Food for Everyone

WINTER 2015/16

FOOD ACCESS:

Challenges for LOW-INCOME SENIORS and HOMELESS INDIVIDUALS in San Jose Acknowledgements

Tamara Calise, PhD. and Clancey Bateman of John Snow, A special thanks to the following individuals for providing Inc. conducted a literature review, data collection, surveys, feedback and informing the recommendations in this report: interviews, and focus group for this report. Aurelia Bailey, Community Services Supervisor, City of San Brian Fulfrost & Associates collected data and produced the Jose Housing Department maps used for GIS analysis in this report. Ray Bramson, Homelessness Response Manager, City of San Jose Housing Department We would like to thank the following individuals and Abraham Chacko, Program Manager, City of San Jose Parks, organizations for participating in interviews, contributing Recreation, and Neighborhood Services data, and providing input for this report: Wayne Chen, Division Manager, City of San Jose Housing Swamini Bajpai, Program Director, MidPen Housing Department Marilou Cristina, Interim Executive Director, Alzheimer’s Kathryn Kaminski, Development Officer, City of San Jose Activity Center Housing Department Edita Cruz, Executive Director, Martha’s Kitchen Mary O’Meara, Recreation Supervisor, City of San Jose Parks, Susan Fent, Division Director of Community Living Services for Recreation, and Neighborhood Services Santa Clara County, Institute on Aging Adam Marcus, Policy Manager, City of San Jose Housing Pinki Fung, Senior Wellness Program Coordinator, Asian Department Americans for Community Involvement Diana Miller, Program Manager, Seniors’ Agenda, County of Lydia Guel, Chief of Staff at Office of Councilmember Raul Santa Clara Department of Aging and Adult Services Peralez, City of San Jose District 3 Jacky Morales-Ferrand, Director, City of San Jose Housing Tracey Gott, San Jose Senior Nutrition Program, Parks, Department Recreation, and Neighborhood Services Brandon Pham, Analyst, County of Santa Clara Department of Poncho Guevara, Executive Director, Sacred Heart Community Aging and Adult Services Service Bruno Pillet, Vice President of Programs and Services, Second Linda Jones, Program Manager at HomeFirst Harvest Food Bank Madeline Martin, Marketing & Development Director, Loaves Jim Ramoni, Director, County of Santa Clara Department of & Fishes Aging and Adult Services Lori Mathis, Community Programs Manager, Second Harvest Angel Rios, Director, City of San Jose Parks, Recreation, and Food Bank Neighborhood Services Cindy McCown, Vice President of Programs and Services, James Stagi, Housing Policy and Planning Administrator, City Second Harvest Food Bank of San Jose Housing Department Jenny Niklaus, Vice President, Innovation Networks, American Suzanne Wolf, Deputy Director, Recreation & Community Leadership Forum Silicon Valley Services Division, City of San Jose Parks, Recreation, and Neighborhood Services Jan Pfiffner,Department of Aging and Adult Services, County of Santa Clara AnnMarie Zimmermann, Executive Director, Loaves and Fishes Family Kitchen Steven Schmoll, Executive Director, Sourcewise Paul Tatsuda, Community Transportation Manager, Outreach We thank the City of San Jose Housing Department and the Mobility Management David and Lucile Packard Foundation for generously joining Applied Survey Research The Health Trust in funding this report. Destination:Home The following Health Trust Staff contributed to this report: City of San Jose Housing Department Co-author: Rachel Horst, Program Associate City of San Jose Planning Department Co-author: Rachel Poplack, Director of Strategy City of San Jose Police Department Frederick Ferrer, Chief Executive Officer Santa Clara County Social Services Agency Todd Hansen, Chief Operating Officer Santa Clara Valley Transportation Authority Paul Hepfer, Vice President of Programs Jennifer Loving, Executive Director of Destination: Home Infographics by Cesar Ramirez Cara Sansonia, Director of Healthy Aging Design and layout by Design Action Collective Letter from the CEO

A healthier Silicon Valley for everyone.

That’s our vision; what we strive to accomplish. It’s ensuring that health related policies and services exist so that race, language, income and age aren’t barriers to eating affordable, quality, nutritious food.

Sadly, this doesn’t hold true...yet, especially with the most vulnerable populations of our community, low-income seniors and individuals that are homeless. It’s no secret that food insecurity runs rampant among these populations. But what we didn’t know before, we do now:

• Where food assistance resources are relative to these populations • Where the gaps lay between the resources and the individuals that need them most • The financial esourcesr required to fill the gaps

This is exactly what Food for Everyone details. It’s a thorough assessment of healthy food access among low-income seniors and individuals that are homeless in San Jose.

The County of Santa Clara and City of San Jose now have an invaluable resource at their disposal. This report allows them to use data to drive informed decision making, while maximizing resources in their efforts to end homelessness and increase food access to seniors. But Food for Everyone is more than just a resource, it’s a call to action. Its imperative that we curb the food insecurities plaguing the most vulnerable among us.

Resolving this plight doesn’t rest solely on the shoulders of our policy makers. It takes all of us working collectively to impact change; change that is attainable as laid out by the findings in the report. As such, we are moving forward with the formation of a Food Access Implementation Task Force. Consisting of City and County officials, and nonprofit partners, this task force will take the lead on ensuring that the findings of this report result in actionable solutions.

As you will read, the findings and recommendations in Food for Everyone present many challenges. But within every challenge, lies opportunity. Access to and consumption of affordable, quality, nutritious food, for everyone. That’s the challenge. Now, let’s seize the opportunity.

Frederick J. Ferrer

Chief Executive Officer

The Health Trust Contents

Executive Summary �������������������������������������������������������������������������������������� 1

I. Introduction ���������������������������������������������������������������������������������������������� 7

II. Definitions ���������������������������������������������������������������������������������������������� 10

III. Methodology ���������������������������������������������������������������������������������������� 11

IV. Individuals that are Homeless ��������������������������������������������������������������� 12

Analysis: Access to Food Assistance ������������������������������������������������������������� 12

Analysis: Transportation and Walksheds ������������������������������������������������������� 22

Analysis: The Retail Food Environment ��������������������������������������������������������� 24

Recommendations: Individuals that are Homeless ��������������������������������������� 28

V. Low-Income Seniors ������������������������������������������������������������������������������� 30

Analysis: Availability of Food Assistance ������������������������������������������������������� 30

Analysis: Transportation and Walksheds ������������������������������������������������������� 38

Analysis: Retail Food Environment ���������������������������������������������������������������� 42

Analysis: Crime and Safety ���������������������������������������������������������������������������� 50

Analysis: Mobility of Low-Income Seniors ����������������������������������������������������� 52

Recommendations: Low-Income Seniors ������������������������������������������������������ 58

Conclusion ������������������������������������������������������������������������������������������������� 59

Appendix A. Detailed Methods: Primary Data Collection �������������������������� 61

Appendix B. Detailed Methods: GIS Mapping ������������������������������������������� 62

Appendix C: List of Maps ��������������������������������������������������������������������������� 64

Appendix D: Food Assistance Programs in San Jose ��������������������������������� 74

Appendix E: Organizations Interviewed ���������������������������������������������������� 75 Executive Summary

To have sufficient food access means having “access, at coordination between nonprofits, the City, and the all times, to enough food for an active, healthy life for County to ensure that individuals, whether chronically all household members.”1 In San Jose, a city of both homeless or experiencing a period of housing instability, great wealth and great poverty, 30% of all households receive the support they need. are living below the self-­sufficiency standard, the income level at which an individual or family can afford to meet This report underlines the importance of making access their basic needs­­.2 to healthy food an integral part of this coordinated response to homelessness. Using a variety of methods, Two groups disproportionately affected by poverty and including GIS mapping, interviews with providers, food insecurity are individuals that are homeless and Census data, and local data sets, it identifies significant low-­income seniors. According to the 2015 City of San gaps in healthy food access and opportunities for Jose Homeless Census and Survey, on any given night, the City and County agencies, The Health Trust, there are 4,063 individuals that are homeless in San Jose, community-based organizations, and other stakeholders and 2,810 of them are unsheltered.3 Of adults over 65 in to provide services more cost-effectively. San Jose, 29,755, or 27%, are low­-income, meaning they earn less than 200% of the Federal Poverty Level.4 This This assessment is intended to be used as a guide report analyzes the gaps in healthy food access among on important questions of resource allocation and these two populations and identifies opportunities to coordination in the City’s response to homelessness. Since expand and improve food assistance in San Jose. the analysis portion of this assessment was completed, data from the 2015 Homeless Census have become available, showing that the population of homeless individuals has decreased and spread out to areas beyond Individuals that downtown San Jose. These developments reinforce the are Homeless following findings: There are over 4,000 individuals in San Jose that are FINDINGS: homeless, with over 2,800 individuals unsheltered. For many, securing a consistent and healthy source of food • Providers noted that food safety-net resources is a daily burden, costing time and resources that could are scarce outside of downtown San Jose, and otherwise be spent taking care of their basic needs. mapping of these sites confirms this. The location and number of homeless safety net providers does The City’s approach to homelessness recognizes that in not consistently match with where individuals that addition to housing, providing the full range of supports are homeless are located. There is the strongest and services leads to better outcomes for individuals, alignment of population and resources within and to lower public costs. This approach requires close downtown. In several Census tracts outside of

1 USDA definition. “USDA ERS ­Food Security in the U.S.” USDA ERS ­ downtown San Jose, individuals that are homeless Food Security in the U.S. September 8, 2015. Accessed December 16, 2015. have no access to a food safety-net provider. http://www.ers.usda.gov/topics/food­nutrition­assistance/food­securityin­ ­ the­ us.aspx. 2 “Healthy Food within Reach: Helping Bay Area Residents Find, Afford, and Choose Healthy Food.” February 2015. Accessed December 16, 2015. • Providers expressed that an overall lack of www.spur.org coordination between providers makes it difficult to 3 Applied Survey Research. “San Jose 2015 Homeless Point-in-Time Census and Survey.” 2015. Accessed December 16, 2015. https://www.sanjoseca. align resources with the population in areas outside gov/DocumentCenter/View/44727. of downtown. 4 U.S. Census Bureau; American Community Survey, 2008­2012 5Y­ ear Esti- mates, Table B19037 . • Only 14 of 42 food safety-net providers report 3. Create a flexible congregate meal system for serving congregate meals, despite the fact that they individuals that are homeless that can move as the are the primary source of food for individuals that population moves. are homeless. Providers noted that many congregate 4. Formalize partnerships with faith-based meal sites are “overwhelmed” with clients that are communities to meet the needs of individuals that homeless or living in poverty. If all individuals are homeless in areas of the city that lack food that are homeless received 1 meal 5 times a week, resources. it would require 20,315 meals. Congregate meal providers serve approximately 8,598 meals per week, 5. Explore opportunities to increase and use Senior leaving a gap of 11,717 meals. Nutrition Program funding to better meet the needs of older adults that are homeless. • Not all recently housed individuals have adequate 6. Explore opportunities to increase CalFresh access to food safety-net providers. This report enrollment of individuals that are homeless. presents opportunities to integrate food into the 7. Develop infrastructure that supports an ongoing, necessary supports and services provided to recently coordinated solution to the food access needs of housed individuals. individuals that are homeless. 8. Explore opportunities in the existing safety-net • In many parts of San Jose, individuals that are infrastructure for cross-population services (e.g., homeless have very low access to transit to and from could kitchens at Senior Nutrition Program service providers, shelters, and healthy food retail. sites prepare to-go meals for individuals that are Access to public transit-- measured by the number of homeless). transit stops within a half-mile of safety-net providers and shelters-- is very low for all but one site outside 9. Form partnerships where possible between food of the downtown area. safety-net providers and other service providers.

• Many providers noted the need for a “centralized Low-Income Seniors area” that could make it easier for individuals that are homeless to receive various forms of assistance. The Building healthy communities is one of the central maps show that individuals that are homeless in San themes of Envision 2040, the City’s General Plan. The Jose most likely do not have access to the full range document that sets the tone for future planning and of services they need within walking distance. development in San Jose recognizes that equitable access to healthy food is an opportunity to promote social • The retail food environment within walking cohesion, spur economic development, and contribute to distance of safety-net providers and shelters a safer and healthier built environment. By addressing provides few healthy food options. Measured with the food access concerns of one of the City’s most the Modified Retail Food Environment Index vulnerable populations, the City has the opportunity to (mRFEI), the majority of the 42 safety-net provider invest in building stronger, healthier neighborhoods. sites and 44 shelters have moderately low to no This investment is also a timely one; the percentage of healthy food access within walking distance. residents over 65 in San Jose is expected to more than double by 2060. Planning for the needs of seniors, then, is planning for the City’s future. Currently, there are RECOMMENDATIONS approximately 29,755 low-income seniors in San Jose, 1. Integrate food access into City and County many of whom experience food insecurity. The forms homeless support services. of food assistance available to them include CalFresh/ SNAP, Senior Nutrition Program congregate meals, 2. Develop a food assistance protocol to assist those brown bag and food pantry sites, and Meals On Wheels, most affected by, or most at risk of nutrition- a home delivered meal service for homebound seniors. related chronic conditions.

2 THE HEALTH TRUST Using GIS mapping, interviews with providers, and • The number of seniors served by Meals On Wheels analysis of Census data, this assessment identified a number is small compared to the number of low- income of missed opportunities for investment in the current food seniors with ambulatory difficulty and living assistance environment in San Jose with potential returns alone in San Jose. Both the number and location for the City, low-income seniors, and their neighborhoods. of seniors with ambulatory difficulty in San Jose The findings presented here are intended to guide the City, strongly suggest that the population in need of County, The Health Trust, and other non-profit partners in delivered meals is currently underserved. future decision making on how to allocate limited resources and where to focus their efforts to support the health and well-being of low-income seniors in San Jose. RECOMMENDATIONS 1. Identify senior communities, affordable housing FINDINGS units, and other residential areas with high concentrations of seniors that would benefit from • The location and number of senior safety-net cost-effective solutions such as food drops or providers does not consistently match with where mobile produce units. low-income seniors are located. There is the strongest alignment of population and resources 2. Develop a Senior Nutrition Program outreach within downtown. In several Census tracts outside strategy to increase participation in communities of downtown San Jose, seniors-- including many with high concentrations of low-income seniors with ambulatory difficulty-- have no access to a and SNP congregate meal sites with the potential safety-net provider. to increase capacity.

• Twenty-two percent of seniors in San Jose have 3. Increase funding for mobile meal services, i.e., ambulatory difficulty. Low-income seniors with Meals On Wheels, for the lowest-income, most limited mobility may not be able to travel to reach vulnerable older adults in San Jose. Senior Nutrition Program congregate meal sites 4. Explore innovative solutions to allow low-income or brown bag sites, especially outside of downtown seniors to access food resources in the community San Jose, increasing their risk of food insecurity and (e.g., restaurant vouchers, grocery delivery service). social isolation. 5. Incentivize healthy food retail in the City’s planned • Transit access within walking distance of many growth areas. Senior Nutrition Program congregate meal sites 6. Explore opportunities in the existing safety-net is limited. The lack of transportation may prevent infrastructure for cross-population services (e.g., some low-income seniors from attending congregate could kitchens at Senior Nutrition Program meals, depriving them of adequate food and sites prepare to-go meals for individuals that are nutrition and the opportunity for social interaction. homeless).

