LIFE ElderCare VIP Rides Program's TITLE VI PROGRAM

LIFE ElderCare VIP Rides Program’s

TITLE VI PROGRAM

Developed: January, 2018 Approved by LIFE ElderCare Board of Directors

February 27th, 2018

Patricia Osage, Executive Director LIFE ElderCare, 3300 Capitol Ave.

Fremont, CA 94538 510-894-0370 x 5

www.LifeElderCare.org

INTRODUCTION

This document was prepared by LIFE ElderCare to comply with Title VI of the Civil Rights Act of 1964, including new provisions detailed in U.S. Department of Transportation’s FTA Circular 4702.1B, “Title VI Requirement and Guidelines for Federal Transit Administration Recipients.”

http://www.lifeeldercare.org/

VIP Rides - TITLE VI PROGRAM

Updated: 2/20/2018 2

Table of Contents

Title VI Notice to the Public Pg. 3 List of Locations Where Title VI Notice Is Posted Pg. 4 Title VI Complaint Procedures Pg. 5 Title VI Complaint Form Pg. 6 List of Transit-Related Title VI Investigations, Complaints, and Lawsuits Pg. 13

Public Participation Plan Pg. 13 Summary of Outreach Efforts Pg. 14 Language Assistance Plan Pg. 16 Table Depicting the Membership of Non-Elected Committees And Councils Pg. 21

Title VI Equity Analysis Pg. 21

Board of Directors Approval of Title VI Program Pg. 27

VIP Client Outreach- Chinese Pg. 28 VIP Volunteer Outreach- Chinese Pg. 29 LIFE Program Intake- Spanish Pg. 30 LIFE Program Intake- Chinese Pg. 33


Updated: 2/20/2018 3

LIFE ElderCare - Title VI Notice to the Public

Notifying the Public of Rights Under Title VI LIFE ElderCare

• LIFE ElderCare operates its programs and services without regard torace, color, and national origin in accordance with Title VI of the Civil

Rights Act. Any person who believes she or he has been aggrieved by any unlawful discriminatory practice under Title VI may file a complaint

with the Executive Director at LIFE ElderCare. • For more information on LIFE ElderCare’s civil rights program, and the

procedures to file a complaint, contact 510-894-0370, or visit our administrative office at 39180 Liberty Street #200 Fremont, CA. For more

information, visit [email protected]. • A complainant may file a complaint directly with the Federal

Transit Administration by filing a complaint with the Office of CivilRights,

Attention: Title VI Program Coordinator, East Building, 5th Floor-TCR, 1200 New Jersey Ave., SE, Washington, DC 20590

• If information is needed in another language, contact 510-574-2091

Notificar al público de los derechos bajo el título VI LIFE ElderCare

• LIFE ElderCare opera sus programas y servicios sin respectoa raza, color y origen nacional con arreglo al título VI de la Civil

Ley de derechos. Cualquier persona que cree que él o ella ha sido agraviado por

cualquier práctica discriminatoria ilegal bajo el título VI puede presentar una queja con

Executive Director at LIFE ElderCare • Para obtener más información sobre el programa derechosciviles capaz de industrias y el procedimientos para presentar unaqueja,

llame al 510-894-0370, o visite nuestra oficina administrativa en 39180 Liberty Street #220, Fremont, CA. Para más información información,

visite [email protected]. • Un demandante puede presentar una queja directamente con el

Federal Transit Administration por archivar una queja con la Office of Civil Rights,

Attention:Title VI Program Coordinator, East Building, 5th Floor-TCR, 1200 New Jersey Ave., SE, Washington, DC 20590

mailto:[email protected]



Updated: 2/20/2018 4

List of Locations Where Title VI Notice Is Posted

LIFE ElderCare notice to the public is currently posted at the following locations:

Location Name Address City Fremont Senior Center 40086 Paseo Padre Pkwy – at entry Fremont, CA City of Fremont offices 3300 Capitol Ave. Upon entry/on desk Fremont, CA Weekes Community Center 27182 Patrick Ave. – posted on main

office door Hayward, CA

LIFE ElderCare Fremont 2 offices

39180 Liberty Ave. by copy machine at entry

Fremont, CA

The Title VI notice and program information is also provided on LIFE ElderCare website at www.LifeElderCare.org. The email address is: [email protected]

有关标题VI的公众权益通知

老年人生活护理中心 • 根据民权法案中标题VI的有关规定，老年人生活护理中心的各项规定和服

务不因种族、肤色、和国籍而有所区分。任何人相信自己遭受任何非法歧视的对待，可向老年人生活护理中心的执行董事会提交投诉。

• 如需更多关于老年人生活护理中心的民事权利规定以及申请投诉的流程，请联系510-894-0370，或亲临行政办公室 39180 Liberty Street #220, Fremont CA

如需更多信息，请访问@LifeElderCare.org.

• 投诉者可直接向联邦运势管理局的民事权利行政办公室（the Office of Civil

Rights）提交投诉，注: 标题六项目管理人在 East Building, 5th Floor-

TCR, 1200 New Jersey Ave., SE, Washington, DC 20590

http://www.lifeeldercare.org/


mailto:%E8%AF%B7%E8%AE%BF%E9%97%[email protected]


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Title VI Complaint Procedures

As a recipient of federal dollars, LIFE ElderCare is required to comply with Title VI of the Civil Rights Act of 1964 and ensure that services and benefits are provided on a non-discriminatory basis. LIFE ElderCare has in place a Title VI Complaint Procedure, which outlines a process for local disposition of Title VI complaints and is consistent with guidelines found in the Federal Transit Administration Circular 4702.1B, dated October 1, 2012.

Any person who believes she or he has been discriminated against on the basis of race, color, or national origin by LIFE ElderCare may file a Title VI complaint by completing and submitting the agency’s Title VI Complaint Form. LIFE ElderCare investigates complaints received no more than 180 days after the alleged incident. LIFE ElderCare will only process complaints that are complete.

Within 10 business days of receiving the complaint, LIFE ElderCare will review it to determine if our office has jurisdiction. The complainant will receive an acknowledgement letter informing her/him whether the complaint will be investigated by our office. LIFE ElderCare has 30 days to investigate the complaint. The complainant will be notified in writing of the cause to any planned extension to the 30-day rule.

