Executive Summary

Introduction

In July 2001 the Federation applied for a grant from The California Wellness Foundation (TCWF) to support, build capacity of, and evaluate the Federation’s existing senior services, and to conduct a needs and resource assessment of local services for Latino seniors. TCWF awarded the Federation a two-year grant in the amount of $87,500. This report provides information about how the grant was used to meet these stated goals, including an assessment of services currently available to low-income Latino seniors who have cultural and linguistic barriers to accessing services.

The Federation’s proposal to TCWF indicated that a consultant would be hired to conduct the needs assessment and contribute to Federation capacity building by acting as a liaison to the seniors services community. Cheverton & Associates (C&A), a San Diego-based consulting firm with expertise in research, evaluation, needs assessment, program design, grantsmanship, training, and networking, was contracted to perform these tasks, beginning work in February 2004. More information about C&A is available at www.cheverton.net.

In conducting the needs assessment and evaluation, C&A sought answers to questions about:

· Needs and gaps in services for Latino seniors considered important by service providers in San Diego County, and how to address them.

· Standards of practice for providing social services support to Latino seniors.

· Promising practices for services to Latino seniors.

· Issues and options related to planning and coordinating more effective services to Latino seniors.

Qualitative and quantitative methods consisted of:

· Face-to-face and telephone interviews.

· Archival review, document analysis, and online research.

· Participant observation of the Federation’s Senior Services Program

· An online survey of service providers.

Methodology

For the Needs Assessment, Researchers used a combination of quantitative and qualitative methodologies to obtain information about senior services for low-income Latino seniors in San Diego County and about standards of care for such services nationwide. Quantitative methods included a written online survey for which C&A sent out approximately 500 electronic invitations to participate. C&A also announced the survey at several meetings of senior services providers. In addition, County HHSA AIS and Elderhelp posted a link to the survey on their websites. Qualitative methods included in-person and phone interviews with 22 subject matter experts, document and website research.

Needs Assessment

Online Survey

To assess service assets for Latino seniors in San Diego County, to learn more about how others provide services and their perceptions of gaps in the system of care, and to offer suggestions for how the Federation can help improve service delivery to its seniors target population, C&A created and conducted an on-line survey and conducted interviews with key stakeholders. Tables detailing responses to each question in the online survey are in Attachment 5.

A total of 61 individuals completed the survey. Due to the small geographic area where most of the population targeted by the Program resides, we decided to open the survey to providers of senior services throughout the county. We learned that problems we identified are similar across all areas of our large and diverse region because substantial populations of poor Latinos are scattered throughout the region. Along with other research presented in this report, the survey results paint a picture of a substantial gap in services for a silent population of low-income elderly Latinos who do not speak English or who may have limited or no social or family support.

Survey responses revealed a clear pattern, as respondents raised the same issues repeatedly in various contexts. Whether discussing needs and gaps in the service delivery system, obstacles to filling gaps, barriers to service access for the target population, or the best ways to improve services and address or eliminate access barriers, respondents sent a consistent and familiar message. Issues associated with meeting the needs of low-income Latino seniors are predictable and unsurprising, and the issues associated with meeting their needs effectively are reasonably consistent with issues identified in research among other age groups that hold traditional Latino cultural values. In compiling, analyzing, and synthesizing survey responses, researchers drew the conclusions below based on themes that emerged from the data:

· More funding is needed.

· Outreach practices are inadequate to reach the target population in culturally and linguistically relevant and appropriate ways.

· Bilingual does not necessarily equate with bicultural, even among Latinos. We have not adequately prepared Latino youth to obtain advanced education nor motivated them to develop professional careers in “helping professions.”

· Lack of adequate transportation remains one of the foundational barriers for members of the low-income Latino community.

· Individuals see the benefits of interagency and interdisciplinary collaboration, but organizations have not fully committed to or adequately invested in collaborative projects and processes.

Key Stakeholder Interviews

Researchers conducted 22 face-to-face and phone interviews with key informants on the subject of services to low-income Latino seniors. Individuals we interviewed included experts and leaders in government, private, and nonprofit organizations. Interview subjects told us about senior service programs their organizations either operate or support, how services could be integrated better, how to reach Latino seniors and how to enhance senior services to low-income Latinos in the San Diego community. They also gave us their views on needs and gaps in serving Latino seniors, which are discussed in full below.

Needs Assessment Findings

In compiling, analyzing, and synthesizing interviews, online surveys, archival materials, and a research of standards of care and literature, researchers drew the conclusions below about the themes that emerged.

Low-income Latino seniors need greater access to services.
Organizations need more bilingual/bicultural staff to effectively serve Latino seniors.
Organizations serving seniors do not adequately collaborate and integrate services for low-income Latino seniors.
Low-income Latino seniors may not seek necessary services because of their fear of government institutions and/or immigration issues.
Inadequate funding to sustain or expand existing senior programs or to establish new senior programs negatively impacts low-income Latino seniors, who may be left out when resources are scarce.
Lack of affordable housing is a desperate issue among low-income Latinos.
Illiteracy and low-literacy in Spanish and English creates dependency in low-income Latino seniors since they need others to explain documents, applications etc. to them.
Traditional cultural values may deter low-income Latino seniors from seeking preventive health care or help outside the family, leading them into lives of isolation until a crisis occurs.
Coordinated outreach is required across disciplines to inform low-income Latino seniors of their rights and the benefits to which they may be entitled.
Government policies as well as organizational policies must be changed to allow easier access to health care and other services for low-income Latino seniors, if we are to effect savings over the long term.
Some low-income Latino seniors are denied benefits or health care based on residency or immigration issues. These issues may also prevent Latino seniors from requesting assistance based on fear that they will be deported.
Transportation is one of the highest concerns for low-income Latino seniors. Without adequate, efficient transportation, they cannot maintain their independence, and become dependent on others for daily existence, as well as in times of crisis.

