dss….aging services… connecting the dots · oaa administrative structure and reach the older...

NCDHHS, Division of Aging and Adult Services | Aging and DSS Connecting the Dots | August 1, 2019 1

DSS….Aging Services… Connecting the Dots

Jessalyn Bridges, No Wrong Door Coordinator

Lorrie Roth, NC In Home Aide Consultant

August 1, 2019

NC Department of Health and Human Services Division of Aging and Adult Services


Funding and Coordination of the Aging Network

Congress passed the Older Americans Act (OAA) in 1965 in response to concern by policymakers about a lack of community social services for older persons.

The law also established the Administration on Aging to administer the newly created grant programs and to serve as the federal focal point on matters concerning older persons and called for the creation of State Units on Aging.

Administration for Community Living established in 2012, bringing together the Administration on Aging, the Office on Disability and the Administration on Developmental Disabilities.


• Focuses on 60 years of age and older, minority, rural, limited English, greatest social or economic need

• There is targeting criteria for services but there are not specific income or clinical eligibility criteria

• Donations may be requested or cost-sharing

• Limited funding = waiting list

• OAA is not an entitlement program

The Older Americans Act (OAA):


OAA Administrative Structure and Reach

The Older Americans Act Helps Over 11 Million Seniors (1 in 5)

Remain at Home through Low-Cost, Community-Based Services

AoA

618 Area Agencies on Aging

More than 15,000 Service Providers & Hundreds of Thousands of Volunteers

Provides Services and Supports to Nearly 1 in 5 Seniors

225

million

meals

24

million

rides

41 million hours of personal

care, homemaker & chore

services

741,000

caregivers

assisted

6 million

hours of

respite care

520,000

ombudsman

consultations

3.7 million

hours of case

management

56 State Units & 270 Tribal Organizations

Source: ACL’s OAA State Performance Report


NC Department of Health and Human Services

NCDHHS

Aging and Adult Services

Services for the Deaf and Hard of Hearing

State Operated Healthcare Facilities

Health Service Regulation

Medical Assistance (Medicaid)

Social Services Human Resources

Mental Health, Development Disabilities,

Substance AbuseVocational Rehabilitation

ServicesOffice of Rural Health

Services for the Blind

Child Development and Early Education

Public Heath


State Units on Aging

−Report data on OAA program participants, services, and expenditures

−Provide leadership, advocacy, and policy development

−Set state aging priorities

−Develop the state plan on aging

−Develop a funding formula and contracting with AAAs

−Monitor AAA performance


Federal GovernmentAdministration for Community Living

State GovernmentNC Dept. of Health and Human Services (DHHS)

Division of Aging & Adult Services

16 Area Agencies on Aging(AAAs)

Non-ProfitAgencies

For-Profits Agencies

County Government

Agencies

100 County Governments

County Departments of Social Services (100)

Service Delivery System


Division of Aging and Adult Services-a Continuum of Care for Older NC

Well

At Risk

High Risk

Congregate Meals

Information and Options Counseling

Senior Centers

Volunteer Development

Adult Day Care/ Day Health

Help for caregivers- Lifespan Respite, Project Care, FCSP

Homemaker, In Home Aide, Special Assistance

Home Delivered Meals

Housing and Home Repair

Legal

Transportation

Adult Protective Services

Guardianship

Ombudsman

Placement


Area Agencies on Aging

Scotland

Guilford

Rockingham

Moore

Anson nson

Union

Richmond

Mecklenburg

Cabarrus Stanly

Surry Ashe

Wilkes Yadkin Forsyth

Stokes

Davidson

Randolph Rowan

Cleveland Gaston

Iredell

Caldwell Alexander

Catawba Burke

McDowell Buncombe

Rutherford

Polk

Madison Yancey

Watauga

Cherokee

Graham

Clay Macon

Jackson

Swain

Avery

Davie

Montgomery

Henderson

Transylvania

Haywood Wake

Granville Person

Orange

Lee

Hoke

Robeson

Columbus

Brunswick

Pender Bladen

Sampson

Duplin

Onslow

Jones

Lenoir Wayne

Johnston

Harnett

Carteret

Craven Pamlico

Beaufort Hyde

Tyrrell Dare

Gates Hertford

Bertie

Martin

Pitt

Greene

Wilson

Nash

Franklin

Warren

Halifax

Northampton

Edgecombe

Vance

Durham

Cumberland

Washington

Currituck Camden

Pasquotank Perquimans

Chowan

New Hanover

Chatham

Caswell

Mitchell

Alleghany

Lincoln

E

Alamance

F

Q

G

M

N

J

K

L

O

P

R

D

A

B

C


• Counseling, caregiver training and education

• Dementia-specific information, • Respite care vouchers to

reimburse family caregivers for breaks from caregiving duties

• Connects families to community resources and local agencies to meet their needs

Project C.A.R.E.

