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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 community-
based 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 system-
wide perspective.

3. The LTC Director shall be able to oversee the expansion and improvement of a social-
medical 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.

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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 mid-
and 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.