One of the oft quoted witticisms of Ronald Regan was when he said: “The nine most terrifying words in the English language are: I'm from the government and I'm here to help." These words were brought to mind at a conference I attended a few weeks ago. The discussion was around services and support for the elderly LGBT community. The comment was made that in talking with older folks the one thing that became very clear was that they did not care for the paternalistic attitude of the government telling them what needed to be done but rather would prefer to be asked.

Now that we are a fully licensed and certified member of the Long Term Support Services component of the state, we follow with an even greater interest the ideas and changes that are being talked about in Sacramento right now with particular reference to the Master Plan for Aging.


Having just been through the arduous process of becoming licensed to provide services, we have experienced firsthand the baffling redundancy, the contradictions among various agencies and the overwhelming regulations that have to be met that have little to do with the quality of patient care, whether the food tastes good or, in seems in some cases, that they replace old fashioned common sense. One of my favorite regulations we had to write up on a day when we were being tested by one of agencies we are governed by is what I have termed our “Zombie Apocalypse Policy”. It was noticed we did not have a policy to cover what we should do if there was a major catastrophic event in our area and we had people arriving at our door for help. But, do not fear, we now have a policy that handles that eventuality safely tucked away in our book of over 600 regulations.

One of the recommendations before the Long Term Support Service group working on the Master Plan is to reduce the number of agencies by combining and restructuring the agencies in the attempt to reduce the current silo effect that is so prevalent in healthcare and government. An example posed is the combining of the area office on aging agencies with the adult protective services group and the conservator and guardian program. Having dealt with each of these agencies over time, it is understandable how they would benefit from more cooperation and communication but in practice they might be seen not to share too many people across the bell shaped curve of the aging population. Would be interesting to ask some of us who actually provide services to these disparate populations.

We have worked for years on trying to find the combination of services that can be delivered across a vertical delivery system the way services are needed. This is termed a continuum of care starting with easy access and support all the way along the road.


The roadblock has always been that services are delivered in horizontal silos and, even more importantly, paid for in an episodic and horizontal manner further entrenching our current system.  It is our intent to develop more medial services to support the older population in a medical hub that allows them to receive services in a central and comprehensive space allowing each person to focus on their quality of life, their relationships and their enjoyment of everyday. We don’t expect the systems of payment nor the systems of care to keep up with us, but we will be working with the governmental agencies to see if they can at least follow us. We are committed to keep asking folks what they need and will what will make their lives better and providing those service at the lowest cost and offering the highest access possible.  


If you are interested in reading the draft of recommendations to the Master Plan regarding LTSS – send me an email and I will forward you the current draft.