The meeting and mayor and jim smith. Can you call item one. Clerk motion verifying a careless match, llc doing business under the dark horse. The issuance of type 87 general Liquor Licence. I dont see is there anyone from the Police Department that is going to present on this item . No. We have someone from oawd . Please feel free to come forward, yes. Well here from superior safai. I wanted to be here for this licence because its the first time in our citys history were issuing this type of licence, it was created in the past year, this is called a type 87 licence, its very similar, you have heard me at the board of superiors talk about the maximum of five right now, one is pretty accessible and real because people are able to go out to dinner and have full alcohol and wine. The type 47 licences, its a restaurant that has the ability to have a full alcohol menu. And in a lot of businesses, particularly restaurants, it is a life saver to have that ability. It helps with the margins and with the success and often is an indicator of a strong restaurant. Many of the economically depressed parts of San Francisco are not served by type 47 licences and often what happens, type 47 are a commodity and sold on the often market for 3 or 400,000. As a starting Small Business restaurant owner, its usually a barrier to access that. And even if they are located in an area they can move and theyre mobile. If you look at a map of San Francisco, the vast majority of type 47 licences are located in the downtown area or closer to hotels, more of the tourist locations in the city. But when you go to the commercial quarters like the Excelsior Outer Mission or ocean avenue, areas with less restaurants, you see less of these if any at all. This program was developed to be an economic generator and they have to remain in the commercial corridors theyre designated for. Over the next six years there will be five transferrable type 87 licences that will be sold for only 13,000. So think 400,000 to 13,000 for an existing restaurant or someone trying to get into the business, its like hitting the lottery. So today im proud to say one of our restaurants out in the Excelsior Outer Mission, the dark horse is going to be accepting this licence. We have been encouraging them and supporting them and were really excited about the opportunity. So we ask for your full support of this and we have a neighbor to come talk about this from the office of work force development. Thank you. Good afternoon chair ronen and members of the committee. Thank you superior safai for really fully listing the policy goals behind the program. Im going to talk briefly about the specific structure of the state resolution in front of you. Under the state law before an applicant can submit a full application for a type 87 neighborhood restricted Liquor Licence, they have to do preapplication community outreach. That is unique to this licence and all the stakeholders thought it was important since they are for neighborhood serving businesses, they though have the extra touch with the neighborhood itself. Prior to submitting a full application to the abc, the applicant needs to sign off on an additional form that they have done the outreach. They have to hold at least one Community Meeting at their premises or within a mile of the premises, 14 days before, they have to send out a mailer to all residents within 500 feet of the establishment and neighborhood groups on the Department List and Police Department as well. Following the completion of the outreach it has to be certified by the board of supervisors, thats whats in front of you. If this resolution moves forward, the dark horse will sign off and submit their full application. Thats all i have unless there are technical questions. What department is in charge of the permits for that, is it planning . Is it cph . All Liquor Licence regulation is done by the California Department of alcoholic beverage control. Should this move forward, it would get referred to planning and through the regular process. But liquor licencing is done at the state level, that is one of the challenges in adopting reforms, needing to go to the state to make it happen. So the type 87 licence, is it a licence that has to be renewed annually, every five years. Tell me a little about that. Sure. Theres an annual fee. Its not like theres an annual renewal, formal renewal process. But the idea of the licences being non transferrable, part of that means should a business go out of business with the licence, it will get cancelled but then abc can issue a new one that qualifies under the existing program. Thats the renewable part of the program. Thank you. Chair, i want to add one more thing, im really excited about not just the business itself but the proprietors, they have been active in the Community Since opening the business, this is an enhancement to the business, they have formed the excelsior outer Merchants Association and our movie night that we funded last year. Widely successful. They have engaged in fundraisers supporting our schools and our local free clinic. Theyre active members of the community. I couldnt think of a better group or business to be one of the first recipients of this. Theyre available in your district, supervisor yee in yours. Sorry it doesnt say gary. Well have to talk to okay. Thank you. And would you like to present from the business . Good afternoon. Im one of the owners of the dark horse inn. 942 geneva avenue. We did complete the required steps of sending out the letter. It was sent out november 9th. Excuse me. The meeting was held november 24th. Attendance, which is unfortunately