2011 ads annual report

Fiscal Year 2011 Annual Report Aging and Disability Services

June 2011

Aging and Disability Services Department of County Human Services

Independence. Dignity. Choice.

Life changes, and those changes can be hard to handle alone. Multnomah County Aging and Disability Services is here to help navigate through the wide array of choices and decisions facing seniors and people with disabilities, family members, and the communities in which our service recipients live. We provide a range of care resources to help people live as independently as possible in their community. It all starts with just one phone call to the ADS Helpline (503‐988‐3646). Helpline counselors are trained to assist people to make decisions about the right services, including safety, transportation, in‐home and long term care support, housing, meals, legal help and more. For urgent calls the Helpline operates all night and on weekends and holidays. ADS depends on the services of more than 60 volunteers. These volunteers are critical to our organization; they provide important services that free paid staff for other work and pitch in to pick up tasks that would almost certainly go undone. The members of our three citizen advisory committees — Elders in Action, the Disability Services Advisory Council, and the Multi‐ethnic Action Committee — review policies and chart future actions, advocate with decision‐makers and keep us informed of conditions affecting service recipients. Thanks, volunteers!

“Aging and Disability Services

promotes independence,

dignity and choice in the lives of seniors and people with disabilities.”

ADS Mission Statement

Table of Contents ADS Services Promote Greater Independence ......................................................................................... 1 Long Term Care .......................................................................................................................................... 4 Transition and Diversion.................................................................................................................. 6 Community Services .................................................................................................................................. 8 Food Security ................................................................................................................................... 9 Aging and Disability Resource Connections..................................................................................10 Public Guardian and Conservator............................................................................................................. 12 Adult Care Home Program .......................................................................................................................16 Adult Protective Services .........................................................................................................................18

Aging and Disability Services Annual Report

At Multnomah County Aging and Disability Services (ADS) we serve adults with disabilities, veterans, seniors and caregivers in lots of different ways, but the common thread woven throughout all our efforts is supporting the independence of those we serve. To accomplish that goal, our staff of 300 uses a variety of approaches (including person‐centered advocacy) and taps a variety of federal, state, and county‐based programs and grants.

As people achieve more control over their lives, they feel better about themselves and their surroundings. This translates into a secure and productive place in their community. Throughout this report, we’ve shared some of these inspirational stories. The point of entry for service information is the ADS Helpline (503.988.3646). Calls are answered by staff with special training and national certification in providing the best possible support and assistance for callers. The Helpline staff assist callers and face‐to‐face inquiries to navigate not only Aging and Disability Services with its five branches, five district centers, and 40+ programs; the Helpline is also the entryway to a complete range of community resources that might be utilized by any Multnomah County senior, veteran, caregiver, or person with a disability. See page 10 to learn more about an upcoming transformation that will ensure our information system is even more helpful. Every day our Long Term Care program (page 4) touches the lives of thousands of low‐income seniors and people with disabilities living in Multnomah County. Eligibility workers determine which nutrition, medical and financial resources are appropriate to recipients’ needs. Our specially trained Transition and Diversion team (page 6) works with residents in nursing facilities who want greater independence, to assess needs and explore the various options for moving back to the community.

Aging and Disability Services Promote Greater Independence

It all begins with a call to the ADS Helpline.

