good afternoon members of the meeting of the housing human services and transportation committee when i'll come to order it is just about one thirty four p m on thursday october fifteenth twenty fifteen i am y all turn off or silence our cell phones or any other noise making devices and at this time i'd like to introduce our committee voting members members thank you for being here we do have pretty much a executive i guess director on the council on aging deborah stone was thank you for being here and of course our ever reliable district office is the nice fernand thank you denise we don't have staff available today to provide enter active testimony from from harner so in regards to public testimony for individuals who will be testifying in the chamber please sign up at the desk located in the floor lobby just outside the chamber door if you will be testifying from there remote testimony locations express supplied on the meeting agenda please sign up with the council staff at that location and testimony would be limited to the items listed on the agenda today pursuant to the rules of to cancel each test fire will be allowed to testify for up to three minutes per item with one minute to conclude if requested when testifying please state your name and the name of any organization you are representing before we call our process the prior thank you for being here c mony from the molokai district office thank you so members it appears as though we don't have any testifies this afternoon so if we have no objections at this time i'd like to close to we will start with our first agenda item members  transmitting a proposed bill to require baby diaper changing accommodations for certain new establishments and uses basin correspondence dated october eighth twenty fifteen from the department of the corporation council transmitting a revised proposed bill entitled a bill for an ordinance amending title eight moey county called relating to requirements for baby diaper changing accommodations the committee thank you chair and good afternoon members of the committee this is one topic that i personally have experience with having had two or having two young children two of which were in diapers both at the same time and one who just graduated you know she just graduated from diapers maybe about six months ago or so up until last march or so i was  were still changing diapers and we know both my husband and i understand how these diaper changing facilities are very helpful when we go to different  places there have been times where both kids needed to be changed at the same time so both he and i were able to go into either the men's room my husband of course and i into the women's room restroom and and change our kids at the same time there have been times when there weren't facilities made available and we kind of made do with what we had so seeing this bill come before us before the department the department did take a really good look at it  and it took us a while to see review we had some concerns we had some questions relating to the language we also discussed this with our counterparts in the city and because it's our understanding that they passed a very similar ordinance not too long ago back in august and diaper changing accommodations we did ask our counterparts at the city and how they've been able to apply this ordinance this similar type of warnings with their building permits and because it's pretty brand new they said that they haven't had they didn't have a an approved permit yet that had to go through or be reviewed against their new ordinance relating to the diaper changing accommodations but we will be keeping in touch with them and seeing how they're moving along with with their enforcement and their reviews of various building permits we had about four comments to the proposed bill for an ordinance we did provide an attachment the attachment is basically the current written bill with some red lines and questions along along the margins and we also wanted to note that when we start if this bill were to pass it would take maybe a little bit longer for our department to review the plan reviewers would need to first determine if the establishment is subject to the proposed bill and then we'll need to do an analysis of the valuation of the existing and proposed improvements determine floor area impacted  review any signage requirements associated with these diaper changing stations and then also we'd need to create a policy on what constitutes baby diaper changing accommodation currently in this proposed bill there's a definition of what a baby changing baby diaper changing accommodation would be and it's we were just wondering if there were any size requirements or even things like a portable table if that would be considered such a such accommodation it also need to determine and work with the applicant whether or not an exemption would be  would be warranted if they ever came in with such exemption and we also had a question as to how fines and penalties would be applied in this bill there's no  section that refers to a penalty or violations and then also we suggests that maybe we would engage the state department of health in the discussion of baby diaper changing accommodations and  seeing if they would include any standards in title eighteen of the hawaii administrative rules relating to sanitation so those are just the comments that we had from the department of public works bill if you would like to provide some remarks and mr lee cochran and thank you chair and thank you for having this heard today and i appreciate the department's scrutiny and really you know doing their due diligence in going through this bill and as you stated in your opening comments it has been inspired by the honolulu city and county bill that they have pushed forward and we our there i think in order to accommodate this on their behalf they were advised they're building code and we're trying to not have to do that but i'd like to have further discussion with yourselves the department if that could be an avenue to to look at a way to implement this but share i again appreciate all the changes and suggestions and questions that have been brought for lack of and they needed the need for these accommodations so i'd like to see is come to a consensus to move this forward and i'm looking forward to the discussion thank you thank you misc our current members i open up to four of you have any questions comments or further discussion are there are restrooms required for the public chair there are restrooms are required under the code it would depend on the type of occupancy for the number of