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Gaps in Senior Services, Yolo County

Claire Legendre-Sholl

Candidate, Master in Public Health

University of California, Davis Master of Public Health

Program

Preceptor: Sheila Allen, RN, PHN, PhD, Executive Director

Yolo Healthy Aging Alliance

Yolo County, CA

UCD Faculty Advisor: Rosemary Cress, DrPH

August 2013

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Table of Contents

Executive Summary .........................................................................................................................3

Introduction ......................................................................................................................................5

Objectives ........................................................................................................................................9

Methods............................................................................................................................................9

Results ............................................................................................................................................12

Discussion ......................................................................................................................................18

Acknowledgments..........................................................................................................................22

References ......................................................................................................................................22

Table of Abbreviations ..................................................................................................................24

Appendix A: List of Interviewees .................................................................................................24

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EXECUTIVE SUMMARY

Background: A “silver tsunami” is approaching the United States, and we are underprepared

for it. It is projected that the number of older adults, age 65 years and older, in the United States

will more then double in size from 40 million in 2010 to 88.5 million by the year 2050. This

growing population of seniors will continue to put a strain on already limited aging services. It is

important that effective aging services exist and are available in order for the older population to

experience a healthy and independent life.

The elderly population of Yolo County, California is following the aging trends of the

United States. Yolo Healthy Aging Alliance (YHAA) is a new community-based non-profit

organization, whose goal is to serve as the unified voice for older adults in Yolo County. YHAA

is reviewing Yolo County senior services in order to find ways to close gaps in senior services.

Objectives: There were three primary objectives:

1) Identify gaps in senior services of Yolo County by performing a comprehensive analysis

of five top senior needs.

2) Compile pertinent senior service information to post on the newly created Yolo Healthy

Aging Alliance website resource page.

3) Assist the YHAA Education Committee in developing one education program related to

aging issues and present a community program.

Methods: In order to identify gaps in aging-related services, I researched current senior services,

reviewed relevant reports and literature, conducted key informant interviews, and participated in

YHAA committee meetings and other senior-specific talks. Gaps in senior services were found

in the following areas: food resources, transportation, mental health, elder abuse and senior

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fraud. For the YHAA website resource page, my focus was on the following main categories:

transportation, food resources, mental health counseling, in-home care and support services, and

information and referral resources. For each senior service, I validated their information and

wrote a brief description of each service. To fulfill the objective of an aging related education

program, I developed a presentation regarding my practicum experience and findings and

presented it to RISE Inc. Valley Senior group.

Results: A common gap found for most senior services was a lack of adequate funding. The

Elderly Nutrition Program of Yolo County has been hit by the sequestration. Elderly in the rural

areas of Yolo County are affected the most by lack of adequate transportation options. Budget

cuts have reduced mental health programming geared toward the elderly. Elder abuse also

apprears seems to be on the rise possibly due to early release of prisoners from local jails. In

addition, there is an issue of seniors being re-admitted to emergency rooms and hospitals due to

inadequate discharge referrals after their ER/hospital stay. In the case of senior fraud, there is a

shortage of affordable legal assistance and not enough senior fraud victims are reporting it.

Conclusion: The main implication of these study results is that senior programs will have to do

more with less. Budget cuts to senior service programs and the growing elder population will

continue to put a strain on current and future services. Organizations that provide for seniors

will have to become creative in their tactics.

It is recommended to investigate successful senior-related programs elsewhere to see if

they could be replicated in Yolo County. Research is needed in other top senior needs not

included in this study such as health care, housing, and caregiver respite. Also, it is important to

continue the collaboration, advocacy, and education processes that YHAA has already

established.

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INTRODUCTION

Aging Population

A “silver tsunami” is approaching the United States, and we are underprepared for it.

