Gray Matters: A Look at the Orange County Office on Aging

Funding from the Orange County General Fund in support of the Office on Aging has not kept pace with the rapid increase in senior population. Allocation to Office on Aging from the OC General Fund in 2005-2006, prior to the recession, was $2.20 per senior per year. Over the past five years the allocation dropped to only $1.32 per senior person per year in FY 2015-16.

Lack of resources for the Office on Aging hampers its ability to accomplish its mission and mandates as required by the California Code of Regulations-WIC 9400-9404. The Office on Aging is required to be the County’s lead planner and advocate for seniors, working with public and private partners to create an updated, coordinated countywide strategic plan to better leverage and integrate all available resources to address the rapidly growing senior population. Organizational Issues at the Office on Aging

The position of the Division Manager for the Office on Aging is only a part time position, shared with the Veteran’s Service Office. Increasing outreach and Call Center demand require full time management at this level.

Limited funding to support staff positions results in chronic vacancies within the Office on Aging, negatively affecting service and responsiveness.

Limited staffing resources prevent the pursuit of grants to support senior services. Information and Assistance

The Office on Aging website is outdated and needs technological modernization immediately. There is no provision for access by mobile device or on-line chat capability. Senior Nutrition and Ombudsman Programs

The County of Orange provides no on-going budgetary support beyond the original contract to non-profit subcontractors for the recruitment of volunteers.

Orange County provides no budgetary support to the non-profit agency that publishes the “Answers” publication beyond the cost of individual county department advertising. Senior Non-Emergency Transportation Program

Annual and semi-annual mechanical vehicle inspection is the responsibility of the Office on Aging, but no licensed mechanic is on staff to do this.

Mileage verification of each Senior Non-Emergency Medical trip is the responsibility of the Office on Aging, an inefficient, labor intensive effort requiring manual input of subcontractor supplied data.

o r e b 1500 Inbound m u N 1000 Outbound 500 0 FY 2014-2015 The Office on Aging website has had a steady increase in users since January 2013. The online resource directory page is consistently the second most viewed OOA webpage every month, suggesting that the community is augmenting traditional phone usage with online resources. The website needs updating in content and technology to reflect that current users are more technologically proficient and expect current information to be posted. An on-line chat function would also enhance the functionality of the website. Staffing the Call Center The OOA software statistics shows that the Call Center handles an average of 80-90 calls per day. While the average length of each call is 3-4 minutes, some callers are on hold for half an hour or more, depending upon staffing levels. During peak periods, particularly at winter holiday time, it receives as many as 120 calls per day. A wall mounted screen displays a running total of the number of calls handled that day and also shows the number of calls which went unanswered. During a visit to the Call Center 40 calls were answered, while seven were unanswered for a 15% abandonment rate. Call Center personnel confirmed that this is typical, but that the target for unanswered calls is 10%. A key reason for dropped calls is unfilled staff positions. Of the five authorized staff positions available to operate this center one position has been vacant since 2012. Office on Aging Outreach One task of the OOA is educating the senior Orange County population about the host of services available to them. As a typical example, in the month of October, 2015, the OOA engaged in five local outreach events, attended by a total of 1,027 seniors. In order to reach as many seniors as possible, the OOA also cosponsors and coordinates large scale events with stakeholders, including the Board of Supervisors and non-profit organizations. Budget constraints hamper this very effective and efficient means of speaking to seniors. Funds are not available to enable the OOA to hold these large events every year in each of the county areas. In 2015 the Office on Aging participated in one large event, the South County Senior Summit, held in Laguna Woods, cosponsored by the District 5 Supervisor. Over 1000 seniors and other interested voters attended this event. A similar North County Senior Summit was