Services Eligibility

• Caregiver of someone with Alzheimer’s disease or a related dementia

• Not eligible to receive similar services through programs such as VA, Medicaid, etc

• Priority is given to low-income, rural, and minority families who cannot afford private respite services

• Care recipient must be frail and unable to safely stay alone


How can my county get meals or transportation?

• NC created a comprehensive and coordinated community-based systems of services and supports for older adults through a common funding stream, Home and Community Care Block Grant (HCCBG).

• HCCBG is unique to NC because we combine our state and federal dollars into the one funding stream.

• To increase county flexibility with respect to budgeting for aging services.

• Simplify the administration of aging services by establishing uniform service standards, eligibility, reporting and reimbursement policies.

• HCCBG county planning committees are a group of individuals, appointed by county commissioners, to decide what services are most needed in their counties, how much money needs to go toward the services and what agencies will provide the services.


• Congregate Nutrition • Home Delivered Meals • Adult Day Care • Adult Day Health Care • Care Management • Skilled Home (Health) Care • Housing & Home

Improvement • Information & Options

Counseling• In-Home Aide (Levels I-IV)

Allowable HCCBG Services

• Transportation • Group and Overnight

Respite• Institutional Respite Care• Senior Center Operations• Health Screening• Mental Health Counseling• Senior Companion • Volunteer Program

Development• Health Promotion &

Disease Prevention


HCCBG: What does that look like in NC?

Over $66 million worth of services and supports were provided to more than 60,000 older adults in NC in SFY 2018.

80% of HCCBG funding is allocated to 4 core services:

• In- Home Aide (Home Care) – 30%; 96 counties; 2018 clients served – 6,531

• Home Delivered Meals (MOW) – 23%; 98 counties; 2018 clients served – 18,577

• Congregate Nutrition Program – 16%; 100 counties; 2018 clients served – 23,702

• Transportation – 10%; 92 counties; 2018 clients served – 9,328


What does that look like in NC?

20% of funds is allocated to the other 14 HCCBG services:

• Senior Center Operations – 8%; 171 Senior Centers in 96 counties

• Adult Day Health – 4%; 2018 clients served – 697

• Information and Options Counseling – 3% - 2018-clients served-

• Adult Day Care – 3%; 2018 clients served – 582

• Housing and Home Improvement – 2% - 2018 clients served – 984

• Average HCCBG client receiving any service:

− a female (70%)

− who lives alone (49%)

− at or below poverty (46%)


In Home Aide Program

• DEFINITION

− In-Home Aide Services are those paraprofessional services which assist the individual and/or family with essential home management and/or personal care tasks and/or family to remain, and function effectively, at home as long as possible.

− In-Home Aide Services incorporate a wide variety of types and levels of home management and personal care tasks that may be offered by the provider.

SOURCE: In-Home Aide Services – Policies and Procedures, 10A NCAC 06A, 10A NCAC 13J, DAAS Service Operations Toolkit for New Monitors


In Home Aide Program• I. Statement of Philosophy and Purpose

• In-Home Aide Services are intended to assist individuals and their families with attaining and maintaining self-sufficiency, and improving quality of life. These services are aimed at preventing the deterioration of individuals’ functional capacity, preventing abuse, neglect and/or exploitation and avoiding premature institutional care by assisting individuals in maintaining themselves in their own homes as long as possible. It is the intent of the In-Home Aide Services Program to assist, but not replace, family members in carrying out their responsibilities for those individuals needing care or support.

SOURCE: In-Home Aide Services – Policies and Procedures, 10A NCAC 06A, 10A NCAC 13J, DAAS Service Operations Toolkit for New Monitors


Home Care Independence

• An option of assistance for potential consumers of service

• “Employer of record’

• Financial Management Service handles payroll functions

• Limited availability in NC

• Solution to current issues

• What Is Consumer-Directed Services (CDS)?