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Some of the people we serve reside in their own home or apartment, often with some help from a paid caregiver. That little bit of on‐going assistance can mean the difference between self‐reliance and dependence. When living in one’s own home is not a possibility, ADS offers a variety of care options. One of those options is the Adult Care Home Program (page 16), which licenses about 600 homes run by independent owner‐operators. The program also maintains the Find‐a‐Home website, which can connect all seniors, people with disabilities and their families with just the home they are looking for. Our branches and district centers located throughout Multnomah County provide a presence at the neighborhood level. District Centers sponsor a wide variety of services, from Medicare Prescription Drug counseling to exercise for seniors and people with disabilities. They are places to gather and chat over a meal or a cup of hot coffee, or visit with a case manager to find out about resources in and around the community. Veterans old and young can take advantage of services that provide counseling and advocacy for benefits with the Veterans Administration . Veterans can use the case managers in the Veterans program to access or determine eligibility for other county programs as well. ADS takes its role as protector of vulnerable seniors very seriously. Our Adult Protective Services Program (page 18) follows up on every call and complaint about abuse of seniors and people with disabilities, whether in a nursing facility or in the community. The program’s innovative Multi‐disciplinary Team uses professional resources from various areas to consult on difficult cases. Some county residents are unable to make informed decisions for themselves and are in harm’s way. The deputies at the Public Guardian and Conservator’s Office (page 12) work with people who need protection not otherwise available through regular community supports. After a judge determines that the program is legally responsible for these individuals, deputies move in quickly to resolve severe problems that usually include abuse, neglect and financial exploitation. Program staff work closely with these mentally impaired adults to find the right combination of self‐reliance, safety and independence. At Multnomah County Aging and Disability Services, we operate with one goal in mind: to keep our county’s seniors and people with disabilities safe, in the community and independent.

A small amount of assistance can mean the difference between

dependence and independence.

3 Aging and Disability Services Annual Report

Pauline Remaining in her home, with the help of a long term care case manager and contract nurse Throughout her life, 71 year‐old Pauline was active in both her community and church, so remaining in her own home was very important to her. More recently her activities have become limited by a series of complex health problems, including diabetes and arthritis. She now takes as many as 18 medications a day in addition to daily insulin injections. Over the last two years Pauline was in and out of nursing facilities for a series of increasingly difficult health issues. Each time she was discharged, she expressed a strong desire to return to her own home and community. As Pauline’s health declined, her ability to safely meet her needs at home become more and more difficult. Pauline began working with her case manager to develop a care plan that respected both her wishes and her safety concerns. Pauline’s county case manager arranged for a nurse to visit Pauline and her in‐home caregiver. The nurse taught them both about medication management, eating well and exercising at home. The case manager then helped Pauline get a donation of a lift chair and arranged for the repair of her hospital bed so she could move around her apartment more easily. Finally, her case manager helped Pauline meet her goal of getting out to the local senior center where she now visits with friends and participates in exercise classes. By creatively utilizing contracted and community providers, Pauline’s case manager helped her meet her goals for remaining independent. Pauline reports that she is relieved to know she has an alternative to a nursing facility.

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Long Term Care

Last fiscal year, Aging and Disability Services Long Term Care program determines financial eligibility, nutritional, medical and case management services for about 24,000 low‐income seniors and persons with disabilities . Intensive case management is provided to an average of 6,200 people each month who meet the Medicaid criteria for nursing home care due to the need for help with important daily self‐care tasks such as mobility, eating, bathing and toileting. Of that number, Long Term Care serves over 5,000 individuals in community‐based settings and 1,200 residents in nursing facilities. The program also infuses more than $30.5 million each year into the local economy through SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps), and medical and long term care benefits received by program recipients.

Medicaid recipients in nursing facilities

The Long Term Care Program keeps a close eye on the ratio between Medicaid recipients in nursing facilities and those living in the community. Using this measure — presently about 80% of nursing home‐eligible Medicaid recipients are living in the community — we are national leaders. If all states followed Multnomah County’s example, Medicaid costs nationwide would drop dramatically and more Medicaid recipients could return from more restrictive settings to live in their own communities.

July 2010

June 2011

Medicaid recipients in the community

All Multnomah County Nursing Home‐Eligible Medicaid Recipients


Medicaid Recipients in Multnomah County: Monthly Averages

Medicaid recipients receiving long term care and supports

FY2011 Avg./month

Living in their own home 2,728

Living in an adult care home 1,036

Living in a residential care facility 413

Living in an assisted living facility 400

Living in a skilled living facility 35

Living in a nursing facility 1,330

Total 5,942

Medicaid Recipients receiving medical assistance and/or SNAP

FY2011 Avg./month

Oregon Health Plan 776

SNAP (Food Stamps) Only 2,459

Oregon Health Plan and SNAP 401

Oregon Supplemental Income Program (OSIP) 14,192

Special Medicare Beneficiary 5,455

Total 23,283

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Transition and Diversion Specialized staff work to transition residents out of nursing homes or divert them from unnecessary nursing home stays.