held in 2014. Outreach efforts to this group of graying voters would be greatly improved if the Office on Aging coordinated an event with each of the Supervisors on the Board of Supervisors to hold an event in each district once a year utilizing the Board members’s office funds. However, these events are labor intensive and, without additional staff, impact the ability of the existing Office on Aging staff to perform their regular duties. Senior Nutrition Program The Senior Nutrition program targets “food insecure” seniors. There are nearly 80,000 adults age 60+ living alone in Orange County. Those numbers increase each year and it is expected that in just five years there will be 160,000. Many of those are insecure because of physical, mental, and/or financial limitations. These restrictions make it difficult or impossible for them to obtain food or meals on a regular basis, further impairing their health and safety. According to county providers, the Home Delivered Meals Program (sometimes known as Meals-on-Wheels) serves over 1,100,000 individual meals annually to more than 2700 individual Orange County seniors. The purpose is to provide healthy meals seven days a week to those medically qualified seniors who are homebound. While, meals are delivered five days a week, meals for the week-end are left with the Friday delivery. This program is a major tool in achieving the goal of stakeholders from all levels of government. That goal is encouraging aging-in-place. As a result of this valuable program, capable seniors have been able to avoid placement in expensive long term care facilities when they no longer have easy access to food. All clients in the Home Delivered Meals (Meals on Wheels) program are screened for eligibility, which includes physical limitations, age and self-care ability. Federal regulations prevent means testing of the recipients, although there is a requested “donation” of up to $ 6.50- 7.50 per day to help defray costs. Those unable to pay receive their meals free of charge. There is also a full pay program, at a cost of $10/ day, for those who do not qualify under the guidelines. Those who have sufficient mobility to visit local senior centers may take part in the Congregate Lunch program served at a total of 37 senior centers around Orange County. The Congregate Lunch program provides both a nutritious lunch and social interaction to those who are still mobile, but may no longer be willing or capable of preparing food for themselves on a regular basis. Waiting lists vary greatly. At present there is no waiting list in South County, but North Orange County has a wait list of 200 people, with most in Santa Ana and Anaheim. The federal and state governments hand down complex, demographic based funding formulas using the 2010 Census. They do not adjust for shifts in local senior populations between censuses. In addition, two charitable foundations in the North region redirected major grants away from senior care toward children in 2014. The loss of this money will exacerbate the situation in the North, impacting day-to-day planning and allocation of resources. Observations of the Home Delivered Meals Program Providers sub-contracted to the Office on Aging operate three central commercial kitchens to create and prepare the meals. One serves South County, one serves North County and the City of Irvine serves Irvine. A dietician at each site creates the menus and oversees compliance with nutrition regulations. From the commercial kitchens, the meals are dispersed by truck to senior centers throughout Orange County. Volunteer drivers pick up the meals at the senior centers and deliver them to individuals at home. Members of the Grand Jury accompanied volunteers from different regions in the county on their meal delivery routes. In one region, hot lunch meals packaged with cold dinner and breakfast meals are prepared at a subcontracted commercial kitchen and delivered to a local senior center in insulated bags. Volunteers then deliver the meals along an assigned route. Some customers on the route receive meals five days a week, while others choose only two or three times a week. In that same region, one senior center distributes meals to approximately 75 home-bound clients each day. There are nine routes with 6-9 clients in each route. The routes operate five days a week, requiring a total of 45 volunteer drivers. According to representatives of the non-profit organizations, it is sometimes a struggle to find enough volunteers. If a route is uncovered, clients do not receive their meals and are put on a waiting list. A member of the Grand Jury accompanied a driver to the six clients on his route. The clients visited included a 97 year old woman living with