Napa City Council
August 16, 2022

955 School Street
Napa, CA 94559
www.cityofnapa.org

CITY OF NAPA
MEETING MINUTES - Draft

CITY COUNCIL OF THE CITY OF NAPA
Mayor Scott Sedgley
Vice Mayor Mary Luros
Councilmember Liz Alessio
Councilmember Bernie Narvaez
Councilmember Beth Painter
3:30 PM City Hall Council ChambersTuesday, August 2, 2022 3:30 PM Afternoon Session
6:30 PM Evening Session
3:30 P.M. AFTERNOON SESSION

1. CALL TO ORDER: 3:30 P.M.

1.A. Roll Call:

Councilmember Alessio, Councilmember Narvaez, Councilmember Painter, Vice Mayor Luros, and Mayor Sedgley

Present: 5 -

2. AGENDA REVIEW AND SUPPLEMENTAL REPORTS:

Deputy City Clerk Pascoe announced the following supplemental documents:

Item 3.A: PowerPoint presentation from Elaine Clark, Executive Director of the Napa/Solano Area Agency on Aging.

Item 7.A: PowerPoint presentation from Staff.
(Copies of all supplemental documents are included in Attachment 1)

3. SPECIAL PRESENTATIONS:
(See supplemental document in Attachment 1)

3.A. 259-2022
Napa/Solano Area Agency on Aging Presentation
Assistant City Manager, Liz Habkirk, introduced Elaine Clark, Executive Director of the Napa/Solano Area on Aging, who provided the presentation on Age Friendly Designation. Following the presentation, Council commented and asked questions of Ms. Clark.

ATTACHMENT 1

August 2, 2022CITY COUNCIL OF THE CITY OF
NAPA
MEETING MINUTES - Draft

4. PUBLIC COMMENT:

Jim Hinton - expressed his approval on cannabis access within City limits.

Announced his next area of focus would be upgrading the City's parks.

5. CONSENT CALENDAR:

Approval of the Consent Agenda
A motion was made by Councilmember Painter, seconded by Councilmember Alessio, to approve the Consent Agenda. The motion carried by the following vote:

Aye: Alessio, Narvaez, Painter, Luros, and Sedgley5 -

5.A. 282-2022
City Council Meeting Minutes
Approved the July 19, 2022 Regular Meeting Minutes.

5.B. 274-2022 Emergency Solutions Grant
Adopted Resolution R2022-071 approving an application for funding of a grant agreement and any amendments thereto from the 2022-2023 funding year of the State ESG Program, Balance of State Allocation NOFA and authorizing the City Manager to: (A) submit the application on behalf of the City to the California Department of Housing and Community Development (“HCD”) in an amount of up to $200,000 for homeless street outreach; and (B) execute a grant agreement and any amendments thereto with HCD.

Enactment No: R2022-071

5.C. 281-2022
Monthly Budget and Investment Statement
Received the Monthly Budget and Investment Statement as of May 31, 2022.

6. ADMINISTRATIVE REPORTS:

6.A. 265-2022 Proclamation of Local Emergency to Respond to the Coronavirus (COVID-19)
City Manager Potter provided the report.

There were no requests to speak from the public.

A motion was made by Councilmember Narvaez, seconded by Vice Mayor Luros, to continue the Proclamation of Local Emergency authorizing the City Manager to take actions necessary to respond to the Coronavirus (COVID-19); and ratify actions taken by the City Manager in implementation of the Proclamation of Local Emergency. The motion carried by the following vote:

August 2, 2022CITY COUNCIL OF THE CITY OF
NAPA
MEETING MINUTES - Draft

Aye: Alessio, Narvaez, Painter, Luros, and Sedgley5 -

7. PUBLIC HEARINGS:

7.A. 239-2022 Outdoor Dining Municipal Code Amendments
(see supplemental document in Attachment 1)
Mayor Sedgley asked Councilmembers if they had any information to disclose learned outside of the hearing. Councilmember Narvaez spoke with several local business owners to clarify the agenda item.

Councilmember Alession spoke with Los Gatos City Manager and staff regarding their parklet program.

Senior Planner Michael Walker provided the report.

Mayor Sedgley opened public testimony. There were no requests from the public to speak, Mayor Sedgley closed public testimony.

Discussion was brought back to Council. Brief individual Council comments and questions ensued.

A motion was made by Councilmember Painter, seconded by Councilmember Narvaez to:
1) approve the first reading and introduction of an Ordinance amending the Napa Municipal Code by repealing existing Chapter 12.64 "Outdoor Dining in Public Rights of Way" in its entirety and replacing it with a new chapter 12.64, "Outdoor Dining on City Property," and determining that the actions authorized by this ordinance are exempt from CEQA; and
2) approve the first reading and introduction of an Ordinance amending the Napa Municipal Code Section by repealing existing section 17.52.340 "Outdoor Dining" in its entirety and replacing it with a new section 17.52.340, "Outdoor Dining," and determining that the actions authorized by this ordinance are exempt from CEQA. The motion carried by the following vote:

Aye: Narvaez, Painter, Luros, and Sedgley4 -
No: Alessio1 -

8. COMMENTS BY COUNCIL OR CITY MANAGER:

Councilmember Narvaez encouraged Council and the public to attend a 9/11 Community Event presented by the Napa Rotary Club.

9. CLOSED SESSION:

City Attorney Barrett introduced the Closed Session item.

August 2, 2022CITY COUNCIL OF THE CITY OF
NAPA
MEETING MINUTES - Draft

9.A. 287-2022 CONFERENCE WITH REAL PROPERTY NEGOTIATORS (Government Code Section 54956.8): Property: Approximately 37,360 square foot portion of an access road across a 343-acre property (APN 032-010-078) generally located along the southeastern side of Lake Hennnessy and south of SR-128, taking access from SR-128. Under Negotiation: price and terms of payment. City Negotiators: Steve Potter, Phil Brun, Joy Eldredge, Michael Barrett. Negotiating Parties: City of Napa, and the following property owners:
• Chappellet Vineyard, LLC.
• Chappellet Winery, Inc.
• Mary Alyce Chappellet
• Dominic Chappellet
• Cyril Scott Chappellet
• Cyril Donn Chappellet
• Lygia Chappellet
• Jon Mark Chappellet
• Carissa Chappellet
• Alexa Chappellet
• Luanne C. Wells and Paul Heeschen, Trustees of the Palm Trust • Daniel L Wojtkowiak , Trustee of the Wojtkowiak Daniel L Trust • TMR Wine Company, LLC.
• Timar, LLC.
• Timothy J. Mondavi
• Villa Del Lago, LLC
• Bryant Vineyards LTD
• David Loveland McBride and Lee Ching, Trustees of the McBride David Loveland and Ching Lee Trust
• Charles W Dunn
• Diane Murphy
• Nancy Killefer
• Robert E Cumby
CITY COUNCIL RECESS: 4:47 p.m.
6:30 P.M. EVENING SESSION

10. CALL TO ORDER: 6:30 p.m.

10.A. Roll Call:

Councilmember Alessio, Councilmember Narvaez, Councilmember Painter, Vice Mayor Luros, and Mayor Sedgley

Present: 5 -

August 2, 2022CITY COUNCIL OF THE CITY OF
NAPA
MEETING MINUTES - Draft

11. PLEDGE OF ALLEGIANCE:

Mayor Sedgley invited Napa Police Sergeant Medina to lead the pledge of allegiance.

12. AGENDA REVIEW AND SUPPLEMENTAL REPORTS:

Deputy City Clerk Pascoe announced the following supplemental items:

Item 14.A: Letter from Mr. Rasmussen withdrawing his Cultural Heritage Commission application.

Item 15.A: PowerPoint presentation from Staff.
(Copies of all supplemental items are included in Attachment 2)

13. PUBLIC COMMENT:

Jill Wollman - voiced concerns regarding unsafe working conditions at the Queen of the Valley emergency room.

Irena Miles - voiced concerns regarding parking issues on Beecham St. and safety hazards caused by too many cars parked on the street, including long term car storage in the neighborhood.

14. COMMISSION INTERVIEWS AND APPOINTMENTS:

August 2, 2022CITY COUNCIL OF THE CITY OF
NAPA
MEETING MINUTES - Draft

14.A. 251-2022 Cultural Heritage Commission Membership
Mayor Sedgley explained the appointment process and welcomed all applicants.

Interviews began with each applicant providing a brief, three minute introduction and statement, in the following order:

1. William Tuikka

2. Joshua Satten

3. Bruce Heid
Council questions of individual applications followed.

Each Councilmember voted, by paper ballot, to identify the three preferred candidates to be appointed to the Commission.

Deputy City Clerk Pascoe announced that the greatest number of votes were received by Joshua Satten with 5 votes, and William Tuikka with three votes.

She also announced the vote of each Councilmember for the candidates was as follows:

Mayor Sedgley: Satten, Heid.

Vice Mayor Luros: Satten, Tuikka
Councilmember Alessio: Satten, Heid
Councilmember Painter: Satten, Tuikka
Councilmember Narvaez: Satten, Tuikka
A motion was made by Vice Mayor Luros, seconded by Councilmember Alessio, to reappoint incumbents William Tuikka and Joshua Satten to the Cultural Heritage Commission for terms effective immediately through June 30, 2024, with William Tuikka continuing to serve as a Design Professional. The motion carried by the following vote:

Aye: Alessio, Narvaez, Painter, Luros, and Sedgley5 -

15. ADMINISTRATIVE REPORTS:

August 2, 2022CITY COUNCIL OF THE CITY OF
NAPA
MEETING MINUTES - Draft

15.A. 210-2022 Local Roadway Safety Plan
Receive a presentation on the recommendations from the draft Local Roadway Safety Plan.

Transportation Planner, Lorien Clark, joined by TJKM Transportation Consultants Cory Peterson and Ruta Jariwala provided the report.

Mayor Sedgley opened public comment.

Maureen Trippe, Slow Down Napa - recommended lower speed limits and "daylighting" which improves visual barriers.

Cindy Deutsch, Chair of BTAC - encouraged City staff to invest in grants.

Sharon Macklin - expressed concerned about Spruce Street as a speedway and is concerned about public safety.

Discussion was brought back to Council. Brief individual Council comments and questions ensued.

16. REPORT ACTION TAKEN IN CLOSED SESSION:

City Attorney Barrett announced that there was no reportable action taken in Closed Session.

17. COMMENTS BY COUNCIL OR CITY MANAGER:

Mayor Sedgley requested to add a presentation to the August 16, 2022 Council meeting agenda welcoming a delegation from the sister city, Motalcino, Italy; and raising their flag at City Hall.

Councilmembers supported the request.

18. ADJOURNMENT: 8:24 p.m.

Submitted by:
_______________________________
Samantha Pascoe, Deputy City Clerk

ATTACHMENT 1

SUPPLEMENTAL REPORTS &
COMMUNICATIONS Office of the City Clerk
City Council of the City of Napa
Regular Meeting
August 2, 2022

FOR THE CITY COUNCIL OF THE CITY OF NAPA
AFTERNOON SESSION:

SUBMITTED PRIOR TO THE CITY COUNCIL MEETING

3. SPECIAL PRESENTATIONS:

3.A. Napa/Solano Area Agency on Aging Presentation
• PowerPoint Presentation from Executive Director Elaine Clark. 1) Supplemental documents provided by Councilmember Alessio.

7. PUBLIC HEARINGS:

7.A. Outdoor Dining Municipal Code Amendments
• PowerPoint Presentation from City Staff.

202
2 Livable Community Designation – Why Get Involved?
Napa City Council
July 2022
aaans.org
City Council Regular Meeting
8/2/2022
Supplemental - Item 3.A.

From: Elaine Clark, Executive Director

Liva
ble
Communities
Include e
ssential
features that allow
residents of all ages
and backgrounds to
thrive.

Napa/Solano
Area Agency on Aging www.aaans.org

Liva
ble Community
Com
mitment
Napa/Solano
Area Agency on Aging www.aaans.org
• Lens of Older
Adults
• Intention
• Inclusion

Pro
cess
• Resolv
e to commit to the Livable
Community process
• Submit Letter of Intent and
Application
Napa/Solano
Area Agency on Aging www.aaans.org

Napa/Solano
Area Agency on Aging www.aaans.org
Bes
t Time to Act
• City Plan/Stra
tegic Planning
• Plan Reviews

Sta
ff Requirements
Napa/Solano
Area Agency on Aging www.aaans.org
• Point
Person
• Parks and
Recreation
• Communications
• City Manager
“How does this affect an 85-
year-old in our community?... Is
there something we haven’t
considered?”

Tim
eline
Year 1
– Join
Year 2 – Survey/Action
Plan
Year 3 – 5
Implementation
Napa/Solano
Area Agency on Aging www.aaans.org

Next
Steps

1. Commit to including
an age-
inclusive lens to planning

2. Commit to a 5-year process

3. Pick a Department
Champion

4. Complete the paperwork
Napa/Solano
Area Agency on Aging www.aaans.org

Que
stions?

Napa/Solano Area
Agency on Aging

Health Needs
Assessment
2019
BY: SOLANO PUBLIC HEALTH ADMINISTRATION
DATE: AUGUST 25, 2019

1 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019 Contents
Executive summary ....................................................................................................................................... 2 Introduction .................................................................................................................................................. 4 Methods ........................................................................................................................................................ 4 Demographics ............................................................................................................................................... 4 Findings: Focus Group and Key Informant Interviews .................................................................................. 6 Participant Information ............................................................................................................................. 6 Issues, Challenges and Barriers ................................................................................................................. 7 Gaps in Services ...................................................................................................................................... 10 Vulnerable Populations ........................................................................................................................... 11 Solutions ................................................................................................................................................. 11 Top Three Issues ..................................................................................................................................... 14 Top Five Requested AAA Services ........................................................................................................... 14 Findings: Community Survey ...................................................................................................................... 14 Safety and Help with Activities of Daily Living ........................................................................................ 14 Emergency Preparedness ....................................................................................................................... 14 Caregiving ................................................................................................................................................ 15 Legal Resources ....................................................................................................................................... 15 Healthcare Access ................................................................................................................................... 15 Economic Factors .................................................................................................................................... 15 Social Connectedness ............................................................................................................................. 15 Mortality Data ............................................................................................................................................. 15 Appendix A: Bay Area Regional Health Inequities Initiative (BARHII) Framework ..................................... 17 Appendix B: Methods.................................................................................................................................. 18 Appendix C: Focus Group Facilitator Guide ................................................................................................ 19 Appendix D: Area Agency on Aging Available Services Worksheet ............................................................ 22 Appendix E: Key Informant Interview Facilitator Guide ............................................................................. 23 Appendix F: Top 10 Requested Area Agency on Aging Services ................................................................. 25 Appendix G: Community Survey Data ......................................................................................................... 26 Appendix H: Detailed Mortality Data .......................................................................................................... 46

2 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019 Executive summary
To fully understand the health status and needs of the senior community and the drivers that influence health in this population, the Public Health Departments in Napa and Solano counties elected to undertake a comprehensive senior needs assessment. It is hoped that findings from the assessment will be used by different agencies, organizations and the senior and general communities to collectively work to address both long-term and short-term actionable solutions to ensure that seniors remain healthy and full participants of society.

