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Agenda 04/09/2019 Item #10A04/09/2019 EXECUTIVE SUMMARY Recommendation to accept the year-end report of the Senior Advisory Ad Hoc Committee (SAC), consider their recommendations, and allow the Ad Hoc Committee to sunset on April 18, 2019. OBJECTIVE: Accept the SAC year-end report and determine if the committee should be allowed to sunset or if the committee should be created as a standing committee to the BCC. CONSIDERATIONS: This nine-member ad hoc committee was established on November 14, 2017, by Resolution No. 2017-220, to assist the Board of County Commissioners in compiling and identifying issues and relevant best practices concerning senior citizens in Collier County. The appointments of the initial members at the February 27, 2018 BCC Meeting, Item 12A. Following an orientation meeting held on April 4, 2018, the first meeting was held on April 18, 2018. Through the year the Committee held 12 meetings where they received several presentations from staff and community groups regarding topics important to seniors. Based on the infor mation received and information gathered from other communities the Committee identified the focus areas identified in the year -end report. The following individuals and groups presented information to the Committee: • Louise Pelletier - Collier County Senior Services • Mike Sheffield - Collier County Communications • Sean Callahan - Collier County Veteran’s Services • Michelle Arnold - Collier County Area Transit • Eileen Connolly-Keesler - Community Foundation of Collier (Richard M. Shultz Family Foundati on Community Assessment) • Chief Tabatha Butcher - Collier County EMS • Dan Summers - Collier County Bureau of Emergency Services • Shelley Rhoads-Perry & Donna Messer - Home Sharing programs • William Barker & Jigsha Desai - Naples Daily News • Anne Chernan - Jewish Family Center At the meeting on April 1, 2019 the Committee discussed its future and determined that operating in the sunshine made it difficult to communicate and develop ideas to share with the Board. They discussed alternative methods to achieve the intentions of the Committee and ultimately felt that a Non-Government Committee would be more effective. Without the need to operate in the sunshine the Committee felt that they could get more interest and be nimbler to respond to issues of interest. The Committee has recommended establishing a senior level Point-of-Contact within the County to enhance the communication of the area organizations that work with and for seniors. The County currently has a manager of senior programs and services as well as additional senior programs within other divisions of Public Services. Staff does not recommend the addition of another full -time employee at this time. FISCAL IMPACT: There are no fiscal impacts associated with this executive summary. GROWTH MANAGEMENT IMPACT: There are no Growth Management Impacts associated with this Executive Summary. LEGAL CONSIDERATIONS: This item has been reviewed by the County Attorney, is approved as to form and legality, and requires majority vote for approval. -JAK RECOMMENDATION: to accept the year-end report of the Senior Advisory Ad Hoc Committee (SAC), consider their recommendations, and allow the Ad Hoc Committee to sunset on April 18, 2019. Prepared by: Geoffrey Willig, Senior Operations Analyst for the County Manager’s Office 10.A Packet Pg. 77 04/09/2019 ATTACHMENT(S) 1. SAC Final Draft Report to BCC Apr 9 2019 (DOCX) 10.A Packet Pg. 78 04/09/2019 COLLIER COUNTY Board of County Commissioners Item Number: 10.A Doc ID: 8524 Item Summary: Recommendation to accept the year-end report of the Senior Advisory Ad Hoc Committee (SAC), consider their recommendations, and allow the Ad Hoc Committee to sunset on April 18, 2019. (Chairman Charles D. Hartman) Meeting Date: 04/09/2019 Prepared by: Title: Operations Analyst – County Manager's Office Name: Geoffrey Willig 04/03/2019 8:41 AM Submitted by: Title: County Manager – County Manager's Office Name: Leo E. Ochs 04/03/2019 8:41 AM Approved By: Review: Office of Management and Budget Valerie Fleming Level 3 OMB Gatekeeper Review Completed 04/03/2019 9:33 AM Office of Management and Budget Laura Zautcke Additional Reviewer Completed 04/03/2019 10:38 AM County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Completed 04/03/2019 2:17 PM County Manager's Office Geoffrey Willig Level 4 County Manager Review Completed 04/03/2019 2:19 PM Board of County Commissioners MaryJo Brock Meeting Pending 04/09/2019 9:00 AM 10.A Packet Pg. 79 1 | P a g e Final Report to Collier County Board of County Commissioners by the Senior Advisory Committee (ad hoc) April 2019 The Senior Advisory Committee was created by the Board of County Commissioners one year ago as an ad hoc advisory committee with a 12-month life. This report is a summation of the findings and recommendations of the Committee upon the completion of that term. Before turning to the recommendations