typical for the neighborhood was small, but fully supportive of our plan. We had a subsequent meeting with sfpd, i believe it was inspector i just have forgotten her name. The permitting department and they were supportive as well once we presented our plan. We plan to continue running our business the way we have run it for the past six years. We serve largely locally sourced food, all housemade. Our beer is local craft beer, our wines are Small Vineyards from california and a few from france and we plan to do the same with the liquor. We plan to start with a small selection and cocktails that are kind of geared toward pairing with our foods. Price points will remain the same for the neighborhood. Accessible but not so low that it inspires any kind of abuse. Meaning pretty much we dont want 3 shots of cheap liquor. We have a family environment and we want to keep it that way. So basically this is just to serve as an extension of our Current Business plan. There would be no major changes as far as that. And thus far everybody has been incredibly supportive and we dont have any negative feedback to date. Knock on wood. We ask for your support in this as well. Thank you. Is there any public item on this Public Comment on this item . If there is, now is the time. Seeing none, Public Comment is closed. If theres no more comment, i wanted to thank those work ing with the business to take advantage of the opportunity, its a very unique one. I know its not easy to get all the items in on time. I want to say congratulations for getting the application on time. I know were going to have a meeting first thing in january to consider the other businesses that are going to take advantage of the unique opportunity. I know you have been advocating for this for quite some time. I wanted to say congratulations for seeing it through and i believe it will really help with revitalization of some of the corridors that need a little help. Im excited about it. And colleagues, i wanted to ask if we can entertain a motion to refer this item to the full board as a Committee Report for the january 12th meeting if thats okay december 12th . Yes. I have one question chair if you dont mind. Normally when we see the Liquor Licence come before the committee, we have a report from the Police Department and i think we asked for Sergeant George today, with this type of licence, will that not be necessary anymore . This is a preapplication process today. I think youre referring to the public convenience necessity process, which for restaurant licences, for type 47 licences, those dont come to the board, theyre handled by abc. Similar to that, the process would be addressed by the abc. The public needs for necessity is a type 48 before the board, the 21 liquor stores, bars, other things. Yeah, so the answer is you wouldnt hear the public convenience necessity for this licence consistent with the other licences but theres more process after this to make sure sfpd and everybody is involved. Yeah. Okay. Great. So ill make the motion to refer this to the full board for consideration on december 12, 2017. I second that. Without objection that motion passes. Can i receive a motion to send this item with a positive recommendation. I make the motion. Without objection that motion passes. Thank you. Mr. Clerk, can you call item two . Clerk a hearing to consider the state of institutional housing, particularly assisted living with small beds for seniors in the city and county of San Francisco. Supervisor would you like to make some opening comments. Thank you for joining me today in this important topic affecting our citys seniors. The critical shortage of board and care homes, that is not meaning the housing deeds of our increasing population of San Francisco. As we are all familiar, the issue of housing in general and specifically Affordable Housing is a hot button topic in San Francisco in the bay area. However, the topic of housing for seniors is often side lined. I just want to give you some basic stats and what i have seen and why this issue is such a crucial issue. According to a 2016 report, city wide seniors comprise 20 of our population and over 40 of those seniors live alone. As of june 2017 when compared to neighboring counties, San Francisco had the lowest ratio of what we call residential chair facilities, beds for seniors. For every thousand people over the age of 65 in San Francisco we only have 29 beds of this sort. The counties with the highest ratios for every thousand seniors over 65, they have 48 beds in their counties. Its not quite double but it certainly is getting close to that. The lack of longterm care facilities for seniors is not just a San Francisco issue. Its regional and statewide issue. To demonstrate the gap between the average available income of seniors compared to cost of longterm care, according to a 2016 data, 16 are over 25,000 of our city seniors live below the poverty line. An income of less than 981 per month. About half of San Francisco seniors live on less than 2943 per month, about 300 of federal poverty level. Yet the average cost of what we call the rcfes, is about 45,000 per month. The Social Security reimbursement rate has not kept up with rising costs of longterm care. Unfortunately the Social Security income special benefits rate as of january 1st, 2017, is only 1,158 for an individual and in 2017, ssi facility rate is 1026 for an individual. You can see that what people are getting is way short of whats needed to house them in these rcfes. So, the unfortunately for so many people today, especially what we call the Sandwich Generation. Which i used to be part of and now im