If more information is needed to resolve the case, LIFE ElderCare staff may contact the complainant. The complainant has 10 business days from the date of the letter to send requested information to the investigator assigned to the case. If the investigator is not contacted by the complainant or does not receive the additional information within 10 business days LIFE ElderCare can administratively close the case.

A case can be administratively closed also if the complainant no longer wishes to pursue their case. After the investigator reviews the complaint, s/he will issue one of two letters to the complainant: a closure letter or a letter of finding (LOF). A closure letter summarizes the allegations and states that there was not a Title VI violation and that the case will be closed. An LOF summarizes the allegations and the interviews regarding the alleged incident, and explains whether any disciplinary action, additional training of the staff member, or other action will occur. If the complainant wishes to appeal the decision, s/he has 10 business days after the date of the letter or the LOF to do so.

A person may also file a complaint directly with the Federal Transit Administration, at FTA Office of Civil Rights, 1200 New Jersey Avenue SE, Washington, DC 20590.


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LIFE ElderCare Title VI Complaint Form COMPLAINT FORM

Section I: Please write legibly

1. Name:

2. Address:

3. Telephone: 3.a. Secondary Phone (Optional):

4. Email Address:

5. Accessible Format Requirements?

[ ] Large Print [ ] Audio Tape [ ] TDD [ ] Other

Section II:

6. Are your filing this complaint on your own behalf? YES* NO

*If you answered “yes” to #6, go to Section III.

7. If you answered “no” to #6, what is the name of the person for whom you are filing this complaint? Name:

8. What is your relationship with this individual: 9. Please explain why you have filed for a third party:

10. Please confirm that you have obtained permission of the aggrieved party to file on their behalf. YES NO

Section III:

11. I believe the discrimination I experienced was based on (check all that apply):

[ ] Race [ ] Color [ ] National Origin

12. Date of alleged discrimination: (mm/dd/yyyy)

13. Explain as clearly as possible what happened and why you believe you were discriminated against. Describe all persons who were involved. Include the name and contact information of the person(s) who discriminated against you (if known), as well as names and contact information of any witnesses. If more space is needed, please attach additional sheets of paper.


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LIFE ElderCare Title VI Complaint Form, Page 2

COMPLAINT FORM Section IV: 14. Have you previously filed a Title VI complaint withLIFE ElderCare? YES NO

Section V: 15. Have you filed this complaint with any other Federal, State, or local agency, or with any Federalor State court?[ ] YES* [ ] NO

If yes, check all that apply: [ ] Federal Agency [ ] State Agency [ ] Federal Court [ ] Local Agency [ ] State Court

16. If you answered “yes” to #15, provide information about a contact person at the agency/courtwhere the complaint was filed.Name:

Title:

Agency:

Address:

Telephone: Email:

Section VI: Name of Transit Agency complaint is against:

Contact Person:

Telephone:

You may attach any written materials or other information that you think is relevant to your complaint.

Signature and date are required below to complete form:

Signature Date

Please submit this form in person or mail this form to the address below: LIFE ElderCare Executive Director 3300 Capitol Ave, Fremont, CA 94538


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Titulo VI Procedimiento de Queja

Como un receptor de dólares federales, LIFE ElderCare. tiene que cumplir con lo dispuesto en el Titulo VI de la ley de los derechos civiles de 1964 y asegúrese de que los servicios y los beneficios se proporcionen sobre una base no discriminatoria. VIP Rides Progrm.ha puesto en marcha un procedimiento de queja Titulo VI, que emboza un proceso de disposición local de quejas del Titulo VI y es consistente con las pautas de Administración Federal de Transito Circular 4702.1B, de Octubre 1, 2012.

Cualquier persona que cree que ha sido objeto de discriminación por motives de raza, color, u origen nacional por LIFE ElderCare.. puede presentar al Titulo VI su denuncia. LIFE ElderCare.investiga las quejas no mas de 180 días después del incidente. VIP Rides Progrm.. solo tramitara las quejas que están completas.

En un periodo de 10 días de haber recibido la demanda, LIFE ElderCare .la revisara para determinar si nuestra oficina tiene la jurisdicción. El autor de la queja, recibirá un acuse de recibo informándole al denunciante que será notificado por escrito si el caso de él/ella el será investigado por nuestra oficina. LIFE ElderCare .tiene 30 días para investigar la queja.

Si necesita mas información para resolver el caso, LIFE ElderCare puede contactar al autor de la queja. El autor de la queja tiene 10 días de la fecha que recibió la carta para solicitar un investigador que sea asignado al caso.

El caso se puede cerrar también si el autor de la queja no desea proseguir con el caso. Después de que el investigador analice la queja, el / ella emitirá una de las dos cartas a la denunciante.


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LIFE ElderCare Title VI FORMA DE QUEJA Seccion I: Escribir en forma legible

1. Nombre:

2. Direccion:

3. Telefono: 3.a. Telefono secundario(opcional):

4. Direccion de correo electronico:

5.Reuistos de forma accesible?

[ ] Impresion grande [ ] Cinta de audio

[ ] TDD [ ] Otros

Seccion II:

6.Esta presentando esta queja en su propio nombre? Si No

*Si usted contesto “Si” to #6, vaya a la Seccion III.

7. If you answered “no” to #6, what is the name of the person for whom you are filing this complaint? Name:

8. Cual es su relacion con este individuo:

9. Por favor, explique por que han presentado para una tercera parte:

10. Por favor, confirme que ha obtenido el permiso de la parte agraviada en el archivo en su nombre.

Si No

Seccion III:

11.Creo que la discriminacion que he experimentado fue basado en (marqu todas las que correspondan):

[ ] Raza [ ] Color [ ] Origin nacional

12. Fecha de supuesta discriminacion: (mm/dd/aaaa)

13.Explica lo mas claramente posible lo que ocurrio y por que usted cree que son objeto discriminacion. Describir todas las personas que han participado. Incluir el nombre y la informacion de contacto de la(s) persona(s) que discrimina contra usted (si se conoce), asi como los nombres y la informacion de contacto de los testigos. Si se necesita mas espacio, por favor adjunte hojas adicionales de papel.