of the Committee it is necessary to cover our thoughts on the future of the ad hoc Committee which expires on April 18, 2019. The assigned mission is “to review county plans and provide practical recommendations to the Board of County Commissioners to be more inclusive of senior needs by leveraging the expertise and experience of seniors in the community”. This mission has two parts: first, to advise the BCC on the impact of their policies and decisions on the senior community and, secondly, to act as a voice for the senior community on issues arising from within their ranks. This report contains several recommendations falling under the first part but none under the second. The restrictions of the Florida Sunshine Law made it difficult to work with elements of the private sector on a timely basis to reflect their concerns. Before getting into the details, we would to thank the County staff for their wonderful assistance which was provided throughout the year. Particularly, we would like to thank Geoffrey Willig who acted as our liaison with the County Manager’s office. 10.A.1 Packet Pg. 80 Attachment: SAC Final Draft Report to BCC Apr 9 2019 (8524 : Senior Advisory Committee Final Report) 2 | P a g e FINAL DISPOSITION OF THE COMMITTEE It is now time for the Commission to decide the future of the Committee. We believe there are three options: 1. Establish the Senior Advisory Committee as a standing and permanent Advisory Committee to the Commission. 2. Disband the Ad Hoc Committee. 3. Create a senior position of, ”Senior Affairs Coordinator“, responding directly to the County Manager or Deputy County Manager and responsible for coordinating the aspects of county programs affecting seniors in all departments and agencies and acting as a single point of contact for private sector organizations with the County government on issues of policy and regulation. This individual would have no operational authority but rather act as a policy and program coordinator for the County Manager. This would allow the private sector to organize an umbrella coordinating Committee formed outside of the Sunshine Laws to work closely with the Senior Affairs Coordinator. The Senior Affairs Coordinator also could act as the supervisor for the weekly or bi-weekly “Senior Page” in the local media as we will discuss in a minute We recommend options 2 and 3 if they can be done together. COMMITTEE RECOMMENDATIONS The first four meetings of the committee were dedicated to organizing and selecting the area of focus for the committee during the initial year. We initially looked at five areas of possible concern. They were: 1. Information access and resource awareness and delivery, 2. Food security and hunger reduction, 3. Affordable housing, 4. Affordable and accessible health care, and 10.A.1 Packet Pg. 81 Attachment: SAC Final Draft Report to BCC Apr 9 2019 (8524 : Senior Advisory Committee Final Report) 3 | P a g e 5. Transportation and public safety We were aware that that food security, affordable housing, health care, and transportation were primarily the concern of other advisory committees or of other groups in the private sector, but each of them contains unique elements that impact seniors. We focused on these elements. During that review the issue of information access and resource awareness was determined to be an area that could benefit the most from additional attention. When we say information access and resource awareness, we are referring to improving the visibility, understanding, and access by seniors who need guidance or assistance in order to identify, locate, or access needed services whether from the private sector or government. It involves recommendations for general communication strategies, the creation of educational material, and possible information dissemination strategies. In reaching a decision to focus on information dissemination by the government, we reviewed several studies including the recent Collier County Needs Assessment, funded by the Community Foundation of Collier County and the Schulze Family Foundation, and the FGCU assessment of County needs created at the request of the Naples Senior Center. In addition, we drew upon the experience over the last 10 to 20 years of various members of the committee in evaluating whether this was the area we wanted to focus on. Our experience in attending Town Hall meetings organized by members of the Commission earlier last year added to our concerns. The citizens participating in these and other meetings demonstrated a low level of understanding of what the BCC and County government staff were proposing in the affordable housing area and why. Additionally, we have found that too many of the senior citizens in the County have questions about what government services are available and how to find them. We concluded that this issue indicated that a gap exists between the intentions of the County government and the understanding of the citizens on those subjects. The