Recommendations

1. The Federation should increase efforts to aggressively network and collaborate with other organizations serving seniors in San Diego County, with the aim of developing, initiating, and spearheading an effective partnership and regional planning coalition to advocate for Latino seniors and to improve and expand outreach and direct services to a larger population of culturally and/or linguistically isolated low-income Latinos in the project target area[*] and throughout San Diego County. Potential issues for the coalition to explore arise from the Needs Assessment and include (but are not limited to):

a) Availability of funding and collaborative fund-seeking approaches.

b) Lack of Spanish literacy among non-English-speaking low-income Latinos.

c) Developing ways to promote careers in the helping professions among young people and others with bilingual and bicultural skills.

d) Using existing delivery systems (e.g., social services, I&R services, healthcare, schools, and other sectors to disseminate needed information about available services to low-income Latino seniors, their families, caregivers, and other stakeholders.

2. The Federation should promote self-sufficiency among the broader population of culturally and linguistically isolated low-income Latino seniors by building their capacity, and the capacity of their family members and/or caregivers, to access and receive benefits for which they are eligible, by developing, facilitating, and/or sponsoring training classes on available benefits and application procedures for Social Security, Medicare and Medi-Cal, tax credits, ways immigration laws may affect eligibility for benefits, etc., as well as Spanish literacy classes for illiterate Spanish-speakers. Such classes should be conducted in neighborhood settings easily accessible to seniors and their families, by culturally competent bilingual trainers selected by the Federation or another appropriate entity.

3. The Federation should consider developing an internal information and referral (I&R) database of services specifically relevant and useful to low-income Latinos of all age groups, categorized by age group and cross-referenced by service category. This reference guide would allow Federation personnel, regardless of program or expertise, to quickly and efficiently direct any client to culturally competent, linguistically appropriate services, creating a “no-wrong-door” service environment that would better serve the Federation’s constituency.

The database would then serve as the basis for a printed brochure containing referral information for services typically needed by low-income Latinos. The Federation should seek separate funding for this project.

4. The Federation should consider developing written agency-wide standards and evaluation procedures for both linguistic and cultural competency that are attentive to the wide variety of traditions and multi-cultural and multi-ethnic origins of those who constitute the Latino population in San Diego County.

I. Purpose of the Study

[Deleted from this abridged version.]

II. Assumptions and Limitations of the Research

[Deleted from this abridged version.]

III. Methodology

Introduction

In this study, C&A used a combination of quantitative and qualitative methodologies. Quantitative research allowed C&A to study local senior service issues raised by providers and other stakeholders using standardized, objective measures. Quantitative methods included the online survey of providers serving seniors, which was distributed as described earlier. C&A also used qualitative methods to compare documents and narratives, including transcripts of face-to-face and phone interviews with key informants;[†] analysis of responses to qualitative survey questions; and analysis of archival materials.

Researchers reviewed websites and archival and additional resource materials, observed the Federation’s Senior Service Program operation, and conducted key informant interviews with 22 local senior service providers, subject matter experts, and other key stakeholders. Copies of the interview questions and the survey instrument used in this study are in Attachments 2 and 3 respectively. We were careful to seek and include input from members of a range of disciplines and sectors that individually and collectively have a significant stake in the outcomes of our region’s senior service programs.

Overall Research Questions

C&A pursued three main branches of inquiry:

· What senior service issues are of paramount interest to those who provide services to Latino seniors?

· How can the Federation help bridge gaps in services for Latino seniors?

· How can the Federation’s Senior Services Program improve in providing services to Latino seniors?

Specific Methodologies

Qualitative Research

Archival Document Review

To gain context for our research and to better understand the Federation’s goals and objectives, C&A thoroughly reviewed and summarized documents provided by the Federation at the initial project meeting as well as those provided by the Federation’s Senior Services Program.[‡] Later, additional documents were reviewed on-site at the Senior Services Program to gain further insights into the Program and its practices. We also reviewed and analyzed documents located online and provided by other organizations, including the Survey of Senior Americans conducted by County of San Diego AIS, results of which were published in September 2003 and discussed further in other sections of this report.

Key Informant Interviews

Researchers conducted 22 face-to-face and phone interviews with local key informants during April through July 2004. Key informant interviews allowed C&A to gather both information about programs and services, and opinions about senior service issues. Criteria used to identify interview subjects included their:

· Personal knowledge of or involvement in local senior service delivery.

· Personal knowledge of or involvement in local services to Latino seniors in other disciplines.

· Positions as stakeholders in senior services delivery outcomes or services to seniors.

· Identification by C&