LONG TERM CARE COORDINATING COUNCIL Guiding the development of an integrated system of home, community-based, and institutional

services for older adults and adults with disabilities DRAFT: October 12, 2005

The Selection of a Long Term Care Director
Background. Long term care does not mean only nursing home care anymore. Today, in addition to nursing home care, there are many home and community-based options to assist older adults and adults with disabilities to maximize self-sufficiency, safety and health, and remain living in the community as long as possible. Older adults and adults with disabilities are living longer with functional impairments and chronic conditions. In San Francisco, long term care refers to a range of social, health, mental health, medical, supportive housing, and other supportive services to assist people in maintaining their independence, and assure their individual dignity and choice. San Francisco’s continuum of long term care services includes a significant number of risk prevention and health promotion services like nutrition programs, transportation, senior centers, community services, and caregiver services, among others, to support independence, maintain functional ability, and prevent further disability. Long term care and supportive services can be provided in home and communitybased settings as well as in institutional settings, depending on need and choice.

Principles for Selection of a Long Term Care Director
1. A Long Term Care (LTC) Director shall provide citywide leadership over all issues related to long term care for older adults and adults with disabilities. 2. The LTC Director shall have the necessary authority to ensure that LTC policy is implemented in a manner that benefits LTC needs of San Franciscans from a systemwide perspective. 3. The LTC Director shall be able to oversee the expansion and improvement of a socialmedical model of LTC service delivery in San Francisco. 4. The LTC Director shall be charged with the responsibility to provide oversight and direction for all home, community-based and institutional LTC programs and services. 5. The LTC Director shall have experience and expertise with home and community-based LTC programs and services as well as experience with nursing homes. 6. No matter where the position of LTC Director is located, there needs to be a significant cross-departmental effort to expand and improve LTC services. a. The LTC Director shall work cooperatively with DPH, DHS, DAAS, and the institutional leadership of Laguna Honda & San Francisco General Hospital. b. The LTC Director shall work with the Mayor and the Board of Supervisors to carry out city policies related to scope of responsibilities for LTC programs and services. c. The LTC Director shall oversee the expansion and improvement of all community-based LTC programs and services.

Recommendations for the Location of a Long Term Care Director
1. The LTC Director will need to have appropriate staff support and infrastructure to perform effectively. 2. The LTC Director should be located within a city department as opposed to the Mayor’s Office. Past experience with the Mayor’s Office of Homelessness demonstrated that placing a significant position and function in the Mayor’s Office, without budget authority, staff or infrastructure, was not successful. 3. The LTC Director should not be placed within the Department of Public Health (DPH) because the medical model in this department supersedes home and community-based services. a. There should also be a position in DPH dedicated to long term care in order to have a greater focus on this issue within this department. b. However, this position should not be the LTC Director that oversees the entire service delivery system, which is based on a social-medical model. 4. The best location for the LTC Director is within the Department of Aging and Adult Services (DAAS) because it fits with this department’s mission: The mission of DAAS is to assist older adults and adults with disabilities, and their families, to maximize self-sufficiency, safety, health and independence so that they can remain living in the community for as long as possible and maintain the highest quality of life. DAAS coordinates an integrated, comprehensive range of social, mental health, and long term care services that fosters independence and self-reliance in the most enriching environment. 5. DAAS, as part of the Human Services Agency, has the necessary infrastructure and staff support that is required to facilitate the work of the LTC Director.

Recommendations for the Success of a Long Term Care Director
1. Defining the scope of responsibility. Based on recommendations from the commissions of the departments of Aging and Adult Services, Health, and Human Services, as well as the recommendations of the Long Term Care Coordinating Council, the Mayor and the Board of Supervisors should determine the scope of the county responsibilities in regard to long term care services. 2. Delineating the scope of responsibility. To clearly delineate this scope, the Living with Dignity Strategic Plan should be reviewed and amended, where appropriate, with achievable goals, objectives and strategies, in terms of expanding supportive housing and community-based LTC services for older adults and adults with disabilities – over a ten year period. 2

3. Endorsement. The Mayor and the Board of Supervisors should, within this scope, endorse the provision of community-based LTC services whenever possible. 4. The Mayor’s commitment: The Mayor should designate long term care as one of his top priorities and communicate this to his staff. a. The Mayor should create a cluster group that focuses on long term care – just as there is now one cluster group focused on housing and another cluster group focused on homelessness. b. This cluster group - like other cluster groups - should meet every two weeks (or monthly) to coordinate departmental efforts and to implement the 10-year plan. c. The department where the LTC Director is located should chair the LTC cluster group. d. The director of the Mayor’s Budget Office should attend LTC cluster group meetings. 5. The departments’ involvement: There needs to be significant level of involvement from the departments of Public Health, Human Services, Housing, & Aging and Adult Services to improve the delivery of LTC services. a. The departments of Public Health, Human Services, Housing, & Aging and Adult Services should to commit to their roles and responsibilities to achieve the goals, objectives and strategies identified. 6. The LTC director’s role: The role of the LTC Director should be to coordinate the work of the different county departments and community-based service providers. a. One of the primary roles of the LTC Director is to promote ongoing communication and coordination among county departments. b. This individual should be able to encourage and facilitate coordination at a midand upper management level. Without this high level coordination among departments, the success of the LTC Director will be severely hampered. c. This individual should have the power of persuasion to get the departmental directors to think in terms of crafting their budgets in a manner that promotes the achievement of the goals, strategies and objectives of the 10-year plan. d. Another role of the LTC Director is to promote ongoing communication and coordination among and between community-based LTC programs and services, and those programs and services provided by county departments.

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