Florida Master Plan on Aging

2007-2009

Florida Master Plan on Aging

2007-2009

Florida Department of Elder Affairs

Charlie Crist, Governor

E.Douglas Beach, Ph.D., Secretary

Florida Department of Elder AffairsFlorida Department of Elder AffairsFlorida Department of Elder AffairsFlorida Department of Elder AffairsFlorida Department of Elder Affairs

Mission StatementMission StatementMission StatementMission StatementMission Statement

To create an environment that provides choices, pro-motes independence and enables older Floridians to

remain in their communities for a lifetime.

VVVVVisionisionisionisionision

To lead the nation in assisting elders to age in place,with dignity, purpose, security, and in an elder-

friendly community.

VVVVValuesaluesaluesaluesalues

Elder RightsCompassion

AccountabilityCaregiver Support

VolunteerismQuality

Intergenerational PartnershipsDiversity

Table ofTable ofTable ofTable ofTable ofContentsContentsContentsContentsContents

Table of Contents i

Introduction 1

Policy Framework 5Goal 1: Create a Long-Term Care System that isStreamlined, Cost-Effective and Elder-Friendly 7

Formal Long-Term Care 8

Goal 2: Create a Greater Support Network for Elders,Families and Caregivers 19

Informal Long-Term Care 20

Goal 3: Create an Elder-Friendly Environment that Valuesthe Contributions and Needs of Elders 30

Communities For a Lifetime 31Independent Housing 32Transportation 42Health and Wellness 52Employment and Volunteerism 64Disaster Preparedness 72Elder Rights 86

Conclusion 106

Technical AppendicesA. The State of Aging in Florida-A Monograph and Needs Assessment 113B. Inventory of Agency Elder Care Services 155C. Excerpt from the White House Conference on Aging (50 Resolutions) 167D. Concurrency Matrix- Policy Domain Themes 177

E. Concurrency Matrix- Ch. 430, F.S., Topics 189

i

IntroductionIntroductionIntroductionIntroductionIntroduction

he Florida Department of Elder Affairs (DOEA) was created in1991 as the primary agency responsible for administering

services and advocating for elder citizens throughout the state. Chapter430 of the Florida Statutes dictates the roles and responsibilities of theagency.

A function of the department is to prepare a “master planfor policies and programs in the state relating to aging.”The plan must identify the needs of the elder populationin the areas of housing, employment, education andtraining, medical care, long-term care, preventive care,protective services, social services, mental health,transportation, long-term care insurance, and other

relevant areas that significantly impact elders. The purpose of the planis to establish a set of policy recommendations that will serve toenhance and improve the services that the state provides to the agingpopulation.

As provided in Florida law (Chapter 430.04, F.S.), the Master Plan isdeveloped in partnership with input from stakeholders and eldercitizens throughout the state. It is the result of a detailed process thatprocured input from numerous sources including staff from other stateand local agencies, elected officials, policy makers, researchers at stateand national universities, advocates, and, most importantly, the elderswho generously participated in sharing their time and knowledge.

TTTTT

1

THE MASTER PLAN ON AGING

Interagency

Workgroups

Public

Input

White House

Conference

on Aging

Research

State

Agencies

Services

to Elders

Master

Plan on

Aging

Input

Policy Guidelines

Programs

Input

Input Input

2

In keeping with the input received, the Master Plan is organizedthematically into the following three programmatic policy areas:

Create a Long-Term Care System that is Streamlined, Cost-Effective and Consumer Friendly

Create a Greater Support Network for Elders, Families and Caregivers

Create an Elder-Friendly Environment that Values the Contributions and Needs of Elders

The plan embodies the input of a dedicated group of partnersand stakeholders who contributed their expertise and experienceto its drafting. Eight interagency workgroups comprised ofrepresentatives from state agencies with an interest in elder careservices met throughout the planning process to identify needsand policy solutions for Florida’s elders. Additionally, severalpublic town-hall meetings were held to collect the thoughts andinput of elder care professionals, caregivers, elder constituents,and all other interested parties. State agency and universityresearch combined with the 2005 White House Conference onAging resolutions helped contribute to the development of theMaster Plan.

1.

2.

3.

3

Scope of theMaster Plan on

Aging

Master Plan on Aging:

Identifies needs and issuesthat impact Florida’s elders.

Examines policies and programsin Florida related to aging.

Establishes a programmaticaction framework to meet elderneeds.

The Master Plan on Aging, 2007-2009 document is organized intofour main sections. The first section introduces the scope andpurpose of the Master Plan. The second section provides aprogrammatic action and policy framework, guiding the visionfor the future. The conclusion details the future steps requiredfor implementation of the plan. Finally, the technical appendicesinclude a profile of the state of aging in Florida and an inventoryof state programs serving elders. This profile provides thecontext for existing programs and policies. Several matricesdepicting concurrency with legislative and federal requirementsand the relationships between the various themes depicted in theplan are also included in the appendices.

1. Introduction

2. PolicyFramework

3. Conclusion

4. TechnicalAppendices

The Master Plan onAging, 2007-2009 isdivided into thefollowing sections:

4

his section provides the program policy framework toguide development and administration of services for

mature citizens throughout the state. It is the result of acollaborative process that engaged state agencies, researchers,advocacy organizations and individual citizens. Thepresentation of this policy framework is organized around threegoals:

• Goal 1: Create a Long-Term Care System that isStreamlined, Cost-Effective and Consumer-Friendly

• Goal 2: Create a Greater Support Network forElders, Families and Caregivers

• Goal 3: Create an Elder-Friendly Environment thatValues the Contributions and Needs of Elders

TTTTT

Program PolicyProgram PolicyProgram PolicyProgram PolicyProgram PolicyFrameworkFrameworkFrameworkFrameworkFramework

5

The policy discussions, centering around each of the goals, are organized thematicallyinto distinct program areas as follows:

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Goal 1:Create a Long-Term Care System That isStreamlined, Cost-Effective and Consumer-Friendly

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Formal Long-Term Care-BackgroundLong-term care is defined by the Centers for Medicare andMedicaid Services as “a variety of services that help people withhealth or personal needs and activities of daily living over aperiod of time. Long-term care can be provided at home, in thecommunity, or in various types of facilities, including nursinghomes and assisted living facilities.” Services include a widerange of medical and non-medical support services to helppersons with chronic health impairments and functionaldisabilities meet health or personal needs over an extended time.Long-term care can be informal services, provided by family orfriends or formal paid services provided by professionals oragencies.

The ideal long-term care system combines consumer preferencewith cost-effectiveness. The long-term care setting preferred bymost elders is their own home. Long-term care can be expensive.While most frail elders in their homes rely on an informal systemof family, neighbors and community organizations for the bulkof home and personal care services, sometimes these servicesneed to be complemented or substituted with formal, for pay,long-term care. This can be costly to the individual, families andthe state.

There is growing concern that public long-term careexpenditures may overwhelm the fiscal capacity of the state. Thedemand for long-term care services is projected to double by2020. The result of this increased demand will be a significantrise in public and private long-term care expenditures for elders.Seven of the top 10 2005 White House Conference on Agingresolutions are related to formal long-term care issues. The 2005White House Conference on Aging projected an increase in long-term care expenditures from $123 billion in 2000 to $207 billionby 2020.

In general, Florida is doing a good job of containing the publiccost of long-term care compared to other states. Even so,Florida’s Medicaid expenditures for nursing home care for

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epersons age 60 and older were close to $2.0 billion, andexpenditures for community-based long-term care were over$450 million in 2004-2005.

While consumer preference is for home care, public expendituresare heavily weighted toward the option of nursing home care.Available community options, reimbursement mechanisms andimmediacy of need often limit choice, making nursing home carethe more accessible option for elders. If frail elders do not haveaccess to affordable community options as they age, nursinghomes may become their only alternative.

The 2005 White House Conference on Aging estimated that morethan one-third of persons age 65 and older will spend some timein a nursing home, and half of these will spend over a year in anursing home. Options available through innovative programs,particularly for lower income and rural elders, can defray ordelay a person being forced into a more costly institutionalsetting.

The complexity of Florida’s long-term care system can bechallenging, fragmented, inefficient and confusing. It is notuncommon for several agencies to be involved when a personreceives publicly funded long-term care. Failure to coordinateservices is a significant obstacle to aging in a community setting.Developing a system that provides more choices for care in theleast restrictive setting will require effort. The coordination ofacute and chronic long-term care services to address thecontinuum of service needs through the end of life must be apriority. Prevention and early planning are needed to make theprocess easier and help elders receive their care optionpreferences. The wide array of services, programs and providersconfounds the issue. Constant monitoring and evaluation arenecessary to determine which services and programs provide themost value and to ensure that elders get the best quality and themost appropriate services.

Florida must make needed changes in the way it delivers andfinances long-term care services before baby-boomers enter theirhigh-risk years. Changes and improvements to the formal long-term care system are needed to better address the needs of the

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aging baby-boomer generation and make services moreconsumer-directed and supportive of community living. Arecent report sponsored by the Robert Wood Johnson Foundationconcludes that expanding home and community-based servicesis ranked first among state long-term care policy priorities,followed by controlling nursing home expenditures. Policyobjectives and strategies described in this plan address thesepriorities.

As Florida looks to the future, it must find ways to give eldersmore community choices, increase nursing home diversions,offer more transitions to community options and reduce theoverall cost of formal long-term care services. Florida must seeka better system of long-term care that will contain costs, improveoutcomes and increase consumer satisfaction. To accomplishthis, Florida must look at innovative ways to:

• Improve how elders access services andinformation;

• Maximize financing and cost-effectiveness of care;• Improve program, service and provider

accountability;• Find ways to integrate and coordinate acute and

chronic care;• Rebalance or redirect the system so there are more

cost-effective community options;• Monitor and evaluate service and program

effectiveness; and• Ensure and enhance consumer choice and quality

of life.

Formal Long-Term Care-Inventory of Services

The Florida Department of Elder Affairs (DOEA) plays a key rolein the coordination of formal long-term care services. Theseservices include screening, assessment and monitoring forindividuals entering nursing homes and home and community-based services, training for staff in assisted living facilities, andrule writing with respect to Alzheimer’s disease training andtraining curricula.

For more information on formal long-term care trends, please see Appendix A.

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eThe Agency for Health Care Administration (AHCA) is DOEA’ssister agency in the provision of formal long-term care services.The mission of AHCA is to champion accessible, affordable,quality health care for all Floridians. AHCA services that affectFlorida’s formal long-term care system include health facilityregulation, long-term care services, managed health care,Medicaid services, certificates of need, and a complaint andinformation call center. AHCA also manages two long-term carepilot programs, the frail elder program and channeling.

Other significant agencies involved in the formal long-term carearena include the Department of Children and Families, theDepartment of Veterans’ Affairs, and the Department of FinancialServices/Office of Insurance Regulation.

See Appendix B for details.

Formal Long-Term Care-Objectives:

Objective 1- Simplify, expedite and improve the ability ofelders to access long-term care informationand an integrated array of health and socialsupports.

Objective 2- Develop a flexible funding system that haspredictability of costs, encourages costcontainment and is sustainable in the longrun.

Objective 3- Ensure that program administration istransparent and competitive and that serviceproviders are accountable throughcontracting standards and performancemeasures.

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Objective 4- Coordinate and integrate a holistic approachto the long-term care system to improveoutcomes, reduce complexity, streamline thesystem, and make it easier to use.

Objective 5- Continually monitor and evaluate programsand services to ensure high quality and cost-effectiveness and to consider the effects ofpublic policies and program design on themarket for privately paid long-term care.

Objective 6- Rebalance the long-term care system fromnursing homes to more cost-effective homeand community options.

Objective 7- Administer publicly funded long-term careon the axioms that quality of life andconsumer autonomy are at the root of theideal long-term system.

Formal Long-Term Care-Key Implementation Strategies,

Roles and Responsibilities:

The state agencies considered most critical in serving elders inthe formal long-term care arena include the Department of ElderAffairs, the Department of Veterans’ Affairs, the Agency forHealth Care Administration, the Department of Children andFamilies, and the Department of Financial Services/Office ofInsurance Regulation. The following matrix lists each of theseagencies with their appropriate roles in carrying out formal long-term care strategies.

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Legend:

Lead

Support

Partnership ---

* Strategy is similar to an objective/strategy in another topic area.

Strategy DO

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Integrate acute and long-term care in a

seamless care system using risk-

sharing financial mechanisms

(Objective 2)

--- ---

Expedite ways to move individuals

from institutional settings to

community settings (Objective 1,4,6,7)

Encourage access to aging veteran

population and long-term care needs of

younger disabled veterans (Objective

1,4,6,7)

Ensure the availability of skilled

nursing home beds (Objective 1)

Continue to simplify eligibility policies

(Objective 1,6)

Enhance access to eligibility

determination services through

community partnerships and

enhanced technology (Objective 1,4)

Ensure continued service availability

during and following disasters

(Objective 1)*

--- --- --- --- ---

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Legend:

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Partnership ---

* Strategy is similar to an objective/strategy in another topic area.

Strategy DO

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DC

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Increase access to means-tested

community-based programs when

funding is available (Objective 1,6)

Facilitate access to services in all

geographical locations (Objective 1,7)--- --- --- --- ---

Maximize limited funding for

community care (Objective 2,6)

Ensure affordability and availability of

insurance (Objective 2,7)

Ensure affordability and availability of

liability insurance for licensed nursing

homes (Objective 2)

Encourage federal and state funding for

health care facilities (Objective 2)

Participate in Medicare reform

activities to ensure that elders have the

ability to get quality and affordable

health care (Objective 1-7)

--- ---

Invest in programs that assist working

adults and families with financial

planning for their own long-term care

needs (Objective 2,7)*

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* Strategy is similar to an objective/strategy in another topic area.

Strategy DO

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Facilitate the development of a long-

term care system that is affordable for

middle income families (Objective

1,2,6,7)

--- ---

Invest in programs that reduce the

need for long-term care through

prevention and early intervention

(Objective 1,2,7) *

--- --- --- ---

Review, strengthen and/or develop

requirements and enforcement policies

governing program and service

operations (Objective 3,7)

--- ---

Require aging-service providers to

provide evidence to stakeholders and

funding agencies that programs are

effective and in compliance with

service, legal and fiscal requirements

(Objective 3,5)

--- ---

Require agencies that provide services

to elders to perform according to

agreed-upon terms with measurable

performance outcomes (Objective 3,5)

Continue to reduce the level of

fragmentation and duplication of

services among state agencies

(Objective 1,4)

--- --- --- ---

Encourage creative healthy living

environments in the long-term care

setting (Objectives 5, 7)

--- --- ---

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Continue to favor funding for

programs that integrate long-term care

across settings (Objective 1,2,4)

Continue to favor funding for

programs that integrate acute and

rehabilitative care with long-term care

and place emphasis on prevention

(Objective 1,2,4,7)

Review aging services funding policies

to increase the number and quality of

choices available to older persons and

their caregivers to meet long-term care

needs (Objective 2,6,7)

Increase public awareness about

available community options for care

(Objective 1,6,7)

Explore ways to devote additional

resources and increase care

coordination services for targeted

groups such as minority, low-income

and rural elders (Objective 1,2,4,6,7)

Increase transition housing

opportunities including those that link

housing and supportive services

(Objective 4,6,7)

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* Strategy is similar to an objective/strategy in another topic area.

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Continue implementation of a person-

centered performance measurement

system (Objective 3,5)

Evaluate individual programs in the

context of their impact on the entire

long-term care system, public and

private (Objective 3,5)

Find innovative ways to meet

increased demand for long-term care

services due to aging of baby boomers

(Objective 1,7)

Encourage affordable housing for

elders and people with disabilities

(Objective 7)*

Support the efforts of developers and

municipalities to make new

construction supportive of persons

with decreased physical capacity

(Objective 7)

Request adequate funding for

community-based care programs

(Objective 2,6,7)

Support a motivated, stable workforce

through adequate compensation,

workforce training and career

development opportunities (Objective

7)*

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Goal 2:Create a Greater Support Network forElders, Families and Caregivers

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areInformal Long-Term Care-BackgroundInformal long-term care is defined as the unpaid servicesprovided to support individuals who need assistance withactivities of daily living.1 These services can come from familymembers, relatives, friends, neighbors or volunteerorganizations. Caregivers can be considered the most importantsource of informal long-term care services. They are a crucialresource that allows many elders to stay in their homes whilereceiving the long-term care they need.

The demographic composition of caregivers continues to evolveover time. An emerging trend is the declining age of caregivers.Spouses have traditionally been the primary source of care.However, children and grandchildren are increasingly becomingcaregivers. According to research conducted by the Universityof Wisconsin-Milwaukee, family members provide 80 percent ofthe informal care provided to individuals. This suggests theneed for a holistic and supportive family system approach inplanning for long-term care programs and services.

Caregivers themselves face challenges in caring for Florida’selders. According to a study conducted by the CommonwealthFund, caregivers are less likely than non-caregivers to beemployed, more likely to miss days of work, and more likely tolack adequate health insurance coverage. In addition, caregiversalso are more likely than non-caregivers to experience healthproblems of their own. Despite these trends, very little emphasisis placed on the caregiver as a client with needs, but rather as aservice provider to the elders who are benefiting from theirservices. Therefore, there is a greater need to expand programsthat support and train caregivers on how to cope with thepersonal barriers they face in caring for their loved ones.

1An exception being stipended volunteer programs.

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The availability of caregivers is another growing concern. The“dual aging” phenomenon, the aging of persons with disabilitiesas well as their caregivers, will continue to put more demands onthe service system.2 It is estimated that fewer spouses and familycaregivers will be available in the future in urban areas. Ruralareas present even more challenges in getting elders the help theyneed. Lack of transportation and problems in finding appropriatehelp is considerably more amplified in these areas. Communityresources and support are also lacking in many regions. Volunteernetworks, community-based organizations and faith-based groupsare all crucial resources to maximize the ability of many elders toremain in their community.

The bureaucratic structure of the formal long-term care system canbe a stumbling block for many elders in accessing the services theyneed. An over-reliance on technology and phone and voicemailsystems by the long-term care system frustrate many elders.Elders prefer accessible people in making inquiries and seekingnecessary information. Access to information such as fundingand the Medicare drug plan are specific examples of how thesystem is confusing and fragmented.

Flexibility is another key issue in trying to maximize efficiencyand effectiveness within the caregiver support system. There is aneed to expand caregiver support. Additionally, there should behigher levels of coordination of caregiver issues. Currently, manywaiver programs provide support to the client but not specificallyfor the caregiver. Overcoming the bias towards institutions inlong-term care program funding and development is critical.There is a great need to emphasize the value and importance ofcaregiving to long-term care policy decision-makers.

Consumer-directed care, in which the customers choose the typesof long-term care services and providers they want, is an optionwith increasing availability. Allowing this flexibility while at thesame time ensuring accountability remains a priority to ensurethat the long-term care system is equitable and effective.

For more information on informal long-term care trends, please see Appendix A.

2Strong Center for Developmental Disabilities

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Inventory of Services:

Caregiver support programs administered by the Department ofElder Affairs include the Older Americans Act funded NationalFamily Caregiver Support Program, the state general revenueprogram funded Alzheimer Disease Initiative, the Home Carefor the Elderly program and other supportive community careservices. The Department of Elder Affairs maintains an advocacyrole concerning informal long-term care issues in addition toadministering caregiver support programs.

The ADA Working Group and Agency for Persons withDisabilities both serve and advocate on behalf of Florida’sresidents with disabilities. The Department of Health andDepartment of Children and Families also have clientpopulations that benefit from informal caregivers. Theseagencies work closely together on issues facing disabledindividuals as well as their caregivers.

The Agency for Persons with Disabilites administers programsthat provide support to elder adults caring for children,including adult children, with developmental disabilities. Ofparticular interest is the Consumer Directed Care program,where caregivers provide direction and contract for the care oftheir children.

The Department of Children and Families administers cashsupport programs for adults that care for grandchildren.

See Appendix B for details.

Informal Long-Term Care-Objectives:

Objective 1- Increase the visibility and awareness ofcaregiver issues and the value of caregivers.

Objective 2- Support incentives to assist caregivers.

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Objective 3- Strengthen and develop tools to assessfamily needs with emphasis on the socialand physical well-being of caregivers.

Objective 4- Include caregiver counseling, education andtraining services in Medicaid waiverprograms.

Objective 5- Strengthen programs that compensatecaregivers.

Objective 6- Encourage private sector to offer incentivesand programs to assist caregiving.

Objective 7- Strengthen resources and support forgrandparents raising grandchildren.

Objective 8- Provide a streamlined interagency caregiverhelpline with linkage to help, informationand services.

Objective 9- Develop and disseminate information toolsfor caregivers.

Objective 10- Strengthen system of formal supports forcaregivers.

Objective 11- Promote individual planning for future self-care.*

Informal Long-Term Care-Key Implementation Strategies,Roles and Responsibilities:

The Department of Elder Affairs, Agency for Persons withDisabilities, the ADA Working Group, the Department ofEducation, the Department of Children and Families, theDepartment of Health and the Agency for Health CareAdministration all play a key role in providing informal long-term care services to elders. Some strategies identified willrequire the cooperation of other entities, such as the federalgovernment and the private sector. The following matrix spellsout each agency’s role in carrying out these strategies.

*Objective is similar to an objective/strategy in another topic area.

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Include caregiver

issues at aging forums

and conferences,

including FCOA

(Objective 1)

--- --- ---

Encourage community

forums on aging,

including sponsoring

CFAL events and

approaching faith-

based groups

(Objective 1)

Support tax credits for

caregivers and other

incentives, such as

restructuring tax code

to support caregivers

(Objective 2)

--- --- --- --- ---

Support efforts that

make it easier for

people to volunteer

(Objective 2)*

Revise current

assessment instrument

and/or process to

better address

caregiver needs

(Objective 3)

Provide care manager

training (Objective 3)--- --- --- ---

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Encourage CMS to

include direct

caregiving services in

the waiver (Objective

4)

Seek agency support on

encouraging direct

caregiving services to

be included in the

waiver (Objective 4)

--- --- --- --- ---

Support advocacy for

increased federal

funding for a broader

array of services as per

WHCOA (Objective 4)

--- --- --- --- ---

Ensure that Scope of

Services includes

services for caregivers

as an indirect benefit to

frail elders (Objective

4)

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Expand HCE program

(Objective 5)

Expand CDC and

similar programs,

subject to funding

(Objective 5)

--- --- --- ---

Brainstorm an

approach that would

enable elders to benefit

from corporations that

target them as primary

consumers (Objective

6)

Develop a workplan for

the cooperative effort

with the private

industry (Objective 6)

Develop partnerships

to increase support for

grandparents raising

grandchildren

(Objective 7)

--- ---

Identify existing

activities addressing

grandparents raising

grandchildren

(Objective 7)

Promote awareness of

the value of services

caregivers provide

(Objective 8)

--- --- --- --- --- --- --- --- ---

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Create an information

kit for caregivers,

including a “crisis

package” for these

suddenly thrust into a

caregiving role (Not

just from the senior

perspective.) (Objective

9)

--- --- --- --- ---

Market and broadly

publicize the

information kit, using

every avenue a

caregiver might be

encountering,

including grocery

stores, public service

announcements, health

care professionals, etc.

(Objective 9)

--- --- --- --- ---

Put together a second

information kit

specifically for

grandparents raising

grandchildren

(Objective 9)

--- ---

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ng

-Term C

are

Legend:

Lead

Support

Partnership ---

*Strategy is similar to an objective/strategy in another topic area.

Strategy DO

EA

AH

CA

DM

S/A

DA

WG

AP

D

DO

E

DO

H

DO

R

DF

S/O

IR

AG

DV

A

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lun

teer

FL

DD

Co

un

cil

DO

AC

S

DC

F

Fed

s

Pri

vat

e

Oth

er

Encourage more

availability of

telephone reassurance.

Have customized

support especially for

grandparents raising

grandchildren as a

growing segment of

caregivers (Objective 9)

--- --- --- --- --- --- ---

Create awareness of

the significance of

current informal

support systems

(Objective 10)

--- --- --- --- ---

Create awareness that

current informal

supports are currently

peaking and will likely

decline over time

(Objective 10)

--- --- --- --- ---

Establish an education

campaign on the need

to plan for self-care in

later years (Objective

11)*

29

Communities For a Lifetime

The department' statewide initiative Communities For aLifetime assists Florida’s communities in planning andimplementing improvements that enhance opportunities forpeople to continue living in their own communities for alifetime.

The department provides technical assistance toencourage communities throughout the state tocreate a more elder-friendly environment. Thedepartment supports opportunities for businesspartnerships, community education, efficient useof natural resources and volunteer opportunitiesto foster Communities For a Lifetime goals. TheCommunities For a Lifetime initiative focuses onseveral areas of interest in support of these objectives.

Independent housing, transportation, health and wellness,employment and volunteerism, disaster preparedness andelder rights are areas of interest identified by the CommunitiesFor a Lifetime initiative as the key strategic components that theMaster Plan needs to address..

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Goal 3:Create an Elder-Friendly Environment ThatValues the Contributions and Needs of Elders

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gIndependent Housing-BackgroundOverall, the greatest challenge many elders face today is findingand sustaining available, affordable and/or accessible housingthat enables them to live in their community of choice over theirlifetime. The major issues and barriers that adversely affecthousing for elders are, for the most part, similar to those ofspecial needs populations and the general population. Theseinclude:

• Household incomes that are not keeping pace withthe substantial increase in the cost of existinghousing, development property, as well as homeconstruction, modification and repair;

• Existing housing supply, availability of land forhousing development, the rate of development andinsufficient construction workforce not meeting thedemand of a growing general and agingpopulation, especially for extremely low tomoderate income households;

• Conversion of affordable rental housing to morelucrative market rate rental and home ownershipunits; and

• Lack of or insufficient resources, funding, incen-tives and interest in developing new andpreserving existing affordable housing thatequitably meets the demand in all areas of the state.

