANYONE IN THE ROOM HAVE COMMENT? NO PUBLIC COMMENT IN THE ROOM? ALL RIGHT. DO WE HAVE ANYONE ONLINE?

>> WE HAVE ONE PERSON. WHAT'S HER NAME? CARMEN. YOU ARE UN-MUTED. CARMEN?

>> THERE WE GO.

>> WE CAN HEAR YOU.

>> THANKS, EVERYONE, FOR ALL OF THIS INFORMATION. IT'S WONDERFUL STUFF. I'M SUPER EXCITED ABOUT IT. I'M CARMEN, A MEMBER OF THE PUBLIC, A CAREGIVER FOR MY MOTHER AND COMMISSIONER ON THE SANTA CLARA COUNTY SENIOR CARE COMMISSION. I'M ATTENDING AS A CAREGIVER FOR MY MOM. I WOULD LIKE TO SHARE, LOOKING AT THE CURRENT LTSS REPORT WHERE YOU HAVE AT THE BEGINNING, YOU HAVE THE BULLETS. OBJECTIVES THAT YOU PULLED OUT. I'M THINKING THERE IS A WAY TO STRUCTURE THAT SO IT COMES OUT MORE POWERFULLY. WE HAVE ABOUT 40 SOMETHING PAGES. I WOULD LOVE TO SEE THAT COME OUT IN A WAY THAT IT POPS AND GRABS FOLKS ATTENTION, AND I'M HAPPY TO HELP FORMAT THAT. IT DOESN'T REQUIRE A LOT OF CHANGES, JUST WAYS TO POSITION --

[LOSS OF AUDIO ]

>> CARMEN? DID THE CALL DROP?

>> RESEARCH COMMITTEE --

>> OH, WE HEAR YOU AGAIN.

>> CAN YOU HEAR ME NOW?

>> YES, WE CAN.

>> THE OTHER THING I WANTED TO ASK A QUESTION OF THE RESEARCH COMMITTEE, DO THEY HAVE DATA ON WHAT THE COSTS ARE IF WE DON'T IMPLEMENT? ARE YOU LOOKING INTO THAT?

>> THANK YOU SO MUCH FOR THAT QUESTION. THIS IS GRETCHEN. GIVEN THE COMPLEXITY OF THE INTERSECTION OF THE RECOMMENDATION FROM THIS COMMITTEE, KNOWING THEY ARE GOING TO ROLL UP, WE DO NOT AT THIS TIME HAVE A DATA SOURCE THAT WOULD PROVIDE THAT KIND OF -- I THINK -- A CONGRESSIONAL BUDGET OFFICE ESTIMATE. OFFERING UP A RECOMMENDATION THROUGH PUBLIC COMMENT OF THAT KIND OF EVALUATION TO BE DONE, IF THESE CHANGES AREN'T PUSHED FORWARD, WHAT MIGHT THAT -- WHAT MIGHT BE THE IMPLICATION OF THAT? I THINK IT'S

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A VALUABLE PIECE OF PUBLIC COMMENT YOU PROVIDE TO THE MASTER PLAN FOR AGING TEAM.

>> IT SOUNDS LIKE IT'S SOMETHING WE WOULD WANT TO INCORPORATE, CORRECT?

>> I THINK IT'S A VALUABLE CONTRIBUTION TO THE PROCESS. WE DON'T HAVE KNOWLEDGE OF DATA PROCESS TO GENERATE THAT FOR THE DASHBOARD, BUT IT SOUNDS LIKE A VALUABLE CONTRIBUTION TO THE PROCESSES THAT WILL BE REQUESTED. THANK YOU. OUR NEXT COMMENTER IS BILL SIZE. YOU SHOULD BE UN-MUTED.

>> BILL SIZ E. I SUBMITTED THREE QUESTIONS. HOPEFULLY YOU CAN SEE THEM. ONE ON CLIMATE CHANGE AS RELATED TO CHIS. I DON'T SEE A LOT OF THAT ADDRESSED IN GENERAL, HOW CLIMATE CHANGE AFFECTS HEALTH. I PARTICIPATED IN MANY OF THESE BUT NO ONE HAS DIRECTLY SPOKEN ABOUT THEM. I THINK WE ARE MISSING THE BOAT THERE. I HOPE YOU CAN CONSIDER IT. THAT'S ALL. THANK YOU SO MUCH.

[LOTS OF FEEDBACK ]

>> THANK YOU, BILL. THAT IS SOMETHING WE NEED TO TALK ABOUT MORE. WE APPRECIATE THE COMMENT. I THINK THAT WOULD BE IN THE GOAL THREE AREA, HEALTH AND WELL BEING, SARAH?

>> SARAH: THANK YOU, BILL. THIS IS CERTAINLY IN THE ISSUES THAT WE SEE A STRONG CONNECTION ACROSS THE GOAL AREAS. WHILE WE RECOGNIZE YOU CAN'T SEPARATE THE DISCUSSION THINKING ABOUT LONG-TERM SERVICES AND SUPPORT NEEDS FOR PURPOSES OF THE SCOPE OF THE ISSUES THAT WERE ADDRESSED IN THE LTSS COMMITTEE, IT WAS DETERMINED THAT, THAT ISSUE OF DEATH AND DYING AND RELATED ISSUES WERE BEST ADDRESSED IN THE HEALTH AND WELL BEING GOAL GROUP. THAT'S SOMETHING WE ARE HOPEFUL. THEY ARE MEETING THURSDAY, AND THEY'LL INCLUDE IN THEIR RANGE OF ISSUES AND RECOMMENDATIONS.

>> ALL RIGHT. I BELIEVE THAT CONCLUDES OUR PUBLIC COMMENTS. WE WANT TO SAY -- IN TERMS OF NEXT STEPS, ONE OF THE THINGS WE ARE GOING TO BE DOING WHEN WE GET BACK TO THE OFFICE OR TOMORROW MORNING IS PUTTING TOGETHER A CONCRETE TIMELINE WE HAVE WORKED OUT OF WHAT HAPPENS ON WHAT DAY AND 48 HOURS AND WHERE THE REPORT GOES, AND GET BACK TO YOU ON THE QUESTIONS YOU HAVE ABOUT HOW THIS GETS TRANSMITTED TO THE GOVERNOR. THAT'S A GOOD

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QUESTION. THE OTHER THING WE'LL BE -- THE PARTY AT SARAH'S HOUSE. HE'S INVITED. THE LAST THING WE NEED TO COME TO AGREEMENT ON THAT WE DIDN'T DO TODAY, WE CAME TO THE AGREEMENT THAT WE WANTED A SPRING BREAK. THERE IS ALSO VALUE IN CONTINUING TO MEET. WE'LL CONTINUE TO TALK AS A GROUP ABOUT TIMING FOR THAT AND HOW TO BEST TIME THAT WITH ALL OF THE OTHER TIMELINES OF THE COMMITTEES HAPPENING RIGHT NOW AS WELL. THANKS. THAT CONCLUDES THE MEETING.

[APPLAUSE]

>> THANKS, EVERYONE ON THE PHONE.

>> THANKS, EVERYBODY IN THE ROOM.