russians that are provided  and you know and in the previous code before the one that we currently have today the restrooms are not were not required to be public but now new under the new code reasons i asked because i know you know have a hard time finding a restroom and some of these some are bigger stores and they may take you to the employee's restroom and it's kind of like you feel like you're intruding ok so they are now required on new buildings that are saying depending on the site if any and this the other thing is i know you say airports in here my question is are we can get exempted but but they would have to comply in some way the there are other establishments in here that when we checked one title nineteen for the definition of these  establishments for example day care facilities as defined in chapter nineteen it also includes adult daycares facilities eating establishments they also include ours so i don't know if diaper changing station would be appropriate perhaps in a in a bar so i that's why we had that the comment there to aligned establishments with those defined in chapter nineteen and also to consider the size of this stablish mince and any impacts to small businesses we took a look at some other pieces of legislation from different states and a lot of the proposed legislation relating to the opera changing stations determine like a star a certain size saw some would say anything greater than ten thousand square feet or five thousand square feet and then says it would be like a retail and design according to the laws so there would be some you know you would need to meet the requirements through federal law and but you know there are i don't know of any a t m requirements for diaper changing stations but i think you would need to have at least some clearing for doors and sing and be able to fit the diaper changing station and not have it interfere with any doors opening when when these when the decks are lord or or someone's trying to get out of the restroom  or into the stall different establishments so you're saying that accordingly to this list anything that would be built or or remodeled from the point of this being passed to conform to this bill there would be so every every every other establishment would be grandfathered in they wouldn't have to build a diaper changing  accommodation just what you would call deck or something like that is that correct chair i think you are understanding in reading the ordinance so you have a new establishment or an existing use so any time so let's take a an existing use for example if it becomes substantially modified which means that you have reconstruction rehabilitation addition that requires more than fifty percent of other gross floor area or if you have improvements that total fifty thousand and we big we suggested saying creator th fifty thousand i think that's what it was meant to say then or if you do a new or renovate an existing restroom and the value is greater than ten thousand that would trigger the need for a diaper changing accommodation to me and then the other question i have on the definition i'm sorry thank you very much  definition on eight point three six point zero one zero and the last sentence where it's more similar amenity that is installed or placed in a separate needed location  i'm not quite understanding this separate designated location where data is that separate from them the women's in the lens or is that is that a separate location with  thank you chair as mentioned earlier we didn't draft this but we were viewed it my understanding was looking at the wahoo one and reading some of the intent behind our one was that basically there just needs to be baby paper changing accommodation accessible to men and women so if you only have one in the ladies room then you have to point in the men's room and i'm understanding that we have one in like one of those you know those family bathrooms  then you're good if you have one in there you're good so you could have that separate designated could just be like another room accessible by either sex for baby changing  changing accommodations so it could just be a separate room ok because the language is kind of strange because it says installed or placed in a separate designated location so to me it's either installed or placed in a completely separate room but i would rather that language be cleaned up whereas it's more clarified where you can just put a table you know that the folding thing that comes down in the  room or the women's room i think that's adequate and i've been in situations where i just put them up on the washing area you know where you wash your hands but as long as there's some kind of table thing that you can just get them up on there and just do the quick change i think that would be adequate enough i don't i don't see a real ness necessary need to have an entire room built in you know that's just my public works or yes and again thank you department for going through this and i guess in the first question under definitions the word death i guess in particular is what you folks are questioning deck and you wanted to know if you want to specs on that size is that spelled out in particular for the word  is that what you're questioning cherice into in general i think that section that's highlighted perhaps there should be more clarity to the definition of what a diaper changing accommodation is because it's i mean you have direct table or similar amenity and i mean it could just be a folding table i don't know  is there a size requirement is there for the table or similar amenity i think it general it's just if if if you can  if we can work together on trade there defining this or coming up with something a little bit more clear and easy to understand and something that our staff  mean are you looking at those koala cara type that fall down or is it a separate table or something attached to the wall or is a portable i  you know designated for diaper changing but i mean you want to secure that where you're not going to put a child on is going to topple over you know flip on its side in and then i guess you would probably know better than any of us what size you would need as your child you know the size of the children you need to do such action you know so i definitely you know will need to work on the language and be specific but i think the intent is something that safe and you know hygenic and so of that nature i think mr couch said there's stuff in airport restrooms  have not seen those sorry chair mr couch has saw something that he is describing going to for diaper changing type of mystical thank you yeah it