The comprehensive senior needs assessment included focus group discussions, key informant interviews, a survey, mortality data analyses and data from publicly available resources for additional information.

ISSUES, CHALLENGES AND BARRIERS:

The key issues identified from focus group discussions and key informant interviews were grouped into 10 broad categories:
• Economic issues related to housing, healthcare, and food costs and a livable income; • Transportation accessibility to medical appointments as well as to other places like senior centers, libraries, Sunday service and other community events; • Healthcare access due to a shortage or lack of geriatric, primary, dental, mental and specialty care and limited pharmacy hours;
• Housing accessibility due to a shortage of smaller, single story homes that are senior friendly, especially to those with mobility issues, and a shortage of rental apartments, in part due to wildfires in recent years;
• Senior classes and education on various issues like fall prevention, healthy eating, disease management, using the computer, STDs and end-of-life planning; • Coordination of efforts and services between the County, cities, medical community and community organizations to ensure that the needs of seniors are met; • Isolation/social support/connectedness largely due to seniors losing their sense of purpose, leading to depression and chronic loneliness; this is especially important for the LGBTQI+ community depending on the support that they get from family and the community; • Belonging/inclusion/visibility due to seniors being excluded from many meetings, not having their voices heard and the stigma and negative stereotypes associated with seniors and the LGBTQI+ community;
• Institutional inequities due to lack of advocacy and funding for seniors and the government’s (from local to federal) role in developing policies that limit the benefits that seniors receive, such as SSI, and may not be senior-friendly, and the historical exclusion of LGBTQI+ on needs assessments that has contributed to the unmet needs of this community; and, • Heterosexism due to prejudice and anti-LGBTQI+ sentiments locally, nationally and globally and the hostility and bullying that they experience in certain environments.

3 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019 VULNERABLE POPULATIONS:

Below are the groups of seniors that were identified who were more vulnerable or would need extra assistance:
• Older seniors
• People of color
• Rural residents
• Non-English speakers and immigrants
• Undocumented immigrants
• Seniors with low socioeconomic
status or limited financial resources
• Those who are homebound or who
have mobility limitations that limit
their ability to leave home

SOLUTIONS:

Participants had many suggestions for potential solutions to the issues that were identified.

These were broadly categorized into five groups: intergenerational community, advocacy and policy, coordination of services, transportation and senior education/classes. • Intergenerational community through a broad range of solutions, such as co-location of senior housing and day care facilities or community events, where people from different generations and diverse backgrounds are co-located or frequently get together. This can build a strong sense of community where everyone belongs, a community that is inclusive and where everyone is “neighboring”.
• Advocacy and policy by: developing a community coalition or grassroots movement to advocate for the needs of seniors; elected officials engaging with the senior community and incorporating senior needs into city general plans; reducing regulatory burdens on care facilities; incentivizing the construction of smaller, single story homes that are senior-friendly and providing subsidies for seniors to add modifications to their homes that meet their specific needs; and, subsidies for caregiving services for seniors without insurance coverage or who are not eligible for IHSS. • Coordination of services by: developing senior navigator positions that connect seniors to available resources; fostering collaboration and partnerships between the cities, the County, healthcare providers and non-profits to address all of a senior’s needs; having a one-stop shop where seniors can get all the information they need; and, providing culturally-appropriate and sensitive training to providers related to seniors, people with disabilities and those who are LGBTQI+.
• Transportation by: expanding current transportation services to take seniors not just to medical appointments but to other places, such as the library, or events; subsidizing on-demand transportation along with assistance in booking the rides; coordinating with healthcare providers to schedule long-transit patients on the same day; and, having the Napa and Solano transportation authorities maintain a fleet of wheelchair accessible vehicles for nonprofits to borrow for free.
• Senior education and classes by offering classes and activities such as fall prevention and technology use, and creating satellite senior centers.

4 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019 Introduction
To fully understand the health status and needs of the senior community and the drivers that influence health in this population, the Public Health Departments in Napa and Solano counties elected to undertake a comprehensive senior needs assessment. It is hoped that findings from the assessment will be used by different agencies, organizations and the senior and general communities to collectively work to address both long-term and short-term actionable solutions to ensure that seniors remain healthy and full participants of society.

The frameworks of social determinants of health (SDoH), and equity and the Bay Area Health Inequities Initiative (BARHII) model (see Appendix A) were used in developing and facilitating the focus group discussions and key informant interviews and in developing the questionnaire. The World Health Organization defines SDoH as “the conditions in which people are born, grow, work, live, and age. These circumstances are shaped by the distribution of money, power and resources at the global, national and local levels” and PolicyLink defines equity as “the just and fair inclusion into a society in which all can participate, prosper, and reach their full potential.” The BARHII model (Appendix A) demonstrates the connection between social inequities and health and how addressing the upstream issues of social and institutional inequities through strategic partnerships, advocacy and policy affect the living conditions and the more downstream issues of health behaviors, disease, injury and mortality.

Methods
Primary data collection was performed through focus group discussions and key informant interviews and a survey. Mortality data from death records and data from publicly available sources were used to provide additional information. For more details on methodology, see Appendix B.

Demographics
In 2018, the combined total population of adults age 60 years or older in Napa and Solano counties was 135,074. Both counties are projected to have a significant increase among this age-group.

By 2024, Solano is projected to see a 23% increase and Napa is projected to see a 16% increase in the population of adults age 60 or older1 (Figure 1).

1 California Department of Finance, P2: County Population Projections (2010 -2060)

5 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019 Figure 1. Population of seniors age 60 years and Figure 2. Population of seniors age 60 years older in Napa and Solano Counties, 2018-2024 and older by sex, Napa and Solano County combined, 2018

The mean household income for seniors age 65 or older in Napa is about $79,000 and in Solano it is about $61,000. However, almost 8% of seniors in Napa and 7% of seniors in Solano live below the federal poverty line2, which is approximately $17,000 for a household of two people3.

Of seniors age 65 or older in Solano County, 29% speak a language other than English at home and 15% of seniors speak English less than “very well”. Over 10,000 seniors in Solano speak Asian languages (primarily Tagalog), and about 5,000 seniors speak Spanish. In Napa County, 18% of seniors speak a language other than English at home and 10% of seniors speak English less than “very well”.

About 2,000 seniors in Napa speak Spanish, and about 1,500 seniors speak Asian languages (primarily Tagalog)4.

In Napa County, non-Hispanic whites account for 77% of adults 60 years or older and people of color account for 22% in the same age group. In Solano County, 53% of seniors 60 years or older identify as non-Hispanic whites and those that identify as a person of color in same age group is 45%5 (Table 1).

2 U.S. Census Bureau, 2013-2017 American Community Survey 5-Year Estimates; table S0103 3 U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/glossary/federal-poverty-level-FPL/ 4 U.S. Census Bureau, 2013-2017 American Community Survey 5-Year Estimates; table S1601 5 California Department of Finance, P2: County Population Projections (2010 -2060) 99,264
122,553
35,810 41,596
2018 2024
Between 2018 and 2024, the senior
population is expected to increase
by 23% in Solano County and 16% in
Napa County
Solano
Napa
Female
55%
Male
45%
More than half of seniors
age 60 or older are female
in Napa and Solano
Counties

6 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019 Table 1. Percentage of seniors 60 years or older by Race/Ethnicity, Napa and Solano Counties, 2018

RACE/ETHNICITY NAPA SOLANO
American Indian/Alaskan Native, NH* 0.4 0.5
Asian, NH* 6.6 18.4
Black, NH* 1.3 12.9
Latinx/Hispanic, any race 13.7 12.4
Native Hawaiian/Pacific Islander, NH* 0.1 0.7
White, NH* 76.8 53.4
Multiracial, NH* 1.0 1.7
*NH=non-Hispanic

Over 4 in 5 (82%) of Napa County seniors age 60 years or older live in the cities of American Canyon (45%) and Napa (37%). Seniors age 60 years or older in Solano County are more spread out throughout the County with one-third (33%) living in Fairfield, one-fifth (20%) living in Vallejo and almost an equal proportion living in Vacaville (14%) and Benicia (12%)6 (Table 2).

Table 2. Distribution of seniors age 60 years or older by City, Napa and Solano Counties, 2018

NAPA SOLANO
City Percent City Percent
American Canyon 44.98 Benicia 12.42
Angwin 3.43 Dixon 5.55
Calistoga 3.01 Fairfield 33.10
Deer Park 1.48 Rio Vista 7.66
Napa 36.75 Suisun City 7.81
Oakville 0.00 Vacaville 13.95
Rutherford 0.11 Vallejo 19.50
St. Helena 6.51 Unincorporated/Outside city limits Not Available Yountville 3.73
Unincorporated/Outside
city limits Not Available

Findings: Focus Group and Key Informant Interviews
Participant Information
Focus Group Interviews
A total of 15 focus groups were conducted throughout Napa and Solano Counties. Three focus groups were held with service providers, 10 were held with residents and two were with combined residents and service providers. Six sessions were held in Napa County: Calistoga (2), St. Helena (1), and Napa (3). Eight sessions were held in Solano County: Dixon (1), Fairfield (3), Rio Vista (1), Vallejo (2), and Vacaville (1). Additionally, focus group notes with senior service providers that was conducted by a

6 US Census Bureau, 2013-2017 American Community Survey 5-Year Estimates; table S0101

7 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019 contractor for the hospital Community Health Needs Assessment for Napa and Solano Counties were shared with Solano Public Health and used as part the analyses. Two focus groups were conducted in Spanish, two specifically recruited LGBTQI+ seniors, and three were with low income seniors.

One hundred and twenty-three Focus Group participants completed the AAA Service Menu Prioritization worksheet.

Key Informant Interviews
A total of 18 key informant interviews was conducted. Seven interviewees represent Napa County, 10 represent Solano County, and one works equally in both counties.

Issues, Challenges and Barriers
Participants were asked what the biggest issues, challenges and barriers currently facing seniors were as well as what challenges and barriers they foresee arising in the near future. Below are the biggest issues, challenges and barriers grouped into 10 broad categories.

Economic
Healthcare cost is an important issue that seniors face in both counties. Participants mentioned that MediCare coverage is limited and some must pay out of pocket for certain services. The costs of hearing devices and vision care are also high and some may not be covered by insurance. The high costs of dental care, specialty medical and dental care, prescription medications and caregivers put significant financial burden on seniors.

Affordable housing, including Section 8, and livable income are two issues that most seniors face, especially those on fixed income, such as Supplemental Security Income (SSI). Some are becoming homeless because they can’t afford costs associated with owning a home, such as taxes and utilities. The high cost of housing is making it hard for seniors to afford medicine, medical care and other daily necessities. Some seniors also skip or cut the size of their meals or buy cheap unhealthy food because they don’t have enough money after paying for rent. Lack of affordable housing, however, doesn’t just affect seniors, but their families and caregivers as well.

Other economic issues mentioned were affordable health insurance, increasing cost of healthy food and fitness classes, cost of assisted care, lack of MediCare and MediCal coverage for specialty memory care, assisted living and skilled nursing facilities and lack of financial planning services and education that would benefit younger seniors who still have time to save money. There is a higher financial burden overall among seniors in Napa compared to Solano.

Transportation
Participants emphasized that once seniors stop driving they become increasingly isolated, and the currently available transportation options are insufficient for a lot of seniors. Seniors who live in rural areas or who lack access to the technology required to use on-demand ride services are particularly challenged. Participants noted that they find it difficult to access care in other cities or in another county because of transportation issues. Participants also emphasized that most transportation programs and services available to seniors are centered around transportation to medical appointments, but that seniors also need transportation to go grocery shopping, run errands, attend Sunday service, go to the library or go to social events that will get seniors out in the community.

8 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019 Healthcare access
Participants mentioned that there is a general shortage of primary, dental and mental health care providers in both counties and getting an appointment at local clinics can take months. A notable shortage of geriatricians and providers that understand the medical and health needs of seniors was identified by participants. LGBTQI+ participants stated the huge lack of specialty, training and focus on LGBTQI+ healthcare needs in both counties and, as such, seniors go out of the county for services.

Access to medications and benefits-related counseling is needed, particularly among the aging population with HIV who are trying to navigate the multiple layers of Medicare Part D and AIDS Drug Assistance Program (ADAP) insurance benefits. Veteran healthcare and most specialty medical and dental care services are located outside city or county limits and getting there can be a challenge and take a long time, especially if using public transportation. Limited clinic and pharmacy hours are barriers that participants mentioned. They would like to see clinic hours at night and on weekends and longer pharmacy hours. Other healthcare access related issues identified were lack of provider training on and knowledge of medical needs of clients with special needs (like those with developmental disability or Alzheimer’s disease), shortage of licensed social workers and caregivers and lack of culturally- appropriate and culturally-sensitive healthcare providers.

Housing accessibility
Participants mentioned that many seniors are aging out of their homes and are living in large homes that they cannot maintain, and many cannot afford to downsize. There is also a lack of homes on the market that are smaller and that would work for a senior with limited mobility. A lot of homes in this area have stairs, narrow hallways, bathtubs or other features that make them not suitable for seniors.

There is also a shortage of Section 8 housing and a long waiting list that it can take months to years to find available housing. Natural disasters, like the fires, that have damaged the North Bay in recent years, have affected the availability of rental properties. There is also an issue of senior housing facilities and shelters not being accessible to seniors in wheelchairs, walkers, or with other mobility issues and those with certain health conditions.

Senior classes and education
Seniors want more classes and educational opportunities that are free or available at a low cost.