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Seccion IV:

14. 14. Anteriormente ha presentado un Titulo VI denuncia con la LIFE ElderCare.

Si No

Seccion V:

15. Ha presentado esta queja con cualquier otro local, estato o federal, o con cualquier Federal o Estato?

[ ] Si* [ ] No si la respuesta es si Marque todo lo que apliqua

[ ] Agencia Federal [ ] Agencia Estatal [ ] Federal Tribunal [ ] Agencia Local [ ] Tribunal Estatal

16. Si usted contesto "si" a la posicion #15, proporcionan informacion acerca de una persona de contacto en la agencia/tribunal donde se presento la denuncia.

Nombre:

Titulo:

Organismo:

Direccion:

Telefono: Correo electronico:

Seccion VI:

Nombre de organismo Transito denuncia es contra:

Persona de contacto:

Telefono:


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老年人生活护理中心关于标题六投诉表格投诉表格

第一部分: 请用英文填写以下内容； 1. 姓名:

2. 地址 : 3. 电话 : 3. 其他电话（选填）:

4. 邮箱地址:

5. 可以接受何种回访方式？ [ ] 信件 [ ] 电话录音 [ ] 网络联系 [ ] 其他

第二部分 6. 请问您是否代表您本人填写这份投诉表格？是* 否 *如果您在第六题回答“是”，则请到第三部分答题。 7.如果您在第六题回答“否”，则请问您是代表谁填写这份表格？姓名:

8.您与这位先生（女士）的关系是:

9.请解释您向第三方申请投诉的原因 : 10. 请问您是否已获得代表受害方的授权文件是否第三部分:

11. 我认为我所受到的歧视是属于（可多选）:

[ ] 种族 [ ] 肤色 [ ] 原国籍 12. 遭受歧视的日期:（月/日/年）

13. 请简述您遭受歧视的原因与经过，并描述出所有与此次事件有关人员、相关目击证人的姓名与联系信息（假如您知道）。如需更多空白位置，请随附纸张。


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老年人生活护理中心关于标题六（Title VI）投诉表格第二页

投诉表格第四部分:

14.请问您是否曾经申请过向老年人生活护理中心提交过投诉？

是否

第五部分:

15.您是否曾将这个投诉提交给其他联邦、州、或地方机构,或者任何联邦或州法院？[ ] 是* [ ] 否如是，请填写您所提交的部门:

[ ] 联邦机构 [ ] 州政府机构

[ ] 联邦法院 [ ] 地方机构

[ ] 州法院

16.如您在第15题回答“是”，请提供您提交申请的该机构/法院的联系人信息。姓名:

职位:

机构名称:

地址:

电话: 邮箱:

第六部分:

投诉被驳回的代理机构名称:

联系人:

电话:

您可随附任何有关于此投诉的书面材料或相关信

您需要在以下位置签名与填写日期:

签名日期请将此表格提交或邮寄到以下地址 : LIFE ElderCare Executive Director 3300 Capitol Ave, Fremont, CA 94538


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List of Transit-Related Title VI Investigations, Complaints, and Lawsuits

As of February 20th, 2018 LIFE ElderCare has not been involved in any transportation-related or other Title VI investigations, lawsuits or complaints.

LIFE ElderCare List of Investigations, Lawsuits and Complaints

Type of Process Date Summary (including basis of complaint)

Status Action(s) Taken

Investigations 1. None Lawsuits 1. None Complaints 1. None

Public Participation Plan Public Participation Plan that includes an outreach plan to engage minority and limited English proficient populations as well as a summary of outreach efforts made since the last Title VI Program submission. May include other constituencies that are traditionally underserved, such as people with disabilities, low-income populations, and others.

------------------------------------------------------------------------------------------------------------------- The VIP Rides Program of LIFE ElderCare provides volunteer-driven rides to South and Central Alameda County and Oakland to disabled and older adults age 18 and up; taking them to medical and necessary appointments such as pharmaceutical, grocery and sundry shopping and helping them as needed at their destination. The people who use our service are primarily those who are of advanced age and frail with disabilities such as balance, vision, hearing, or memory challenges. Some use walkers or wheelchairs. Those who use wheelchairs are escorted on Paratransit vehicles. This is a door to and through door service so our drivers are trained to provide sight, memory, and steadying assistance or help with item section or carrying packages. Our dispatchers work, not only with the passenger, but also with family members/caregivers who are responsible for the older adult. Every effort is made to ensure that our passengers are well- served and can be safely transported to their destinations.


Updated: 2/20/2018 14

This program exists under the auspices of LIFE ElderCare. Before this program began, there were community focus group meetings to determine the need for senior transportation. As a result of those community meetings, the City of Fremont and Measure gap funds approved partial funding for VIP Rides (originally called ‘The Escort Program’- you can see why we changed it), and LIFE ElderCare hired its first program coordinator in 2005. Every 2 years, the program coordinator submits a budget to the City of Fremont Transit Coordinator who uses it to re-apply for Measure B Gap Grant Funding. Measure B is a half-cent transportation sales tax approved by nearly 82 percent of Alameda County voters. The Alameda CTC administers these funds to deliver essential transportation improvements and services, including special transportation for seniors and people with disabilities. The VIP Rides program won a prestigious STAR Award for quality in 2014 from the National Volunteer Transportation Center of Washington, DC. We are now significantly expanding our program based on need and demand and will do so with the support of the Section 5310 funds.

Purposes of this Plan Participation is the process through which stakeholders can partake directly in program decision- making, and express their concerns, desires, and values. It is the mission of this agency to "Empower the aging to live with independence and interdependence by nourishing mind, body and spirit" We solicit feedback from volunteers after every trip given and do a more in-depth, 3rd party telephone survey with our clients each quarter.

Summary of Outreach Efforts The following includes some of the outreach efforts conducted by LIFE ElderCare as they relate to Title VI requirements under the Public Participation Plan. Many of our activities are conducted in partnership with other service organizations and nonprofit agencies within the community. This is in no way a complete list but rather documents the agency's outreach efforts as they relate specifically to minority, individuals with disabilities, along with low-income populations.

