Joint Finance Committee Hearing Department of Health and Social Services Division of Services for Aging and Adults with Physical Disabilities Joint Finance Committee Hearing Fiscal Year 2016 Jill Rogers Division Director February 24, 2015 Good afternoon Representative Smith, Senator McDowell and members of the Joint Finance Committee. I am Jill Rogers, Director of the Division of Services for Aging and Adults with Physical Disabilities. With me today is Lisa Bond our Deputy Director, Al Griffith our Chief Financial Officer, and Kim Blunt the Acting Director of our Long Term Care Section and Director of the Delaware Hospital for the Chronically Ill. Thank you for the opportunity today to discuss our progress and priorities and to share with you the work we are doing to build access to services and supports for Delawareans who are aging and those with disabilities. I would especially like to express my thanks to Governor Markell, OMB Director Visalli, Secretary Landgraf, and members of the Joint Finance Committee for your support of our efforts to build access to community-based services in spite of the challenging economic times. DSAAPD FY 16 JFC Presentation – February 2015 1

Growth of the Older Population in Delaware First let me share a snapshot of what we look like today and where we are headed as a state. The size of the age 60+ population in Delaware began to spike dramatically around 2005 and will continue to expand steadily for the next 20 years. The age 75+ population will begin a sharp increase in about 2015. The “oldest old” population, age 85+, most in need of support services, will nearly double between 2005 and 2020, then double again by 2040. By 2030, Delaware is projected to have the 9th highest proportion of persons aged 65+ among all states. DSAAPD FY 16 JFC Presentation – February 2015

Persons with Disabilities in Delaware by Age (2012) Under 5 Years Old (850 persons) 5 to 17 Years Old (7,697 persons) 18 to 34 Years Old (11,324 persons) 35 to 64 Years Old (46,496 persons) 65 to 74 Years Old (16,756 persons) 75 and Over (25,274 persons) 2% of age group 5% of age group 6% of age group 13% of age group As Delaware’s aging population continues to grow, we must also think about meeting the needs of those of us with disabilities. As you can see, about 12% of us have one or more disabilities and the likelihood of having a disability increases significantly with age. Among Delawareans age 75 and older, almost half have at least one disability. 22% of age group 46% of age group In total, 108,397 Delawareans (12% of the population) have one or more disabilities. The incidence of disability increases with age. DSAAPD FY 16 JFC Presentation – February 2015

Increasing Effectiveness by Streamlining Access Aging and Disability Resource Center (2014) Information and Assistance Options Counseling Services Guides Website Persons served 21,341 1,047 Guides Distributed (hard copy and electronic) 606,900 Web Hits (DSAAPD and ADRC) 1,314,885 To address the needs of our rapidly growing aging population and those with disabilities, we continue to focus on improving the effectiveness and efficiency of our support system by building access, expanding the capacity of our community-based services, and reducing our reliance on facility-based services. In pursuit of this goal, one of the Department’s key initiatives is the Delaware Aging and Disability Resource Center (ADRC). Part of a nationwide network designed to streamline access to long-term supports and services, the ADRC provides Delawareans with a single point of access to information and services. The ADRC is a key element of Delaware’s long term services system, allowing us to support a variety of needs of older Delawareans, those with disabilities and caregivers. Core components of the ADRC include a call center to provide access to information and services, a website for 24/7 access to information, and options counseling in which a caseworker sits down with an individual and his/her family to explore long-term care options available in Delaware and help develop a plan that works for them. The ADRC also includes enrollment support to help families enroll in services and partners with each of our hospitals on discharge planning. This connection to acute-care hospitals is important as older individuals often need long-term supports after hospital care. In 2014 alone, Delaware’s ADRC received over 21,000 requests for assistance. Much of the development of the ADRC has been possible through several federal grants secured in recent years totaling more than $1.0 million. I would like to highlight the number of Delawareans accessing services and information via our websites. We had more than 1.3 million hits to the ADRC and DSAAPD websites in 2014 – almost 25% higher than in 2013. DSAAPD FY 16 JFC Presentation – February 2015

Persons Served in Key Home and Community-Based Services (2014) Case Management – 1,341 Home-Delivered Meals – 3,941 Respite Care - 382 Personal Care - 549 Personal Attendant Services - 104 Several studies released in recent years provided evidence that Delaware has been over-reliant on facility-based services. While facility-based care is a critical component of a comprehensive long-term support system, the commitment we have made as a state to providing the right care in the right place at the right time required us to think differently about when and for whom facility care makes sense. Consistent with the Americans with Disabilities Act, we have also embraced the need to provide services in the most integrated setting appropriate to individual needs. Over the last several years, and with your support, we have built a truly statewide network of community-based services - rebalancing our resources to more effectively meet needs. For many of us who are aging or have a disability, a home-delivered meal or a caregiver in the home only a few hours a week can be the difference between staying in our homes and living independently or having to move into a facility. About 4,000 Delawareans received at least one community-based service in 2014. Had they been required to move into one of our facilities, the cost to the health care system would have exceeded six hundred and 22 million dollars ($622,690,000). DSAAPD FY 16 JFC Presentation – February 2015

Average Daily Census of Long Term Care Facilities: 1995 to 2015 As Delaware’s community-based services have grown, we have seen the census in our three long-term care facilities continue to decline. Since 1995, the total census has dropped from more than 500 residents to fewer than 230. In addition to supporting more Delawareans in more appropriate settings, the reduced census has enabled us to repurpose space and better fulfill public health preparedness responsibilities, enhance services related to substance abuse and behavioral health, and provide outpatient care for residents with HIV. We have also reduced staffing through attrition, reduced costs for medical services and medications, and significantly reduced overtime costs. We expect the census to continue to decline and are especially appreciative of your guidance via epilogue language that we reallocate resources to meet the growing demand for community-based services. DSAAPD FY 16 JFC Presentation – February 2015

EPBH Questions DSAAPD Website www.dhss.delaware.gov/dsaapd Telephone Number 302-255-9941 Email Address DSAAPDBissellquestions@state.de.us As you are aware, one challenge of operating our three LTC facilities is the age and condition of the buildings themselves. On February 6th, after several months of issues, the hot water system at Emily P. Bissell Hospital (EPBH) failed. We were able to make temporary repairs which are holding and we are hopeful that an emergency evacuation will not be necessary. Because we anticipate that it will take at least six (6) months to replace the system, we are in the process of moving all of the EPBH residents to other accommodations. That process began on February 17th and we anticipate that it will be completed over the next 30-45 days. Management at EPBH are working with individual residents, families and staff to identify the best placement for each person whether it be in the community, at a private facility or another State-owned LTC facility. We are providing regular progress updates on our website and at a special hotline set up to receive calls and questions. I look forward to providing you with regular updates as well. DSAAPD FY 16 JFC Presentation – February 2015

FY16 Governor’s Recommended Budget Annualization-Reduction in Waiting Lists $910.0 I would like to thank you for the $910.0 included in our FY 15 budget to reduce waiting lists for community-based services. As a result of that allocation, an additional 105 Delawareans received personal care services, 23 received home delivered meals and 35 received home modifications enabling them to remain in their homes. The FY 2106 Governor’s Recommended Budget includes an increase of $910.0 to annualize funding for the reduction in waiting lists. DSAAPD FY 16 JFC Presentation – February 2015

Thank You. I thank you for your ongoing support for the services provided by DSAAPD as Delaware continues to build a world-class community-based support system and becomes a national leader in care for those of us who are aging or have a disability. I look forward to answering any questions you might have. DSAAPD FY 16 JFC Presentation – February 2015