Last year, 479 Medicaid recipients were transitioned or diverted from nursing facilities

51% returned to their own home

Medicaid Costs and Savings for Nursing Home-Eligible Recipients, FY 2011

7.67.77.87.98.08.18.28.3

Jul-10 Aug-10

Sep-10

Oct-10 Nov-10

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Jan-11 Feb-11

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June 2011

July 2010

Multnomah County Nursing Facility costs. During FY11, Multnomah County expended an average of $7.9m each month on Medicaid nursing facility costs. Total cost for the fiscal year: $95m.

Nursing facility costs without the Transition and Diversion team. Last fiscal year the team saved the Medicaid system $2.8m.

26% returned to

Assisted Living

23% returned to an Adult Care home

Costs

Savings


Frank The Special Medical Needs Program After a long illness, Frank’s wife passed away, and the small savings account they had accumulated was emptied to pay her final medical bills and the costs of her burial. He had put off the expense of fixing his dentures while his wife was alive, and now had no money to repair them. Even though he was a veteran, no VA program was available to help him. The broken dentures were now affecting his ability to talk and chew. He had to restrict himself to soft food; still, he often would choke on his food. There was no way Frank was able to save for new dentures; his meager living expenses equaled his monthly social security income. Frank spoke to a county‐contracted district center worker, who got him in touch with the case manager in charge of the Aging and Disability Services Special Medical Needs Program. This small program was unable to cover the cost of new dentures, so the program director negotiated the price with a local denturist. The denturist agreed to a lower price; at that point the Special Medical Needs Program covered the cost of his new dentures. Today, Frank has his new dentures and is grateful because now he can eat regular food again, and is able to converse more comfortably and clearly. “They’re beautiful” he told his worker. “They’re great! I eat steak and corn on the cob! I receive compliments on my teeth; some people think they’re my real teeth and I don’t even tell them. This has helped my self‐esteem as much as my ability to eat.”

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Community Services

Programs and Services FY 2010 FY 2011 Percent Change

Veterans: Benefits Recovered $30m $35m 17%

Special Medical Needs Assistance 225 248 10%

Emergency Housing Assistance 489

Senior Medicare Benefit Calls 207

Transportation vouchers 1,088 1,390 28%

Family Caregiver Respite 262 379 44%

Prescription Assistance 149 167 12%

Last year, Community Services programs served double the

proportion of Multnomah County residents of color as there are in the underlying

county population.

Aging and Disability Services Access and Early Intervention Services are the first point of contact for the county’s 200,000 elderly, people with disabilities and veterans. Annually, 71,292 Helpline and district center callers receive information and assistance and 11,357 people receive a variety of in‐home, community and emergency services that support independence and prevent institutionalization and homelessness. Most services are provided through the ADS Helpline and nine District Senior Centers (neighborhood‐based non‐profit agencies).


Community Services provides food security through the Older Americans Act and SNAP (formerly Food Stamps)

More than 34,000 seniors and people with disabilities received SNAP (formerly Food Stamps) through ADS.

More than 375,000 meals were delivered to home‐bound elders.

Over the last fiscal year:

More than 500,000 meals were offered through our senior meal sites.

Community Services provides nutrition services in several different ways: congregate meal sites, including ethnic meal sites, Meals on Wheels, and SNAP (formerly Food Stamps). These services are provided through Loaves and Fishes and the pro‐gram’s five contracted district centers.

More than 8,000 lunches were served through our four ethnic meal sites.

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Aging and Disability Services is transforming its information services to better meet the needs of Baby Boomers approaching retirement age. The new Aging and Disability Resource Connection (ADRC) includes a single access point for seniors and people with disabilities seeking information and assistance, access to public benefits, benefits counseling, and Options Counseling. The ADRC will be used by people of all income levels for all kinds of community care options and state‐wide resources. The county’s new ADRC will begin early 2012. We are already gearing up for the transition with new technology, new databases, and comprehensive staff training. Services include: Options Counseling Services with partners Providence Medical

Systems, Washington County and Tuality Community Hospitals. Care Transition Services with Adventist Medical Center, Cascade

Terrace, and Village Health Care. Information and assistance to find resources Access to public benefits Health promotion and disease management information Medicaid and Medicare benefits counseling

The Aging and Disability Resource Connection

Helpline Calls, 2009-11

30,000

32,000

34,000

36,000

38,000

40,000

42,000

2009 2010 2011

The number of calls to the ADS Helpline increased by almost 20% last year, and continues to grow.