goes along with my question on this placed in a separate designated location the ones i've seen and some of the airports they're actually in a stall one side is on this side and folds down and in cover it basically covers the toilet you know above the toilet and it looks like it so would that count in something like this because i'm concerned about so that many different things can fit the bill so it's not just saying you have to have x y or z it's kind of seen you just need something that meets the stand why it's not always  standard to something you can let mr goes missing something you just need a flat or he had a change of baby's day for hire and you know i believe it was left broad on purpose but you know i didn't drop the honolulu bill and i believe this was taken directly from the dinner for us on the most of the commercial buildings is seventy five to one hundred years old was never meant to have this kind of things on plantation rural community so my thing is think we need to you need to help us craft what makes sense for the urbanized areas and don't confuse with some of the rural areas as i don't view it is one size fits all so seeing that that be a correct understanding on my part i'm thinking if it were to state that there's no there's exemptions for hardship in here but the proposal yes i think you are on its feet so you would probably be in a different section of the code saw if the intent is to exclude or to make sure that the standards for the business country town district yes apply in front of this we should probably state that in this bill you may want to include other areas too if necessary but without reading what the that as the committee looks at this piece of legislation that you consider the types of uses the different establishments and the size in some laws that i've not laws but proposed bills that i've seen they they only require it for larger type of establishments also perhaps the committee would want to look at the different triggers and decide whether or not it would be for a new construction or for four restrooms or facilities that have a certain size bathroom but i do understand this some of the older buildings a that would be  it would be very difficult because a lot of them are have small restrooms that don't even fit and saw i mean i would be very and i think we would really have a hard time and i think there's an exe there's an exemption section but i think if we outright you know just limit and define define this better in establishments or uses and in the triggers that might because that's going to determine accommodation and i don't want one that is going to know how i feel today so i'm going to rule we need some smart parameters if we're going to allow a discretionary decision that's defensible if it can be consistent in fairness application and there will be a may come in who shall i would like to also just advocate for this size restriction on the list referred under eight point three six point zero two zero and also i'm not sure whether a dollar amount in the i guess part number two number three whether that is to finish it or maybe we should go with the size instead of greater than fifty thousand or greater than ten thousand because you know the cost of you know building permits and things like that fluctuates you know decades later and you know this of you know subsequently lead to you know everyone having to be this this this ordinance be applied to but i think size is probably a better proposed accommodations really involve questions relating to building permitting requirements and actually would be administered and in force by the department of public works would like to recommend as your chair recommend the this be this communication be referred to the i e m committee that member cochran ch infrastructure and environmental management committee any further discussion started just yes yeah but yeah i appreciate it and i'm very happy to to enhance the department's ability to administer requirements i would as that the department's written response be transmitted to the appropriate committee so all those in favor by saying i by the office an agent department of housing and human concerns pursuant to rule seven per be of the rules of the council the committee intends to receive a presentation from the county executive on aging department of housing and human concerns on topics such as resources and services available through the county to its senior population the committee may receive a presentation from the office and agent and discuss related matters members no legislative action will be taken at this time we will receive a powerpoint presentation today from deborah stone begin your presentation just to say thank you madam chair for inviting us here today and we look for to sharing with you thank you for being here well aloha everyone i just want to give you a quick outline of what we will be talking about you do have the power point there but today we're going to basically be covering the basis for the office on aging the descriptions of our activities that will be describing the relationship between the office on aging and the aging in disability resource center that is sometimes confusing for folks talking about who is eligible for in home services the services we offer and then the discussion about future projections so what is the office on aging well we actually exist because of the federal law the older americans act that was signed in one thousand nine hundred sixty five and every county in america has an area agency on aging we're also known as a aaa but we don't change batteries or tires so we are directly connected to the state unit on aging so each state in america as well as all the territories have a state unit on aging as well that are all exist because of the older americans act we are a federally designated office so we not only answer to the mayor but we also answer to the state unit on aging and the administration on aging we are established in the whole revised statutes as well as in the mallee county charter and basically a county office on aging exists because of the commitment of legislators on every level recognizing that older americans who have contributed to the good of their community for many many years have the right to live their remaining years after the age of sixty with dignity and as much financial security as is possible in one thousand nine hundred sixty five when this act was signed the vast majority of older americans lived in abject poverty so congress saw  need to establish a means by which seniors could it could access and receive the help that they needed we were signed the