● We provide our volunteers with large magnets for their cars saying in very large text:

LIFE ElderCare VIP Rides (and the number of the program- depending on which city it is for)

● We have posted flyers at the 15 low-income senior housing facilities in our expanded locale. Most sites are significantly (35-92%) multicultural and all provide housing for those living at or below the federal poverty level. One – Fremont Oak Gardens, reamians firm our previous service area- and as noted in the previous iteration - is a low income senior (55+) affordable housing site that is designated as 50% units for the Deaf.

● We make annual presentations at CRIL (Center for Resources for Independent Living),

The ARC of Alameda County, and many other entities who target services to the disabled community.

● We request a small donation for our services but turn no one away for inability to pay.

This is advertised on our website, in all of our outreach material and at events. The majority of our clients pay nothing with annual revenue from client donations providing 1/12 of the entire program budget.


Updated: 2/20/2018 15

● Both our ridership and our volunteers are highly multicultural. Currently (2018) LIFE has

the following languages in use

Drivers Staff

English English Spanish Tamil Hindi Spanish Sign Language Korean Punjabi Cantonese Tagalog Hindi Urdu Kannada Arabic Telugu Mandarin Spanish Teluau Marathi Cantonese Bengali

● A referral to LIFE ElderCare is often given out to callers who reach out to the local

Senior Helpline- which operates in multiple languages.

● At Senior Symposiums, we speak to seniors of all income levels and ethnicities, advising attendees of the availability of LIFE ElderCare and other senior transportation programs. These events attract 150 to 200 people.

● Program flyers are posted at various community events and in community spaces and

local business and clinics and the 3 large local hospitals (Washington, Palo Alto Medical Foundation and Kaiser; where we additionally work closely with discharge staff to offer services post medical procedure as necessary and feasible).

● The program coordinator provides a report to the City of Fremont monthly and

discussions take place about seniors’ transportation needs and available resources.

● We perform outreach through 33+ local places of worship including the temples, Gurdwaras, churches and mosques. Additionally, we table at least 4 health fairs each year and present to the local rotaries, Elks, and several other membership clubs.

Additional ● The Tri City Voice reaches Fremont, Newark, Union City and Hayward residents and

publishes articles about us periodically. The East Bay Times reaches Oakland and the majority of Alameda county. This is one of our top tools for recruiting volunteer drivers.


Updated: 2/20/2018 16

● The LIFE ElderCare Executive Director and/or the VIP Rides Program Manager attend both the local transit advisory meetings and the larger network of northern California volunteer transit providers as time permits.

● VIP Rides hosts 3 annual lunch meetings to recognize achievements, provide education and training, and offer an opportunity for peer exchange of best practices.

● VIP Rides conducts quarterly client satisfaction telephone surveys via an objective 3rd

party to determine level of satisfaction and gain input regarding unmet needs. VIP Rides solicits feedback from drivers following each trip.

Language Assistance Plan

Overview The first section in this document describes the purpose of the Language Assistance Plan

(LAP). The second section in this document provides the four-factor Limited English Proficient (LEP) analysis (as outlined by the Department of Transportation (DOT) used to identify LEP needs and assistance measures. The four-factor LEP analysis includes:

· Factor 1: The number or proportion of LEP persons in the service area who may be served or are likely to encounter LIFE ElderCare. · Factor 2: The frequency with which LEP persons come in contact with LIFE ElderCare. · Factor 3: The nature and importance of programs and services provided by LIFE ElderCare to the LEP population. · Factor 4: The resources available to LIFE ElderCare and overall cost to provide LEP assistance.

The third and final section discusses the implementation of the Language Assistance Plan, which includes methodologies for identifying LEP individuals, providing services, establishing policies, monitoring the LAP, and recommendations for future LAP implementations.

Purpose of the Language Assistance Plan

Title VI of the Civil Rights Act of 1964 prohibits discrimination on the basis of race, color, and national origin in programs and activities receiving federal financial assistance. One critical concern addressed by Title VI is the language barrier that Limited English Proficiency (LEP) persons face with respect to accessing information about and using transit service. Transit operators must ensure that this group has adequate access to the agency’s programs and activities, including public participation opportunities.

Executive Order 13166, titled “Improving Access to Services for Persons with Limited English Proficiency,” forbids funding recipients from “restricting an individual in any way in the enjoyment of any advantage or privilege enjoyed by others receiving any service, financial aid, or other benefit under the program,” or from “utilize[ing] criteria or methods of administration which have the effect of subjecting individuals to discrimination because of their race, color, or national origin, or have the effect of defeating or substantially impairing


Updated: 2/20/2018 17

accomplishment of the objectives of the program as respects to individuals of a particular race, color, or national origin.”

FTA Circular 4702.1B was developed by the Federal Transit Administration (FTA) and details the administrative and reporting requirements for recipients of FTA financial assistance to comply with Title VI and related executive orders including on LEP.

The United States Department of Transportation (DOT) published guidance that directed its recipients to ensure meaningful access to the benefits, services, information, and other important portions of their programs and activities for LEP customers. LIFE ElderCare language assistance plan (LAP) includes a four factor analysis and implementation plan that complies with the requirements of DOT LEP guidance.

Four Factor Analysis LIFE ElderCare

Factor 1: The number or proportion of LEP persons eligible to be served or likely to be encountered by LIFE ElderCare.