“[the Options Counselor] gave me a lot more skills and ways of doing things.”

Medicaid recipient exiting hospital care


Patricia The Public Guardian Program and Adult Protective Services work together to save a life Patricia was in serious danger. Her dementia was getting worse and glaucoma was dimming her eyesight. Her daughter and granddaughter had recently moved in to Patricia’s home, explaining that they were there to care for her. Unfortunately, that was never their intention. An alert neighbor called Adult Protective Service (APS) because she was worried about Patricia’s well‐being. The neighbor reported seeing suspicious characters going in and out of Patricia’s home. Upon investigation, APS discovered the neighbor’s suspicions were well‐founded: Patricia’s daughter and granddaughter, with the help of friends, had completely drained the elderly woman of her life savings, stealing and spending over $100,000. In addition, they had allowed Patricia’s health to deteriorate . A county nurse determined her daughter had failed almost completely to provide basic care for her mother: Patricia had not been given essential medications needed to preserve her eyesight and mitigate other health conditions; she had missed numerous important medical appointments; and was starving. Adult Protective Services called in Public Guardian and Conservator deputies, who went to work immediately to save Patricia’s life and reclaim whatever was left of her savings. They petitioned the court to act as her guardian and conservator – to make decisions on her behalf – and were granted the request. Patricia was not safe in her own home and she also needed immediate medical attention. The public guardian removed her from the “care” of her child and grandchild and placed her in the memory care unit of a local residential care facility. Her weight returned to normal and she is finally receiving proper treatment for her glaucoma. A medical examination determined that she had been in imminent danger of permanent blindness without the care she received. Her conservator then turned to collecting what she could of Patricia’s life savings. She enlisted the police in gathering the necessary documentation to forward the case to the Multnomah County District Attorney’s office for prosecution of the perpetrators. Finally, the program conservator stepped in quickly to preserve Patricia’s last asset: her house. She evicted the daughter and granddaughter from their mother’s home, preserving the equity needed to pay for Margaret’s care and avoid her dependence on public benefits. Today, Patricia seems like a different person. She is a staff favorite and is best known around the memory care unit for her frequent smiles and hugs.

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Public Guardian & Conservator

The Public Guardian & Conservator program, under court authority, makes vital decisions for 170 of the county’s most mentally incapacitated, functionally dependent and impoverished adults who are current or recent victims of physical abuse, neglect and financial exploitation. Legal authority delegated to deputies by the court enables intervention when no other approach resolves abuse and neglect. In addition, the program provides community education and consultation on matters involving vulnerable adults with diminished mental abilities.

170 individuals are served in the program

64 guardian only 68 guardian and money management 29 guardian and conservator 9 conservator only

Of those 618 inquiries FY 2011

Consultations 389

Diversions 142

All callers connected with other resources 531

New cases accepted 22

In FY11, 618 Inquiries came from: Families Hospitals ADS Developmental Disabilities Mental Health

Last fiscal year, owing to lack of resources, statutory and program capacity limitations, the Public Guardian Program accepted only a fraction of all inquiries. Instead, staff provided consultation and referrals to alternate resources, helping divert potential clients into less costly services or into family and private guardianships/conservatorships.

Guardian: Responsible for all matters of health and safety for the individual who lacks capacity to make independent decisions. Conservator: Responsible for all financial and property matters for the individual.


Risk Statistics at Point of Referral (individuals usually have multiple risk factors, so percentages add up to more than 100%):

82% Abuse and Exploitation. Severe neglect, self‐neglect, financial exploitation.

68% Protective Services/Police Involvement. Frequent protective services and police visits.

73% Mental Health Crises. Recent psychiatric hospitalizations, hospital holds, civil commitments.

