1. Board and Care Residents – Percentage of Total (30,000) San Diego County Public Mental Health Services Consumers

2. Operator Survey 89 Total B & C Operators Surveyed (All Types)  43 Adult Mental Health Operators (43% of all adult, MH facilities in SD County) 64% Female – 36% Male Average Age = 48 Average Years in Operation = 9.2 Average # beds = 12.2 Average Length of Resident Stay 5.2 Years (Range 2 months to 20 years) Average # Residents w/ Chronic Medical Condition = 3.4

3. B & C Operators (MH Facilities) Education Level

4. (%) Ethnicity MH - Residents / Operators

5. Adult Mental Health B & C Operators Years of Operation Facilities

6. MH Operators – On a scale of 1-10, is operating a board and care good business? Mean Rating: 6.6

7. Size of Facilities – Number of Beds

8. Resident Average Length of Stay in Years (69% > 5 years)

9. Residents w/ Chronic Medical (non-psychiatric) Conditions ( 81 Residents in 25 facilities) 30% of facilities have > 4 residents w/chronic conditions Facilities Residents w/ Chronic Conditions

10. Resident ER Trips in Previous 3 Months 28 Facilities report a total of 217 ER visits in the last 3 months 39% of reporting facilities = 10 or more visits in last 3 months

11. Residents and Doctors ( 37 Residents Surveyed) Yes, I have a (physical health) doctor?……….74%  Have a doctor and know their name: …………….. 31% 15 months or more since last physical exam: …… 65%  More than 2 years …………………………………….. 30% 15 months or more since last dentist visit:……….. 56%  More than 2 years ……………………………………. 24% Doctor spends 15 minutes or less / appt…………. 52% B&C Uses “Mobile Physicians” …………………… 48%  Once a month or less ………………………………... 62%

12. WHAT HAVE WE LEARNED? A lot more information needs to be gathered.  A system needs to be created to track and report basic information regarding the condition and operation of facilities, resident health status, resident service needs, utilization rates of residents, etc. It must be recognized that B&C is a housing issue.  People are stuck, with nowhere to go and no way to get there.  The fear residents have of losing their housing effects all aspects of the environment in a real and negative way. There is no real oversight by anyone.  Licensing isn’t / can’t do the job.  Title 9 Advocates aren’t available.  There is no accountability and no incentive for owner/operators to provide quality services.

13. WHAT HAVE WE LEARNED? There is systemic non-compliance with basic regulatory requirements, particularly as it relates to hospital discharge planning, physical health assessments, mental health assessments, Needs and Services Plans, resident rights, and resident councils. (Even the best facilities are substantially out of compliance.) Cultural issues are significant and are not being acknowledged and/or addressed. Residents are unaware of their rights, their choices regarding healthcare, how to access services of all types and are overly dependant upon case managers, clinical providers, conservators, and board and care operators/staff to meet their needs “Passive dependency” is pervasive as residents are generally unmotivated to better their circumstances.

14. Access to Healthcare Problems  SSI linked Medi-Cal beneficiaries don’t get information they are entitled to regarding their choices.  Finding providers is problematic.  Serious lack of discharge planning from acute hospitals, psychiatric and general.  Resident dependency on case managers, others.  Chronic failure to communicate between health providers, particularly mental health and “non-mental health” providers.