Marin CO Commissic Educating & Advocating July 10, 2023 Marin County Civil Grand Jury*

R1

By December 31, 2023, the Board of Supervisors should elevate the Office of Adult and Aging Services (AAS) to a division-level department within the Health and Human Services Department. The lead executive within AAS should be on a peer level with other directors within HHS as part of the HHS Executive team. (3) The recommendation requires further analysis. This recommendation is imperative and needs to be implemented as quickly as possible. While the Director of Aging and Adult Services will participate on the Health and Human Services (HHS) Executive team as of July 1, 2023, this position does not report to the Director of HHS, and AAS remains an office within the Social Services Division of HHS rather than a Division. When this new Division is instituted, there needs to be alignment about the role of this new Division across Divisions within HHS and across other County Departments. While it is anticipated that moving AAS to Division-level within HHS will entail costs, these costs need to be assessed and included in the 2023-24 HHS budget. Analysis of the fiscal impact of this restructuring and the role of this new Division should be finalized no later than September 1, 2023, with elevation to a Division-level status within HHS by no later than December 31, 2023. Additionally, by June 30, 2024, AAS and HHS need to determine how to address inclusion of people with disabilities within the scope of the new Division of Aging and Adult Services. If, during the analysis, HHS is unable to elevate Aging and Adult Services to a Division level with a seat on the Executive Team, then the Board of Supervisors (BOS) should create a new Department of Aging and Disability Services. If a new Department is created, then the implementation of that new Department should be no later than July 1, 2024, to allow time to determine costs and structure for the 2024-25 budget process. (The recommendation requires further analysis with an explanation and the scope and parameters of an analysis or study, and a timeframe 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 timeframe shall not exceed six months from the date of publication of the grand jury report.)

R2

By November 30, 2023, the Board of Supervisors should finish reviewing and then formally approve the IAS Study accepted at the February 7, 2023, Board of Supervisors meeting. North San Pedro Road • Suite 1023, San Rafael, CA 94903 • Tel: 415. 473.7118 • Fax: 415.473.7042 à .. . " Marin Civil Grand Jury Recommendations (2) The recommendation has not yet been implemented. The Marin County Commission on Aging will request that this be on a BOS agenda by no later than November 1, 2023. The intent is to approve the IAS Study and support the recommendations in the Study. (The recommendation has not yet been implemented, but will be implemented in the future, with a timeframe for implementation.)

R3

During the FY25 budget preparation cycle, the Board of Supervisors should direct AAS and HHS to prepare a larger AAS FY25 budget consistent with the IAS Study to be ready for implementation during the FY25 budget year. (2) The recommendation has not yet been implemented but will be implemented in the time frame noted in this recommendation by HHS with strong input by the AAS Division and the Marin County Commission on Aging. (The recommendation has not yet been implemented, but will be implemented in the future, with a timeframe for implementation.)

R4

By December 31, 2023, the Board of Supervisors should direct HHS or AAS - as appropriate - to begin the design of a multilingual electronic "doorway" or portal for older residents and family members through which to access information regarding County services from a single point of entry, with initial design, operational goals and a preliminary budget defined. (2) The recommendation has not yet been implemented but will be implemented by AAS, with staffing support by HHS, in the time frame noted in this recommendation. The development and design of this multilingual "doorway" will begin no later than December 31, 2023, with recommendation for implementation in FY 25. This "doorway" needs to support multi-lingual staff, more in-person hours for drop-in appointments, multiple locations, and up-to-date resource information. This "doorway" will build upon and expand the current information and assistance line (415-473-INFO) and the One Door website. (The recommendation has not yet been implemented, but will be implemented in the future, with a timeframe for implementation.)

R5

By December 31, 2023, the Board of Supervisors should direct HHS or AAS - as appropriate - to begin the design of a comprehensive database-driven communication system. This should enable Older Adult County residents and/or family members to register and opt-in to receive information on aging services, and receive calls or texts as needed for natural disaster notification, wellness checks, etc. (3) The recommendation requires further analysis. Several different approaches may be needed to develop a registry of older adults and family members to receive calls/texts for natural disasters, wellness checks, and information on aging services. However, a registry will also require constant updating and monitoring. Therefore, analysis of the strengths, weaknesses, and costs of such a system is needed. Also, regarding disaster notification and wellness checks, this recommendation may not be solely an HHS effort. It may be a multi-department/agency effort including the Office of Emergency Services, Police, Fire, Sheriff, and non-profits such as Marin Center for Independent Living (MCIL) and Marin Villages. Further analysis is needed by AAS staff, and this planning and design effort should begin by December 31, 2023. North San Pedro Road • Suite 1023, San Rafael, CA 94903 • Tel: 415. 473.7118 • Fax: 415.473.7042 . . Marin Civil Grand Jury Recommendations (The recommendation requires further analysis with an explanation and the scope and parameters of an analysis or study, and a timeframe 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 timeframe shall not exceed six months from the date of publication of the grand jury report.)

R6

By December 31, 2023, the Board of Supervisors should direct HHS or AAS to create an ombudsman position within AAS to assist CBOs and non-profits which provide aging services (e.g., West Marin Senior Services, Vivalon, etc.) in submitting funding and/or services requests. (3) The recommendation requires further analysis. While this recommendation is innovative, it needs further exploration. Potentially, it can help more non-profits seek funding and bring new opportunities to increase services for older adults and people with disabilities and their families. This initiative should include smaller, less-resourced local and niche providers of unique services. This recommendation needs to be further explored by AAS with staff recommendations for the 2024-25 budget year. (The recommendation requires further analysis with an explanation and the scope and parameters of an analysis or study, and a timeframe 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 timeframe shall not exceed six months from the date of publication of the grand jury report.)

R7

By December 31, 2023, the Board of Supervisors should direct HHS or AAS - as appropriate - to fund a "travel stipend" based on the mileage to/from San Rafael County offices to client location based on the applicable IRS mileage rate for IHSS caregivers providing services in rural areas. (3) The recommendation requires further analysis. This recommendation is important and should be relatively easy to analyze and implement. The analysis and eligibility requirements should include the county fiscal office, Marin In Home Supportive Services (IHSS) Public Authority, and AAS and be completed by no later than December 31, 2023. (The recommendation requires further analysis with an explanation and the scope and parameters of an analysis or study, and a timeframe 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 timeframe shall not exceed six months from the date of publication of the grand jury report.) 10 North San Pedro Road • Suite 1023, San Rafael, CA 94903 • Tel: 415. 473.7118 • Fax: 415.473.7042