The “silver tsunami” refers to the large portion of aging Americans and the demands they will

place on aging related services. In 2010, there were around 40 million Americans aged 65 or

older, about 13 percent of the population. The first of the baby boomer generation have recently

turned 65; and by 2030, one out of five Americans will be 65 years or older. By 2050, an

estimated 88.5 million of the U.S. population will be over the age of 65, slightly over 20 percent

of the population (Figure 1). (Vincent G.K. and Velkoff V.A. 2010) In addition, the

demographics of the aging population are becoming more diverse.

Figure 1. U.S. Older Population by Age: 1900-2050 – Percent 60+, Percent 65+, and Percent

85+(Administration On Aging 2010)

Aging Demographics

The ratio of females to males and the ethnic and racial makeup are changing with the

aging population. Currently, women comprise 57 percent of the aging population due to their

longer life expectancy. It is forecasted that men’s life expectancy will increase, narrowing the

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aging population gender ratio. (Vincent G.K. and Velkoff V.A. 2010) In addition, the racial and

ethnic composition of the aging population will become increasingly diverse. A 2012 federal

report on older Americans, projects that by 2050 the elderly Hispanic population will triple while

the proportion of non-Hispanic whites will decrease (See Figure 2). (Federal Interagency Forum

on Aging-Related Statistics 2012) These changes in the aging population’s demographics will

alter the need of certain senior services.

Figure 2. 2010 Data and 2050 Projected Data on Racial and Ethnice Makeup of U.S. 65+ Population (Federal

Interagency Forum on Aging-Related Statistics 2012)

Poverty

Poverty is an issue of concern for the aging population. As of 2011, official poverty

measures indicate that 8.7 percent of elderly persons live in poverty. (Federal Interagency Forum

on Aging-Related Statistics 2012) Poverty remains concentrated among Blacks and Hispanics,

especially among older women. Twenty-one percent of older Black and Hispanic women live in

poverty. (Butrica, Murphy et al. 2010; Federal Interagency Forum on Aging-Related Statistics

2012) Alternative poverty measures that include estimated out-of-pocket health care spending

conclude that 15.1 percent of the senior population lives in poverty. (Butrica, Murphy et al.

2010; Institute for Research on Poverty 2013) The future increase in the aging population will

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lead to higher numbers of those below or near the poverty level, which will lead to a greater need

for services directed towards the elderly poor.

In order for the older population to experience an independent and healthy life, it is

important that effective aging services exist, a are available and are known by consumers and

their providers and caregivers. The main objective of this practicum experience was to identify

gaps in Yolo County senior services while working with the Yolo Healthy Aging Alliance

(YHAA). YHAA is a new community-based non-profit organization whose goal is to serve as

the unified voice for older adults in Yolo County. YHAA promotes the well being of older

adults through education, collaboration, and advocacy. YHAA is funded through a grant from

The SCAN Foundation, a non-profit public charity whose mission is to advance the development

of a sustainable continuum of quality care for seniors. (Yolo Health Aging Alliance 2013)

Yolo County Aging Population

Yolo County is located between San Francisco and Lake Tahoe. Agriculture is the

largest industry with approximately 80 percent of Yolo’s 1,021 square miles comprised of

farmland. (Yolo County 2013)_ENREF_6 There are four incorporated cities in which the

majority, 87 percent, of the population resides – Davis, West Sacramento, Winters, and

Woodland. Over a dozen unincorporated rural communities are spread throughout the County

(See Figure 3). (Yolo County 2012; Yolo County 2013) Yolo County tends to follow the aging

trends of the United States.

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Figure 3. Map of Yolo County, 2011

In 2010, the total population of Yolo County, California, was 200,849. (California

Department of Finance 2013) According to the California Department of Finance, ten percent of

the population, some 19,771 residents, were age 65 or older._ENREF_7 Women comprised 56.9

percent of the senior population in Yolo County. Ethnic minorities made up 27.4 percent of the

elderly population in Yolo County, which is less than the California average of 39.1 percent.