Examples are fall prevention, preparing or cooking nutritious foods, diabetes education, disease management, personal hygiene and other health promotion topics for seniors. Providing education on end of life planning is needed and is especially important for seniors who are developmentally disabled or have no family members. Using the computer so seniors can access resources or social events information would be useful for seniors. It was also mentioned that STD education among seniors is something that most people don’t want to talk about but is needed so seniors can get support and proper treatment. The need for education of seniors and their caregivers on approved caretaking activities was also mentioned. The context through which these classes were mentioned was through senior centers or, in the case of STD education, in senior living facilities.

Coordination of efforts and services
It was mentioned that the health needs of seniors as well as the whole healthcare/benefits system are complex; therefore, a well-coordinated and collaborative partnership is needed. There is a general perceived lack of coordination between the County, cities, medical community and community

9 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019 organizations to ensure that the needs of seniors are met. Participants noted that there is a lack of coordination with discharge plans and follow-up plans, especially among seniors who are discharged home. The ability of seniors to navigate services and find information about resources is a challenge.

Seniors without access to technology are often excluded from communications and they have a difficult time finding services. Participants mentioned that even service providers are often unaware of services that the city, county or others in the community are offering.

Isolation/social support/connectedness
Isolation, lack of family and social support and community connectedness are important issues facing seniors, particularly those who are homebound. A lot of seniors are no longer able to do what they used to be able to do and feel like they no longer have a sense of purpose, so they become increasingly disconnected from family and friends which leads to depression, chronic loneliness and isolation. The issue of isolation is especially important in the LGBTQI+ community depending on how accepting their families are, the loss of friends and partners to AIDS and the social network and support they have developed in the community. It was also stated by one participant that the feelings of isolation are so ingrained in the LGBTQI+ community that they have to be “yanked out” of it and brought out to the community. It was also mentioned that, in Napa and Solano, there is a lack of connectivity to culture that is more present in other Bay Area counties and that the use of technology for seniors who are not computer savvy is a barrier in reaching out to people.

Belonging/visibility/inclusion
Seniors feel invisible when it comes to their issues; they often feel that they don’t have a voice, that they are not heard and that they are excluded from meetings. Participants also stated that there is a lack of respect for, and a stigma and negative stereotypes associated with, seniors and that most people do not consider them as wise elders. One participant mentioned “being my age, we become invisible. We’re just invisible. And that’s all there is to it. And so, if you’re disabled and you’re old, you’re really invisible!” Being included and belonging was a sentiment that LGBTQI+ participants felt were particularly important in the LGBTQI+ community. They mention that although strides have been made in recent years, the LGBTQI+ community still feel like that are not included or visible or feel welcome.

Most LGBTQI+ seniors are not out at work, church or in certain communities where being LGBTQI+ is not as widely accepted.

Institutional inequities
Institutional inequities identified by participants were grouped into three broad categories:
advocacy, funding and government. These three categories are explained in more detail below.

Participants mentioned that there is lack of advocacy for seniors and that a grassroots movement is needed in order for seniors to be heard and be taken seriously. Landlords are increasing rent and seniors need tenant rights protection.

Participants also emphasized the inequity in funding for seniors and senior services and programs and that funding is not keeping pace with the increasing number of the aging population.

Seniors are often overlooked. Participants stated that other groups are funded first and that after everyone else has been funded, there is very little money left for seniors. The lack of funding is more pronounced in Solano than in Napa.

10 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019 The role that the local, national and federal government play in affecting the health of seniors was raised as another issue. A general fear and distrust of the government was expressed, so seniors are not as accepting of services or outreach from the county. At the federal level, lack of federal funding for seniors and policy changes such as a possible cut in social security and a later retirement age were mentioned as issues. It was also mentioned that county and federal surveys have done a disservice to the LBTQI+ community by historically not including them on needs assessment surveys; this has led to the unmet needs of the LGBTQI+ community.

Heterosexism
Heterosexism is defined as a system of oppression that considers heterosexuality the norm and discriminates against people who display non-heterosexual behaviors and identities. Heterosexism was an issue that was brought up numerous times by both LGBTQI+ focus group participants. The LGBTQI+ community, in general, still feel unwelcomed. Heterosexism at the individual, community and institutional levels were identified. Anti-LGBTQI+ sentiments that are happening locally, nationally and in the world, politically and socially, can take a toll on the community and can become overwhelming. It was mentioned that the healthcare system and society in general were not set up for everyone, but rather on a more heteronormative way. Participants noted that they still seek care in another county, especially if they already have one established elsewhere, because coming out to several doctors is hard and some providers, especially older men, are still prejudiced against the LGTQI+ community. Many in the LGBTQI+ community, particularly those who are older, have hesitancy coming out in faith-based communities because of their prior experiences with these institutions. LGBTQI+ seniors have also gone back to the closet once they start living in senior living facilities or have avoided going to senior centers because of the hostility and bullying that they experience in those environments.

Other issues
Other issues, challenges and barriers raised by participants were physical issues (mostly diabetes and mobility limitations), obesity, cognitive issues (like Alzheimer’s and dementia), those with certain chronic diseases, environmental issues (primarily related to climate change, pollution, and safety), lack of resources to support caregivers, lack of facilities that provide care at all levels from board and care homes to skilled nursing facilities, and scams or elder abuse.

Gaps in Services
Below are gaps in current services that participants identified:
• Lack of geriatricians or providers that understand medical needs of seniors • Lack of provider education for senior-specific needs such as screening for cognitive decline • Lack of resources available in languages other than English • Lack of mental health providers, particularly for seniors who are covered by MediCal or Medicare
• Limited affordable housing for caregivers
• General lack of coordination among government services and rigidity in funding that inhibits collaboration
• Transportation to places other than medical appointments and to medical appointments outside of county boundaries

11 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019 Vulnerable Populations
Participants were asked if there were any groups of seniors who were more vulnerable or who would need extra assistance. The most frequently identified groups included:
• Older seniors
• People of color
• Rural residents
• Non-English speakers and immigrants
• Undocumented immigrants
• Seniors with low socioeconomic status
or limited financial resources
• Those who are homebound or who
have mobility limitations that limit their
ability to leave home
Other vulnerable populations that were mentioned include:
• Veterans
• Homeless
• LGBTQ seniors
• Seniors with few social or community
connections
• People with cognitive impairments
(including Alzheimer’s)
One key informant stated that we likely do not know who the most vulnerable seniors are because they are not likely to be interacting with any services or organizations. They suggested that we work with non-traditional partners such as law enforcement and EMS to identify and proactively seek out those at high risk.

Solutions
Participants had many ideas for potential solutions to the issues that were identified. These were broadly categorized into five categories: intergenerational community, advocacy and policy, coordination of services, transportation and senior education/classes.

Intergenerational Community
One theme that was mentioned by almost all focus group participants and key informants was the idea of building a strong sense of community where everyone belongs, a community that is inclusive and where everyone is “neighboring” by building an intergenerational community. This can diminish the problems of depression and isolation that affect seniors and can make them more socially connected and improve their health. It also provides the younger generation an opportunity to learn from the wisdom of older adults and expose them to all diverse groups of people and enrich their lives. Below are ideas that participants identified as possible ways to create an intergenerational community:
• Colocation of senior housing and inexpensive daycare facilities where seniors can volunteer and children learn from elders.
• Seniors living with college student roommate where the student is able to provide help for the senior and the student pays cheaper rent.
• Connect high school students looking for community service with seniors, particularly those who are homebound – “adopt a grandparent”.
• Create communities that allow families to stay together. These communities would be broadly inclusive and provide housing for caregivers, young families, and seniors. • Utilize volunteers and paid positions to help develop more robust community events, reach out to isolated seniors via phone calls.

12 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019 • Have physical spaces where people can connect and bond and for special events and occasions.

For example, a playground developed to accommodate children and seniors or a “gay nucleus” for the LGBTQI+ community where they can go to events and can provide a visual cue of inclusivity.
• Modify existing facilities that seniors frequent to be friendly to those with limited mobility. • Modify senior care facilities to accommodate senior couples who may require different levels of care.
• Have an open space so people can connect with nature. • A safe place for seniors to gather after hours.

Advocacy and Policy
Below are the advocacy and policy related solutions provided by participants:
• Provide education to community members and elected officials about senior needs to advocate for policy change.
• Develop a community coalition or grassroots movement to advocate for the needs of seniors and help ensure that the requests from seniors are not ignored by elected officials. • Encourage elected officials and county staff to continue to engage with the senior population through listening sessions or focus groups so that the needs of the community are well understood and incorporate findings into the city general plans. • Urge city officials to actively engage seniors in creating opportunities for seniors to provide input.
• Address how to make cities aging-friendly and walkable communities by incorporating them into the city general plans.
• Reduce the regulatory burden on care facilities so they can afford to expand to serve more seniors.
• Incentivize the construction of smaller, single story homes with wide doorways and other senior-friendly features.
• Provide subsidies or rebates for seniors to renovate their current homes with features such as grab bars, improved lighting, and emergency alert systems. • Develop a program to offer lower cost or subsidized caregiving services for seniors without insurance coverage and who are not eligible for IHSS.

Coordination of Services
To address the lack of coordination of efforts and services, the following solutions were offered:
• Develop senior navigator positions that can connect seniors to available resources and provide a paper format resource directory for seniors without access to technology. • Foster collaboration between the County, cities, health care providers and non-profits to address all of a senior’s needs.
• Have a one-stop shop for seniors to get all the information they need for the services that they are looking for. It would be ideal to have these places in each city. • Provide job training for young adults to work in service positions that serve seniors. This will build the available pool of caregivers, develop intergenerational relationships, and provide well- paying jobs for young people. Make sure that there are paths for advancement in these fields.

13 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019 • Coordinate a culturally-appropriate and sensitive training for providers that includes how to provide service to seniors, those with disabilities and those who are LGBTQI+. • Hold regular meetings among different organizations and service providers, like the Family Resource Center, library, clinics, churches, police, etc., to provide an update on the services that are available and talk about issues that not only face seniors but the whole community. • Coordinate the availability of clinics that are open at night and on weekends and of pharmacies that are open longer.

Transportation
• The transportation authorities (NVTA and STA) can maintain a fleet of wheel chair accessible vehicles for nonprofits to borrow for free to serve seniors and disabled individuals. • Seniors need transportation that will take them to other activities, and not just medical appointments. Expand current options to cover those other destinations. • Subsidized on-demand transportation along with assistance booking rides would provide the most flexible option for seniors. This could also be expanded to serve those who need to travel with assistive devices such as wheelchairs or motorized scooters. • Coordinate with healthcare providers to schedule long-transit patients (like those going from UpValley to Santa Rosa or from Rio Vista to Vacaville) on the same day so one shuttle could be used to transport people. Providers should also help coordinate on-demand transportation to appointments.
• Help connect seniors with home delivery for necessities such as groceries and prescriptions and other needs such as books.

Senior Education
• Offer classes and activities to seniors around topics like fall prevention, technology use, and exercise classes.
• Programs that allow seniors to share their knowledge and give back to the community would also be valuable.
• Create satellite senior centers to help more seniors. These can be existing structures that are not being used during the day like churches or resident function halls.

Other Solutions
• Better caregiver availability and caregiver respite.
• Create aging-friendly, walkable communities by having benches along streets that people can use to rest, longer pedestrian crossing green lights so everyone can cross the street safely, an audible walking “signal” for those who are hearing impaired, and a sign that states “seniors live here” (similar to “children are present” signs in schools). • Establish a support group for those with early memory loss and mild forms of Alzheimer’s disease and dementia who are still cognitively competent but who are struggling with their new diagnosis.

Overall, there was a large amount of agreement about the health needs of seniors and the strategies that could be used to address those needs despite the diversity in background and geographic location of participants.

14 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019 Top Three Issues
A total of 112 responses were analyzed and the top three issues, ranked by frequency of appearance, identified by focus group participants were the same for both Napa and Solano counties and are as follows:

1. Transportation

2. Medical and Healthcare

3. Housing
Top Five Requested AAA Services
A total of 123 responses were analyzed and for both Napa and Solano counties, “transportation provision and assistance” was overwhelmingly rated the most important service to provide. The top five needs for each county are displayed in Table 3 and the top 10 needs for each county are in Appendix F.

Table 3. Top Five Needs Identified for Napa and Solano counties, AAA Menu of Services Napa County Solano County
Rank AAA Requested Service Rank AAA Requested Service
1 Transportation provision or assistance 1 Transportation provision or assistance 2 Home-delivered meals 2 Senior center activities
3 Assistance in locating housing 3 Home-delivered meals 4 Cash/material aid 4 Education on senior topics and help linking to available resources
5 Education on senior topics and help
linking to available resources 5 Assistance in locating housing Findings: Community Survey
A total of 809 questionnaires were included in the analyses and highlights of the survey findings are included below and detailed response data are included in Appendix G.

Safety and Help with Activities of Daily Living
• The most common feature that seniors need help adding to their home in both counties is bathroom modifications such as grab bars, handrails, taller toilets, or non-slip tiles. • 61% of Solano respondents and 49% of Napa respondents are slightly or very concerned about being able to find a caregiver if needed.

Emergency Preparedness
• More than half of respondents do not have an emergency kit to take with them in case of an evacuation.
• One in four respondents need help maintaining medications or medical equipment in the event of a loss of power/electricity.
• The most effective ways to reach seniors in an emergency were cell phone calls, TV, and text messages.

15 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019 Caregiving
• 10% of respondents report being a caregiver for someone else aged 55 years or older. • The majority (75%) of caregivers report that none of their caregiving hours are paid. More than a quarter report doing more than 40 hours per week of unpaid caregiving work. • In-home respite care was the type of support respondents said would be most useful in their caregiving situation.

Legal Resources
• Only half of respondents report having access to legal services. • Over one quarter report having no future planning documents whatsoever. • Less than half of respondents report having an advanced healthcare directive, a will, and a revocable living trust. Only 15% have long term care insurance, and only 14% have a physician order for life-sustaining treatment (POLST).

Healthcare Access
• Only 76% of respondents have access to dental care. The majority who don’t state that they cannot afford it.
• About 20% of respondents have some sort of barrier that causes them to miss medical appointments. The most frequently reported reason was, “I often cannot make the trip to my medical appointments because of my physical or mental health.” • Most respondents (91%) are able to find a primary care doctor close to where they live.

Economic Factors
• About 38% of respondents report being unable to afford one or more of their basic necessities in the past year.
• 28% of Napa respondents and 23% of Solano respondents expects their financial situation to decline over the next 5 years.
• 38% of respondents report that someone has tried to financially scam or take advantage of them. About one quarter report having told law enforcement, and about a quarter report having told no one.