Home Delivered Meals

• Most HDM programs could not operate without volunteers delivering the meals.

• Eligibility. Remember - there may be a waiting list if there are insufficient funds or volunteers.

• Some county agencies operate three nutrition programs.

• Providers can contract with vendors or prepare the meals themselves.

• Older adult can private pay full cost or contribute toward the cost


Congregate meals

• Congregate meal sites provide “more than just a meal”.

• Meals sites can be located in various places.

• Meal participants

• “More than a Meal”


Transportation

• Transportation service provides travel to and/or from community resources for accessing needed services or carrying out activities of daily living. An agency may provide either general or medical transportation or both.

• Volunteer transportation ministries

• There is typically no cost for their service but donations are accepted.

• Call agencies for details about their specific offerings and reservations policies.


Adult Day Care / Day Health

• Adult Day Care Centers are designed to provide care and socialization for older adults needing assistance or supervision during the day.

• Programs offer relief to family members and caregivers, allowing them to go to work, handle personal business, or just relax.

• Centers are usually open during normal business hours and are located in a variety of settings.

• There are two types of adult day care: adult day care and adult day health care.

• Other activities and programs may include but are not limited to:

• Important considerations:


Information & Options Counseling

• Information and Options Counseling (I & OC) is a service designed to link individuals with resources available to meet their needs and/or interests.

• The three components to this service are: ▪ Information,

▪ Assistance, and

▪ Options Counseling.


Housing and Home Improvement

• Housing and Home Improvement service provides minor repairs.

• In 29 counties

• Reimbursement for projects costs is not to exceed $1,500 per home per program year.

• Persons receiving the minor home repair program are asked to contribute toward the cost of materials.


There are four categories of home improvement services:

• Security Enhancements

• Minor Home Repairs

• Mobility and Accessibility Improvements

• Basic Household Furnishing/Home Appliance Repair, Replacement, or Purchase

Housing and Home Improvement


Senior Centers

“…community facility for organization & delivery of broad spectrum of services, … & recreational activities for older individuals.” –Older Americans Act definition

Access to Vital Services

Preventing Isolation

Health Promotion

Promotion of Volunteerism


Evidenced based programs

• Evidence-based programs (EBPs) offer proven ways to promote health and prevent disease among older adults.

o These are three popular ones offered in NC:

Benefits to Older Adults:


Ombudsman

▪ Ombudsman are housed within the AAA.

▪ Ombudsman assist residents of nursing homes, assisted livings and group homes.

▪ Ombudsman are mandated to provide certain activities

▪ Ombudsman do have parameters

▪ Ombudsman can also be a resource


Legal Services though OAA in NC

Legal Services Developer

NC Division of

Aging and Adult Services

Area Agencies on Aging

16 Regions

12 Legal Service Providers

throughout NC


Legal Services Program

• 42 U.S.C. § 3058j requires the Legal Services Developer to:

• Securing & maintaining the legal rights of 60+ persons;

• Coordinating the provision of legal assistance;

• Provide technical assistance, train and educate;

• Promote financial management services to 60+ persons at risk of conservatorship;

• Assist older persons in under-standing their rights; and

• Improve the quality and quantity of legal services


Project Care

• Project C.A.R.E. (Caregiver Alternatives to

Running on Empty) is the only state funded,

dementia specific support program for

individuals who directly care for loved ones with

Alzheimer’s disease or related dementias.

• Project C.A.R.E. is a coordinated delivery system

that is responsive to the needs, values and

preferences of unpaid family caregivers.

• The state is divided into 6 regions for Project

CARE and each region has a program consultant.


• Counseling, caregiver training and education

• Dementia-specific information

• Respite care vouchers to reimburse family caregivers for breaks from caregiving duties

• Connects families to community resources and local agencies to meet their needs

Project C.A.R.E.


• Caregiver of someone with Alzheimer’s disease or a related dementia

• Not eligible to receive similar services through programs such as VA, Medicaid, etc

• Priority is given to low-income, rural, and minority families who cannot afford private respite services

• Care recipient must be frail and unable to safely stay alone


• Information about available services

• Help gaining access to the services

• Individual counseling, support groups, and training

• Respite care to enable caregivers to be temporarily relieved from their caregiving responsibilities

Specific services vary by countyand region

Family Caregiver Support Program


• Caregiver for a person with Alzheimer's or dementia

• Caregiver for a frail or chronically ill person age 60 and older

• A caregiver (who is not the birth or adoptive parent), age 55 or older, raising a related child age 18 and under or an adult with a disability.


