1. Aging and Disability Resource Centers: An Overview of AoA’s Vision and the ADRC National Initiative: December 2008

2. 1 Mission of the U.S. Administration on Aging Help elderly individuals maintain their independence and dignity in their homes and communities through comprehensive, coordinated and cost-effective systems of long-term care, and livable communities across the U.S.

3. 2 AoA Strategic Priorities – The Business Plan 1. Empower older people and their families to make informed decisions about, and be able to easily access, existing health and long-term care options. 2. Enable seniors who are at high-risk of nursing home placement to remain in their own homes and communities for as long as possible if that is their preference. 3. Empower older people to stay active and healthy through evidence-based disease and disability prevention programs. 4. Ensure the rights of older people and prevent their abuse, neglect and exploitation through adequate Elder Rights Programs. 5. Promote effective and responsive management of AoA human capital resources and grants funds through implementing a system of sound financial controls.

4. 3 Why Is this Strategic Business Plan Important?  Like the natural disasters we have recently witnessed there is another kind of storm brewing in the aging network:  Boomer Phenomenon  Rapid growth in Medicare and Medicaid Program expenditures  Economic downturn and state budget crises

5. 4 The Aging Population

6. 5 Nursing Facility Users Triple by 2050 If Use Rates Remain Constant

7. 6 Cost of Nursing Facility Services Nursing Home Care ØAverage annual cost -- $74,095 Ø$41,975 in Shreveport, Louisiana to $193,815 in Alaska Assisted Living ØAverage annual cost -- $34,860 Ø$19,740 in Jackson, MS to $55,548 in Boston, MA

8. 7 Nursing Home/Medicaid Diversion Strategy Home/Community Nursing Home Spenddown to Medicaid Long-Term Care Risk Groups Low-Risk of NH Placement & Spenddown to Medicaid Medium-Risk of NH Placement & Spenddown to Medicaid High-Risk of NH Placement & Spenddown to Medicaid Effectively Target with Nursing Home/Medicaid Diversion Initiative via ADRC/SEP Systems

9. 8 Nursing Home/Medicaid Diversion Strategy Home/Community Nursing Home Spenddown to Medicaid Low-Risk of NH Placement & Spenddown to Medicaid Medium-Risk of NH Placement & Spenddown to Medicaid High-Risk of NH Placement & Spenddown to Medicaid Nursing Home/Medicaid Diversion

10. 9 Systems Change Vision

11. 10 Administration on Aging Investment in Coherent Systems Management Access ØAging and Disability Resource Center Initiative Services ØOlder Americans Act §Title III §National Family Caregiver Support Program ØAlzheimer's Disease Demonstration Grants Quality ØEvidence Based Disease Prevention Grants Financing ØNursing Home Diversion Modernization

12. 11 Project 2020 Provide the resources to implement consumer- centered and cost-effective long-term care strategies authorized in the 2006 reauthorization of the Older Americans Act. Empower the Aging Services Network to implement these strategies through a three-pronged program encompassing: ØPerson-centered access to information ØEvidence-based disease prevention and health promotion activities ØEnhanced nursing home diversion services

13. 12 National Vision for Aging and Disability Resource Centers To have Aging and Disability Resource Centers serving every community as highly visible and trusted places where people of all incomes and ages can get information on the full range of long term support options and a single point of entry for access to public long term support programs and benefits.

14. 13 Getting Closer to National Vision FY 2004 ADRC FY 2003 ADRC FY 2005 ADRC FY 2008 ADRC

15. 14 Why ADRC or Single Entry Point? Fragmented systems of I&R and services for aging and disability populations, multiple access points, eligibility criteria and funding sources – navigating the system is difficult The number of long term support service options has increased dramatically over last 2 decades – with choice can come confusion A professional, friend or family member may refer an individual to one known service – consumer may never know what other options are available ADRCs build consumer trust through objectivity and by enhancing individual choice, supporting informed decision-making and streamlining access to services.