probably one of the breads on the end. Do you know what i mean by a Sandwich Generation . Youre basically in care of not only your babies and children, but youre caring for elder parents or other members of your family. Those its a hardship and i found that out 15 years ago personally. Like childcare, Senior Services are at the top of my personal priorities. Last year i cosponsored supervisor cohens proposition i, the dignity fund that passed with two thirds vote, increased funding for Senior Services. This march i held a hearing on the needs of the gaps in Senior Services city wide and how the dignity funds would be administered. Despite the steps to increased and enhanced services, San Francisco is still falling way behind when it comes to senior Residential Care. Housing is a healthcare issue. Our seniors have contributed so much to our citys rich political cultural and economic development. We cant forget our seniors when it comes to discussing housing needs. We are standing on the shoulders of our elders and their contributions and they deserve our respect and attention. I want to thank my colleague supervisor safai and ronen for their hearing last week and their continued advocacy on behalf of the families and workers in light of the closing of saint lukes subacute units. The closing of those and the alzheimers center are stark examples of how each point in the whole continuum of care affects each other. The longterm care crisis is further because of the cost of living and fixed incomes of seniors. So while we may not be able to discuss each of the issues at length today, given my conversations with many experts, stakeholders and community members, there are Feasible Solutions we can take action on. As written in the hospital counsels post acute Care Collaborative 2017 draft report, obtaining and expanding Residential Care facilities for the elderly, also known as board and home cares or assisted living is identified as one of three major recommended solutions. These are often familyrun businesses, six bed facilities that provide assistance for tasks such as dressing, bathing and eating. Rcfes are a type of institutional housing in the community. In the past two years, nine of these facilities have already closed. And unless we find ways to help retain and incentive these facilities to operate, the shortage will continue to get worse. Due to the shortage of facilities and beds, too many seniors are being sent out of the counties. I dont know if you know this, its one of the things i have personally felt it, 20 years ago when my mother couldnt live in the home again in her home and needed more assistance, i was able to find something in the city. She was on ssi and then about 10 years ago, this is only a 10year gap. I was taking care of my aunt which was the same issue, trying to take care of her as long as we could in the home which is the best thing for seniors but you realize you cant do it at some point. When we tried to find something for her, there was nothing in the city for her. She had to go out of the county. She was fortunate that people like myself and my other family members are mobile enough or have cars and transportation and could get to her and make sure we kept on supporting her, whereas a lot of these individuals, their family members might not be around for one thing. If they are, they may not have resources. Most of their support network are people who are generally other seniors in the neighborhood and theyre not going to be able to go out of town to give her the right support. So this is such an important topic. Im so glad that the what is it the Hospital Foundation started thinking about this many years ago and have come up with the draft report. It was timely for me, for someone who didnt understand the system, i read the report, it was very educational. If you havent seen the report, when it gets into the final report, i hope everyone gets a chance to read it. All of us in the Community Need to really join hands and find solutions for this population. So i wants to theres going to be a few presenters in this, in the report and they will be Senior HealthProgram Planner from the department of Public Health and sydney cofman, department of aging. And Current CouncilVice President of hospitals. Would you like to come up . Good afternoon supervisors, with the department of Public Health. As supervisor yee mentioned, ill share this presentation with department of aging and hospital counsel of northern and Southern California. So, Residential Care facilities for the elderly provide an important level of care in between adults who can live safely at home and adults who need 24 7 medical care. We know that the as people age, the majority of people want to remain in homes, in their homes which is referred to as aging in place. As adults age, they may require a range of services and supports called longterm care. So Residential Care facilities provide longterm care for people who can no longer live safely at home and for patients or persons who need 24 7 supervision but dont require 24 7 medical care. I want to take a second to define terms we commonly use when talking about longterm care. So longterm care is defined as a variety of services that help meet medical and non medical needs of people with chronic illness or disability who cant care for themselves. These services can be provided at home or a facility. Post acute care is generally a range of medical services that support recovery from illness, following a hospitalization and can include Skilled Nursing services or rehabilitation services. Residential care facilities for the elderly are licensed by