The effects of the 2004 and 2005 hurricane seasons havesignificantly exacerbated the housing challenges facingFloridians, especially elders and other vulnerable populations.For example, more than 50,000 housing units or more than 40percent of the housing stock in Escambia County was damagedor destroyed by Hurricane Ivan in 2004. With the onset ofmultiple hurricanes, many elders throughout the state havefound themselves displaced, living in temporary and/orsubstandard housing, and using significantly more of theirincome and savings for housing-related expenses. Addressingsoaring insurance premiums and risk-based pricing associatedwith these disasters are priority issues. Lessons learned from

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gthese disasters include a significant need for better preparation byresidents and communities to accommodate post-disaster housingrelief and recovery in the future.

A barrier that is more often experienced by elders is the need forhousing that facilitates optimal independence and assistance withactivities of daily living. Another barrier related to housing costsis the limited capacity of elders to increase their householdincome. Universal design in community development andhousing, as well as supportive housing, is a widely recognizedstrategy to enable elders, persons with disabilities and the generalpopulation to reside longer and more optimally in their homesand communities.

The coordination of land use decisions and elder-friendlyinfrastructure design also plays a significant role in planning forindependent housing. The placement of affordable housing withaccess to transportation and other services is crucial to eldermobility and independence. Universal design practices in theconstruction and modification of homes and communities arewarranted to accommodate older Floridians. The standardsadopted by the Federal Fair Housing Law and Florida’sAccessibility Code for Building Construction (FACBC) guide thedesign of housing structures in a way that accommodatesindividuals regardless of functional impairments. Thesestandards should also be considered and incorporated into elder-friendly housing design. Innovative housing options such asaccessory dwelling units for older relatives and cooperativehousing are also increasingly important. Additionally, there is aneed for “green building” principles in appliance and utilityrepair and design. These principles reduce the costs of heatingand cooling, thereby making monthly bills more manageable, andare environmentally friendly.

Consumer awareness and education regarding housing options,resources and housing-related fraud remains a significant area offocus. Assisting elders and their families access housing andrelated resources is recognized as a vital public service.Continued collaboration among federal, state and local housingstakeholders in protecting elders against mortgage, insurance,construction and repair fraud, and discrimination is a priority.

For more information on independent housing trends, please see Appendix A.

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gIndependent Housing-Inventory of Services:

The Florida Housing Finance Corporation (FHFC) administers anumber of state and federally funded multi-family, single familyand special programs that help low-income Floridians obtainaffordable housing that might otherwise be unavailable to them.

FHFC rental housing programs include the Multi-FamilyMortgage Revenue Bond, Low Income Housing Tax Credits,State Apartment Incentive Loan, Elderly Housing CommunityLoan, Florida Affordable Housing Guarantee and HomeInvestment Partnerships programs. The homeownershipprograms include the First Time Homebuyer Program,Homeownership Loan Program and down payment assistanceprograms.

FHFC administers the State Housing Initiatives Partnershipprogram, which provides funds to local governments as anincentive to create partnerships that produce and preserveaffordable homeownership and multi-family housing. Theprogram was designed to serve very low to moderate incomefamilies.

In addition, the Corporation offers the Mortgage CreditCertificate program. It also administers special programsincluding the Predevelopment Loan Program, State HousingInitiatives Partnership, Demonstration Loans and AffordableHousing Catalyst Program that support non-traditionaldevelopers and projects such as affordable assisted living andsupportive housing.

FHFC is developing an affordable rental housing locator Website that provides consumers current information regardinghousing resources and available affordable rental units across thestate. FHFC has invited DOEA and other affordable housingstakeholders to collaborate on the development andimplementation of the Web site.

The Department of Community Affairs (DCA) mission is toassist Florida communities in meeting the challenges of growth,reducing the effects of disasters and investing in community

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grevitalization. It provides housing related programs and servicesto Florida’s low-income residents through its network of localgovernments and non-profit organizations. These services includeassistance with weatherizing homes, paying utility bills andmaking homes safe and sanitary. The DCA Community ServicesBlock Grant program is designed to provide a range of services toassist low-income people in attaining the skills, knowledge andmotivation necessary to achieve self-sufficiency, as well asimmediate life necessities such as food, medicine and shelter.DCA also administers programs that promote and supportcommunity efforts in addressing and meeting local housing andrelated needs.

The Florida Department of Agriculture and Consumer Servicesprovides a telephone and Web-based consumer information andresource clearinghouse, as well as assistance in handlingcomplaints regarding Florida businesses. The department alsoaccepts and investigates reports of price gouging after a declaredstate of emergency.

The Florida Department of Financial Services provides a numberof housing related programs and services to Floridians. Theseprograms and services relate to fire prevention and safety, homeinsurance and financial services. The department offers aconsumer information and inquiry Web site and hot line helpingpersons make informed financial decisions regarding insurance,mortgages, loans and other financial services. The department’sOffice of Insurance Regulation maintains a current Web-based listof continuing care retirement communities in Florida.

The Affordable Housing Study Commission is charged by FloridaStatute to recommend solutions and proposes programs toaddress the state’s acute need for homeownership and rentalhousing for low and moderate income residents, elders andhomeless persons.

The University of Florida Shimberg Center on Affordable Housingis a data and information resource for consumers, researchers,planners and policymakers. The Center maintains a Web-basedFlorida Housing Data Clearinghouse that provides public accessto data about housing needs and supply, subsidized rentalhousing, and household demographics in Florida communities.

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gThe Florida Commission on Human Relations accepts andprocesses complaints from persons who believe they may havebeen victims of discrimination while seeking to rent or buy ahome. The Commission works cooperatively with its federalcounterpart, the U.S. Department of Housing and UrbanDevelopment (HUD), and most cases are dual-filed. Thecommission also registers and maintains a list of elder housingcommunities in Florida.

The Department of Business and Professional Regulation (DBPR)Customer Service Assistance Hotline offers elders informationregarding professional and business licensure or certification andhandles consumer complaints regarding the professions andbusinesses it regulates. These include contractors, communityassociation managers, realtors, mobile home parks andcondominiums.

The Florida Department of Elder Affairs (DOEA), through itsCommunities For a Lifetime initiative, newly established elderhousing unit, planning and evaluation unit and other relatedprograms and services promotes, facilitates, supports andstudies all aspects of housing for older adults. It providesinformation and referral services through the Elder Helpline,contracts with local area agencies on aging, and Web-basedinformation portals. It advocates for affordable housingpromoting aging in place for all elders, including those withminimal resources and physical and cognitive impairments.DOEA promotes and facilitates housing and communitydevelopment issues among its Communities For a Lifetimepartners.

Independent Housing-Objectives

Objective 1- Increase and enhance housing options,capacity and access for all elders andpersons with special needs statewide.

Objective 2- Maximize available housing resources,including housing affordability subsidies forall elders and persons with special needs.

See Appendix B for details.

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gObjective 3- Preserve existing rental and homeownership

units.

Objective 4- Integrate elder and special needs housing intoall aspects of community planning,development and management at the local,state and federal levels.

Objective 5- Maintain a comprehensive and currentunderstanding of short and long-term housingissues, needs, trends, resources and capacityspecific to elders and as part of the generalpopulation.

Objective 6- Maintain a current or “real-time” awarenessand knowledge of the inventory andavailability of elder and special needs rentalunits statewide.

Objective 7- Disseminate comprehensive and currentinformation, regarding elder and special-needshousing, to policymakers, planners, developersand providers, I&R professionals, and thegeneral public.

Objective 8- Enable elders and persons with special needs tolive in the residence and community of theirchoice for a lifetime.

Independent Housing-Key Implementation Strategies,Roles and Responsibilities:

State agencies with key roles in carrying out independent housingstrategies include the Florida Housing Finance Corporation,Department of Community Affairs, Department of Elder Affairs,Department of Agriculture, Department of Financial Services,Agency for Health Care Administration, Department of Childrenand Families, ADA Working Goup, and Agency for Persons withDisabilities. The following matrix identifies the roles andresponsibilities charged to each of the participating entities.

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Legend:

Lead

Support

Partnership ---

Strategy DO

EA

FH

FC

DC

A

DM

S/A

DA

WG

AP

D

DC

F

AH

CA

DF

S

Oth

er

Fully implement the newly established

elder housing unit to focus DOEA’s efforts

to promote, facilitate and address all

aspects of senior housing; participate in

collaborative activities with private and

public stakeholders, as well as

disseminate information (Objective 1, 2, 3,

4, 5, 7, 8)

--- --- --- --- ---

Utilize the elder housing unit as the

department’s initial point of contact and

liaison entity to respond to housing

inquiries and to work with stakeholders

(Objective 4, 5, 6, 7)

Utilize the Communities For a Lifetime

initiative to promote the importance of

affordable, accessible housing for elders

and persons with special needs, as well as

provide technical assistance and tools to

local communities to assess housing needs

and resources, develop a plan and

implement a Communities For a Lifetime

strategy (Objective 4, 7, 8)

--- --- ---

Expand efforts within the department,

among state agencies and among

stakeholders to focus on urgent and long-

term housing that accommodates aging

and special needs and persons of all

incomes (Objective 1, 2, 3, 4, 5, 6, 8)

--- --- --- --- --- --- --- --- ---

Identify and determine the roles,

responsibilities and resources of all

stakeholders with current or potential

relevance to elder housing (Objective 1, 2,

3, 4, 5, 6)

--- --- --- --- --- --- --- --- ---

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Legend:

Lead

Support

Partnership ---

Strategy DO

EA

FH

FC

DC

A

DM

S/A

DA

WG

AP

D

DC

F

AH

CA

DF

S

Oth

er

Enhance collaboration with stakeholders

to identify and address housing barriers,

resource and service gaps, duplication,

opportunities, immediate and/or long-

term needs, as well as advocate for

enhanced and/or additional resources

(Objective 1, 2, 3, 4, 7, 8)

--- --- --- --- --- --- ---

Enhance collaboration among public and

private stakeholders to address elder

housing holistically or regarding specific

issues (Objective 1, 2, 3, 4, 5, 8)

--- --- --- ---

Facilitate and support expanded

collaboration, partnerships and linkages

outside the sphere of state government

and traditional stakeholders (Objective 1,

--- --- --- --- --- --- --- --- ---

Develop and implement an infrastructure

and system to maintain a comprehensive

and current portal(s) of information, data

and resources relevant to elder housing

(Objective 7)

--- --- --- --- --- --- --- ---

Collaborate with the Florida Housing

Finance Corporation’s development and

implementation of a low-income rental

housing locater that provides current

information regarding rental housing

availability statewide (Objective 6, 7)

Identify underserved populations and

geographic areas, prioritizing persons

who are displaced or at risk of

displacement due to disasters, or lack of

preservation and affordability;

supportive housing; and sound

community development (1, 2, 3, 4, 5, 8)

--- --- --- ---

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Legend:

Lead

Support

Partnership ---

Strategy DO

EA

FH

FC

DC

A

DM

S/A

DA

WG

AP

D

DC

F

AH

CA

DF

S

Oth

er

Promote, facilitate and support activities

that collect and compile information from

the public, consumers, providers and

other stakeholders (Objective 5, 6 7)

--- --- --- --- --- --- --- --- ---

Promote, facilitate, support and evaluate

demonstrations and best practices that

improve and enhance housing capacity,

affordability and design through

preservation and new development, that

may be evaluated for replication in

underserved areas and statewide

(Objective 1, 2, 3, 4, 5, 7, 8)

--- --- --- ---

Promote and facilitate the awareness and

understanding of the importance of

incorporating and integrating universal

design philosophy and techniques into all

aspects of community development and

housing for elders and persons with

special needs (Objective 1, 2, 4, 5, 7, 8)

--- --- --- --- --- --- ---

Collaborate among stakeholders to

identify, address, advocate for and/or

provide resources and incentives to

stimulate and facilitate the development,

preservation and modification of home

ownership and rental housing units, as

well as the provision of supportive

services/amenities that meet the needs of

target populations and priority areas

(Objective 1, 2, 3, 4, 5, 7, 8)

--- --- --- --- --- --- ---

Coordinate, hold, support and/or

participate in activities, such as task

forces, committees, advisory boards and

conferences, to facilitate addressing

housing issues and needs (Objective 4, 5,

7)

--- --- --- --- --- --- ---

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nTransportation-BackgroundTransportation is one of the most significant issues facing elderstoday, and it will remain so for the forseeable future. Accordingto the 2025 Florida Transportation Plan, it is anticipated thatFlorida will experience a 92 percent increase in individuals age 65and older by the year 2025. Challenges exist in trying to plan forhow to fund and serve this burgeoning population. The existingtransportation infrastructure must be expanded and improvedupon to keep up with the projected increase in demand.

Urban growth and congestion accompanies population increase.Local land use and transportation decisions go hand in handwhen planning for the needs of elders. Encouraging infilldevelopment, enforcing more stringent downtown parkingpolicies and planning communities in a way that reduces longdistance commutes are just a few of the means for relievingcongestion. Other land use decisions play a vital role in theability of Florida’s seniors to access transportation. Strategicallyplaced housing that is affordable and elder-friendly remains asignificant issue for elders with specialized mobility needs.

As adults grow older, physical and cognitive limitations maybegin to restrict their ability to drive, making it difficult tomaintain involvement in community activities. Limited mobilityaffects the ability of elders to get to essential activities such asmedical appointments and grocery shopping, as well as social orrecreational activities that are equally valued components of theirlives. Many elders feel threatened, isolated and depressed whentheir mobility and sense of independence are hampered. Drivingsafety and the ability to access resources for screening and testingremains a significant need for elders, their caretakers andfamilies. Providing these resources in a way that does not makeseniors feel threatened remain a challenge for policy developers.

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Other safety concerns often identified by Florida seniors include theneed for safer pedestrian and bicycle crosswalks, legible road signs,wider lanes at intersections, increased enforcement of the speedlimit and adjusting pedestrian signal timings.

Another major concern facing elders is the lack of affordable,convenient transportation alternatives. According to the WhiteHouse Conference on Aging, the average American householdspends almost 20 percent of family income on transportation.

Transportation-Inventory of Services:

The Department of Transportation currently serves as the primarystate agency with respect to transportation issues. The Elder RoadUser Program is a program within the department with specificfocus on elder issues. The program includes partnerships withother agencies in planning for and administering safer and moreelder-friendly roadway improvements. Other services within thedepartment significantly impact elders, such as the public transitoffice. This office administers several grants, provides funds forimplementing new programs, helps maintain the Greyhound bussystem and many of the state’s public transportation services. Thedepartment’s planning office addresses transportation policy issuesthat affect elders throughout the state. Other programs affect theaging population as well, such as the DOT Americans withDisabilities Act (ADA) office. This program is geared towardsdesigning facilities to accommodate individuals with disabilities,including frail elders.

The Commission for the Transportation Disadvantaged overseesprograms for those lacking access to transportation. For example,elders who are no longer able to drive or have impairments areincluded in this group. The commission oversees both coordinatedand specialized transportation services.

For more information on transportation trends, please see Appendix A.

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nThe Department of Highway Safety and Motor Vehicles alsofocuses on many programs that affect elders. The FloridaGrandDriver program provides an information and referralnetwork. Several other programs are geared towards eldersafety, such as driver improvement courses, senior driverscreening and monitoring, and the Florida At-Risk DriverCouncil. The agency provides other elder assistance such as afinancial insurance program, a Motorcycle Rider Program, andagencies that issue tags to elders and caregivers.

The Department of Elder Affairs and the Department ofCommunity Affairs share a similar role in transportation. Theseagencies provide planning, review and advocacy leadership ontransportation projects and activities that impact elders. TheDepartment of Veterans’ Affairs also advocates for a significantportion of the elder population.

The Department of Financial Services focuses primarily oninsurance and consumer issues. Services administered throughthe department include general consumer complaint hotlines,information and referral assistance, partnerships with otheragencies and specific outreach programs. This general assistanceaids the elder population on particular issues, includingtransportation.

See Appendix B for details.

Transportation-Objectives:

Objective 1- Expand the transportation planning processto address elder issues.

Objective 2- Expand availability and affordability ofalternative transportation for elders.*

Objective 3- Provide universal access to sites that mightbe inaccessible due to roadway or otherbarriers to prevent inadvertantdiscrimination against nondrivers.

*Objective is similar to an objective/strategy in other topic areas.

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Objective 4- Improve scheduling and timeliness ofalternative transportation/provide real-timeinformation.*

Objective 5- Enhance interagency/ intergovernmentaltransportation coordination partnershipsand activities.

Objective 6- Implement a planning process forimproved coordination of transportationservices.

Objective 7- Improve intergovernmental coordinationon disaster transportation plans.

Objective 8- Develop a process for driver assessmentsand information/referral.

Objective 9- Encourage techniques for optimizingcustomer satisfaction on the quality oftransportation services and the fulfillmentof client needs.

Objective 10- Promote techniques that move peopleefficiently from one location to another.

Objective 11- Support older drivers to ensure safemobility and independence and to assistwith the transition to driving cessation.*

Objective 12- Promote policies that provide for safemobility.

Objective 13- Enhance and promote a safe roadway andpedestrian environment.

Objective 14- Expand the transportation planningprocess to address safety and security.

Objective 15- Promote the creation of transit-orienteddevelopments.

Objective 16- Promote mixed-use development thatincreases access to transportation facilities.

*Objective is similar to an objective/strategy in other topic areas.

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nObjective 17- Promote and increase the availability of

affordable housing near access totransportation.

Objective 18- Develop transportation-related measures toassist elders to age in place.*

Objective 19- Increase transportation funding for elderprograms.

Objective 20- Promote better use of existing funds fortransportation.

Objective 21- Develop an investment policy fortransportation funds.

Transportation-Key Implementation Strategies, Roles

and Responsibilities:

Many entities at the local, regional and state level play a role inaccomplishing the objectives and strategies identified in servingFlorida elders with transportation services. Coordination withlocal governments and Metropolitan Planning Organizations(MPOs) is essential to the implementation of these policies. Theprivate sector is another important group that can be called uponfor partnership and coordination. The state agencies consideredmost critical in assisting elders with transportation needs includethe Department of Elder Affairs, the Department ofTransportation, the Transportation Disadvantaged Commission,Highway Safety and Motor Vehicles, Department of CommunityAffairs, the Department of Financial Services, the Department ofVeterans’ Affairs and the MPO Advisory Council. The followingmatrix identifies the roles and responsibilities charged to each ofthe participating entities.

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Legend:

Lead

Support

Partnership ---

*Strategy is similar to an objective/strategy in other topic areas.

Strategy DO

EA

DO

T

TD

C

HS

MV

DC

A

DF

S/O

IR

DV

A

MP

OA

C

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cal

Go

v

MP

Os

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Fed

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Incorporate elder issues into state,

regional and local transportation

plans (Objective 1,6)

--- --- --- --- --- --- --- --- --- --- --- ---

Involve older residents and

stakeholders in the transportation

planning process (Objective 1,6,14)

--- --- --- --- --- --- --- --- --- --- --- ---

Examine adequate transportation

funding options (Objective 2)--- --- --- --- --- --- --- --- --- --- --- --- ---

Increase public awareness and

education on existing and potential

types of transportation services

available (Objective 2)

--- --- --- --- --- --- --- --- --- --- --- --- ---

Create consumer voucher

programs which allow the user to

choose the transportation system

(Objective 2)*

Improve intergovernmental and

public/private transportation

coordination of services (Objective

2,8)

--- --- --- --- --- --- --- --- --- --- --- --- ---

Develop and implement policies

promoting transportation access

to new retirement villages and

senior developments (Objective 2)

Explore, promote and evaluate

transportation provider liability

countermeasures (Objective 2)

Improve routing to popular

destinations (Objective 3)

Examine, promote and evaluate the

use of innovative transportation

technology, such as GPS/GIS

software (Objective 4)

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Legend:

Lead

Support

Partnership ---

*Strategy is similar to an objective/strategy in other topic areas.

Strategy DO

EA

DO

T

TD

C

HS

MV

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A

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S/O

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DV

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Develop intergovernmental

transportation agreements (Objective

5)

--- --- --- --- --- --- --- --- --- --- --- ---

Encourage the formation of

intergovernmental/private-public

partnerships and assign

responsibilities for transportation

(Objective 1,3,5,14)

--- --- --- --- --- --- --- --- --- --- --- --- ---

Identify, develop and support multiple

shared databases on available

transportation resources and services,

client needs and usage (Objective 6)

--- --- --- --- --- --- --- --- --- --- --- --- ---

Develop and improve a uniform

registry of persons with specialized

needs (Objective 7)

Increase public awareness of disaster

planning and the types of available

assistance (Objective 7)

Plan for customized services for

special needs persons, such as

wheelchairs, oxygen, etc. (Objective 7)

Create a streamlined process for

identifying funding responsibility in

evacuation events (Objective 7)Promote and maintain a “one-stop

shop” transportation website, linking

various agency information (Objective

8)

--- --- ---

Establish focus groups and surveys to

monitor services and customer

satisfaction with transportation

services (Objective 9)

--- --- --- --- --- --- --- --- --- --- --- --- ---

Develop programs for ridesharing,

central dispatching, volunteers

delivering long-distance trips and

other innovative programs (Objective

10)*

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Legend:

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Partnership ---

Strategy DO

EA

DO

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Increase education programs for

drivers and other stakeholders

(Objective 11)

--- ---

Expand resources for mobility

counseling, including connectivity to

driver cessation support groups

(Objective 11)

--- ---

Encourage the development and use of

technology in vehicles, such as

seatbelts, “Carfit” features, and other

safety measures (Objective 11)

--- ---

Analyze and evaluate data with

emphasis on roadway and pedestrian

and alternative modes of

transportation (Objective 12)

Identify and support agency

transportation and roadway safety

policies and programs (Objective 12)

Implement and maintain federal and

state transportation design standards

for older drivers, e.g., FHWA Highway

Design Handbook for Older Drivers

and Pedestrians (Objective 13)

Complete statewide bicycle/pedestrian

network/infrastructure (Objective 13)

Encourage transit access and facilities

in new and suburban neighborhoods

(Objective 15)

Incorporate mixed-use development

policies in subdivision requirements

(Objective 16)

Develop plans that foster mixed-use

development policies (Objective 16)

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Legend:

Lead

Support

Partnership ---

Strategy DO

EA

DO

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TD

C

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Encourage senior housing in mixed-use

developments (Objective 16)

Encourage the co-location of

appropriate medical, social and elder

services (Objective 16, 18)

Encourage developer set-asides of

affordable housing with access to

transportation (Objective 17)

Encourage appropriate housing

densities for seniors in urban and

rural areas (Objective 17)

Provide assistance with home retrofits

in transportation supported aging-in-

place neighborhoods (Objective 18)

Seek alternative funding sources, such

as private resources (Objective 19)--- --- --- --- --- --- --- ---

Seek additional funding sources to

supplement current revenues to

increase transportation services for

older adults (Objective 19)

--- --- --- --- --- --- --- ---

Examine, promote and evaluate the use

of innovative technology in

transportation operations, such as

hybrid cars and Intelligent

Transportation Systems (Objective 20)

Examine potential reallocation/

flexibility/ reprioritization of

transportation funding sources

(Objective 20)

--- --- --- --- --- --- --- ---

Conduct a transportation funding

needs assessment (Objective 21)

Create discounts, tax incentives and

other options for financial assistance

for transportation services (Objective

21)

Seek additional transportation funding

sources (Objective 21)--- --- --- --- --- --- --- --- --- --- --- --- ---

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52

Health

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Health and Wellness-Background

The implementation of policies and programs that promote elderhealth and wellness is increasingly important. A principal themeof this plan addresses a proactive shift toward promoting healthyaging, creating healthy environments, and increasing access tohigh-quality health care for everyone. Each objective and itsstrategies must take a multi-disciplinary approach to achievehealth equity - regardless of an individual’s age, sex, race,ethnicity, income, education, ability level, geographic location orsexual orientation. Early intervention and prevention are keysthat can minimize the incidence of people suffering adversehealth conditions.

Chronic diseases such as heart disease, cancer and diabetes areamong the most prevalent, costly and preventable of all healthproblems. Chronic diseases often have a long course of illness.They rarely resolve spontaneously, and they are generally notcured by medication or prevented by vaccine. Chronic diseasesare the leading cause of death and disability in Florida and thenation. However, consideration of deaths alone severelyunderstates the burden of chronic disease. The prolonged courseof illness and disability from chronic diseases such as heartdisease, stroke, diabetes and arthritis results in extended painand suffering as well as in decreased quality of life for thousandsof Floridians. Early intervention and prevention can greatlyreduce the number of people who must endure these healthconsequences.

Obesity is another health issue that has widespread concern.This concern is inclusive of elders. In Fall 2003, former GovernorBush formed the Governor’s Task Force on the Obesity Epidemicto make recommendations regarding the problem of overweightand obesity in Florida. The Governor appointed a 16-membertask force. Executive Order 03-196, creating the task force notedthat 14.2 percent of high school students are at risk of becomingoverweight, and an additional 10.4 percent are overweight. Fifty-seven percent of adults are overweight or obese, a 63 percentincrease since 1986. Physical inactivity and poor nutritioncomprise the second leading causes of death. In 2002, 26.4

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spercent of Florida adults were physically inactive and only 25.7percent of Florida adults ate the recommended five daily servingsof fruits and vegetables.

The shortage in medical staff, particularly among geriatric andprimary care physicians, remains another issue facing elders asthe baby boomer generation grows older. According to theAmerican Geriatrics Society, it is estimated that, by 2030, therewill be only one geriatrician for every 7,665 older adults in theUnited States. Further, in December 2005, Congress eliminatedthe $31.5 million Title VII funding for geriatrics. It is anticipatedthat these recent cuts will have a significant impact on theshortage crisis. Therefore, major steps are needed to recruit andtrain staff in the aging field.

Mental health is still another issue often affecting elders. Eldersface many situations that can lead to depression and sometimeseven suicide during the aging process. These factors can includeloneliness attributed to the loss of a loved one, social isolation,loss of independence or retirement.

Substance abuse and alcohol is another major issue that affectselders. Only 11 percent of the population is elderly, but 35percent of all prescription and nonprescription drugs is used bypeople aged 65 and older. Elders are the segment of thepopulation with the highest use of over-the-counter (OTC) andprescription drugs (40 percent use at least one OTC drug daily,while 80 percent use a prescription drug daily [Abrams, 1987]).This level of drug use, particularly when combined with evenmoderate alcohol use, contributes to drug use problems amongelders. Further, the problems are sufficiently different from thoseexperienced by other segments of the population that they oftengo undetected or unrecognized.