As a sub-recipient of FTA 5310 Grant funding, the agency's focus is primarily to provide home and community based services to older adults, most having age-based disabilities and non-senior adults with disabilities. The VIP Rides program of LIFE ElderCare provides assisted transportation where current public transit options are insufficient to meet the needs of the local population. We will be serving elders and people with disabilities throughout Alameda County

Data for this section was gathered from: 1. Alameda County, CA l Data USA https://datausa.io/profile/geo/alameda-county-ca/

2. US Census Bureau Fact finder 2016 https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=CF

The most common languages found are listed in order 1. Spanish 2. Chinese 3. Tagalog 646,809 of Alameda County, CA citizens are speakers of a non-English language, which is higher than the national average of 21.5%. In 2015, the most common non-English language spoken in Alameda County, CA was Spanish. 15% of the overall population of Alameda County, CA are native Spanish speakers. 7.62% speak Chinese and 3.44% speak Tagalog, the next two most common languages. When compared to other counties, Alameda County, CA has a relatively high number of residents that are native Chinese speakers. In 2015, there were 124,829 native Chinese speakers

https://datausa.io/profile/geo/alameda-county-ca/

https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=CF


Updated: 2/20/2018 18

living in Alameda County, CA, approximately 8.11 times more than would be expected based on the language's frequency in the US more broadly. Therefore, especially as LIFE expands its reach across the county, we have taken multiple actions to provide meaningful access to those LEP persons who speak Spanish and Chinese.

Factor 2: The frequency with which LEP persons come into contact with the program.

VIP Rides Program serves the elderly and disabled who live alone with little or no nearby family support. We expect the level of LEP persons who come in contact with the program is, therefore, likely to be comprised of 5% or higher amount of individuals whose primary language is Chinese or Spanish and we therefore make every effort to adapt materials and proficiency into those which can be used by those individuals.

Factor 3: The nature and importance of the program, activity, or service provided by the program to people's lives.

LIFE ElderCare VIP Rides is available to those age 18+ who are in need of destination assistance, but is primarily used by people in their 80’s and 90’s to perform grocery/sundry shopping, attend medical and personal appointments. The VIP Rides Program helps people to maintain their independence and live in their own home rather than become institutionalized and acts to help homebound elders stay connected with their community.

Because clients quickly establish trust with staff and volunteers, it also serves as a window for staff and volunteers to learn of other social service needs the clients have. Subsequently, we are able to provide a multitude of additional resources and referrals to individuals typically hard to outreach. Our clients are often unaware of human services or benefits that may assist them in staying healthy and safe and we use VIP Rides as a linkage opportunity.

Via the nature of its service, VIP Rides Program typically serves the elderly and disabled who live alone with little or no nearby family support.

Factor 4: The resources available to the recipient for LEP outreach, as well as the costs associated with that outreach.

The resources available include multiple accomodations for Spanish and Chinese speakers, including translation of vital materials (grievance policy, notice of information sharing practices, confidentiality, and some collateral), found in this document, the hiring of bilingual English/Mandarin and English/Spanish. The costs were approximately $1,900 for translation and printing


Updated: 2/20/2018 19

SUMMARY LANGUAGE ASSISTANCE IMPLEMENTATION PLAN- LIFE ElderCare Methodologies/Providing Services/Communicating Availability of Language Assistance

● If a monolingual person’s family member/friend/caregiver reaches out to LIFE

ElderCare, we have, and will continue to, work with that person to encourage their monolingual family member/friend/client to feel welcome, and to encourage the client or prospective client to feel reassured about their ability to use our transportation services.

● We have both staff and volunteers who speak Mandarin (Chinese) and Spanish. In

addition we have worked to recruit volunteers who can assist with the majority of the other most prevalently spoken languages in our area. Within the VIP Rides Program alone we have volunteer drivers who speak Hindi, American Sign Language, Punjabi, Tagalog, Urdu, Arabic, Teluau, Cantonese, Bengali and Marathi.

● We are fortunate to be co-housed with the Community Ambassadors Program for Seniors

(CAPS). CAPS, using trained volunteer community ambassadors builds capacity to serve seniors in their own communities, in their own language, within their own cultural norms, and does so where seniors live, worship, socialize, and learn. The Ambassadors serve as a bridge between the formal network of social services and faith based and cultural communities. CAPS is a nationally recognized, locally implemented program of the City of Fremont Human Services, originally funded by a grant from the Robert Wood Johnson Foundation. Through CAPS, we have partners in the Federation of Indo Seniors Association India Community Center, Indo-American Senior Association, Muslim Support Network, the Taiwanese Community Help Association, Tiburcio Vasquez Health Center, United Sikhs /Sikhs Engaged in Volunteer Activities and many others. They can help with intake for clients who speak Spanish and Mandarin and other languages, as needed.

● We serve a high percentage of low income senior housing residents (residing in Newark

Gardens, Fremont Oak Gardens, Cottonwood, Vintage Court, Sequoia Manor and others) and elders living in the senior mobile home parks.

Monitoring

● Volunteers submit a post-trip assessment of each ride session. If there are language

barriers, we seek methods such as changing volunteers to abate any possible issues. To date, we have been able to communicate with all passengers and prospective passengers.

● Quarterly Satisfaction Surveys for LIFE ElderCare offer an opportunity for consumers

and their caregivers to provide input or suggest additional services. We have volunteers who speak additional languages help with the survey.


Updated: 2/20/2018 20

Employee Training

● The VIP Rides Program Coordinator trains each new volunteer driver to be sensitive to our passengers’ needs for positive communication, courtesy, etc., so that passengers understand that their personal boundaries are being respected and their personal safety is assured. As new drivers come on board, established drivers reinforce this information during the practice driving sessions.

● As an Alameda County SSA contractor, we are authorized to use their telephone

interpretation services free of charge and staff is regularly trained in how to do so.

● As part of the Accessibility Plan, the program coordinator and manager tag team to work with the service coordinators located in Newark Gardens, Fremont Oak Gardens, Cottonwood, Sequoia Manor, Vintage Court and other low income senior housing complexes and senior mobile home parks to promote the use of VIP Rides and to learn more about their residents’ needs and challenges and to develop strategies for resolving any challenges. Rides are always free- with a donation accepted but no one turned away for lack of ability to donate. When presentation as are made, those with strong English skills translate as needed.

● Staff attend community educational events where information on a variety of topics, such

as recognizing and responding to possible elder abuse is provided.

● Our Title VI notice to the public and complaint form has been translated into Spanish and Chinese and posted on our website.

● Just in 2018, we added a website widget which has a drop-down menu of >100

languages. Any site visitor can click on and it will instantly translate the entire website into the chosen language.