Social Connectedness
• More than half of Napa residents currently volunteer, while just 40% of Solano residents do. 16% of respondents do not currently volunteer but are interested in volunteering. • 13% of respondents do not have access to the internet in any way. Most state that the reason why is because it is too expensive.
• Over 44% of respondents are slightly or very concerned about becoming isolated from others. • Over 1 in 4 (26%) see or talk to people they care about and feel close to 2 times or less a week.

Mortality Data
There were a total of 3,321 deaths among seniors 60 years or older in Napa County from 2015- 2017. The top five leading causes of death were heart disease (795 deaths), cancer (772 deaths,) stroke

16 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019 (203 deaths), Alzheimer’s disease (188 deaths) and chronic obstructive pulmonary disease (COPD, 156 deaths).

A total of 7,574 deaths occurred from 2015-2017 in Solano County seniors 60 years or older. The top five leading causes of death were cancer (1,876 deaths), heart disease (818 deaths), stroke (608 deaths), Alzheimer’s disease (569 deaths) and COPD (448 deaths).

More detailed mortality data are in Appendix H.

17 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019 Appendix A: Bay Area Regional Health Inequities Initiative (BARHII) Framework

18 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019 Appendix B: Methods
Focus Group Interviews
All focus groups (FG) followed a standardized series of questions (See Appendix C). The FG guide was adapted from Harder + Company’s Focus Group Facilitation Guide. Participants’ answers were recorded and notes were aggregated and analyzed using NVivo. Themes were categorized into broad categories using the frameworks mentioned above. After considering the discussion, focus group participants were asked to write down what they believe to be the top three most important issues that seniors face. Responses were categorized and ranked by frequency of appearance.

FG participants were also asked to rank the top 10 choices that they think seniors need among a list of 23 possible Area Agency on Aging is permitted to fund (Appendix D), with #1 being the most important. Focus groups were conducted throughout Napa and Solano Counties from October 2018 through July 2019.

Key Informant Interviews
Key informant (KI) interviews were conducted using a standard interview guide (see Appendix E) adapted from Harder+ Company’s Key Informant Interview Facilitation Guide. All members of the Napa/Solano Advisory Council on Aging were asked to participate in an interview, and a selection of other individuals who hold key positions in both counties were identified and asked to participate.

Participants’ answers were recorded and notes were aggregated and analyzed using NVivo. Interviews were conducted over the phone between June 12th and July 17th.

Survey
A comprehensive survey to assess the needs of seniors and disabled adults throughout Napa and Solano counties was developed by Solano Public Health. Questions were collected from nationally validated surveys, similar surveys administered by neighboring counties, and prior surveys conducted by county agencies. The survey was vetted by Public Health staff in both counties and by subject matter experts in nutrition, transportation, and emergency services. The survey was also field tested with seniors of varying ages, racial/ethnic groups, and education levels.

The survey was open for online submissions in Qualtrics from May 15th through July 15th. Paper copies of the questionnaire were also distributed throughout both counties and were accepted through a postmark date of July 15th. Both the online and paper versions were available in English, Spanish, and Tagalog. Phone numbers were provided that were answered by bilingual staff who were available to answer questions, provide additional accommodations, or administer the survey over the phone.

Several community organizations offered to be collection points for the survey, and surveys could also be mailed to or dropped off at county offices. Paper surveys were entered in Qualtrics and the two versions were merged. Data analysis were performed using Excel and SAS.

Themes
Issues, challenges and barriers identified by FG and KI participants were combined to create the 10 broad categories. Findings from the survey validated some of the findings from the FG and KI.

Additional key findings that did not surface in FG and KI but were identified in the survey are included in the survey findings above.

19 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019 Appendix C: Focus Group Facilitator Guide
2019 Senior Assessment Focus Group – Facilitator Guide
(Facilitator Guide was adapted from Harder + Company Focus Group Facilitator Guide)

Note to facilitator: Text in red should be updated prior to the start of the focus group.

Introduction + Getting Settled (10 minutes)
Hello, my name is ____________ from the Solano County Public Health and I will be leading today’s discussion. This is ____________ and he/she will be taking notes and tracking time. He/she may jump in with any additional questions as we go along. We want to thank you for agreeing to be a part of this discussion, which will last about an hour and a half.

We are here today to help understand the health needs of seniors in your town or city. We will be using the information we collect during discussions like this and data from the health department and census to write our report.

The goal is to understand the health needs of the town or city that you serve/ [FOR SERVICE PROVIDERS]/where you live [FOR COMMUNITY MEMBERS]. (*Show the BARHII Framework when explaining next section.) We will talk today about "health", including health status like asthma and heart diseases, and also things that can influence health, like social, political and environmental situations.

These are sometimes called "social determinants of health" and can include things like how easy it is to get medical care, the economy, safety, transportation and housing, for example. We will also talk about "health equity" in your community, which means how easy or hard it is for everyone to be as healthy as they can be, with no one at a disadvantage because of their race, (dis)ability, sexual orientation or their position in society.

Before we start, I want to share some guidelines for our discussion:
* We want everyone to have an equal chance to speak.
* There are no right or wrong answers, and we hope that you will be as honest as possible. * What you say will be confidential, which means that we will not use your name when talking about what we learn from our discussion.
* Please respect everyone’s opinions. It is fine to have a different opinion, and we hope that you will feel comfortable sharing your opinion even if it is different from what others have said. * Please ask questions if you are not sure what something means. * Because we have a short time together and a lot to talk about, I may interrupt you so that we can hear what everyone has to say about all my questions.

[FACILITATOR ADJUST AS NECESSARY, DEPENDING ON # OF SURVEYS FILLED AT ONSET] We passed out a blue paper earlier. It’s a short survey and a question on additional people/organization that you think we should speak with. If you haven’t yet done so, please fill it out at the end of our discussion and return it to us. The survey is anonymous, so you do not need to put your name on it and we will only use it in our report all together with everyone else's answers.

If everyone is okay with it, we want to record our discussion. We will only use the recording to make sure we remember what we talked about as we write our report. Again, we will never use your name in anything we write. Is it okay with everyone if I record? Does anyone have any questions before we start?

20 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019 Background, Health Issues, Barriers and Challenges- 40 minutes (40 minutes left at the start of this section)

1. Let’s start by introducing ourselves.
a. Residents: Please tell us your name, the town or city you live in, and one thing that you are proud of about your community.
b. Service Providers: Please tell us your name, your current position, and role within your organization.

2. Tell us what it is like to be a senior in the town or city that you live in/serve.

3. What are the biggest issues, including health issues and factors that affect health, like transportation and housing and the ones we mentioned earlier, that people in your town or city struggle with? Do these issues affect different groups of people differently?

4. What are the challenges or barriers to being healthy in your town or city? Again, please think of the broad definition of health when answering this question. a. PROMPT: I know [insert from above conversation if applicable] has already been mentioned, what are some other things that act as barriers or challenges? b. PROMPT: For example, do you have access to fresh food, safe areas to exercise and recreate, community spaces to gather, etc.?
Note to Facilitator: Reflect on what you have heard so far, ask about other types of barriers that may not have been mentioned yet, including the following: behaviors, social factors, economic factors, clinical care factors, or the physical environment (e.g., air, water, sound, land).

5. What resources or services are difficult for you to access or obtain?

6. Do you foresee upcoming changes that could affect your health, either negatively or positively? Again, we would like to remind you to think of the broad definition of health.

Solutions - 20 Minutes (20 minutes left)
Next, I would like you to think about what a "healthy town or city" looks like, keeping in mind the broad definition of health discussed earlier which includes social, political, environmental, and equity factors.

7. Imagine your perfect town or city (give them about 5 seconds or so). What would it take to create that perfect town or city?
a. PROMPT: What senior services or resources can help us get to the ideal?

8. Are there geographic areas or certain groups of people that would need more help to achieve the ideal?

Priorities - 20 minutes (0 minutes left)
Now that we have had a chance to discuss the community’s health needs from a number of perspectives, I would like to ask you to identify the top needs.

21 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019

9. Based on what we have discussed so far, please write down, on the green sheet of paper, the top 3 issues or challenges that should be addressed first.

10. The Area Agency on Aging is one of the agencies that coordinates services to seniors in Napa and Solano Counties. Please help us prioritize the different services that they coordinate using the yellow sheet.

22 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019 Appendix D: Area Agency on Aging Available Services Worksheet Napa/Solano Area Agency on Aging (AAA) SERVICE MENU

The following is a list of services that the AAA is permitted to fund; however, funds are limited and not all services can be provided. Please choose your top 5 services and rank them 1-5, with #1 being the most important so that we can work to make sure the most pressing needs are being met. The following services are required to be provided: Home-delivered meals, congregate meals, and nutrition counseling and education.

____ Home-delivered meals - beyond minimum
____ Congregate meals - beyond minimum
____ Nutrition counseling and education – beyond minimum ____ Medical case management
____ Transportation provision or assistance
____ Legal assistance
____ Cash/material aid: assistance in the form of commodities, surplus food distribution, emergency cash assistance, and vouchers
____ Education on senior topics and help linking seniors to available resources ____ Disaster preparedness planning assistance: includes preparedness kits and educational materials
____ Employment services: career counselling or training to help seniors obtain or maintain full or part-time employment
____ Senior center activities
____ Assistance in locating housing
____ Housing repairs or modifications
____ Interpretation/translation services
____ Mental health services and peer counseling
____ Telephone safety checks: daily check-in calls from agency staff ____ Home visiting to provide safety checks
____ Personal care and homemaking: includes assistance with eating, bathing, grooming, preparing meals, shopping, light housework, etc.
____ Adult Day Care: personal care in a congregate setting during some portion of a day ____ Support and education for caregivers for the elderly ____ Caregiver respite for caregivers for the elderly
____ Support and education for caregivers caring for children ____ Caregiver respite for caregivers caring for children

23 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019 Appendix E: Key Informant Interview Facilitator Guide
2018 Senior Needs Assessment Key Informant Interview – Facilitator Guide (Facilitator Guide was adapted from Harder + Company Key Informant Interview Facilitator Guide)

Introduction + Getting Settled 5 minutes (85 minutes left)

Hello my name is ____________ from Solano Public Health.

The goal of this interview is to understand the health needs of the seniors that you serve.

Health is to be defined broadly, including health outcomes such as asthma and heart diseases, and things that can influence health, like social, political, and environmental situations. These are sometimes called “social determinants of health”, and can include things like the economy, safety, transportation, housing and how easy it is to get medical care, for example.

We will also talk about “health equity” in your community, which means how easy or hard it is for everyone to be as healthy as they can be, with no one at a disadvantage because of their race, age, (dis)ability, sexual orientation, gender identity or their position in society.

Before we begin, I’d like you to know that your responses will be confidential, which means that we will not connect your name with anything you say when we report our findings. There are no right or wrong answers, and we encourage you to be as candid as possible.

If you’re OK with it, we want to record our discussion. We will only use the recording to make sure we remember what we talked about as we write our report. Are you OK if I record?

Do you have any questions for me before we start?

Background- 5 minutes (80 minutes left)

1. Briefly, what is your current position and role within your organization?

2. Can you please describe the individuals or communities that you serve? (How would you define the communities you serve)?
a. It may be helpful to think about the following: specific geographic regions, the racial or ethnic and economic makeup of the community or the physical environment.
b. What services do you provide?

Health Issues – 30 Minutes (50 minutes left)
Next, I’d like you to think about what a healthy environment is, keeping in mind the broad definition of health discussed earlier which includes social, political, environmental, and equity factors.

3. What are the biggest health issues, including health issues and factors that affect health, like transportation and housing and others we talked about earlier using the BARHII framework, that seniors in the community struggle with?

4. Do these health issues affect different groups of people differently? Are some groups affected more or less than others?

5. Do you foresee upcoming challenges that could affect seniors’ health, either negatively or positively? Again, we would like to remind you to think of the broad definition of health.

24 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019 Challenges/Barriers- 15 Minutes (35 minutes left)
We’ve talked about what a healthy community looks like and what needs exist in the community. Now I would like to talk about challenges and barriers to healthy living and a healthy community.

6. What are the challenges or barriers to being healthy that exist in the communities in Solano/Napa County? Please think of the broad definition of health and the BARHII framework when answering this question.

7. What are the challenges and barriers faced by your organization?

Solutions -15 Minutes (20 minutes left)
Now that we’ve identified barriers and challenges that exist in the community that make health hard to attain, I’d like to talk about solutions.

8. What are some solutions that can address the barriers and challenges that you have identified?

9. What gaps in senior services or resources exists in Solano/Napa County?

10. Are there geographic areas or certain groups of people that would need more help for some of the solutions that you mentioned earlier?

Priorities- 10 minutes (10 minutes left)
Now that we have had a chance to discuss the community’s health needs from a number of perspectives, I’d like to ask you to identify the top needs.

11. Based on what we have discussed so far, what are currently the most important or urgent top 3 health issues or challenges that should be addressed first?

12. In your sector or field, what is the most urgent actionable issue that seniors face?

Resources- 10 Minutes

13. What are resources that exist in the community that help your community live healthy lives and address the health issues and inequity we have discussed?

14. Are there existing resources or partnerships/collaborations that should be expanded or supported?

15. Is there anything else you would like to share with our team about the health of the community?

25 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019 Appendix F: Top 10 Requested Area Agency on Aging Services

26 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019 Appendix G: Community Survey Data

1. Demographic information of participants:

A total of 295 surveys from Napa County were included in the analyses. Below are the numbers and percentages broken down by City.

NAPA
City Number Percent
American Canyon 38 12.9
Angwin 5 1.7
Calistoga 46 15.6
Deer Park 6 2.0
Napa 125 42.5
Oakville 1 0.3
Rutherford 1 0.3
St. Helena 57 19.4
Yountville 7 2.4
Unincorporated/Outside city limits 8 2.7
Unknown city 1
TOTAL 295

A total of 502 surveys from Solano County were included in the analyses. Below are the numbers and percentages broken down by city.