older americans act was actually signed about two weeks prior to medicare and medicaid so it was a big year that year for seniors what do we do well we're charged by the older americans act to serve as the lead advocate facilitator plan or policy developer and evaluator relative to all aging and family caregiving issues in the county of maui we inform the public regarding all the problems programs resources and services available we're responsible for allocating the federal state and county funds that we receive so that the home and community needs of maui county seniors are met we serve as the designated operating into t of the aging in disability resource center for maui county and last year we served twelve thousand seven hundred in twelve thousand seventy six individuals and three thousand six hundred sixty five family and informal care givers throughout  that's a total of fifteen thousand seven hundred forty one people with direct service so what exactly is this eighty r c thing well the definition of an a d r c is that we are supposed to be a highly visible and trusted source where people of all incomes and ages can turn to for information regarding the full range of long term support options and access to publicly funded long term support programs and benefits our primary functions are that we provide information and assistance options counseling streamlining the eligibility for long term supports and services and can quality assurance and continuous improvement if we look at the main functions of the a t r see kind of in a chart form you can see basically what distinguishes the eighty r c portion of our office  is a result of a system of operator operand opera operations and standardized tools i was trying to say both of those words together so basically when we get we conduct outreach we receive referrals we have a talk story and then nischelle intake session and generally we're having between sixty and eighty new intakes each month three years ago that number was twelve to fifteen so in september the actual number was seventy one so we're seeing quite an increase in the number of folks that actually participate in our intake process if that intake determines that an individual requires does not require long term supports and services needs we simply reply we simply provide general information and assistance so they might just be calling for a number or they might need some assistance but if they do need long term supports and services then we conduct a more in depth in home assessment and that's considered our tree and during the tree asure it's about a two and a half to three hour process that i'm going to talk a little bit more about in a minute  trio indicates that they don't really need in home services then we give them the end and the enhanced information and referral that they need to get connected to another appropriate state agency during the home assessment and support plan if they do have and long term supports and services need and the they are sixty years and over we go ahead and move them into authorization for care and title three services so this is the eighty r c kind of also in bodies the movement on the federal level in two thousand and twelve the department of health and human services under kathleen sebelius at that time took the administration on aging the office on disability and the administration on developmental disability billet ease and formed them all into one agency known as the administration for community living so we are part of a national initiative that is combining the aging and disability service delivery segments because if you think about it in individual who may be twenty five who may have a disability that prevents them from walking or being able to meet some of their activities of daily living on a long term cochrane she's waving her hand those that needs of that let's say you know if an individual is paralyzed they have many of the same needs as someone dealing with functional deficits two to aging so we wanted to take advantage of all of the resources available and break down some of those silos i like to think about our assessment process as a traffic light a red yellow and green light process how we used to operate is we know there is a red folks that call us and say i need help i can't cl my house i need help i need a home delivered meals meal those things were readily available to us along with that we could also see the green in areas areas they did not need help in so there were no services provided but in recent years our focus has honed in on this yellow light area and those are areas that may not be overly evident but areas in which that individual would benefit from preventive efforts it's kind of like i'm not sure if you all are aware that currently doctors can test someone's blood and perform a d n a analysis to determine i know it's happening a lot in the mental health field they can test that individual's blood and determine which psychotropic medications will best meet that person's need so instead of having to do a trial and error well let's try you on westword all for a little while did it work did it not they can actually test the blood and get right down to the basics of what that individual is going to best respond to and that's kind of what our assessment system does we look at that individual as a whole person and in twenty seven clinical access protocol areas we get a report it's called a trigger report and in it takes us a couple of hours longer but because of that couple of hours longer we're able to create a more comprehensive treatment plan that keeps us from just chasing the red light areas hopefully our goal is to either keep people the goal would be to help people move in green in all areas that's not always possible but at least we can keep them in the yellow area and minimize the number of red lights they have going on so that it helps us sustain services as a whole so who is eligible for our services for in home services the older americans act tells us that what people need to be a u s citizen a qualified alien sixty years of age or older not covered by any other comparable government or private home and community service not residing in an institution such as a nursing home a skilled level skilled nursing home level hospital foster home or arch they have to have an impairment of at least two a t l or i a deal areas or substitute of cognitive impairment and they have to have an unmet need of at least one or more a l's are the activities of daily living things like can you dress yourself bathe your self feed yourself transfer yourself those things deals are the things that help us