Marin Is Aging Are We Ready? Report Date: April 20, 2018

Additional Recommendations 7

These recommendations are not explicitly linked to specific findings.

• R65-69
  18,817 18,963 18,670 18,061 18,177 17,065 14,568 13,549 12,956
• R70-74
  13,694 17,896 18,253 18,070 17,579 17,768 16,766 14,342 13,383
• R75-79
  8,537 12,563 16,686 17,192 17,155 16,785 17,082 16,212 13,922
• R80-84
  5,963 7,429 11,124 14,969 15,633 15,767 15,615 15,970 15,350
• R85-89
  4,492 4,865 6,126 9,239 12,648 13,432 13,778 13,769 14,264
• R90-94
  2,105 2,530 2,776 3,654 5,698 7,943 8,570 9,063 9,074
• R95-99
  514 681 813 991 1,364 2,165 3,053 3,319 3,573 100+ 37 93 117 172 217 345 578 871 1,018 73,899 84,372 93,184 100,990 105,943 106,177 103,870 100,331 98,248 Total 65+ (28%) (32%) (34%) (37%) (38%) (38%) (37%) (36%) (36%) Total 262,105 267,020 270,747 274,243 277,316 278,955 278,811 277,335 275,223 Population 2 “Total Estimated and Projected Population for California Counties: July 1, 2010 to July 1, 2060 in 5-year Increments.” Accessed on December 19, 2017. APPROACH The Grand Jury originally focused on the problem of elder abuse, but found it most instructive to put that examination into the context of Marin’s overall preparedness for a rapidly-aging population. The Jury studied programs addressing aging worldwide, nationwide, in California, and in Marin County itself. In researching elder issues, the Grand Jury: ■ Examined extensive professional research reports as well as articles in the general media. ■ Consulted with individuals and agencies involved with elder issues in Marin and other northern California counties, including experts in dementia, shelters for abused victims, elected officials, and legal experts. ■ Interviewed first responders from Marin County police and fire departments. ■ Interviewed a community religious leader. ■ Examined legal issues relating to elder abuse and elder care. DISCUSSION Preparing for an Aging Population — Worldwide Communities around the world are preparing for an aging population by taking the guidance of the World Health Organization (WHO) and creating age-friendly cities, towns and counties that: ■ Recognize the wide range of capacities and resources among older people. ■ Anticipate and respond flexibly to aging-related needs and preferences. ■ Respect older people’s decisions and lifestyle choices. ■ Protect those who are most vulnerable. ■ Promote older people’s inclusion in and contribution to all areas of community life.3 The WHO initiative proposes eight age-friendly topics for inclusion:4 ■ Housing ■ Social participation ■ Respect and social inclusion ■ Civic participation and employment ■ Communication and information ■ Community support and health services ■ Outdoor spaces and buildings ■ Transportation Preparing for an Aging Population — The Federal Government Federal law provides for adult protective services and grant programs. “The Secretary shall ensure that the Department of Health and Human Services … provides funding authorized by this part to State and local adult protective services offices that investigate reports of the abuse, neglect, and exploitation of elders...”5 The National Center on Elder Abuse (NCEA) serves as a national resource center dedicated to the prevention of elder mistreatment. First established by the U.S. Administration on Aging (AoA) in 1988 as a national elder abuse resource center, the NCEA was granted a permanent home at AoA in the 1992 amendments made to Title II of the Older Americans Act.6 The Elder Justice Act was signed into law by President Obama on March 23, 2010, as part of the Patient Protection and Affordable Care Act.7 It provides federal resources to “prevent, detect, treat, understand, intervene in and, where appropriate, prosecute elder abuse, neglect and exploitation.” The text above refers to just some of the laws and programs in place to help and protect seniors. 3 “Age Friendly Practices.” World Health Organization. 4 “Global Age-Friendly Cities, a Guide.” World Health Organization. 5 “Federal Law 42 U.S Code § 139m-1.” US Government Publishing Office. 6 “What We Do.” National Center On Elder Abuse. 7 “Elder Justice Act.” Oklahoma Department of Human Services. Preparing for an Aging Population — State of California The State of California appears to be actively supporting elders through state laws, initiatives and agencies with the assistance of nonprofits. California Commission on Aging The California Commission on Aging serves as the state’s principal advocate for older adults. Its primary purpose is to advance issues fundamental to ensuring healthy, purposeful and dignified longevity for all Californians. The Commission on Aging advises the state’s Governor and Legislature, along with federal, state, and local agencies, on programs and services that affect older adults. Additionally, the Commission works closely with public, nonprofit, and private-sector institutions to address emerging challenges and opportunities. Established in 1973 by a California government mandate and confirmed in the Older Californians Act, the Commission is comprised of 23 volunteer commissioners (a majority of whom are over 60 years old) representing diverse fields related to aging. Commissioners serve three-year terms and are appointed by the Governor, the Speaker of the Assembly, or by the Senate Rules Committee.8 California Department of Aging The California Department of Aging (CDA) administers programs that serve older adults. The Department contracts with the network of Area Agencies on Aging, which directly manages a wide array of federal-and state-funded services that help older adults find employment, support older and disabled individuals to live as independently as possible in the community, promote healthy aging and community involvement, and assist family members in their vital caregiving role. Elder Abuse In California, elders are defined as persons 65 years and older. Under California law, elder abuse can be both criminal and civil. As far back as 2002 the California Department of Justice partnered with AARP to develop a guide to preventing and reporting elder abuse.9 8 “Your Advocate.” California Commission on Aging. 