• The majority of the City’s planned growth areas, 7. Explore opportunities to increase CalFresh where many low-income seniors reside, contain very enrollment of low-income seniors. few healthy food options and an overabundance of unhealthy food outlets and liquor stores, which 8. Form partnerships where possible between food can encourage unhealthy food choices and serve as safety-net providers and other service providers. potential centers of crime.

• Many of the City’s affordable housing units, of which 22% are “senior units,” are generally located in areas with low access to healthy foods and an overabundance of unhealthy food options.

3 FOOD FOR EVERYONE 4 THE HEALTH TRUST 5 FOOD FOR EVERYONE

I. Introduction

To have sufficient food access means having “access, at all times, to enough food for an active, healthy life for CalFresh Utilization all household members.”5 In San Jose, a city of both great wealth and great poverty, 30% of all households and Limitations are living below the self-sufficiency standard, the income It is widely known that CalFresh enrollment both level at which an individual or family can afford to meet alleviates food insecurity and has a “multiplier effect,” their basic needs--most notably housing or food.6 It stimulating economic activity. The USDA Economic is not surprising that, according to the Santa Clara Research Service estimates that every SNAP County Behavioral Risk Factor Survey, a nearly identical (CalFresh) dollar creates $1.79 in taxable revenue.10 percentage of adults– 33 percent–live in “food insecure Research by California Food Policy Advocates households.” Access to healthy food is also limited has shown that California cities and counties are because of the lack of healthy food retail. In low-income forfeiting dollars from CalFresh redemption. Based areas of San Jose, an average of just 16 percent of all on their estimations for Santa Clara County, the “lost food retailers are considered “healthy.”7 dollars,” or increased economic activity that could Two groups disproportionately affected by poverty and be generated by full CalFresh utilization in San Jose food insecurity are individuals that are homeless and totals over $119 million.11 low-income seniors. According to the 2015 City of San The data on CalFresh enrollment show that many Jose Homeless Census and Survey, on any given night, eligible individuals that are homeless and low-income there are 4,063 individuals that are homeless in San seniors are missing a source of income that would help Jose, and 2,810 of them are unsheltered.8 61% have a to partially offset the burden of food insecurity. Only total monthly income less than $449. Of adults over 65 38% of individuals that are homeless reported receiving in San Jose, 29,755, or 27%, are low-income, meaning CalFresh,12 though this was the most frequently reported they earn less than 200% of the Federal Poverty Level.9 form of government assistance. According to safety-net Despite the size of both groups, relatively little is known providers, the paperwork for CalFresh is complex and about how and to what extent the existing food safety- constantly changing, a difficulty that often prevents net meets the food access needs of low-income seniors them from enrolling eligible clients who are receiving and individuals that are homeless. other services. An increase of 100 in the number of

5 USDA definition. “USDA ERS - Food Security in the U.S.” USDA ERS - Food Security in the U.S. September 8, 2015. Accessed December 16, 2015. http://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in- 10 “USDA ERS - Supplemental Nutrition Assistance Program (SNAP): the-us.aspx. Economic Linkages.” USDA ERS - Supplemental Nutrition Assistance 6 “Healthy Food within Reach: Helping Bay Area Residents Find, Afford, Program (SNAP): Economic Linkages. Accessed January 22, 2016. http:// and Choose Healthy Food.” February 2015. Accessed December 16, 2015. www.ers.usda.gov/topics/food-nutrition-assistance/supplemental-nutri- www.spur.org tion-assistance-program-(snap)/economic-linkages.aspx. 7 Raimi + Associates.”Community Health Existing Conditions Report for the 11 This was calculated by taking 50% of the CFPA estimate of $238,850,598 County of Santa Clara General Plan Health Element.” May 2013. https:// in economic activity generated in Santa Clara County from full CalFresh www.sccgov.org/sites/dpd/DocsForms/Documents/HealthElement_Exist- enrollment. This is likely a conservative estimate, since San Jose represents ing… over 50% of the population, and 67% of individuals below the poverty line 8 Applied Survey Research. “San Jose 2015 Homeless Point-in-Time Census in Santa Clara County. See: Call, Jared, and Tia Shimada. “Lost Dollars, and Survey.” 2015. Accessed December 16, 2015. https://www.sanjoseca. Empty Plates: The Impact of CalFresh on Local Economies.” California gov/DocumentCenter/View/44727. Food Policy Advocates. October 2015. http://cfpa.net/CalFresh/CFPAPub- 9 U.S. Census Bureau; American Community Survey, 2008-2012 5-Year lications/LDEP-FullReport-2015.pdf. Estimates, Table B19037 . 12 San Jose 2015 Homeless Census.

7 FOOD FOR EVERYONE individuals that are homeless receiving CalFresh would total approximately $228,000 in benefits, leading to Food Access $408,120 in additional economic activity in San Jose.13 and Health A major barrier to low-income seniors’ access to CalFresh is an administrative one, as beneficiaries of The health implications of food insecurity among SSI (Supplemental Security Income) are not eligible individuals that are homeless and low-income seniors for CalFresh benefits. Even with the possibility that deserve particular attention, not the least because of some may not qualify for CalFresh, the estimated gap the high costs associated with treating diseases related in senior CalFresh enrollment in San Jose is large, at to nutritional intake. Previous research has found an approximately 6,400 individuals. If just 1,000 additional association between “food insufficiency and increased seniors receive CalFresh benefits, totalling approximately acute health services utilization”17 among individuals that $1.87 million in benefits, it could result in an increase of are homeless. Some of the most common and costliest $3.35 million in economic activity in San Jose.14 medical conditions of individuals that are homeless can be traced to diet. A recent study on the cost of While CalFresh benefits have a positive effect on homelessness in Santa Clara County found that blood the local economy, and its recipients may rely less disease--most often anemia — at an average annual cost on the food safety net, the CalFresh benefit on its of $25,924, was the second-costliest medical diagnosis own is insufficient to eliminate food insecurity. At in 2011-2012, with the largest increase in cost ($1,850) approximately $190 per month, CalFresh benefits for over the six-year period under study.18 individuals that are homeless leave recipients cutting corners or relying on safety-net providers to make it Similarly, many seniors suffer from multiple chronic through the month. For the small number of seniors conditions that directly relate to food access and often who receive CalFresh, the average benefit is $156, an translate into high health costs. Chronic conditions are amount that also does not adequately cover expenses for the leading cause of death among adults over 65, with healthy food.15 heart disease, cancer, stroke, and diabetes accounting for almost two-thirds of all deaths in the United States.19 This may explain in part why the most frequently utilized National data from the Department of Health and service by individuals that are homeless is “free meals,” Human Services show that two-thirds of Medicare at 66%.16 Likewise, low-income and disabled seniors recipients have multiple chronic conditions,20 with are driven to rely on community and home-based food hospitalizations lasting longer and costing nearly 20% assistance services to meet their basic food security needs. more than for hospitalizations of adults without them. As CalFresh is only part of the solution to healthy food Most (County) Senior Nutrition Program participants access among low-income seniors and individuals that have chronic diseases related to diet.21 are homeless, the focus in much of this assessment is on

City-, County-, and nonprofit-run safety-net providers 17 Baggett, Travis P., Daniel E. Singer, Sowmya R. Rao, James J. O’Con- and the services they provide. nell, Monica Bharel, and Nancy A. Rigotti. “Food Insufficiency and Health Services Utilization in a National Sample of Homeless Adults.” J GEN INTERN MED Journal of General Internal Medicine, 2011, 627-34. Accessed December 16, 2015. http://www.ncbi.nlm.nih.gov/ pubmed/21279455. 18 Flaming, Daniel, Halil Toros, and Patrick Burns. “Home Not Found: The Cost of Homelessness in Silicon Valley.” 2015. Accessed December 16, 13 This was calculated using the reported $190 per month in CalFresh benefits 2015. http://destinationhomescc.org/wp-content/uploads/2015/05/er_hom- received by individuals that are homeless and the USDA dollar conversion enotfound_report_6.pdf. on page 7. The estimated monthly benefit is from the focus group with 19 “Healthy Aging Facts - NCOA.” NCOA. June 3, 2015. Accessed December individuals that are homeless and “Frequently Asked Questions.” CalFresh. 16, 2015. https://www.ncoa.org/news/resources-for-reporters/get-the-facts/ Accessed February 05, 2016. http://www.calfresh.ca.gov/pg846.htm. healthy-aging-facts/. 14 This calculation is based on estimates found in the Management Audit of 20 Steiner, Claudia A., M.D., Marguerite L. Barrett, M.S., Audrey J. Weiss, the Santa Clara County Senior Nutrition Program. This was done by taking Ph.D., and Roxanne M. Andrews, Ph.D. “Trends and Projections in 50% of the estimate (12,800 seniors), since San Jose represents over 50% of Hospital Stays for Adults With Multiple Chronic Conditions, 2003–2014.” the population, as 67% of individuals below the poverty line in Santa Clara Healthcare Cost and Utilization Project. November 2014. http://www. County. See: Management Audit Division of the Board of Supervisors. hcup-us.ahrq.gov/reports/statbriefs/sb183-Hospitalizations-Multi- “Management Audit of the Santa Clara County Senior Nutrition Program.” ple-Chronic-Conditions-Projections-2014.pdf. August 29, 2014. Accessed December 16, 2015. https://www.sccgov.org/ 21 Management Audit Division of the Board of Supervisors. “Management sites/bos/Management Audit of the Santa Clara County Senior Nutrition Program.” August 29, 15 Management Audit Division of the Board of Supervisors. “Management 2014. Accessed December 16, 2015. https://www.sccgov.org/sites/bos/Man- Audit of the Santa Clara County Senior Nutrition Program.” August 29, agement Audit/Documents/Senior-Nutrition-Program_FullReport.pdf. 2014. Accessed December 16, 2015. https://www.sccgov.org/sites/bos/Man- agement 16 2015 City of San Jose Homeless Census.

8 THE HEALTH TRUST Although individuals that are homeless and low-income The publication of this assessment will be followed by a seniors in the City are exceptionally vulnerable to food Food Access Implementation Plan to address the food insecurity, and their food insecurity has a significant, access needs of these two populations as an integrated costly, negative impact on their health, there is much less effort across City and County agencies, The Health known about food access resources and barriers among Trust, community-based organizations, and other these groups than other populations. The data in this stakeholders. assessment provide a starting point for determining how, and in what locations, the City can strategically improve access to healthy food with the greatest benefit for Layout of report individuals that are homeless, low-income seniors, and A list of definitions of frequently used terms in this their neighborhoods. report is provided in the next section, followed by a

discussion of methodology. The main analysis contains a series of maps, analyzed together with qualitative Why a food access and quantitative data from interviews and research on the determinants of food access. Findings on assessment? individuals that are homeless and low-income seniors are discussed separately, and each section concludes Commissioned by the City of San Jose Housing with recommendations. Additional maps showing the Department, the analysis here is intended to provide locations of all food safety-net providers can be found in data-driven guidance to the City in its response Appendix C. to homelessness and to a rapidly growing senior population.

There is an urgency in identifying and responding to the unmet food assistance needs of these two populations. It is imperative that healthy food access be an integral part of the response to homelessness, so that the over 4,000 individuals affected in San Jose are helped, not hindered, in achieving permanent stability. At the same time, San Jose is experiencing a major demographic shift, with the population of adults 65 and over expected to grow from 11% to 12% by 2060. Identifying the gaps in service provision for older adults could lay the foundation for a systematic approach to the nutritional and health needs of an aging population in the decades to come.

Increasing access to healthy food for low-income seniors and individuals that are homeless are smart investments in the future, both for the populations in question and the City’s development. The findings and recommendations here complement the City’s overall strategy to build more vibrant, healthier neighborhoods, as outlined in the landmark general plan, Envision 2040. Acting on the data now is the cost-effective alternative to allowing present trends to continue and neighborhoods to miss opportunities for greater social cohesion, economic opportunity, and an improved built environment.

9 FOOD FOR EVERYONE II. Definitions

Food security is a state when all people, at all times, Modified Retail Food Environment Index (mRFEI). have physical, social and economic access to sufficient, The mRFEI analyzes the number of healthy and less safe and nutritious food that meets their dietary needs healthy food retailers within a given geographic area. the and food preferences for an active and healthy life. mRFEI examines food stores within a half-mile of each census block and measures the percentage of healthy food Homeless. An unsheltered homeless person resides in stores out of all (healthy and unhealthy) food stores. The a place not meant for human habitation, such as cars, mRFEI defines “healthy” food retailers as food co-ops, parks, sidewalks, or abandoned buildings (on the street). fruit and vegetable markets, chain grocery stores, ethnic A sheltered homeless person resides in an emergency and independent grocery stores (including small stores), shelter, transitional housing, or supportive housing and warehouse club stores. These stores are considered for homeless persons who originally came from the healthy because they primarily offer healthy products or streets or emergency shelters. For the purposes of this a mix of products that could meet the nutritional needs assessment, we also refer to “recently housed” individuals of a family. “Unhealthy” food retailers are defined as fast that may be considered sheltered. food restaurants (including pizza and sandwich stores), convenience stores, and liquor stores. These stores are Low-income seniors. Low-income seniors were classified as unhealthy because they have very limited or defined as those 65 years or over living at 200% or below no healthy menu options. The mRFEI score is calculated the Federal Poverty Level. for a designated geographic area as follows: mRFEI = Safety-net providers. Providers of meals (hot or cold) (healthy retailers)/(healthy retailers+unhealthy retailers) or grocery programs, free of charge to individuals in need of food. Program types may include: congregate meals, food pantry/grocery/brown bag programs, Meals On Wheels, and informal feeding groups.

The figure below displays the safety-net food environ- ment in San Jose for both groups by program type.

10 THE HEALTH TRUST III. Methodology

OVERVIEW GIS ANALYSIS Multiple methods were used to assess the food The spatial analysis of data on the food safety-net environment in San Jose, including primary data and target populations in San Jose was conducted collection, GIS analysis, and a literature review. using Geographic Information Systems (GIS). The maps created for this report aim to synthesize data on the location of safety-net providers relative to both DATA COLLECTION populations with detailed information to evaluate Primary data collection for this assessment included their capacity and accessibility. Census data on both interviews and surveys with food assistance providers populations were used to identify potential areas of and a focus group with individuals that are homeless. high need and disparities in food access. These were For greater detail on methods and interviews, please see combined with network analysis to evaluate transit Appendix A. accessibility to safety-net providers and healthy food retail. Data on gang hot-spots were used as a proxy for neighborhood safety to identify barriers to healthy food LITERATURE REVIEW or safety-net access. Finally, data on health conditions A literature review on food access was conducted and of homeless individuals and low-income seniors were informed the structure of the analysis, which is built incorporated to identify potential needs within both around six main factors affecting food access (see figure populations and evaluate the ability of existing food to the right): assistance to address them.