(California Department of Finance 2013) Approximately 10.6 percent of the senior population

fell below the federal poverty level. (Area 4 Agency on Aging 2012) Since farmland comprises

a large portion of Yolo County, a higher proportion of seniors live in rural areas compared to the

rest of California. There are proportionally more veterans residing in Yolo County than the rest

of California. (Area 4 Agency on Aging 2012) (do you have a number for this?)

It is projected that there will be over 65,000 people over the age of 65 residing in Yolo

County by 2050, over 22 percent of the total population. (California Department of Finance

2013)_ENREF_8 Half of the baby boomer generation of Yolo County are expected to live to age

85. (Area 4 Agency on Aging 2012) Yolo County is following the aging trends of the United

States with an estimated increase in the aging male population and an increase in ethnic

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diversity. The Hispanic elderly population will continue to be the largest minority group in Yolo

County and will almost double in size from 2010 to 2050 (Figure 4). (California Department of

Finance 2013)

Figure 4. 2010 Data and 2050 Projected Data on Racial and Ethnic Makeup of Yolo County 65+

Population(California Department of Finance 2013)

OBJECTIVES

There were three primary objectives for my practicum:

1) Identify gaps in senior services of Yolo County by performing a deeper analysis of five

selected top senior needs.

2) Gather pertinent senior service information to post on the newly created Yolo Healthy

Aging Alliance website resource page.

3) Assist the YHAA Education Committee in developing one education program related to

an aging issue and present a community program.

METHODS

In order to identify gaps in senior services of Yolo County, I searched out current senior

services, researched and reviewed relevant reports and literature, conducted key informant

interviews, and attended YHAA committee meetings and other senior-specific talks. Area 4

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Agency on Aging is a non-profit organization that is responsible for administering the Federal

Older Americans Act and Older Californian Act programs. (Area 4 Agency on Aging 2012)

Reports and survey results from the 2008 and 2012 Area 4 Agency on Aging needs assessments

were reviewed in detail, and the following areas were identified as top concerns for Yolo County

elderly: health care, transportation, in-home care, housing, legal advice/assistance, elder abuse

prevention and consumer protection, food, and caregiver respite. (Area 4 Agency on Aging 2009;

Area 4 Agency on Aging 2012) Due to time limitations and the breadth of senior service topics, I

narrowed down the categories that were investigated. I focused on food resources (primarily

Meals on Wheels), transportation, mental health, elder abuse, and legal advice/assistance

(primarily senior fraud). These selected categories evolved organically from discussions with

my preceptor, issues discussed at the YHAA committee meetings, results of the 2010 Yolo

Aging Summit (you may want to add this to reference list) and key informant interviews.

“Key informants” are people who have first hand knowledge of a certain topic. With

direction from my preceptor, I conducted twenty key informant interviews with employees and

representatives of the local senior centers, members of YHAA, various Yolo County departments

and many others (Appendix A). These key informant interviews provided first-hand insight and

detail on the selected topics that might not have been collected otherwise. Key informant

interviews also contributed to my comprehension and knowledge of senior services and senior

needs.

A review of relevant literature, reports, and websites helped lay a foundation for a better

understanding of the most prominent senior needs. I thoroughly reviewed several dozen research

articles and Yolo County specific reports and documents regarding the key topics. I compiled

data and statistics from a variety of federal, state, local, and private sources.

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I assisted in the development of the YHAA website by gathering pertinent Yolo County

senior service information to post on the YHAA resource webpage. For each senior service, I

validated their information, wrote a brief description of each service, and included contact

information and a web link (if available). I focused on the following five categories of senior

services and referenced a total of sixty-six resources: transportation (17 resources), food

resources (6 resources), mental health counseling (14 resources), in-home care and support

services (16 resources), and information and referral resources (13 resources) (Figure 5). This is

not an exhaustive list of Yolo County senior resources; other categories of senior resources will

be added to the website by YHAA in the future. A comprehensive list of senior services is

compiled by Legal Services of Northern California and published as Yolo Senior Link.