9 “A Citizen's Guide to Preventing and Reporting Elder Abuse.” California Department of Justice. Preparing for an Aging Population — Marin County Year of the Older Adult In January, the Marin County Board of Supervisors proclaimed 2018 as the “Year of the Older Adult.” The stated goals of this project are to: ■ Promote Marin as a great place to age. ■ Bring all ages together to understand and celebrate the social, cultural, and economic contributions of Marin’s older adults. ■ Raise community awareness of ageism affecting the opportunities that an older population brings to Marin. ■ Align and showcase collaborations between and among neighbors, businesses, government, education, and community organizations to expand opportunities for older adults. ■ Identify new strategies, programs, and resources to support and address the needs of Marin’s older population.10 The Board of Supervisors has published a 2018 calendar of events that will take place at least monthly to bring attention to these goals. Age-Friendly Communities AARP has an initiative affiliated with WHO with the same objective of identifying age-friendly communities. Marin County has an age-friendly planning committee aimed at guiding cities and towns through the process. Currently, five communities in Marin have received the Age-Friendly designation from both WHO and AARP: Sausalito (2013), Corte Madera (2015), Fairfax (2015), San Rafael (2017), and Novato (2017). Mill Valley, Larkspur, San Anselmo, Tiburon, and the district of Tam Valley are currently working toward this designation. 10 “Year of the Older Adult.” Marin County Board of Supervisors. Programs for Elders Provided by Nonprofits Homeward Bound Homeward Bound of Marin is the primary provider of Marin County homeless shelters and services for homeless families and individuals. Homeward Bound also has a program that is currently providing permanent supportive housing to 60 homeless seniors (62+) in Novato11 and eight in Mill Valley. Another program, which will serve an additional 11 homeless seniors, has passed the first stages of an approval process in Larkspur. The residents in the new program will be referred by the Marin Housing Authority from a list of seniors eligible for “housing choice”, also called Section 8, subsidies that allow them to pay 30% of their income in rent.12 Marin Villages The “Village” concept, born in Boston in 2001, is designed to give elders the ability to continue living at home by providing basic services, such as transportation and assistance with home maintenance, as well as providing social, cultural, and educational opportunities in the community. In response to a 2007 Grand Jury Report on aging in Marin, Marin Villages was formed as a nonprofit umbrella for individual “Villages” in the County. Currently, Homestead Valley, Mill Valley, San Rafael, Novato, Ross Valley, Tiburon Peninsula, and Twin Cities participate in Marin Villages, and Sausalito Village operates independently.13 Members pay a modest annual fee and can request services as needed. Volunteers are vetted and sign up for services they would like to provide. An efficient online dashboard coordinates requests with volunteers. Many participants are both members and volunteers who can provide and receive services. “Villages” are growing and changing with the needs of the community and are a vital part of the age-friendly movement. 11 “Warner Creek Senior Housing.” Eden Housing. 12 “Larkspur Partnership Offers Senior Housing.” Homeward Bound of Marin. 13 “Welcome to Marin Villages.” Marin Villages. Whistlestop “Founded in 1954 as Marin Senior Coordinating Council, Whistlestop promotes the independence, well-being and quality of life for older adults and people living with disabilities in Marin County. Whistlestop’s Active Aging Center provides nutritious meals, educational classes, multicultural gatherings and helpful information and referral services. Whistlestop also provides special needs transportation services through Marin Access, a partnership of Whistlestop, Marin Transit and Golden Gate Transit.”14 Senior Access Senior Access provides day activity programs for elders with memory loss that benefit both the elder and the family members who care for them. Their services include: an adult day program with therapeutic exercise, art and other activities; memory screenings; and day excursions for those with early-stage memory loss. It also provides respite, support groups, and educational workshops for family caregivers.15 Alzheimer’s Association The Alzheimer’s Association of Northern California and Northern Nevada has an office in San Rafael that provides information, education, and support groups for people with dementia, their families and caregivers. The 24/7 helpline can match the needs of dementia sufferers with various services meant to smooth the way. The Alzheimer’s Association also has a training program for professionals who work with people with dementia.16 Services for Elders Provided by the County of Marin Marin Aging and Adult Services, a division of Health and Human Services (HHS), provides an information telephone line (415-457-4636) that is answered by a person (not a recording) who can direct elders to appropriate services throughout the County. Someone is always available during regular business hours.17 Area Agency on Aging (AAA) is set up to administer federal dollars that come to the County for elder services. Most of these funds are contracted out to nonprofits in the community. The AAA is the leading administrator and funder of services for persons over 60 and family caregivers in Marin County.18 Adult Protective Services (APS) provides an array of services for elders that will be discussed later under the topic of elder abuse. 14 “Welcome to Whistlestop.” whistlestop.org. 15 “Senior Access.” senioraccess.org. 16 “Alzheimer’s Association.” alz.org. 17 “Aging and Adult Services.” Marin Health & Human Services. 18 “Area Agency on Aging.” Marin Health & Human Services. First Responders Marin’s law enforcement and fire departments’ training goes beyond minimum requirements for