a home care provider and a couple consisting of a fragile husband and his wheel-chair bound wife. In this example, all of the clients had nothing but praise for the service. The only complaint heard had to do with the type of food provided – one client bemoaned the lack of sauerkraut in her meals. In another program, a microwaveable frozen dinner, prepared by the contactor’s own off-site commercial kitchen, is packaged with a cold lunch and breakfast. The Grand Jury visited the commercial kitchen which prepares the meals using purchased, not donated, food. The kitchen appeared to meet the strict cleanliness and documentation standards of a hospital kitchen. Several members of the Grand Jury took part in ride-alongs with drivers delivering meals. The City of Irvine operates its own on-site commercial kitchen at the Lakeside Senior Center. About 100,000 meals are prepared each year with over 54,000 meals served to 186 individual, unduplicated seniors provided through the Home Delivered Meals (Meals on Wheels) program. Over 1,000 home delivered meals are provided weekly by more than 150 volunteers, covering over 11 routes. Twenty thousand meals per year are provided for the very popular Congregate Lunch program at the Lakeview Senior Center and another 20,000 meals provided to the Adult Day Care Facility co-located with the Lakeview Senior Center. All meals are “ no added sugar”, low-sodium and meet the Nutritional Daily Allowance guidelines for older adults. It is obvious that clients not only trust their volunteer driver, since the doors were left open at most of the homes, but that the driver becomes a welcome friend and visitor to lonely, fragile aged. The driver is also another pair of eyes and ears monitoring the condition of the client, reporting any changes in physical and/or mental condition through the provider staff to the Office on Aging. The driver is also required to report any suspected elder abuse. This service allows many seniors to age at home, instead of needing to go to assisted living or nursing facilities. Long Term Care Ombudsman Program Ombudsmen investigate all complaints from residents in long-term care facilities. Ombudsmen work to resolve problems and concerns of individual residents by creating a presence through regular unannounced visits, monitoring conditions and care, and providing a voice for those unable to speak for themselves. The Long-Term Care Ombudsman Program (LTCOP) serves 1,100 care facilities for the elderly in Orange County. These include 75 large assisted living facilities and nearly 1,000 six bed Residential Care Facilities for the Elderly (RCFE). In 2015 there were three times as many Residential Care for Elderly homes (RCFEs) in Orange County than there were thirty years ago. Ten percent of all California RCFEs are located in Orange County. Only Los Angeles County has more. These state licensed RCFEs are located in single family homes throughout the county and are indistinguishable from any other residence in the neighborhood. A maximum of six residents live in each RCFE and receive around the clock care from a team of care providers. The team usually consists of two people, but there is no minimum number required by the State Licensing Board. Most residents are elderly with varying degrees of dementia and/or Alzheimer’s disease and are either alone with no relatives nearby or can no longer be cared for by family. These RCFEs are profit centered businesses, which depend upon reputation to be successful. (Non-profit ombudsman provider) In the past, most of the county’s facilities had an assigned Ombudsman making regular announced and unannounced visits, which included building relationships with the residents. As a result of funding deficiencies, 160 facilities with 960 residents did not have an assigned Ombudsman in 2013. The result was a decline in the complaint resolution rate from 82% in FY 2010-2011 to 66% in FY 2013-2104. (OOA Area Plan Update, 2015-16) As a state program, the Long-term Care Ombudsman Program has advocated two separate pieces of legislation. One bill would have increased the number of required inspections and oversight by the licensing agency. The second was to restore funding to the pre-2008 levels. Unfortunately, neither bill made it past the governor’s desk. At that time, a grant from a generous corporate sponsor allowed Orange County’s primary non-profit ombudsman provider to fill in that gap. In 2014, for the first time in the history of the program, 100% of the facilities in Orange County had a designated Ombudsman, up from 85% one year ago (Non-profit ombudsman provider). While the program has always been responsible for investigating complaints and abuse allegations, a designated Ombudsman in each