Figure 5. Screenshot of the Yolo Health Aging Alliance Website Resource Page (Yolo Healthy Aging Alliance

2013)

Finally, to fulfill the objective of an aging related education program, I developed a

presentation regarding my practicum experience, findings, and recommendations and presented it

to RISE Inc. Valley Senior group. RISE Inc.- Valley Senior group is a social group for seniors

in the Capay Valley, a mainly rural area of Yolo County, that meets to socialize, discuss and

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learn about senior-related issues. This presentation was also delivered to the YHAA board of

directors and collaboration committee and the powerpoint presentation will be posted on the

YHAA website..

RESULTS

Results are separated into the following five main categories: food resources (focus on

Elderly Nutrition Program), transportation, mental health, and elder abuse, and legal

advice/assistance (focus on senior fraud). Introducing each category are national data and

statistics from the literature review. Each section concludes with a summary of the gaps in Yolo

county senior services encountered while conducting the key informant interviews.

Food Resources – Elderly Nutrition Program

From a 2008 report on senior hunger in the United States, it was concluded over 5 million

older adults, 11.4 percent of all older adults, experienced some form of food insecurity, meaning

they do not have consistent access to enough food for an active, healthy life. (Ziliak, Gundersen

et al. 2008) Food insecurities occur most often with seniors who are below the poverty level,

live alone, reside in rural areas, are African American, reside in rental properties, lack education,

are disabled, and who have a grandchild present in their residence. (Ziliak and Gundersen 2009;

Sanders 2011) Not all food insecure seniors live below the poverty line; over 50 percent of all

seniors who are at-risk of hunger have incomes above the poverty line. (Ziliak, Gundersen et al.

2008) Only 30 to 40 percent of eligible seniors participate in the Supplemental Nutrition

Assistance Program (SNAP, formerly food stamps). (Ziliak, Gundersen et al. 2008) Do you have

the Yolo stat? It is even lower.

The Elderly Nutrition Program (ENP) of Yolo County is a private, non-profit

organization better known as Meals on Wheels. According to the 2011-2012 Yolo County

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Elderly Nutrition Program report, they served 82,027 meals through their home delivery program

and congregate meal program. The number of homebound seniors who receive the daily

delivered meals has risen by 15 percent in the past 3 years. (Elderly Nutrition Program of Yolo

County 2012)

ENP offers more than just meals to seniors. ENP volunteers and employees are often times

the only person homebound seniors may come into contact with all day. ENP provides a ‘safety

and security’ check for their homebound clients. ENP also serves as a resource for referrals and

information regarding senior services. Listed are some of the additional services ENP offered in

2011-2012: (Elderly Nutrition Program of Yolo County 2012)

1,154 comprehensive evaluations to assess clients’ needs and link them to other

community resources

466 clients were screened for signs of nutritional risk

590 disaster preparedness packets and personal alert devices were provided

233 falls prevention information packets and home safety checklists were provided

375 Fraud Alert from the District Attorney’s Office were distributed

Currently, one of the main gaps in services for ENP is continued funding. The 2011-2012

core operating costs of ENP increased between 4 percent to 25 percent from the previous year.

(Elderly Nutrition Program of Yolo County 2012) Due to the recent sequester cuts, more than

$51 million will be cut from the Federal Older Americans Act Nutrition Programs which

includes the Meals on Wheels congregate nutrition, home-delivered nutrition and nutrition

services incentive programs. (Meals on Wheels 2013) The sequester cuts will reduce the number

of meals served, the number of seniors served, add to the wait list, and reduce staff hours and

eliminate staff positions.

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Other gaps in ENP services include the inability to reach the ‘four corners’ of the county.

Yolo County has a large rural area and it is difficult to reach seniors in remote locations,

especially with the cost of fuel and limited manpower. For some seniors, the meal delivered to

them at lunchtime is the only meal they get for the day. ENP would like to investigate the

possibility of including a breakfast meal, but with the recent sequester that likelihood is slim.