new 311 service for the County will help but is not the total communication solution for seniors 10.A.1 Packet Pg. 82 Attachment: SAC Final Draft Report to BCC Apr 9 2019 (8524 : Senior Advisory Committee Final Report) 4 | P a g e We believe there are three steps that can be taken immediately that will improve citizen awareness of the services and resources available. They are: 1. The creation of a joint government / private sector “Senior Web Page” that will contain, among other things, information and/or links on the following: a. the schedule of Government open meetings and the principal subjects to be covered, b. a listing of the main senior services available either from the government or the private sector with information on how to contact them, c. a listing of the major civic events and private sector meetings that may interest seniors, d. lists of community events of interest to seniors. This web page could possibly be paid for and operated by one of the non- profits serving the Community. 2. Holding discussions with the Naples Daily News to publish weekly or bi- monthly, “Senior Page”, containing the information listed above. Discussions were held with the management of the NDN. They supported the concept but wanted compensation for the space and needed more specifics about the content of the proposed page. The Committee wanted the space on a “Public Service” basis. The difference was not resolved but the issue is still open. We note that since those meetings, the level of reporting on civic events has increased particularly on the editorial pages. 3. The creation of a weekly thirty-minute, interview formatted, program on the County TV station covering a topic of interest to seniors in the County and having the airing schedule reported on the senior web page and the NDN senior page. This could be organized by the new “Senior Affairs Coordinator”. 10.A.1 Packet Pg. 83 Attachment: SAC Final Draft Report to BCC Apr 9 2019 (8524 : Senior Advisory Committee Final Report) 5 | P a g e AFFORDABLE SENIOR HOUSING We note that the following comments are made based on our assumption that all agree on the basic principles that our community should be organized to allow all our citizens to “Age in Place” and retain their independence for as long as possible and that we seek to treat all age groups, both the young and the old, equitably. The recent analysis done by ULI and the BCC appointed stake-holders committee focused on the need for workforce housing. It is clearly a growing crisis. But little was said about senior housing needs which parallel those of the workforce and require basically the same solution. Collier County’s current demographic indicated that 31.4% of our population are over 65 and more than half are over 50. We expect that most of the newcomers will be retired millennials. By the time Collier County is built out, a majority of our citizens will probably be over 65. We need to build homes that are affordable for them as well as the added workforce needed to support them. It is not unreasonable to assume that four or five low income seniors will stand in line for affordable housing beside every worker. The demand for affordable housing has been vastly underestimated by focusing only on workforce needs. “UNIVERSAL DESIGN” AS A HOME PURCHASE OPTION FOR SENIORS In addition to the need for more senior housing units there is the issue of redesigning our new homes to better fit senior needs. There are new home designs created by organizations such as the National Association of Home Builders and AARP that detail changes to the interior construction of homes that make them “age friendly” for residents throughout their life cycle. The life-cycle extends from their first home purchase when they were younger and physically active to the final period in their lives where many are limited in mobility and find it difficult to live in a home with a conventional layout. Conventional in the sense that they are often multi-level and have high cabinets and narrow doorways among other things. The new recommended lay-outs is being called “Universal Design”. We believe the Commission should direct the staff to evaluate a requirement that all new home developers offer a Universal Design option to all new home buyers. Making the modifications involved in Universal Design are low 10.A.1 Packet Pg. 84 Attachment: SAC Final Draft Report to BCC Apr 9 2019 (8524 : Senior Advisory Committee Final Report) 6 | P a g e cost when included before the unit is built out but far more expensive if made to an existing structure. The National Association of Home Builders estimates that the cost of basic Universal Design modifications to a new home before it is built- out could be less than $300.00 USD. We emphasize that we are advocating requiring that new home developers offer a universal design option to buyers but not mandating that anyone use it. TRANSPORTATION AND SAFETY There are four issues of interest in the transportation and safety