1. Socioeconomic factors: high cost of living, cost of For a detailed discussion of the methods used food, location of services, and competing financial for GIS analysis, please see Appendix B. priorities. A list of all maps in this assessment is in 2. Food assistance: type, location, capacity, and service Appendix C. of safety-net providers.

3. Transportation: availability and accessibility of public transportation, and access within walking distance.

4. Retail food environment: type of food stores, locations, CalFresh/SNAP-eligibility, and healthy versus unhealthy foods (based on mRFEI- Modified Retail Food Index)

5. Crime and safety: gang hot-spots.

6. Health conditions: mental and physical health.

11 FOOD FOR EVERYONE IV. Individuals that are Homeless

Analysis: Access to Food Assistance

Maps with the 2013 data showed that most individuals OVERVIEW that are homeless were located in Census tracts The maps in this section provide a visual overview immediately in and around downtown San Jose; 2015 of the food assistance landscape for individuals that data reflect a population spread out over a larger area are homeless in San Jose. The accompanying analysis to the north and south. This new dataset shows that identifies potential areas of unmet need. Downtown the total population of individuals that are homeless San Jose appears as a service hub, with concentrations decreased by 15%, from 4,770 in 2013 to 4,063 in 2015. of both safety-net providers and individuals that are The 2015 data reinforce the importance of the main homeless. In several pockets outside of downtown, on finding based on the 2013 Homeless Census: individuals the other hand, there are significant gaps in access to that are homeless in and around downtown San Jose food assistance and other services. Focusing on these may have adequate access to the necessary safety-net gaps in access would enhance the City’s response to providers and services, but access to food in other parts homelessness in these areas of San Jose, with potentially of the city is very limited. more individuals able to achieve stability and lower long- term public costs related to persistent homelessness.

The analysis in this report is based on figures from the 2013 San Jose Homeless Census. Data from the 2015 Homeless Census have recently become available. 12 THE HEALTH TRUST Source: San Jose 2015 Homeless Point-in-Time Census and Survey.” 2015. https://www.sanjoseca.gov/DocumentCenter/View/44727 13 FOOD FOR EVERYONE THE HEALTHTHE TRUST 14 INDIVIDUALS THAT ARE HOMELESS everal of the brown bag and food pantry siteslabeledashomeless providers ofthe brown bagandfood pantry everal 22 • • County-, andstate-sponsored publicprograms. organizations, faith-basedorganizations, orCity-, of foodassistanceare provided bycommunity-based sites. feeding andinformal locations mealsites, inadditionbag orfoodpantry toshelter bothcongregate mealsitesandbrownThe mapincludes area ofthecity. providersconcentration inthedowntown ofsafety-net individuals thatare homeless. visibleisthe Immediately of providers Joseandthelocation inSan food safety-net The adjacentmapshows ofhomeless thedistribution HOMELESS INDIVIDUALS THATAND ARE SAFETY-NET PROVIDERS LOCATIONS OFFOOD

populations. are alsofeatured inthemapson low-income both seniors, asthesesitesserve S brown bag/food pantry sites in San Jose. sitesinSan brown bag/foodpantry at numerous sitesthroughout thecity. Food Harvest bySecond Bankaresupported located Br homeless. There Jose. are 14ofthesesitesin San source offoodforindividualsthatare primary requires orpreparation, nofoodstorage are a Co have access to a food safety-net provider. toafoodsafety-net have access providers.safety-net Manyindividuals thatare thedowntowncore homeless outsideof donot Individuals thatare Joseare homeless indowntownSan likelyaccess tofood tohave sufficient own bag and food pantry programs run and and programs run own bagandfoodpantry ngregate mealprograms, that analternative ARE FOODSAFETY-NET PROVIDERS LOCATED WHERE These various types types These various INDIVIDUALS THATLOCATED?HOMELESS ARE ARE 221 There are 29 assessment, pleaseseeAppendix D. For providers more information on inthis thesafety-net there ofproviders isanotablelack inandaround them. numberof individualsthatarea significant homeless; outsideofdowntown Censustracts several thathave JosebyCensustract.are homeless inSan There are The mapalsoshows thenumberofindividualsthat groups feeding informal include ther alternatives •

feeding groups.feeding Jose.shelters inSan There are 4informal currently and outreach programs orshelters. There are 44 O The highestconcentration downtown San Jose. downtown of providers isin of

INDIVIDUALS THAT ARE HOMELESS 15 FOOD FOR EVERYONE THE HEALTHTHE TRUST 16 INDIVIDUALS THAT ARE HOMELESS in new or existing food safety-net sites. orexistingfood safety-net in new Investing in andmore investment strategic smarter help toinform providers,hours ofoperation offoodsafety-net can that are homeless, location, including capacity, and tofoodaccessamongThe dataon individuals barriers 87 andHighway 101. east ofHighway 101, Highway between andinacluster Jose, insouthSan located Censustracts These include with thegreatest needforadditional resources. are near aprovider notlocated are examplesofareas tothatprovider.Census tract inred Censustracts that distancefrom their theshort individuals may travel Census tract. Ifthere isaprovider inanadjacenttract, providers toindividualsthatare homeless ineach here ofsafety-net need iscalculated bytheratio ofaccess.Not inred alack tracts all indicate Unmet group sites. providers,of safety-net shelters, feeding andinformal in theadjacentmap(inred), along withthelocations Areas ofunmetneedforfoodassistanceare highlighted FOOD ASSISTANCE AREAS OFUNMET NEEDFOR highest areas unmetneed. of notably, Highway101—have the Highways87and101eastof Highway280between southof providers. unmetneedforfoodsafety-net Many Censustracts have significant Areas in red— most WHICH AREAS ARE MOST INNEEDOF ADDITIONAL FOODRESOURCES? {} costs associatedwiththem. fornutrition-relatedhospitalization diseases, andthe alsodecrease of availablecan therisk consistently into chronic homelessness. Makinghealthy foodaccess offalling andreduce thepossibility food insecurity homelessness and temporary individuals experiencing providers reachhere more can meansthatsafety-net food assistanceintheresource-poor areas identified self-sufficiency orstability.” anything elsetoincrease their time doingthat andnotdoing each site...They spendalot of and what are therestrictions at distributed at different sites exactly whichdayfoodis their wholeweek-theyknow “There are peoplethat spend -Homeless Safety-NetProvider INDIVIDUALS THAT ARE HOMELESS 17 FOOD FOR EVERYONE THE HEALTHTHE TRUST 18 INDIVIDUALS THAT ARE HOMELESS {} Expanding capacity is necessary toincreasing healthy isnecessary Expanding capacity 8,598 mealsperweek, leavingagapof11,717meals. approximately congregate mealproviders serve times aweek, itwouldrequire 20,315meals. Currently, individualsthatareIf all homeless received one mealfive 101, hasnocongregate which mealproviders. Jose,areas assouthSan such 87and eastofHighways congregate meal. individualsover large This includes of individualsthatare homeless withoutaccesstoa south ofCapitolExpressway), there may behundreds congregate sofew mealsites(andnoproviders With assistance, sites. brown bagandfoodpantry including of food toaccesssome toadjacenttracts type travel from theprevious mapsthatindividualsmay It isclear weekly.higher numberserved Highway 87. dotson themapsignifya Larger-sized largeproviderstwo southofHighway 280andeastof concentratedinthedowntownare area, primarily with weekly.individuals served Asthemapsshow, thesesites shows thesesites, along withtheestimatednumberof for individualsthatare homeless. The adjacentmap source offood Congregate mealsitesare theprimary LOCATIONCAPACITY AND CONGREGATE MEAL SITE 20,315 meals—making a current 20,315 meals—makingacurrent “meal gap” 11,717. of prepare food. allindividuals thatare homeless If received onecongregate day, mealper fiveweek, daysa itwould require foodforindividualsCongregate thatare of source homeless, meals are storage of a primary duetolack orequipmentto Jose, sites existing increasing of isnotenoughtoclose thegap thecapacity incongregate mealaccess. or twoisoften dumped or sold.” food that isnotconsumedinaday receive from brown bagprograms… to store ortransport the foodthey not havetheequipmentorability congregate meals becausetheydo “Homeless individualsrely more on -Homeless Safety-NetProvider ARE THERE SUFFICIENT CONGREGATE MEALS ACCESSIBLE 24 TO INDIVIDUALS THAT ARE HOMELESS? Since mostcongregate mealsites are located indowntownSan meal services forseniorsthatare homeless. meal services ofthesolution toexpandingcongregate potential part relevant tothissection asan untappedresource anda Nutrition Program congregate mealsitesare nevertheless homeless are attendingSNPcongregate meals. Senior numbersofindividualsthatare thatsignificant evidence sites are there notfeatured on thismapbecause isno Nutrition ProgramSenior congregate mealsites. SNP sites listedhere, seniorsthatare homeless may attend It shouldbenotedthatinaddition tothecongregate meal aweek. beingopen7days meal sitesreported oron weekends.the evenings Currently, 5congregate only making itdifficultformany individualstoaccessfoodin regular openduring businesshourson weekdays, only often providers are notedthatmostsafety-net group participants accessible tomore individualsthatare homeless. Focus ofmakingcongregatesites may beanotherpart meals Expanding thehoursofoperationcongregate meal solution tothisgapincongregate mealaccess. congregate mealproviders ofthe are anotherpart inareassites located where there are no currently individualsthatareneeds ofall homeless. Additional food access, notsufficetomeetthefoodaccess butitwill 24 23 22

This calculation assumesoneThis calculation mealperindividual. as The gapwascalculated congregate mealprovider basis. on aweekly one meal, by each timesaweek, five minusthesumofindividualsserved the numberofmealsrequired individualsthatare forall homeless receiving

222324 INDIVIDUALS THAT ARE HOMELESS 19 FOOD FOR EVERYONE THE HEALTHTHE TRUST 20 INDIVIDUALS THAT ARE HOMELESS surrounding 280and85. Highways Jose, gapsinaccessarewith moderate inwestSan ZIP code, thanbyCensustract.] rather Two areas $520,000. housedindividualsis a weekto1,000recently providing one congregate mealperday, days five access tofoodassistance. The estimatedcostof toguarantee foropportunities examined further housedindividuals,recently theseareas shouldbe for andservices ofaccesstosupports importance 27 ur Work Destination: Home.” Destination Home. 2015. http://destinationhomescc.org/our-work/ 26 25 1000 campaign. rehousedindividuals recently through theHousing The adjacentmapshows of thelocation INDIVIDUALS RECENTLY HOUSED

individuals were considered tohave “sufficient resources.” ofthis analysis. low ZIPcodeswithnorecently providers forthepurposes ratio were housedindivid¬¬ualswithnosafety-net 20 recently considered avery tohave providers provider were housedindividualsand2safety-net 50and100recently considered orbetween 1 safety-net alow tohave ratio. than ZIPcodeswithfewer providers werehoused individualsandnosafety-net considered ratio. amoderate tohave housedindividualsand 20and50 recently ZIPcodeswitheitherbetween This c ZIP codeswithmor “O individuals withoutadequate providers. tofoodsafety-net access shown inorange, Highways 280and85, surrounding have thegreatest recently of number housed There are gaps providers amongrecently tosafety-net inaccess housedindividuals. The areas alculation thecostpermeal($2), contains only and doesnotreflect additional costsassociated withexpandingfoodassistance. 27 25 [These ratios are ratios presented [These by e than 50 recently housed individuals and no safety-net providers were housedindividualsandnosafety-net e than50recently considered ahighratio. tohave ZIPcodeswithmore than20recently DO RECENTLY HOUSEDINDIVIDUALS HAVE ADEQUATE ACCESS 26 Given the Given {} TO FOODSAFETY-NET PROVIDERS? allows forrecovery, stabilityandwellness.” services, includingnutritiousfood, asthis equally committed tohousingandsupportive system-- andoncehoused, weshouldbe food arobust ourcrisis response part of our community. We oweittothemmake and children whoare strugglingdailyin vulnerable men,for thethousandsof women, isacommonthreadfood andthelackthereof newlyhousedorstillonthestreets,“Whether Executive Destination: Director Home of - Jennifer Loving, INDIVIDUALS THAT ARE HOMELESS 21 FOOD FOR EVERYONE THE HEALTHTHE TRUST 22 INDIVIDUALS THAT ARE HOMELESS Analysis: TransportationWalkshedsand individuals that are homeless have very low accessto individuals that are homeless very have asahalf-mile. Jose,analysis ofSan Inmany parts stopswithinwalkingdistance,transit definedinthis Transit bythenumber of was calculated accessibility TRANSIT ACCESSIBILITY from one pointtoanother. ofgetting ofthedifficulty needbecause they services homeless may ready of not have range accesstothefull The mainfindinghere isthatmany individuals thatare providers considerably. andsheltersvaries safety-net shelters usingpublictransit. Transit of accessibility providers and tosafety-net for individualstravelling offoodassistance theaccessibility evaluates This analysis forfood.people spendtraveling amountoftime options totheextensive contribute Providers thatlimited publictransportation alsoreported to foodaccess, withhighcosts inbothmoney andtime. homeless, wascitedasacommon barrier transportation withindividualsthatare In focusgroup interviews OVERVIEW ARE FOODSAFETY-NET PROVIDERS ACCESSIBLE VIA PUBLIC TRANSIT? different points inthecity. consistent way tocompare asite’s to relative connectivity asasufficientproxy, stopsserve transit a offering network.transit For ofsites, themajority however, pointsinthe transfer nearimportant for siteslocated example, ofstopsmay lesssignificance have thequantity capture asite’sof stopsmay notfully accessibility. For measuredIt shouldbenotedthattransit bythenumber access around homeless shelters]. of downtown [seeAppendix Cforthemapoftransit stopsforsheltersoutside transit pattern, fewer witheven access. Transit accessaround sheltersfollows asimilar Jose,as thoseinsouthSan theleastpublictransit have low accesstopublictransit. isolatedsites, Relatively such andsouthofthedowntownareas north core very have downtown Jose, San whilemany providers in located providers around isplentifulin transit mostsafety-net stops(1-10). transit few Asthemapshows,very public points, provider representing each with asafety-net providers,safety-net beseeninthered-colored thiscan On theadjacentmapshowing accessaround transit providers toandfromtransit and shelters. safety-net INDIVIDUALS THAT ARE HOMELESS 23 FOOD FOR EVERYONE THE HEALTHTHE TRUST 24 INDIVIDUALS THAT ARE HOMELESS “unhealthy” bythemRFEI. Jose,San 84%offood retailers on average are considered Prior research hasshown thatinlow-income areas of walking accesstoSNAP/Calfresh retailers from shelters. providers andshelters,distance ofsafety-net and 29 28 Food Environment Index, ormRFEI This isdone ways: intwo through theModifiedRetail food environment inandaround providers andshelters. oftheretail thequality assessment attemptstoevaluate providers,In addition toaccesssafety-net this OVERVIEW Analysis: The Retail Food Environment few healthy foodoptions.few markets tobesmall orconvenienceare stores likely with is low accesstohealthy foodretail (alow mRFEI score) Retailers acceptingSNAP/CalFresh inareas where there with thepresence ofretailers acceptingSNAP/CalFresh.