Volunteers and kitchen staff are another need. Over 485 ENP volunteers contributed

approximately 19,000 man-hours this past year, yet the number of volunteers seems to be

decreasing. (Elderly Nutrition Program of Yolow County 2012)

Transportation

Older adults will now ‘outlive’ their ability to safely drive a car by about eight years.

(Area 4 Agency on Aging 2009) Mobility is important to an older individual’s social life, and

cessation in driving or lack of access to transportation is associated with a decrease in an older

adult’s social network. (Mezuk and Rebok 2008) Nationally, the proportion of older adults

living in rural areas, about 24 percent, is greater than that of the general population at 19 percent.

Older adults in rural settings suffer a lack of health care services due in part to a lack of

transportation. (Goins, Williams et al. 2005; McGinnis and Moore 2006) Around 62.4 percent of

fixed route transportation (regular bus routes) is readily available in rural areas compared to 97.9

percent in suburban and 85 percent in urban areas. (National Center on Senior Transportation

2010) Older minority females, lower income, less educated and those in fair or poor health

experience a greater transportation deficiency. (Kim 2011)

Transportation difficulties are a barrier for many older adults especially in the rural

portions of Yolo County. Gaps in transportation services include lack of availability in rural

areas. Services that do offer senior transportation tend to focus on medical visits only. This

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results in a deficiency of a senior’s ability to travel to non-medical locales such as the grocery

store, general shopping, or social activities. Other issues include lengthy transportation time,

especially without access to restroom facilities. Bus stops may be difficult for seniors to get to

and may lack adequate places to sit. Transportation is a major link between many senior

services. Though a needed service may be offered, it will prove useless if an older adult cannot

reach the service destination.

Mental Health

Currently, 5.6 to 8 million Americans age 65 or older have a mental health or substance-

abuse disorder, yet there are fewer then 1,800 geriatric psychiatrists. By 2030, it is estimated

that 10.1 to 14.4 million Americans over the age of 65 will have a mental health or substance-use

disorder. It is also estimated that the number of geriatric psychiatrists will decrease to 1,650.

(Bartels and Naslund 2013) Unfortunately, only about 40 percent of all adults seek treatment

for a mental health disorder. (Bjorklund 2011)

According to the American Association of Suicidology, in 2010, the United States suicide

rate for adults over the age of 65 was 14.9 per 100,000 people. The national rate of suicide for

all ages is 12.4 per 100,000 people. Elderly white males have the highest rate of suicide at 29.0

per 100,000 people each year. Older adults have a higher completion rate of suicide then other

age groups. For those over the age of 65, there is an estimated one death by suicide for every

four attempted suicides. All ages combined, there is one suicide death for every 100-200

attempts. (American Association of Suicidology 2010)

Gaps in Yolo County mental health services pertain mainly to budget cuts or limitations

in services delivered by the Yolo County Department of Alcohol, Drug, and Mental Health

Services. One gap in mental health services for the elderly in Yolo County is the need for a

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case management service that includes home visits and assessments by a trained social worker,

nurse or other health care provider. The case manager would also connect seniors to other

needed services. Yolo County had such a service in their Prevention and Early Intervention

program but due to budget cuts this service is no longer offered. There is also a need for public

health nurses. According to the Yolo County Mental Health Services Act Coordinator, before

reductions to their budget they had 5 or 6 public health nurses on staff but now they maintain

only 1.5 public health nurse positions. (Beesley 2013)

Yolo County Mental Health Services can only collect reimbursement foron clients who

have Medi-Cal; therefore, Medicare-only clients are unable to access the services offered by

Yolo County Mental Health. There is a very limited number of geriatric psychiatrists available

in Yolo County who accept Medicare. Medicare reimbursement to mental health practitioners is

low which may be why there are a limited number of psychiatrists who accept Medicare in Yolo

County. (Beesley 2013)

Other gaps in mental health services include an underrepresentation of minority and

ethnic groups receiving mental health care. Support services directed towards the Spanish-

speaking and Russian-speaking elderly communities are missing. Also, there are no specific

mental health offerings to the lesbian, gay, bisexual and transgender (LGBT) senior community.