facility insures a more persistent presence via announced and unannounced visits. The Long-term Care Ombudsman Program continues to be the only program protecting all the residents of Orange County in long-term care facilities. However, such corporate funding is not predictable or guaranteed and leaves a significant number of seniors vulnerable in its absence. Ombudsman Program Structure A single non-profit organization under subcontract to the Office on Aging is the only agency in the state providing countywide Ombudsman protection. It has been under contract since the inception of the program in 1973. This agency recruits, trains and monitors Ombudsman volunteers. Currently the Ombudsman program has 27 paid part time staff and a volunteer base of 78. Each Ombudsman, whether paid or volunteer, receives 36 hours of state- mandated training at the non-profit agency’s offices plus another ten hours of field training. Ombudsmen make unannounced visits to each facility once a month and attend regular resident council meetings at the assisted living facilities. Office on Aging Programs in Conjunction with the Ombudsman Program The Office on Aging is currently conducting a pilot Music Therapy Project. A small group of 25- 30 residents are being followed for six months to see if music therapy enhances their responsiveness and quality of life. If the pilot program is successful, the provider will apply for a grant to expand the program. The provider is also working with the State Ombudsman Office on a plan to reduce the use of psychotropic drugs in skilled nursing facilities. The Office on Aging is working with the Alzheimer’s Association and the University of California, Irvine (UCI) to bring education and training to assisted living facility staff on the care and well-being of residents with dementia. There is currently no specific program in place to educate the administrators and caregivers in the small 6 bed facilities about working with dementia residents. Observations of the Ombudsman Program Ombudsmen are indispensable eyes and ears, calling attention to below standard elder care. As a result of Ombudsman efforts, most recently two RCFEs in Anaheim, as reported by the Orange County Register on February 11, 2016, had their licenses revoked. The Orange County Grand Jury accompanied Ombudsmen on their routes to both RCFEs and assisted living facilities across Orange County. The Grand Jury observed how the Ombudsmen checked the physical condition of the facilities, the physical and emotional condition of the clients and how they conducted their inspections and reporting. The Ombudsmen were queried about their training and any barriers to the performance of their duties. One of the most frequent comments was the amount of paper work required. Since most of the Ombudsmen are volunteers, this was cited as one of the reasons that potential Ombudsmen who completed the initial training course did not continue to become Ombudsmen. The Office on Aging should partner with its non-profit ombudsman provider and the California Department of Aging to explore if the reporting system could be accessed from a tablet or mobile phone. This improvement would allow the Ombudsman to immediately write a report after a visit. The quality of volunteer Ombudsmen varies. At one end of the spectrum were dedicated, caring individuals, who connected with each resident in the facility. At the other end, the Grand Jury also found volunteers who followed their training with regard to compliance with paperwork and interaction with facility management, but, during the period of the Grand Jury’s observation, were observed to do little to cultivate a trusting relationship with their clients. The Ombudsman program is experiencing an attrition of volunteers because of relocation and retirement. A smaller pool of volunteers may make it increasingly difficult to maintain high volunteer standards. Much more needs to be done by the County of Orange to assist in the recruitment of Ombudsmen. Senior Reference Guide The Ombudsman non-profit agency contracted with OOA produces a senior services reference handbook called “Answers” outside of its county contract. This publication is an alternative to the Office on Aging Call Center and website, which sometimes can be challenging for seniors to use. The non-profit agency funds its production with no support from the Office on Aging other than a paid advertisement. Since it is basically an extension of the Office on Aging outreach function, it should be integrated with that effort and receive funding from the Office on Aging. Budget constraints at the non-profit agency prevent this publication from being more widely available. The OOA should partner with the non-profit