area that are short term and have low-cost fixes. If we are going to create an “Age-Friendly” “Livable” community, we need to concern ourselves with issues of senior mobility. In other words, we need to focus on making our public and commercial spaces friendly to residents of all ages. 1. There are areas of the County that need additional sidewalks and more streetlights, particularly in the Immokalee area. Older seniors find it difficult enough to walk with a cane or walker during daylight over smooth surfaces. It is all but impossible when lighting is limited, or the surface is unimproved. The lack of both, in some areas, results in many seniors being effectively locked into their homes after dusk. 2. There is a clear need for more bus stop shelters and benches for the CAT system. Seeing an older senior sitting on the curb in the sun at a bus stop in mid-August is an absurdity in a county as wealthy as Collier. If money cannot be found in the County Budget, we should explore allowing private sector entities to pay for the shelters and benches and being acknowledged by placing their name or ad on them. This can be done with dignity and without crass or offensive signs we all seek to avoid. Your staff has estimated that this can be done at a cost of only $35,000 per shelter. 3. We need to examine the feasibility of placing pedestrian islands halfway across some of our large and high traffic roads, particularly those that are six lanes and more in width. Low mobility seniors are afraid to attempt to cross in the time allocated before the light changes. We understand that 10.A.1 Packet Pg. 85 Attachment: SAC Final Draft Report to BCC Apr 9 2019 (8524 : Senior Advisory Committee Final Report) 7 | P a g e light timing is dictated by concerns about traffic flow, but it should also be dictated by concerns for seniors with lower mobility. 4. The issue of placing cement curbs at the end of parking spaces in our public parking lots needs to be reexamined. The list of complaints by residents, both older and younger, who trip over them when walking between parked cars is too large. An informal survey of lots that do not include the curbs indicate no increase in disarray or neatness. In many locations, they may be more dangerous than beneficial. HEALTHCARE The principal concern expressed by seniors in the health care area is the growing shortage of primary care physicians who are willing to accept Medicare and Medicaid patients. Even if they can find a willing physician, they are faced with long delays before they can be seen. This is a national problem and probably cannot be solved locally. It reflects the turmoil that exists in the private sector and government medical insurance programs. In any event, the solution to this problem is beyond the scope of the Senior Advisory Committee. We can only acknowledge that it exists and that for those affected, represents a serious problem. EDUCATION AND SOCIAL SERVICES Education is an area outside of the scope of the Committee’s charter. Collier County operates a small social services division. Its primary purpose is to operate several state and federal programs in access to housing, transport assistance and food distribution. The staff has advised the Committee that its active client list currently is around 200+ and that there is a waiting list of more than 700 qualified needy residents. The county staff indicated that they take a passive approach to identifying needy citizens in that they wait for them to come to the county offices and sign up for services. In a county with more than 125,000 senior citizens, serving 200 needy is miniscule. 10.A.1 Packet Pg. 86 Attachment: SAC Final Draft Report to BCC Apr 9 2019 (8524 : Senior Advisory Committee Final Report) 8 | P a g e Moreover, the needs studies found that many needy citizens do not know what services are available or how to find them. This is a specific area in which information dissemination is wanting. CITIZEN WELLBEING AND COMMUNITY COHESION Most seniors are very satisfied with the level of community wellbeing and are proud of the awards given to Naples by groups like Blue Zones and others. However, there is a continuing concern about how we're handling new construction and growth. We continue to build our new neighborhoods based on the availability and use of the automobile. We are building sprawl of the worst kind. The new neighborhoods are not walkable or bikeable. They are isolated from the commercial services and social centers that seniors need and want. They do not contain enough mixed or affordable housing. They are not friendly to older seniors, working poor or beginning professionals. We need to look at how we plan our new communities as we grow to the East. Since WW II, we have developed our road systems and our suburban housing areas on the assumption that almost all citizens have access to an automobile. As our average life expectancy has extended well into the 80s and is headed for the 90s, seniors are outliving