Existing_Health_Conditions_FINAL_May_2013.pdf. https://www.sccgov.org/sites/dpd/DocsForms/Documents/HealthElement_ HealthElement.” Plan General May Clara 2013. ofSanta the County R and convenience stores). of lesshealthy foodretailers (e.g., fastfoodrestaurants, stores, grocery small markets, agriculture) compared andcommunity-supported tothenumber the numberofhealthy foodretailers (e.g., supermarkets, gardens farmer’s The modifiedRetailF aimi +Associates. for HealthExistingConditions“Community Report IS HEALTHY FOOD AVAILABLE FORPURCHASE AROUND SHELTERS? ood Environment index (mRFEI) provides for aratio 29 This goes handin 28 withinwalking food accessatall. access tounhealthy foods—where there isany retail that are homeless andreceiving CalFresh greater have walksheds on thefollowing page, show thatindividuals the dataon SNAP/CalFresh retailers inthesehalf-mile providers] safety-net These findings, combined with food. Appendix CformapofmRFEI [See around lower, low tonoaccesshealthy moderately indicating providers scores42 homeless have safety-net of25%or 26 fordefinition), whilethosearound butthree all of highhealthy foodaccess(seepage moderately indicating mRFEIof 44sheltershave scores higherthan25%, providers.other safety-net Walksheds around eight betterretail foodenvironmentscomparatively than to healthy food, thoughsome sheltersare in located providersaround tendstoreflect safety-net pooraccess The retail foodenvironment inthehalf-milewalkshed AROUND SHELTERS RETAIL FOODENVIRONMENT INDIVIDUALS THAT ARE HOMELESS 25 FOOD FOR EVERYONE THE HEALTHTHE TRUST 26 INDIVIDUALS THAT ARE HOMELESS accepting SNAP/CalFresh. vendors accessto2orfewer have these generally littleaccesstoanyappear tohave kindoffoodretail; food retailers ingeneral. on theCity’s periphery Shelters walking distance, reflects which thehighernumberof the mostretailers acceptingSNAP/CalFresh within The adjacentmapshows thatsheltersdowntown have SHELTERSCALFRESH AROUND RETAILERS ACCEPTINGSNAP/ CalFresh retailers. CalFresh. tohealthyfood, Josehave lowaccess Areas insouthSan toSNAP/ access butalsolack Shelters inthedowntowncore have thelargest retailers concentration of SNAP/ accepting ARE THERE RETAILERS ACCEPTING SNAP/CALFRESH AROUND SHELTERS? INDIVIDUALS THAT ARE HOMELESS 27 FOOD FOR EVERYONE THE HEALTHTHE TRUST 28 INDIVIDUALS THAT ARE HOMELESS 5. toincrease anduse Explore opportunities 4. withfaith- Formalize partnerships 3. Create andmobilecongregate aflexible 2. afoodassistanceprotocol toassist Develop andCounty 1. foodaccessintoCity Integrate INDIVIDUALS THAT AREHOMELESS RECOMMENDATIONS are homeless. better meettheneedsofolderadultsthat fundingto Program Nutrition Senior foodresources. thatlack the city individuals thatare homelessinareas of based communities tomeettheneedsof moves. homeless thatmoves asthepopulation forindividualsthatare meal system chronic conditions. nutrition-related by,those mostaffected of ormostatrisk services. homeless support {} that manyfaceonadailybasis.” need andtofindcreative waystoovercome thebarriers need toworksmarter togethertotarget theareashigh of most strugglingwithfoodinsecurity. As a community, we theCity’sare someof lowest-incomeresidents, andthose “Individuals that are homelessandlow-incomeseniors CEO of SecondHarvestFoodCEO of Bank 9. Form where possiblebetween partnerships 8. an thatsupports 7. infrastructure Develop 6. toincrease CalFresh Explore opportunities

providers. providers andotherservice food safety-net homeless). to-go mealsforindividualsthatare sitesprepare Program Nutrition at Senior (e.g., couldkitchens services population forcross- infrastructure safety-net homeless. food accessneedsofindividualsthatare ongoing, coordinated tothe solution homeless. enrollment ofindividualsthatare Explore opportunities in the existing intheexisting Explore opportunities - Kathy- Jackson,

THE HEALTHTHE TRUST 30 LOW-INCOME SENIORS consistently afford healthyconsistently food. incomeshave thatare farlower thanwhatisneededto San Jose ofseniors in portion assumed thatasignificant forthe48contiguous states.at thesamelevel be Itcan level,county theU.S. threshold Censussetsthepoverty basedon thecostsoflivingat measureswhich poverty Analysis: Availability of Food of Assistance Analysis: Availability ee Poor“Hidden byAge.” UCLA CenterforHealthPolicy Research. 30 foodinsecurity.may experience UnliketheElderIndex, under-estimateofthenumber seniorswho a likely At 27%oftheseniorpopulation, thisisalargegroup but threshold. poverty lessthan200%ofthefederal earning There Josethatare are low-income, 29,755seniorsinSan OVERVIEW V. Low-Income Seniors

S elder-health/Pages/hidden-poor-by-age.aspx. August 2015. http://healthpolicy.ucla.edu/programs/health-disparities/ 30

CensusBureau; Survey, Community American 2008-2012 5-Year 31 [lessthan100%FPL]. poverty andare livingin adisability Josehave 5,000 seniorsinSan are low-income,with adisability Censusdatashow that itisunknownwhatpercentage ofseniors exactly While incomes areLower alsoassociatedwithhavingadisability. definedasdisability “ stairs,” definedasdisability “ difficulty, ambulatory Josehave 22% ofseniorsinSan a toshopforandpreparetheir ability food. For example, are healthproblems tohave thatimpact alsomore likely toafford sufficientfood,In addition tostruggling seniors

gov>. Estimates, Tables B18105, B18107andC18130

LOW-INCOME SENIORS 31 FOOD FOR EVERYONE an Jose, south of Storyan Jose, Road and east of est San Jose, west of Highway 17 surrounding surrounding 17 Highway west of est San Jose, outh San Jose, between Highway 87 and Highway 87 and Highway between Highway outh San Jose, Highway 101. There are over 3,000 low-income 3,000 low-income over are There 101. Highway The two closest serve providers seniors in this area. seniors weekly (97 and 52/ 483 and 262 low-income respectively. day), Valley Medical Center, and south of Curtner Medical Center, Valley northThe area of 87. of Highway west Avenue bag or food pantry has no brown Curtner Avenue The two closest serve providers 235 and providers. respectively; 149 seniors weekly (47 and 30/day), seniors. 2,000 low-income over contains the area servingSouth provider is one of Curtner Avenue 2,000 over 135 seniors weekly; contains the area seniors. low-income S The closest 101 and south of Branham Lane. serves provider the area 262 seniors weekly (52/day); seniors. 1,500 low-income over contains East S W

In addition to these gaps in access, the number of gaps in access, to these In addition seniors with ambulatory difficulty in San Jose strongly seniors who indicates low-income unmet need among be best servedmay meals. by home-delivered Many seniors also rely on brown bag or food pantry brown seniors also rely on Many bag sites to brown Access of food. as sources programs as most in these same areas, also appears insufficient meal located to congregate addition near or in sites are sites. Particularly underserved bag- for brown areas areas food pantry programs include: • • • an Jose, south of Storyan Jose, east of Road and est San Jose, west of Highway 87 and on both both 87 and on west of Highway est San Jose, sides of Highway 85. There is no congregate meal is no congregate There 85. sides of Highway the north in Curtner to Camden site from Avenue The Almaden Community in the south. Avenue and is Center is located Camden Avenue on budgeted to serve just 245 meals weekly (49/day). seniors includesThis area 1,000 low-income over and along either side of Almaden Expressway on 85. Highway W East S A single Buena Road. Yerba 101 to Highway a Senior Community Center), (Evergreen provider site budgeted to serve Program Nutrition 415 meals area. is located in the entire per week (83/day), south of Curtner Avenue provider is one There serving over 135 meals weekly; contains the area seniors. 2,000 low-income

• The Senior Nutrition Program, consisting of congregate of congregate consisting The Senior Program, Nutrition service, meal is intended meals and a home-delivered food access exacerbatedto fill by healthy the gaps in the As a community resource, or disability. incomes low potential to generate has the Senior Program Nutrition seniors, For many the food itself. benefits beyond of the Cityattending a meal at one or County Senior of healthy sites is both a source Program Nutrition Senior food and a chance for vital social interaction. a helpful tool to get seniors to leave are meal programs and access secondarytheir homes support services they The Senior Program Nutrition otherwisemay avoid. a building block community cohesion, also promotes low-income for many Yet neighborhoods. of strong in particular the east in neighborhoods on seniors, access to Senior Nutrition and west sides of the City, meal sites appears limited. congregate Program Particularly underserved for congregate areas meals include: • THE HEALTHTHE TRUST 32 LOW-INCOME SENIORS approximately 54%ofSNPparticipation. Jose.with 26sitesinSan Joseresidents accountfor San County, Clara older maintainssitesthroughout Santa SNP congregate meal program foradultsaged60and aswell. inparticipation arise has experienced The Nutrition ProgramSenior congregate meals program 33 32 60 andover hasmore thandoubledsince2009; population. The numberof CalFresh recipients aged in recent years, reflecting theincrease inthesenior among seniorsUtilization offoodassistancehasrisen Highway 85andwestofHighway 87. 101 andsouthofHighway 280, of and thearea north providers;no foodsafety-net notably, eastofHighway areas withhighnumbersoflow-income seniorshave numbersofseniors. withmoderate Census tracts Some map shows thesesinglesitessurrounded byseveral the ofthecity; isolated sitesare inotherparts located high concentrations oflow-income seniors. More along Highway 280, where there are corresponding meal sites, ­in par The adjacentmapshows thatsafety- LOW-INCOME SENIORS SAFETY-NETPROVIDERS AND LOCATIONS OFSENIORFOOD

2015. Accessed December 18, 2015. http://sccgov.iqm2.com/. Progress Report.” MeetingPortal - Clara, ofSanta California.The County agement Audit/Documents/Senior-Nutrition-Program_FullReport.pdf. 2014. Accessed December16, 2015. https://www.sccgov.org/sites/bos/Man- Nutrition Program.” Senior County Audit Clara ofthe Santa August 29, ManagementA “Senior Nutrition Program Management Program“Senior FY2014-2015Mobility ticular, Nutrition Program Senior congregate low-income seniors have no access toaprovider.low-income seniorshave noaccess theintersection Highways85and87, Highway101andinthearea of east of surrounding many sites are located where there are low-income seniors. of highnumbers areas, Inother mostnotably Jose, congregate In downtownSan Program SeniorNutrition mealandbrown bag/food pantry ­ ar e concentratedindowntown Joseand San udit Division of the Board of Supervisors. udit Division oftheBoard ofSupervisors. “Management ARE SENIORFOODSAFETY-NET PROVIDERS LOCATED WHERE ­ net pr 33 ovider sites,

32

the LOW-INCOME SENIORS ARE LOCATED? a caretakerprepare mealsathome. congregate require mealsites—andthey thatseniorsor Nutrition Program as Senior ofsupport the samelevel toexpandcapacity, morehave ability donotoffer they source offoodformany low-income seniorsandmay a singleprovider. brown bagsitesare aprimary While with highnumbersoflow-income seniorsdonothave be clustered, Jose whilelargeareas insouthandeast San on themap,This isevident sitesappearto where several access are similartothoseofthecongregate mealsites. Nutrition Program congregate mealsites, thegapsin orneartoSenior are inthesamefacility located low-income seniors. many brown Since bagprograms are inareaswhether they located withhighnumbersof FoodHarvest Bank. These siteswere mappedtoassess Brownthrough theSenior Bagprogram, bySecond run Joseprovide andothernonSan groceries In addition tocongregate meals, sitesin 22distribution meals. inSNPcongregatemay orlimit participation encourage as thelocation, capacity, ofsites accessibility ortransit income seniors’ accesstoSNPsitesandhow factorssuch group. low- attemptstoevaluate The following analysis isnothigheramong thisgrowingparticipation age asreasons“social why SNP stigmaofgettingsupport” atcongregate mealsites, aperceived food served oreven of andtype quality ofawareness,suggested lack varying togrow.for SNPparticipation Previous research has Jose, inSan there potential food insecurity issignificant thenumberoflow-income of Given seniorsandlevels ­ -pr epared foods LOW-INCOME SENIORS 33 FOOD FOR EVERYONE THE HEALTHTHE TRUST 34 LOW-INCOME SENIORS to approximately 8,184individualsfrom FY2013- Program congregate Joseincreased mealprogram inSan Nutrition bytheSenior The numberofseniorsserved no accesstoacongregate mealsite. have where largenumbersoflow-income seniorsclearly 280, ofHighway 85, andwestofHighway 87andnorth the areas eastofHighway 101andsouthofHighway Nutrition Program congregate mealsites. This includes isolatedfrom are Censustracts any largely Senior Other tract.site inaneighboring frommay toacongregate travel theirCensustract meal Nutrition ProgramSenior congregate mealsite. Seniors some cases, however, are they witha adjacenttotracts withthemostlowhighest intracts congregate mealsites. Not surprisingly, is thisratio oflowratio indark[Census tracts red]. bythe This wascalculated Nutrition Program congregate mealsmay behighest 34 The map CONGREGATE MEALS NUTRITION PROGRAM UNMET NEEDFORSENIOR

purposes ofthisanalysis. purposes low-income inthe zero seniorswere included “low” grouping ratio forthe providers weresafety-net considered alow tohave ratio. with Census tracts ratio. nineand 71low-income withbetween Censustracts seniorsandno providers were safety-net consideredand 1orfewer amedium tohave providers 73and128low-income or between safety-net seniors or fewer ratio. 129and 189low-income withbetween Censustracts seniorsandone providers were safety-net considered orfewer ahigh seniors andtwo tohave providers, safety-net seniors andthree orfewer or190-287low-income breaks.using natural 288and502low-income withbetween Censustracts SNPsite.for each classes were Censustracts grouped population intofive withapopulationfor Censustracts ofmore than50low-income seniors Nutrition ProgramSenior congregate mealsites. wascalculated The ratio Census tr north of Highway85, of north showwhere theneedforadditional resources isgreatest. meal sites. Highway280, Highway101andsouthof Areas Highway87and eastof of orwest The areas indark red congregate showwhere Program there isunmetneedforSeniorNutrition 34 acts were according oflow-income ranked totheratio seniorsto shows theareas where unmetneedforSenior ­-inco me seniors to Senior Nutrition Programme seniorstoSenior -inco ­ WHERE IS THE GREATEST UNMET NEEDFORSENIOR me seniors. In NUTRITION PROGRAMCONGREGATE MEALS? ­ 14 to benefit from congregate mealsthanothers. appears thatsome low-income seniorsare lessable to SNP congregate meals. thesecurrent locations,With it factorinseniors’sites isanimportant in participation growing age group. of This mapsuggeststhatlocation reasons why isnothigheramong this SNPparticipation aperceived even as “social stigmaofgettingsupport” atcongregate mealsites, offoodserved or and type research quality ofawareness, hassuggestedlack varying togrowpotential forSNPparticipation further. Previous Jose, inSan there offoodinsecurity issignificant levels 2014 36 Senior ofAgingandAdult Services, Department County anta Clara 35