It is important to note that several key informants broached the subject of elderly suicide and the

public’sits lack of awareness of this issue in the general community.

Elder Abuse

According to the National Center on Elder Abuse, about 1 in 10 adults will experience

some form of elder abuse (not including financial abuse) and only 1 in 14 cases of elder abuse

come to the attention of authorities. The most at-risk elderly are those suffering from some type

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of dementia. (National Center on Elder Abuse 2013) Many cases of elder abuse go unreported

so these statistics are underreported.

Adult Protective Services (APS) of Yolo County provides intervention in cases of elder

abuse. They too suffer from a lack of funding. They have a need for more administrative help

and monies for outreach programs geared to the elderly.

An emerging form of elder abuse has come to the attention of APS – abuse of elderly

parents by their recently paroled adult child. Some parolees, who are released early from jail due

to overcrowding in California prisons and jails, are moving back in with their parents. Some of

these situations turn into various types of abuse in which the adult child financially or

emotionally abuses their parent(s). Since this is a new finding, and is usually underreported,

there are no current data or statistics to report. With the recent ruling of the Supreme Court to

not delay the release of up to 10,000 Californian prisoners, there is a possibility of an increase in

the number of cases of elder abuse.

One more gap in service, which greatly affects APS, though not necessarily considered

elder abuse, is inadequate discharge planning services from local hospitals and emergency

rooms. Older adults are being released from the hospital or emergency room without much or

any type of referral or action plan. Recently discharged elderly often times end up right back in

the hospital or emergency room when they could have received assistance elsewhere if they had

been informed or directed. This turns the hospital into a revolving door for seniors.

Legal Assistance/Advice – Senior Fraud

Nearly 25 million American are victims of fraud each year with minorities suffering

fraud at a higher rate than non-minorities. (National Crime Prevention Council 2013) In 2010, a

MetLife Mature Market Institute study found that seniors lost over $2.9 billion due to financial

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abuse that year alone. (MetLife Mature Market Institute 2011) As in the case of elder abuse,

victims of fraud often do not report the crime and; therefore, these statistics are underreported.

A main gap in services to those who are victims of senior fraud is limited affordable legal

services in Yolo County. Another gap would be increasing the number of seniors who report

being a victim of fraud. The elderly often feel embarrassed if they fall prey to a scam or the

perpetrator may be a family member.

DISCUSSION

Summary

With the increase of the elderly American population, the availability of effective senior

services is essential. A goal of Yolo Healthy Aging Alliance is to make sure the senior service

community older adults isare prepared for the “silver tsunami” by identifying gaps in current

senior services and taking the appropriate steps to close these gaps. In order to better identify

and define these gaps, key informants were interviewed and relevant reports and literature were

reviewed regarding top senior needs. A focus was placed on the following senior needs: food

resources (focus on Meals on Wheels), transportation, mental health, elder abuse, and legal

advice/assistance (focus on senior fraud).

A common gap for most senior services is lack of adequate funding. Budget cuts have

reduced and eliminated programs geared toward the elderly. Cuts have occurred at the Federal,

State, and local levels and, unfortunately, with the recent sequestration, will continue into the

future. Currently, four programs that assist the elderly are being affected by the sequestration.

Social Services Block Grants, which funds Meals on Wheels and other organizations, will lose

$117 million, Aging and Disability Services programs are being reduced by $75 million,

Community Service Employment for Older Americans will be cut by $23 million and Housing

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for Elderly programs is being reduced by $19 million. (Office of Management and Budget 2013)

In order to provide needed services to current and future seniors it will be important to protect

and preserve effective senior programs.

Strengths & Limitations

The main strength of this practicum experience was the in-depth search into a select high

priority needsfew of the seniors inneeds of Yolo County. Surveys, reports and statistics helped

pinpoint categories of senior needs, but it was the key informant interviews that brought forth

detailed information. The main limitation of this project was the inability, due to time

constraints and sheer volume of senior needs and services, to delve into more of the top senior

needs. Within each of the main categories of senior needs there were many subcategories. Also,

it was difficult to find statistics and data for certain topics such as elder abuse and senior fraud.