actually live and live our daily lives can you shop can you drive can you access transportation can you pay your own bills can you use your phone that's the difference between those two areas now anyone is eligible for our information access  outreach referral and assistance programs but these folks in order to get the in home services need to meet all six of these criteria the services we currently offer i thought i'd make one of these at least a little fun personal care chore homemaker home delivered meals adult day care case management helping that family think outside the box and come up with unique ideas for solutions congregate meals transportation and legal services more services we offer nutrition counseling and education information referral outreach and education health promotion chronic disease self management and enhance fitness and this is an area we're really focusing in on because  growing number of seniors we believe it is our obligation as an office on aging to help people become healthier and help them remain healthier and we have quite a reputation actually in  america at this point we are currently under agreement with the centers for medicare and medicaid services or c m s they're studying both our chronic disease self management program and our enhanced fitness program programs to determine if medicare will reimburse for either or both of these programs so we are seeing that many county is seen as one of the standards in america as far as having high quality programs that medicare is actually looking to determine whether or not they can reimburse for programs across the nation so we're actually quite proud of that self directed care is a is a program we have that we called community living and that program pulls people out of the traditional realm of services like we don't just say well you'll get personal care home delivered meals and transportation the self directed care program actually gives individuals a budget so that they hire their own workers or they create with that budget they fill the needs that they have a particular family they had enough family help actually to meet daily needs but what they really needed was some assistance my modifying the bathroom so that they could put in you know one of those top bathtubs that has a door that opens and closes so they use their monthly budget to remodel their bathroom so that they're able now to keep their loved one at home and safe so it's a very creative program that meets people where they are we currently have twenty four individuals in maui county on that program we also offer telephone reassurance friendly visiting and access and assistance  here's just a chart this was from the state report from federal fiscal year two thousand and fourteen in some of our areas that the other counties also do you can see statewide there were forty forty thousand two hundred sixty one hours of adult day care and now we county provided forty two percent of those or sixteen thousand eight hundred thirty two you can see going down the second one is case management that one's a little different  on the state's books they have that we provided six hundred and seventy two hours however we are one of two counties who has those workers in house we do not contract that out so in actuality we provided eight thousand nine hundred ninety two hours it's not in our state report because that was not that those monies were not sent out to the public rather they were used to support our own staff also the transportation one looks a little different cording to the chart in the report we only provided six percent of the statewide transportation but we county does transportation a little differently you guys know than the amount of funding you provide every year to the department of transportation that then get it's contracted to any of four for paratransit and for the transportation that takes folks to congregate meals so our actual percentage statewide is much higher than this we just don't have a means by which to show it in this particular report we provided thirty seven percent of all congregate meals in the state twenty six percent of all home delivered meals sixty two percent of all homemaker services and forty percent of all personal care in the state for federal fiscal year two thousand and fourteen we also provide of variety of family caregiver services  then if it doesn't accurately reflect what this county does in providing in the various categories are financial support as well as program and operational support what good is this for us because it doesn't give the real picture of what i'm getting from the office thank you for that question remember a whole comma i think well if i took off transportation chance to explain in actual asking the executive office on aging to find a way that each county reports in a consistent manner there's no way for us to determine because i don't have access to the department of transportation numbers for how many rides they provide to seniors so what this tells me is i don't have a way to accurately give that information to the kit of office on aging in the same way that the other counties are because each of us handles transportation a little differently yeah so this number only shows what provides through our contract with them because each county is a little different in the way that they contract it's   i don't think we're being hurt at all because it's it's just a report of the money that that this county uses for specific copernic air transportation county shows that we have been a very good supporter and provider of services to our elderly but unless they know all of it and it just read what is their report my concern is to come up with it i'm sure and i share that concern actually last month i did send a report i worked with joanne johnson weiner to get some ass to mint sent least also from m e o two let the state be sure and know that we provide far more than is reflected in both of the these areas transportation and case management and i have in writing called for the counties to come together to make sure we are reporting services such as this in a consistent manner across the state so that it becomes a true reflection any kind of data cherry aside i was able to receive some data and i forwarded that data to the state so that they knew i also asked them for permission to include that next year in our report in another column so that we could more accurately reflect what all mally county does i think the main emphasis of this slide is that as we represent not even fifteen percent of the state in most services we are vastly outperforming every other county in the direct