the California Department of social services and known as assisted living, or board and care homes. Typically board and care are smaller facilities with six or fewer beds and often Single Family homes in residential neighborhoods. Assisted living facilities are larger apartment style buildings and these facilities provide a range of services to help individuals support their activities of daily living. Skilled nursing facilities provide rehabilitation and assistance with activities of daily living and to define activities of daily living, these are the tasks we do every day, dressing, bathing, toileting, eating and transferring and grooming. So as i mentioned, longterm care is a provision of both medical and non medical services that can meet an individuals needs, so someone who is turning age 65 today has almost a 70 chance of needing some type of longterm Care Services in the remaining years. Some of the medical services that can be provided are listed here on the left side of the slide, i have already referenced many of them. I wont read through them. Some of the non medical services are on the right side of the slide, activities of daily living, meal delivery, transportation services, home repairs and modifications and financial and legal services. So longterm care can be provided in the home or in a facility, and this slide shows the different types of services by their location. So i wont read through all of this, but i wanted to note that someone can receive both medical and non medical services at home, but in general those are provided on a limited parttime basis. And the second thing to note, when we look at facility based care, Residential Care facilities, is that Residential Care facilities provide non medical care and Skilled Nursing facilities have medical and non medical care. So, also according to national data, about 37 of seniors are expected to receive care in a facility such as a Skilled Nursing facility or assisted living facility at some point in their lives for an average of one year. How is this care paid for . This figure shows the level of care, the duration of care needed and different pair Sources Associated with this. Starting at the top, if someone needs medical care for a short period of time. You can see most insurance plans can cover this. However, if they need longterm care, most people pay out of pocket unless they qualify for medical which is an Insurance Program for low income individuals. If someone is receiving care in a Residential Care facility, most of the residents pay out of pocket. Individuals eligible for Social Security can get a benefit that can be used to stay in a Residential Care facility, however there are very few facilities that will accept that benefit alone. So, we know that most patients who do receive care or who can discharge from a hospital to a sniff might be able to be supported in lower levels of care. So the post acute Care Collaborative conducted a point in time survey earlier this year to understand how many patients are waiting in acute Care Hospitals who needed placement in lower levels of care. What that survey found, about 50 of patients waiting to be placed in Skilled Nursing facilities primarily needed help with assistance of activities of daily living. Additionally about 24 of patients could be supported in lower levels of care. Meaning not a sniff. And so while many patients could be supported in a facility like a Residential Care facility, we know many patients wait for a Skilled Nursing facility because its covered by insurance. If you look at this from a cost perspective, it is significantly more expensive for someone to be in a Skilled Nursing facility than Residential Care facility. So what do we know about Residential Care facilities in San Francisco . So first we know that our senior population is growing. At the same time, this graph on the left indicates we have seen a reduction in Residential Care facilities in the past five years. It looks like the bed supply has remained relatively stable and the smaller and more are not as reliable. The table on the right shows the facilities we have on the bed side. About 60 are smaller facilities with 14 or fewer beds and recently the department of aging conducted a survey of our facilities and found there were about 93 occupied. With that im going to hand it to cindy to talk about some of the challenges. Thank you. Supervisors, the challenges we have seen in the residential facilities are really around accessibility. As pointed out in the previous slide, there are 19 fewer facilities in San Francisco now than in 2012. We work with many rcfes and in the conversations we have had with owners, reasons foreclosures included retirement with no interested family members to take over. The high cost of San Francisco and increased regulations making it hard for the smaller to make ends meet. And the smaller homes are closing their doors because financially its not feasible anymore. Some of the owners said their property was worth more than their business so they were opting to sell their home. The affordability of rcfes i think is the biggest barrier to low and middle income residents of San Francisco. 