their ability to drive safely. We need to rethink the layout of our neighborhoods. Numerous organizations have begun to address this problem and have come up with plans to redesign neighborhoods and commercial centers to accommodate the need of the growing and aging population. Among these are AARP with its “Livability” programs and the National Association of Home Builders with its “Universal Design Program” mentioned earlier. We believe the Commissioners would benefit from a review of these programs. ISOLATED SENIORS There is one issue that probably should fall under this category and that is the identification of isolated seniors prior to any emergency such as a hurricane. The experience with IRMA confirmed that there are numerous seniors living alone that were not accounted for when most were evacuated before Irma arrived. 10.A.1 Packet Pg. 87 Attachment: SAC Final Draft Report to BCC Apr 9 2019 (8524 : Senior Advisory Committee Final Report) 9 | P a g e Seniors that are isolated either due to physical isolation or loss of their social support networks are a growing concern. There is no centralized list identifying them. Many separate groups such as churches, food distribution charities and Government operated social services have partial lists but there is no central clearing house or list that can be made available to police or EMS personnel during an emergency. The committee looked at several options and following discussions with EMS personnel, it was determined that the use of the of the CERT teams would be the ideal, low cost solution. Since these team will be given specific geographical areas of responsibility and be responsible for reporting back through the EMS network the level of damage and emergency needs in their zone, it would be a simple add on to require them to identify those isolated seniors in their areas of responsibility. This could be done as part of any annual exercise of the network scheduled before an emergency occurs. Since these teams will be the first trained responders with individual portable communication to enter their zones, they are the ideal organization to assume responsibility for this requirement. This could take a significant burden off the Emergency Centers that otherwise would spend many hours responding to out of County calls from relatives and friends checking up on these seniors when they cannot contact them. One idea would be for the BCC to declare a Senior Day on a Saturday in late Spring and in conjunction with Collier County School District and the Sherriff’s Office to form teams that could do a door to door survey of each CERT area. The school district could encourage and organize volunteer high school juniors and seniors to fill out the teams as part of a county wide “Civic Day”, not dissimilar from “Earth Day” programs In sum, the Committee has found several issues affecting seniors that we think are deserving of the Commissioner’s attention. Most require a programmatic approach to solve the problem. The restrictions imposed by Florida’s Sunshine laws make it difficult for an advisory committee such as ours to organize solutions for the problems identified. 10.A.1 Packet Pg. 88 Attachment: SAC Final Draft Report to BCC Apr 9 2019 (8524 : Senior Advisory Committee Final Report) 10 | P a g e CREATION OF COMMUNITY PARAMEDICS CORPS A final problem identified by the Committee involves follow-up on patients discharged from our hospitals without suitable support in their homes to ensure that the patients follow discharge instructions on medications and physical therapy. A similar problem exists for the Fire and EMS services when they make an emergency call on a patient requesting assistance and determine that the patient is not sufficiently injured to require transport to the Emergency Room. Many of these calls are repeat calls for patients that have fallen repeatedly or who are mismanaging their prescribed drugs or alcohol. There is no organized follow-up to ensure that their primary care physicians are notified, or other remedial action is taken. This problem is not unique to Collier County. It has been reported in many communities throughout the United States. The recommended solution is the creation of a County Paramedic Corps consisting of a few individuals trained to conduct follow-ups. This would save the expense and unnecessary dispatching of Fire and EMS assets and would likely pay for itself in saved trips and avoidable readmissions to our hospital system. We recommend that the Commission instruct the staff to evaluate this option and develop recommendations for action. SUMMARY These are our recommendations to the Commissioners. We believe they can be implemented without significant budgetary or programmatic changes and ask that they be considered by the Commissioners. Respectfully submitted Charles D. Hartman Chair Senior Advisory Committee 10.A.1 Packet Pg. 89 Attachment: SAC Final Draft Report to BCC Apr 9 2019 (8524 : Senior Advisory Committee Final Report)