SOLANO
City Number Percent
Benicia 123 24.6
Dixon 24 4.8
Fairfield 83 16.6
Rio Vista 10 2.0
Suisun City 20 4.0
Vacaville 66 13.2
Vallejo 167 33.3
Unincorporated/Outside city limits 8 1.6
Unknown city 1

2. How would you describe your overall health?
Overall Health Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
Poor-Fair 302 37.6% 196 39.4% 103 35.2%
Good-Excellent 501 62.4% 302 60.6% 190 64.8%

27 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019

3. How would you describe your quality of life?
Quality of Life Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
Poor-Fair 215 27.1% 151 30.8% 63 21.7%
Good-Excellent 578 72.9% 340 69.2% 227 78.3%

5. How often do you exercise, including walking, for 20 minutes or more? How often
exercise
Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
Never 86 10.9% 62 12.7% 21 7.2%
A few times 128 16.2% 81 16.6% 46 15.9%
1-2 times 160 20.3% 96 19.7% 61 21%
3-5 times 249 31.5% 153 31.4% 94 32.4%
Daily 167 21.1% 96 19.7% 68 23.4%

6. Do you have any of the following challenges with eating or your diet? Challenges with
eating or diet
Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
Protein 107 13.5% 71 14.4% 35 12.2%
Salt 121 15.3% 78 15.8% 41 14.2%
Calcium 197 24.8% 127 25.8% 66 22.9%
Fruits 338 42.6% 214 43.4% 117 40.6%
Eat alone 272 34.3% 165 33.5% 103 35.8%
Chewing/swallowing 79 10% 52 10.5% 27 9.4%
Clean water 8 1% 8 1.6% 0 0%
None 209 26.4% 121 24.5% 85 29.5%

7. What type of housing do you currently live in?
Type of housing Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
House 536 67.3% 370 74.9% 160 54.6%
Mobile 74 9.3% 17 3.4% 56 19.1%
Apartment 105 13.2% 65 13.2% 39 13.3%
Senior
independent 56 7% 27 5.5% 29 9.9%
Assisted living 0 0% 0 0% 0 0%
LTCF 2 0.3% 1 0.2% 1 0.3%
Boarding house 3 0.4% 2 0.4% 1 0.3%
HUD 41 5.1% 24 4.9% 17 5.8%
Board and care 3 0.4% 1 0.2% 2 0.7%
Hotel 2 0.3% 1 0.2% 1 0.3%
Family 32 4% 23 4.7% 8 2.7%
Shelter 2 0.3% 0 0% 1 0.3%

28 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019

8. Do you own or rent your primary place of residence?
Own or rent Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
Own with mortgage 249 31.9% 185 38.1% 61 21.3%
Own no mortgage 199 25.5% 116 23.9% 81 28.3%
Rent 233 29.9% 139 28.7% 91 31.8%
Mobile 49 6.3% 13 2.7% 36 12.6%
Other 50 6.4% 32 6.6% 17 5.9%

9. Who else is living with you in your home?
Who else live with Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
Alone 289 36.6% 160 32.7% 124 42.9%
Spouse 337 42.7% 221 45.2% 112 38.8%
Adult children 123 15.6% 79 16.2% 43 14.9%
Children under 18 21 2.7% 16 3.3% 5 1.7%
Friends 23 2.9% 19 3.9% 3 1%
Paid caregiver 4 0.5% 1 0.2% 3 1%
Parents 19 2.4% 16 3.3% 3 1%
Roommates 23 2.9% 16 3.3% 7 2.4%
Adult grandchildren 15 1.9% 10 2% 5 1.7%
Grandchildren under
18 18 2.3% 15 3.1% 3 1%

10. What are your monthly housing costs including mortgage or rent for your residence? Please include any HOA, monthly fees, insurance, site rent, taxes, utilities, etc.? Monthly housing
cost
Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
$0-$500 80 11.6% 44 9.9% 35 14.8%
$501-$1000 164 23.7% 92 20.7% 68 28.8%
$1001-$2000 207 29.9% 140 31.5% 64 27.1%
$2001-$3000 138 19.9% 96 21.6% 40 16.9%
$3001-$4000 58 8.4% 35 7.9% 22 9.3%
$4001-$5000 24 3.5% 19 4.3% 5 2.1%
$5001-$6000 13 1.9% 11 2.5% 2 0.8%
over $6000 8 1.2% 8 1.8% 0 0%

29 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019

11. Would you be willing to share your living space to help pay for the rent or mortgage? Share living space Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
Yes, not currently
renting
35 4.6% 21 4.5% 14 5.0%
Yes, currently renting 39 5.1% 28 6.0% 10 3.5%
No 585 76.6% 356 75.7% 219 77.7%
Not sure 105 13.7% 65 13.8% 39 13.8%

12. How often do you see or talk to people that you care about and feel close to? (For example:
talking to friends on the phone, visiting friends or family, going to church or club meetings) See or talk to people Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
< 1/week 65 8.4% 52 10.9% 13 4.6%
1-2 x 135 17.4% 77 16.1% 54 19%
3-5 x 191 24.7% 111 23.2% 75 26.4%
5 or more 383 49.5% 238 49.8% 142 50.0%

13. How concerned are you about being isolated from others? Concern about
being isolated
Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
Not 420 55.6% 256 54.8% 156 56.3%
Slightly 244 32.3% 150 32.1% 92 33.2%
Very 91 12.1% 61 13.1% 29 10.5%

14. Over the last 2 weeks, how often have you been bothered by feeling down, depressed, or hopeless?
Feeling down Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
Not at all 415 57.2% 250 55.8% 158 59.6%
Several days 200 27.6% 120 26.8% 78 29.4%
> half of days 57 7.9% 36 8.0% 19 7.2%
Nearly every day 53 7.3% 42 9.4% 10 3.8%

15. Over the last 2 weeks, how often have you been bothered by little interest or pleasure in doing things?
Little interest Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
Not at all 463 62.0% 288 62.3% 169 61.9%
Several days 175 23.4% 97 21.0% 75 27.5%
> half days 50 6.7% 37 8.0% 10 3.7%
Nearly every day 59 7.9% 40 8.7% 19 7.0%

30 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019

16. How do you like to learn about upcoming events and access your news? Learn about events
and news
Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
Websites 449 58.0% 290 61.1% 151 52.4%
Newspaper 374 48.3% 208 43.8% 162 56.3%
Mailings 299 38.6% 164 34.5% 132 45.8%
Posters 168 21.7% 90 18.9% 76 26.4%
Text 194 25.1% 113 23.8% 79 27.4%
Phone 183 23.6% 96 20.2% 86 29.9%
Emails 355 45.9% 204 42.9% 144 50.0%
Word of Mouth 357 46.1% 196 41.3% 158 54.9%
Faith-based 130 16.8% 71 14.9% 57 19.8%

17. What form(s) of transportation do you currently use? Forms of
transportation
Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
I drive 602 77.6% 372 77.8% 220 76.9%
Friends 219 28.2% 133 27.8% 83 29.0%
Public 136 17.5% 85 17.8% 49 17.1%
Taxi 42 5.4% 26 5.4% 16 5.6%
Paratransit 15 1.9% 11 2.3% 4 1.4%
Volunteer 15 1.9% 1 0.2% 14 4.9%
Van 20 2.6% 8 1.7% 12 4.2%
Walking 153 19.7% 93 19.5% 59 20.6%
On-demand 50 6.4% 34 7.1% 15 5.2%
Hired 9 1.2% 7 1.5% 2 0.7%
No transportation 5 0.6% 4 0.8% 1 0.3%

18. Are there certain activities that you are not able to attend due to the lack of affordable and accessible transportation options?
Activities not able
to attend because
of transportation
Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
Not limited 546 74.1% 340 75.7% 195 70.7%
Medical appt 59 8.0% 42 9.4% 16 5.8%
Grocery 51 6.9% 34 7.6% 17 6.2%
Errands 59 8.0% 36 8.0% 23 8.3%
Visiting friends 70 9.5% 45 10.0% 25 9.1%
Entertainment 84 11.4% 44 9.8% 40 14.5%
Work 7 0.9% 6 1.3% 1 0.4%
Worship 30 4.1% 18 4.0% 12 4.3%
School 13 1.8% 9 2.0% 4 1.4%

31 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019

19. What assistive devices do you need to navigate or travel with? Assistive devices to
navigate
Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
Cane 180 23.9% 116 25.1% 60 21.4%
Walker 137 18.2% 76 16.5% 58 20.7%
Wheelchair 51 6.8% 37 8.0% 14 5.0%
Guide dog 12 1.6% 11 2.4% 1 0.4%
Do not need 457 60.7% 279 60.4% 173 61.8%

20. What additional types of transportation would be helpful for you? Additional types of
transportation
Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
I have adequate
transportation 412 56.8% 257 58.3% 149 54.2%
Between counties 102 14.1% 48 10.9% 53 19.3%
More public
transportation 160 22.1% 95 21.5% 65 23.6%
Wheelchair accessible 31 4.3% 20 4.5% 11 4.0%
Same-day 93 12.8% 57 12.9% 35 12.7%
Door to door 145 20.0% 85 19.3% 58 21.1%
Inside to inside 38 5.2% 24 5.4% 13 4.7%
Someone who
accompanies me 52 7.2% 39 8.8% 13 4.7%

21. What services do you currently receive?
Services currently
receive
Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
Case management 34 4.6% 17 3.8% 17 6.1%
Transportation 43 5.8% 20 4.4% 23 8.3%
Adult day care 35 4.7% 13 2.9% 22 7.9%
Chore 111 15.0% 59 13.1% 51 18.4%
Information 33 4.5% 13 2.9% 20 7.2%
Homemaking 109 14.7% 65 14.4% 44 15.9%
Personal care 28 3.8% 16 3.5% 12 4.3%
Legal 23 3.1% 11 2.4% 12 4.3%
Home delivered meals 46 6.2% 37 8.2% 9 3.2%
Medication 28 3.8% 18 4.0% 10 3.6%
Community meals 33 4.5% 21 4.7% 11 4.0%
None 447 60.5% 288 63.9% 150 54.2%

32 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019

22. What additional services do you currently need to help you to remain independent in the community, but you cannot afford or find them?
Additional services
needed
Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
Case management 33 4.7% 24 5.4% 9 3.5%
Transportation 70 9.9% 46 10.4% 24 9.3%
Adult day care 24 3.4% 14 3.2% 10 3.9%
Chore 121 17.1% 70 15.9% 49 19.1%
Information 43 6.1% 30 6.8% 13 5.1%
Homemaking 108 15.2% 69 15.6% 37 14.4%
Personal care 34 4.8% 24 5.4% 10 3.9%
Legal 50 7.1% 34 7.7% 14 5.4%
Home delivered meals 37 5.2% 27 6.1% 10 3.9%
Medication 21 3.0% 14 3.2% 7 2.7%
Community meals 20 2.8% 12 2.7% 8 3.1%
None 431 60.8% 273 61.9% 151 58.8%

23. Do any of the following limit your daily activities? Limit your daily
activities
Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
Hearing 130 17.4% 79 17.2% 49 17.8%
Vision 81 10.8% 48 10.5% 32 11.6%
Shortness of
breath 120 16.1% 74 16.1% 44 15.9%
Mobility 232 31.1% 141 30.7% 86 31.2%
Memory 63 8.4% 39 8.5% 24 8.7%
None 330 44.2% 207 45.1% 119 43.1%

24. Do you have difficulty doing the following daily activities because of health or physical problems?
Difficulty doing
daily activities
Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
Housework 223 30.0% 143 31.6% 75 27.0%
Grocery 149 20.1% 103 22.7% 45 16.2%
Preparing meals 137 18.4% 92 20.3% 43 15.5%
Eating 27 3.6% 20 4.4% 7 2.5%
Finances 67 9.0% 37 8.2% 29 10.4%
Bathing 57 7.7% 37 8.2% 20 7.2%
Out of bed/chair 51 6.9% 32 7.1% 19 6.8%
Walking 174 23.4% 114 25.2% 59 21.2%
Telephone 34 4.6% 20 4.4% 14 5.0%
None 429 57.7% 257 56.7% 165 59.4%

33 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019

25. Do you need help adding any of the following features to your home? Add features to home Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
Easier access 57 8.1% 37 8.5% 20 7.6%
Bathroom
modifications
126 17.8% 82 18.8% 43 16.4%
Improved lighting 52 7.3% 35 8.0% 17 6.5%
Medical emergency
response 85 12.0% 58 13.3% 27 10.3%
None 483 68.2% 298 68.2% 178 67.9%

26. Do you have someone to call if you need help with medical care, food, a ride somewhere, or other things you may need?
Have someone
to call
Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
Yes 607 81.5% 372 81.4% 224 81.2%
Not sure 72 9.7% 42 9.2% 30 10.9%
No 66 8.9% 43 9.4% 22 8.0%

27. How concerned are you about being able to find a caregiver if you needed to? Finding a Caregiver Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
Not concerned 320 44.2% 175 39.5% 137 50.9%
Slightly concerned 283 39.1% 182 41.1% 99 36.8%
Very concerned 121 16.7% 86 19.4% 33 12.3%

28. Are you concerned about falling?
Concern about Falling Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
No, I am not concerned 354 48.4% 236 52.3% 110 41.2%
Yes, I am concerned about
falling outside my home 302 41.3% 174 38.6% 125 46.8%
Yes, I am concerned about
falling inside my home 301 41.1% 185 41.0% 112 41.9%

34 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019

29. Which of the following describes your fall history within the last year? Fall History Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
I did not fall 391 53.1% 240 53.0% 141 51.8%
I had a fall that did not
require medical treatment 242 32.8% 151 33.3% 89 32.7%
I had a fall that required a
trip to the emergency room
and/or a hospital stay 95 12.9% 55 12.1% 40 14.7%
Other (please specify) 35 4.7% 22 4.9% 13 4.8%

30. Which of the following best describes how well you are managing financially these days? Financial Situation Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
Living comfortably 284 38.4% 167 36.9% 112 40.7%
Doing okay 249 33.6% 156 34.4% 89 32.4%
Just getting by 129 17.4% 81 17.9% 47 17.1%
Finding it difficult to get by 78 10.5% 49 10.8% 27 9.8%

31. Over the next 5 years, how do you expect your financial situation to change? Change in Finances Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
I do not know 114 15.6% 70 15.6% 41 15.2%
I expect it to decline 185 25.3% 104 23.1% 76 28.3%
I expect it to improve 96 13.1% 67 14.9% 26 9.7%
I expect it to stay the
same 336 46.0% 209 46.4% 126 46.8%