Safe Harbor Provision The Federal Transit Authority Circular 4702.1B states:

"DOT has adopted DOJ’s Safe Harbor Provision, which outlines circumstances that can provide a “safe harbor” for recipients regarding translation of written materials for LEP populations. The Safe Harbor Provision stipulates that, if a recipient provides written translation of vital documents for each eligible LEP language group that constitutes five percent (5%) or 1,000 persons, whichever is less, of the total population of persons eligible to be served or likely to be affected or encountered, then such action will be considered strong evidence of compliance with the recipient’s written translation obligations. Translation of non-vital documents, if needed, can be provided orally. If there are fewer than 50 persons in a language group that reaches the five percent (5%) trigger, the recipient is not required to translate vital written materials but should provide written notice in the primary language of the LEP language group of the right to receive competent oral interpretation of those written materials, free of cost. These safe harbor provisions apply to the translation of written documents only. They do not affect the requirement to provide meaningful access to LEP individuals through competent oral interpreters where oral language services are needed and are reasonable. A recipient may


Updated: 2/20/2018 21

determine, based on the Four Factor Analysis, that even though a language group meets the threshold specified by the Safe Harbor Provision, written translation may not be an effective means to provide language assistance measures. For example, a recipient may determine that a large number of persons in that language group have low literacy skills in their native language and therefore require oral interpretation. In such cases, background documentation regarding the determination shall be provided to FTA in the Title VI Program."

We have translated the Title VI notice into 3 other languages. We work closely with the Afghan Elderly Association (AEA) who state their population of refugees has a very low literacy rate and oral interpretation is considered to be effective vs. written translation of materials. As they are co-housed with us, the Farsi/Dari/English trilingual staff of the AEA and are available to translate for us as needed. We translate our primary brochure (and all vital materials) into Spanish and English. However, we are unable to translate the program brochure into all the languages we would like and therefore insert the following notice in into our brochure when distributed at multicultural health fairs and in low income senior affordable housing. It states: “You have the right to an interpreter at no cost to you” and is written in 5 languages as follows: Chinese 中文你有權利要求一位免費的傳譯員。

Spanish Español Usted tiene derecho a un intérprete gratis.

Korean 언어 여러분은무료로전문통역자의도움을받을권리가있습니다.

Vietnamese Tiếng Việt Quý vị có quyề n đư ợ c mộ t thông dị ch viên miễ n phí.

Hindi आपके पास मु� म� एक दुभािषया का अिधकार है

Membership of Non-Elected Committees and Councils

LIFE ElderCare does not have a non-elected transit related advisory council at this time.

Title VI Equity Analysis LIFE ElderCare does not have transit related facilities.


Updated: 2/20/2018 22

责任免除 Release of Information

已向我解释了 LIFE ElderCare 计划的风险和优势。为参加 LIFE ElderCare 计划，我、我的继承人、继任人和受让人同意，免除 LIFE ElderCare 及其出资者和雇员因本人参与 LIFE ElderCare 计划而产生或与之相关的一切索赔、要求、责任、损害、诉讼以及其他起诉，包括但不限于人身伤害或死亡或财产

损失，为 LIFE ElderCare 及其出资者和雇员进行抗辩、对其进行赔偿或使其免受损害。我已阅读 LIFE ElderCare 的“信息共享实践通知”。

我授权公布：

（信息类型）

给：

信息将公布给的个人或实体的名称和职位）

位于：信息将公布给的个人或实体的地址和/或电话）

出于目的：

（获得发布信息的原因）

本人了解可随时通过书面方式撤销此项同意。

参与者正楷姓名：

参与者签名：

今天的日期： / /


Updated: 2/20/2018 23

LIBERACIÓN DE RESPONSABILIDAD Release of Information Me han explicado los riesgos y beneficios del programa LIFE ElderCare. Para participar en un programa LIFE ElderCare, yo, mis herederos, sucesores y cesionarios, accedemos a liberar, defender, indemnizar y eximir de responsabilidad a LIFE ElderCare, sus patrocinadores y empleados, de y contra todos los reclamos, demandas, responsabilidades y daños , demandas judiciales y otras acciones, incluidas, entre otras, lesiones personales, muerte o daños a la propiedad que surjan o estén relacionados de alguna manera con mi participación en los programas de LIFE ElderCare. He leído el Aviso de prácticas de intercambio de la información de LIFE ElderCare.

Autorizo la divulgación de:

(tipo de información)

a: (nombre y cargo de la persona o entidad a la que se divulgará la información)

(dirección y/o número de teléfono de la persona o entidad a quien se divulgará la información)

con el fin de: (motivo para obtener la liberación) Entiendo que puedo revocar este consentimiento en cualquier momento por escrito.

Nombre del participante con letra de molde:

Firma del participante:

Fecha de hoy: / /


Updated: 2/20/2018 24

信息共享实践通知 Notice of Information

Sharing Practices

在 LIFE ElderCare，我们最大限度地尊重每位计划参与者的隐私和福祉。请

您务必了解您提供的信息必须在您的护理团队（您的护理团队可能包括 LIFE

ElderCare 工作人员、护理计划参与者，您的医疗服务提供商和/或您的紧急联系人）内部严格保密，以下例外情况除外：

1) 如果我们认为您可能遭到了虐待；

2) 如果您透露了伤害自己或他人的强烈意图；

3) 如果我们认为对您可能有健康风险。

此外，少数来自 LIFE ElderCare 的政府出资实体、受过培训的代表可能会在其代理监督期间审查您的档案，以确保您获得高质量的服务和支持。这不会影响您获得服务的权利，将在合适的时候以匿名方式进行。另外，审查员也不会收到医疗信息、社会保险号码等敏感信息。