Lifespan Respite Voucher Program • The Lifespan Respite Voucher Program reimburses up to $500 in

respite services per year to unpaid primary caregivers caring for an individual of any age.

• The program is consumer-directed: caregivers who are awarded vouchers can choose from a variety of options to provide their respite services.

• The program is intended to serve those caregivers who are “falling through the cracks” because they are unable to access other sources of publicly-funded respite and cannot pay privately.


Who is eligible for a Voucher?

• The caregiver must be 18 years old and a NC resident.

• The caregiver must be providing unpaid care for an individual of any age.

• Neither the caregiver nor the care recipient can be receiving ongoing publicly funded in-home care or respite care, including adult day care services.

• Those who are on waiting lists for these services are eligible.

• Exceptions can be made if there are emergency situations or special circumstances.


More Voucher Information

Priority for Lifespan Respite Vouchers is given to:caregivers with the greatest economic need;caregivers who provide direct care for their loved one; andcaregivers who have not received a publicly funded respite break within the past 6 months.

Caregivers must be able to:use the respite voucher within 90 days;screen and hire their own respite provider;pay for services in advance if bill arrives prior to reimbursement; andcomplete required paperwork (Respite Provider Agreement, Record of Respite Services).


Partnerships


NC 2-1-1

No Wrong Door partners with NC 2-1-1 to:

• enhance the data base to include LTSS resources

• train call specialists to identify and assist LTSS callers,

• provide follow-up to insure connection to service

• develop statewide reporting to identify gaps in service and areas of needed capacity.

• www.nc211.org

http://www.nc211.org/


Senior’s Health Insurance Information Program (SHIIP)

• To assist Medicare beneficiaries and their families in understanding their choices of insurance products and services available;

• To provide free unbiased and factual health insurance information;

• To serve as a clearinghouse for consumer publications (CMS & NAIC).


SHIIP’s Role

•Help Medicare beneficiaries in their community with questions regarding:•Medicare •Medicare supplements•Medicare Advantage Plans•Medicare Prescription Drug Plans•Medicare financial assistance programs•Medicare Fraud, Waste and Abuse


CHEROKEE

GRAHAM

SWAIN

CLAY

MACONTRAN-

SYLVANIA

HENDER-SON

POLK

MADISON

AVERY

GASTON

LINCOLN

CATAWBABURKE

UNION

CABARRUS

ROWAN

STANLY

RANDOLPH

MOORE

ANSONHOKE

CHATHAM

LEE

HARNETT

ROBESON

SCOT-LAND

BLADEN

SAMPSON

COLUMBUS

BRUNSWICK

PENDER

PERSONGRAN-VILLE

WARREN

FRANKLIN

WAKE

NASH

JOHNSTON

WAYNE

DUPLIN

GREENE

LENOIR

PITT

JONES

ONSLOWCARTERET

PAMLICO

BEAUFORT

CRAVEN

HYDE

DAREWASH-

INGTON

BERTIE

GATES

HALIFAX

EDGE-COMBE

STOKESSURRY

FORSYTH GUILFORDYADKIN

DAVIE

ASHE

WILKES

ALLE-GHANY

CALDWELL ALEX-ANDER

MCDOWELLWILSON

NC Seniors’ Health Insurance Information ProgramRegional Manager Territory Map


Additional Resources • NC Coalition on Aging −www.nccoalitiononaging.org/

• STHL−www.ncsthl.org

• Governor’s Advisory Council−www.ncdhhs.gov/divisions/daas/daas-council-committee

• Dementia Friendly America−www.dfamerica.org/

• SHIIP −www.ncshiip.com 855-408-1212

http://www.nccoalitiononaging.org/

http://www.ncsthl.org/

http://www.ncdhhs.gov/divisions/daas/daas-council-committee

http://www.dfamerica.org/

http://www.ncshiip.com/


Contact Information

For more information on these services, to find your Area Agency on Agency, or county provider contact information please visit:

https://www.ncdhhs.gov/divisions/daas

Or call 919-855-3400

https://www.ncdhhs.gov/divisions/daas

dss….aging services… connecting the dots · oaa administrative structure and reach the older...

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