agency to provide funding to produce sufficient copies of this resource for all seniors who are interested. Senior Non-Emergency Medical Transportation Program The Office on Aging administers the Senior Non-Emergency Medical Transportation (SNEMT) program, providing approximately 135,000 medical-related trips for approximately 2,000 unduplicated Orange County older adults who lack other transportation options. (OOA Area Plan Update 2015-16). Orange County is divided into three specific geographical SNEMT regions covering the entire county: North County, Central and South County. In accordance with standard county contracting procedures, the OOA selects a provider in each region to provide the transportation services. Providers can cover multiple regions. Fifty to sixty percent of Senior Non-Emergency Medical Transportation participants use the service for recurring dialysis appointments. Chemotherapy, physical therapy and doctor’s appointments account for the rest. Seniors can reserve transportation a month in advance. Because dialysis is often on a three day a week schedule, service is available from 4 AM six days a week, including Saturday. There is currently no waiting list for service, except for Saturday. There is a $2 fee, waived for low income clients. There is a 15 mile limit for trips, but there are exceptions on a case by case basis. The number of SNEMT trips in North and Central County has increased by a factor of six over the past three years. There were 20,000 trips in 2012 in Central and North areas; there were 120,000 in 2015. (SNEMT Contractor) According to the OOA, customer complaints are rare, amounting to less than five a year. There is a procedure for customers to report complaints to the subcontractor. The subcontractor investigates and attempts to resolve the issue. It is also required to report the complaint to OOA. Drivers originate some complaints, most often involving safety issues; such as, customers are not cooperating in wearing their seatbelts. Others originate with customers, who most often complain about pick- up times. Accidents are required to be reported to the County Risk Management Agency, but there were no accidents in 2015. The Office on Aging is required to physically inspect the vehicles used in the SNEMT program. Although this is a technical, mechanical inspection, it is currently assigned to an Administrative I level employee at the Office on Aging. Another duty of the Office on Aging is mileage verification of trips taken through the SNEMT program. Even though performed through sampling of 10% of the total trips, it remains a labor intensive effort, since the start and end location of each trip, as reported by the subcontractor, must be entered manually into MapQuest or similar software. As another example of the fragmentation of senior services, the Orange County Transportation Authority (OCTA) offers its own paratransit transportation program, ACCESS, funded by the Americans with Disabilities Act, for the disabled of any age, including qualified seniors. Although OCTA is the county’s public transit service, SNEMT is considered a social service program because of its funding source, and, therefore, is not administered by OCTA. The SNEMT program is funded by County Measure M2, Tobacco Settlement Revenue, and a grant through OCTA from the federal New Freedom Program. However, the New Freedom funds ended in September of 2015 for a loss of $171,184 to the SNEMT program. Although some seniors may be eligible for both programs, there is no coordination to maximize accessibility or service. Public – Private Partnership According to non-profit organizations, the revenue from governmental sources, including the OOA, does not meet the current expenditure necessary to meet current demand. The non-profit organizations attempt to bridge this gap with charitable donations from individuals, corporate sponsors and voluntary donations for service from clients. They report that it is difficult to fill the funding gap in the present environment and will be an even greater challenge as the client population increases, becomes older and more frail. The thinking is that since the economy has recovered and is doing well, less government help is needed. Those on fixed incomes have suffered in the low interest rate environment and are not benefitting from the improved economy. Service to seniors also has suffered recently as some major charities have prioritized their efforts away from senior programs toward children. In general, charitable gifts are considered easier to obtain for children’s services than for seniors. Volunteers are essential to the delivery of service in the Ombudsman and Nutrition Programs, yet there is virtually no funding available