机密、敏感和/或个人信息只允许披露给：

1. 根据他/她的要求，经验证的资料当事人或授权法定代表人， 2. 经过资料当事人/授权法定代表人书面同意的第三方， 3. 法律允许的公共机构。

由国家机构或其承包商/供应商维护、收集、访问或存储并且根据 PRA 或其他适用的州或联邦法律的规定不得披露的任何机密信息，但是可以向以下对象披露：

1. 您要求的信息所属的个人或授权的法定代表人（需要适当的身份证明）；


Updated: 2/20/2018 25

2. 经信息所属个人或授权法定代表人书面同意的第三方； 3. 依法授权管理该项目的公共机构； 4. 提供支付服务的财政中介机构；以及政府监督机构。

我们必须获得书面同意才能存取或发布您的个人信息，并且同意必须包括：

1. 您的签名（作为信息所属的个人）或授权法定代表的签名； 2. 签名日期； 3. 您或管理员同意公布的记录的说明。

AVISO DE PRÁCTICAS DE INTERCAMBIO DE LA INFORMACIÓN

Notice of Information Sharing Practices En LIFE ElderCare, tenemos el mayor respeto por la privacidad y el bienestar de cada uno de los participantes de nuestro programa. Es importante que comprenda que la información entregada se mantiene en estricta confidencialidad dentro de su equipo de atención (su equipo de atención puede estar compuesto por personal de LIFE ElderCare, participantes del programa de enfermería, sus proveedores médicos y sus contactos de emergencia) con las siguientes excepciones: 1) Si percibimos que le ocurre un posible abuso; 2) Si revela una intención seria de hacerse daño a usted mismo o a otros; 3) Si percibimos un posible riesgo de salud para usted. Además, un pequeño número de representantes capacitados de las entidades de financiamiento gubernamental de LIFE ElderCare puede revisar su archivo durante el monitoreo de la agencia a fin de garantizar que reciba un servicio y apoyo de gran calidad. Esto no tiene relación con su derecho a recibir servicios y se hará de forma anónima siempre que sea posible. Además, ningún revisor recibirá información delicada, como información médica, números de seguridad social. La información confidencial, privada y/o personal solo se puede divulgar a:

1. sujetos con datos verificados o un legal autorizado 2. su representante ante solicitud, 3. terceros con el consentimiento por escrito del 4. sujeto de datos/un representante legal autorizado, 5. agencias públicas según lo permitido por la ley.


Updated: 2/20/2018 26

No se divulgará ninguna información confidencial, incluyendo información almacenada, recopilada, accedida o guardada por una agencia estatal o sus Contratistas / Proveedores que esté exenta de divulgación según las disposiciones de la PRA u otras leyes estatales o federales aplicables, excepto a:

1. personas a quienes pertenece la información o su representante legal autorizado a petición suya (se requiere identificación adecuada);

2. terceros con el consentimiento por escrito de la persona a la que pertenece la información o un representante legal autorizado;

3. agencias públicas con el propósito de administrar el programa como lo autoriza la ley;

4. intermediarios fiscales para el pago de servicios; y agencias de supervisión del gobierno.

Debemos obtener un consentimiento por escrito para acceder o divulgar su información personal y ese consentimiento debe incluir:

1. Su firma (como la persona a la que pertenece la información) o la firma de un representante legal autorizado;

2. La fecha de firma; 3. La descripción de los registros que usted o el conservador acepten

divulgar.

Board of Directors Approval of LIFE ElderCare Title VI Program

A RESOLUTION OF THE BOARD OF DIRECTORS OF LIFE ELDERCARE AUTHORIZING THE TITLE VI COMPLIANCE PLAN.

WHEREAS, LIFE ElderCare desires to comply with Title VI of the Civil Rights Act of 1964, including new provisions detailed in U.S. Department of Transportation's FTA Circular 4702. lB, "Title VI Requirement and Guidelines for Federal Transit Administration Recipients,"

WHEREAS, LIFE ElderCare wishes to authorize approval of the compliance plan developed by staff to comply with necessary provisions of the Civil Rights Act,

NOW, THEREFORE BE IT RESOLVED, by Board of Directors of the LIFE ElderCare as follows:

1. The Executive Director and staff are authorized to implement thecomponents of the plan in order to meet Federal requirements.

2. The Executive Director and staff are authorized to implement policies thatmay be necessary to comply with subsequent revisions or interpretations tothe Civil Rights Act.

PASSED AND ADOPTED by the Board of Directors for LIFE ElderCare, located in the State of California, on this 27th day of February, 2018.

Jane Mueller, Chair- Board of Directors, LIFE ElderCare

27

28

您是否需要VIP接送服务？ -------------------------------------------------------------------------------------

□ 请问您是一位长者或者18岁或以上的残疾人士？

□ 请问您是否存在行动不便，视力障碍，或其他原因使你无法外出或购物？

□ 请问您是否一直或者在某些时间段没有人可以可帮助您前往目的地？

如以上三个条件都符合，您可能可以接受我们的VIP接送服务: 经过培训的志愿者们提供上门服务。他们有结实有力的手臂，会为您提供方向指导，挑选货架上的商品，推购物车，搬包裹，等等。如果您感兴趣或者有需要，请联系 510-574-2096或电邮 [email protected]

由阿拉米达县交通运输委员会成立- Measure B Gap Grant


29

为何要成为VIP 接送服务的志愿

者？

以下是一些志愿者的回答… “为了回馈社区。”

“为了创造积极的改变。”

“为了得到快乐。”

无论您的理由是什么，在社区里面

有很多人需要您的帮助去看医生或

者外出购物。

以下事件你应该提供帮助: 提供坚稳的手臂搀扶一位虚弱的老人

帮助挑选商品以及推购物车

帮助盲人找到医疗诊所

我们的志愿者是非常善良的！他们

告诉我们做义工是一项快乐的工

作。

我们向您请求您每个月中两个小时

的时间为我们的老人驾驶。我们会

灵活安排您的行程. 由阿拉米达县交通运输改善协会成立- - Measure B Gap Grant.

30

INGRESO DEL CLIENTE (Universal Intake) Nombre del participante: # de ID único de

participante Fecha de

conclusión: (Apellido) (Nombre) (IM) Motivo:

Rev. Ene 15, 2014 -P

Categorías de servicio solicitadas o que le interesan: Tranquilizador telefónico- Estándar (FV)

Tranquilizador telefónico- Lavanda Adultos mayores (FV)

Paseos VIP Otro Comidas para entregar en

el hogar Prevención de caídas

Visitador - Estándar) Visitador - Lavanda (FV)

DATOS PERSONALES (Por favor escriba claramente) Etnicidad

No es hispano / latino Teléfono de casa

Hispano / Latino Se rehúsa a declarar

Segundo teléfono

Últimos 4 dígitos del # de SS

Correo electrónico

Fecha de cumpleaños

Edad

Calle y Apt ¿MediCal? Sí No Se rehúsa a declarar

Intersección más cercana

¿Medicare? Sí No Se rehúsa a declarar

Dirección, ciudad, estado y C.P.