Florida seniors are a hardy group that includes individuals whohave survived the Depression, two World Wars and a world thathas changed many times over. This independent, resilient grouphas been an infrequent user of social services and is generallyunaccustomed to obtaining assistance from state agencies. Acloser look at the health and social system has revealed that,despite the myriad of state-funded services available to seniors,the reality is that there is little coordination between the serviceentities.

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When an individual seeks assistance, an assessment specificallygeared to that service may be conducted. Persons seekingmultiple services may result in their receiving treatment orassistance in a fragmented manner by multiple entities. A largerneed which may not be as easily addressed can go overlooked.To improve care, individual physical, mental and spiritualconcerns must be addressed within a system broad enough toresolve problems while remaining flexible enough toaccommodate individual need. Adopting a whole-person focuswill require a basic shift in how services are developed,structured and funded. Therefore, services become person-centered rather than symptom-centered. An individual mightneed only one service, or they may have a constellation of needs.

Health and Wellness-Inventory of Services:

Health and wellness programs in most state agencies arecentered on prevention and education. The Department ofHealth currently serves as the primary agency for health andwellness promotion. Programs currently include cancerawareness, osteoporosis prevention, arthritis prevention, heartdisease and stroke awareness, chronic disease, and substanceabuse program. The agency also encourages physical fitnessthrough its “Step Up, Florida” campaign and “HealthyCommunities, Healthy People” initiative.

The Department of Elder Affairs has similar programs, withprevention and promotion programs in areas such asosteoporosis and mental health screening. The department’sFlorida Injury Prevention Program for Seniors (FLIPS) programis another service aimed at preventing injuries from falls. Othergeneral services are administered through Older Americans Act(OAA) funds that contribute to elder health and well-being,including nutritional services.

For more information on health and wellness trends, please see Appendix A.

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sThe Department of Children and Families works with individualsexperiencing severe and persistent mental illness or who are in amental health crisis. Two recent mental health initiatives targetelders.

The Department of State also has several health and wellnessprograms. The Florida Center for Creative Aging promotessuccessful aging by improving quality of life through arts andhumanities. Similarly, the Florida Arts Council is a visioningprogram that includes health and wellness. The agency is alsoinvolved in several partnerships with other state agencies thatassist in encouraging the health and well-being of Florida’s elders.

See Appendix B for details.

Health and Wellness-Objectives:

Goal: Increase the quality and years of healthy life and eliminatehealth disparities (Healthy People 2010).

Objective 1- Encourage and promote healthy agingthrough early intervention and preventionprograms.*

Objective 2- Ensure that seniors are financially secure tomeet obligations, purchase necessary medicalservices and prescription drugs and othervital necessities of life. Support local, stateand federal programs that target financialviability of seniors, including Social Security,Medicare, Medicaid, local taxes, publicpolicies, etc.

Objective 3- Ensure that Americans have transportationoptions to retain their mobility andindependence.*

*Objective is similar to an objective/strategy in other topic areas.

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Objective 4- Develop a coordinated federal, state andlocal emergency response plan for seniors inthe event of public health emergencies ordisasters.*

Objective 5- Attain an adequate number of personnel inall health care professions who are skilled,culturally competent and specialized ingeriatrics.*

Objective 6- Support older adults in making complexhealth care decisions.

Objective 7- Increase the number of service models thatoffer integrated health and aging services.

Objective 8- Decrease the waiting period for older adultsthat need mental health and substance abuseservices.

Objective 9- Support improvements in senior nutritionprograms.

Objective 10- Encourage community designs to promotelivable communities that enable aging inplace.*

Objective 11- Foster innovations that prevent sight andhearing loss and that aid older adults withsight and hearing-loss and other physicaland mental disabilities to actively engage intheir communities.

Objective 12- Promote the development of acomprehensive oral health program toreduce dental diseases, including dentalcaries, periodontal diseases and oral cancer;and to reduce associated risks of diseasesthat are showing interrelatedness toperiodontitis.

*Objective is similar to an objective/strategy in other topic areas.

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Health and Wellness-Key Implementation Strategies,Roles and Responsibilities:

The desired holistic approach to health and wellness issues willinvolve the Department of Elder Affairs, Department of Health,Department of Children and Families, Department of State,Department of Financial Services and the Department ofTransportation, committing themselves to develop andimplement a coordinated plan to serve seniors. Although stateagencies take the lead in carrying out many of the strategies tosupport seniors, local community resources are the bedrock offace-to-face services for millions of seniors. Communitypartnerships, particularly when they reach out to nontraditionalpartners, can be among the most effective tools for improvinghealth in communities. The following matrix identifies the rolesand responsibilities of the state’s key players in delivering healthservices to Florida’s older residents.

Strategy DO

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Develop and implement wellness programs for

seniors, accessible at sites such as senior

centers, ensuring access for individuals with

disabilities (Objective 1,10)

--- --- ---

Develop and implement fall prevention and

balance maintenance programs for seniors

(Objective 1,10)

--- --- ---

Develop tools for families to assist in decision-

making with regard to health conditions and

lifestyle behaviors (Objective 6)

Support local outreach efforts through

resources such as senior centers, to inform

seniors and their family members of programs

that aid in understanding health-related issues

and treatment options (Objective 1,6)

--- ---

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Strategy DO

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DO

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Promote regular screening as a standard

protocol for early identification for numerous

conditions (Objective 1, 7)

--- --- ---

Attain a higher proportion of older adults who

are vaccinated annually against influenza and

pneumococcal disease (Objective 1,7)

Develop and implement programs that are

culturally and linguistically appropriate to

reduce health disparities for disease

prevention, detection and treatment (Objective

1,7)

Encourage public and private health insurers

to broadly cover preventive care for disease

prevention (Objective 1,2)

Promote programs that educate individuals

with chronic disease to assuage their disease

with proper diet (Objective 1,9)

--- ---

Promote nutritional programs targeted to low-

income older adults (Objective 1,9)--- ---

Strengthen the link between healthful dietary

habits and increased physical activity

(Objective 1,9)

--- ---

Support a strong national and state program

for basic and applied nutrition research to

provide a sound scientific base for dietary

recommendations and effective interventions

(Objective 1,9)

--- ---

Promote programs that reverse the

‘Westernization’ of diets (Objective 1,9)--- ---

Increase physical activity opportunities that

enhance a consortium of care and self-

management practices (Objective 1,10)

--- --- --- ---

Develop and implement obesity reduction

programs for seniors (Objective 10)--- --- ---

Promote direct deposit for federal beneficiaries

to reduce the risk of mail theft (Objective 2)--- ---

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Legend:

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Partnership ---

*Strategy is similar to an objective/strategy in other topic areas.

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Promote programs that equip seniors with the

tools and resources they need to make

informed financial decisions about personal

financial issues, including personal savings

accounts, long-term care insurance, applying

for loans, managing debt, making sound

investment choices and saving for retirement

(Objective 2)

Revise SHINE curriculum to include a resource

to refer seniors who request further financial

information (Objective 2)

Explore the modification of transportation

funding to furnish vouchers to clients rather

than transportation providers in order to

enhance client choice and sharpen competition

among providers (Objective 3)*

--- --- ---

Work with officials to ensure availability of

inexpensive transportation for health related

appointments and errands (Objective 3)

--- ---

Fund Medicaid to provide transportation to

health related appointments and errands, even

across county lines (Objective 3)

Improve efforts to reach older adults to

identify immediate needs (Objective 4)

Improve efforts to provide swift assistance in

the aftermath of health emergencies or

disasters (evacuation, potable water, MREs,

etc.) (Objective 4)*

Ensure an adequate supply of prescription

drugs, eye glasses, and durable medical

equipment is available in the event an

individual’s supply is destroyed or runs out

(Objective 4)

Improve the state’s tarp program to cover

exposed roofs when individual has insufficient

funds to make repairs (Objective 4)

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Legend:

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Partnership ---

*Strategy is similar to an objective/strategy in other topic areas.

Strategy DO

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Prior to transitioning a senior back into their

home from a special needs shelter, conduct

home inspections to identify potential

dangerous or unsanitary conditions, and work

with local authorities to locate alternate

housing when the home is unsafe (Objective 4)

Increase the number of special needs shelters

that are appropriately equipped and

maintained, and publicly promote the shelters

and the need to pre-register (Objective 4)*

Allow caregivers to evacuate with their

disabled relative to maximize continuity of

care and to reduce adverse effects of stress on

disabled seniors (Objective 4)

--- --- ---

Promote programs that encourage individuals

to enter the health care field, and increase the

ratio of geriatricians serving the age 65+

population from Florida’s current 15 per

100,000 to the national rate of 23 per 100,000

(Objective 5)

--- ---

Work with appropriate agencies to increase

the number of health professionals, especially

those serving seniors with special needs and in

long-term care facilities (Objective 5)

--- ---

Expand loan forgiveness programs for

professionals working in medically

underserved areas (MUAs) and medically

underserved populations (MUPs) (Objective 5)

--- --- ---

Support increasing the capacity of Florida's

higher education and vocational training

systems to produce more medical and allied

professional and paraprofessional personnel,

particularly in primary care (Objective 5)

--- ---

Support strategies offered by health literacy

advocates to develop a comprehensive

program to create easily understandable

health information through available state

agencies, commissions and the private sector

(Objective 6)

--- --- --- --- --- --- ---

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*Strategy is similar to an objective/strategy in other topic areas.

Strategy DO

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Improve patient transition from inpatient care

to community settings (Objective 7)--- --- ---

Reduce the treatment gap for older adults with

severe persistent mental illness (SPMI)

(Objective 8)

Support programs that provide treatment to

severely and persistently mentally ill (SPMI)

older adults (Objective 8)

Ensure that older adults have access to mental

health services and substance abuse services

(Objective 8)

Promote and enhance screening and outreach

services to facilitate early identification of

substance abuse, depression and suicide risk

(Objective 8)

Continue to fund or seek external funds for

evidence-based models of recruitment and

substance abuse prevention for older adults

(Objective 1, 8)

Continue to expand the Brief Intervention and

Treatment for Elders (BRITE) pilot program, an

innovative outreach program designed to

provide services to older adults that need

services in non-traditional settings (e.g., home)

(Objective 8)

Continue collaboration among state agencies

and service providers to build a

comprehensive system of care and services for

older adults (Objective 8)

Develop and implement safe driving programs

for seniors (Objective 10)*

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Legend:

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*Strategy is similar to an objective/strategy in other topic areas.

Strategy DO

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Support co-location of services for seniors

directly adjacent to public transportation

routes (Objective 10)*

Promote education on prevention of sight and

hearing loss and community resources

(Objective 11)

Provide ongoing access to health care for

individuals with sight and hearing disabilities

(Objective 11)

Remove barriers to physical activity due to

sight and hearing loss and other physical and

mental disabilities (Objective 11)

Provide oral health care targeted to

individuals with diseases for which research

shows systemic associations to periodontitis:

heart disease, diabetes, osteoporosis,

respiratory infections, etc. (Objective 12)

Increase access to dental care for low-income

adults with special needs (Objective 12)

Support fluoridation programs in areas with

non-fluoridated community water systems

(Objective 12)

Promote awareness among health care

providers and the public about the importance

of annual oral cancer exams for seniors who

have ever used tobacco products (Objective

1,12)

Support emerging programs that increase the

oral heath professional workforce and expand

the capacity of nursing homes and other long-

term care facilities to furnish basic care to

individuals in nursing homes (Objective 12)

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teerismEmployment and Volunteerism-Background

With nearly one-fifth of the workforce projected to be age 55 orolder by 2015, older workers will play an increasing role in bothprivate and public sector organizations. This brings importantsocial implications for corporate and nonprofit governmentalagencies. Older workers provide a resource in the rapidlychanging environment with regard to the civic engagement ofFlorida’s growing senior population.

Florida has 1.3 million older workers. National labor statisticsindicate the most dramatic job gains of any age group in recentyears are among individuals 55 years of age and older. Olderworkers comprise 17 percent of Florida’s workforce and offer atremendous economic value to Florida’s business community.

The state needs to prepare for future labor shortages due toretiring baby boomers. According to the U.S. Bureau of LaborStatistics, this year (2006) there are 151 million jobs and only 141million people to fill them.

More organizational leadership is needed in addressing issues ofthe aging workforce, including how to best integrate olderemployees and retirees into transitional employment orvolunteer programs. Businesses have an important role to play inhelping employees and retirees navigate transitions in andbetween work, civic engagement and volunteerism.

Organizations should be aware of the value of retiringemployees and engage them before they stop reporting to workon a daily basis, recognizing the importance of maintaining goodwill with retirees and making them a strategic part of a changingworkforce or a corporate volunteer program. Older workers may be encouraged to remain in the workforcewhen offered flexible work schedules, part-time positions, job-sharing opportunities, fringe benefits and other opportunities tohelp foster economic self-sufficiency, volunteer opportunities orcivic engagement.

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Currently there are limited employment opportunities offered toelders in Florida. Lack of advanced technological training hasbeen identified as a barrier for seniors seeking job opportunitiesto supplement basic retirement benefits. Age discriminationremains another barrier for elders looking for employment.

Volunteer opportunities abound in Florida. However,organizations have not made enough modifications to encouragebaby boomers to volunteer. A survey of leaders of volunteerorganizations by the National Council on the Aging (NCOA)found that, while leaders all saw potential in boomer volunteers,the vast majority had no strategic plan to attract them. In fact,one-third reported that they were not interested in making anychanges to encourage recruitment of elder volunteers.

Baby boomers want choice. They want a variety of volunteeroptions so that they can pick the one that most closely matchestheir unique needs and interests. Traditional volunteeropportunities are not plausible for the majority of future retirees;short-term or more flexible positions are examples oforganizational strategies that will attract more older volunteers.

Employment and Volunteerism-Inventory of Services:

Services currently available to elder Floridians from theDepartment of State (DOS) include free admission to museums,life-long learning opportunities, ADA accessibility, convenientscheduling and the availability of arts and cultural grants. DOSencourages its elder visitors to volunteer at state museums andlibraries. DOS also hires elder workers who work during publichours of museums and libraries. DOS also relies heavily onelders to volunteer at the polls during elections. Elder Floridiansmake up a significant proportion of the poll volunteersthroughout the state.

The Agency for Workforce Innovation (AWI) provides jobdevelopment activities, an extensive employer database, self-

For more information on employment and volunteerismtrends, please see Appendix A.

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teerismemployment assistance and supportive services at One-StopCareer Centers around the state. Additionally, AWI provides abroad spectrum of workforce services to veterans (at no cost).Several other programs offer opportunities to improve theemployment likelihood for the older worker; use of grants fromnon-AWI funding sources, partnerships with community-basedorganizations and three additional funding sources from the U.S.Department of Labor. AWI currently works closely with thedepartment’s Senior Community Service Employment Program(SCSEP), funded by the U.S. Department of Labor.

The Department of Business and Professional Regulation (DBPR)Customer Service Assistance Hotline offers elders informationand referral on professional licensing, examinations andcontinuing education opportunities.

The Department of Elder Affairs receives approximately $5million dollars annually in federal funding to operate the SeniorCommunity Service Employment Program (SCSEP.) The SCSEPis funded under Title V of the Older Americans Act (OAA). Thepurposes of the SCSEP are to foster and promote useful part-time opportunities in community service activities forunemployed, low-income persons 55 years of age and older andwho have poor employment prospects; to foster individualeconomic self-sufficiency; and to increase the number of olderpersons who may enjoy the benefits of unsubsidizedemployment in both the public and private sectors. There arealso six national SCSEP sponsors operating in the state; AARP,Experience Works, U.S. Forestry Service, Senior Service America,National Center and Caucus on the Black Aged, and SER Jobs.Through these combined efforts, over 3,500 older individuals inFlorida receive services through the SCSEP annually.

The Florida Department of Elder Affairs (DOEA) connects elderswith opportunities to share their knowledge and experiencethrough volunteerism. Working with area agencies on aging andlocal organizations, DOEA matches volunteer opportunities withelders seeking volunteer placements. DOEA is the first stateunit on aging in the country to have a statutorily mandatedoffice focusing on volunteer issues and promoting volunteerprograms throughout the state.

See Appendix B for details.

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Employment and Volunteerism-Objectives:

Objective 1- Develop active learning opportunities forelders to increase knowledge on financialplanning, life planning, retirement andexposure to employment opportunities.

Objective 2- Promote older worker skills/reliability/availability.

Objective 3- Provide skill upgrading and retraining forelders.

Objective 4- Increase intergenerational pairing forknowledge transfer/opportunities.

Objective 5- Promote wellness programs for elders in theworkplace.

Objective 6- Seek to reduce barriers to employment andvolunteer opportunities.*

Employment and Volunteerism-Key Implementation Strategies,Roles and Responsibilities:

Many agencies at the local and state level play a key role inaccomplishing the objectives and strategies identified in assistingFlorida elders in the employment and volunteer arenas. Stateagencies considered most critical in serving elders in employmentand volunteerism include the Department of Elder Affairs,Department of Business and Professional Regulation, Agency forWorkforce Innovation, Department of State and Department ofVeterans’ Affairs. The following matrix identifies the roles andresponsibilities charged to each of the participating entities.

*Objective is similar to an objective/strategy in other topic areas.

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Provide a better means of supplemental

income/benefits training (Objective 1)--- --- --- --- --- ---

Create a resource manual for job opportunities

(Objective 1)--- --- --- --- ---

Create a resource base information sharing of

income opportunities/exposure to employment

opportunities (Objective 1)

--- --- ---

Provide exposure to contingent employment

(Objective 1)--- --- ---

Provide information on retirement planning/needs

(Objective 1)--- --- --- --- --- --- ---

Utilize senior volunteers to provide outreach and

education to new retirees (Objective 1)--- --- --- --- --- --- ---

Promote the identification of Disability Navigator

as a resource to local agencies that provide services

to people with disabilities (Objective 1)

--- ---

Increase awareness of career

transition/change/opportunities/one stop centers

(Objective 1)

--- --- --- ---

Encourage pre-retirees to seek volunteer

opportunities, to gain transitional skills and to

network and expand opportunities and contacts

(Objective 1)

--- --- --- --- --- ---

Develop Web links of available services provided to

elders (Objective 1)Create awareness of how to access employment

and training opportunities through Florida's one

stop employment system (Objective 1)

--- --- --- ---

Increase partnerships with state and local entities

to host regional conferences, events and workshops

on elder issues (Objective 1,2)

--- --- --- --- --- --- --- --- ---

Establish community liaisons (point persons) for

elder assistance (Objective 1,4)

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Increase reach out programs to private entities

(Objective 1,2,4)

Establish improved linkages and partnerships

outside of state government (Objective 1,2,4)

Develop public service announcements and

endorsements from high profile elders/workers

(Objective 2)

Increase awareness of the value of seniors among

business (HR counselors) communities (Objective

2)

Develop relationships with professional

associations and civic associations to network,

recruit workers and develop job opportunities for

elders (Objective 2)

Dispel stereotypes of health issues associated with

older workers (Objective 2,6)

Provide elder sensitivity training to partner

organizations, employers and state and local

government organizations to reduce barriers

(Objective 2,6)

Conduct semi-annual meetings and other ad hoc

communications to strengthen cooperation on

elder issues in employment and volunteerism

(Objective 2,3,5)

Partner with agencies to provide free/low cost

basic computer skills and internet access (Objective

3)

Target training to build skills, i.e. computer literacy

(Objective 3)

Identify transferable skills for current/future job

market (Objective 3)

Establish program set-aside, earmarking money for

elder training (Objective 3)--- ---

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*Strategy is similar to an objective/strategy in other topic areas.

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Increase retention incentives to encourage elders to

remain in the workforce (Objective 5)--- --- --- --- ---

Increase collaboration with the transportation

disadvantaged board to increase older worker

access to transportation (Objective 6)

Develop a community network of volunteers and

other potential partners for alternative

transportation sources (Objective 6)*

Explore alternative routes and times of service to

existing transportation (Objective 6)*

Promote safe driver programs to extend the

abilities of capable older drivers (Objective 6)*

Investigate the utilization of assistive driving

devices for elder drivers (Objective 6)

Promote telecommuting opportunities (Objective 6) --- --- --- --- --- --- ---

Develop cross-agency workgroups as standard

practice to improve the quality of services for

seniors (Objective 5)

--- --- --- --- --- --- --- ---

Seek additional federal resources for older workers

and volunteers (Objective 1-6)--- --- --- --- --- --- --- ---

Obtain input from the transportation

disadvantaged board (Objective 6)

Explore incentives for taxi companies who provide

elder transportation (include private

transportation services) (Objective 6)

Provide resources and information for perception

changing on elders in the workplace (Objective 2,6)

Establish community partnerships/community

involvement and elder advisory committees to

solicit input on elders driving (Objective 6)

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essDisaster preparedness has emerged as a significant issue forFlorida’s elder population due to a climatic cycle characterized byan increase in hurricane activity in recent years. Lessons learnedfrom recent hurricane seasons have highlighted the need forimproved planning and coordination at the state, local andindividual levels.

A major challenge in preparing Florida’s elders for disasters iscreating a culture of preparedness among elders to ensure that aplan for their safety and security is in place before a disasterevent occurs. Florida’s elders must take personal responsibilityto ensure their safety during emergency situations and developan emergency plan which includes: emergency supplies,transportation, prescriptions, funds to cover unplanned expenses,evacuation and sheltering plans, plans for pets and a plan forcommunicating with family and friends.

Evacuating is often problematic for elders who may findthemselves unable to evacuate due to mobility limitations anddeteriorated driving skills, lack of transportation, fuel shortages,shortage of expendable funds for unplanned expenses, congestedevacuation routes before the disaster or damage to infrastructurefollowing the disaster. Some are unwilling to leave their homesdue to a lack of planning, a false sense of complacency caused byoutcomes of previous emergencies which were not catastrophic,uncertainty regarding availability of shelters or accommodationsto meet the needs of their family members or caregivers, or thefear of loosing friends, valued possessions or pets.. Often thechoice to evacuate is not made and lives are unnecessarily put injeopardy when individuals remain at home. Local governmentsshould be aware of these issues and have plans in place to assistand educate elders on making informed decisions.

Elders with special medical needs are particularly vulnerableduring disasters and often have limited knowledge of where togo and who to turn to for assistance in the event of a disaster.Although special needs shelters are available in each county inFlorida to provide temporary shelter for those with special

Disaster Preparedness-Background

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medical needs, elders may be reluctant to use this option due tolack of information about the special needs shelters or due to adesire to remain independent. Individuals who are dependentupon uninterrupted electrical power are particularly at risk whenpower outages and fuel shortages occur as a result of the disaster.It is incumbent upon local governments and the aging network toeducate the elder population about the availability of specialneeds shelters, to ensure that those requiring special medicalassistance are identified and registered, to provide transportationto the shelters as needed, and to have appropriate services,nutrition and medical assistance available at the shelters.

Catastrophic events, public health emergencies, and long-termpower outages create problems not only for frail elders but alsofor those elders who, under normal conditions, are aging in placeand leading dignified, healthy and independent lives. These self-sufficient elders may require assistance during a disaster if theyfind themselves stranded in their homes, separated from familyand friends, experience disruption of regular services that supportan independent life, reside in high rise condominiums with non-functioning elevators, or become unable to access medical care,appropriate nutrition and medicine.

Post-disaster relief and services are critical for the elderpopulation. In many instances, entire housing communities aredestroyed, leaving limited, affordable housing options for manyof Florida’s elder residents. Elders, most often on fixed incomes,can easily become adversely affected due to the impact offinancial issues following a disaster including the cost ofrebuilding homes and difficulty in obtaining adequate insurancecoverage and affordable premiums. The need to protect eldersfrom fraud is heightened following a disaster event.

Disaster Preparedness-Inventory of Services:

The Department of Community Affairs’ Division of EmergencyManagement is the chief agency responsible for ensuring that thestate is prepared to respond to, recover from and mitigate againstthe impacts of Florida’s potential emergencies and disasters. Theagency participates in policy planning and support, preparednessand response, and recovery and mitigation.

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essThe Department of Health takes a lead role in overseeing theoperations of each county’s special needs shelters in the event ofpublic health and catastrophic emergencies. This agency isresponsible for the coordination of recruiting health care staff toprovide medical services at these shelters and to ensure thesafety and security of special needs shelter clients.

The Department of Financial Services/Office of InsuranceRegulation and the Department of Business and ProfessionalRegulation play key roles in assisting Florida’s residents in theevent of a disaster. Issues such as insurance fraud andregulation, post-disaster construction and licensure and damagerecovery are all concerns that arise following disasters. Thebusiness and financial recovery efforts are regulated andoverseen by these agencies.

The Department of Elder Affairs plays a key role in disasterpreparedness and response for elders. Through partnershipswith other state agencies and the aging network throughout thestate, the agency deploys and dispatches response services toFlorida’s elders in the event of hurricanes and other types ofnatural and man-made disasters. Additionally, Chapter Law2006-71 provides that the Department of Elder Affairs isresponsible for providing multi-agency special needs shelterdischarge planning teams to assist special needs shelters in eachcounty with the discharge of special needs clients to alternatefacilities, such as temporary housing accommodations, assistedliving facilities and nursing homes. The Secretary proactivelyworks with other state agencies to ensure that multi-agencyspecial needs shelter discharge planning teams are ready toassemble and deploy rapidly upon a determination by theSecretary or by state emergency management officials that adisaster area requires additional assistance. Each multi-agencyspecial needs shelter discharge planning team shall include atleast one representative from each of the following stateagencies: Department of Elder Affairs, Department of Health,Department of Children and Family Services, Department ofVeterans’ Affairs, Department of Community Affairs, Agency forHealth Care Administration, and Agency for Persons withDisabilities.

See Appendix B for details.

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Disaster Preparedness-Objectives:

Objective 1- Encourage the integration of a coordinatedfederal, state and local emergency responseplan for elders in the state’s ComprehensiveEmergency Plan (CEMP) in the event ofpublic health emergencies, catastrophicevents or disasters.*

Objective 2- Provide education, demographicinformation, training and technical assistanceon disaster planning and emergencyresponse for elders to increase publicawareness, create a culture of preparednessand provide expertise to local, state andfederal officials.