16. 15 ADRC Goals Better coordinate aging and disability service systems Raise visibility about the full range of options that are available Provide objective information and assistance Empower people to make informed decisions about their long term supports Serve as convenient entry points for all public and private long term-care programs and support services

17. 16 ADRC Key Functions Awareness & Information ØPublic Education ØInformation on Options Assistance ØOptions Counseling ØBenefits Counseling ØEmployment Options Counseling ØReferral ØCrisis Intervention ØPlanning for Future Needs Access ØPrivate Pay Services ØOne-Stop Access to All Public Programs ØEligibility Screening for Public Services ØComprehensive Assessment ØProgrammatic Eligibility Determination ØMedicaid Financial Eligibility Determination

18. 17 Perspective from the Outside Home and Community Based Services Nursing Homes Options Counseling Health Promotion Employment Services Peer Counseling Private Services Public Programs Inside One-Stop Access

19. 18 ADRC Critical Elements Seamless system from consumer perspective High level of public visibility and trust Coordinates or integrates aging and disability service systems Formal partnerships across aging, disability and Medicaid agencies Serves individuals of all income levels

20. 19 ADRCs are not about replacing existing organizations and networks. They’re about building a better, more coordinated network.

21. 20 Critical ADRC Partners Area Agencies on Aging Centers for Independent Living State Health Insurance Assistance Program (SHIP) 2-1-1 Adult Protective Services Medicaid Services providers (e.g. senior centers, home health agencies) Providers along critical pathways to LTSS (e.g., hospital discharge planners, physicians) Average # of Formal ADRC Partners at State Level 9 Average # of Formal ADRC Partners at Local Level 8

22. 21 Partnership Activities Formal agreements Formal referral protocols Co-location of staff Cross-training staff Joint marketing and outreach activities Collaboration on client services I&R resources are shared Sharing client data Compatible IT Systems Client data shared Regular communication

23. 22 Lessons Learned about Partnerships Involve partners early in the planning process Set clear and realistic expectations for partners Recognize and account for differences in staff and organizational capacity across organizations Focus on similarities between organizations and where mission, values and goals align Pick a specific project to work on together to get started Be aware of differences in terminology or interpretation (client, peer, consumer-direction, case management, peer counseling) Collaboration makes you stronger and helps you serve your community better Collaboration is critical to sustainability

24. 23 Options Counseling – A Key ADRC Function Long-Term Support Options Counseling is an interactive decision-support process whereby consumers, family members and/or significant others are supported in their deliberations to determine appropriate long-term support choices in the context of the consumer’s needs, preferences, values, and individual circumstances

25. 24 The Need for Options Counseling Families of all income levels need support making decisions about long term care Few people plan ahead for long term support needs Lots of information is available on-line, but it can be complex, contradictory, and confusing Institutional placements often occur without consideration of available community-based options

26. 25 When Might Options Counseling Happen? Situations An individual has immediate or short range long-term care needs A family caregiver has concerns about loved one or needs help to continue providing care System flow As follow-up to I&R service During SHIP counseling During peer counseling At the time of applying for publicly funded benefits While waiting on an application to be processed After denial of application for public programs During hospital discharge After admission to a long-term care facility As part of a nursing facility transition

27. 26 What Information is Discussed? The Individual Personal history Personal goals and desired lifestyle Primary concerns Functional capacities and limitations Natural supports Service Options Home care Community services Residential care Nursing home care Case Management service Financing Options Personal and family financial resources Community resources Public long term support programs

28. 27 Who Delivers Options Counseling? Three ADRC Staffing Models Front-line staff – first contact with consumers (information and referral/assistance workers) All staff to some degree – I&R/A specialists, case managers, SHIP counselors, peer counselors Specialized staff - conducts only OC and possibly assists with other functions ØSome states require specialized staff to have certain minimum qualifications (e.g. Masters, RN)

29. 28 Staff Characteristics and Skills Needed ØObjectivity ØSensitivity ØUnderstanding ØCreativity ØFlexibility ØResourcefulness ØKnowledge about public and private-pay service options ØProfessional ØTrustworthy ØDiscrete ØRespectful ØConsumer-Directed ØOpen Minded ØCulturally Competent ØCollaborative ØA Good Listener Options Counseling Requires: Options Counselors Should Be:

30. 29 Streamlining Access - A Critical ADRC Function

31. 30 ADRCs Making Major Changes to Medicaid Application Process

32. 31 More Integration/Coordination with Financial Eligibility Process

33. 32 More Integration/Coordination with Level of Care Eligibility Process

34. 33 ADRC is More a Process than an Entity Moving from experts working in isolation to partnership, co-location, coordination, routine communication, cross-training Moving from focus on eligibility and offering set menu of services to a proactive consumer-oriented approach, intensive outreach to individuals of all ages and income levels, comprehensive options counseling