service provision to older adults but i  share your i share your desire to report it accurately i don't have a concern about our funding getting cut because that's not actually how we receive  and should be receiving additional financial support yes sir that's what i'm also looking at for your office yes sir and we actually have been we have been saying that as well for a few years in in state fiscal year fifteen we did receive about half of the healthy aging funding that was released statewide because we are doing about half of all of the healthy aging services statewide so we are making progress in a couple of areas the a t r sihamoni we are receiving about one third of that that has been released and again the healthy aging so we're seeing some progress typically it's been for funding formula federal funding formula with no concessions and we have been saying what about us we're doing this we're doing this  so we're making progress in getting a little more funding for the things that we actually are over producing in or producing more than the other counties proportionately i guess so they're recognizing a that funding is released we have a federal funding formula that we receive funding regardless of our outputs according to the number we have in poverty our general population our population density there are several measures that are weighted in order for us to receive that percentage of the overall  thank you sir i appreciate your support we are truly lucky here in a county again this is a brief listing of our family caregivers services that we provide powerful tools for caregivers is another evidence based program that maui county has led the state in we have in home respite adult day care respite sundowners as a program on friday evening often folks with all simers experience what is called sundowner syndrome that's when the sun begins to set is when they begin to wander so i don't day care has a friday evening program so that families can kind of in their we having a meal together mom and dad are safe and it's just a nice little name called sundowners for that respite time home delivered meals i believe we provided ninety two percent of all home delivered meals for family caregivers in the state last fiscal year legal assistance access assistance and information in a firm and referral why this is all important is that in america right now ten thousand people every day are turning sixty five and even more are turning sixty it must be a good eight and they need is only going to grow i did provide you with a blue and white chart that is actually taken from page twenty six of our area plan and there is an error on it in the year twenty thirty five down in the eighty to eighty four age group that number should be eight thousand five hundred and fifty six it is correct in your area plan on page twenty six what this shows you in county we we're having in the next five years we will have eight thousand additional people turning age sixty that means they'll be eligible eligible for for our services has four point two a day about one hundred thirty two a month and one in two are calling our office so for the next five years that's what we'll see a hundred  thirty two new people eligible every every month so the projection is why we better figure out how to do our jobs efficiently effectively help people stay safe and healthy as much as possible and to turn on the passion because we're really going to need the passion and commitment  and then here's our phone number two seven zero seven seven seven four on maui or toll free from orland i e six four three a t r c this trend for the aging somehow i missed it but you have it on your handouts the trend for the aging population is going to continue for forty more years we will see these increases in numbers so thank you again for the thank you chair i would just like to commend up on a stone walls for an amazing job and the department has performed in a stellar fashion and it's just proof you know things like medicare using us as a case study in a that my thing is are you having issues with feeling vacancies currently is this a d p s thing where you waiting for qualified lists of applicants or you still need for them to have the examinations to give you a qualified list to consider or are those that we have recently picked just not cutting it out on line i chair ye three of these positions are the operations assistant to the aging and disability services specialist one and then the program specialist two  interviewing d p s is in the process right now the program specialist doesn't close until next tuesday the twentieth but the other two operations assistant we have a list and we've interviewed we are waiting for the list for the aging and disability services specialist ones there's two on maui and a half time position on line so let me assure you that we have someone on line i e every week  have on our phones on our office door we have our toll free number we check those messages and i am unaware of anyone waiting services who has called our office where we are definitely paying close attention to lynn i e and making sure that our supervisor is over there twice a month and our other staff members are over there at least twice a month sometimes we are going over more th that are funded in purple at this point at this point the funding is not in issue for the purple funding the funding for the blue those are federally funded folks and they this group of people has been funded by the older americans act since the seventy's but because of the restriction on our funding amount we are it's not just one thing our federal funds are restricted we can only is two hundred sixty five thousand of our federal funds to to fund these positions you can imagine since the seventy's over time that amount does no longer meet the need for all of these seven positions in recent years while since i've been in that position we have supplemented that federal funding with our administration funding from the federal as well as the state we are now kind of last year we had a windfall from the a t r see this purple money they accidently gave us two years of funding instead of one so we haven't been able to to also supplement but we are actually running out of our room to keep all of these people federally funded that we have no more room to to wiggle with our administrative funds so we are actually working with the administration on that issue this year to try to see what we can do to shift some of these folks to a just mention from you know personal experience in trying to get some services for my mom on the mainland in two different states it just