Estimates, Table B17024 U.S. port%20Final.pdf org/sites/ssa/daas/snp/Documents/SNP%20FY14-15%20Annual%20Re- Nutrition Program forFY2014-15 https://www.sccgov. Annual Report S ­-15. CensusBureau; Survey, Community American 2008-20125-Year 35 Given thenumberoflow Given ­ -inco me seniorsand

36 36 LOW-INCOME SENIORS 35 FOOD FOR EVERYONE THE HEALTHTHE TRUST 36 LOW-INCOME SENIORS necessary fundingincrease from theCounty.necessary demand, the andmatch are ifthey abletoexpandcapacity inresponse year each tohigher volume budgetedtoserve Nutrition Program congregate mealsitesmay increase the Nutrition ProgramSenior congregate meal sites. Senior the budgeted, at notactual, volumeofmealsserved One limitationshow tothedatainthismapisthatthey income seniorsinthoseCensustracts. seniors from surrounding areas, thenumberoflow- given Josemay beinsufficienttoserve per week)insouthSan congregate from mealsites(ranging 100to350meals Nutrition Program Senior ofmoderately-sized capacity where low-income seniorsare located. Inparticular, the congregate with consistently mealsitesdoesnotmatch oftheseareas,Outside however, of thebudgetedcapacity seniors. are corresponding highconcentrations oflow-income neighborhoods], andAlumRock the Mayfair where there downtown corresponding Jose[roughly with andeastSan and 858mealsperweek(78172/day), arein located themostmeals, 390 between The sitesbudgetedtoserve basis;highest numberofmealson aweekly red thelowest. the meal site. Greenbudgetstoserve pointsindicate Nutrition Program Senior ateach congregate weekly serve thenumberofmealsbudgetedto The mapillustrates CONGREGATE MEAL SITES SENIOR NUTRITIONPROGRAM CAPACITY AND LOCATION OF mation obtained from Santa Clara County Department ofAgingand Department County mation Clara obtained from Santa 38 37 one- Program mealsare low, approximately as itcontributes toprovide Nutrition coststotheCity Senior The overall

agement Management A Infor 2014. Accessed December 16, 2015. https://www.sccgov.org/sites/bos/Man Nutrition Program.” Senior County Audit Clara oftheSanta August 29, Adult Services. unlimited, anykind. anditwillnotaddress providers of Joselack thatsomeareas thefact San of congregate Program SeniorNutrition mealsites increase can capacity, isnot butthiscapacity thir ­ d of the total cost of each meal,d ofthetotalcosteach about$6.47. ARE THE CURRENT CAPACITY AND LOCATION OFSENIORNUTRITION udit Division of the Board of Supervisors. udit Division oftheBoard ofSupervisors. “Management PROGRAM CONGREGATE MEAL SITESSUFFICIENT TO MEET THE FOOD ACCESS NEEDSOFLOW-INCOME SENIORS? 37

38

­ already capacity. reached full Nutrition Program fact thatanumberofSenior siteshave meals served, to the extent that capacity allows. totheextentthatcapacity meals served, funding forCity- The County, withalargershare ofthecost, match will funds. matching andfederal additional County leverage to Nutrition Programthe Senior isanopportunity toprovide mealsthrough Expanding theCity’s capacity 41 ofAgingand Department County mation Clara obtainedfrom Santa 40 39 than theactualvolumeserved. basedon thebudgetissimilartoor meals served Camden, Glen],Willow theestimatedtotalnumberof Jose[Seven sites insouthSan Trees, Southside, Almaden, for FY2014-15shows thatforthesemoderately-sized Nutrition Programthe Senior congregate mealprogram statisticson releasedA comparison withrecently County through othermeans. ofsocialisolation mayhigher risk require foodassistance livingalone andat difficulty seniors withambulatory climbing stairs.”“difficulty walkingor In particular, difficulty,ambulatory definedbytheU.S.as Census Approximately Jose have 22percent ofseniorsinSan tothesesites. itemsmay notbeabletotravel pantry in congregate mealsorreceive brown bagorfood Furthermore, many seniorswhowanttoparticipate ofthecity.in many parts thepopulation soonnotsufficetoserve will site capacity theassumption thatexisting alsosupport participation seniors andrecent Nutrition Program increases inSenior

Services. Infor Nutrition Program Senior forFY2014-15. Annual Report Services, N Adult Services. Infor ew data is from the Santa Clara County Department ofAgingandAdult Department County Clara dataisfromew theSanta mation from Santa Clara County Department ofAgingandAdult Department County mation Clara from Santa ­ r un sites that increase the number of un sitesthatincrease thenumberof 41 The growing population of 40 This iscoupledwiththe 39 lower LOW-INCOME SENIORS 37 FOOD FOR EVERYONE THE HEALTHTHE TRUST 38 LOW-INCOME SENIORS Analysis: TransportationWalkshedsand in Santa Clara County. Clara in Santa provider service Outreach, transportation thesubsidized andassistancefrom on rely publictransportation Others toaccessfood. forrides andfamily may on rely friends Nutrition Program siteorabrown bagsite. Many ofa Senior intheimmediatevicinity seniors donotlive As theprevious mapsdemonstrate, many low-income Nutrition Programthe way toSenior orbrown bagsites. sidewalks,uneven heavytraffic, ofcrosswalks orlack on walkingdue to common as unsafe such feel hazards In addition, some providers thatseniorclients reported inaccessibletoseniorswithlimitedmobility.otherwise walkingdistancesare withinshort providers even located toaccessingfood. becritical can Safety-net public transit For low-income seniorsabletotravel, of theavailability OVERVIEW With its adoption of Mobility Managementin2014, itsadoption ofMobility With 43 hasitsown contract withOutreach.ote thattheCity According tothe 42 Nutrition Program toindividualSenior sites. allocated Nutrition ProgramSenior sites. These subsidieswere to toprovide transportation with Outreach subsidized Prior contracted toJune2013, County Clara Santa TRANSPORTATION ACCESS RECENT CHANGES TO SENIOR mileage reimbursement andtaxis. Additional funding bus passses, gascards, services, vanandvolunteerdriver to individuals, andexpandedtheprogram toinclude subsidies transportation beganallocating the County

Management Program Progress Report. help seniorsgainaccess tocongregate mealsites.” FY2014-2015Mobility &Escort, program (SNP)andOutreach Inc.trition (OUTREACH) to Mobilit 2013-14.” totaling$240,000inFY pants through agreement aseparate withOutreach toSNPpartici- Joseprovides services ofSan additional transportation City Nutrition Program Audit, Board ofSupervisors County Clara Santa “The N y Managementis “a Nu- theSenior between coordinated effort 43 42

LOW-INCOME SENIORS 39 46 FOOD FOR EVERYONE I

County-- 1,416 unduplicated about seniors. The chart includes Outreach below the data from on sites of tripstotal number Senior to Program Nutrition varioususing the the Mobilitymodes of transit through The chart the breakdown shows Management Program. of Senior estimated percentage of SNP sites with the using Outreach meals accessed Program Nutrition including Catholic Charities sites, some services. For of Santa Clara County and Southside Community and nearly half of Senior Program Nutrition Senior Center, form of some accessed through meals are congregate Outreach service. Please at the time of this note that not available. data for all were sites assessment, 46 bid.

44 The most frequently 45 e served In FY monthly average on in FY 2013-14. Measur running 2017. through however, temporary, of 2015.These funds are 571 seniors wer served an average seniors were of 1,598 2014-15, Mobility monthly from A combined. Management and Measure

used feature was bus passes [followed by gas cards by and was bus passes [followed used feature San approximately constitute residents Jose rides]. ADA 59% of Mobility utilization Management in the It is important to note that these data represent only Senior Nutrition Program trips. Seniors access Senior Nutrition Program sites trips. Seniors access Senior Nutrition Program only Senior Nutrition Program It is important to note that these data represent sites. the attendance at Senior Nutrition Program this may underestimate services. As a result, other Outreach through SENIOR NUTRITION PROGRAM CONGREGATE MEAL SITES ACCESSED BY OUTREACH BY ACCESSED SITES MEAL CONGREGATE SENIOR NUTRITION PROGRAM 44 45 e Areported serving 1,790unduplicated seniorsinthefirstquarter for transportationsites is to Senior Program Nutrition Transportation A–Senior Measure the through provided Mobility Program. Management According to the latest estimates, over 2,400 over latest estimates, to the According unduplicated seniors in the County benefited from Mobility A) in FY 2014-15; (and Measure Management the average these services number of seniors utilizing by 64%. monthly has increased THE HEALTHTHE TRUST 40 LOW-INCOME SENIORS Program Progress for2014-2015, Report the most meals. Management According to theMobility Nutrition Program accesstoSenior affects congregate how exactly publictransitIt isdifficulttodetermine different pointsinthecity. consistent way to compare asite’s to relative connectivity asasufficientproxy, stopsserve transit a offering network.transit For ofsites, themajority however, pointsinthe transfer nearimportant for siteslocated example, ofstopsmay lesssignificance have thequantity capture asite’sof stopsmay notfully accessibility. For measuredIt shouldbenotedthattransit bythenumber limited, asthesitesinred on andorange the mapshow. Transit accessaround many ofthesesitesappears Nutrition Programto Senior congregate mealsites. challenges, whoare torequire more likely transportation there are numbersofseniorswithmobility significant Program congregate mealsite. Italsoshows where the quarter- The adjacentmapshows stopsin thenumberof transit for seniorswasdefinedasaquarter-mile. site.within walkingdistanceofeach Walking distance stops,number oftransit asaproxy network, foratransit the congregate bymeasuring mealsiteswasevaluated Nutrition Program accesstoSenior transit Public CONGREGATE MEAL SITES SENIOR NUTRITIONPROGRAM TRANSIT ACCESS AROUND congregate mealsites. the map). Insomeareas, increasing tocongregate access mealswillalsorequire establishing new challenges seniorswithmobility of with poortransit andhighnumbers (showninred access on congregate Program SeniorNutrition mealsites of varies.The transit accessibility There are areas ­ mile walkshedar ARE SENIORNUTRITIONPROGRAMCONGREGATE MEAL SITES ound each Senior Nutrition Senior ound each Senior Nutrition ProgramSenior sites. solution toconsider may beincreasing thenumber of meals among low-income seniors, themore appropriate meals. To address theunmetneedforcongregate fully assessing low-income seniors’ accesstocongregate factortoconsider when isnottheonly accessibility Program congregate mealparticipation, transit Nutrition toSenior actasanobstacle can it clearly social atmosphere, needs. ortheirown mobility While ofreasons, offood,for avariety asthetype such the Nutrition Program Senior sitesattend– particular shows thatlow-income seniorsattend–ordonot there alimitedeffect. have will Furthermore, evidence the totallow-income seniorpopulation; improvements For percentage asmall of only one, serves Outreach solution tofoodaccessforlow-incomecatch-all seniors. time, doesnotpresent a thattransportation itisclear income seniors’ accesstocongregate meals. At thesame increaseimproving options can low- transportation Nutrition Program seemtoconfirm that participation andSenior In general, services increases inOutreach by modeoftransit. the factthatsite-specificdataare notbroken down Nutrition ProgramSenior sites. This iscompounded by otherthan tolocations Managementfortrips Mobility seniors maypurchase usethebuspasses they through Low-income service. Outreach the mostwidely-used buspasses, tosubsidized funds (39%)were allocated ACCESSIBLEPUBLIC TRANSIT? VIA LOW-INCOME SENIORS 41 FOOD FOR EVERYONE THE HEALTHTHE TRUST 42 LOW-INCOME SENIORS into the planning and development process.into theplanninganddevelopment foodaccessgoals toincorporate present anopportunity intended tobemixed-use andtransit-oriented, andthey Plan.2040 General These plannedgrowth areas are over thenext25years, Jose’s asoutlinedinSan Envision been selectedforfocusedgrowth injobsandhousing the City’s plannedgrowth areas, specificareas thathave theretailThis assessmentevaluated foodenvironment of withinwalkingdistance. vendors Analysis: Retail Food Environment The modifiedRetail Food Environment index(mRFEI) providesratio for a 47 details) Food Environment Index, for ormRFEI (seeGlossary usingtheModified Retail income seniorswasevaluated ofthe retail foodenvironmentThe quality forlow- OVERVIEW

and convenience stores). of lesshealthy foodretailers (e.g., fastfoodrestaurants, stores, grocery small markets, agriculture) compared andcommunity-supported tothenumber the numberofhealthy foodretailers (e.g., supermarkets, gardens, farmer’s 47 measuring accesstohealthy measuring retail and SNAP HOW MANY LOW-INCOME SENIORS ARE IN AREAS OF THE CITY WHERE THERE WILL BE THE GREATEST POPULATION GROWTH? City forplannedgrowth.City theareas indicate designatedbythe outlined inblack to bethegreatest population growth. The shapes growth areas, Josewhere there ofSan isexpected parts withintheCity’sseniors inCensustracts planned The adjacentmapshows thenumberoflow- GROWTH AREAS PLANNED forseniors. that are notexclusively to themany seniorslivinginaffordable housingunits Joseare designated San “senior units.” This isinaddition in34complexes in deed-restricted affordable apartments in affordableseniors live housing. 22%, Nearly or3,894 housing units, numberoflow-income asasignificant healthy foodretail wasalsomeasured from affordable Walking distancetoSNAP/CalFresh and vendors ­ inco me LOW-INCOME SENIORS 43 FOOD FOR EVERYONE THE HEALTHTHE TRUST 44 LOW-INCOME SENIORS {} support transit use.”support inamixed-use format,retail and services andother walking,that support toincorporate provide opportunities attractive totheCity’s projected population demographics, areasVillage thatare anddenseform withacompact neighborhoods. Urban Italsoenables new development of Areas helpsthe Growth toprotect existing of thequality City’s jobandhousinggrowth. Focusing into growth new which the are of plannedtoaccommodate the majority Areas arePlanned Growth “specificSan José areas of GROWTH AREAS PLANNED RETAIL FOODENVIRONMENT IN Envision San Jose 2040.” City of San Jose Planning Department. Novem- Jose2040.” JosePlanning Envision San ofSan City 48