in the OOA budget to partner in the recruitment of these volunteers. Without enough volunteers there is an unavoidable reduction in service. There are waiting lists in some Home Delivered Meals programs. Ombudsman complaint resolution drops. Similarly, in the area of outreach, there is no specific funding available to partner in the production of a countywide directory of services, which is published by a non-profit agency. Only a fraction, 71,000 of the 500,000, or 14%, of seniors have received this resource guide. A public- private partnership, in which Orange County demonstrates its commitment to its senior citizens with substantial budgetary support, is necessary. The non-profit organizations leverage each dollar put forth by the County through the use of volunteers to carry out the programs. This multiplier effect cannot be undervalued. Orange County needs a comprehensive and visionary approach to bridge the increasing gap between the senior population growth and the declining services. Since the stated mission of the Office on Aging as an Area Agency is to provide that leadership, it must be given the resources it needs to accomplish that mission. FINDINGS In accordance with California Penal Code Section 933 and Section 933.05, the 2015-2016 Grand Jury requires (or, as noted, requests) responses from each agency affected by the findings represented in this section. The responses are to be submitted to the Presiding Judge of the Superior Court. Based on its investigation titled “Gray Matters, A look at the Office on Aging,” the 2015-2016 Orange County Grand Jury makes has arrived at ten principal findings, as follows: Orange County General Funds F1: Funding from the Orange County General Fund in support of the Office on Aging has not kept pace with the rapid increase in senior population. Allocation to Office on Aging from the OC General Fund in 2005-2006, prior to the recession, was $2.20 per senior per year. Over the past five years the allocation dropped to only $1.32 per senior person per year in FY 2015-16. F2. Lack of resources for the Office on Aging hampers its ability to accomplish its mission and mandates as required by the California Code of Regulations-WIC 9400-9404. The Office on Aging is required to be the County’s lead planner and advocate for seniors, working with public and private partners to create an updated, coordinated countywide strategic plan to better leverage and integrate all available resources to address the rapidly growing senior population. Organizational Issues at the Office on Aging F3: The position of the Division Manager for the Office on Aging is only a part time position, shared with the Veteran’s Service Office. Increasing outreach and Call Center demand require full time management at this level. F4: Limited funding to support staff positions results in chronic vacancies within the Office on Aging, negatively affecting service and responsiveness. F5: Limited staffing resources prevent the pursuit of grants to support senior services. Information and Assistance F6: The Office on Aging website is outdated and needs technological modernization immediately. There is no provision for access by mobile device or on-line chat capability. Senior Nutrition and Ombudsman Programs F7: The County of Orange provides no on-going budgetary support beyond the original contract to non-profit subcontractors for the recruitment of volunteers. F8: Orange County provides no budgetary support to the non-profit agency that publishes the “Answers” publication beyond the cost of individual county department advertising. Senior Non-Emergency Transportation Program F9: Annual and semi-annual mechanical vehicle inspection is the responsibility of the Office on Aging, but no licensed mechanic is on staff to do this. F10: Mileage verification of each Senior Non-Emergency Medical trip is the responsibility of the Office on Aging, an inefficient, labor intensive effort requiring manual input of subcontractor supplied data. RECOMMENDATIONS In accordance with California Penal Code Section 933 and Section 933.05, the 2015-2016 Grand Jury requires (or, as noted, requests) responses from each agency affected by the recommendations presented in this section. The responses are to be submitted to the Presiding Judge of the Superior Court. Based on its investigation titled “Gray Matters, A look at the Office on Aging,” the 2015-2016 Orange County Grand Jury makes the following twelve recommendations: R1: Board of Supervisors should restore funding to the Office on Aging from Orange County General Funds or any other available and reliable, permanent source of at least $1,294,000 in FY 2016-2017, based upon the pre-recession amount of $2.20 per senior per year, to restore