Aging

1
Aging Disability Resource Centers (ADRCs)

• Optimizing Consumer Access, Creating Systems
  Change
• Virginia Dize, NASUA
• National Aging and Disability
• IR/A Symposium
• June 7, 2005

2
Why organize access to the long term care
system?

• The coming age wave
• Increasing demand for institutional alternatives
  from consumers and caregivers
• Control/reduce Medicaid spending
• Improve effectiveness and efficiency

3
Efforts to streamline entry to Long Term Care
may include

• Adoption of no wrong door philosophy
• Developing a consumer-centered one-stop
  Information Referral /Assistance resource system
• Bringing together administration of the range of
  long term care service programs, including Older
  Americans Act, Medicaid waiver, state-funded
  HCBS, etc.
• Obtaining an Aging and Disability Resource Center
  grant
• Establishment of a single entry point

4
No wrong door philosophy

• Focuses on seamless access to services no matter
  how or where consumers first encounter the
  service system. Information is the core
  function.
• Brings together service programs, funding
  streams.
• Information technology is a key to success.
• No wrong door philosophy may be applied in an
  information and referral system that serves as
  the virtual doorway to the service system.

5
Consumer-Centered One-Stop Aging Information
System

• Comprehensive information on the full range of
  services and supports
• Responsive to ensure consumers have access to the
  information they need to make fully informed
  decisions
• Coordination Integration - Linkages
• Knowledge Building harness and share the
  collective knowledge base

6
Administration of the Range of Long Term Care

• Objectives
• Respond to the wishes of older people and their
  families
• Reduce/control Medicaid spending
• Decrease nursing home use/increase availability
  of HCBS
• Organized effort to reduce waiting lists

7
Administration of the Range of Long Term Care

• Hallmarks
• Consumer-centered and responsive
• Comprehensive
• Flexible
• Efficient
• Effective

8
Aging Network Role in HCBS

• In addition to OAA programs, 51 SUAs administer
  state-funded HCBS programs
• 33 SUAs administer Medicaid HCBS Waiver programs
  (AL, AR, CA, CT, DE, FL, GA, IL, IN, KS, KY, ME,
  MD, MA, MN, MO, NV, NH, NJ, ND, OH, OK, OR, PA,
  RI, SD, TN, UT, VT, WA, WV, WI, WY)
• AAAs in 23 (of 46 states with AAAs) provide case
  management and/or other Waiver services (AL, AR,
  GA, ID, IL, IN, IA, KS, MD, MA, MI, MS, MO, MT,
  NE, NJ, OH, PA, TN, VT, VA, WA, WI)

9
Aging Network Role in HCBS

• 23 SUAs have administrative responsibilities for
  2001, 2003 2004 Real Choice/Systems Change
  Grants (AL, AK, AR, CO, CT, DE, GA, IN, KS, LA,
  MN, MO, MT, NE, NV, NH, ND, OH, OK, SC, VT, WI,
  WY)
• SUAs administered 2 of the 3 original Cash and
  Counseling Demonstration Projects (AR, FL) and
  serve as the lead agencies for 5 of the 11 new
  projects (AL, NM, VT, WA WV)

10
Single Entry Points

• Provide information
• Streamline application processes
• Address eligibility
• Monitor/oversee services

11
Potential Functions of Single Entry Points

• Information and referral (42)
• Screening (38)
• Assessment (41)
• Functional Eligibility (38)
• Financial Eligibility (17)
• Care plan development (43)

• Service authorization (41)
• Monitoring (43)
• Reassessments (41)
• Protective Services (9)
• Other resource development advocacy tracking
  waiting lists ombudsman services

12
32 States with 43 SEPs

• Arizona Maine
• California Maryland
• Colorado Massachusetts
• Connecticut Michigan
• Delaware Minnesota
• District of Columbia
• Florida Missouri
• Georgia Montana
• Hawaii Nebraska
• Illinois New Hampshire
• Indiana New Jersey
• Kansas North Carolina
• North Dakota

• Ohio
• Oregon
• Pennsylvania
• South Carolina
• South Dakota
• Tennessee
• Vermont
• Washington
• Wisconsin

13
Aging Disability Resource Centers

• Awareness highly visible and trusted resource
• Information and Assistance - one-stop shop in
  the community to support decision-making
• Integrated Access - single entry point to
  publicly funded system, streamlined eligibility
  processes, linkages to private pay resources and
  providers

14
Aging DisabilityResource Centers

• Serve people with disabilities of all ages and
  income levels of identified target groups
• Shift the institutional bias
• Meaningful involvement of consumers

15
Aging and Disability Resource Centers
16
Entry Point System Decisions

• Population served
• Geographic area
• Access functions information, application,
  eligibility

17
INFORMATION

• Can a consumer identify the programs and services
  that she/he may qualify for? Who provides it?
• Does the public know about programs and options?
• -Publicity, web sites, brochures, etc.
• Is information provided to everyone?
• How easy is it to access information?
• Is information complete, in clear and
  understandable language, and in alternative
  formats?

18
APPLICATION

• Is the application process simple and
  coordinated? Who controls it?
• Can you apply for all services at one site?
• Must you go to one designated site or can
  multiple sites help you apply for the range of
  service options?
• What assistance is available to help you complete
  an application?

19
ELIGIBILITY

• Do eligibility rules support home and community
  based care? Who controls it?
• Are financial eligibility requirements the same
  for HCBS and nursing home care?
• Are financial eligibility rules based on
  realistic standards for enabling consumers to
  live in the community and meet their everyday
  needs?
• Can financial eligibility for HCBS be as easily
  established as nursing home eligibility?
• Is a standardized assessment tool used to
  determine functional eligibility for HCBS and
  nursing home care?
• Are the consumers ability to provide self-care
  and preferences regarding the help they need
  taken into consideration in the assessment
  process?

20
References

• Aging and Disability Resource Centers.
  www.aoa.gov www.adrc-tae.org
• The Consumer Direction Tool Kit.
  www.consumerdirection.org
• 40 Years of Leadership The Dynamic Role of State
  Units on Aging. Will be posted at www.nasua.org
• No Wrong Door A Discussion Paper, by Lee
  Bezanson, susan Reinhard and Darrell Jones.
  Unpublished paper.
• Single Entry Points Systems State Survey
  Results. www.hcbs.org
• Vision 2010 and Designing the Aging Information
  Resource System of Tomorrow The Vision 2010
  Self-Assessment Guide. www.nasua.org