Objective 3- Support efforts to improve access andtransportation to special needs shelters,including improvements to the special needsregistry, and ensure the appropriateness ofservices available at special needs shelters.

Objective 4- Support efforts to improve and standardizespecial needs shelter procedures fordischarge planning and transition assistancefor elders in the event of a public healthemergency, catastrophic event or disaster.*

Objective 5- Develop a comprehensive planning templateand sample plan for communities to use inpreparing to address unique needs of eldersto mitigate the effects of public healthemergencies, catastrophic events anddisasters.

Objective 6- Seek support to identify resources availableto locate and contact elders in the generalpopulation who are not currently receivingassistance or services from the aging networkbut who may require assistance during apublic health emergency, catastrophic event,power outage or disaster.

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essObjective 7- Work with local emergency response

agencies and county emergency operationscenters to maximize their ability to plan forand meet the needs of elders in the event ofpublic health emergencies, catastrophicevents or disasters.

Disaster Preparedness-Key Implementation Strategies, Roles and

Responsibilities:

It is essential that the State of Florida develop and implementreliable communication, coordination, and delivery of servicesacross government agencies, the aging network and care providersystems as the foundation of emergency plans. The Departmentof Elder Affairs, other agencies whose charters require services toelders and, in particular, the Division of Emergency Managementshould assist local governments to facilitate emergencypreparedness and disaster planning at federal, state and locallevels. Government should be sensitive to the unique needs andresources of seniors. Some seniors will require assistance withincreased physical, mental and emotional needs duringemergencies. Those in institutions and with limited mobility mayrequire transportation and other assistance. Actively involvedseniors can serve as useful resources supporting emergencyresponse efforts as they bring their expertise to bear on disasterpreparedness.

*Objective is similar to an objetive/strategy in other topic areas.

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Continue on-going collaboration with state

and local emergency operations centers to

increase awareness and understanding of

special needs of elders (Objective 1-7)

Provide updated demographic information

and statistics on elder populations for each

county to state and county emergency

operation centers (Objective 2,3,5,6,7)

Champion the development and designation

of emergency operations center

liaisons/teams at the local level to

coordinate and assist in responding to the

specific needs of elders (Objective 1-7)

Recommend minimum standards and

critical elements to be included in state,

agency and county Comprehensive

Emergency Management Plans (CEMP) to

address the needs of elders. Examples

include redundancy plans for essential

services and transportation needs during

evacuations (Objective 1-7)

Review the State of Florida Comprehensive

Plan, State of Florida Comprehensive

Emergency Management Plan, and state

agency and county plans to ensure each

addresses the needs of elders (Objective 1-7)

Review the state CEMP and regional,

county, local and agency plans to identify

"best practices for elders” to be used as a

template for other regional, county, local

and agency plans (Objective 1-5, 7)

Collect and share best practices by

gathering input from the aging network on

"what worked and why" and "what didn't

work and why" from past experiences in

preparing for, responding to and recovering

from a disaster (Objective 1-7)

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Make recommendations on levels of care

needed and services to be provided to

address the differences between the

emergency needs of elders who reside in

urban and rural areas (Objective 1-7)

Encourage more comprehensive emergency

and disaster pre-planning in communities

with significant special needs and elder

populations at the local level (Objective 1-7)

Support the efforts of the Communities For a

Lifetime initiative to create elder-ready

communities (Objective 1-7)

Continue to collaborate on interagency

efforts and proposed legislation to improve

access to special needs shelters, services and

discharge planning for persons with special

needs (Objective 1-5, 7)

Ensure that multi-agency response teams

are ready to assemble and deploy rapidly

upon a determination by state emergency

management officials that a disaster area

requires additional assistance (Objective 1-

5, 7)

Support efforts to ensure that local and

facility evacuation plans identify where

elders go if the event impacts facilities (e.g.,

nursing homes, assisted living facilities,

hospices and hospitals) (Objective 1-5, 7)

Encourage counties and municipalities to

develop mutual aid agreements and

establish a communication structure to

coordinate efforts in providing services to

elders during catastrophic events (Objective

1-7)

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*Strategy is similar to an objective/strategy in other topic areas.Legend:

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Identify regional care centers, and plan with

other agencies to have response options in

place for catastrophic events when local

operations may become overwhelmed and

shelters may become compromised due to

the event or additional unforeseen

circumstances (e.g., extended power

outages, lack of fuel) (Objective 1,3,4,7)

Encourage health officials and members of

the medical community to enable easier

access to medical records, prescriptions and

medications during declared disasters

(Objective 1-7)

Determine the appropriate level of medical

expertise (asset management) needed for

staffing at general population shelters and

special needs shelters, and support the

development of uniform consistent

standards statewide to ensure that the

needs of the elder population are met

(Objective 1-5, 7)

Encourage counties and municipalities to

plan for the care of special needs elder

populations following disaster events.

Special needs shelters must have adequate

infrastructure to provide continuity of care

that may be dependent upon durable (life

sustaining or life supporting) medical

equipment such as oxygen, respirators,

wheelchairs, etc., and provide meals that

meet dietary restrictions and nutritional

requirements (Objective 1-3,5-7)*

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Work to ensure reimbursement issues are

resolved for health care facilities that

receive discharged special needs shelter

clients, and that a funding mechanism is put

in place in advance of a disaster (Objective

1, 3-5, 7)

Ensure that special needs shelter discharge

planning procedures are standardized

throughout the state (Objective 1, 3-5, 7)

Ensure that special needs shelters are open

to caregivers (Objective 1-5,7)

Encourage the establishment of more “pet

friendly” general population shelters and

special needs shelters. Support efforts to

educate and train emergency shelter staff

regarding regulations pertaining to service

animals (Objective 1,3,5,7)

Encourage local and county emergency

officials to plan for and provide appropriate

security at shelters (Objective 3,5,7)

Continue to work with FEMA to adopt a

standardized rapid needs assessment tool

that can be used in general population

shelters, special needs shelters or disaster

recovery centers to prioritize elders needing

housing, transportation, medications,

placement assistance, food and water

(Objective 4,5,7)

Encourage local emergency operations to

review the potential need of elders for

sheltering due to extreme emergency

conditions (e.g., long-term power outages,

extensive numbers of damaged or

condemned structures, flooding, damaged

roofs, shortages of tarps, continuing rain

storms, etc) (Objective 1-7)

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Communicate the necessity of planning at

the state and local level for the effect of long-

term power outages and lack of fuel on

otherwise independent and self-sufficient

elders. Support efforts to ensure adequate

fuel supply is available for emergency

responders and service providers within

the aging network (Objective 1,2,5-7)

Support efforts to improve the efficiency

and accuracy of information contained in

the emergency status database of available

beds (Objective 1-5,7)

Consider requiring elder residential

communities, condominiums and long-term

care facilities (e.g., assisted living facilities,

nursing homes, etc.) to ensure their ability

to maintain care and provide safe housing

post event (e.g., a requirement for generators

at such facilities to insure the continuation

of power and ability to operate elevators.)

(Objective 2,5,7)

Encourage county and local emergency

officials to establish contact networks in

their response plans to ensure that elders

have been checked on to determine their

needs and status after a disaster (e.g.,

seventy-two hour check, eight-day check,

buddy system, call tree, etc.) (Objective 1,2,

5-7)

Communicate the need for state, county and

local officials to prioritize the allocation of

resources, assistance and distribution of

emergency supplies to meet the needs of the

state's most vulnerable populations

following a disaster: elders, children and

persons with special needs or disabilities,

etc. (Objective 1,2,4-7)

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Encourage state, county and local

emergency officials to develop procedures

for delivery of supplies to elders in

residential communities and persons with

special needs who, for safety and health

reasons, should not attempt to travel to

established points of distribution (PODs)

sites designated for the general population

(Objective 1,2,4-7)

Support efforts to coordinate the

distribution of food, water, ice and supplies

to the general population at major food

stores or supply chain stores once these

outlets open or become operational with the

use of generators. This practice will allow

resources to become available to meet the

needs of vulnerable and elder populations

(Objective 1,2,5,7)

Provide training and technical assistance to

county EOCs and local communities in

developing plans for disaster preparedness

and response, to ensure that procedures for

coordinating efforts, acquiring supplies and

obtaining assistance for elders are in place

and understood (Objective 2,5, 7)

Support the training of county EOCs and

local communities in understanding how to

escalate issues to and communicate with the

state EOC in the event that local resources

are unable to meet the needs of the elder or

special needs populations (Objective 1-5,7)

Develop a training guide template and/or

disaster kit related to emergency

preparedness and post-event survival that

local communities and agencies can use for

outreach, education and communication

with elders and special needs clients to

create a culture of preparedness prior to

disaster events (Objective 2,3,5-7)

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Collaborate in the publicity and

distribution of the Department of Financial

Services financial emergency preparation

kit and legal survival kit (Objective 2,5-7)

Promote opportunities for professionals and

emergency officials to increase their

awareness of and education on the special

needs of elders during emergency situations

(e.g., conferences, best practice sessions,

workshops, publications, etc.) (Objective 2-

7)

Support the establishment of one-stop

service centers in partnership with other

response agencies ( e.g., DFS insurance

villages) to streamline the delivery of

services and increase the efficiency and

effectiveness of post disaster assistance and

community outreach efforts (Objective 2, 5-

7)

Participate in State Hazard Mitigation

Planning Advisory Council (Objective 2, 5-

7)

Provide staffing at Disaster Recovery

Centers to conduct rapid needs assessments,

identify local resources and champion the

needs of elders to ensure that housing and

medical needs are prioritized and services

are provided (Objective 1,2,5-7)

Provide information to emergency officials

regarding the unique nutritional

requirements of elder populations to ensure

the appropriateness and elder-friendliness

of post disaster meals distributed to elders

(e.g., low sodium, diabetic, restricted caloric

diets, etc.) (Objective 2-7)

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Support efforts to develop community

education and outreach regarding

registration and special needs shelters and

general information regarding shelter stays

(Objective 2,3,6, 7)Ensure that each county EOC and

community has a pre-designated location

for a special needs shelter(s). Information on

the pre-designated location, services

available, and access to transportation to

the special need shelter(s) must be

announced to the public prior to the event

to assist special needs clients in pre-

planning (Objective 2,3,5-7)

Educate the emergency community

regarding the unique mental health issues

and potential changes in behavior

experienced among elder populations

during times of stress and disorientation.

Include specialized information on

Alzheimer's and dementia, along with

effective strategies for communicating with

older adults to minimize emotional impact

of the event. Ensure that emotional support

and counseling are available to elders (pre-

event, during the immediate aftermath and

during long-term recovery) (Objective 1-5,

7)

Support efforts of service agencies,

community-based service providers,

including home health care providers, and

hospices to collect registration information

for elders with special needs as part of their

program intake process. Establish programs

to increase the awareness of the registration

process, plan for continuity of care,

minimize disruption of services and educate

clients about procedures that may be

necessary for their safety during disasters

(Objective 2-7)

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Input from the public and the interagency workgroup suggeststhat there are five key issues that affect the rights of Florida’smature citizens. The five areas are: legal services; guardianshipand alternatives to guardianship; adult protective services; long-term care facility residents’ rights; and consumer protection andcrime prevention.

Legal Services

Demographically, Florida leads the nation in the percentage ofthe total population comprised by elders, with 23 percent of thestate population age 60 and older.1 The problems Florida eldersface are increasingly complex and range from housing andpublic benefits to consumer protection and life planning. Thereare a variety of legal service programs in Florida to assist seniorsin these areas, including services funded by Title IIIB of theOlder Americans Act, the new Statewide Senior Legal Helpline,local legal aid and legal service programs and local pro-bonoprograms. However, there is likelihood that many legal needs ofelders in Florida go unmet. In the fall of 2005, the Legal ServicesCorporation released a study of the unmet civil legal needs oflow-income Americans, documenting that 80% of the civil legalneeds of low-income Americans are not being met.2

Guardianship and Alternatives

Guardianship and alternatives to guardianship also pose issuesfor Florida elders. When any adult becomes incapacitated andcan no longer make decisions, a surrogate decision maker mustbe designated. Florida law emphasizes that the least restrictiveform of surrogate decision-making should be utilized. Whenpeople take the time to prepare for their possible incapacity andexecute advance directives, then guardianship, the mostrestrictive and expensive form of surrogate decision-making,may be avoided.

Elder Rights-Background

1 2000 U.S. Census2 The study can be accessed online at the Legal Services Corporation website, www.lsc.gov.

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tsFor incapacitated persons who have not designated a surrogatedecision maker and have limited financial means and no familyor friends to assist them, the courts look to appoint a publicguardian. Securing adequate funding for public guardianshiphas been a challenge since Article V, Revision 7 changes to theFlorida Constitution and subsequent changes to Florida Statutes.Prior to July 2004, counties had the option of enacting a localordinance that allowed for an add-on filing fee to civil courtcases. This fee could not exceed $15.00. With the shift of courtfunding to the state level, Chapter 2005-265, Laws of Florida,repealed the funding mechanism for public guardianship.

A Department of Elder Affairs (DOEA) analysis of the need forpublic guardianship, Public Guardianship: An Assessment of Need2004, indicates that there are between 5,000-10,000 persons peryear that need the services of a public guardian. This study onlyaccounts for persons within the Department of Children &Families Adult Protective Services program. This same studyconcluded that the average cost for a public guardian to serve award is $2,363 per year. To meet the estimated need of adultprotective services cases alone would take approximately $24million. It is important to note that this figure does not includepersons who never enter the adult protective services program,e.g., those persons who may be physically secure in a nursinghome or other type of facility but are poor and do not have anyfamily or friends to assist with decision making.

Another area of concern related to guardianship matters involvesthe monitoring of guardianship cases. According to the FloridaSupreme Court Commission of Fairness GuardianshipCommittee Report, although the majority of guardians andlawyers are law abiding, there are cases where monitoring isnecessary. It is in everyone’s best interest, especially a ward whois incapacitated to be proactive in ensuring the guardian’scompliance. If the court has to wait until a problem occurs, thisnegatively impacts the vulnerable wards by exposing them topotential harm, both physical and financial. Proper oversighthelps to ensure wards are protected and standards are met.Further, a working relationship between the courts and lawenforcement would not only help with timely prosecution ofthose responsible for abuse, neglect or exploitation but mightalso act as a deterrent.

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Adult Protective Services

Adult Protective Services meets a critical need for Florida’selders. In fiscal year 2004-05, the Department of Children andFamilies investigated 41,028 reports of abuse, neglect orexploitation. Allegations included physical abuse,environmental neglect, inadequate food, mental injury and lackof adequate health care and supervision. Of all the reportsreceived during this time period, 72 percent involved personsover the age of 60.

As Florida’s population continues to age, the likelihood of abuse,neglect or exploitation will also increase. This is evidenced bythe increase in the number of reports over the past seven years.These numbers do not, however, reflect the actual number ofvictims. According to a survey conducted by the NationalCenter on Elder Abuse, in 2004 over 65 percent of victims age 60+were women. Over 40 percent of victims in the 60+ age categorywere 80 years of age and older.

During fiscal year 2004-05, the Department of Children andFamilies experienced a growth rate of approximately sevenpercent in the number of reports received for investigation. Onereason for the increase in reports may be successful efforts toeducate both the general public and state agencies aboutreporting known or suspected abuse, neglect or exploitation.There has also been considerable publicity on domestic violenceand crimes against the elderly. Further, increased Florida AbuseHotline call floor staff has resulted in a reduction of abandonedcalls.

Another reason for the increase in reports received forinvestigation could be the fact that Floridians are living longerand, as they age, this population experiences physical andcognitive difficulties for which they need assistance, that may ormay not be available. There is some speculation, however, thatthe limits of what the informal sector can provide have beenreached, leaving more frail elders on their own.

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tsResidents’ Rights

Another area of emphasis is the health and safety of elders inFlorida’s long-term care facilities. Long-term care facilities inFlorida fall into one of three categories: nursing homes (812facilities, 80,889 beds), assisted living facilities (2,249 facilities,74,219 beds), and adult family care homes (469 facilities, 2,023beds). Administrative inspections of these facilities focus on therights, health, safety and welfare of residents. Inspections aremandated by section 400.0073, F.S., and are conducted annually.Ombudsmen are advocates who are responsible for ensuring that afacility is meeting the needs of residents and is in compliance withstate statute and federal law. Specific complaints range fromaccidents and falls to improper medication administration andproblems with personal hygiene.

In SFY 2004-2005, ombudsmen completed a total of 2,908inspections of approximately 82 percent of licensed long-term carefacilities in Florida. Although most complaints in SFY 2004-2005were reported by relatives of long-term care facility residents (47percent), concerns were also reported by residents themselves (19percent) and their guardians or legal representatives (six percent).Friends of residents, facility staff, medical personnel, agency staffand even ombudsmen also filed complaints.

Consumer Protection and Crime Prevention

Crimes such as consumer fraud also affect Florida elders.According to the National Center on Elder Abuse, 5 million cases ofelder financial exploitation are estimated to occur annually. Manyof these cases go unreported. Seniors may be too embarrassed toreport fraud or are unaware they are being victimized. It isanticipated that elders will increasingly become victims of fraudwith the aging of the baby-boomer generation. Over 70 percent ofthe nation’s wealth resides with individuals age 50 and over.Therefore, it is anticipated that these individuals will be targets forscams as they approach more vulnerable years. Relatives andcaregivers are a significant proportion of individuals responsiblefor the financial exploitation of elders.4

3 2004-2005 LTCOP Annual Report4 “The Final Indignity.” Newsweek. July, 2005.

For more information on elder rights trends, please see Appendix A.

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Elder Rights-Inventory of Services:

The department’s Elder Rights unit works to better coordinatethe provision of legal services and information, to assist them inmaintaining self-sufficiency and self-determination.

The Department of Elder Affairs’ Long-Term Care OmbudsmanProgram is a volunteer-based organization seeking to improvethe quality of life of frail, vulnerable elders who live in long-termcare settings, including nursing homes, assisted living facilitiesand adult family care homes. Ombudsmen investigate andresolve complaints submitted by, or on behalf of, residents oflong-term facilities who are 60 years of age and older, section400.0060, F.S. In addition, ombudsmen monitor developmentand implementation of federal, state and local laws, regulations,and policies applicable to long-term care facilities andrecommend any policy changes; maintain a statewide reportingsystem to collect and analyze data; provide informationregarding long-term care facilities; and annually assess eachlong-term facility to ensure the health, safety and welfare of theresidents.

The Department of Elder Affairs also provides outreach andeducation to prevent abuse, neglect or exploitation. Education isprovided for consumers and professionals to recognize andintervene when signs of abuse, neglect and exploitation aresuspected. In collaboration with Department of Children andFamilies and other stakeholders, many training programs haveevolved.

The Department of Elder Affairs oversees the statewide Triad, aprogram consisting of eight state agencies and five associationsthat work together with local law enforcement and seniors todevelop, promote and operate programs to prevent thevictimization of elders.

The Department of Children and Families and the Department ofElder Affairs have an interagency agreement for Adult ProtectiveServices referrals, specifically vulnerable elders in need ofservices (self-neglecting). The adult protective services programis a system of specialized social services directed towardprotecting vulnerable adults from abuse, neglect or exploitation.

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tsThe Office of the Attorney General, Department of Legal Affairs,is committed to bringing to justice those who defraud and exploitFlorida’s senior citizens. With emphasis on consumer protection,prosecuting elder abuse and neglect, and providing criminaljustice training programs, the Department of Legal Affairs takes aproactive approach to accessing and ensuring the safety ofseniors who live independently, as well as those receiving partialor full residential assistance. The Attorney General’s MedicaidFraud Control Unit (MFCU) investigates and workscooperatively with local, state, and federal law enforcement andprosecutors to bring to justice individuals and businesses whodefraud the Medicaid system and jeopardize the safety ofMedicaid recipients. Additionally, the MFCU leads twoprograms designed to ensure seniors receive the dignity theydeserve. Operation Spotcheck, a community law enforcementprogram, performs unannounced multi-agency inspections ofresidential health care facilities. The PANE Project–Patient Abuse,Neglect, and Exploitation — is another community lawenforcement effort that combines resources of the Department ofChildren and Families (DCF) and the Attorney General’s MFCUto focus on detecting and investigating criminal acts committedagainst residents in health care facilities. This collaborativeproject has become a national model for similar programs inother states.

The Office of the Attorney General also provides proactive seniorawareness and protection programs and identifies senior victimsthrough other agency divisions including Citizen Services,Economic Crimes, and the Seniors vs. Crime, Inc. program. Forexample, senior callers to the Attorney General’s Toll-Free FraudHotline may be eligible for enhanced penalties imposed againstthose who prey on seniors. The frequency of calls from seniorfraud victims also assist the Attorney General in identifying newor pervasive trends in exploitation of seniors. The AttorneyGeneral’s “Seniors vs. Crime” program provides community-based volunteer services by seniors and for seniors in Florida.Seniors vs. Crime volunteers assist the Attorney General’s Officeto fight back against con artists, allowing seniors to becomeinvolved in not only their own protection, but also that

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of their fellow citizens. In addition, the Office of the AttorneyGeneral serves seniors by hosting MyFloridaRx.com, the statemandated prescription drug price Web site, as well as a stateprice-gouging hotline. Crime prevention programs of specialbenefit to seniors include citizen outreach programs and lawenforcement training in the areas of price gouging, identity theft,telemarketing fraud and other consumer protection issues. Byproviding all of these legal, educational and investigativeservices to Florida seniors, the Office of the Attorney General isan active partner with other state agencies that share the samededication to protecting this vulnerable population.

The Division of Consumer Services (Department of FinancialServices) is committed to helping Floridians make informeddecisions about insurance coverage, companies and agents, aswell as financial institutions, consumer finance companies,mortgages, mortgage brokers and securities dealers. Educatingconsumers about these matters empowers and helps protectthem from becoming victims of financial or insurance fraud. TheDivision accomplishes this mission through its toll-freeConsumer Hotline, mediation program, regional service officeslocated throughout the state, free community outreachprograms, the Department of Financial Services Web site and itsvarious consumer publications. The Division also partners withServing Health Insurance Needs of Elders (SHINE) through theFlorida Department of Elder Affairs to assist seniors with theirhealth insurance and Medicare questions.

The Department of Agriculture and Consumer Services, throughits Division of Consumer Services, serves as the state’sclearinghouse for consumer information, complaints andinquiries. To accomplish this mission, the Division administers:1) The Consumer Call Center which implements the state’s toll-free consumer telephone hotline for consumer or businessrelated questions. 2) The Complaint Clearinghouse, whichinformally mediates consumer disputes, particularly those thatdo not fall within the jurisdiction of other federal, state or localagencies, such as landlord/tenant, satellite or Internet services.3) Regulatory programs, that investigate violations of consumerprotection laws involving unfair and deceptive trade practices.

See Appendix B for details.

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tsElder Rights-Objectives:

Legal Services

Objective 1- Raise awareness of importance of legalservices to seniors.

Objective 2- Increase access to legal services for elderswho cannot afford an attorney.

Objective 3- Improve ability of legal providers toaddress issues most impacting seniors.

Objective 4- Increase funding to ensure adequateprovision of no or low cost legal services.

Guardianship and Alternatives

Objective 5- Expand education on alternatives toguardianship.

Objective 6- Increase public guardianship funding.

Objective 7- Expand guardianship monitoring.

Adult Protective Services

Objective 8- Enhance crime prevention and sensitivityprograms related to the elderly populationfor elder consumers and provider agencies.

Objective 9- Promote intergenerational and cross-cultural education opportunities forconsumers and providers.

Objective 10- Strengthen families through caregiversupport, education and access to programs.

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Residents’ Rights

Objective 11- Strengthen program systems to enhance theLong-Term Care Ombudsman Program’sability to educate consumers about theprotection of residents’ rights.

Objective 12- Develop initiatives to increase volunteerombudsman ranks so residents have“meaningful access” to ombudsman servicesand that will assist the program’s efforts toidentify the underlying issues as we changepolicy, laws, and regulations to improveresidents’ quality of life.

Objective 13- Strengthen interagency communication onresidents’ rights.

Consumer Protection and Crime Prevention

Objective 14- Develop resources and programs tostrengthen education and improve qualityand accessibility of information onconsumer protection among agencies.

Objective 15- Develop education programs pertinent tosenior related issues, e.g., major currentevents facing seniors.

Objective 16- Strengthen community-based, cooperativelaw enforcement efforts to detect andinvestigate activities endangering seniors.

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tsElder Rights-Key Implementation Strategies,Roles and Responsibilities:

The 1992 reauthorization of the Older Americans Act (OAA)strengthened the OAA mission by creating the new VulnerableElder Rights Title (Title VII), which calls on all state units onaging to take substantially increased leadership in developing anadvocacy system that brings together diverse groups of servicesproviders and advocates and to coordinate efforts to identify andaddress the needs and concerns of their state’s most vulnerableelders.

In 2005, the Department of Elder Affairs created the Elder RightsUnit, which oversees Title VII programs including Elder AbusePrevention, Legal Services Development, Long-Term CareOmbudsman Program and the State Health Insurance AssistanceProgram, known as SHINE.

Other agencies also provide protective and legal services toelders. These include the Attorney General’s Office, Departmentof Agriculture and Consumer Services, Department of Childrenand Families, Department of Financial Services, law enforcementagencies and legal service agencies. The following matrix spellsout the role of each entity in the implementation of the followingstrategies.

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Elder Rig

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Legend:

Lead

Support

Partnership ---

Strategy DO

EA

AP

D

DF

S

AG

DO

AC

S

DC

F

Flo

rid

a B

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Flo

rid

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egal

Ser

vic

es

AA

As

AH

CA

FD

LE

Fed

s

Lo

cals

Oth

e r

Develop interagency partnerships

throughout the state to promote

the importance of legal services as

a part of the overall structure of

service to seniors (Objective 1)

Raise awareness among seniors of

the legal dimension to their

problems and the option of

assistance from attorneys who

may be able to offer legal solutions

(Objective 1)

Enhance promotion of the network

of providers of free legal services

(Objective 2)

Work with legislature to provide

for permanent funding for the new

statewide senior legal helpline to

sustain this meaningful benefit for

Florida seniors and an easy point

of entry into the system of legal

services (Objective 2)

Work with bar associations and

sections to encourage pro-bono

legal services for seniors (Objective

2)

--- ---

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Legend:

Lead

Support

Partnership ---

5The federal Older Americans Act, Title IIIB, requires apercentage of Title IIIB funding to be allocated for theprovision of legal services to seniors.