- Envision 2040, Chapter1, Context Issues andKey “ ber 2011. https://www.sanjoseca.gov/DocumentCenter/Home/View/474. (mRFEI =0). contain low-incomeseniors. of highnumbers theseareas 60%of tohealthyfood have noaccess Areas,Planned Growth selected 25years, injobsandhousingover thenext forfocusedgrowth healthy options.” markets that don’thave only haveaccesstocorner junk foodswamps…Sothey are notfooddeserts butare ourneighborhoods “Most of - SeniorSafety-NetProvider IS THERE HEALTHY FOOD AVAILABLE FORPURCHASEIN AREAS OF THE CITY WHERE THERE WILL BE THE GREATEST POPULATION GROWTH? 48 bag/food pantry providers.bag/food pantry Nutrition ProgramSenior congregate mealsitesorbrown lacking some oftheareas intheOverview described low-income seniors.net provider thatserves This includes scores. Many plannedgrowth areas asafety- donothave noaccesstohealthyhave food, based on theirmRFEI The mapshows that60percent ofplannedgrowth areas 50 aimi +Associates. forthe HealthExistingConditions“Community Report 49

S ing_Health_Conditions_FINAL_May_2013.pdf. www.sccgov.org/sites/dpd/DocsForms/Documents/HealthElement_Exist- HealthElement.” Plan General May Clara 2013. ofSanta County https:// R jections-2014.pdf. reports/statbriefs/sb183-Hospitalizations-Multiple-Chronic-Conditions-Pro- Cost andUtilization Project. November 2014. http://www.hcup-us.ahrq.gov/ forAdults Multiple Chronic Conditions,Stays With 2003–2014.” Healthcare Ph.D., andRoxanne M. Andrews, Ph.D. “Trends andProjections inHospital teiner, ClaudiaA., M.D., L. Marguerite Barrett, M.S., Audrey J. Weiss, 49

50 \\ 49, 50 LOW-INCOME SENIORS 45 FOOD FOR EVERYONE THE HEALTHTHE TRUST 46 LOW-INCOME SENIORS seniors intheseareas. food, reinforcing thegapinfoodaccessforlow- housing complexes withlow ornoaccesstohealthy affordable several providers alsoinclude food safety-net healthy foods. The areas senior identifiedaslacking that many areinareas located withlow accessto Joseshows ofaffordable housingunitsinSan Analysis AFFORDABLE HOUSING HEALTHY FOODRETAIL AROUND food (mRFEI=25%orlower). complexes. One-third senioraffordable of housingcomplexes tohealthy have lowornoaccess Access tohealthyfoodretail withinwalkingdistance islowaround affordable housing IS HEALTHY FOOD AVAILABLE FORPURCHASE AROUND ­ inco me AFFORDABLE HOUSINGCOMPLEXES? all affordableall housing, seeAppendix C.] distance. [To seethemapofhealthy foodretail around walking low ornoaccesstofoodwithinaquarter-mile designated housing; one-third ofthesecomplexes have that healthy foodretail accessisalsolow among senior- to healthy foodwithinwalkingdistance. The mapshows hasnoaccess percent affordable ofall housinginthecity healthy ofseniorunits; foodiscomprised however, 39 N ee the list of affordable housing maintained by the San JoseHousing ee thelistofaffordable housingmaintainedbytheSan 51

ot all affordableot all housing withlow ornoaccessto Department: https://www.sanjoseca.gov/DocumentCenter/View/18668 S 51 LOW-INCOME SENIORS 47 FOOD FOR EVERYONE THE HEALTHTHE TRUST 48 LOW-INCOME SENIORS or convenience stores unhealthy selling foods. options forseniorCalFresh recipients are markets small thatinmany areas,map indicates retail theonly food scores inthewalkshedsaround affordable housing, this together withthedatainpreviousmapon mRFEI retailer withinaquarter- complexes accesstoatleastone have SNAP/CalFresh The adjacentmapshows thatmany affordable housing AFFORDABLE HOUSING SNAP/CALFRESH AROUND RETAILERS ACCEPTING low-income seniorsandtheirneighborhoods. areas, investing around inhealthyfoodaccess affordable for housingwouldhave significant returns complexes; however, are they nothealthyfoodretailers. somanylow-incomeseniorsinthese With There are manySNAP/CalFresh retailers withinwalkingdistance affordable of housing ARE THERE FOODRETAILERS ACCEPTING SNAP/CALFRESH AROUND ­ mile walkshed. Taken AFFORDABLE HOUSINGCOMPLEXES? food retail environment wouldbefar-reaching. slated foreconomic growth, thebenefitsofahealthier numbers oflow-seniors inmany oftheneighborhoods point forimproving healthy foodaccess. significant With housing, design, andinnovative urban starting isalogical emphasis on creating through neighborhoods jobs, vibrant growth areas. concept,The Urban Village withits healthy foodaccessintotheCity’s planned incorporate food retail, to alsopresent butthey anopportunity gapsinaccesstohealthy significant These findings reveal LOW-INCOME SENIORS 49 FOOD FOR EVERYONE THE HEALTHTHE TRUST 50 LOW-INCOME SENIORS Analysis: CrimeandSafety ability toaccesshealthy foods. ability seniors’ mightbeaffecting how levels crime to analyze City’s ganghot-spotsasaproxy areas forhigh-crime seniors from attending. This assessmentmappedthe in neighborhoods, some“unsafe” prevents likely which thatsomereported congregate mealsitesare located their safety. Providers Nutrition Program intheSenior providers ofconcerns for stores because orsafety-net may avoidwalkingtogrocery levels with highercrime food environment. livinginneighborhoods Seniors and, walkabilty neighborhood inturn, theneighborhood affect can andperceptions ofcrime ofsafety Levels OVERVIEW DO SENIORSFEEL SAFE ACCESSING FOODRESOURCES determining low-incomedetermining seniors’ access tohealthy food. in about therole any ofcrime needed todraw conclusions are located, butadditional research on theseareas is areas where providers low-income seniorsandsafety-net in This mapprovides ofsafety some context forthelevel their proximity. providers intheareaaccessing thesafety-net despite high numbersofseniors, some ofwhom may notbe multiple or hot-spotswithmoderate Jose includes ofsafety. ofaperceived lack because Downtown San Program tobrown mealsortraveling bagproviders areas may bedeterred Nutrition from attendingSenior net providers inthearea. seniorsinthese Low-income concentration oflow-income seniors andnosafety- The mapshows three areas where there isahigh HIGH LEVELSOF VIOLENCE WITH IN AREAS PROVIDERS ACCESS TO FOODSAFETY-NET IN THEIR NEIGHBORHOODS? IN THEIR LOW-INCOME SENIORS 51 FOOD FOR EVERYONE THE HEALTHTHE TRUST 52 LOW-INCOME SENIORS may instead rely on caregivers for grocery shopping may on forgrocery insteadrely caregivers upunpreparedor pick foodsfrom abrown bagsite, and mayThey notbeabletoattendSNPcongregate meals the home, may andpublic transit notbeanoption. around radius small walking distancemay entailavery For difficulty, many low-income seniors withambulatory gaps inaccesstofoodassistance. Analysis: Mobility of Low-Income Seniors Analysis: Mobilityof mbulatory difficulty isdefined bytheUSCensusas difficulty walkingor mbulatory “difficulty 52 difficulty ambulatory of thepopulation. Censusestimatesofseniorswith but there remains subset unmetneedamong asignificant formany seniors, foodservice safety-net and effective Congregate mealsand brown bagsitesare aconvenient OVERVIEW

A climbing stairs.” climbing 52 were usedtoidentifypossible On Wheels program. On Wheels delivered mealsandtheneedforexpansion oftheMeals gapsinaccess to indicate San Josestrongly in difficulty ofseniorswithambulatory The numberandlocation asMealsOn programs such Wheels. meal delivery to benefitfrom congregate mealprograms thanfrom aprofile seniorswithsuch areLow-income lesslikely for seniorsreliant on foodassistance. more chronic diseasemanagementarechallenging often require minimalpreparation. demandsof The nutritional and foodpreparation, on orrely processed foodsthat LOW-INCOME SENIORS 53 0 28 14 21 24 27 28 42 23 23 24 19 15 23 35 17 22 21 27 29 31 17 18 21 22 26 13 18 21 14 21 25 22.5 Seniors Percent Percent Difficulty Difficulty Ambulatory Ambulatory FOOD FOR EVERYONE 0 47 73 605 950 260 101 580 927 173 879 800 701 729 263 464 801 810 903 193 166 1182 1174 1034 1601 1020 1286 1407 1917 1041 1062 1155 24304 Total Total Seniors Difficulty Difficulty Ambulatory Ambulatory 6 0 9 17 24 44 40 51 87 55 29 29 10 27 39 22 17 25 39 31 37 18 15 19 27 36 29 16 19 17 21 21 27 Low- Income Seniors Percent Percent 0 10 85 714 468 209 734 600 955 984 778 225 429 162 729 848 245 166 954 1076 1766 2141 2504 1117 1804 1324 1673 1013 2077 1237 1270 1097 29394 Income Seniors Seniors Total Low- Total (< 200% FPL) (< 200% 0 166 241 917 561 781 4268 4549 1073 4438 4165 4531 2542 3826 5752 3501 4628 6005 5809 6773 2589 6608 3334 4363 1490 2219 4733 3088 4586 4403 1420 4545 107904 Total Seniors Seniors Total (65 and over) (65 and 2 3 1 2 3 5 1 1 4 4 8 2 8 4 Council District Total 95013 950329503795110 9,10 95111 10 2, 95112 3,6,7 95113 2,7 95116 3,7 95117 95118 3,5 95119 95120 10 9, 9512195122 10 95123 2,8 95124 5,7,8 2,9,10 9512595126 6,9 95127 6,7,9 9512895129 95130 1,6 9513195132 95133 3,4 95134 95135 3,4,5 9513695138 2,7,9,10 95139 95148 2,8 95002 Area Zip Code Zip Code Tabulation Tabulation Zip Code Tabulation Areas are used by the US Census for data-gathering purposes. They do not are Areas Zip Code Tabulation those given in the analysis, from will be slightly different in all cases to postal ZIP codes. Totals correspond aligned. not perfectly are Areas as Census tract boundaries and Zip Code Tabulation and B17024 Estimates, Tables 2008-12 5-Year American Community Survey, Bureau; US Census Source: B18105 http://factfinder2.census.gov SENIOR DEMOGRAPHICS BY ZIP CODE TABULATION AREA TABULATION CODE ZIP BY DEMOGRAPHICS SENIOR THE HEALTHTHE TRUST 54 LOW-INCOME SENIORS population withoutadisability. are higherthanthatofthe difficulty asambulatory such among rates olderadultswitha disability that poverty show Survey Community Data from theAmerican agegroups.all andlow socioeconomic disability between statusamong low-income, research hasfoundastrong correlation are difficulty percentage ofseniorswithambulatory reported disability.reported and over intheUnitedStates, itisthemostcommonly San Jose. in difficulty ambulatory For thoseaged65 The mapshows ofseniorswith thedistribution MOBILITY LIMITED SENIORS WITH 56 55 54 ierson, Christofer. intoAmerica’s“Insights withDisabilities.” Seniors 53 alone. associated witholderage, beingfemale, andliving and other disabilitiesare also difficulty Ambulatory percent ofthoseaged74-80, and38percent for alone, live 65-74 withadisability compared to30 ambulatory difficulty in San Joseare alsolow-income. in difficulty ambulatory data, estimatedthatover itisroughly 6,600seniorswith

This c He P Ibid. census.gov Survey,munity 2008-125-Year Estimates, Table B18105http://factfinder2. San Jose. in difficulty USCensusBureau; Com- with ambulatory American acs-29.pdf. http://www.census.gov/content/dam/Census/library/publications/2014/acs/ 2012.” U.S. Census. December 1, 2014. Accessed December18, 2015. icsny.org/aging-disability-report/. ICSNY. 19, February 2015. Accessed December18, 2015. http://www. unable healthyfood. toaccess Areas live; indark difficulty red showwhere theseseniorsare seniorswithambulatory manyof San Jose.It isestimated in difficulty thatthere are 6,600low-incomeseniorswithambulatory 56 , Wan, J. andLuke Larsen. 2008- withaDisability: Americans “Older Nationally, ofindividualsaged aquarter nearly alculation wasmadebytaking27%ofthetotalnumber ofseniors 53 While it is unclear exactly what exactly itisunclear While 54

WHERE ARE THERE LARGENUMBERSOFSENIORS WITH Based on theavailable 55 that 5,700 low-income seniors in San Jose live alone.that 5,700low-income Joselive seniorsinSan alone. are women. 63%ofparticipants the Federal halfofthemlive Poverty andnearly Level, atorbelow live MOWAlmost 70%ofall participants seniorsare over old. 80years MealsOn County Wheels County. Clara inSanta client On halfof Wheels Over Meals theaverage describe Many ofthesecharacteristics hospitalizations. andpoorhealthoutcomes asincreasednutrition such ofsocialisolation,risk linkedtopoor isinturn which those 85andolder. 59 58 nwell, Erin, andLINDA WAITE. Disconnectedness,“Social Perceived 57 {}

15. S 5-Year Estimates, Table C11010http://factfinder2.census.gov living alone. USCensusBureau; Survey, Community American 2008-12 This c nlm.nih.gov/pmc/articles/PMC2756979/. Behavior. March 1, 2009. Accessed December18, 2015. http://www.ncbi. Isolation, Adults.” andHealthamong Older of HealthandSocial Journal Cor LIMITED MOBILITY INSAN JOSE? anta Clara County Senior Nutrition Program Senior FY2014- Annual County Report anta Clara alculation wasmadebytaking27%ofthetotalnumber ofseniors are goingtoseethat day.” driver istheonlypersonthey they wake upbecausetheir meal [from] themomentthat “They are waitingfortheir - SeniorSafety-NetProvider 57 Basedon availabledata, isestimated Livingalone putsseniorsathigher 59 58

LOW-INCOME SENIORS 55 FOOD FOR EVERYONE HOW MANY SENIORS WITH LIMITED MOBILITY ARE NOT GETTING THE FOOD ASSISTANCE THEY NEED?

As many as 4,111 seniors who could benefit from home-delivered meals are currently not receiving Meals On Wheels. Areas in dark red—notably, east of Highways 101 and 680 and bordering Highway 85— show the areas of greatest unmet need.

SENIORS NOT SERVED BY MEALS ON WHEELS The County Meals On Wheels program served 682,988 meals to 1,689 unduplicated seniors in FY 2014-2015, and an additional 80,000 meals were served to 800 unduplicated seniors through the Meals On Wheels program run by the Health Trust. It is likely that there are far more seniors in need of delivered meals than the number currently served by Meals On Wheels. An estimated 4,111 low-income seniors with ambulatory difficulty in San Jose are currently not receiving Meals On Wheels.