¿SSI? Sí No Se rehúsa a declarar

Código de puerta

¿SSDI? Sí No Se rehúsa a declarar

Estado civil

Soltero (nunca casado) Casado Raza Divorciado Separado Viudo Caucási

co Negro Afgano Arábica Hindú

Pareja de hecho Se rehúsa a declarar Pakistaní Indio Americano / Nativo de Alaska

Orientación sexual

Gay Lesbiana Bisexual Otro: Múltiples razas Heterosexual Otro Asiático: Se rehúsa a declarar Indio Asiático Camboyano Chino

Veterano Sí No Se rehúsa a declarar Filipino Japonés Coreano

Género Masculino Femenino Transgénero Laosiano Vietnamita Otra asiática Otro Se rehúsa a declarar Hawaiano / otras islas del Pacífico: Información de contacto de emergencia Guamaniano Hawaiano Samoano

Nombre Otra isla del Pacífico Se rehúsa a declarar Relación Referido a LIFE por: Teléfono

Correo electrónico

Idioma Principal Secundario Vive con: (Tenga en cuenta la relación, es decir, hijo, cónyuge, proveedor de cuidados, etc.) y los horarios habituales en el hogar del cliente, es decir, días de la semana, noches, durante la noche.

¿Necesita traducción? Sí No ¿Referir al programa CAPS? Sí No ¿Vive solo? Sí No Se rehúsa a declarar ¿HoH Mujer? Sí No Se rehúsa a declarar Tipo de residencia (cerrada, apta ...) Mascotas (tipo)

NOTAS:

Rev. Ene 15, 2014 -P

31

Cuenta con apoyos actualmente

El cliente participa en estos programas adicionales (encierre en un círculo):

Servicios de soporte en el hogar IHSS Agencia y contacto:

Prevención de caídas en el hogar Agencia y contacto:

Prevención de caídas fuera del hogar Agencia y contacto:

Programa de ejercicio Agencia y contacto:

Grupos culturales (es decir, ancianos afganos, red de apoyo musulmana, etc.)

Agencia y contacto:

Otro programa Agencia y contacto: Otro programa Agencia y contacto:

PACE Sí No Kaiser Sí No

¿Qué transporte? ¿Cuidado de relevo para el de cuidado?

proveedor o cuidado

Sí No ¿Cuidado cognitivo (Alzheimer)?

Sí No

¿Cuidado diurno para adultos de salud diurno para adultos?

Sí No Nombre Días

Médico de atención primaria / teléfono Especialistas u otros proveedores médicos: Nombre Ciudad Teléfono Tipo de especialidad Fecha en que se

vio por última vez

A continuación solo para fines internos

Referencia a la Ciudad de Fremont Fecha de Referencia: (iniciales):

COF - CM

Su nombre Su # de teléfono

Rev. Ene 15, 2014 -P

32

Razón para referir:

西班牙裔/拉丁裔

最后 4 位 SS 号码拒绝透露

电子邮件年龄：

门牌号拒绝透露

否是社会安全残障保险 (SSDI)？

拒绝透露否是附加社会保障收入

(SSI)？城市和邮政编码

拒绝透露否是医保服务? 十字路口

拒绝透露否是医疗补助? 街道和公寓

出生日期：

第 2 台电话

家庭电话

非西班牙裔/拉丁裔民族

个人资料（请打印清楚）

防摔倒送餐服务

其他 VIP 接送

请求或感兴趣的服务类别：

电话重新确定 - 标准 (FV)

电话重新确定 - Lavender Seniors（加州的社会服务组织） (FV)

参观 - 标准）参观 – Lavender (FV)

婚姻状况

单身（未婚）已婚离婚分居寡居同居伴侣拒绝透露

性取向

男同性恋女同性恋双性恋异性恋其他拒绝透露

退伍军人是否拒绝透露

性别男女跨性别其他拒绝透露

紧急联系人信息

姓名

关系

电话

电子邮件

语言主要语言第二语言

是否需要翻译？是否

转到 CAPS 计划？是否

独自生活？是否拒绝透露

女户主？是否拒绝透露

居住类型（门控、公寓……）宠物（类型）

Rev. Jan 15, 2014 –P 33

参与者姓名：

患者接受 Universal Intake 唯一的参与者 ID 编号

终止日期：

（姓）（名）（中间名）原因：

注：

种族白人黑人阿富汗阿拉伯海地巴基斯坦美洲印第安人/阿拉斯加原住民其他：多种族

亚洲：亚洲印度人柬埔寨人中国人

菲律宾人日本人韩国人

老挝人越南人其他亚洲人

夏威夷/其他太平洋岛民：关岛人夏威夷人萨摩亚人其他太平洋岛民拒绝透露

LIFE 推荐人：

共同生活：（注明关系，即子女、配偶，护理人员等）和平患者家中的时间，例如工作日、晚上、过夜等。

目前支持

客户参与这些附加计划（系列）：

居家照顾服务（IHSS）机构与联系人：

居家防止跌倒机构与联系人：

户外跌倒预防机构与联系人：

锻炼计划机构与联系人：

文化团体（例如阿富汗长者、穆斯林支持网络等）机构与联系人：

其他项目机构与联系人：

其他项目机构与联系人：

PACE 组

织是否 Kaiser 组织是否

交通方式？

护理提供者的喘息服务？成人日间护理或成人日间保健？

是是

否认知（阿尔茨海默氏症）护理？是否否姓名天数

主要保健医生/电话专家或其他医疗机构姓名城市电话专业类型上次查看日期

以下仅供内部使用

转到弗里蒙特市转介日期： COF – CM（缩写）:

您的姓名您的电话号码

转介原因：

Rev. Jan 15, 2014 –P

34

LIFE ElderCare VIP Rides Program's TITLE VI PROGRAM

Documents