Strategy DO

EA

AP

D

DF

S

AG

DO

AC

S

DC

F

Flo

rid

a B

ar

Flo

rid

a L

egal

Ser

vic

es

AA

As

AH

CA

FD

LE

Fed

s

Lo

cals

Oth

er

Identify and evaluate legal needs of

older Floridians in order to target

resources for improved access to

legal services (Objective 2)

Work with existing legal services

providers and offer educational

opportunities to enhance

understanding of legal issues that

are unique to seniors (Objective 3)

Work with the Florida Bar to

enhance communication among

providers of legal services to

seniors (IIIBs5, legal aids, local bar

associations, pro bono groups, etc.)

in order to share resources and

knowledge (Objective 3)

Provide elder sensitivity training

for attorneys who may serve

seniors (Objective 3)

--- --- --- ---

Raise statewide standards for the

provision of legal services through

allocation of Title IIIB dollars

(Objective 4)

Encourage AAAs to dedicate

increased percentage of Title IIIB

dollars for the provision of legal

services (Objective 4)

Work with the state legislature to

secure state funding to supplement

federal funding allocated for the

provision of legal services to

seniors (Objective 4)

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Legend:

Lead

Support

Partnership ---

*Strategy is similar to an objective/strategy in other topic areas.

Strategy DO

EA

AP

D

DF

S

AG

DO

AC

SD

CF

Flo

rid

a B

ar

Flo

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egal

Ser

vic

es

AA

As

AH

CA

FD

LE

Fed

s

Lo

cals

Oth

er

Continue coordination with

Statewide Public Guardianship

Office, state agencies, Florida Bar,

on advance directives education

activities. Provide information on

alternatives to guardianship

(Objective 5)*

--- --- ---

Educate high school students and

encourage them to execute advance

directives (Objective 5)*

--- ---

Work with the legislature to secure

permanent public guardian

funding (Objective 6)

Subject to funding allocations,

expand public guardianship across

Florida to areas of need (Objective

6)

With the court system as lead,

expand guardianship monitoring

to every area of Florida. Provide

educational opportunities to court

personnel and clerk’s staff

responsible for guardianship case

review. Develop procedures for

effective and efficient review of

cases (Objective 7)

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Legend:

Lead

Support

Partnership ---

Strategy DO

EA

AP

D

DF

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AG

DO

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CF

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Flo

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AA

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CA

FD

LE

Fed

s

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cals

Oth

er

Coordinate monitoring activities

with law enforcement and provide

information/education to law

enforcement. Create and

implement interagency procedures

for effective investigation and

prosecution of abuse, neglect and

exploitation (Objective 7)

--- --- --- ---

Identify funding resources for the

development and implementation

of interagency cross-training

programs that specifically target

prevention and sensitivity issues

related to Florida’s elder

population (Objective 8)

Conduct interagency public

awareness campaigns that address

increasing prevention and

sensitivity with general

population (Objective 8)

---

Encourage and support

collaborative programs such as

Triad, training programs and the

APS Referral Tracking Tool

(Objective 8)

--- ---

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Partnership ---

Strategy DO

EA

AP

D

DF

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AG

DO

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CA

FD

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Lo

cals

Oth

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Identify educational opportunities

that will provide primary agencies

with knowledge, understanding

and sensitivity to cultural

differences and inter-generational

involvement (Objective 9)

Produce media that sensitize the

general public concerning cultural

and inter-generational issues

(Objective 9)

Expand the capacity for caregiver

educational opportunities that

focus on prevention, appropriate

care, and access to programs

(Objective 10)

Increase the availability of respite

care for caregivers to avoid stress,

burnout and inappropriate care of

clients (Objective 10)

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Partnership ---

Strategy DO

EA

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D

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CA

FD

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s

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cals

Oth

er

Develop “friendly visitor”

programs based on pilot projects

initiated in several local councils to

increase ombudsman presence and

deliver information regarding

residents’ rights to clients

(Objective 11)

Proactively develop partnerships

with resident councils to

cooperatively address systems

issues that affect residents' lives

(Objective 11)

---

Enhance the LTCOP’s website to

make it more user-friendly for

volunteers, families and long-term

care facility staff to access cutting

edge information on the program,

trends in long-term care and other

best practices to effectuate change

within long-term care facilities to

move toward a non-institutional

model (Objective 11)

---

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Legend:

Lead

Support

Partnership ---

Strategy DO

EA

AP

D

DF

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AG

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F

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AA

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CA

FD

LE

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s

Lo

cals

Oth

er

Develop strategies to reduce

language barriers and other

communication impairments for

residents (Objective 11)

Execute a proactive public

relations campaign that raises

visibility and awareness among

relevant audiences and assists in

recruiting new volunteers

(Objective 12)

Develop initial training strategies

and materials that will include

program resources needed to train

ombudsmen to handle complaints

(Objective 12)

Modernize complaint and

documentation systems that will

allow volunteers to input cases,

track follow-up of cases in real

time and deliver critical

information expeditiously,

minimizing the “paperwork” for

volunteers (Objective 12)

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Legend:

Lead

Support

Partnership ---

Strategy DO

EA

AP

D

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Develop statewide and local

interagency councils that provide

a forum for sustained dialogue

regarding all facets of elder rights

throughout the continuum of care

so systems can be adapted to meet

the evolving needs of Florida’s

elders (Objective 13)

Implement interagency council to

strengthen coordination among

agencies on consumer protection

issues (Objective 14)

--- --- --- --- --- --- --- --- --- --- --- --- ---

Determine specific consumer

education components based upon

services and information currently

provided to seniors (Objective 15)

--- --- --- --- --- --- --- --- --- --- --- --- ---

Provide continuous elder crime

prevention training for advocates

and law enforcement (Objective

15)

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Legend:

Lead

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Partnership ---

Strategy DO

EA

AP

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Provide consumer protection and

consumer awareness education for

seniors (Objective 15)

Provide community law

enforcement program that

performs unannounced multi-

agency inspections of residential

health care facilities statewide

(Objective 16)

Provide community law

enforcement effort that combines

multi-agency resources statewide,

focusing on detecting and

investigating criminal acts

committed against residents in

health care facilities including

nursing homes, assisted living

facilities, and group homes

(Objective 16)

105

ConclusionConclusionConclusionConclusionConclusion

TTTTT he Master Plan on Aging, 2007-2009 reflects the vision ofthe department in creating an environment that provides

choices, promotes independence and enables older Floridians toremain in their communities for a lifetime. At the heart of thegoals and objectives identified throughout this document lie thecore values of the Department of Elder Affairs: elder rights,compassion, accountability, caregiver support, volunteerism,quality, intergenerational partnerships and diversity.

Accountability and agency commitment are essential ingredientsto success in implementing the Master Plan on Aging, 2007-2009.Achieving the goals and objectives outlined in the plan willrequire the collaboration of partner entities working together onan ongoing basis. Partners providing elder services have definedtheir roles in improving the services to elders throughout thestate. Sustained commitment to this end will make a profounddifference in the lives of our elder residents.

This plan is only one of several resources that the department

produces to assist policy makers and other concerned stakeholders

in their decision-making. For more information about the

department’s services and programs, visit the department’s Web

site at http://www.myflorida.com, or contact the department to

obtain copies of the following documents: State Plan on Aging and

the Long-Range Program Plan.

106

107

108

TechnicalTechnicalTechnicalTechnicalTechnicalAppendicesAppendicesAppendicesAppendicesAppendices

109

110

Appendix AAppendix AAppendix AAppendix AAppendix A

111

112

The State ofThe State ofThe State ofThe State ofThe State ofAging in FloridaAging in FloridaAging in FloridaAging in FloridaAging in Florida- A Monograph- A Monograph- A Monograph- A Monograph- A Monographand Needsand Needsand Needsand Needsand NeedsAssessmentAssessmentAssessmentAssessmentAssessment

he following section provides an overview of Florida’scurrent and projected elder demographics. The section

includes a demographic analysis and needs assessment.

Population Growth andDistribution

Florida is the fourth most populous state,with over 17.8 million citizens. Havingover 3.9 million persons age 60 and older,Florida ranks number one in thepercentage of its citizens who are elders (23percent in 2004). (See Figure 1.)

TTTTT

113

Since 1990, Florida’s elder population has increased by almostone million – a 29 percent increase. However, the rate ofgrowth is not homogeneous among age groups; the oldest oldage group increased fastest. (See Figure 2.) During the last tenyears, the number of persons age 85 and older grew four timesfaster than persons age 60 to 84. This growth is significant forpolicy makers and planners as the oldest old are four timesmore likely to need long-term care services.

Nevertheless, in the near future this differencein growth rates among elderly age groups willbe almost eliminated as baby boomers entertheir early senior years starting in 2005. By2020 when baby boomers start turning 75,demand for long-term care services willintensify. What this suggests is that, as a recentAARP report states, “there will not be a tidalwave for long-term supportive services for atleast two decades, even if utilization trendsstay constant at recent rates.”1

The growth of the population age 60 and olderhas not occurred uniformly throughout thestate. About half of the population growth

Less than 15%15% - 16%17% - 18%19% or more

Figure 1Percentage of the Population Age 60And Older by State (2000)

Source: 2000 U.S. Census

Figure 2Florida’s PopulationGrowthBy Age Group(1990 – 2020)

Source: Office of Economic andDemographic Research. The FloridaLegislature. “Florida Census DayPopulation 1970 – 2020"

114

among the elderly comes from amenity-seeking retirees whomove to Florida. In the past, the traditional destination countieshave been in Southeast Florida. However, during the last tenyears, an increasing number of retirees has been moving intocounties in Northeast, Northwest andSouthwest Florida. Figure 3 shows thegrowth of the elder population bycounty.

The counties with the largest number of elders are located inSouth and Central Florida. The top ten counties by size of theirelder population are Miami-Dade, Broward, Palm Beach,Pinellas, Hillsborough, Lee, Sarasota, Orange, Brevard andVolusia. These ten counties account for 55percent of the elder population in the state.(See Figure 4.)

Figure 3Florida’s 60 and OlderPopulation Growth by County(1990 – 2020)

Source: Department of ElderAffairs based on Office ofEconomic and DemographicResearch, Florida Legislature

Figure 4Florida’s PopulationAge 60 and OlderBy County

Source: Department of ElderAffairs based on Office ofEconomic and DemographicResearch, Florida Legislature

115

Having a large elder population does not necessarily meanhaving a relatively older population. For instance, counties suchas Miami-Dade, Broward and Palm Beach also have sizableyounger populations. On the other hand, some smaller countieshave a much larger share of the population age 60 and older.Among counties with a population larger than 10,000, Floridahas the three top counties in the nation with the largest share ofelders: Charlotte, Citrus and Highlands. In each of thesecounties, the incidence of elders is more than 40 percent. Thereare another 13 counties with elder population densities in excessof 30 percent. Among large counties, Miami-Dade has 18percent, Broward 20 percent and Palm Beach 28 percent. (SeeFigure 5.)

Income and Poverty

Although the median family income of elder Floridians is$26,796 (mean is $41,223), an estimated 11.2 percent of allresidents age 60 and older have annual family incomes that fallbelow poverty level as defined by the U.S. Department of Healthand Human Services (single person = $8,980, as of February2003). Among elders, the likelihood of being poor increases withage.2

Source: Department of ElderAffairs based on Office ofEconomic and DemographicResearch, Florida Legislature

Figure 5Population DensityAge 60 and OlderBy County

116

Social Support Programs

The economic well being of elders is very dependent on socialincome-support programs such as Social Security, whichprovides an income safety net for a majority of elders. About 50percent of the cash income of Floridians age 65 and older comesfrom Social Security, and about 46 percent of elders would bepoor if not for this program. Another income support programfor the elderly is Supplemental Security Income (SSI).

In-kind support programs are also very important for the well-being of the elderly. The most important of such programs isMedicare. Also included in this category are Medicaid, FoodStamps and supportive services under Title III of the OlderAmericans Act. Medicare has a fungible value worth on averageabout $8,000 per family. Figures 6 and 7 show the importance ofpublic programs. Figure 6 shows the distribution of income(cash and in-kind) for all elder households. Figure 7 shows thedistribution of income (cash and in-kind) for at-risk elders whowould be poor if not for public income-support programs.

In-kind (Medicaid, Medicare,

Food Stamps)

24%

Income Support (SS,

SSI, Vet, Disability)

32%

Earned Income (work)20%

Unearned Income

(pensions, interest, etc.)

24%

Figure 6Income by SourceElder FamiliesAll Income Levels

Public programs60%

Earnings9%

Unearned individual

private Pensions0%

Public programs in-kind31%

Figure 7Income by SourceFor At-Risk Elders

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Living Situation

Over 60 percent of all elders in Florida live with their spouse.Some might also live with children, grandchildren and/or otherpeople. Over 75 percent of elders residing in rural areas livewith their spouse. (See Figure 8.) Knowing the number of eldersliving with a spouse is important in assessing the needs of olderadults. A spouse is often the first person called upon to be acaregiver.

Additionally, federal income-support programs favor marriedcouples by providing increased benefits leading to lower povertyrates for married elders. (See Figure 9.) Over half of Florida

elders living inhigh poverty areaslive alone. Poorelders are twice aslikely as others tolive alone. (SeeFigure 10).

Elders living aloneare more likely tobe at risk forMedicaid nursinghome care. Theyhave no family

$12,011

$16,781

$8,163

$13,077

$6,000

$8,000

$10,000

$12,000

$14,000

$16,000

$18,000

Single Married

Income Support Programs Public Programs In-kind

Figure 9Income andIn-Kind SupportsBy Marital Status

Source: Department ofElder Affairs

0% 20% 40% 60% 80%

Statewide

Poor

Rural

Minority

Figure 8Percent of EldersWho Live withTheir Spouse

Source: Assessing theNeeds of Elder Floridians,2004, Department ofElder AffairsAffairs

118

members tocare for themwhen frailtysets in, andmight lack themeans to payfor care.

Rural elders are least likely to livealone. The hardship of living alonein geographical isolation mayencourage widowed rural elders tomove to urban areas.

Minority elders are three times aslikely to be poor than non-minorities.(See Figure 11.) However, as Figure12 shows, most of the difference inpoverty rates is due to differences ingovernment income-supportprograms.

Non-minorities are more likely to bemarried—due to the longer lifespans of white males— and havework histories that represent higherSocial Security payments.

Figure 13 shows that education has animpact on the amount of support re-ceived from public programs, becausehigher educational levels aretied to higher earnings andhigher support payments. Toa large extent, povertyamong the elderly is a reflec-tion of racist educational andworkplace policies of 60years ago.

Statewide Poor Rural Minority0%

10%

20%

30%

40%

50%

60% Figure 10Percent of EldersWho Live Alone

Source: Assessing theNeeds of Elder Floridians,2004, Department ofElder Affairs

$8,000

$9,000

$10,000

$11,000

$12,000

$13,000

$14,000

$15,000

$16,000

$17,000

White Non Hispanic Black Hispanic All

Income Support Programs Public Programs In-kind

Figure 12IncomeSupportand In-KindProgramsBy Race/Ethnicity

$13,953

$15,094 $15,288

$9,977

$11,472$11,677

$6,000

$7,000

$8,000

$9,000

$10,000

$11,000

$12,000

$13,000

$14,000

$15,000

$16,000

Less than High School

High SchoolDiploma

College or Advanced Degree

Income Support Programs Public Programs In-kind

Figure 13IncomeSupportand In-KindProgramsByEducationalAchievement

Source:Department ofElder Affairs

8.4%

25.6% 23.0%

55.1%

64.3%

56.3%

0%White

Non-HispanicBlack Hispanic

Poor (Actual) At-Risk (W/O Income Support Programs)

Source: Assessing theNeeds of ElderFloridians,2004, Department ofElder Affairs

Figure 11PovertyRatesBy Race/Ethnicity

119

Gender and Marital Status

Women have a substantially longer lifespan than men. Figure14 shows that, while men are 46 percent of the population in the60 to 74 age group, they make up only 34 percent of those age 85and older. Since the likelihood of requiring long-term care isfour times greater at age 85 than at age 60, most persons in needof long-term care are women who have outlived their malepartners. Currently, about 47 percent of persons age 65 andolder do not have a spouse, and the likelihood of not having a

partner is muchhigher for elders age85 and older.

Long-term trendsindicate that thelongevity gap hasbeen narrowing, andis expected tocontinue to do so.(See Figure 15.) Thistrend has positiveimplications for the

demand on public long-term care. The main determinant for theneed for long-term care is the absence of a caregiver. As malelongevity increases, the number of years women live without acaregiving spouse will be reduced.

46%

43%

34%

30%

35%

40%

45%

50%

60-74 75-84 85+

Figure 14The Percentage ofMalesBy Age Group inFlorida (2000)

Source: The Office ofEconomic andDemographic Research.The Florida Legislature

34%

37%

39%

30%

32%

33%

35%

37%

38%

40%

2000 2010 2020

Figure 15The Percentage ofMales Among PeopleAge 85 and Older inFlorida (2000-2020)

Source: The Office ofEconomic andDemographic Research.The Florida Legislature

120

Ethnicity and Linguistic Isolation

Minority populations constitute 18 percent of the total number ofFloridians age 60 and older. Among minorities, Hispanics aremost numerous, accounting for ten percent of the elderpopulation, African Americans accounting for seven percent,and other minorities about one percent. For the period 1995through 2010, U.S. Census projections predict an estimated 102percent increase in the number of individuals of Hispanic originage 65 and older residing in Florida, from approximately 237,670to 479,556 individuals. Over this same 15-year period, thenumber of persons of Hispanic origin age 85 and older will growfrom an estimated 24,734 individuals to 63,599, an increase of157 percent.

The distribution of minority and linguisticallyisolated elders is not uniform throughout thestate, as Figures 16 and 17 show. The non-Englishspeaking elder population is concentrated inseven of Florida’s 67 counties, with a singlecounty (Miami-Dade) accounting for two outevery three elder Hispanics. Other minorities aremore evenly distributed, with African Americansthe most prevalent minority in North Florida.

Figure 16Non-EnglishSpeaking Densityof 60 and OlderPopulationBy County

Source: Department of ElderAffairs based on Office ofEconomic and DemographicResearch, Florida Legislature

Figure 17Minority PopulationDensity of 60And OlderPopulationBy County

Source: Department of ElderAffairs based on Office ofEconomic and DemographicResearch, Florida Legislature

121

Dependency and Disability

A growing body of evidence proves that, during the last 20 years,disability rates have declined substantially. Declining rates haveproven overly pessimistic past forecasts wrong. Figure 18illustrates that in 1999 the number of disabled elder Americanswas 2.3 million less than would have been expected based on1982-1984 age specific disability rates. That represents almost a25 percent decline. Most of the research exploring this trendstrongly suggests that the main forces behind this decline are

improvements inelder health,socioeconomicimprovements andmedical advances.

Improvements inelder health andmedical advancesreduce the demand forlong-term supportiveservices bycompressingmorbidity and acutedisability towards theend of life, resulting in

significant gains in disability-free years.3 Even as theprevalence of chronic conditions has increased, medicaltechnology advances have made the effects of these conditionsless incapacitating. Particularly notable are advances thatmitigate the disabling effects of arthritis and eye problems, suchas cataracts and diabetes induced retinopathies.

9.3

6.4

7.0 7.1 7.0

8.3

7.5

6.0

6.5

7.0

7.5

8.0

8.5

9.0

9.5

1982 1989 1994 1999

(In

Millions)

Actual Older Persons with DisabilityProjected at 1984 Disability Prevalence

Figure 18Past Estimatesand ActualNumbers ofAmericans 65and Older witha ChronicDisabilitySource: AARPPublic PolicyInstitute. Based on1994 National Long-Term Care Surveyand U.S. CensusBureau Population,Middle Series.

122

Evidence from the National Long-Term Care Survey and SocialSecurity data demonstrates that disability declines are associatedwith a higher educational level and white-collar occupations.Continuing increases in educational levels and improvement inworkplace safety suggest that disability rates will continue theirdecline. Therefore, projections assuming that current disabilityrates will not continue their downward trend could produceinaccurately high forecasts.

Survey data indicates that the impairment rate of Florida’s elderpopulation is seven percent less than the national rate,contributing to a relatively low nursing home occupancy rate incomparison with other states. Additional evidence comes fromthe 2000 Census, which reports that, even though Floridianshave overall slightly higher physical disability rates, theirdisabilities are less likely to be of the type concomitant with theneed for supportive care. The Census also reports that theprevalence of severe disability (two or more disabilities,including a self-care disability) among elder Floridians is 17percent lower than the national average.

According to 2004 Department of Elder Affairs needs assessmentfindings, over 90 percent of Florida elders surveyed said thatthey are able to do personal tasks either “always” or “most of thetime.” Rural elders are more likely to respond this way; poorand minority elders are less likely to respond this way. (SeeFigure 19.)

Statewide

70% 75% 80% 85% 90% 95% 100%

Poor

Rural

Minority

Figure 19Percent ofElders WhoAre Always orMost of theTime Able toDo BasicPersonalTasks

Source: Assessing theNeeds of Elder Floridians,2004, Department ofElder Affairs

123

Less than half of those who need help with personal care receivesuch help either “always” or “most of the time.” Poor and ruralelders who need help are more likely to receive the help they

need. Onlyabout one-thirdof minorityelders are ableto get thepersonal carethey need. (SeeFigure 20.)

Statewide, over85 percent of

elders surveyed said that they are able to do householdmanagement tasks on their own either “always” or “most of thetime.” All three special populations were less likely to respond

this way. Minority eldersare the least likely torespond this way. (SeeFigure 21.)

Among those who needhelp with householdmanagement tasks, someare more likely to get thishelp than others.Statewide, slightly more

than half of these elders are able to gethelp with household management tasks if they need it. Ruralelders are slightly more successful in getting this help. However,less than 40 percent of minority elders and less than 20 percent ofpoor elders are able to get help with household managementwhen they need it. (See Figure 22.)

0%

10%

20%

30%

40%

50%

60%

70%

Statewide Poor Rural Minority

Figure 20Percent ofElders NeedHelp withPersonalTasks, WhoReceive theHelp Always orMost of theTime

Source: Assessing theNeeds of Elder Floridians,2004, Department ofElder Affairs

68%

72%

76%

80%

84%

88%

Statewide Poor Rural Minority

Figure 21Percent ofElders WhoAre Alwaysor Most ofthe TimeAble to DoHouseholdManagementTasks

Source: Assessing theNeeds of Elder Floridians,2004, Department ofElder Affairs

124

Caregiving

The long-term care setting preferred by most elders is their ownhome. To make this happen, family members, neighbors, faith-based organizations and community volunteers are relied uponto provide the bulk of home and personal care services. It isestimated that there are 1,427,899 caregivers in Florida (abouthalf being primary caregivers) currently providing $11.2 billionworth of informal (not for pay) care for disabled Floridians.Nationally, this figure tops $196 billion.4 By comparison,Florida’s total public expenditures on long-term care were about$2.5 billion in state fiscal year 2002-03. Therefore, in Florida, thevalue of informal services provided by caregivers constitutesapproximately 81 percent of the total cost of all long-term care.

Findings of the National Caregivers Survey (1997) show thatabout one in four households in America is involved in caringfor an elderly relative. About 72 percent of those providing careare women, and 68 percent of them are middle-aged or elders.More than 30 percent of caregivers are caring for two or moreelderly relatives or friends, and almost one-fourth of caregiversare dealing with someone who suffers from some form ofdementia.5

The survey also indicates that the average caregiver spends 18hours a week providing care while many spend more than 40hours a week. The typical recipient of care is a 77-year-oldwoman with chronic illnesses. About 64 percent of caregiverswork full-time. Some quit their jobs or retire early to providecare; others take leaves of absence or reject promotions, whilesome try to accommodate the demands of both job andcaregiving.

0% 10% 20% 30% 40% 50% 60% 70%

Statewide

Poor

Rural

Minority

Figure 22Percent ofElders, WhoNeed HelpwithHouseholdManagementTasks, AreAble to GetHelpAlways orMost of theTime

Source: Assessing theNeeds of ElderFloridians, 2004,Department of ElderAffairs

125

Results from a recent survey of caregivers conducted by theDepartment of Elder Affairs (DOEA) suggest that the greatestnegative effects of caregiving are on household finances, with 62percent of caregivers reporting that caregiving creates a financialburden. The survey also suggests that about one-fourth ofcaregivers are very frail and at high risk of discontinuing theircaregiving. This survey also reported that the most frequentlyrequested service by caregivers was help in navigating the mazeof social and medical agencies that administer services to elders.6

Programs that assist caregivers are highly cost effective. Forexample, it is estimated that the Home Care for the Elderly(HCE) program, a caregiver cash-support program targetedtoward caregivers of elders at high risk of nursing homeplacement, provides a savings of almost five-dollars in nursinghome costs for every dollar spent by the program.7

Caregivers are also a critical component in the formal long-termcare system. Without caregivers, the most impaired elders beingserved in the community through formal publicly-funded long-term care programs would not be able to stay out of nursinghomes without substantially increasing their care plan costs. Forexample, only 32 percent of DOEA customers who are atmedium risk for nursing-care placement have a caregiver. Incontrast, 66 percent of those at very high risk of nursing homeplacement have a caregiver. Without such caregivers, customerswould require either nursing home based care or a much moreexpensive publicly funded care plan.

A study done by the Florida Policy Exchange on Aging Centerdetermined that “whereas exactly half of Florida’s nursing homelong term residents require assistance with all five activities ofdaily living, fully 40 percent of the state’s home and community-based clients who have informal caregivers also need help withthe five activities of daily living. When considering the specificamount of assistance needed with individual activities of dailyliving among the very impaired, the home and community-basedsample was found to have a substantially higher percentageneeding total help than was found in the nursing home sample.The home and community-based services clients who live withinformal caregivers were also more likely to have severeimpairment than nursing home residents.”8

126

According to the Department of Elder Affairs needs assessmentsurvey, statewide, about 23 percent of elders are caregivers. Thispercentage is fairly consistent among poor and minority eldersas well. Rural elders are more likely to be caregivers. (SeeFigure 23.)