The map shows this potential gap in access with the difference between the number of seniors receiving Meals On Wheels and those with ambulatory difficulty in each Census tract.

60

60 Santa Clara County Department of Aging and Adult Services, Senior Nutrition Program Annual Report for FY 2014-15 https://www.sccgov. org/sites/ssa/daas/snp/Documents/SNP%20FY14-15%20Annual%20Re-

LOW-INCOME SENIORS LOW-INCOME port%20Final.pdf

56 THE HEALTH TRUST LOW-INCOME SENIORS 57 FOOD FOR EVERYONE RECOMMENDATIONS LOW-INCOME SENIORS

1. Identify senior communities, affordable 5. Incentivize healthy food retail in the City’s housing units, and other residential areas planned growth areas. with high concentrations of seniors that 6. Explore opportunities in the existing would benefit from cost-effective solutions safety-net infrastructure for cross- such as food drops or mobile produce units. population services (e.g., could kitchens 2. Develop a Senior Nutrition Program at Senior Nutrition Program sites prepare outreach strategy to increase participation to-go meals for individuals that are in communities with high concentrations homeless). of low-income seniors and SNP 7. Explore opportunities to increase CalFresh congregate meal sites with the potential to enrollment of low-income seniors. increase capacity. 8. Form partnerships where possible 3. Increase funding for mobile meal services, between food safety-net providers and i.e., Meals On Wheels, for the lowest- other service providers. income, most vulnerable older adults in San Jose.

4. Explore innovative solutions to allow low- income seniors to access food resources in the community (e.g., restaurant vouchers, grocery delivery service). LOW-INCOME SENIORS LOW-INCOME

58 THE HEALTH TRUST Conclusion

This assessment used stakeholder interviews, constituent environment around safety-net providers and shelters focus groups, GIS mapping and extensive data collection also reflects poor access to healthy food, according to the to identify gaps in healthy food access and opportunities mRFEI scores in the half-mile walkshed around them to make smarter investments in food assistance for the nearly 30,000 low-income seniors and over 4,000 These findings argue for making food access a priority individuals that are homeless in our city. Analyses for both in the response to homelessness. Evidence from Santa low-income seniors and individuals that are homeless Clara County shows that access to the full range of revealed a concentration of food assistance resources supports and services, in addition to housing, leads to downtown and a mismatch of resources to the population better outcomes for individuals that are homeless. As in many other parts of the city. At the same time, this one of these services, access to healthy food can mean report identified several opportunities to improve healthy fewer diseases related to nutrition and more resources food access among individuals that are homeless and that can be directed towards finding housing and low-income seniors-- solutions that are within the reach achieving stability. Focusing on the gaps in food access— of partners in City and County government, safety- with evidence of why and where they are occurring—can net providers and other non-profits working to serve make the City’s response to homelessness more effective these populations, and other key stakeholders. With a for individuals, and ultimately less costly to health, social 61 commitment to partnership and a vision for a San Jose service, and justice systems. where no one lives outside and no senior goes hungry, There are numerous opportunities to make small but we can fundamentally improve food access for those who significant changes in the approach to food assistance need it most. for individuals that are homeless. The recommendations here emphasize communication between providers and developing the mobility to provide food where necessary. Individuals that These steps are important to elevating food access as one of the essential components of the City’s response are Homeless to homelessness and meeting the specific needs of individuals that are homeless. These findings, based on data from the US Census and from interviews with safety-net providers and individuals that are homeless, show that there are numerous reasons why access to healthy food is so Low-Income Seniors variable. Findings on low-income seniors’ access to food, based In some parts of San Jose, healthy food access is limited on data from the US Census and Santa Clara County by the lack of a safety-net provider nearby; this is and from interviews with safety-net providers, show that compounded by low public transit accessibility near some low-income seniors are less able to benefit from providers outside of downtown. In other cases, the the senior food safety-net than others. accessibility of healthy food may depend on providers’ capacity, or the days and times that food is available: 61 Flaming, Daniel, Halil Toros, and Patrick Burns. “Home Not Found: The Cost of Homelessness in Silicon Valley.” 2015. Accessed December 16, several congregate meal providers appear overburdened, 2015. http://destinationhomescc.org/wp-content/uploads/2015/05/er_hom- and only a small number of brown bag and congregate enotfound_report_6.pdf. meal sites are open 7 days a week. The retail food

59 FOOD FOR EVERYONE Healthy food access for low-income seniors outside of Low­-income seniors’ access to healthy food is made downtown San Jose is more limited in part because of more challenging because many seniors experience the lack of Senior Nutrition Program congregate meal some degree of mobility problems; 22% of seniors in and brown bag sites, particularly in the east and south San Jose report having ambulatory difficulty. The high of the City. Public transit access to many of these sites number of seniors with forms of limited mobility and is low. Some seniors can reach them using Outreach, low-incomestrongly suggests that there are many seniors the subsidized transportation service supported by the in need of a delivered meal service, though fewer than City and County, though the data suggest several other 2,500 currently receive Meals On Wheels. As the senior reasons keeping seniors from SNP congregate meal sites, population grows, expanding food assistance to seniors including the type of food, the social atmosphere, and in need through Meals On Wheels should be at the seniors’ mobility needs. Increases in SNP congregate forefront of the conversation on access to healthy food in meal participation (along with the number of low- San Jose. income seniors in recent years) also raise the concern that existing sites may be reaching or exceeding capacity. NEXT STEPS Senior Nutrition Program congregate meal sites are The next step is to develop a Food Access a main focus of this assessment because they increase Implementation Plan, a multi-stakeholder effort that seniors’ access to healthy food, and because they are incorporates the findings here into a detailed action plan. a valuable community asset. The expansion of SNP With a deeper understanding of gaps in food access and congregate meal sites could enable more seniors to various opportunities to improve food assistance for benefit from congregate meals in their neighborhoods, at individuals that are homeless and low-income seniors in the same time contributing to neighborhood cohesion. San Jose, it is now time to address the food needs of two The same may be said for improving the overall retail of the most vulnerable groups in our city. food environment in Urban Villages and other planned growth areas. At present, the mRFEI scores of quarter- mile walksheds around affordable housing units and planned growth areas— where many low-income seniors reside—indicate a poor retail food environment. The benefits of a healthier food retail environment, as described in Envision 2040 as part of the City’s vision for healthier and more vibrant neighborhoods, are multidimensional. From small business opportunity to increased public safety, making a concerted effort to improve food retail goes beyond a strategy that serves only seniors.

60 THE HEALTH TRUST Appendix A. Detailed Methods: Primary Data Collection

PHONE & EMAIL SURVEY OF KEY INFORMANT INTERVIEWS FOOD ASSISTANCE PROVIDERS We conducted key informant interviews with food assistance providers serving homeless and senior clients In order to collect information on the availability and that could provide insight on the target populations as accessibility of safety-net food resources for the target well as those who have the potential to address food populations, we identified and surveyed 125 providers access but are currently experiencing barriers. Interviews regarding hours and days of operation, meal services/ discussed assets and challenges at the organizational, programs offered, clients served, and information political, and systems-levels as well as potential about enrollment services for public food assistance opportunities to address food access within their (SNAP, WIC). respective organizations. Organizations were identified We identified 72 providers that met the following for interviews by The Health Trust staff and the City of criteria: 1) provide food assistance in the form of a San Jose public agencies. These sites had a reputation brown bag/grocery program, meal program, or other of or were known to provide a large number of meals program (e.g. Senior Nutrition Program); and 2) are or serving a large number of homeless or low-income located within the City of San Jose. Sites were initially seniors clients in San Jose. Additional food assistance included (n=192) if they were listed as a Second Harvest sites were identified for interviews during the course Food Bank distribution site or were listed on a public of data collection. In addition, we conducted a group resource directory as organizations that provide food interview with five homeless providers at a meeting assistance to one of the target populations (homeless organized by the City of San Jose. individuals or low-income seniors).

A member of the research team recorded as much FOCUS GROUP information as available from online resources (including JSI conducted a focus group with homeless individuals information about hours, program offerings, and at a large homeless shelter (HomeFirst) in San Jose to location) prior to calling identified sites. Sites were gather information about how they were accessing food called to confirm their address, request basic information and food assistance resources. This information helped to about the food assistance provided (e.g., program type, assess how available safety-net resources are meeting the days/hours, eligibility requirements, and number of food needs of the homeless population. Two facilitators people served per day), and obtain contact information asked questions about individuals’ habits and preferences for a staff member that could answer in-depth questions for accessing food or food assistance resources as well as via email. Sites were removed from the final list if: challenges and needs to accessing food. 1) they no longer existed or no longer provided food assistance of any kind, or 2) if they did not serve meals and/or distribute food on-site (e.g., were an administrative office).

61 FOOD FOR EVERYONE Appendix B. Detailed Methods: GIS Mapping

All mapping and related spatial analyses were completed in ArcGIS 10.2.2. All analyses were calculated within FOOD ASSISTANCE the City of San Jose. Demographic data for low-income AVAILABILITY & ACCESSIBILITY seniors was obtained from the 2008-2015 American Community Survey 5-Year Estimates at the Census tract Accessibility and availability were mapped as both level. Tracts were clipped to the boundary of the City of concentrations and/or walking distances. Concentrations San Jose. For tracts that overlapped the city boundary, were calculated as frequency of safety-net providers weighted averages for demographic values were calculated in relationship to the number of individuals that are based on the proportion of the area of the tract within homeless or low-income seniors within a given tract the city and by reviewing urban land use patterns in these to identify possible unmet need. These are intended locations using high resolution aerial photos. to highlight potential gaps in availability and/or accessibility. • Low-income seniors were defined as those 65 years or older with incomes under 200% of the Federal Poverty Level. TRANSIT ACCESSIBILITY The number of transit stops within walksheds was used • The population of individuals that are homeless as proxy for transit accessibility. The number of transit was obtained at the Census tract level; however, stops within a half mile (quarter mile for low-income weighted averages were not applied to the seniors) were grouped into accessibility categories (e.g., population of sheltered homeless individuals. low to high access). Walking distances were calculated by tracing along the street centerline network obtained • The locations of retail food, shelters, SNAP from the City of San Jose up to ¼ or ½ mile from a vendors, and safety-net providers were geocoded given point (e.g., a safety-net provider). Walksheds (both using ArcGIS online world geocoding service. ¼ and ½ mile) are the areas that encompass these streets. Half-mile walksheds were calculated for food safety- net providers and/or shelters serving individuals that • The modified Retail oodF Environment Index are homeless. Quarter-mile walksheds were calculated (mRFEI) was calculated using geocoded locations around safety-net providers primarily serving seniors. of healthy and unhealthy food retailers downloaded from the California Nutrition Network (September 2014).

• Housing 1000 participants were reported as the number of individuals by zip code. Only participants for zip codes that are mostly within the City of San Jose were included in the analysis.

62 THE HEALTH TRUST UNMET NEED (RATIO RATIO OF LOW-INCOME SAFETY-NET PROVIDERS SENIORS TO SENIOR NUTRITION TO INDIVIDUALS THAT ARE PROGRAM CONGREGATE HOMELESS) MEAL SITES Census tracts were ranked according to the ratio of Census tracts were ranked according to the ratio of safety-net providers to the number of individuals that low-income seniors to Senior Nutrition Program are homeless. Census tracts with no safety-net providers congregate meal sites. Census tracts were grouped into and more than 20 individuals that are homeless were five population classes using natural breaks. Census considered to have high unmet need. Census tracts with tracts with between 288 and 502 low-income seniors one safety-net provider and more than 50 individuals and three or fewer safety-net providers or 190-287 low- that are homeless were considered to have medium income seniors and two or fewer safety-net providers unmet need. Census tracts with one safety-net provider were considered to have a high ratio. Census tracts and up to 50 individuals that are homeless were with between 129 and 189 low-income seniors and one considered to have a low unmet need. Census tracts or fewer safety-net providers or between 73 and 128 with more than one safety-net provider or fewer than 10 low-income seniors and 1 or fewer safety-net providers individuals that are homeless were also included in the were considered to have a medium ratio. Census tracts “low” unmet need grouping. with between nine and 71 low-income seniors and no safety-net providers were considered to have a low ratio. Census tracts with zero low-income seniors were RATIO OF RECENTLY HOUSED included in the “low” ratio grouping. INDIVIDUALS TO SAFETY-NET PROVIDERS LOW-INCOME SENIORS AND ZIP codes with more than 50 recently housed individuals MEALS ON WHEELS and no safety-net providers were considered to have a Utilization of the county Meals On Wheels (MOW) high ratio. ZIP codes with more than 20 recently housed program was determined by subtracting the number individuals and no safety-net providers were considered of MOW participants (FY 13-14) from the number of to have a moderate ratio. ZIP codes with either between seniors with ambulatory difficulty. 20 and 50 recently housed individuals and 1 safety- net provider or between 50 and 100 recently housed individuals and 2 safety-net providers were considered to have a low ratio. ZIP codes with fewer than 20 recently housed individuals with no safety-net providers were considered to have a very low ratio for the purposes of this analysis. ZIP codes with no recently individuals were considered to have “sufficient resources.”