35 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019

32. Over the past year, have you been unable to afford the following items? Unable to Afford Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
I have been able to afford
all of these items 430 62.1% 257 60.6% 167 65.0%
Recreation or
entertainment
151 21.8% 94 22.2% 56 21.8%
Healthy food 106 15.3% 68 16.0% 35 13.6%
Clothing 104 15.0% 70 16.5% 34 13.2%
Utilities 83 12.0% 63 14.9% 17 6.6%
Rent/mortgage 77 11.1% 51 12.0% 24 9.3%
Transportation 71 10.3% 48 11.3% 23 8.9%
Medications 64 9.2% 40 9.4% 23 8.9%
Health insurance 62 9.0% 45 10.6% 15 5.8%
Phone service 58 8.4% 40 9.4% 17 6.6%
Medical bills 55 7.9% 39 9.2% 15 5.8%
Property and income
taxes
48 6.9% 34 8.0% 13 5.1%
Caregiver and/or child
care 26 3.8% 19 4.5% 7 2.7%

33. Have you ever been diagnosed by a physician with any of the following medical conditions? Disease Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
High BP 364 52.4% 237 55.1% 123 48.6%
Arthritis 322 46.4% 200 46.5% 116 45.8%
Diabetes 167 24.1% 105 24.4% 60 23.7%
Obesity 158 22.8% 107 24.9% 49 19.4%
Heart 142 20.5% 82 19.1% 58 22.9%
Cancer 123 17.7% 72 16.7% 49 19.4%
Other 121 17.4% 80 18.6% 40 15.8%
Asthma 113 16.3% 81 18.8% 29 11.5%
COPD 76 11.0% 49 11.4% 24 9.5%
None 54 7.8% 36 8.4% 16 6.3%
Stroke 50 7.2% 36 8.4% 14 5.5%
Alzheimers 22 3.2% 9 2.1% 13 5.1%

36 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019

34. Do you need assistance managing your medications?
Assistance with
Medications
Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
I do not need assistance 645 89.6% 397 90.2% 238 88.1%
I have a hard time reading
or seeing the information
on the bottles 34 4.7% 24 5.5% 10 3.7%
I need help taking or
administering my
medications 34 4.7% 16 3.6% 18 6.7%
I have a hard time keeping
track of my medications 32 4.4% 18 4.1% 14 5.2%
I have a hard time
understanding the
information and managing
the side effects 19 2.6% 12 2.7% 7 2.6%

35. What forms of health insurance do you have?
Insurance Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
None/I do not have
insurance
5 0.7% 2 0.4% 3 1.1%
MediCal 139 19.0% 85 18.9% 53 19.6%
MediCare 454 62.1% 276 61.3% 171 63.1%
Tricare 44 6.0% 35 7.8% 8 3.0%
MediCare Advantage 156 21.3% 92 20.4% 61 22.5%
Part D/prescription
coverage
172 23.5% 107 23.8% 64 23.6%
Supplemental
insurance
200 27.4% 108 24.0% 88 32.5%
Private insurance 187 25.6% 124 27.6% 61 22.5%

36. Are you able to find a primary care or family doctor that takes your insurance close to where you live?
Find provider Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
I do not know 22 3.0% 14 3.2% 8 3.0%
No 46 6.4% 26 5.9% 19 7.1%
Yes 655 90.6% 403 91.0% 242 90.0%

37 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019

37. Are there barriers that cause you to miss medical appointments? Missing Medical Appointments Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
No, I have no barriers 594 82.8% 349 80.4% 236 86.8%
I am not able to find or afford
transportation to my medical
appointments 27 3.8% 19 4.4% 8 2.9%
My transportation often makes me late
to my medical appointments 25 3.5% 14 3.2% 11 4.0%
I often cannot make the trip to my
medical appointments because of my
physical or mental health 46 6.4% 35 8.1% 11 4.0%
It takes too long to get to my medical
appointments 26 3.6% 18 4.1% 7 2.6%
Other (please specify) 43 6.0% 30 6.9% 11 4.0%

38. Do you have access to dental care?
Access to Dental Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
Yes 557 76.1% 350 78.5% 199 72.4%
No, I cannot afford it 125 17.1% 66 14.8% 58 21.1%
Other (please specify) 38 5.2% 24 5.4% 12 4.4%
No, there are no
providers available close
to where I live 12 1.6% 6 1.3% 6 2.2%

39. Does your primary care/family doctor speak to you in a way that you understand? Understand Provider Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
I do not have a primary
care/family doctor 12 1.6% 6 1.3% 6 2.2%
No 27 3.7% 9 2.0% 17 6.3%
Yes 689 94.6% 430 96.6% 249 91.5%

40. Are you a caregiver for someone else?
Caregiver Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
No 622 86.6% 379 85.6% 235 88.7%
Yes, for someone age 55
years or older
70 9.7% 44 9.9% 25 9.4%
Yes, for someone under
the age of 18 years
16 2.2% 11 2.5% 4 1.5%
Yes, for someone age 19-
54 years
16 2.2% 13 2.9% 3 1.1%

38 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019 How many unpaid hours do you provide caregiving in a typical week? Unpaid hours
Caregiving
Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
Less than 20
hours per week 34 34.3% 28 40.6% 6 21.4%
More than 40
hours per week 28 28.3% 18 26.1% 8 28.6%
None 19 19.2% 12 17.4% 7 25.0%
20-40 hours per
week 15 15.2% 9 13.0% 6 21.4%
Not sure 3 3.0% 2 2.9% 1 3.6%

What type(s) of support would be useful for your caregiver situation? Support for Caregiver Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
Not sure 39 46.4% 30 48.4% 8 40.0%
In-home respite care 24 28.6% 16 25.8% 7 35.0%
Residential respite care (skilled
nursing, assisted living)
15 17.9% 11 17.7% 4 20.0%
Caregiver support groups 15 17.9% 11 17.7% 4 20.0%
Caregiver education 15 17.9% 9 14.5% 6 30.0%
Day activity programs 14 16.7% 9 14.5% 4 20.0%

41. How would you describe your current paid employment situation? Paid Employment Status
Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
Retired 532 74.3% 315 72.4% 208 77.0%
Employed - full time or
more 54 7.5% 38 8.7% 16 5.9%
Employed - part-time and
not looking for more work 46 6.4% 26 6.0% 20 7.4%
Other (please specify) 46 6.4% 33 7.6% 12 4.4%
Unemployed - not looking
for work 41 5.7% 25 5.7% 16 5.9%
Employed - self-employed 26 3.6% 16 3.7% 9 3.3%
Unemployed - looking for
work 16 2.2% 13 3.0% 3 1.1%
Employed - part-time and
looking for more work 9 1.3% 6 1.4% 3 1.1%
Employed - seasonal work 3 0.4% 2 0.5% 1 0.4%

39 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019

42. Are there adequate employment opportunities available to you? Adequate
Employment
Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
I do not know 136 37.0% 75 34.1% 59 41.6%
Yes 124 33.7% 68 30.9% 38 26.8%
No 108 29.3% 77 35.0% 45 31.7%

43. Do you currently volunteer?
Do You Volunteer Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
Yes 312 45.7% 169 40.8% 137 53.3%
No, and I do not want
to volunteer 261 38.3% 169 40.8% 89 34.6%
No, but I would like to
volunteer 109 16.0% 76 18.4% 31 12.1%

44. Do you feel physically and emotionally safe in your home? Safe in Your
home
Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
Yes 670 91.2% 401 88.9% 259 94.9%
Not sure 43 5.9% 32 7.1% 11 4.0%
No 22 3.0% 18 4.0% 3 1.1%

45. Do you feel physically and emotionally safe in your community? Safe in Your
Community
Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
Yes 608 83.3% 353 78.8% 247 91.1%
Not sure 64 8.8% 48 10.7% 16 5.9%
No 58 7.9% 47 10.5% 8 3.0%

46. Has anyone ever tried to financially scam or take advantage of you? Scammed Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
No 401 56.1% 237 54.0% 159 60.0%
Yes - a stranger 270 37.8% 171 39.0% 93 35.1%
Yes - someone
that I knew 70 9.8% 52 11.8% 18 6.8%

46a. Who did you tell?
Who did you tell? Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
Family or friend 149 49.0% 97 49.7% 50 48.5%
Law enforcement 90 29.6% 48 24.6% 41 39.8%
No one 83 27.3% 60 30.8% 21 20.4%
Other (please specify) 51 16.8% 36 18.5% 13 12.6%
Adult Protective Services (APS) 2 0.7% 2 1.0% 0 0.0%

40 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019

47. Do you have access to legal services?
Access to
Legal
Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
Yes 355 50.5% 201 46.2% 149 57.8%
I do not need
legal services 180 25.6% 117 26.9% 61 23.6%
No 168 23.9% 117 26.9% 48 18.6%

48. Do you have any of these future planning documents? Future Planning
Documents
Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
Will 330 47.6% 183 42.2% 144 57.6%
Revocable Living Trust 300 43.3% 184 42.4% 113 45.2%
Advanced Health Care
Directive 342 49.4% 199 45.9% 139 55.6%
Power of Attorney 232 33.5% 139 32.0% 90 36.0%
Long Term Care Insurance 104 15.0% 69 15.9% 34 13.6%
Burial Plan 178 25.7% 107 24.7% 68 27.2%
POLST (Physician Order
for Life-Sustaining
Treatment) 97 14.0% 54 12.4% 43 17.2%
None of the above 184 26.6% 127 29.3% 55 22.0%

49. How do you access the internet?
Internet Access Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
I have internet in my home 568 81.8% 361 83.8% 199 78.3% I access the internet with
my computer, laptop, or
tablet 327 47.1% 214 49.7% 108 42.5%
I access the internet with
my mobile or smartphone 305 43.9% 220 51.0% 82 32.3%
I can access internet
outside my home at coffee
shops, libraries, senior
centers, etc. 127 18.3% 85 19.7% 41 16.1%
I do not have access to the
internet 95 13.7% 58 13.5% 37 14.6%

41 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019 49a. What are the reasons you do not have internet at home? Reason no internet at home Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
Internet service is too expensive
at my residence 40 34.8% 20 29.0% 20 43.5%
I do not want internet in my
home 37 32.2% 23 33.3% 14 30.4%
I do not have a computer or
device to connect to the internet 34 29.6% 22 31.9% 12 26.1% I am not able to use the internet
because of a physical or mental
condition such as poor eyesight,
cognitive issues, or another
condition 17 14.8% 12 17.4% 5 10.9%
Other (please specify) 5 4.3% 4 5.8% 1 2.2%
Internet service is not available
to my residence 3 2.6% 1 1.4% 2 4.3%

50. How can individuals in your household receive information during an emergency such as a fire or earthquake?
Receiving Info in Emergency Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
Cell phone call 585 79.7% 374 82.4% 201 74.7%
TV 557 75.9% 366 80.6% 182 67.7%
Text message 455 62.0% 310 68.3% 139 51.7%
Email 432 58.9% 276 60.8% 150 55.8%
Word of mouth 397 54.1% 233 51.3% 158 58.7%
Land line telephone call 371 50.5% 214 47.1% 154 57.2%
AM/FM radio 349 47.5% 210 46.3% 135 50.2%
Social media 259 35.3% 181 39.9% 74 27.5%
NextDoor post 207 28.2% 133 29.3% 71 26.4%
Organizations' websites (such
as Red Cross) 99 13.5% 61 13.4% 37 13.8%
Other (please specify) 37 5.0% 20 4.4% 15 5.6%
Not sure 15 2.0% 10 2.2% 5 1.9%

42 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019

51. If authorities announced a mandatory evacuation from your community due to an emergency or disaster (such as a wildfire), would anything prevent you from evacuating? Preventing Evacuation Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
No, I will evacuate no
matter what 502 70.9% 306 69.9% 187 71.9%
Concern about leaving
property 126 17.8% 91 20.8% 35 13.5%
Concern about leaving pets
or livestock 112 15.8% 83 18.9% 28 10.8%
I have nowhere to go 88 12.4% 58 13.2% 30 11.5%
Concern about personal
safety 75 10.6% 54 12.3% 21 8.1%
Lack of transportation 58 8.2% 44 10.0% 13 5.0%
Health problems or
medically unable to
evacuate 56 7.9% 42 9.6% 14 5.4%
Lack of trust in public
officials 32 4.5% 29 6.6% 3 1.2%
It is too expensive to
evacuate 31 4.4% 23 5.3% 8 3.1%
Other (please specify) 20 2.8% 10 2.3% 10 3.8%

52. Do you have an emergency kit that you can take with you in the event of an evacuation? Emergency
Kit
Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
No 425 59.6% 281 63.7% 137 52.5%
Yes 288 40.4% 160 36.3% 124 47.5%

53. Does anyone in your household have any of the following conditions that could be barriers to effective communication during an emergency or disaster? Barriers to
Communication in
Emergency
Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
None 416 60.5% 249 58.3% 160 63.7%
Impaired hearing 137 19.9% 87 20.4% 48 19.1%
Physical disability 133 19.3% 97 22.7% 36 14.3%
Impaired vision 70 10.2% 40 9.4% 30 12.0%
Cognitive impairment or
disability 51 7.4% 44 10.3% 6 2.4%
Difficulty understanding
written material 19 2.8% 14 3.3% 5 2.0%
Difficulty understanding
the English language 17 2.5% 7 1.6% 10 4.0%
Other (please specify) 17 2.5% 16 3.7% 1 0.4%

43 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019

54. Thinking about what you have in your pantry and any medications you have on hand, for how many days would you be able to stay in your home without having to leave for additional supplies?
Days in Home Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
7 days or more 371 51.8% 234 53.1% 132 50.0%
4 to 6 days 189 26.4% 114 25.9% 73 27.7%
1 to 3 days 98 13.7% 54 12.2% 42 15.9%
Not sure 58 8.1% 39 8.8% 17 6.4%

55. If your home lost power/electricity, would you need help maintaining medications or medical equipment?
Help Maintaining
Meds Loss of
Power
Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
No 550 76.6% 329 74.6% 210 79.3%
Yes 168 23.4% 112 25.4% 55 20.8%

56. Which of the following categories best describes the total annual income that your household received in the last 12 months?
Household total
annual income
Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
Less than $10,000 48 7.8% 32 8.4% 16 7.1%
$15,000 - $24,999 86 14.0% 51 13.5% 30 13.4%
$10,000 - $14,999 64 10.4% 31 8.2% 32 14.3%
$25,000 - $34,999 66 10.8% 37 9.8% 29 12.9%
$35,000 - $49,999 61 10.0% 36 9.5% 24 10.7%
$50,000 - $74,999 76 12.4% 49 12.9% 26 11.6%
$75,000 - $99,999 64 10.4% 45 11.9% 19 8.5%
$100,000 - $149,999 60 9.8% 42 11.1% 17 7.6%
$150,000 - $199,999 26 4.2% 22 5.8% 4 1.8%
$200,000 or more 22 3.6% 18 4.7% 4 1.8%
Not sure 40 6.5% 16 4.2% 23 10.3%