64% Frequent Hospitalizations. Frequent emergency room visits and hospital stays.

77% Unmet Medical Needs. Insufficient medical care and significant medical risk.

82% Unsafe Housing. Unsafe housing, homelessness, evictions, inadequate care.

Ninety percent of new cases have all urgent needs addressed within five days of court appointment.

Most public guardian cases fluctuate in and out of crisis. At any point during the last year, a

typical public guardian deputy experienced a continuing fluctuation in the ongoing needs of

his or her caseload, with many individuals suddenly requiring an intensive level of service.

Despite these challenges, public guardian deputies have consistently helped 80% of

individuals on their caseloads remain in the community and out of nursing facilities.

Public Guardian cases are extremely complex

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Duane The Adult Care Home Program creates a safe and happy alternative to nursing facility care

Seventy‐four year old Duane wanted to live in the community despite the increasing problems posed by his muscular dystrophy. His loss of muscle tissue was getting worse. He had lived in his own apartment with limited support for most of his life, and was proud of the fact that he was as independent as possible. After a short stay at a nursing facility last fall, Duane tried to go back home again. His caregivers were unable to meet his increasing needs and he was forced to return to the facility. Duane’s ADS case manager worked to bring about a compromise between what Duane wanted and what he needed. From the Adult Care Home Program, Duane learned about options where he could live as independently as possible while having his physical care needs met. Adult care homes are small family businesses that provide an attractive alternative to nursing home care for seniors and people with disabilities who need more assistance to stay independent. With the care, assistance and support of his case manager, he ultimately made the decision to live safely in a adult care home setting. Duane’s case manager reports the happy ending to this story: “Duane is adjusting well to his new residence; he loves the food and people at his adult care home.”


Paul The ADS Adult Care Home Program works with the Transition and Diversion Team to insure a dream is preserved Paul was 54 years old when his multiple sclerosis became too disabling and he was forced to quit his job. His elderly father stepped in to provide care for his son. Soon after Paul became bed‐bound and needed help being fed, going to the bathroom, taking a bath and getting dressed. Suddenly Paul’s father suffered a stroke and was forced to leave the house for recovery in a nursing home. Without his care provider, Paul moved to the same nursing home. Both Paul and his father were determined to move back to their home and began working with the Transition and Diversion program to look at supports. The Transition and Diversion case manager helped Paul and his father come up with a plan to address their complex physical care needs and their desire to maintain their lifelong connection to the African‐American community. Just as they were about to move, Paul’s father suddenly died. Paul was devastated and his health deteriorated. The Adult Care Home program worked with Paul’s Transition and Diversion case manager to develop another safety and care plan. Eventually, Paul was well enough to relocate. The case manager asked the Adult Care Home Program and the provider to widen the doorway to Paul’s room to accommodate his wheelchair. Paul is now living in a safe environment with a highly quali‐fied caregiver and his outlook on life has improved dramatically. He is able to visit with his friends, take trips and participate in weekly barbecues at his new home. And, the cost of Paul living in the community is much less than the cost for nursing facility care.

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Adult Care Home Program

Statistics FY 2011

Number of licensed homes 593

Beds per home 4.46

Number of nursing home‐eligible residents in adult care homes 1,143

Average cost of residence in an adult care home $2,127/mo

Average cost of nursing home care $5,900/mo

Cost of an adult care home as a portion of nursing home cost 36%

Adult care homes are licensed under state and local laws to insure 24‐hour care and supervision of their residents. They offer a less expensive, homelike alternative to an institutional facility, resulting in affordable, quality care in a safe and culturally appropriate setting. The ADS Adult Care Home Program provides licensing services (inspections, training) and monitors all 593 independently‐owned adult care homes in Multnomah County. These 593 homes represent 2,645 beds available to elderly and disabled individuals who pay for their care through either Medicaid or private resources. The program also licenses 66 room and board facilities that offer low cost housing to elderly and disabled residents who need a supportive living environment but are not eligible for financial assistance. Last year Medicaid residents in these homes provided $2.4 million to the local economy.

Adult Care Homes Found in Compliance with State and Local Laws

84%

86%

88%

90%

92%

2006 2007 2008 2009 2010

Residence in an adult care home is one‐third the cost of residence in a nursing home.