staffing levels, update the Call Center and reposition the Office on Aging as the county’s lead planner and advocate. (F1, F2) R2: The Office on Aging should apply any increased funds received above the current baseline to restore service levels and to provide strategic leadership countywide. (F1, F2) R3: Add a position to serve as event coordinator at the Administrative Manager level 1 to Office on Aging to support OOA outreach and visibility by July 1, 2017. (F2) R4: Increase Full Time Equivalent Division Manager of the Office of Aging from FTE 0.5 to FTE1.0 and separate the Veterans Service and the Office on Aging by January 1, 2017. (F3) R5: Initiate a recruitment to fill one vacant longstanding Senior Citizen Representative position in the Information and Assistance Call Center by January 1, 2017 (F4) R6: Add a position to serve as grant writer at the Administrator II level by July 1, 2017. (F5) R7: Update and upgrade the Office on Aging website to provide for mobile device access and an on-line chat function by December 31, 2017. (F6) R8: Enter into a negotiation for a cost share with non-profit subcontractors in volunteer recruitment activity by December 31, 2016. (F7) R9: Enter into negotiations to cost share with the applicable non-profit agency to produce the book “Answers” by December 31, 2016. (F8) R10: Institute an annual Board of Supervisors Volunteer of the Year Award for senior services rendered in the form of recognition and an award funded by the County by December 31, 2016. (F7) R11: Add a requirement in the next Request for Proposal for the Senior Non-Emergency Transportation Program to require the subcontractor to handle the physical and mechanical inspection of vehicles at subcontractor’s cost with documentation required by the Office on Aging that the inspection was conducted at the County’s Public Works/Fleet Services Division. (F9) R12: Add a requirement in the next Request for Proposal for the Senior Non-Emergency Transportation Program that the sub-contractor produce mileage verification data obtained through MapQuest or similar software and require contractors to submit mileage verifications with payment request. (F10) REQUIRED RESPONSES The California Penal Code Section 933 requires the governing body of any public agency which the Grand Jury has reviewed, and about which it has issued a final report, to comment to the Presiding Judge of the Superior Court on the findings and recommendations pertaining to matters under the control of the governing body. Such comment shall be made no later than 90 days after the Grand Jury publishes its report (filed with the Clerk of the Court). Additionally, in the case of a report containing findings and recommendations pertaining to a department or agency headed by an elected County official (e.g. District Attorney, Sheriff, etc.), such elected official shall comment on the findings and recommendations pertaining to the matters under the elected official’s control within 60 days to the Presiding Judge with an information copy sent to the Board of Supervisors. Furthermore, California Penal Code Section 933.05 subdivisions (a), (b), and (c), detail, as follows, the manner in which such comment(s) are to be made: (a) As to each Grand Jury finding, the responding person or entity shall indicate one of the following: (1) The respondent agrees with the finding (2) The respondent disagrees wholly or partially with the finding, in which case the response shall specify the portion of the finding that is disputed and shall include an explanation of the reasons therefore. (b) As to each Grand Jury recommendation, the responding person or entity shall report one of the following actions: (1) The recommendation has been implemented, with a summary regarding the implemented action. (2) The recommendation has not yet been implemented, but will be implemented in the future, with a time frame for implementation. (3) The recommendation requires further analysis, with an explanation and the scope and parameters of an analysis or study, and a time frame for the matter to be prepared for discussion by the officer or head of the agency or department being investigated or reviewed, including the governing body of the public agency when applicable. This time frame shall not exceed six months from the date of publication of the Grand Jury report. (4) The recommendation will not be implemented because it is not warranted or is not reasonable, with an explanation therefore. (c) If a finding or recommendation of the Grand Jury addresses budgetary or personnel matters of a county agency or department headed by an elected officer, both the agency or department head and the Board of Supervisors shall respond if requested by the Grand