Statewide, caregivers choose respite care most often if they couldhave multiple services or are limited to one service choice.Emotional support and information about resources are the nextmost common choices, if any number of services could be chosenor if they could only choose one.

Low income, rural and minority elders are more interested ininformation about resources for elders than respite services. Theresults of the needs assessment survey identify the need forgreater outreach among the three subgroups. The types ofservices needed by minority, rural and poor elders varyconsiderably. Programs that target caregivers should focus onthe unique needs of the clients (See Figures 24 and 25.)

0% 10% 20% 30%

Statewide

Poor

Rural

MinorityFigure 23Percent ofElderFloridiansWho AreCaregivers

Source:Assessing theNeeds of ElderFloridians, 2004,Department ofElder Affairs

127

Rural Issues

The number of elders living in urban areas is about five timesgreater than those living in rural areas, according to the Floridadata of the 2000 U.S. Census. Figure 26 shows the distribution ofthe rural population.

Formal long-term care availability in rural areas is limitedbecause of a low target population density that makes theprovision of services unattractive for home health provideragencies. Some policymakers assume that providing services inrural areas is less expensive due to lower unit labor costs.However, rural service providers have to deal with issues relatedto lower density, such as longer travel times and severe shortagesof qualified workers, factors that often make service provisionmore expensive than in urban areas.

0%

20%

40%

60%

80%

Statewide Poor Rural Minority

Respite, Relief or Time OffEmotional supportInformation about resourcesFinancial helpHelp with household Chores TransportationPersonal Care HelpCare Training

Figure 24For ThoseWho NeedHelp withCaregiving,What Kindof Help isWanted(ChoosingAnyNumber)

Source:Assessing theNeeds of ElderFloridians,2004, Departmentof Elder Affairs

Statewide Poor Rural Minority0%

10%

20%

30%

40%Figure 25For ThoseWho NeedHelp withCaregiving,What Kindof Help isWanted(ChoosingOnly One)

128

Rural customers of long-term careservices, whether frail elders or theircaregivers, often face a lack of choiceand service availability due to fewerservice providers operating in the ruralareas. This situation can result inearlier institutional placements relativeto urban areas that have more servicesavailable. Unmet transportation needsare particularly acute in rural areas.

Affordable and available housingoption needs for elders are especiallyevident in rural areas, where the elderpopulation was 400,000 in the year2000. Overwhelmingly, these eldersprefer to own their own homes, andmany do. Most people who live in rural areas do so by choice,but many aging rural residents are finding they need housingalternatives, such as rental housing or assisted living facilities.The scarcity of housing options significantly inhibits housingchoices for elders in rural Florida.Access to Health Care

Statewide, over 85 percent of Florida elders surveyed said thatthey are always able to get medical care. Rural elders are aboutas likely to respond this way as the general population. Minorityelders are the least likely to respond this way and are the onlygroup in which less than 75 percent responded that they werealways able to get medical care. (See Figure 27.) Access tomedical care might be related to differences in insurancecoverage.

Figure 26Rural PopulationDensity of within thePopulation Age 60And OlderBy County

Source: Department of ElderAffairs based on Office ofEconomic and DemographicResearch, Florida Legislature

65% 70% 75% 80% 85% 90%

Statewide

Poor

Rural

Minority

Source: Department of ElderAffairs based on Office ofEconomic and DemographicResearch, Florida Legislature

Figure 27Percent ofElders WhoAre AlwaysAble to GetMedical Care

129

Since the survey targeted elders age 60 and older, some of theelders were not old enough to be eligible for Medicare. Even so,not all elders are eligible for Medicare on their 65th birthday.Although the percentage of elders not covered by any insuranceis low relative to the under 65 population (20.6 percent, Florida

HospitalAssociation),these eldersmight findprivate medicalinsurance nearlyimpossible toacquire. Poorand minorityelders are themost likelygroups not to

have any insurance. (See Figure 28.)

Of particular concern, even among insured elders, is theaffordability of items not typically covered by Medicare.Department of Elder Affairs’ needs assessment survey revealsthat there are about 600,000 that had to do without dental careand about 400,000 that had to delay acquiring eyeglasses in thelast 12 months because of a shortage of money. Overall, aboutthree quarters of elder Floridians had to limit health care due tofinancial concerns. Overall, access was limited to a higher degreeamong poor, minority and rural elders. (See Figure 29.)

0%

2%

4%

6%

8%

Statewide Poor Rural Minority

Figure 28Percent ofEldersWho DoNot HaveHealthInsurance

Source:Assessing the Needsof Elder Floridians, 2004,Department of Elder Affairs

0%

5%

10%

15%

20%

25%

30%

35%

Drugs Eyeglasses Dental Care Hearing Care

All Poor Rural Minority

Figure 29Percent ofEldersWho HadtoPostponeor Dowithout inthe Last12 Months

Source:Assessing the Needsof Elder Floridians,2004, Department ofElder Affairs

130

Access to Information

Most Florida elders get information about what is happening intheir community from the newspaper. The newspaper was themost popular means of getting information for each of thespecial populations as well. Poor and minority elders are aboutas likely to get information from television as they are fromnewspapers. (See Figure 30.)

Elders can, and do, receive information from a number ofdifferent sources. Responses to this survey question can behelpful in determining the most effective ways of disseminatinginformation to elders.

Access to Food

Statewide, about 90 percent of Florida elders surveyed reportthat they are able to get all of the food they need. Florida’s ruralelders are slightly more likely to have all of the food they need.Florida’s poor elders are the least likely to be able to get all of thefood they need all of the time. (See Figure 31.)

0%10%20%30%40%50%60%70%80%

Statewide Poor Rural Minority

NewspaperTelevision

RadioFamily, Neighbors and Friends

Community Newsletters, Flyers or Internet By Being Active in the Community

Figure 30Percent ofEldersWhoReceiveInformationthroughVariousSources

Source:Assessing theNeedsof ElderFloridians, 2004,Department ofElder Affairs

131

Even though90 percent ofelders get all ofthe food theyneed, thatleaves almost400,000 inFlorida who donot. Lack ofparticipation inthe U.S.

Department of Agriculture’s Food Stamp Program for Florida’spoor elderly is aproblem. (SeeFigure 32.)

Financial issuesare the mainreason whyelders are notalways able toget all of the foodthey need.Health

conditions that make eating difficult is the next most commonreason. Difficulty in preparing food is the third main reason.This ranking is consistent across the subgroups. Successfulstrategies for improving elder access to food will depend on the

reasonsrestrictingaccess.Figure 33presents thereasonselders are notable to get allthe food theywant.

70%

75%

80%

85%

90%

95%

Statewide Poor Rural Minority

Figure 31Percent ofEldersWho GetAll theFood TheyNeed (Allof theTime)

Source:Assessing the Needsof Elder Floridians,2004, Department ofElder Affairs

Non Participants66%

Participants34%

Figure 32Percent of Eligible EldersWho Participate in the FoodStamp Program 2004

Source:Assessing the Needsof Elder Floridians, 2004,Department of Elder Affairs

0%10%20%30%40%50%60%70%80%

Statewide Poor Rural Minority

Not enough money, no transportationHealth and/or physical problems

Difficulties preparing food /Don't like to eat alone

Figure 33Reasons WhyElders Are NotAble to Get Allthe Food TheyNeed (All ofthe Time)

Source:Assessing the Needsof Elder Floridians,2004, Department ofElder Affairs

132

Senior Centers and Focal Points

Over 90 percent of Florida elders surveyed said that they “neveror hardly ever” go to a senior center. Poor elders are the leastlikely to respond this way; however, over 82 percent of thispopulation said they never or hardly ever go to a senior center.This lowparticipationrate could reflecta special niche ofclients on whomsenior centerstend to focus orcould indicate agreater need foroutreach bysenior centers.(See Figure 34.)

When asked for the reason why they do not go to the seniorcenter, most elders responded that they don’t want to go. Thisreason is the most common for the three subgroups as well. Thisresponse suggests that senior centers might have an imageproblem. (SeeFigure 35.)Other reasonsinclude a lackof time and alack ofawareness ofsenior centers.These resultswereconsistent intheir rankorder for eachof the subpopulations.

76% 80% 84% 88% 92%

Statewide

Poor

Rural

Minority

Figure 34Percent ofElders WhoNever orHardly EverGo to aSeniorCenter

Source:Assessing the Needsof Elder Floridians,2004, Department ofElder Affairs

0%

10%

20%

30%

40%

50%

60%

70%

Statewide Poor Rural Minority

Don't want to go to senior centerDon't have time/other responsibilitiesLack of awareness

Figure 35Main ReasonsElders Give forNot Going to aSenior Center

Source:Assessing the Needsof Elder Floridians,2004, Department ofElder Affairs

133

Access to Transportation

According to the survey, most older Floridians are fully capableof driving. Over 70 percent of Florida elders surveyed said thatnothing limits them from driving. Elders living in high povertyareas are more likely to have limitations in their driving.However, about half of elders living in high poverty areas are

able to drivewhenever theywish. (SeeFigure 36.)

Nonetheless,over onemillion elderFloridians arelimited in theirability to drive.This situationrepresents a

major challenge for transportation providers. Among the elderswho reported limitations in their driving, health and age issuesare the most common. Other reasons given include financialconsiderations, including insurance, gas or car maintenanceexpenses; having never learned to drive; and certain limitations

related to nightdriving, weatherconditions,highway drivingand other specialconditions. Poorelders are morelikely to belimited in theirdriving, andmost likely to belimited by healthconditions andfinancialrestrictions. (SeeFigure 37.)

0%10%20%30%40%50%60%70%80%

Statewide Poor Rural Minority

Figure 36Percent ofElders WhoHave NoDrivingLimitations

Source:Assessing theNeedsof Elder Floridians,2004, Departmentof Elder Affairs

0%

5%

10%

15%

20%

25%

Statewide Poor Rural Minority

Health or AgeCannot or Do Not DriveEnvironment (Night, Distance, Weather)Financial Limitations

Figure 37What LimitsElders FromDriving

Source:Assessing theNeedsof ElderFloridians, 2004,Department ofElder Affairs

134

Most Florida Elders Feel Valued byCommunity

Over 80 percent of Florida elders surveyed said that they feeltheir community values older people. Rural elders are morelikely to feel valued. Even though poor elders are less likely tofeel that elders are valued in their city or town, a strong majoritydo feel valued.(See Figure 38.)the Departmentof Elder Affairs ’Communities fora Lifetimeprogram mighthave an impacton this sense ofvalue by drawingattention to theimportant roleseniors play inFlorida’scommunities.

When asked whythey felt thecommunityvalued or did notvalue elders,most eldersresponded withbroad generalstatements. Twoconceptsappeared fairlyoften in surveyresponses: “nice people” and “being treated/not treated withrespect.” Respondents who said that their communities valuedelders tended to attribute this to “nice people,” while elders whodid not feel valued attributed this to lack of respect by theircommunities. Issues regarding respect are more pronounced inthe high poverty areas and among minorities than other groups(See Figures 39 and 40.)

Statewide

60% 65% 70% 75% 80% 85%

Poor

Rural

Minority

Figure 38Percent ofElders WhoFeel Their Cityor TownValues OlderPeople

Source:Assessing theNeedsof Elder Floridians,2004, Department ofElder Affairs

0%

10%

20%

30%

40%

50%

60%

70%

Statewide Poor Rural Minority

Other

Don't KnowTreated/ Not Treated with RespectTransportation Availability/ Lack of

Nice/ Not Nice People

Figure 39Reasons EldersFeel Their City orTown ValuesOlder People

Source:Assessing the Needsof Elder Floridians,2004, Department ofElder Affairs

135

Access to Housing

Statewide, less than ten percent of Florida elders surveyed notedthat they had housing problems, such as repairs, upkeep orcrime. Housing problems are more common among the specialpopulations, especially among Florida’s poor elders. (See Figure41.)

For those elders reporting problems with their homes, the needfor major repairs is the most common issue. Minor repairs andupkeep is the second common problem. Environmental (pestcontrol, flooding, etc.), landlord and other problems tend to bemore common among elders living in high poverty areas andminorities. (See Figure 42.)

0%

10%20%

30%40%

50%60%70%80%

Statewide Poor Rural Minority

Figure 40Reasons EldersFeel Their City orTown Does NotValue OlderPeople

0% 2% 4% 6% 8% 10% 12% 14%

Statewide

Poor

Rural

MinorityFigure 41Percent of Elderswith HousingProblems

Source:Assessing the Needsof Elder Floridians,2004, Department ofElder Affairs

Other

Don't KnowTreated/ Not Treated with RespectTransportation Availability/ Lack of

Nice/ Not Nice People

136

Advocacy and Consumer Protection

Less than a third of elders surveyed were aware that Florida hasspecial programs and low-cost legal services that protect eldersfrom overly aggressive sales people. Poor and minority eldersare the least likely to be aware of these programs. (See Figure43.) Since poor and minority elders are among Florida’s mostvulnerable populations and arguably the most in need of theservices, greateroutreach to thoseelder populationsmight make theseprograms moreeffective.

0%

10%

20%

30%

40%

50%

60%

70%

80%

Statewide Poor Rural Minority

Major RepairsToo Much Upkeep/Minor Repairs

EnvironmentalOtherLandlord IssuesHigh Crime/Bad Neighborhood

Figure 42The Nature ofElders’ Problemswith TheirHomes

Source:Assessing the Needsof Elder Floridians,2004, Department ofElder Affairs

0%

5%

10%

15%

20%

25%

30%

Statewide Poor Rural Minority

Protection from overly aggressive sales people

Low-cost legal services to help older adults

Figure 43Percent ofElders WhoAre Aware ofSpecialPrograms

Source:Assessing theNeedsof ElderFloridians, 2004,Department ofElder Affairs

137

Some Floridaelders havemade purchasesor financial/legalcommitments asa result ofpressure tactics.These problemsare morepervasiveamong eldersliving in highpoverty areas(see Figure 44).Since these

elders are some of the most vulnerable people in the state,increased awareness of this issue and greater outreach ofprograms that help seniors avoid these problems would behelpful in reducing victimization of elders by consumer fraud.

Volunteering

One way that elders contribute to the community is throughvolunteering. Overall, about 30 percent of Florida’s eldersvolunteer. Part of the Department of Elder Affairs ’ mission is tofacilitate the work of volunteers. The annual value of thecontributions by volunteers age 60 and older is estimated to be$2.5 billion. Rural elders are more likely to volunteer. (SeeFigure 45.) Elder Floridians are generous with their time. In the

year 2000,elderscontributedvolunteertime andtalenttotaling 7.5millionperson days.

0% 10% 20% 30% 40%

Statewide

Poor

Rural

MinorityFigure 45Percent ofElder WhoVolunteer

3.8%4.5%

2.3%2.5%

5.8%6.3%

5.1%

4.1%

1%

2%

3%

4%

5%

Statewide Poor Rural Minority

Florida elders who have bought something because of feeling pressured or threatened

Florida elders who have felt pressured to make financial or legal commitments they did not agree with

0%

7%6%

Figure 44ThePercentage ofFlorida EldersWho HaveBeenPressured IntoCommitments

Source:Assessing theNeedsof ElderFloridians, 2004,Department ofElder Affairs

138

Older Floridians volunteer for a large variety of programs.However, most volunteer for community programs and religiousgroups. Other programs include volunteer efforts sponsoredschools and senior centers. Many seniors volunteer for multipleprograms across multiple categories. Rural elders are morelikely to volunteerfor religiousgroups than thecommunity atlarge. (See Figure46.)

Employment

Florida elders are a vital part of the state’s workforce. Accordingto the needs assessment survey, nearly a quarter of elders areworking. (See Figure 47.) Minority elders are more likely to beemployed than other elders. Older Floridians work in a widevariety ofpositionsandsituations.

0%

10%

20%

30%

40%

50%

60%

70%

Statewide Poor Rural Minority

Community

Church

School

Other

Senior Center

None of the Above

Figure 46OrganizationsWhereEldersVolunteer

Source:Assessing theNeedsof ElderFloridians,2004,Departmentof ElderAffairs

0%

5%

10%

15%

20%

25%

30%

Statewide Poor Rural Minority

Figure 47Percent of EldersWho AreEmployed

Source:Assessing the Needsof Elder Floridians,2004, Department ofElder Affairs

139

Of those elders in Florida who are unemployed, roughly a thirdare interested in full or part-time work. A smaller percentage isinterested in job training. Fewer still believe they have beenrefused a job because of age. Unemployed elders living in highpoverty areas are more likely to be interested in full or part-timework or job training. Unemployed elders living in rural areas areless likely to be interested in full or part-time work or jobtraining. (See Figure 48.)

Elders as Consumers

Historically, Florida’s economy has rested on three legs: tourism,agriculture and retirees. A healthy retirement industry is criticalfor the ongoing prosperity and well-being of the state of Florida.Direct spending by mature Floridians9 and the value of theirfederal health benefits is estimated at $150 billion. From a fiscalperspective, Florida’s elder residents represented a net benefit of$2.8 billion in taxes, to state and local governments, in the year2000.

Every month in the year 2004, $3.5 billion in Social Security andmilitary retirement payments are transferred to Floridianresidents; these payments represent over $75 billion in direct andindirect spending. Federal transfers on behalf of matureFloridians account for about 40 percent of the amount of Florida’stotal share of federal revenue. In that same year, for every dollarthat Florida workers and employers paid in Social Security taxes,the state received $1.26 in social security benefits for its citizens.10

0%5%

10%15%20%25%30%35%40%

Statewide Poor Rural Minority

Unemployed and interested in full or part-time work

Unemployed and would like job trainingFeel have been refused a job because of age

Figure 48WhatUnemployedElders AreLooking For

Source:Assessing theNeedsof ElderFloridians,2004,Department ofElder Affairs

140

Trends and Conditions In Long-Term Care

Trends in supply and demand for elder services and care can beexplained on the basis of population growth patterns anddisability rates. Disability rates are, in turn, dependent ondemographic factors, particularly age, health conditions andavailable medical and assistive technologies. In addition, thedemand for publicly financed services will be influenced by theeconomic conditions of the elder population, the availability ofinformally (not for pay) provided care, the affordability ofprivately provided formal (for pay) care and the public’s attitudetowards using public assistance services.

In Florida, a very small percentage, 2.4 percent, of the populationage 65 and older reside in nursing homes; this number comparesvery favorably with the national average of 4.3 percent.10

Floridians age 65 and over are 45 percent less likely to requirelong-term nursing home care than elders from other states.11

Possible reasons for Florida’s lower demand for nursing homecare include Florida’s lower disability rates, a specialized supplyof medical services and assistive technologies and affordableoptions for custodial care. The supply of medical services andassistive technologies and the affordable options for custodialcare are made possible by the state’s high incidence of elders andfavorable migratory patterns.

Relative to the rest of the country, Florida has a rich supply ofspecialized medical services and assistive technologies whichresult in lower disability rates among elders and inimprovements to caregivers’ health. Lower disability ratesreduce the number of people requiring nursing home care ontwo accounts. It reduces the number of disabled personspotentially requiring nursing home care and, at the same time,increases the supply of able caregivers who can provide carelonger and at a higher intensity.

141

Demand for Long-Term Care

Favorable migratory patterns also help reduce Florida’s demandfor nursing home care. The large majority of elders who relocateto Florida after retirement are “amenity seeking” retirees. Theyare characterized by good health and economic self-sufficiency,and most are married. These retirees are usually young elders intheir sixties. On the other hand, Florida has a net outflow ofelders relocating due to increasing frailty, severely disabledmigrants, who relocate seeking nearness to adult children, andreadily available of nursing home facilities. According to Census2000 figures, Florida had a net migratory loss of persons age 85and older.

Florida’s demand for nursing home care is further reduced by theavailability of affordable substitutes for custodial care, mostnotably assisted living facilities. These options will be discussedbelow under the heading “The Supply of Long-Term Care inFlorida.” Alternative projections of Medicaid nursing home

utilization areillustrated in Figure49.

The trendsrepresented in thechart show future usepatterns of long-termnursing home carethat are in keepingwith the decline inthe overall incidencerate of severedisability among theaged. This chart

shows a range of three alternative scenarios. The first scenarioshows the forecasted number of nursing home bed months underthe assumption of declines in disability rates that are consistentwith the declines observed from 1989 through 1994. Thisrepresents the medium growth scenario and projects nursinghome bed use to grow by 20 percent between the years 2000 and2020.

500,000

540,000

580,000

620,000

660,000

700,000

740,000

780,000

820,000

2000 2005 2010 2015 2020

Bed

Month

sPer

Year

89-94 Decline Projected LTC Financing Model94-99 Decline Projected

Figure 49Projected Demandfor MedicaidNursing HomeBeds. AlternativeScenarios inFlorida (2000-2010)

Source:Florida Department of ElderAffairs. Projections based onNational Long-Term CareSurvey: Disability Rates 1989-1999. Population Projections,Economic and DemographicResearch, Florida Legislature.

142

The second scenario assumes that disabilities will continue todecline at the rates observed from 1994 through 1999. Thisscenario represents the low growth option and projects amarginal absolute decline between the years 2000 and 2020.

The third scenario is the high growth option based on theassumptions of a national model developed by the Lewin Group,which assumes mortality and disability declines of 0.6 percentper year, for a total growth in demand of 42 percent over thetwenty year period.

These scenarios yield annual growth rates in the Medicaidnursing home caseload of 0.67 percent, 1.36 percent and 0.17percent for the medium, high and low scenarios, respectively.

Additional evidence about Florida’s declining growth rate in theuse of Medicaid nursing home care is provided by nursing homeutilization historical reports from the Agency for Health CareAdministration.Figure 50 showsthat the growth inMedicaid nursinghome bed day usehas been decliningsteadily for at least12 years, even as thepopulation age 75and older wasgrowing at anaverage rate of 3.1percent per year.

While acute care is temporary and episodic, with a focus onrestoration of health, long-term care has a focus on trying to helpa person manage an irreversible disabling condition. Long-termcare can be provided in a variety of settings: in the home withformal (paid) assistance; informal (unpaid) assistance by familymembers, relatives or friends; or in a long-term care facility. In-home formal assistance includes community-based long-termcare that encompasses an array of interventions such as day care,caregiver respite and in-home services, including personal careand home-delivered meals.

1.00

1.10

1.20

1.30

1.40

1.50

1989 1991 1993 1995 1997 1999 2001

Medicaid Bed Utilization Population 75+

Figure 50The Relative Growth ofMedical Nursing HomeBed Day Utilization andPopulation Age 75+ inFlorida (1990-2001)

Source:Florida Department of ElderAffairs based on Agency forHealth Care Administrationreports and EconomicDemographic Research,Florida Legislature

143

A variety of service providers comprise the community-basedlong-term care system. They can range from senior centers,which also provide many preventive services, to Councils onAging, home health agencies and others. Many of these agenciesprovide a host of services. Others may provide a single servicethrough a contractual agreement with the case management orlead agency. Long-term care facilities in Florida are comprised ofnursing homes, assisted living facilities and adult family carehomes.

Occupancy rates in nursing homes have declined from about 91percent in 1990 to 85 percent in 2001, even though the populationage 85 and older grew very rapidly during the same period.Since 2001, the occupancy rate has inched up to a current level of87 percent, possibly due to the nursing home bed moratoriumestablished in 2001 by the state legislature.

Unfortunately, the scenarios regarding control in the growth ofMedicaid expenditures for nursing homes are not so positive.Per diem reimbursement rates have been growing at a fast pacefor the last few years. Indeed, from January 1997 to July 2002,this amount went from $93.25 to $136.89 for a compoundedgrowth rate of 7.3 percent per year. A continuation of recent

trends in per diemreimbursementgrowth would resultin expenditure growthdoubling the nursinghome Medicaidbudget every tenyears, for acompounded growthof 490 percent from2000 through 2020.(See Figure 51.)

These figures suggest that, in order to control the Medicaidnursing home budget, there is a need to control the growth in thecaseload through community diversions and the growth in theper diem reimbursement to nursing homes. A projection ofnursing home caseload growth through 2020 yields a growth rateof less than one percent per year. Assuming per diem increasesequal to the general inflation rate, growth would yield a

1.00

1.25

1.50

1.75

2.00

2.25

1991 1993 1995 1997 1999 2001

Rela

tive

Gro

wth

Medicaid Bed Utilization Nursing Home Budget Growth

Figure 51The RelativeGrowth ofMedicaid NursingHome Bed DayUtilization andNursing HomeBudget in Florida(1990-2001)

Source:Florida Department of ElderAffairs based on Agency forHealth Care Administrationreports.

144

projected future cost of $2.5 billion in constant 2003 dollars for anet increase of 20 percent. On the other hand, if per diemreimbursementrates were toincrease at therate observedover the lastfive years - fivepercent overinflation - theprojectedfuture cost, inconstant 2003dollars, wouldbe $5.5 billionfor a netincrease of 164 percent. (See Figure 52.)

Since caseload assumptions are the same under both of thesescenarios, the difference in the projected level of expenses for2020 is due only to differences in per diem assumptions, and theenormous size of such differences points to the importance ofreimbursement rates vis-à-vis caseloads in budget control.

Home and Community-Based ServicesSupply

Under Medicaid rules, all qualified individuals are entitled tothe services included in the state’s Medicaid plan. Since nursinghome care is part of the state Medicaid plan, it is a Medicaidentitlement. On the other hand, most Medicaid home andcommunity-based services (HCBS) are provided on a “waiver”basis. Therefore, unlike nursing home long-term care, home andcommunity-based services are not entitlements for medicallyand economically qualified persons. Federal Medicaidparticipation requirements mostly determine which services arecovered by the state plan. However, states can elect to addoptional services. Examples of such services are prescriptiondrugs, physical therapy, durable medical equipment andcommunity mental health.