52,000 a year is the average with no type of assistance, making it essentially out of reach for any of the middle or low income families. Some longterm Care Insurance policies will cover a portion of rcfes but it depends on the policies and the number of people who can afford this type of insurance. And finally the limitations associated with facilities who have people with behavior or cognitive challenges, includes affordability and expertise. In order to work with the population, it takes additional staffing to ensure the residents are safe and staff who have been trained to work with this population in an effective way. There are challenges in finding and training the staff that are needed and then paying them a wage that compensates them for the work theyre actually doing. In addition to the high cost of rcfes, most of us want to remain in our homes. For the department of aging and Adult Services, this the services we support are to achieve these goals. Only Community Based care and Wraparound Services are essential to help adults maintain independence, prevent institutional care and support aging in place. The department of aging and Adult Services supports programs that bridge the gap between acute care pointed out in some of the slides and Community Based care settings through programs that include home Care Services, in our department includes in home supported services, a medical benefit offering personal care for people with functional impairments, meet criteria and can live in their own homes. Another program is supportive home, targeting middle income populations with financial and functional needs ineligible for iihs, Community Living fund or other wavered programs. Parameters include a sliding scale, an ability to pay as well as a cap of 15 hours per week. Funding for this pilot has been made possible by an add back from the board of supervisors. Case management which assists people in accessing coordinating needed services, home delivered meals, home delivered groceries, transportation and caregiver support are key items in helping people stay in their homes. The Community Living fund, the last item on the slide is slightly different. I would like to talk more about that program. This focuses on people with the next level of need, who want to live in the community and are able to do so, the supports are intensive Case Management and Purchase Services or items to help them remain in the community. The Community Living fund is considered the payer of last resort in the purchase of these goods. Just to give you an idea of the Community Living fund, it has a three pronged approach, one is transferring people from sniff back into the community and diverting people in hospitals or short term rehab stays to prevent them from longterm stays. As well as the community from going into longterm sniffs as well, an example of the community diverting someone in the community would be someone with dementia that needs 24hour care, they cant afford an rcfe and have to go into a sniff. Those are the populations that cls is trying to serve. This has been a very successful model in San Francisco, over 80 of the clients were stabilized in the community, which means they did not end up in laguna honda. They have purchased rcfe slots since 2007. During that time, the program has spent over 4 million on board and care patches on behalf of 67 clients. The Program Supports about 30 clients a year with an average subsidy of 2,400 a month. We have seen that patch grow rapidly in recent years. In 2014 it was closer to 2,000 a month. So i bring this up, and we have always thought there was a cost savings, it was better for the participants who were participating in cls but we couldnt show the cost savings because we didnt have all the data points. We contract out with the institute on aging, they took the program and replicated it by working with a county health plan. It is in essence the same program. The county organized Health System and so they were able to gather all the data points that includes hospitalizations, sniff utilization, Durable Medical Equipment and alike. They have shown in the tracking for the past three years, the drum roll please, a 50 per member per month cost savings and 40 reduction in total longterm care spends over the past three years. What theyre comparing to is preenrollment cost and utilization to the post enrollment cost and utilization. Which has shown improvement for the care to the clients as well as savings to the health plan. In addition to that, they have shown a 33 reduction in overall healthcare costs. Currently they plan to replicate this program in santa clara starting in 2018. All of these services allow people to remain living in the community for as long as possible while maintaining their cal quality of life. We recognize some people need a higher level of care. We believe it should be delivered in the least restrictive environment. There are many longterm care needs for the individuals, to speak of the post collaborative, i want to introduce the regional Vice President of the counsel of northern and Southern California hospitals. Supervisor yee, thank you for calling the hearing. And it was an honor to work for the city for 14 years and work with great Public Servants like the ones behind me. As was mentioned and i want to give a bit of background before getting to the recommendations that the post acute Care Collaborative put together. In february 2016, the department of Public Health engaged in a post acute care project report. And that was to provide an assessment of the post acute care landscape in the city and county of San Francisco. Identifying the high demand and supply tension, that report is robust, a lot of data and a lot of experts were on it and it made a few recommendations to the commission they adopted, one, ensure were meeting the high demand for the sniff bed situation in San Francisco and increase home and Community Based options and really something this committee is interested in right now, important aging in place options. So we engaged in that endeavor earlier this year, the post acute