As a consequence of increased education and continued inspection, more homes are in compliance with state and county regulations.


Gladys The Adult Protective Services Multi‐Disciplinary Team keeps a senior with disabilities safe

Gladys lived independently in her own apartment, receiving medical coverage and SNAP (formerly Food Stamps). When she became ill she was hospitalized and then transferred to a nursing facility. Workers in the nursing facility observed immediately that Gladys had developed significant signs of dementia. She was insistent on returning home but it was clear to her case manager that living alone at home, even with the assistance of a paid caregiver, would not be a safe plan. The case manager decided to bring the case to the ADS Multi‐Disciplinary Team (MDT). MDT members along with a deputy public guardian visited Gladys in the nursing facility and conducted a dementia assessment along with a holistic assessment to determine a more appropriate living situation. The team confirmed the presence of dementia, and talked to the family about Gladys’ high risk of living alone. Ultimately, after multiple meetings with family members, consultations with medical professionals, and dozens of hours of county case management , the MDT helped forge a compromise that balanced the very complex legal and emotional issues, honoring the wishes of all while maintaining Gladys’ safety. Gladys agreed to be moved to a nursing facility of the family’s choice.

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Allegations 2009 2010 Percent Change

Substantiated 871 892 2.5%

Unable to Substantiate 395 423 7%

Not Substantiated 1,416 1,581 12%

Total Allegations 2,682 2,896 8%

Total Reports 2,335 2,547 9%

Adult Protective Services is responsible for ensuring Multnomah County’s 200,000 seniors, people with disabilities and veterans are free from from abuse, financial exploitation, neglect and self‐neglect. Protective Services workers prevent further harm in cases of abuse and link abuse victims to vital health, legal and human services. This program conducts abuse screenings and investigations, provides risk management, abuse prevention and consultation, and educates the community about abuse of vulnerable adults. An innovative method for providing adult protective services is the Multi‐Disciplinary Team (MDT). The MDT consists of professionals from areas including law enforcement, psychiatry, social work and nursing. The team convenes to problem‐solve difficult abuse cases. Eighty‐nine percent of MDT participants showed improvement shortly after MDT intervention.

Adult Protective Services

As the economy has deteriorated, Adult Protective Services has seen an increase

in financial abuse.


Client Safety: Percent of Clients Who Experience No Further Abuse After APS Intervention

94%

96%

98%

100%

2006 2007 2008 2009 2010 2011 2012*

est.

All abuse in Multnomah County: Unknown.

Screening: 8,327 cases came to APS for screening during FY11. Investigation: APS

investigated 2737 cases.

Substantiation: Abuse was determined in 832 cases. Risk Management: APS

monitored 100 cases closely to prevent clients from experiencing further abuse or neglect.

The FY 2011 Adult Protective Services Funnel

Consultations FY 2011 Enhanced abuse consultation and referral 862

Screened out 785

All consultations 1647 All other calls not warranting investigation 6,680

All Screenings 8,327

When investigation is not warranted, APS often consults with callers to

determine a course of action.

Information and assistance (Helpline: 503.988.3646)

Adult Care Home Program

Nutrition services, including SNAP (Food Stamps)

Medical benefits and medical benefit counseling

Long Term Care Options counseling

Long Term Care in‐home services

Adult Protective Services

Public Guardianship and Conservatorship programs

Emergency services

Transportation

Referral to professional legal services

Veteran’s advocacy and case management

Family caregiver support

Prevention and health promotion

Assistance with transition and diversion from hospitals and nursing facilities back to the community

Multnomah County Aging and Disability

Services direct and contracted

services include:

Multnomah County Aging and Disability Services Department of County Human Services 421 SW Oak Street, Suite 510 Portland OR 97204

ADS 24‐hour Helpline: 503.988.3646

Report created by Ralph Holcomb, MSW, Ph.D. Office of Research and Evaluation This report is located on the web at www.multco.us/ADS

“ADS promotes independence, dignity and choice in the lives of seniors and people with disabilities.”

ADS Mission Statement

2011 ads annual report

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