2003 2020

Co

nsta

nt20

03D

olla

rs

$2.5 Billion

$5.5 Billion

Per diem increaseequal to inflation

Per diem increase equal to 5% over inflation

$2.1 Billion

Figure 52Projected FutureFlorida MedicaidNursing HomeCosts in Constant2003 Dollars(2003-2020)

Source:Florida Department of ElderAffairs

145

On the other hand, provision of home and community-basedservices is dependent upon availability of appropriations withinthe state budget and federal approval of “waivers” to Medicaidrules. Unlike nursing home care, non-Medicaid programsprovide much of the funding for HCBS.

HCBS non-independent housing options in Florida’scommunities include adult family care homes (AFCHs), assistedliving facilities (ALFs) and ALFs within public housing. Theseforms of non-independent housing provide elders with neededpersonal services in a supportive, residential environment. Thereis wide diversity in the accommodations, types of servicesoffered and overall cost among these non-independent housingcategories. A significant problem in Florida is that the supply ofthese types of housing arrangements is very limited in ruralareas.

Generally speaking, assisted living is a residential setting thatprovides housing, meals, personal care services, 24-hour

supervision andsocial andrecreationalactivities. In the1990s, assistedliving was thefastest growingtype of elderhousing, with anestimated 15 to20 percent annualgrowth rate, withless than 19,000beds in 1991 to

about 75,000 beds in 2003. Over the past few years, however,there has been a slight decline. As of December 2003, there wereabout 2,250 licensed assisted living facilities in Florida. (SeeFigure 53.)

There is little doubt that the emergence of the ALF industry hashad a major impact on the demand for nursing home beds. Thegrowth of ALFs in the 1990s corresponds with a decline in thegrowth rate of the nursing home industry. For non-Medicaidparticipants, assisted living is an affordable, more appropriatealternative to nursing home care.

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

1991 1993 1995 1997 1999 2001 2003

Nursing Home Beds ALF Beds

Figure 53Number ofLicensed NursingHome andAssisted LivingFacility Beds inFlorida (1991-2003)

Source:Agency for Health CareAdministration

146

There is evidence that in Florida, a significant proportion of ALFresidents exceeds the minimum acuity criteria for nursing homeplacement. The estimates of this proportion vary from a low of20 percent to a high of 30 percent.12 Based on these estimates, itis possible that nearly 20,000 potential nursing home patients areserved in assisted living facilities at substantial savings to thestate. In contrast to the nursing home industry, most ALFresidents are private pay.

The concept of allowing elders to age in their own communitiesand avoid nursing home placement has led to several innovativeprograms. For example, with the assistance of the Departmentof Elder Affairs ’ Coming Home Program, public housingauthorities have recently begun to explore and utilize assistedliving as way to serve their elder-housing consumers.

Currently, there are three housing authorities in Florida thathave successfully licensed assisted living facilities. Bycombining federal housing subsidies with available assistedliving programs in Florida, these housing authorities are able toprovide assisted living services to low-income, subsidizedhousing consumers who, without services, would be at-risk ofdisplacement or nursing home placement. Many other housingauthorities have also expressed an interest in pursuing assistedliving facility licensure.

Adult family care homes represent another assisted housingoption for Florida’s elders. As with ALFs, adult family carehomes provide housing, meals and personal services to frailelders and disabled adults. The primary differences betweenassisted living facilities and adult family care homes are thatadult family care home providers must reside in the same homeas the residents they serve, and adult family care homes arelimited to a maximum of five residents. On December 1, 2003,there were 452 licensed adult family care homes in Florida.Public funding for this housing option is limited to the OptionalState Supplementation (OSS) and Assistive Care Services (ACS)programs.

Although significant efforts are being made to increase elders’access to supportive services, as individuals age and becomefrail, their need for a more supportive environment increases. Ifelders do not have access to affordable assisted living options,

147

nursing homes become their only alternative. Without extendingsuch options to lower-income and rural elders, there will be anincrease in the number of households forced prematurely intoinstitutional settings at a higher cost.

System Fragmentation

Florida’s long-term care system involves a complex array ofprograms, services and priorities, all with varying fundingstreams. This complexity can be challenging as consumersbecome more involved in care decisions. Many different stateagencies have one or more long-term care functions. It is notuncommon for several agencies to be involved when a personreceives publicly funded long-term care.

Innovative Programs

Florida is seeking a better system of long-term care that willcontain costs, improve outcomes and increase consumersatisfaction. Developing a system that focuses on prevention andprovides care in the least restrictive setting will involve thecoordination of acute and long-term care services to ensure thatservices are targeted optimally. Another approach is ConsumerDirected Care (CDC). CDC empowers consumers to decide whatthey will need and who will provide the services.

Consumer Directed Care

The CDC program is authorized under a Medicaid 1115 Researchand Demonstration waiver, which allows the state maximumflexibility in program design. Consumers already enrolled in ahome and community-based waiver program are given theopportunity to manage a budget that is based on the value of thehome and community services they were receiving. Theconsumers then hire caregivers of their choice who, unlike intraditional waivers, do not have to be enrolled Medicaidproviders and can be family members. DOEA implemented theprogram for elders in various areas of the state, achievingmeasurable success in improving consumer satisfaction andattaining cost neutrality compared to the traditional home and

148

community-based service waiver model. During its 2002session, the Florida Legislature authorized expansion of theprogram to other areas of the state.

Home Care for the Elderly

Another program that increases consumer autonomy is HomeCare for the Elderly (HCE). Under HCE, caregivers receive amonthly cash subsidy that can be used for any purpose. Thesubsidy is relatively small, but since it is targeted to the poorestcaregivers, its impact is substantial.

Consumer Directed Care and HCE are different in severalrespects. CDC is a Medicaid program and provides thecustomer with spending authority that can only be used topurchase HCBS. Also, the customer/provider relationship ismediated by a “fiscal intermediary” who makes payments andretains tax deductions from payments made to thenontraditional providers. The amount of the monthlyallowances under CDC is comparable to those provided underthe existing traditional Medicaid HCBS program. On the otherhand, the HCE subsidy is much smaller but can be used for anypurpose, including paying for groceries, utility bills, non-medical supplies, etc. The HCE subsidy is a straight cashpayment to the caregiver. Internal DOEA estimates suggest thatHCE provides a savings of almost five dollars in nursing homecosts per dollar spent by the program.

The Department of Elder Affairs is also pursuing models tointegrate services in nontraditional locations, such as publichousing. To facilitate aging in place, the department is seekingalternatives to augment traditional approaches and settings.Portability of payment, such as having vouchers individuals canuse for any provider, including assisted living facilities, adds tothe flexibility of options and creates greater consumersatisfaction.

149

Managed Care Approaches

Managed care is a strategy to maximize the use of long-term careresources. An important aspect of managed care is theintegration and case management of long-term care social andmedical needs. There is evidence that medical in-home care caneither substitute for non-medical home and community-basedservices or boost their positive effects. The net effect is thatfederal Medicare dollars substitute or boost the effects of stateMedicaid funds. Therefore, integration of services reduces theuse of state funds by substituting Medicaid waiver services withMedicare health care services or by reducing the incidence ofnegative fiscal outcomes, such as hospitalization or nursinghome placements.

Access to Long-Term Care

Access to services and choice of care options can be limited bynumerous factors, such as the payer source, immediacy of need,knowledge of care options and availability of care options withinthe community. People who have not had experience with thesystem are often unaware of the challenges faced by frail eldersentering the system.

Early planning can make the long-term care process easier andhelp elders to receive preferred care options when care is needed.Pre-planning can also reduce unnecessary expenditures incurredas a result of premature and inappropriate institutionalization.Education for elders and their caregivers can provide thefoundation for informed choices, resulting in cost-effectiveservice delivery and increased consumer satisfaction.

Accessing information on services and choice options can beconfusing. Many entities provide limited information aboutsocial services which can help individuals enter and progressthrough the system. Hospitals, Community Care for the Elderlylead agencies, mental health providers, public housing offices,Department of Children and Families, nursing homes andassisted living facilities are a few examples.

150

Access to each may be limited, depending on where the elderlives or is receiving acute care. To help simplify access toinformation and referral services, the Department of ElderAffairs created the Elder Helpline. A statewide toll-free numbercan connect elders with the resources to meet their needs.National elder care information sources have also beendeveloped. The Elder Care Locator provides referrals anywherein the country through a single toll-free number. The Internethas also increased information availability throughout thecountry.

End Notes

1. Trends In Long Term Care Services Finds Longer Life Does Not Result in MoreDisabilities, AARP Trends, Senior Journal.Com: www.seniorjournal.com/NEWS/Features/3-01- 17AARPtrends.htm.

2. County Level 2002 data provided by the Department of Elder Affairs Research Unit.Based on Census 2000; FloridaLegislature Office of Economic and DemographicResearch.

3. Freedman, Vicki A. and Martin, Linda G. “Contribution of Chronic Conditions toAggregate Change in Old Age Functioning” American Journal of Public Health, Vol. 90pp. 1755- 1760.

4. Extrapolations by the Department of Elder Affairs Planning and Evaluation Unit fromthe 1996 National FamilyCaregiver Survey. “End of Life Care Workgroup Report”,Department of Elder Affairs, December 31, 2000.

5. The National Caregivers “Caregivers Survey”, The National Alliance for Caregivingand the American Association of Retired Persons, May 1997.

6. DOEA Planning and Evaluation Unit Cost/Benefit Analysisof HCE programs, 2002.

7. Survey of DOEA Caregivers. DOEA Planning and Evaluation Unit. 2002.

8. Polivka, Dunlop, and Brooks, “Florida Long Term Care Elder Population Profiles” 1997as reported in Polivka, Larry and Oakley, Mary “Long-Term Care in Florida: Past,Present, and Future 2002.” Florida Policy Exchange on Aging.

9. Department of Elder Affairs Estimate based on Current Population Survey andConsumer Expenditures Survey 2003.

10. Federal Tax Burdens and Expenditures by State. The Tax Foundation Special Report#139; March 2006: Washington, D.C.

11. Reynolds-Scanlon, Sue, PhD., et. Al., Profiles of Older Floridians: Report 2, FloridaPolicy Exchange Center on Ag ing, February 2002.

12. Across the States 2000: Profiles of Long-Term Care Systems, AARP, Public PolicyInstitute, Washington, D.C., 2000.

151

152

Appendix BAppendix BAppendix BAppendix BAppendix B

153

154

Inventory ofInventory ofInventory ofInventory ofInventory ofAgency ElderAgency ElderAgency ElderAgency ElderAgency ElderServicesServicesServicesServicesServices

n keeping with section 430.03(5), F.S., the departmentshall “coordinate interdepartmental policy development

and program planning for all state agencies that provide servicesfor the elderly population in order to prevent duplicative efforts,to maximize utilization of resources, and to ensure cooperation,communication, and departmental linkages.” The followingtable includes services of particular interest to elders identifiedby each of the agencies that participated in the drafting of theMaster Plan on Aging, 2007-2009.

IIIII

For more information on theseprograms, please contact each

agency directly. For departmentcontact information, go to http://

www.myflorida.com.

155

Note: While every attempt has been made to list all programs and agencies of particularrelevance for elders, some may have been inadvertantly omitted.

Organization/Unit Programs/Service

Licensed Home Health Programs

Long-Term Care Waivers, Nursing Home Policy, CARES,

PASRR

Long-Term Care Facility Licensure and Regulation

Managed Care Ombudsman Program

Managed Care Services

Medicaid Pharmacy Services

Medicaid Services

Statewide Provider and Subscriber Assistance Program

Family Care Council

Support Services for Developmentally Disabled Individuals,

Direct and Contracted Services

Employment Related Supportive Services

One Stop Career Employment and Training Services

Services for Job Seekers and Employers

Support Service Referrals to Local Community-Based

Organizations and Agencies

Training for High Skill Occupations

Veterans' Workforce Programs

Workforce Florida, Inc.

Workforce Grant Listings

Florida Elder Crime Practioner Designation Program

Florida Prescription Drugs Pricing Website:

MyFloridaRx.com Oversight

Operation Spotcheck

Patient Abuse and Neglect (PANE) Program

Seniors vs. Crime-Senior Storefront

Smart Consumers Can Stop Fraud: A Guide for Seniors

TRIAD Partnership

Victim Services

Agency for Workforce

Innovation

Attorney General's

Office

Agency For Persons

with Disabilities

Agency for Health

Care Administration

156

Note: While every attempt has been made to list all programs and agencies of particular relevance for elders, some may have been

inadvertantly omitted.

Organization/Unit Programs/Service

A to Z Guide

Consumer Complaint Clearinghouse

Consumer Outreach

Consumer Regulatory Programs

General Consumer Protection Services and Consumer Hotline

Nutrition For Seniors Brochure

Customer Service Assistance Hotline

Employment Service Location

English Proficiency Assistance

Hotline for Unlicensed Activity

Literacy Comprehension Assistance

Special Protection to Elders as Victims of Licensing Crimes

Volunteer/Paid Opportunities

Adult Community Mental Health Program

Adult Protective Services Program--In Home and Institutional

Economic Self Sufficiency Program (Medicaid)

Home Safe Net Tracking System Database

Homelessness Services

In-Home Community Services

Investigation of Abuse Claims

Refugee Services

Substance Abuse Program

Department of

Agriculture and

Consumer Services

Department of

Children and Families

Department of

Business and

Professional Regulation

157

Note: While every attempt has been made to list all programs and agencies of particular relevance for elders, some may have been

inadvertantly omitted.

Organization/Unit Programs/Service

Affordable Housing Technical Assistance

Blueprint For Safety

Community Planning/Visioning

Community Services Block Grant

Family Preparedness

Front Porch Florida

Hazard Mitigation Planning

HUD Consolidated Plan for Special Needs Populations

Hurricane Preparedness

Interagency Partnerships

Low Income Home Energy Assistance Program

Low-Income Emergency Home Repair Program

Mass Migration Planning

Rural Land Stewardship Areas Program

Small Cities CDBG Program

Transportation Planning

Water Supply Planning

Weatherization Assistance Programs

Community Transition

Health Services to Inmates

VINE, Victims' Rights

Braille and Talking Book Library Services

Independent Adult Living Program

Workforce Education/Adult Ed Programs

Department of

Education

Department of

Corrections

Department of

Community Affairs

158

Note: While every attempt has been made to list all programs and agencies of particular relevance for elders, some may have been

inadvertantly omitted.

Organization/Unit Programs/Service

Alzheimer’s Disease Programs

Caregiver Support

CARES Program

Communities for a Lifetime Initiative

Community Care for the Elderly (CCE) Program

Disaster Preparedness Partnerships

Disaster Response

Early Prevention/Intervention Programs

Elder Abuse Prevention Program

Elderly Housing Unit

Florida Affordable Assisted Living Web site

Health Promotion and Wellness Initiatives

Home and Community-Based Services

Hospice and Alzheimer's Disease Rule Writing

Housing Advocacy and Partnerships

Intergenerational Programs

Legal Services Development Program

Long-Term Care Ombudsman Program

Nutritional Services

Senior Community Service Employment Program

Senior Companion Programs

Serving Health Insurance Needs of Elders (SHINE)

Statewide Public Guardianship Program

Supportive Community Care

Transportation Advocacy and Partnerships

Volunteer and Support Services

Department of Elder

Affairs

159

Note: While every attempt has been made to list all programs and agencies of particular relevance for elders, some may have been

inadvertantly omitted.

Organization/Unit Programs/Service

Accessibility at State Parks

Clean Air Florida Program

Greenways and Trails System

Internal Improvement Trust Fund

Senior Camping Discounts

Volunteer Opportunities

Water Resources

Community Outreach Programs

Complaint Services

Consumer Assistance Hotline

Funeral and Cemetary Hotline

Interagency Partnerships

Regulatory Licensing Registry and Information Dissemination

TRIAD Partnership

AIDs/HIV Programs

Arthritis Prevention and Education

Board of Nursing/Health Care Practitioner Regulation

Cancer Awareness Program

Chronic Disease Prevention

Community Health Services

Correctional Medical Authority

Healthy Communities, Healthy People Program

Hearing Aid Program

Heart Disease and Stroke Program

Immunization Services

Osteoporosis Prevention and Education

Prevention and Intervention Services

Public Health Dental Program

Public Health Nursing

Rural Health Program

Step Up, Florida Program

Substance Abuse Program

TB and Refugee Health Services

Trauma Services

You Can! Campaign

Department of Health

Department of

Financial Services

Department of

Environmental

Protection

160

Note: While every attempt has been made to list all programs and agencies of particular relevance for elders, some may

have been inadvertantly omitted.

Organization/Unit Programs/Service

Driver Improvement Courses

Financial Insurance Program

Florida At-Risk Council

Florida GrandDriver

Florida Motorcycle Rider Program

Medical Advisory Board

Tag Agencies

TRIAD Partnership

Neighborhood Accountability Boards

TRIAD Partnership

Victim Services

Computer Crime Center

Identity Theft Resource Center

TRIAD Partnership

ADA Working Group

Clearinghouse on Disability Information

DROP Program

Living Wills

Real Choice Partnership Project

Department of Military

AffairsForward March Program

Property Tax Exemptions

Revenue Service Centers

Archeology Education Programs

Arts and Cultural Programs/Grants

Corporation Information Web site

Florida Center for Creative Aging

Florida Electronic Library

Florida Main Street Program

Florida Memory Project

Free Senior Museum Admission

Historic Preservation Programs

Lifelong Learning Opportunities

Public Library Programs/Grants

Publications and Web Information about Florida

State Library and Archives Programs and Resources

Voter Registration Information

Department of State

Department of

Revenue

Department of

Highway Safety and

Motor Vehicles

Department of Juvenile

Justice

Department of

Management Services

Department of Law

Enforcement

161

Note: While every attempt has been made to list all programs and agencies of particular relevance for elders, some may have been

inadvertantly omitted.

Organization/Unit Programs/Service

Elder Road User Program

Florida Transportation Plan

FTA-10

FTA-53-11

Interagency Partnerships

Intercity Bus Program Coordination

Multi-Modal Planning

New Starts Programs

Physical Access Design Procedures

Safety Grants

Safety Program

Transit Funding

"Well Elder" Customer Survey

Aid and Attendance Program (In-Home and ALF Services)

Domiciliary Home Care

Exemption of Homesteads

Handicapped Toll Permit

Hunting and Fishing License

License Plates/Parking Permits

Medal of Honor Recipients

TRICARE Program

Tuition Deferment

Veterans' Preference in Employment and Retention

Hunting Safety

Wildlife Recreation Opportunities

Safety Education

Victim Advocates

Department of

Transportation

Department of

Veterans' Affairs

Florida Fish and

Wildlife Conservation

Florida Highway

Patrol

162

Note: While every attempt has been made to list all programs and agencies of particular relevance for elders, some may have been

inadvertantly omitted.

Organization/Unit Programs/Service

Affordable Housing Locator Web site

Elder Housing Loan Committee

Home Modification/Repair Through the Local SHIP Program

Home Universal Design

Homeownership Loan and First-Time Buyers Program

Networking/Marketing

Referral to Affordable Housing and Disaster Relief/Recovery

Resources

Supportive Services Network

Florida Lottery Council on Compulsive Gambling (Senior Help)

Project Safe Neighborhoods

Victim Services

Consumer Assistance

Florida Relay Service

Lifeline Assistance Program/Link-up Florida

Digital Divide Council

HIPAA Compliance

Commission Ombudsmen Program

Community Transportation Coordination Program

Disabled Toll Permits

Medicaid Non-Emergency Transportation Program

Rural Capital Equipment Grant

Transportation Disadvantaged Trust Fund

United We Ride Program Administration

Florida Housing

Finance Corporation

Parole Commission

Transportation

Disadvantaged

Commission

Public Service

Commission

State Technology

Office

163

164

Appendix CAppendix CAppendix CAppendix CAppendix C

165

166

50 RESOLUTIONS As Voted by 2005 WHCoA Delegates

Monday, December 12, 2005 (unranked)

Res. 1 Provide Financial and Other Economic Incentives and Policy Changes to Encourage and Facilitate Increased Retirement Savings

Res. 4 Establish Principles to Strengthen Social Security Res. 5 Foster Innovations in Financing Long-Term Care Services to Increase Options

Available to Consumers Res. 7 Strengthen Law Enforcement Efforts at the Federal, State, and Local Level to

Investigate and Prosecute Cases of Elder Financial Crime Res. 9 Modernize the Supplemental Security Income (SSI) Program Res. 10 Strengthen the Social Security Disability Insurance Program Res. 11 Remove Barriers to the Retention and Hiring of Older Workers, Including Age

Discrimination Res. 12 Promote Incentives for Older Workers to Continue Working and Improve

Employment Training and Retraining Programs to Better Serve Older Workers Res. 14 Expand Opportunities for Developing Innovative Housing Designs for Seniors’

Needs Res. 15 Encourage Redesign of Senior Centers for Broad Appeal and Community

Participation Res. 17 Reauthorize The Older Americans Act Within The First Six Months Following

The 2005 White House Conference On Aging Res. 18 Encourage Community Designs to Promote Livable Communities that Enable

Aging in Place

167

168

Res. 19 Create a National Strategy for Promoting Elder Justice Through the Prevention

and Prosecution of Elder Abuse Res. 21 Support Older Drivers to Retain Mobility and Independence through Strategies

to Continue Safe Driving Res. 22 Ensure That Older Americans Have Transportation Options to Retain Their

Mobility and Independence Res. 23 Enhance the Availability of Housing for Older Americans Res. 24 Enhance the Affordability of Housing for Older Americans Res. 25 Encourage the Development of a Coordinated Federal, State, and Local

Emergency Response Plan For Seniors in the Event of Public Health Emergencies or Disasters

Res. 26 Support Older Adult Caregivers Raising Their Relatives’ Children Res. 28 Promote Economic Development Policies that Respond to the Unique Needs of

Rural Seniors Res. 29 Promote Enrollment of Seniors into the Medicare Prescription Drug Program Res. 30 Develop a Coordinated, Comprehensive Long-Term Care Strategy by

Supporting Public and Private Sector Initiatives that Address Financing, Choice, Quality, Service Delivery, and the Paid and Unpaid Workforce

Res. 31 Apply Evidence Based Research to the Delivery of Health and Social Services

Where Appropriate Res. 32 Evaluate Payment and Coordination Policies in the Geriatric Healthcare

Continuum to Ensure Continuity of Care Res. 33 Promote the Importance of Nutrition in Health Promotion and Disease

Prevention and Management Res. 34 Improve The Health And Quality Of Life Of Older Americans Through Disease

Management And Chronic Care Coordination Res. 36 Improve Recognition, Assessment, and Treatment of Mental Illness and

Depression Among Older Americans Res. 37 Prevent Disease and Promote Healthier Lifestyles Through Educating Providers

and Consumers on Consumer Healthcare

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170

Res. 39 Improve Health Decision Making Through Promotion of Health Education,

Health Literacy, and Cultural Competency Res. 40 Attain Adequate Numbers of Healthcare Personnel in All Professions Who are

Skilled, Culturally Competent, and Specialized in Geriatrics Res. 41 Support Geriatric Education And Training For All Healthcare Professionals,

Paraprofessionals, Health Profession Students, And Direct Care Workers Res. 42 Promote Innovative Models of Non-Institutional Long-Term Care Res. 43 Ensure Appropriate Care for Seniors with Disabilities Res. 44 Reduce Healthcare Disparities Among Minorities by Developing Strategies to

Prevent Disease, Promote Health, and Deliver Appropriate Care and Wellness Res. 46 Promote Innovative Evidence-Based and Practice-Based Medical And Aging

Research Res. 47 Encourage Appropriate Sharing Of Healthcare Information Across Multiple

Management Systems Res. 48 Ensure Appropriate Recognition and Care For Veterans Across All Healthcare

Settings Res. 50 Strengthen and Improve the Medicaid Program for Seniors Res. 51 Strengthen and Improve the Medicare Program Res. 52 Educate Americans on End of Life Issues Res. 53 Improve Access To Care For Older Adults Living In Rural Areas Res. 55 Improve Patient Advocacy to Assist Patients in and Across All Care Settings Res. 56 Develop a National Strategy for Promoting New and Meaningful Volunteer

Activities and Civic Engagements for Current and Future Seniors Res. 59 Reauthorize the National and Community Service Act to Expand Opportunities

For Volunteer and Civic Engagement Activities Res. 61 Promote the Integration of Health and Aging Services to Improve Access and

Quality of Care for Older Americans

171

172

Res. 62 Develop Incentives to Encourage the Expansion of Appropriate Use of Health Information Technology

Res. 67 Develop a National Strategy for Supporting Informal Caregivers of Seniors to

Enable Adequate Quality and Supply of Services Res. 69 Implement a Strategy and Plan for Accountability to Sustain the Momentum,

Public Visibility, and Oversight of the Implementation of 2005 WHCoA Resolutions

Res. 71 Improve State and Local Based Integrated Delivery Systems to Meet 21st

Century Needs of Seniors Res. 72 Review Alignment of Government Programs That Deliver Services to Older

Americans

173

174

Appendix DAppendix DAppendix DAppendix DAppendix D

175

176

Concurrency Matrices - Policy Domain Themes

*WHCOA=2005 White House Conference on Aging Resolutions

Policy Domain

Comprehensive List of Master Plan Objectives Fo

rmal

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Simplify, expedite and improve the ability of elders to access long-term care information and an integrated array of health and social supports

x x x

Develop a f lexible funding system that has predictability of costs, encourages cost containment and is sustainable in the long run (WHCOA 5)

x

Ensure that program administration is transparent and competitive and that service providers are accountable through contracting standards and performance measures

x

Coordinate and integrate a holistic approach to the long-term care system to improve outcomes, reduce complexity, streamline the system, and make it easier to use

x x

Continually monitor and evaluate programs and services to ensure high quality and cost-effectiveness and to consider the effects of public policies and program design on the market for privately paid long-term care

x

Rebalance the long-term care system from nursing homes to more cost-effective community options (WHCOA 42)

x x x

Administer publicly funded long-term care on the axioms that quality of life and consumer autonomy are at the root of the ideal long-term system

x x

Increase the visibility and aw areness of caregiver issues and the value of caregivers

x

Support incentives to assist caregivers xStrengthen and develop tools to assess family needs w ith emphasis on the social and physical w ell-being of caregivers

x

Include caregiver counseling, education and training services in Medicaid w aiver programs

x

Strengthen programs that compensate caregivers xEncourage private sector to offer incentives and programs to assist caregiving

x

Strengthen resources and support for grandparents raising grandchildren (WHCOA 26)

x

Provide a streamlined interagency caregiver helpline w ith linkage to help, information and services

x

Develop and disseminate information tools for caregivers xStrengthen system of formal supports for caregivers xPromote individual planning for future self-care x