Care Collaborative. We were pleased that the countys department of transition, the cochair, it was a collection of Public People and private Hospital Leaders and healthcare leaders rolling up their sleeves, this is an Incredible Group of people, trying to zero in on its mission, which was to identify implementble, financially Sustainable Solutions to the post acute Care Challenge for high risk individuals in the city and county of San Francisco. Can you see this slide . Is it up or thank you. Referenced the collaborative did a lot of in time surveys, looking at the data, did a great survey, a deliberative data driven effort and we identified two population groups we thought we should focus on, one cognitively impaired and two behaviorally challenged. We thought we should come up with solutions applicable to each of those subpopulations is and thats what we did. You see that before you in its draft form. A standardize post acute care assessment tool, so all the hospitals can speak the same language and have the same assessment terminology. A great recommendation. A roving team to place patients in the right kind of care and access to the Residential Care facilities for elderly and independent housing with Wraparound Services. That has two elements, one, ensuring the partnership to increase these kinds of fundings and then secondly, advocate with the Mayors Office that his Housing Initiative include this element. Thank you. Thank you for your presentations. Any questions. I would like to maybe have Public Comment at this time. So im going to call up some names who have signed up for Public Comments. You have two minutes to speak, state your name and so forth, that would be great. Ken barns, i think. Benson nadel, anne lugwig. Go ahead and line up to that side. To my left or your right. My name is ken barns. Im a physician who worked at saint lukes for over 30 years, a hospice physician for eight years. I worked in rcfes, Skilled Nursing facilities, including saint lukes, visited patients in socalled memory units and for the past several years working for healthcare housing and jobs for justice as we fight for the right for good healthcare for all of San Francisco. As has been made abundantly claire, San Francisco is in the midst of a post acute care crisis, actually an emergency, in the aging community and those particularly who are most frail and vulnerable. This is about Human Dignity and caring for our elderly in a compassionate and respectful manner. Were at a point that cries out for action, not more study. There needs to be a plan to rapidly identify sniff and rcfe faults. We urge you to regulate solutions to give incentives of Residential Care to open new facilities and maintain a High Standard of training. Begin looking for land where they can be built, already existing buildingss to house new beds. And Dementia Care has to be a high priority. The program must remain open and not closed. Please dont lose sight of what we need to do on a deeper level. Unconditional love and compassion in our dangerously violent world. Our task is to genuinely care for others wellbeing and demonstrate the essential will for good. I have two documents here that represent thinking of San Francisco for healthcare housing jobs and justice and we wanted to share it with you. Thank you. Thank you very much. Supervisors yee and everyone, thank you for listening to this very important program. I have left copies of the list of rcfes, the Demographic Data for each district and Additional Information if you wish to see it. I have also filed my testimony online. I run the unbutton program in San Francisco, i have been doing the program for like 30 years. I have a look back and a look forward in terms of forecasting a bleak picture for those individuals who might need around the clock care and supervision. I was on the discharging Planning Task force, dementia expert panel and longterm care coordinating counsel and this m Ombudsman Program is mentioned in the local ordinance. We get grievances and abuse reports on behalf of everyone in longterm care facilities from mandated reporters. We have been going into small board and care homes and large assisted living facilities and Skilled Nursing facilities. I cant possibly cover everything in a minute and a half. Was is happening in the system, the hospitals are now using Community BasedSkilled Nursing for medicare utilization and the Skilled Nursing facilities are pushing out those individuals eligible for medical into unknown destinations. The hospital is determining the policy for every constituent in San Francisco by being pushed out because the need to keep the medicare beds open. The destination would be naturally you step down unit for Residential Care but there are not any in the market place. Consequently, i want to ask the supervisors if the hospital needs are the driving force for creating longterm care policy based on forecasting and not reaction. Thank you. Mr. Benson, you dropped something. Next speaker. Good afternoon, im anne ludwig. My husband, a 79yearold advanced runner is now a victim of advanced alzheimers. What can family members do when this kind of disaster occurs. Three years ago it was impossible for carl to live and be cared for at home, we were so fortunate to move him to swindeles. They have extraordinary loving and expert caregivers, many of whom have worked there most of the 20 years of existence. They are our family now. The hospital counsel report recommends this type of care but the largest member is shutting down the facility, that should be expanded to meet a growing need. Some of us were told it would be moved to another