44 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019

57. What is your assigned sex at birth (on your original birth certificate)? Sex assigned
at birth
Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
Female 500 69.7% 288 65.6% 205 76.8%
Male 217 30.3% 151 34.4% 62 23.2%

58. Do you identify as a member of any of the following groups? Sexual Orientation and
Gender Identity
Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
Heterosexual or straight 559 93.8% 345 92.7% 204 95.3%
Genderqueer, gender non-
conforming, or agender 4 0.7% 4 1.1% 0 0.0%
Lesbian, gay, bisexual or other
non-heterosexual orientation 32 5.4% 22 5.9% 10 4.7%
Transgender 1 0.2% 1 0.3% 0 0.0%

59. What is your current relationship status?
Relationship Status Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
Married 274 38.4% 177 40.3% 92 35.0%
Widowed 174 24.4% 91 20.7% 81 30.8%
Divorced 148 20.8% 96 21.9% 48 18.3%
Never married 62 8.7% 39 8.9% 23 8.7%
Not married but living
with my partner 27 3.8% 17 3.9% 10 3.8%
I have a partner but I
am not living with
them 16 2.2% 10 2.3% 6 2.3%
Separated 12 1.7% 9 2.1% 3 1.1%

60. What is the highest level of education you have completed? Level of Education Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
Bachelor’s degree 148 21.0% 91 20.9% 55 21.2%
Graduate or professional
degree (Masters, PhD, MD, etc.) 167 23.7% 108 24.8% 58 22.3% Some college, Associate degree
(AA), or technical school 267 37.8% 162 37.2% 99 38.1%
High school graduate or GED 78 11.0% 54 12.4% 23 8.8%
Some high school or less 46 6.5% 21 4.8% 25 9.6%

45 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019

61. Are you a Veteran of the US Armed Forces?
Veteran
Status
Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
No 615 86.3% 368 83.6% 239 90.5%
Not sure 4 0.6% 3 0.7% 1 0.4%
Yes 94 13.2% 69 15.7% 24 9.1%

62. What is your race?
Race/Ethnicity Overall
Number
Overall
Percent
Solano
Number
Solano
Percent
Napa
Number
Napa
Percent
White 511 73.5% 293 68.0% 210 83.0%
Hispanic 75 10.8% 43 10.0% 32 12.6%
Asian 42 6.0% 38 8.8% 4 1.6%
Black 38 5.5% 35 8.1% 1 0.4%
Multi-Race 21 3.0% 16 3.7% 4 1.6%
American
Indian/Alaskan Native 7 1.0% 5 1.2% 2 0.8%
North African/Middle
Eastern 1 0.1% 1 0.2% 0 0.0%

46 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019 Appendix H: Detailed Mortality Data
Leading causes of death in seniors age 60 years and older, Napa County, 2015-2017 Cause of Death Number (3 years)
1 Heart disease 795
2 Cancer 772
3 Stroke 203
4 Alzheimer's disease 188
5 COPD 156
6 Unintentional injuries 109
7 Diabetes 92
8 Influenza/pneumonia 78
9 Liver disease 31
TOTAL DEATHS 3321

Leading causes of death in adults age 50-59 years old, Napa County, 2015-2017 Cause of Death Number (3 years)
1 Cancer 66
2 Heart disease 49
3 Unintentional injuries 22
4 Diabetes 15
5 Liver disease 14
6 Stroke 6
7 COPD 3
8 Influenza/pneumonia 2
9 Alzheimer's disease 0
TOTAL DEATHS 239

Leading causes of death in adults age 60-79 years old, Napa County, 2015-2017 Cause of Death Number (3 years)
1 Cancer 433
2 Heart disease 248
3 COPD 62
4 Stroke 51
5 Unintentional injuries 41
6 Diabetes 38
7 Alzheimer's disease 32
8 Liver disease 30
9 Influenza/pneumonia 20
TOTAL DEATHS 1,222

47 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019 Leading causes of death in adults age 80 years or older, Napa County, 2015-2017 Cause of Death Number (3 years)
1 Heart disease 547
2 Cancer 339
3 Alzheimer's disease 156
4 Stroke 152
5 COPD 94
6 Unintentional injuries 68
7 Influenza/pneumonia 58
8 Diabetes 54
9 Liver disease 1
TOTAL DEATHS 2,099

Leading causes of death in seniors age 60 years and older, Solano County, 2015-2017 Cause of Death Number (3 years)
1 Cancer 1876
2 Heart disease 818
3 Stroke 608
4 Alzheimer’s disease 569
5 COPD 448
6 Diabetes 354
8 Influenza/pneumonia 216
9 Hypertension 207
7 Unintentional injuries 175
11 Kidney disease 108
10 Liver disease 88
12 Parkinson's disease 71
13 Septicemia 51
TOTAL DEATHS 7574

48 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019 Leading causes of death in adults age 50-59 years old, Solano County, 2015-2017 Cause of Death Number (3 years)
1 Cancer 307
2 Unintentional injuries 79
3 Heart disease 72
4 Diabetes 55
5 Liver Disease 54
6 Stroke 31
7 COPD 19
8 Influenza/pneumonia 16
9 Hypertension 12
10 Kidney disease 10
11 Septicemia 7
12 Alzheimer’s disease 2
13 Parkinson's disease 0
TOTAL DEATHS 942

Leading causes of death in seniors age 60-79 years old, Solano County, 2015-2017 Cause of Death Number (3 years)
1 Cancer 1207
2 Heart disease 371
3 COPD 222
4 Diabetes 219
5 Stroke 175
6 Unintentional injuries 104
7 Influenza/pneumonia 81
8 Alzheimer’s disease 81
9 Liver disease 80
10 Hypertension 78
11 Kidney disease 48
12 Septicemia 23
13 Parkinson's disease 21
TOTAL DEATHS 3534

49 Napa/Solano Area Agency on Aging Senior Health Needs Assessment August 25, 2019 Leading causes of death in seniors age 80 years or older, Solano County, 2015-2017 Cause of Death Number (3 years)
1 Cancer 669
2 Alzheimer’s disease 488
3 Heart disease 447
4 Stroke 433
5 COPD 226
6 Diabetes 135
7 Influenza/pneumonia 135
8 Hypertension 129
9 Unintentional injuries 71
10 Kidney disease 60
11 Parkinson's disease 50
12 Septicemia 28
13 Liver disease 8
TOTAL DEATHS 4040

Age-Friendly Talking Points

Why
• One in three Americans is 50 years or older.
• 10,000 people turn 65 every day – fastest growing population group • People age 50 years and older are the fastest growing homeless population

Overview
Livable Communities – Age-Friendly – is a recognition that when we include the lens of older residents when looking at the 8 domains of livability, we make our communities better for all.

• Outdoor Spaces
• Transportation
• Communication and Information
• Civic Participation and Employment
• Respect and Social Inclusion
• Health Services and Community Supports
• Social Participation
• Housing

Adopting the Age-Friendly designation helps communities

1. Participate in a larger discussion about community involvement

2. Support the work of the Area Agency on Aging and the state Master Plan for Aging

3. Access to mini grants for new services and community improvements

4. Access to customizable survey tool to establish local priorities – needed for the AAA Area Plan

5. Access to Emergency Preparedness, Public Safety, Dementia-Friendly, and Elder Abuse Prevention tools and best practices

The Ask
Support efforts for communities to adopt the Livable Community designation process through AARP.

Process

1. Governing body (City Council, County Board of Supervisors) votes to apply for designation

2. Letter and application are filed with AARP

3. Once approved, the municipality appoints a person/department/body as point to help create 5-year plan of priorities to be more inclusive of planning for all ages.

What’s Needed
A governing official bring the vote to the body for approval during May, Older Americans Month.

Outdoor
Dining NMC
Amendments
August 2, 2022

Background
• City Council Update – May 2022
✓ Municipal Code Amendments (12.64)
✓ Zoning Ordinance Amendment (17.52.340)
❑Master Fee Schedule Update
❑Napa Al Fresco! Guidelines

Municipal Code Updates
• Chapter 12.64 – Outdoor Dining in Public
Rights-of-Way
– Comprehensive Revision
– Streamlined Permit Process
– Expansion to Include “City Property”
– Administrative Regulations (Napa Al Fresco!)
• Section 17.52.340 (Zoning Ordinance)

Guidelines Updates
• Current Outdoor
Dining Standards
• Safety & Technical
Standards
• Napa Al Fresco!
Guidelines

Administrative Regulations
(Napa Al Fresco!)
• Operational
Standards
• Safety & Technical
Standards
• Aesthetic
Guidelines
• Flexibility

Parklets

Parklets

Recommendation
• First Reading & Introduction of an
Ordinance Repealing and Replacing
Chapter 12.64 of the NMC;
• First Reading & Introduction of an
Ordinance Repealing and Replacing
Section 17.52.340 of the Zoning
Ordinance

Questions

Outdoor Uses & Parklet Locations

SUPPLEMENTAL REPORTS & COMMUNICATIONS
Office of the City Clerk
City Council of the City of Napa
Regular Meeting
August 2, 2022

FOR THE CITY COUNCIL OF THE CITY OF NAPA
EVENING SESSION:

SUBMITTED PRIOR TO THE CITY COUNCIL MEETING

14.A. CULTURAL HERITAGE COMMISSION MEMBERSHIP:
1) Email from Kent Rasmussen received on July 29, 2022.

15. ADMINISTRATIVE REPORTS:

15.A. Local Roadway Safety Plan
• PowerPoint Presentation from City Staff.

SUBMITTED DURING THE CITY COUNCIL MEETING

13. PUBLIC COMMENT:
1) Handout from Irena Miles received on August 2, 2022.

ATTACHMENT 2

From: Kent Rasmussen Sent: Friday, July 29, 2022 9:50 AM To: Paulee Cooper Cc: Tiffany Carranza; Samantha Pascoe Subject: Re: Regular Meeng Agenda: City Council of the City of Napa 8/2/2022

[EXTERNAL]
Good Morning

Thank you for sending over the informaon about the upcoming City Council meeng and Cultural Heritage Board interviews.

Aer looking at the other candidates' applicaons, I can see that there are well qualified applicants for this round of appointments.

It has worried me that I may have several issues of my own coming before the CHB this year and thus may have conflicts.

I would like to withdraw my applicaon for appointment in 2022. I am very keen on being a member of the Cultural Heritage Board, but think that it would be prudent to wait and apply again next year once my potenal conflicts have been resolved.

Please confirm receipt of this email.

All the best, Kent

On Thu, Jul 28, 2022 at 4:00 PM Paulee Cooper <
[email protected]> wrote:

Good aernoon Cultural Heritage Commission applicants! (Bcc’d)

Thank you again for your interest in serving your community. As previously communicated, the City Council will be interviewing and making appointments to the Cultural Heritage Commission at the 6:30 p.m. evening session of our August 2, 2022 City Council Meeng.

We look forward to seeing you all next week for your interviews.

Follow this link to access the regular meeng agenda for August 2, 2022:

City Council of the City of Napa Regular Meeng

Please let me know if you have any quesons. Thank you!

Best regards,
Paulee

Paulee Cooper
Office Assistant II
City Clerk’s Office, City of Napa
Item 14.A.

955 School Street, Napa, CA 94559
Phone (707) 257-9474
Email [email protected]
Website www.cityofnapa.org
Social www.facebook.com/CityOfNapa · @CityOfNapa

--
Kent Rasmussen

Napa, California 94559

Local
Roadway Safety Plan
Napa Cit
y Council Meeting
August 2, 2022
6:30 pm
City Council Regular Meeting
8/2/2022
Supplemental - Item 15.A.

From: City Staff

Agenda
• What is a
n LRSP?
• Project Status and Milestones
• Community Input
• Collision Analysis Findings
• Emphasis Areas
• Engineering & Non-Engineering
Countermeasures
• Safety Projects
• Implementation
• Open Discussion/Comments

What i
s a Local Roadway Safety Plan (LRSP)?
• Overar
ching Goals:
• To reduce fatalities and severe injuries on City
roadways and intersections attributed to traffic
collisions
• To identify, analyze and prioritize roadway and
intersection safety improvements on City roads
• A required document to be eligible for the Highway
Safety Improvement Program (HSIP) grant funding
• Considers engineering and non-engineering strategies
• 4 E’s of Traffic Safety: Education, Enforcement,
Engineering and Emergency Medical Services (EMS)

Project Sta
tus and Milestones
Data C
ollectionData C
ollection Collision
Trend
Analysis
Collision
Trend
Analysis
Identifi
cation of
High-Injury
Locations
Identifi
cation of
High-Injury
Locations
Identif
y Emphasis
Areas
Identif
y Emphasis
Areas
Develop
Coun
termeasures
Toolbox
Develop
Coun
termeasures
Toolbox
Cost-
Estimates
and BCR
Cost-
Estimates
and BCRLRSP Rep
ortLRSP Rep
ort Develop
Safety
Projects
Develop
Safety
Projects
1st Stakehol
der Meeting
– March 30, 2022
2nd Stakehol
der Meeting
June 22, 2022
Community Outr
each
through Website and
Interactive Map
Input

• 808 c
omments received
• Map was promoted on City website and social media
• Comments came from website or through
community groups
Community
Input
0 50
100
150
200
250
300

Collisi
on Analysis Findings
• 1,207
injury collisions
between 2016-2020
• 80 fatal and severe injury
(F+SI collisions)
# of Collision
s
241
221
24 5
293
207
13 17 15 17 18
0 50
100
150
200
250
300
350
2016 2017 2018 2019 2020
Total F+SI
Fatal
1%
Severe
Injury
5%
Vi
sible
Injury
34%
Complaint
of Pain
60%

Collisi
on Analysis
Findings
All
Collisions
Violation Category
Collision Type
Collisions by Motor Vehicle Involved With
10%
90%
Roadway Segment Intersection
7%
93%
Roadway Segment Intersection
F+SI Coll
isions
7% 7%
26%
40%
8%
1%
9%
3%
11 %
3%
10%
24%
15%
3%
30%
5%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Head- On Sideswipe Rear End Broadside Hit Object Overturned Vehicle/ Pedestrian
Other
Total F+SI
10%
22%
4%
12 %
20%
6%
2%
11%
2% 2%
4% 5%
20%
8%
3%
8%
11% 11%
15%
4% 5%
1%
5%
10%
0%
5%
10%
15%
20%
25%
Total F+SI
0% 2%
10%
64%
5% 9% 8%
0%0%
6%
35 %
28%
6% 8%
18%
0%
0%
10%
20%
30%
40%
50%
60%
70%
Not Stated Non-Collision Pedestrian Other Motor
Vehicle
Parked
Motor
Vehicle
Bicycle Fixed Object Other Object
Total F+SI