177

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Concurrency Matrices - Policy Domain Themes

*WHCOA=2005 White House Conference on Aging Resolutions

Policy Domain

Comprehensive List of Master Plan Objectives Fo

rmal

Lo

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rep

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s

Eld

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ts

Increase and enhance housing options, capacity and access for all elders and persons w ith special needs statew ide

x

Maximize available housing resources, including housing affordability subsidies for all elders and persons w ith special needs

x

Preserve existing rental and homeow nership units xIntegrate elder and special needs housing into all aspects of community planning, development and management at the local, state and federal levels (WHCOA 14)

x

Maintain a comprehensive and current understanding of short and long-term housing issues, needs, trends, resources and capacity specif ic to elders and as part of the general population

x

Maintain a current or “real-time” aw areness and know ledge of the inventory and availability of elder and special needs rental units statew ide

x

Disseminate comprehensive and current information regarding elder and special-needs housing to policymakers, planners, developers and providers, I&R professionals, and the general public

x

Enable elders and persons w ith special needs to live in the residence and community of their choice for a lifetime

x

Expand the transportation planning process to address elder issues

x

Expand availability and affordability of alternative transportation for elders (WHCOA 22)

x

Provide universal access to sites that might be inaccessible due to roadw ay or other barriers to prevent inadvertant discrimination against non-drivers (WHCOA 22)

x

Improve scheduling and timeliness of alternative transportation/provide real-time information (WHCOA 22)

x

Enhance transportation interagency/ intergovernmental coordination partnerships and activities

x

Implement a planning process for improved coordination of transportation services

x

Improve intergovernmental coordination on disaster transportation plans

x x

Develop a process for driver assessments and information/referral (WHCOA 21)

x

Encourage techniques for optimizing customer satisfaction on the quality of transportation services and the fulf illment of client needs (WHCOA 22)

x

Promote techniques that move people eff iciently from one location to another (WHCOA 22)

x

179

180

Concurrency Matrices - Policy Domain Themes

*WHCOA=2005 White House Conference on Aging Resolutions

Policy Domain

Comprehensive List of Master Plan Objectives Fo

rmal

Lo

ng

-T

erm

Car

e

Info

rmal

Lo

ng

-T

erm

Car

e

Ind

epen

den

t H

ou

sin

g

Tra

nsp

ort

atio

n

Hea

lth

an

d

Wel

lnes

s

Em

plo

ymen

t an

d

Vo

lun

teer

ism

Dis

aste

r P

rep

ared

nes

s

Eld

er R

igh

ts

Support older drivers to ensure safe mobility and independence and to assist w ith the transition to driving cessation (WHCOA 21)

x

Promote policies that provide for safe mobility (WHCOA 21) xEnhance and promote a safe roadw ay and pedestrian environment (WHCOA 22)

x

Expand the transportation planning process to address safety and security

x

Promote the creation of transit-oriented developments (WHCOA 22)

x x

Promote mixed-use development that increases access to transportation facilities (WHCOA 22)

x x

Promote and increase the availability of affordable housing near access to transportation (WHCOA 22)

x x

Develop transportation-related measures to assist elders to age in place

x x

Increase transportation funding for elder programs xPromote better use of existing funds for transportation xDevelop an investment policy for transportation funds xEncourage and promote healthy aging through early intervention and prevention programs

x

Ensure that seniors are f inancially secure to meet obligations, purchase necessary medical services and prescription drugs and other vital necessities of life. Support local, state and federal programs that target f inancial viability of seniors, including Social Security, Medicare, Medicaid, local taxes, public policies, etc.

x

Ensure that Americans have transportation options to retain their mobility and independence (WHCOA 22)

x x

Develop a coordinated federal, state and local emergency response plan for seniors in the event of public health emergencies or disasters (WHCOA 25)

x x

Attain an adequate number of personnel in all health care professions w ho are skilled, culturally competent and specialized in geriatrics (WHCOA 40)

x

Support older adults in making complex health care decisions xIncrease the number of service models that offer integrated health and aging services (WHCOA 61)

x

181

182

Concurrency Matrices - Policy Domain Themes

*WHCOA=2005 White House Conference on Aging Resolutions

Policy Domain

Comprehensive List of Master Plan Objectives Fo

rmal

Lo

ng

-T

erm

Car

e

Info

rmal

Lo

ng

-T

erm

Car

e

Ind

epen

den

t H

ou

sin

g

Tra

nsp

ort

atio

n

Hea

lth

an

d

Wel

lnes

s

Em

plo

ymen

t an

d

Vo

lun

teer

ism

Dis

aste

r P

rep

ared

nes

s

Eld

er R

igh

ts

Decrease the w aiting period for older adults w ho need mental health and substance abuse services. (WHCOA 36)

x

Support improvements in senior nutrition programs (WHCOA 33)

x

Encourage community designs to promote livable communities that enable aging in place (WHCOA 18)

x x

Foster innovations that prevent sight and hearing loss and that aid older adults w ith sight and hearing-loss and other physical and mental disabilities to actively engage in their communities

x

Promote the development of a comprehensive oral health program to reduce dental diseases, including dental caries, periodontal diseases and oral cancer; and to reduce associated risks of diseases that are show ing interrelatedness to periodontitis

x

Develop active learning opportunities for elders to increase know ledge on f inancial planning, life planning, retirement and exposure to employment opportunities

x

Promote older w orker skills/reliability/availability xProvide skill upgrading and retraining for elders xIncrease intergenerational pairing for know ledge transfer/opportunities

x

Promote w ellness programs for elders in the w orkplace x xSeek to reduce barriers to employment and volunteer opportunities

x x

Encourage the integration of a coordinated federal, state and local emergency response plan for elders in the state’s Comprehensive Emergency Plan (CEMP) in the event of public health emergencies, catastrophic events or disasters

x x

Provide education, demographic information, training and technical assistance on disaster planning and emergency response for elders to increase public aw areness, create a culture of preparedness and provide expertise to local, state and federal off icials

x

Support efforts to improve access and transportation to special needs shelters, including improvements to the special needs registry, and ensure the appropriateness of services available at special needs shelters

x x x

Support efforts to improve and standardize special needs shelter procedures for discharge planning and transition assistance for elders in the event of a public health emergency, catastrophic event or disaster

x x x

Develop a comprehensive planning template and sample plan for communities to use in preparing to address unique needs of elders to mitigate the effects of public health emergencies, catastrophic events and disasters

x x

Seek support to identify resources available to locate and contact elders in the general population w ho are not currently receiving assistance or services from the aging netw ork but w ho may require assistance during a public health emergency, catastrophic event, pow er outage or disaster

x x

183

184

Concurrency Matrices - Policy Domain Themes

*WHCOA=2005 White House Conference on Aging Resolutions

Policy Domain

Comprehensive List of Master Plan Objectives Fo

rmal

Lo

ng

-T

erm

Car

e

Info

rmal

Lo

ng

-T

erm

Car

e

Ind

epen

den

t H

ou

sin

g

Tra

nsp

ort

atio

n

Hea

lth

an

d

Wel

lnes

s

Em

plo

ymen

t an

d

Vo

lun

teer

ism

Dis

aste

r P

rep

ared

nes

s

Eld

er R

igh

ts

Work w ith local emergency response agencies and county emergency operations centers to maximize their ability to plan for and meet the needs of elders in the event of public health emergencies, catastrophic events or disasters

x x

Raise aw areness of importance of legal services to seniors (WHCOA 72)

x

Increase access to legal services for elders w ho cannot afford an attorney

x

Improve ability of providers to address issues most impacting seniors

x

Increase funding to ensure adequate provision of no or low cost legal services

x

Expand education on alternatives to guardianship (WHCOA 52)

x

Increase public guardianship funding (WHCOA 34, 36, 43) xExpand guardianship monitoring (WHCOA 7) xEnhance crime prevention and sensitivity programs related to the elderly population for elder consumers and provider agencies

x

Promote intergenerational and cross-cultural education opportunities for consumers and providers

x

Strengthen families through caregiver support, education and access to programs

x x

Strengthen program systems to enhance the Long-Term Care Ombudsman Program’s ability to educate consumers about the protection of residents’ rights (WHCOA 42)

x x

Develop initiatives to increase volunteer ombudsman ranks so residents have “meaningful access” to ombudsman services and that w ill assist the program’s efforts to identify the underlying issues as w e change policy, law s, and regulations to improve residents’ quality of life

x

Strengthen interagency communication on residents' rights xDevelop resources and programs to strengthen education and improve quality and accessibility of information on consumer protection among agencies

x

Develop education programs pertinent to senior related issues, e.g., major current events facing seniors

x

Strengthen community-based, cooperative law enforcement efforts to detect and investigate activities endangering seniors

x

185

186

Appendix EAppendix EAppendix EAppendix EAppendix E

187

188

Concurrency Matrices - Chpt. 430, F.S. Topics

*WHCOA=2005 White House Conference on Aging Resolutions

Chpt. 430, F.S. Topics

Comprehensive List of Master Plan Objectives Ho

usi

ng

Em

plo

ymen

t

Ed

uca

tio

n/T

rain

ing

Med

ical

Car

e

Lo

ng

-Ter

m C

are

Pre

ven

tive

Car

e

Pro

tect

ive

Ser

vice

s

So

cial

Ser

vice

s

Men

tal H

ealt

h

Tra

nsp

ort

atio

n

Lo

ng

-Ter

m C

are

Insu

ran

ce

Inte

rgen

erat

ion

al

Rel

atio

nsh

ips/

Act

ivti

es

Simplify, expedite and improve the ability of elders to access long-term care information and an integrated array of health and social supports

x x

Develop a f lexible funding system that has predictability of costs, encourages cost containment and is sustainable in the long run (WHCOA 5)

x

Ensure that program administration is transparent and competitive and that service providers are accountable through contracting standards and performance measures

x

Coordinate and integrate a holistic approach to the long-term care system to improve outcomes, reduce complexity, streamline the system, and make it easier to use

x

Continually monitor and evaluate programs and services to ensure high quality and cost-effectiveness and to consider the effects of public policies and program design on the market for privately paid long-term care

x

Rebalance the long-term care system from nursing homes to more cost-effective community options (WHCOA 42)

x x x x x x x x x

Administer publicly funded long-term care on the axioms that quality of life and consumer autonomy are at the root of the ideal long-term system

x x x x x x x x x

Increase the visibility and aw areness of caregiver issues and the value of caregivers

x x x

Support incentives to assist caregivers x xStrengthen and develop tools to assess family needs w ith emphasis on the social and physical w ell-being of caregivers

x x x x x

Include caregiver counseling, education and training services in Medicaid w aiver programs

x x

Strengthen programs that compensate caregivers x xEncourage private sector to offer incentives and programs to assist caregiving

x x

Strengthen resources and support for grandparents raising grandchildren (WHCOA 26)

x x

Provide a streamlined interagency caregiver helpline w ith linkage to help, information and services

x

Develop and disseminate information tools for caregivers x xStrengthen system of formal supports for caregivers x xPromote individual planning for future self-care x x

189

190

Concurrency Matrices - Chpt. 430, F.S. Topics

*WHCOA=2005 White House Conference on Aging Resolutions

Chpt. 430, F.S. Topics

Comprehensive List of Master Plan Objectives Ho

usi

ng

Em

plo

ymen

t

Ed

uca

tio

n/T

rain

ing

Med

ical

Car

e

Lo

ng

-Ter

m C

are

Pre

ven

tive

Car

e

Pro

tect

ive

Ser

vice

s

So

cial

Ser

vice

s

Men

tal H

ealt

h

Tra

nsp

ort

atio

n

Lo

ng

-Ter

m C

are

Insu

ran

ce

Inte

rgen

erat

ion

al

Rel

atio

nsh

ips/

Act

ivti

es

Increase and enhance housing options, capacity and access for all elders and persons w ith special needs statew ide x

Maximize available housing resources, including housing affordability subsidies for all elders and persons w ith special needs

x

Preserve existing rental and homeow nership units xIntegrate elder and special needs housing into all aspects of community planning, development and management at the local, state and federal levels (WHCOA 14)

x

Maintain a comprehensive and current understanding of short and long-term housing issues, needs, trends, resources and capacity specif ic to elders and as part of the general population

x

Maintain a current or “real-time” aw areness and know ledge of the inventory and availability of elder and special needs rental units statew ide

x

Disseminate comprehensive and current information regarding elder and special-needs housing to policymakers, planners, developers and providers, I&R professionals, and the general public

x

Enable elders and persons w ith special needs to live in the residence and community of their choice for a lifetime

x

Expand the transportation planning process to address elder issues

x

Expand availability and affordability of alternative transportation for elders (WHCOA 22)

x

Provide universal access to sites that might be inaccessible due to roadw ay or other barriers to prevent inadvertant discrimination against non-drivers (WHCOA 22)

x

Improve scheduling and timeliness of alternative transportation/provide real-time information (WHCOA 22)

x

Enhance transportation interagency/ intergovernmental coordination partnerships and activities

x

Implement a planning process for improved coordination of transportation services

x

Improve intergovernmental coordination on disaster transportation plans

x

Develop a process for driver assessments and information/referral (WHCOA 21)

x

Encourage techniques for optimizing customer satisfaction on the quality of transportation services and the fulf illment of client needs (WHCOA 22)

x

Promote techniques that move people eff iciently from one location to another (WHCOA 22)

x

191

192

Concurrency Matrices - Chpt. 430, F.S. Topics

*WHCOA=2005 White House Conference on Aging Resolutions

Chpt. 430, F.S. Topics

Comprehensive List of Master Plan Objectives Ho

usi

ng

Em

plo

ymen

t

Ed

uca

tio

n/T

rain

ing

Med

ical

Car

e

Lo

ng

-Ter

m C

are

Pre

ven

tive

Car

e

Pro

tect

ive

Ser

vice

s

So

cial

Ser

vice

s

Men

tal H

ealt

h

Tra

nsp

ort

atio

n

Lo

ng

-Ter

m C

are

Insu

ran

ce

Inte

rgen

erat

ion

al

Rel

atio

nsh

ips/

Act

ivti

es

Support older drivers to ensure safe mobility and independence and to assist w ith the transition to driving cessation (WHCOA 21)

x

Promote policies that provide for safe mobility (WHCOA 21) xEnhance and promote a safe roadw ay and pedestrian environment (WHCOA 22)

x

Expand the transportation planning process to address safety and security

x

Promote the creation of transit-oriented developments (WHCOA 22)

x x

Promote mixed-use development that increases access to transportation facilities (WHCOA 22)

x x

Promote and increase the availability of affordable housing near access to transportation (WHCOA 22)

x x

Develop transportation-related measures to assist elders to age in place

x x

Increase transportation funding for elder programs xPromote better use of existing funds for transportation xDevelop an investment policy for transportation funds xEncourage and promote healthy aging through early intervention and prevention programs

x x

Ensure that seniors are f inancially secure to meet obligations, purchase necessary medical services and prescription drugs and other vital necessities of life. Support local, state and federal programs that target f inancial viability of seniors, including Social Security, Medicare, Medicaid, local taxes, public policies, etc.

x x x x

Ensure that Americans have transportation options to retain their mobility and independence (WHCOA 22)

x

Develop a coordinated federal, state and local emergency response plan for seniors in the event of public health emergencies or disasters (WHCOA 25)Attain an adequate number of personnel in all health care professions w ho are skilled, culturally competent and specialized in geriatrics (WHCOA 40)

x x

Support older adults in making complex health care decisions xIncrease the number of service models that offer integrated health and aging services (WHCOA 61)

x x x x

193

194

Concurrency Matrices - Chpt. 430, F.S. Topics

*WHCOA=2005 White House Conference on Aging Resolutions

Chpt. 430, F.S. Topics

Comprehensive List of Master Plan Objectives Ho

usi

ng

Em

plo

ymen

t

Ed

uca

tio

n/T

rain

ing

Med

ical

Car

e

Lo

ng

-Ter

m C

are

Pre

ven

tive

Car

e

Pro

tect

ive

Ser

vice

s

So

cial

Ser

vice

s

Men

tal H

ealt

h

Tra

nsp

ort

atio

n

Lo

ng

-Ter

m C

are

Insu

ran

ce

Inte

rgen

erat

ion

al

Rel

atio

nsh

ips/

Act

ivti

es

Decrease the w aiting period for older adults w ho need mental health and substance abuse services. (WHCOA 36)

x

Support improvements in senior nutrition programs (WHCOA 33)

x

Encourage community designs to promote livable communities that enable aging in place (WHCOA 18)

x x

Foster innovations that prevent sight and hearing loss and that aid older adults w ith sight and hearing-loss and other physical and mental disabilities to actively engage in their communities

x x

Promote the development of a comprehensive oral health program to reduce dental diseases, including dental caries, periodontal diseases and oral cancer; and to reduce associated risks of diseases that are show ing interrelatedness to periodontitis

x x

Develop active learning opportunities for elders to increase know ledge on f inancial planning, life planning, retirement and exposure to employment opportunities

x x

Promote older w orker skills/reliability/availability x x

Provide skill upgrading and retraining for elders (WHCOA 12) x xIncrease intergenerational pairing for know ledge transfer/opportunities (WHCOA 56)

x x x

Promote w ellness programs for elders in the w orkplace xSeek to reduce barriers to employment and volunteer opportunities (WHCOA 11)

x x

Encourage the integration of a coordinated federal, state and local emergency response plan for elders in the state’s Comprehensive Emergency Plan (CEMP) in the event of public health emergencies, catastrophic events or disastersProvide education, demographic information, training and technical assistance on disaster planning and emergency response for elders to increase public aw areness, create a culture of preparedness and provide expertise to local, state and federal off icials

x

Support efforts to improve access and transportation to special needs shelters, including improvements to the special needs registry, and ensure the appropriateness of services available at special needs shelters

x x

Support efforts to improve and standardize special needs shelter procedures for discharge planning and transition assistance for elders in the event of a public health emergency, catastrophic event or disaster

x x

Develop a comprehensive planning template and sample plan for communities to use in preparing to address unique needs of elders to mitigate the effects of public health emergencies, catastrophic events and disasters

x

Seek support to identify resources available to locate and contact elders in the general population w ho are not currently receiving assistance or services from the aging netw ork but w ho may require assistance during a public health emergency, catastrophic event, pow er outage or disaster

195

196

Concurrency Matrices - Chpt. 430, F.S. Topics

*WHCOA=2005 White House Conference on Aging Resolutions

Chpt. 430, F.S. Topics

Comprehensive List of Master Plan Objectives Ho

usi

ng

Em

plo

ymen

t

Ed

uca

tio

n/T

rain

ing

Med

ical

Car

e

Lo

ng

-Ter

m C

are

Pre

ven

tive

Car

e

Pro

tect

ive

Ser

vice

s

So

cial

Ser

vice

s

Men

tal H

ealt

h

Tra

nsp

ort

atio

n

Lo

ng

-Ter

m C

are

Insu

ran

ce

Inte

rgen

erat

ion

al

Rel

atio

nsh

ips/

Act

ivti

es

Work w ith local emergency response agencies and county emergency operations centers to maximize their ability to plan for and meet the needs of elders in the event of public health emergencies, catastrophic events or disastersRaise aw areness of importance of legal services to seniors (WHCOA 72)

x

Increase access to legal services for elders w ho cannot afford an attorney

x

Improve ability of providers to address issues most impacting seniors

x

Increase funding to ensure adequate provision of no or low cost legal services

x

Expand education on alternatives to guardianship (WHCOA 52)

x

Increase public guardianship funding (WHCOA 34, 36, 43) x xExpand guardianship monitoring (WHCOA 7) x xEnhance crime prevention and sensitivity programs related to the elderly population for elder consumers and provider agencies

x x

Promote intergenerational and cross-cultural education opportunities for consumers and providers

x x

Strengthen families through caregiver support, education and access to programs

x x

Strengthen program systems to enhance the Long-Term Care Ombudsman Program’s ability to educate consumers about the protection of residents’ rights (WHCOA 42)

x

Develop initiatives to increase volunteer ombudsman ranks so residents have “meaningful access” to ombudsman services and that w ill assist the program’s efforts to identify the underlying issues as w e change policy, law s, and regulations to improve residents’ quality of life

x x

Strengthen interagency communication on residents' rightsDevelop resources and programs to strengthen education and improve quality and accessibility of information on consumer protection among agencies

x

Develop education programs pertinent to senior related issues, e.g., major current events facing seniors

x

Strengthen community-based, cooperative law enforcement efforts to detect and investigate activities endangering seniors

x

197

198

Appendix FAppendix FAppendix FAppendix FAppendix F

199

200

Acknowledgements

The Department of Elder Affairs wishes to thank the many individuals who

contributed extensively to the production of this document. Input came from

willing participants who graciously gave of their time and effort. This report

represents the knowledge and effort of these valued professionals and citizens.

We are grateful to those individuals from the department who helped chair, lead,

or assist the interagency workgroups. These included the following individuals:

David Oropallo, Formal Long-Term Care interagency workgroup

Laurie Koburger, Informal Long-Term Care interagency workgroup

Christine Kucera, Informal Long-Term Care interagency workgroup

Bill Aldinger, Independent Housing interagency workgroup

Sherilyn Toro, Transportation interagency workgroup

Ken McLeod, Transportation and Health and Wellness interagency

workgroups

Karen Pelham, Health and Wellness interagency workgroup

JoAnn Williams, Employment and Volunteerism interagency workgroup

Nicole Hargraves, Employment and Volunteerism interagency workgroup

Reggie Williams, Employment and Volunteerism interagency workgroup

Fran Brooks, Disaster Preparedness interagency workgroup

Martha Billings, Disaster Preparedness interagency workgroup

George Tokesky, Disaster Preparedness interagency workgroup

Sarah Halsell, Elder Rights interagency workgroup

Michelle Hollister, Elder Rights interagency workgroup

Brian Lee, Elder Rights interagency workgroup

Ann Getman, Elder Rights interagency workgroup

Gail LaRosa, Formal Long-Term Care and Disaster Preparedness

workgroups

We are equally grateful to the many individuals who served on and participated

in these workgroups, including the following:

Julia Kates, ADA Working Group

Alberta Granger, Agency for Health Care Administration

Alisha Bradley-Nelson, Agency for Health Care Administration

Bill McCort, Agency for Health Care Administration

CaraLee Starnes, Agency for Health Care Administration

201

Carol Schultz, Agency for Health Care Administration

Keith Young, Agency for Health Care Administration

Molly McKinstry, Agency for Health Care Administration

Noel Lawrence, Agency for Health Care Administration

Wendy Smith, Agency for Health Care Administration

Judy Meyer, Agency for Workforce Innovation

Mitch Collier, Agency for Workforce Innovation

Monesia Brown, Attorney General's Office

Gwen Worlds, Department of Agriculture and Consumer Services

JR Kelly, Department of Agriculture and Consumer Services

Ali Jaglowski, Florida Department of Health

Carol Scoggins, Florida Department of Health

Christie Brown, Florida Department of Health

Heather Murphy, Florida Department of Health

Karen Eaton, Florida Department of Health

Mike Jacobs, Florida Department of Health

Ray Runo, Florida Department of Health

Susan Allen, Florida Department of Health

Arlene Forbring, Florida Dept. of Business and Professional Regulation

Mike Whitehead, Florida Dept. of Business and Professional Regulation

Carrie Sheffield, Florida Dept. of Children and Families

Chris Shoemaker, Florida Dept. of Children and Families

Linda Riddle, Florida Dept. of Children and Families

Roy Etheridge, Florida Dept. of Children and Families

Barbara Bratcher, Florida Dept. of Community Affairs

Tracy Suber, Florida Dept. of Community Affairs

John Venable, Florida Dept. of Financial Services

Laurie Cain, Florida Dept. of Financial Services

Tom Terfinko, Florida Dept. of Financial Services

Selma Sauls, Florida Dept. of Highway Safety and Motor Vehicles

Jeana Brunson, Florida Dept. of State

Karin Stanford, Florida Dept. of State

Lee Modica, Florida Dept. of State

Bob Romig, Florida Dept. of Transportation

Dean Perkins, Florida Dept. of Transportation

Ed Coven, Florida Dept. of Transportation

Gail Holley, Florida Dept. of Transportation

Steve Murray, Florida Dept. of Veterans’ Affairs

Earl Daniell, Florida Dept. of Veterans’ Affairs

Courtney Heidelberg, Florida Dept. of Veterans’ Affairs

202

Freyja (Harris) Sutherland, Florida Housing Finance Corporation

Howard Glassman, Florida MPO Advisory Council

Dan Keating, Office of Insurance Regulation

Linda Zeigler, Office of Insurance Regulation

Becky Maguire, Office of Persons with Disabilities

Lisa Bacot, Transportation Disadvantaged Commission

In addition, we want to extend thanks to those who contributed input to the plan

by providing public testimony at public hearings throughout the state, including

the following individuals:

Peggy Bailey, Citizen

Joanna Bielak, Hospice of Naples

Daniel Bottamy, Metropolitan Orlando BPAC

Linda Carter, No Person Left Behind

Clarke Dahlgren, AARP

Larry D’Angelo, Citizen

Julia Davis, SWFRPC

June Farrell, FDOT

David Gluck, Citizen

Mark A. Hahn, C of A

Catherine Hanson, Lake County BOCC

Jane Icely, Senior Friendship

Jeff Johnson, AARP Florida Advocacy Manager

Evelyn Jordan, Miami-Dade CAA

Edith Lederberg, Area Agency of Aging of Broward County, Inc.

Mary Y. Cookie Martin, FDHA

Sharon Melton, Alzheimers Association

Yolando Rodriguez, Florida Association of Senior Centers

Sheila Salyer, Fl. Association of Senior Centers

Representative Irving Slosberg, Florida House of Representatives

Casimer J. Smerecki, Citizen

Judy Thames, AARP

Angela Vazquez, Southwest Social Services Program, Inc.

203