pales in comparison to what we do here and i hear when we go to if we lose the federal funds are they and we can't fund them here are they pretty much have to be reduction in force or how's that going to work are they now in the system i mean are they l t a's or are they full time employees these actually are full time employees only one is listed as an age c f but even that one let me see which position it's number one six six even that when when that one was established right before i came on and it actually started as a permanent civil service we are now  you can see in the purple ones listing folks only as temporary at at this point when all of these were established they were permanent civil service so so essentially that if if the federal funding goes away then the c t s get bumped up by these into the four five six people seven i don't know that these guys would qualify for those positions that's an interesting interesting question m idea is actually these people provide a direct service to our county and the county again since the seventy's has been covering their friend everything and i think that it is a death it is a demonstration of the dedication of the county the people in purple we cover their friends the people in blue  have never covered their friends if we lost if we lost any person now our case loads are going to pretty much go through the roof right now we have case loads of about depending on the region one hundred fifty to one hundred ninety per person if we lose people seniors needing help will be facing the situation much like your mother's case on the mainland we just won't be able to get to them  because this money is not flexible with our federal government i my proposal to the administration  hopefully will help bring a remedy and i don't know if i should say it or ok so my idea frankly you the county council has been so incredibly generous over the years with the direct service money that you provide and my proposal would be since these people have been treated for cents again the one nine hundred seventy s like county employees is that you would reduce my amount of direct service dollars in the grant for frail and elderly by the same amount as the service as the salary of these federally funded people then i can just use that federal funded bucket to go directly towards direct service because i would have no limitations on that otherwise i will be needing to have really read deuced although we help people through the process we have to really cut back on if we have individuals in this county that have two million dollars in the bank we are not providing them with any direct services we are however helping them a stablish private pay opportunities for themselves sometimes just trying to you know it becomes overwhelming to get help what we used to do is we used to just provide them service now when we find out they have income and assets that are over a certain level where instead of us just using the public money to meet their need we are helping them meet their own need through our case management or assistance so we are cutting back in those areas so you may be hearing about people that are losing  services but generally if it's an issue of health and safety we are not pulling services if it's an issue of health and safety and they have private funds where they can pay for their own services were helping them pay for their services i can see no way to meet the growing needs other than ensuring that people that do have means kind of pick up that that responsibility sometimes it's hard people have a mindset that i've worked my whole life so i can leave money to my children and we're really trying to change that cultural value of well you've worked your whole life and now you get to take care of yourself which is really valuable in today's world so we're trying to do what we can frankly in every area again the emphasis on  health personal health that's a huge thing for us we need to help people stay healthy or we're just going to be having greater and greater need and that's unacceptable thank you thank you madam chair i'm glad that you brought that up because we're going to have to hear this ad budget and it's good to hear it in advance give us forewarning so that you know if it happens to be two in the morning when you come up and say i need more money at least we know in advance what what the concern is so thank you for bringing that up sooner rather than in the middle of all the budget like case management or do you have or is there any kind of plans to i guess is a process future wise you know if to sustain or do you have  income coming in i don't even know if that's possible if the government so if i'm understanding your correct question correctly you're wondering can we bill people for their insurance i'm sorry the medical insurance or we are medicaid or medicare for certain services we can only like enhanced fitness that's one of the reasons wearing gauged in that process and we are seeking accreditation through the american association of diabetes educators so that our diabetes self management programs can be we can recover money from medicare we are looking at all of those everything that's available i think my peers across the state would tell you where anything that we can do to bring in money i'm like let's do it yesterday we had a conference call on the medicaid federal financial participation we anticipate we could bring in about twenty nine percent of our current operating costs on the call i was saying to my peers what are we waiting for we need to do this we simply cannot sustain services unless we begin to be more proactive in bringing in some of these external forms of funding so we are we have made some progress in that arena and our enhanced fitness programs are ok thank you members we have no furthe session and having a temporary disability gone on or a now i understand the people that have long term needs as i have just temporarily yeah i think god for services that you provide you know as you mentioned just the door in the shower thing it's just every year every day monday and things you folks take for granted you can do and when you can't do it yeah enough yes so my poor mom is ninety she's the one caregiv random question but in twenty thirty five the ages of eighty to eighty four there's like a real dramatic drop it's stays in here is what's the reason behind that from seven thousand two hundred twenty two and then thank you for being here we have completed today's agenda i'd like to thank the representatives from the administration for your participation i also would like to think carla and clear it up all up for