63 FOOD FOR EVERYONE Appendix C

List of Maps

Locations of Food Safety-Net Providers and Individuals that are Homeless Areas of Unmet Need for Food Assistance Location and Capacity of Congregate Meal Providers Recently Housed Individuals Transit Accessibility of Food Safety-Net Providers mRFEI within Walking Distance of Shelters Food Retailers Accepting SNAP/CalFresh around Shelters Locations of Food Safety-Net Providers and Low-Income Seniors Unmet Need for Senior Nutrition Program Congregate Meals Transit Access Around Senior Nutrition Program Congregate Meal Sites Location and Capacity of Senior Nutrition Program Congregate Meal Sites Transit Access Around Senior Nutrition Program Congregate Meal Sites Low-Income Seniors in Planned Growth Areas mRFEI in Planned Growth Areas mRFEI within Walking Distance of Affordable Housing (Senior Complexes Only) Food Retailers Accepting SNAP/CalFresh around Affordable Housing Low-Income Seniors in Gang Hot-Spots Seniors with Ambulatory Difficulty Seniors with Ambulatory Difficulty not Served by Meals On Wheels

In Appendix only:

2015 San Jose Homeless Census data Transit Access around Homeless Shelters mRFEI within Walking Distance of Safety-Net Providers mRFEI within Walking Distance of Affordable Housing (all)

64 THE HEALTH TRUST MAP LAYER SOURCE YEAR

American Community Survey Number of Low-incomeSeniors (by tract) 2008-12 (2008-2012 5-Year estimates)

Applied Survey Research Number of Unsheltered Homeless Individuals (by tract) 2013, 2015 (City of San Jose Homeless Census)

Recently Housed – Housing1000 (by zip) Destination Home 2015

Safety Net Providers (homeless) – all sites BFA/JSI 2015

Safety Net Providers (homeless) – congregate meal sites BFA/JSI 2015

Safety Net Providers (homeless) – brown bag sites BFA/JSI 2015

Safety Net Providers (homeless) – food pantry sites BFA/JSI 2015

Safety Net Providers (seniors) – all sites BFA/JSI 2015

Safety Net Providers (seniors) – Senior Nutrition Program BFA/JSI 2015 (SNP) congregate meal sites

Safety Net Providers (seniors) – brown bag sites BFA/JSI 2015

Unmet Need (Ratio Food Safety-Net Providers to BFA/JSI [American Community Survey (2008- 2012/2015 Homeless Individuals) 2012 5 Year estimates)]

Ratio of Low-Income Seniors to Senior Nutrition BFA/JSI [American Community Survey 2012/2016 program Congregate Meal Sites (2008-2012 5 Year estimates)]

Transit Stops Santa Clara Valley Transportation Authority 2015

Transit Routes Santa Clara Valley Transportation Authority 2015

Walksheds (½ mile) of Safety Net Providers (homeless) BFA/JSI 2015

Walksheds (¼ mile) of Safety Net Providers (seniors) BFA/JSI 2015

Walksheds (½ mile) of Shelters BFA/JSI 2015

Transit Accessibility (# of transit stops w/i walksheds) of BFA/JSI 2015 Safety Net Providers (homeless)

Transit Accessibility (# of transit stops w/i walksheds) of BFA/JSI 2015 Safety Net Providers (seniors)

Transit Accessibility (# of transit stops w/i walking BFA/JSI 2015 distance) of Shelters

BFA/JSI (California Nutrition Network; mRFEI within Shelter Walksheds 2015 Destination Home)

BFA/JSI (California Nutrition Network; City of San mRFEI within Safety-Net Provider Walksheds 2015 Jose Housing Dept.)

BFA/JSI (California Nutrition Network; City of San mRFEI within Affordable Housing Walksheds 2015 Jose Housing Dept.)

BFA/JSI (California Nutrition Network; City of San mRFEI within Planned Growth Areas 2015 Jose Planning Dept)

Number of SNAP vendors within walking distance to BFA/JSI (USDA; City of San Jose Housing Dept.) 2015 Shelters

Number of SNAP vendors within walking distance to BFA/JSI (California Nutrition Network; City of San 2015 Affordable Housing Jose Housing Dept.)

American Community Survey (2008-2012 5 Year Number of Low-Income Seniors within Crime Hot Spots 2008-12, 2015 estimates); City of San Jose Police Dept.

American Community Survey (2008-2012 5 Year Number of Seniors with Ambulatory Difficulty not estimates); Santa Clara County Social Services 2008-12, 2013-14 served by MOW (County) Agency (FY 13-14) 65 FOOD FOR EVERYONE 66 THE HEALTH TRUST 67 FOOD FOR EVERYONE 68 THE HEALTH TRUST 69 FOOD FOR EVERYONE 70 THE HEALTH TRUST Map Key: Individuals that are Homeless Number Location of Informal Feeding Site

1 River Park Drive 2 St. James Park 3 Martin Luther King Library 4 Tully and Galveston Number Name of Provider Address Type

1 Cathedral Basilica of St. Joseph 80 S Market St, San Jose, California, 95113 Food Pantry 2 Crossroads Bible Church - Downtown Outreach 150 E San Fernando St, San Jose, California, 95112 Food Pantry 3 Gloria Dei Lord’s Pantry 121 S White Rd, San Jose, California, 95127 Brown Bags 4 Goodwill of Silicon Valley 1080 N 7th St, San Jose, California, 95112 Congregate Meals 5 Holy Redeemer Lutheran Church 1948 The Alameda, San Jose, California, 95126 Congregate Meals 6 Martha’s Kitchen 311 Willow St, San Jose, California, 95110 Congregate Meals 7 Most Holy Trinity Church Pantry 2040 Nassau Dr, San Jose, California, 95122 Brown Bags 8 Our Lady of Guadalupe Catholic Church 2020 E San Antonio St, San Jose, California, 95116 Brown Bags 9 Family supportive housing (San Jose Family Shelter) 692 N King Rd, San Jose, California, 95133 Brown Bags 10 Santa Maria Urban Ministry 778 S Almaden Ave, San Jose, California, 95110 Food Pantry 11 Westgate Church/South Hills Community Church 6601 Camden Ave, San Jose, California, 95120 Brown Bags 12 Antioch Baptist Church 268 E Julian St, San Jose, California, 95112 Food Pantry 13 Archer Studios (Catholic Charities of SCC) 98 Archer St, San Jose, California, 95112 Brown Bags 14 Bethel Church 1201 S Winchester Blvd, San Jose, California, 95128 Food Pantry 15 Bible Way Christian Center 2090 Oakland Rd, San Jose, California, 95131 Brown Bags 16 Bill Wilson Center- Drop in Center. 693 N 2nd St, San Jose, California, 95112 Congregate Meals 17 Boxer’s Mayfair 44 N Jackson Ave, San Jose, California, 95116 Brown Bags 18 Cathedral of Faith Reaching Out 2315 Canoas Garden Ave, San Jose, California, 95125 Brown Bags 19 Church of Christ Feeding Program 81 N 8th St, San Jose, California, 95112 Congregate Meals 20 City Team International, Rescue Mission (Soup Kitchen) 1174 Old Bayshore Hwy, San Jose, California, 95112 Congregate Meals 21 CityTeam Ministries 1297 N 13th St, San Jose, California, 95112 Food Pantry 22 Community Outreach Ministry Endeavor (COME), First Immanuel Church 121 E San Salvador St, San Jose, California, 95112 Food Pantry 23 East Valley Pentecostal Church 2715 S White Rd, San Jose, California, 95148 Food Pantry 24 Eastside Church of God in Christ 2490 Story Rd, San Jose, California, 95122 Brown Bags 25 First Christian Church: “Recovery Cafe” program 80 S 5th St, San Jose, California, 95112 Congregate Meals 26 First Presbyterian Church 49 N 4th St, San Jose, California, 95112 Food Pantry 27 Food Not Bombs San Jose 95112, San Jose, California Congregate Meals 28 Girasol Apartments 1710 Alum Rock Ave, San Jose, California, 95116 Brown Bags 29 Grace Baptist Church/Grace Community Center 484 E San Fernando St, San Jose, California, 95112 Congregate Meals Congregate Meals 30 HomeFirst ( Formerly EHC LifeBuilders) Boccardo Reception Center 2011 Little Orchard St, San Jose, California, 95125 (and Food Pantry) 31 Kings Crossing (Catholic Charities of SCC) 678 N King Rd, San Jose, California, 95133 Brown Bags 32 Loaves and Fishes Family Kitchen at Eastside Neighborhood Center 2150 Alum Rock Ave, San Jose, California, 95116 Congregate Meals 33 Loaves and Fishes Family Kitchen Saint Maria Goretti Kitchen 2980 Senter Rd, San Jose, California, 95111 Congregate Meals 34 Maranatha Outreach Center - Mission Possible 1811 S 7th St, San Jose, California, 95112 Brown Bags 35 Mission Possible Re-Entry Program 151 W Mission St, San Jose, California, 95110 Brown Bags 36 Ohlone Chynoweth Commons 5300 Terner Way, San Jose, California, 95136 Food Pantry 37 Paseo Senter at Coyote Creek 1898 Senter Rd, San Jose, California, 95112 Food Pantry 38 Penzione Esparanza (Catholic Charities of SCC) 598 Columbia Ave, San Jose, California, 95126 Brown Bags Brown Bags (and 39 Sacred Heart Community Service/ Louise’s Pantry 1381 S 1st St, San Jose, California, 95110 Food Pantry) 40 Salvation Army/Emmanuel House 405 N 4th St, San Jose, California, 95112 Congregate Meals 41 St. Isabel Kitchen 1375 E Santa Clara St, San Jose, California, 95116 Congregate Meals 42 St. Julie Billiart Parish 366 St Julie Dr, San Jose, California, 95119 Brown Bags

71 FOOD FOR EVERYONE 72 THE HEALTH TRUST Map Key: Low-Income Seniors Number Name of Provider Address Type

0 Alma Senior Center 1 136 W Alma Ave, San Jose, CA 95110 Brown Bag 1 Alma Senior Center 2 137 W Alma Ave, San Jose, CA 95110 SNP Congregate meal 2 Almaden Community Center 6455 Camden Ave, San Jose, CA 95120 SNP Congregate meal 3 Asian Americans for Community Involvement 2400 Moorpark Ave, San Jose, CA 95128 SNP Congregate meal 4 Berryessa Community Center 3050 Berryessa Rd, San Jose, CA 95132 SNP Congregate meal 5 Boxer’s Mayfair Village Senior Apartments 44 N Jackson Ave, San Jose, CA 95116 Brown Bag 6 Cambrian Center 2360 Samaritan Pl, San Jose, CA 95124 Brown Bag 7 Camden Community Center 3369 Union Ave, San Jose, CA 95124 SNP Congregate meal 8 Cryyout Christian Fellowship 3167 Senter Rd, San Jose, CA 95111 Brown Bag 9 Cypress Senior Center 1 403 Cypress Ave, San Jose, CA 95117 SNP Congregate meal 10 Eastside Neighborhood Center (Catholic Charities of SCC) 1 2150 Alum Rock Ave, San Jose, CA 95116 SNP Congregate meal 11 Eastside Neighborhood Center (Catholic Charities of SCC) 2 2150 Alum Rock Ave, San Jose, CA 95116 Brown Bag 12 Evergreen Community Center 4860 San Felipe Rd, San Jose, CA 95135 SNP Congregate meal 13 First Immanuel Lutheran Church 374 S 3rd St, San Jose, CA 95112 Brown Bag 14 Gardner Community Center 520 W Virginia St, San Jose, CA 95125 SNP Congregate Meal 15 Girasol Apartments 1710 Alum Rock Ave, San Jose, CA 95116 Brown Bag 16 Gloria Dei Lutheran Church 121 S White Rd, San Jose, CA 95127 Brown Bag 17 Hope Senior Center 30 Las Colinas Ln, San Jose, CA 95119 SNP Congregate meal 18 John XXIII Multi-Service Center (Catholic Charities of SCC) 1 195 E San Fernando St, San Jose, CA 95112 SNP Congregate meal 19 John XXIII Multi-Service Center (Catholic Charities of SCC) 2 195 E San Fernando St, San Jose, CA 95112 Brown Bag 20 Live Oak Adult Day Services (Willow Glen location) 1147 Minnesota Ave, San Jose, CA 95125 SNP Congregate Meal 21 Mayfair Community Center 1 2039 Kammerer Ave, San Jose, CA 95116 SNP Congregate meal 22 Mayfair Community Center 2 2039 Kammerer Ave, San Jose, CA 95116 Brown Bag 23 Mayfair Golden Manor – 1 2627 Madden Ave, San Jose, CA 95116 Brown Bag 24 Our Lady Of Guadalupe Church 2020 E San Antonio St, San Jose, CA 95116 Brown Bag Portuguese Organization for Social Services and Opportunities 25 1115 E Santa Clara St, San Jose, CA 95116 Brown Bag (POSSO) – 1 26 Roosevelt Community Center 901 E Santa Clara St, San Jose, CA 95116 SNP Congregate Meal 27 Sacred Heart Church 325 Willow St, San Jose, CA 95110 Brown Bag 28 Santa Clara Valley Blind Center 101 N Bascom Ave, San Jose, CA 95128 SNP Congregate Meal 29 Seven Trees Community Center 1 3590 Cas Dr, San Jose, CA 95111 SNP Congregate meal 30 Southside Community and Senior Center 1 5585 Cottle Rd, San Jose, CA 95123 SNP Congregate meal 31 St. Maria Goretti Catholic Church 2980 Senter Rd, San Jose, CA 95111 Brown Bag 32 The Salvation Army Silicon Valley 359 N 4th St, San Jose, CA 95112 SNP Congregate meal 33 Trinity Episcopal Cathedral 81 N 2nd St, San Jose, CA 95113 Brown Bag 34 Westminster Presbyterian Church 1100 Shasta Ave, San Jose, CA 95126 Brown Bag 35 Willow Glen Community/Senior Center 2175 Lincoln Ave, San Jose, CA 95125 SNP Congregate meal 36 Willow Glen United Methodist Church 1420 Newport Ave, San Jose, CA 95125 Brown Bag 37 Yu Ai Kai ( Japanese American Community Services) 1 588 N 4th St, San Jose, CA 95112 SNP Congregate meal 38 Northside Community Center 488 N 6th St, San Jose, CA 95112 SNP Congregate meal 39 Alviso Senior Center 5050 N 1st St, San Jose, CA 95134 SNP Congregate meal 40 Billy De Frank LGBT Community Center 938 The Alameda, San Jose, CA 95126 SNP Congregate meal 41 Cypress Senior Center 2 403 Cypress Ave, San Jose, CA 95117 Brown Bag 43 Korean American Community Services 1099 N 4th St, San Jose, CA 95112 SNP Congregate meal 44 Mayfair Golden Manor – 2 2627 Madden Ave, San Jose, CA 95116 SNP Congregate meal Portuguese Organization for Social Services and Opportunities 45 1115 E Santa Clara St, San Jose, CA 95116 SNP Congregate meal (POSSO) – 2 46 Seven Trees Community Center 2 3590 Cas Dr, San Jose, CA 95111 Brown Bag 47 Southside Community and Senior Center 2 5585 Cottle Rd, San Jose, CA 95123 Brown Bag 48 Yu Ai Kai ( Japanese American Community Services) 2 588 N 4th St, San Jose, CA 95112 Brown Bag

73 FOOD FOR EVERYONE Appendix D: Food Assistance Programs in San Jose

74 THE HEALTH TRUST Appendix E: Organizations Interviewed

SAFETY-NET PROVIDERS SAFETY-NET PROVIDERS FOR FOR INDIVIDUALS THAT ARE LOW-INCOME SENIORS: HOMELESS: • Alzheimer’s Activity Center

• HomeFirst • Asian Americans for Community Involvement • Loaves & Fishes • City of San Jose, Senior Nutrition Program • Martha’s Kitchen • Institute on Aging • Sacred Heart Community Service • MidPen Housing • Second Harvest Food Bank • Outreach Mobility Management • Santa Clara County Senior Nutrition Program • Sourcewise • The Health Trust

75 FOOD FOR EVERYONE The Health Trust Board of Trustees

Charles Bullock, Ph.D., Board Chair Roberta L. Robins, J.D., Board Vice Chair Cindy Ruby, Board Secretary Craig Capurso Darren A. Cde Baca, C.I.M.A., C.F.P. Michael Celio, J.D. Frederick J. Ferrer, M.S. Jim Heerwagen, B.S.C. Marianne Jackson, M.A. David Katz, M.A., M.B.A. Emily Lam, M.P.P David Neighbors, C.P.A.

76 THE HEALTH TRUST