The Commission on Affordable Housing and Health Facility
Needs for Seniors in the 21st Century
January 14th, 2002
Alliance for Human Services
MS. ALEXANDRIA DOUGLAS: And I apologize. My earlier speaking engagement ran longer than expected.
I'm Alexandra Douglas. I'm the Executive Director of an entity in Miami-Dade County that was recently formed called the Alliance for Human Services. The Board of Directors is comprised of all of the major funders, public and private, state and county, local, of health and social services in Dade County.
Our mission is to put together a comprehensive health and social services plan for Dade County, and this plan, once approved by the Board of Directors, becomes the blueprint for allocating resources, for developing quality improvement projects, including cross-system collaboration, coordinated funding.
We're looking into the issues of revenue-maximization because our community has really never looked at how to combine our public and private funds to draw down the match that we might need.
As you know, some of the challenges in Florida relate to the fact that we don't have an income tax and we've been hit very, very hard in the health and social services community by the events of September 11th.
So while I'm a lifelong planner for health and social services, I guess I'd say to you it becomes even more crucial to us that we develop a plan that is data-driven, it's researched-based, that identifies we might be able more effectively coordinate our existing resources. There's simply, you know, no way we can afford any waste.
So this is our basic framework. In the notion of how do we conceive such a plan, it was our feeling that we would really step away from all the different categorical funding streams.
We wanted to make sure this plan was driven by what people need, not within the silos of all the different titles of all the different pieces of legislation.
It's called a Master Plan because there's an awful lot of planning that already takes place. But as you may well know, a lot of that is within the, you know, the confines -- my Board Chair likes to call them to "the silos" of who's already engaged in that particular issue, that particular funding stream.
So the Alliance for Human Services decided we would come up with a notion of how real people actually access services. Some you really need right at home in your neighborhood, in your community; and some you really can access at the community-wide level.
The notion of clusters was that at different stages in one's life, you may have to access a different array of service, okay.
We have the children, youth and families cluster. We have an elders cluster. We have a children and adults with disabilities, refugees, immigrants and new entrants, who comprise a continuous challenge to our community to be able to serve effectively.
And then an area that we called Special Needs Populations, which was in the first year of our three year planning process. This represented an effort to really take a look at the populations who we might say are the most demanding across every system.
We put substance abuse, mental health, homelessness, victims of domestic violence, rape and sexual assault in this one area and had a first cluster meeting that involved a lot of cross system planning just within that entity.
In this year two, which my Board is about to review our recommendations for year two, we've added a health cluster. We've done a Special Needs Population for ex-offenders returning to our community.
And we've also looked at the issues of rural service delivery, because while we're a very, very metropolitan community, some of the challenges of serving folks in the rural south Dade area are just extraordinary, because most of our services are still pretty much metropolitan, pretty city-based.
So given that as a construct, we have the elders cluster, but we didn't want an elders silo either, you know. The notion was that we would try to identify the continuum of care at various stages in the life of the elders, and we really in a sense came up with two different continuum.
One was for aging in place, which I think is pretty much the focus of this Commission hearing, that we know there's an array of services that have to do with supporting people to live with dignity in their own homes for as long as possible.
Our goals were to try to support the aging in place to assist elders to maintain independent living and their quality of life and to protect or mitigate the impact of any crisis events; to provide a coordinated support system across all of our health and social services providers.
Our second continuum really focused on the frail elders, those folks who are now home-bound and who are going to require a high quality of care, coordination between the health and social services delivery systems. And in the event of a crisis, should there be adult protective, domestic violence, hospitalization, that there's an array of services to support not only that person who's homebound, bu the care giver.
In the issue of care giver supports, we noted that a number of the elderly in our community are caring for their grandchildren and that should be a factor in our Master Plan. So again, you can see the interaction between clusters; in this case, the children, youth and families and the elders cluster.
And we also noted that many of the elderly are caring for adult children who are disabled, which also calls on tremendous, tremendous amount of resources -- well, a need for it, developing resources because that has not been a strength, i.e., the care giver support area for our community.
In the area of the frail elders, we looked at:
- How do we maintain optimum health and safety for those who are no longer able to live independently?
- How do we maintain health and safety of adults with medical or cognitive deficits? and
- How do we overall improve the quality of care?
There's been a tremendous concern about home care in our community, not just the waiting lists, which are terrible. But just the concern about constant turnover there, the lack of training, the lack of a living wage.
We have a tremendous number of folks who are providing health care -- home care who themselves have no health care. And so these are great issues and how does that affect the frail, elder who is homebound? So that gives you a broad sense of our mission for elder services.
We tried to define the array of services and because we're supposed to target funding across all of the funders, what would be the core services that are essential to the best of --
MR. JAMES INTRONE: We'll have copies of that?
MS. ALEXANDRIA DOUGLAS: If you'd like that, sure.
MR. JAMES INTRONE: Yes, please.
MS. ALEXANDRA DOUGLAS: I've brought some extra handouts. What we were basically looking at is absolutely essential was on the aging in place side, that we need to address public and specialized transportation.
Both of these are a great challenge for people living independently or attempting to in our community.
Issues of housing and domicile. Not only was there a concern about affordable housing -- a great, great issue, and having resources for home repairs was a great concern.
Weatherization: Should there be a hurricane, who's going to help that elderly homebound person to make sure that their home is ready.
Issues of set-asides and our housing dollars currently have no particular set-aside for the elderly or disabled, and we were going to propose a 15 percent set-aside there.
In our special needs cluster where we addressed homelessness, we've talked about the concern that our affordable housing really does not go to the most vulnerable population. We would like to have a set-aside or a target of 30 percent of the affordable housing units being set aside for people under 30 percent of poverty. It currently goes up to 60 percent of poverty in our state.
MR. JAMES INTRONE: Okay. If you could sort of make that available to us. Then I want to just -- we're running out of time and I want to get the questions.
MS. ALEXANDRIA DOUGLAS: Okay. Well, the last thing I wanted to be sure to stress is that apart from adult protective services, we see a great concern -- and this is the focus of our year two plan for elders -- for cross system collaboration as kind of an early intervention and support system.
There's so many seniors, with or without care givers frankly, who are at some degree of risk. And we need to create a coordinated neighborhood-based support system for people who are living in their own homes, whether the issues are mental health, substance abuse, domestic violence.
We learned that our fire safety people respond to thousands and thousands of calls from the elderly; talk about cross system. And these are cases where someone really needs hands-on support to help deal with the crisis or to avoid the crisis in the first instance.
So I wanted to be sure you heard the flavor of what can happen if you actually promote cross system planning.