campus when the current building is sold and demolished, but medicare and medical dont pay for this kind of care and suter decided were not profitable enough. Theyre letting it widther by atrition, shutting us down next year. We protest this decision that is wrong for our loved ones and our city. We have decided as a group, were not moving and you will hear from other members of our council. Thank you. Thank you. While the next speaker comes up, ill call a few more names. Come on up. Victoria claymen, dr. Teresa palmer. Im linda, the daughter of penny who is 103 yearsold. She has adjusted and being well cared for at the center. She sometimes sings, laughs with the staff. She has sun downers syndrome. Her nights and days are mixed up. Staff share meals with her so shes not alone at night. I am here to plea with you to not close the facility. I look at other facilities i cannot afford. At this time, my mother spent down her investment, granted a subsidy grant for 50 a year and a half ago. I am paying less than 3,000 a month, i am paying my moms care with her Social Security check and my pension now. I applied for medical, veterans, ssi, i have been approved for medical but it doesnt pay for assisted living. Im here for your help to find solutions to solve the situation and future problems with memory care, alzheimers care for assistance where its privately owned. Where will we go when we are in the situation . Will we be tossed in the street like homeless to care for ourselves since there will be no place to care for us. And become a problem for our family. Thank you. Thank you. I would like to thank you all for being here and especially thank norman yee, my supervisor. My mother was very angry, she didnt know she was losing her mind. Im a flight attendant. I cant take care of her. She needs 24hour supervision. I called around to many of the small homes, i called one and they said oh, will your mother watch tv . No, my mother wanders around. They said were a small facility and we need to keep her in her room to watch tv. At swindels, they have people who love the patient and families. We have at least six neuro science schools in San Francisco. They should be studying these models, they should be a part we get two interns each time and they are excited because there is trauma therapy, they sing together, i saw one uncommunicative person help my mother when she was trying to get up. These people are a family, they need to stop getting ready to close down the units, they dont paint the walls, the staff is worried because they love their patients and we love them. Please stop this unit from closing. Help cpmc, expand it for the city of San Francisco. Thank you so much. Thank you. Thank you all for the opportunity to speak. My name is victoria cleamen, my mother has been a resident at the residential memory care for nearly two years. I wish you could have known my mom, three and a half years ago before she had a massive stroke in the right frontal lobe of her brain. She was brilliant, adventurous, vital and engaged. Before coming to the facility she had many cognitive traumas at other facilities. I want to ask you to hold the person you love most in the world in your minds eye. Imagine they cant speak, walk, give you a kiss or share a hug. Imagine you are no longer able to care for them at home and your finances are rapidly being devastated. Then all of a sudden, theres an answer to a prayer and called swindels residential. It has given my mom unparallel love and care by the staff who are angels. Lets realize how important it is to do the right thing. The inequality of races in our past and present is horrible. The treatment of our elderly currently is. Do the right thing. Do not allowed loved ones and future elderly citizens of San Francisco to be pushed aside, the ability to maintain dignity and their lives is in your hands. Thank you for your time, attention and compassion. Were all depending on you to do the right thing. Thank you so much. Thank you. Excuse me for a second before you come up. Is it okay to allow her to come first . Yeah. I am if its allowable, i intend to speak about the people who would otherwise be eligible for admission to shelters in the city of San Francisco. Something that would have to be built. They suggested that im raising is that they one of the city shelters, not the largest one, be a senior shelter, especially Senior Center. I have raised the idea with supervisor of district six and he was very enthusiastic about it. When i raised it about maybe two years ago. I didnt have to argue or across the street about half a block away on the other side is a Senior Center for activities and lunches, and its all flat area, so people dont have to hike up a hill or cross at a guarded street. Theres actually a crossing there on the street. And thats eight street, 201 sanctuary shelter. And it does need some renovations, like the people who are residents there need an elevator to the second floor to use the laundry room, it has been used for people to go up there from the first floor, which is the womens floor. Theres a second floor for mens floor. It might be a one gender shelter, but it operates as a two gender one right now. And my name is nancy cross, and lets see, what else did i want to say. I have been working on San Francisco for about three or four years, but not publicly. I mean thank you. Thank you. Can somebody help bring her walker closer. Hi everyone on the board. Im one of the caregivers that has been at the irene swindel alzheimers unit since it opened and we have several coworkers here. We wanted to express to the board that the whole department