Jury, but the response of the Board of Supervisors shall address only those budgetary /or personnel matters over which it has some decision making authority. The response of the elected agency or department head shall address all aspects of the findings or recommendations affecting his or her agency or department. Comments to the Presiding Judge of the Superior Court in compliance with Penal Code Section 933.05 are required or requested from: Responses Required: Responses are required from the following governing bodies within 90 days of the date of the publication of this report: Orange County Board of Supervisors (Findings 1-10, Recommendations 1-12) Responses Requested: Responses are requested from the following non-elected agency or department heads: Director, Orange County Community Resources (Findings 1-10, Recommendations 1-12) Works Consulted 2003-2004 Grand Jury Report, Senior Transportation in Orange County 2005-2006 Grand Jury Report, The Long Term Care Ombudsman Program: Are We Ready for the Coming “Age Tsunami”? 2010 US Census, Quick Facts for Orange County –website www.census.gov/2010census California Department of Aging, Population Data for Orange County -website 2015 OC Community Indicators Office on Aging- website https://officeonaging.ocgov.com 2012-2016 Office on Aging, Area Study and its annual updates Office on Aging, FY 2015-2016 Budget Subcontracts for Nutrition, Ombudsman and Senior Non-Emergency Transportation Programs Orange County, FY 2005-2006 Budget Summary for Office on Aging US Census Bureau, American FactFinder, Orange County, CA, website June, 2015 Works Consulted - Websites Abrazar, http://abrazarinc.com Age Well Senior Services, https://www.google.com/9/22/2015search?q=agewell+senior+services&sourceid=ie7&rls=com.microsoft:en-US:IE-SearchBox&ie=&oe= Age Well Senior Services Annual Report 2014, http://www.agewellseniorservices.org/html/downloads2014_annual_report%20(2),pdf, 9/22/2015 Age Well Senior Services Revenue-Expenses, http://www.agewellseniorservices.org/htmldownloads/PIE_fye%201213.pdf, 9/22/2015 AIRS- Alliance of Information and Referral Systems, www.airs.org,10/2/2015 AIRS –Taxonomy, http://www.airs.org/i4a/pages/index.cfm?pageid=3386,10/2/2015 Area Agencies on Aging, https://www.aging.ca.gov/ProgramsProviders/.../AAA_listing.a..., 10/10/15 California Department of Finance, www.dof.ca.gov/research/demographic, 10/15/2015 California Department of Aging, http://www.aging.ca.gov, 8/23/2015 California Department of Finance-P-1 and P-2, http://www.dof.ca.gov/researchdemographic/projections/#p-1 8/29/2015 City of Irvine Meals on Wheels, http://www.cityofirvine.org/senior-services/meals-wheels Community SeniorServ, http://communityseniorserv.com Council on Aging, http://coaoc.org Facts About California's Elderly - PSA 22, , http://www.aging.ca.gov/Data_and_Statistics/Docs/2015/Program_Statistical_Fact_Sheets_at_the_PSA-Level_(2015).pdf, 8/29/2015 National Care Planning Council, https://www.longtermcarelink.net, 9/30/2015 National Council on Aging-2016 Funding Table, https://www.ncoa.org/resources/federal-budget-fy16-aging-program-funding-table,10/5/2015 Office on Aging, https://officeonaging.ocgov.com,8/26/2015 Office on Aging Area Plan 2012-2016, http://officeonaging.ocgov.com/civicax/filebank/blobdload.aspx?blobid=24205, 8/31/2015 Office on Aging Area Plan Update, http://officeonaging.ocgov.com/civicax/filebank/blobdload.aspx?BlobID=39128, 8/31/2015 Office on Aging FAQ, http://officeonaging.ocgov.com/about/faq, 8/31/2015 Office on Aging Presentation South Senior Summit -2015, http://officeonaging.ocgov.com/civicax/filebankblobdload.aspx?BlobID=46274, 8/26/15 Office on Aging Report Identification of Resources, http://officeonaging.ocgov.com/resources/reports,8/26/2015 Orange County Quick Facts, http://quickfacts.census.gov/qfd/.../18117.html?..., 8/16/2015 Orange County Vital Aging Program, www.ocbrain.org, 8/16/2015 Public Policy Institute of California, www.ppic.org,10/15/2015 Senior Citizens Advisory Council, http://officeonaging.ocgov.com/about/scac, 8/16/2015 US Census Population Projections, http://www.census.gov/population/projections, 8/16/2015 US Census-2010, www.census.gov/2010census, 8/16/2015 15 Appendix 1- Office on Aging Organization Chart DIRECTOR-ORANGE COUNTY COMMUNITY RESOURCES DIRECTOR-ORANGE COUNTY COMMUNITY SERVICES -INTERIM DIVISION MANAGER OFFICE ON AGING/VETERANS SERVICES VACANT VETERANS SERVICE OFFICE POLICY AND PLANNING INFO AND CONTRACTS ASSISTANCE MANAGER 14 BILLETS ADMIN I ADMIN I ADMIN I STAFF SPECIALIST ADMIN I STAFF ASSISTANT ADMIN I ADMIN I SENIOR CITIZEN HEALTH VACANT REP II EDUCATOR SENIOR CITIZEN ADMIN I REP II VACANT SENIOR CITIZEN REP II ADMIN I VACANT SENIOR CITIZEN REP II VACANT STAFF SPECIALIST