Geogr
aphic Collision Analysis
40% of injur
y collisions were broadside 47% of F+SI collisions occurred at night

Geogr
aphic Collision Analysis
22% of injur
y collisions were caused by unsafe speed DUI caused 20% of all F+SI collisions

Geogr
aphic Collision Analysis
30% of all
F+SI collisions were vehicle/pedestrian

Equiv
alent Property
Damage Only (EPDO) Score
EPDO Sc
ore =
(165 x # of
Fatal Collisions) +
(165 x # of Severe Injury Collisions) +
(11 x # of Other Visible Injury Collisions) +
(6 x # of Complaint of Pain Collisions) +
(1 x # of PDO Collisions)
(Source:

Local Roadway Safety Manual 2020, Caltrans)
Collision Se
verity EPDO Score
Fatal and Severe Injury
Combined 165
Visible Injury 11
Complaint of Pain 6
Property Damage Only (PDO) 1

High-
Injury Intersections
ID Inter
section Total
Collisions F+SI Collisions EPDO Score
1 Soscol Ave at W . Imola
Ave 18 3 600
2 SR 29 at Trower Ave 18 2 456
3 Lincoln Ave at Soscol Ave 17 2 430
4 SR 29 at Wine Country
Ave 7 2 370
5 Silverado Trail at Lincoln
Ave/Clark St 5 2 353
6 Redwood Rd at Solano
Ave 17 1 296
7 SR 29 at SR 12 14 1 268
8 W. Imola Ave at SR 29 NB
Ramps 11 1 240
9 SR 29 at Salvador Ave 10 1 234
10 Soscol Ave at Shetler Ave 11 1 230
11 California Blvd at Pueblo
Ave 9 1 228
12 Jefferson St at Sheridan Dr 9 1 228

High-
Injury Corridors
ID Inter
section Total
Collisions
F+SI
Collisions
Length
(miles)
EPDO
Score
A Soscol Ave: W. Imola Ave to Trancas St 38 5 3.3 1073
B Silverado Trail: Soscol Ave to City Limit 24 3 2.4 636 C Solano Ave: Lincoln Ave to Trower Ave 13 2 1.8 426
D Trancas St/Redwood Rd: 450’ E of Dry Creek
Rd to City Limit (East) 31 1 2.3 400
E Lincoln Ave: Yajome St to Silverado Trail 9 2 0.8 372 F S. Freeway Dr/Golden Gate Dr: 900’ N of
Imola Ave to 1,600’ S of Imola Ave 5 2 0.5 353
G SR 29: 1,400’ N of Trancas St to City Limit
(North) 24 1 1.5 338
H W. Imola Ave: Foster Rd to Soscol Ave 22 1 1.8 326
I Browns Valley Rd/First Street: 350’ W of
Austin Rd to 400’ W of Freeway Dr 20 1 1.3 309
J Main St: 750’ N of Lincoln Ave to 5
th St 13 1 1.2 252
K Jef
ferson St: Trancas St to 2nd St 30 0 1.9 235

Top Emphasis Area
s
• Impro
ve Intersection Safety
• Collisions
within 250 feet of intersections
• Addr
ess Rear End Collisions & Unsafe Speed
Violations
• Address Broadside Collisions
• Improve Pedestrian Safety
• Address Nighttime Collisions
• Address Driving Under the Influence (DUI) Collisions
• Address Young Adult Party-at-Fault Collisions

The 4 E’s
of Traffic Safety
Engineering Enforcement
Emergen
cy
Medical
Services
(EMS)
Educ
ation
• Conduct f
ocused public information
and education campaigns
• Create pocket guides and
informational fliers with pedestrian
laws, stop sign violations, etc.
• Safe Routes to School education
programs
• Improve deployment to
collision sites
• Ensure emergency routes
are defined and clear
• Targeted enforcement at high
risk intersections
• Place high priority on
enforcement of violation type
that contribute to the most
fatalities and severe injuries
• HSIP eligible countermeasures
• E.g.: Improve intersection lighting,
install median refuge island, install
bulb outs, improving signs and
striping

Emphasis Area
s Strategies

Count
ermeasure Toolbox – Signalized
Intersections
HSIP
Code
Count
ermeasure
S01 Add intersection lighting
S02 Improve signal hardware: lenses, back-plates with retroreflective borders, mounting, size, and number
S03 Improve signal timing (coordination, phases, red, yellow, or operation) S04 Provide Advanced Dilemma Zone Detection for high speed approaches* S07 Provide protected left turn phase (left turn lane already exists) S08 Convert signal to mast arm (from pedestal-mounted)
S09 Install raised pavement markers and striping (Through Intersection) S10 Install flashing beacons as advance warning (S.I.)
S11 Improve pavement friction (High Friction Surface Treatments)

Count
ermeasure Toolbox – Signalized
Intersections
HSIP
Code
Count
ermeasure
S12 Install raised median on approaches (S.I.)
S13PB Install pedestrian median fencing on approaches
S17PB Install pedestrian countdown signal heads
S20PB Install advance stop bar before crosswalk (Bicycle Box) S21PB Modify signal phasing to implement a Leading Pedestrian Interval (LPI)

Signalized
Intersection Improvements
Impro
ve Signal
Hardware & Timing
Install raised pavement markings Modify signal phasing to implement a Leading Pedestrian Interval (LPI) Advance Stop Bar (Bicycle Box) Advan
ce Flashing Beacon
Impro
ve pavement friction

Count
ermeasure Toolbox – Unsignalized
Intersections
HSIP Code Coun
termeasure
NS01 Add intersection lighting (NS.I.)
NS06 Install/upgrade larger or additional stop signs or other intersection warning/regulatory signs
NS07 Upgrade intersection pavement markings (NS.I.)
NS12 Improve pavement friction (High Friction Surface Treatments) NS19PB Install raised medians (refuge islands)
NS21PB Inst
all/upgrade pedestrian crossing at uncontrolled locations (with enhanced safety featu
res)

Unsignaliz
ed Intersection Improvements
Add in
tersection lighting Install/upgrade larger or additional stop signs or other intersection warning/regulatory
signs
Upgrade intersection
pavement markings
Install/upgrade pedestrian crossing
(with enhanced safety features)
Install median refuge island

Count
ermeasure Toolbox – Roadway
Segments
HSIP Code
Countermeasure
R01 Add Se
gment Lighting
R02 Remove or relocate fixed objects outside of Clear Recovery Zone R03 Install Median Barrier
R09 Install median (flush)
R13 Add two-way left-turn lane (without reducing travel lanes) R14 Road Diet (Reduce travel lanes from 4 to 3 and add a two way left-turn and bike lanes)
R21 Improve pavement friction (High Friction Surface Treatments) R22 Install/Upgrade signs with new fluorescent sheeting (regulatory or warning)
R23 Install chevron signs on horizontal curves

Count
ermeasure Toolbox – Roadway
Segments
HSIP Code
Countermeasure
R24 Inst
all curve advance warning signs
R26 Install dynamic/variable speed warning signs
R27 Install delineators, reflectors and/or object markers R28 Install edge-lines and centerlines
R30 Install centerline rumble strips/stripes
R31 Install edgeline rumble strips/stripes
R33PB Install Separated Bike Lanes
R34PB Install sidewalk/pathway (to avoid walking along roadway) R35PB Install/upgrade pedestrian crossing (with enhanced safety features) R37PB Install Rectangular Rapid Flashing Beacon (RRFB)

Roadwa
y Segment Improvements
Inst
all delineators, reflectors, and/or
object markers
Install/Upgrade signs with new fluorescent
sheeting (regulatory or warning)
Install/upgrade pedestrian crossing
(with enhanced safety features)
Install Separated Bike Lane
Install dynamic/variable speed
warning signs
Inst
all chevron signs on horizontal curves

Non Engineering
Strategies
• Educ
ation
• Conduct
public information and education campaign for intersection safety laws, unsafe speeds, distracted driving, improper turning and driving under the influence. • Conduct bicycle and pedestrian safety campaigns and outreach to raise their awareness of bicycle and pedestrian safety needs through media outlets and social platforms in Napa every 3-5 years • Enforceme
nt
• Targ
eted enforcement at high-injury locations.
• Increase the number of personnel who have completed Advanced Roadside impaired Driving Enforcement (ARIDE) training
• EMS
• Inst
all emergency vehicle pre-emption systems
• Increase the number of EMS/fire control personnel taking Traffic Incident Management Training

Signalized

Intersection
Safety Projects
Project # Count
ermeasure
Project 1 S09 - Install raised pavement markers and striping (Through Intersection) S11 - Improve pavement friction (High Friction Surface Treatments) Project 2
S02 - Improve signal hardware: lenses, back-plates with retroreflective borders, mounting, size, and number
S03 - Improve signal timing (coordination, phases, red, yellow, or operation) S10 - Install flashing beacons as advance warning (S.I.) Project 3
S21PB - Modify signal phasing to implement a Leading Pedestrian Interval (LPI) S17PB - Install pedestrian countdown signal heads
S20PB - Install advance stop bar before crosswalk (Bicycle Box) Inter
section Project 1 Project 2 Project 3
Soscol Ave/Imola Ave S09 S11 S03 S10 S21PB S17PB S20PB
SR29/SR12 S09 S11 S03
SR29/Trower Ave S09 S11 S03 S21PB S17PB
Lincoln Ave/Soscol Ave S09 S11 S02 S03 S21PB S17PB S20PB SR29/Wine Country Ave S09 S11 S03 S21PB S17PB
Silverado Trail/Lincoln Ave/Clark St S09 S11 S02 S03 S21PB S17PB S20PB Redwood Rd/Solano Ave S09 S11 S03 S21PB S17PB S20PB
SR29/Salvador Ave S09 S11 S02 S03 S21PB S17PB
Soscol Ave/Shetler Ave S09 S11 S03 S21PB S17PB
W. Imola Ave/SR29 NB Ramps S09 S11 S03 S10 S21PB S17PB
Jefferson St/Sheridan Ave S09 S11 S02 S03 S21PB

Non-Signalized
Intersection Safety Projects
Project #
Countermeasure
Project 4
NS21PB - Install/upgrade pedestrian crossing at uncontrolled locations (with enhanced safety features)
NS06 - Install/upgrade larger or additional stop signs or other intersection warning/regulatory sign NS07 - Upgrade intersection pavement markings
Intersection Pr
oject 4
California Blvd/Pueblo Ave NS21PB NS06 NS07

Roadwa
y
Segment Safety
Projects
Project # Count
ermeasure
Project 5
R22 - Install/Upgrade signs with new fluorescent sheeting (regulatory or warning) R27 - Install delineators, reflectors and/or object markers R21 - Improve pavement friction (High Friction Surface Treatments) Project 6
R35PB - Install/upgrade pedestrian crossing (with enhanced safety features) R37PB - Install Rectangular Rapid Flashing Beacon (RRFB) R26 - Install dynamic/variable speed warning signs
Corridor Project
5 Project 6
Soscol Ave: W Imola Ave to Trancas St R22 R27 R21 R35PB R37PB R26 Silverado Trail: Soscol Ave to City Limits R22 R27 R21 R35PB R37PB R26 Solano Ave: Lincoln Ave to Trower Ave R22 R27 R21 R35PB R37PB R26 Lincoln Ave: Yajome St to Silverado Trail R22 R27 R21 R35PB R37PB R26 Freeway Dr/Golden Gate Dr: 900' N of Imola Ave to 1600' S of Imola Ave R22 R27 R21 SR29: 1400' N of Trancas St to City Limit (North) R22 R27 R21 W. Imola Ave: Foster Rd to Soscol Ave R22 R27 R21 R35PB R37PB R26 Browns Valley Rd/First St: 350' W of Austin Rd to 400' W of Freeway Dr R22 R27 R21 R35PB R37PB R26 Main St: 750' N of Lincoln Ave to 5th St R22 R27 R21 R35PB R37PB R26 Jefferson St: Trancas St to 2nd St R22 R27 R21 R35PB R37PB R26 Trancas St/Redwood Rd: 450' E of Dry Creek Rd to City Limits (East) R22 R27 R21 R35PB R37PB R26

Evalu
ate
countermeasures
Evalu
ate
countermeasures
Continue
moni
toring high-
risk locations
Continue
moni
toring high-
risk locations
Implemen
tation
Appro
ve
LRSP
Appro
ve
LRSP
Implemen
t
countermeasures
under E-
strategies
Implemen
t
countermeasures
under E-
strategies
Monit
or high-risk
locations
Monit
or high-risk
locations
Analyz
e
performance
measure
Analyz
e
performance
measure
Discuss wi
th
safety partners
Evalu
ate number
of collisions
Evalu
ate number
of collisions
Update
LRSP
every 2-5 years
Update
LRSP
every 2-5 years+
Successful r
eduction in the
number of collisions
No red
uction in the
number of collisions

Open Discussio
n & Questions

The city of Napa is on notice that that intersection of Beecham and Pueblo is a hazard due to daily parking violations next to the corner/street
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The city of Napa is on notice that Beecham Street and Court are used for long-term car storage High-density housing surrounds the neighborhood. The city has not mitigated the impact of the current high-density housing and yet continues to propose more in the same area. I have observed car owners walk to the apartments on Soscol or being picked up by another driver and driving away, while the car remains in our residential area.

Concluding that the problem is due to too many cars, relinquishes the responsibility the city and the drivers have to parking. As one city council member said the problem is everywhere. A simple root cause analysis would give you a number of possibilities on why the program does not work.

Here is an example of how the program currently works.

Car with lapsed registration parked
since 6/17/2022
10 electronic notifications
o 6/20
o 6/22
o 6/24
o 6/30
o 7/5, parking crew in area,
as noted in email from
Parking Programs Manager
o 7/7
o 7/11
o 7/12
o 7/20 parking crew within
200 ft as observed by neighbor and yet no ticket
o 7/22 via email, the Parking Programs Manager did not know why the car was not tagged. "The officer should have red-tagged the vehicle while at that location." o 7/23
Car left 6pm Aug 1, 2022, total of 48 days
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