Implications

The main implication of this project is that senior oriented programs will have to do more

with less. Gaps in services due to financial instability coupled with the growing senior

population are putting a greater strain on existing services. Organizations like Yolo Healthy

Aging Alliance will need to be creative in finding solutions.

We are all aging. Addressing the gaps in senior service needs is a topic that is important

to everyone. We cannot predict the future and though we may be able to afford to take care of

ourselves now – one accident, major medical issue, or financial crisis may change our way of

life. We too may relayy on senior services at some point. Older adults and their family members

will have to know where to go to seek assistance and know that the services they are receiving

are not just adequate but effective, efficient, and safe. Most individuals who work within the

realm of aging services are cognizant of these gaps in senior services. It will be important to rely

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this information to the broader public health community, elected officials and the general

population so they too may become aware of the need to close these gaps.

Recommendations

First of all, there are some great programs geared toward seniors in Yolo County run by

some wonderful, hard-working individuals – many of whom I interviewed. The continuation of

current senior- oriented programs in Yolo County is vital to its elderly population. Yolo County

is diverse in terms of demographics and geography. There is no one-size-fits-all solution.

Services will have to be tailored towards a senior population’s abilities and community.

One recommendation would be to investigate successful senior-related programs elsewhere

to see if they could be replicated in Yolo County. Yolo County could benefit from a program

like the “Veggie Mobile” in New York in which a van carried fresh produce to low-income areas

to sell at reduced prices. (AbuSabha, Namjoshi et al. 2011) Perhaps, Yolo’s own Woodland

Community Care Car service, which offers steeply discounted rides for local seniors, could

expand into neighboring areas.

The service needs researched for this project are only a few of many. As mentioned

previously, there were several other categories of senior issues that ranked as top senior needs of

Yolo County in the 2008 and 2012 Area 4 Agency on Aging surveys. Key informant interviews

and the literature review also brought up areas of concern for seniors. Topics that should be

investigated for gaps in services include (but not limited to):

Health Care

Changes to senior health care access with the Affordable Care Act

In-Home Care

Housing

Caregiver Respite

Accessing senior information/services

Homeless elderly

End of Life Care/Hospice

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Long term care needs

Dementia/Alzheimer

Finally, it is highly recommended that YHAA continue the collaborative, advocacy, and

educational work it has started. Their collaborative process brings together a diverse group of

senior service organizations and representatives into one room to network and discuss pertinent

issues. Advocacy for senior services will be extremely important as budgets are cut and the

elderly population increases. Educating seniors, the general public, elected officials and even

those within the senior service industry will be a continual process. YHAA and its sister

organizations will have to work together in order to close theses gaps in senior services.

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ACKNOWLEDGMENTS

I would like to thank the following people and organizations for their time, assistance and

knowledge:

Sheila Allen, RN, PhD Supervisor Jim Provenza

Elaine Roberts Musser Louise Bettner, PhD

BBCan Broderick Christian Center

Davis Senior Center Elderly Nutrition Program

Legal Services of Northern California RISE Inc.

The Centaur Group West Sacramento Community Center

Woodland Senior Center Yolo 211

Yolo Adult Day Health Center

Yolo County Dept. Employment & Social

Services

Yolo County Dept of Alcohol, Drug and

Mental Health Services

The SCAN Foundation

Yolo Healthy Aging Alliance Susan K. Harlander, PhD

REFERENCES

AbuSabha, R., D. Namjoshi, et al. (2011). "Increasing Access and Affordability of Produce

Improves Perceived Consumption of Vegetables in Low-Income Seniors." Journal of the

American Dietetic Association 111(10): 1549-1555.

Area 4 Agency on Aging. (2009). 2008 Senior Survey for People 60 and Older in Yolo County,

Area 4 Agency on Aging: 1-19.

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Area 4 Agency on Aging. (2009). The Dual Challenge: Preserving Services for the Oldest Old

Today; Planning for the Elderly Baby Boomers of Tomorrow.

Area 4 Agency on Aging. (2012). 2012 Supplemental Needs Assessment Report, Area 4 Agency

on Aging.

Area 4 Agency on Aging. (2012). 2012-2016 Area Plan, Area 4 Agency on Planning.

Area 4 Agency on Aging. (2012). "Area 4 Agency on Aging." Retrieved June 1, 2013, from

http://www.a4aa.com.

Administration on Aging. (2010). "Projected Future Growth of Older Population." Retrieved

June 18th, 2013, from

http://www.aoa.gov/AoARoot/Aging_Statistics/future_growth/future_growth.aspx.

National Center on Elder Abuse. (2013). Retrieved June 15, 2013, from

http://www.ncea.aoa.gov/.

Yolo Healthy Aging Alliance "Yolo Healthy Aging Alliance." Retrieved June 1, 2013, from

http://www.yolohealthyaging.org.

Bartels, S. J. and J. A. Naslund (2013). "The Underside of the Silver Tsunami — Older Adults

and Mental Health Care." New England Journal of Medicine 368(6): 493-496.

Beesley, J. (2013). Mental Health Services Act Coordinator, Cultural Competency Coordinator

of Yolo County Department of Alcohol, Drug and Mental Health Services. Interviewed

by C. Legendre-Sholl.

Bjorklund, B. R. (2011). The Journey of Adulthood. Upper Saddle River, NJ, Pearson Education.

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TABLE OF ABBREVIATIONS

Abbreviation Definition

APS Adult Protective Services

ENP Elderly Nutrition Program

IHSS In-Home Supportive Services

LGBT Lesbian, gay, bisexual and transgender

SNAP Supplemental Nutrition Assistance

Program

YHAA Yolo Healthy Aging Alliance

APPENDIX A: LIST OF INTERVIEWEES

Sheila Allen Executive Director Yolo Healthy Aging Alliance

Kris Bain Recreation Supervisor City of Woodland Parks & Recreation

Joan Beesley

Mental Health Services

Act Coordinator; Cultural

Competency Coordinator

Yolo County Alcohol Drug and Mental

Health

25

Anthony Bennet Social Work Practitioner

Yolo County Department of

Employment and Social Services -

Adult Services Division

Louise Bettner, PhD Licensed Psychologist Licensed Psychologist

Beth

Conn-

Ossenfort

Referral/Resource

Specialist & Elder

Recreation Coordinator RISE Inc

Charlotte Dorsey BBCan representative BBCan

Nancy Edgar Social Worker

Yolo County Alcohol Drug and Mental

Health

Laurie Haas Social Work Supervisor

Yolo County Department of

Employment and Social Services -

Adult Services Division

Justin Hall Outreach Specialist II

Yolo County Alcohol Drug and Mental

Health

Maggi Jeffrey Social Work Practitioner

Yolo County Department of

Employment and Social Services -

Adult Services Division

Victoria Lewis

Coordinator, Outreach

Specialist II Yolo 211

Patricia MacDonald

Broderick Christian

Center Representative Broderick Christian Center

Nicki McCabe Executive Director

Elderly Nutrition Program of Yolo

County

Alysa Meyer Managing Attorney

Legal Services of Yolo County/Senior

Link

Elaine

Roberts Musser Attorney at Law

Vice Chair Yolo County Commission

on Aging & Adult Services

Peggy Phelps

Caregiver Resource

Specialist Yolo Adult Day Health Center

Christine Prater Recreation Supervisor

City of West Sacramento Parks &

Recreation

Irene Santiago

Information & Assistance

Specialist

City of West Sacramento Parks &

Recreation

Laurie Smith

Activity/Transportation

Coordinator Yolo Adult Day Health Center