Area Agencies on Aging and LongTerm Care Services

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Area Agencies on Aging and Long-Term Care Services
Virginia Department for the Aging
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Mission Statement
Virginia Department for the Aging

• To promote the dignity, independence, and
  security of older Virginians by promoting
  partnerships with families and communities.

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Federal Executive Branch
U.S. Department of Health and Human Services
Administration on Aging
Tribal Organizations (244)
State Units on Aging (56)
Area Agencies on Aging (655)
Local Service Provider Organizations (29,000)
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History of VDA

• 1958 General Assembly created a Commission on
  Aging.
• 1970 Division of State Planning and Community
  Affairs was named the state unit on aging under
  the Older Americans Act.
• 1974 General Assembly created an independent
  Office on Aging.
• 1982 General Assembly created the Virginia
  Department for the Aging.

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What Does VDA Do?

• Coordinates Aging Services in Virginia
• Advocacy, Outreach, Education
• VDA is a State Unit on Aging under the federal
  Administration on Aging (AoA)
• VDA funds Area Agencies on Aging and other
  Providers

Bill MacMillan, 75-year-old, Forest Hill Park
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Older Americans Act (OAA)

• Part of the1965 Great Society Legislation
• The Act has been reauthorized or amended 14
  times, most recently in 2006
• A goal of the original act was the provision of a
  comprehensive array of community-based long-term
  care services

President Johnson signing the OAA in 1965
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Older Americans Act (OAA)

• The federal Older Americans Act provides the
  framework for the provision
• of home and community-based long-term care
  services through the
• nations state agencies on aging and local Area
  Agencies on Aging. The
• Act includes specific Titles
• For Support Services
• Community Based Services and In-Home Services
  adult day care, checking (reassuring contact),
  chore, homemaker, personal care, residential
  repair and renovation.
• Access Services care coordination, information
  and assistance, transportation.
• For Nutrition / Meals
• Congregate (Group) Meals
• Home Delivered Meals (Meals on Wheels)
• For Disease Prevention and Health Promotion
• And for the National Family Caregiver Support
  Program
• Support for grandparents raising their
  grandchildren
• Support for family caregivers

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History of Virginias AAAs

• 1969 - OAA was amended to create model
  demonstration projects across the nation.
  Southeastern Virginia Areawide Model Project
  (SEVAMP) in Norfolk now the Senior Services of
  Southeastern Virginia - was one of the original
  nine.
• 1972 OAA was amended to create the nutrition
  program. Funds from this program allowed
  Virginia to establish a congregate meal program
  in the 25 planning districts.
• 1973 OAA was amended to create the AAAs.
• In Virginia, regions (generally planning
  districts) developed a plan for their area. With
  the states approval of the plan, grants were
  given to start a local AAA.
• Most AAAs were established in 1974 and 1975.
• In 1977 the AAA in planning district 8 (Northern
  Virginia) asked to be split into 5 local
  government AAAs.
• Currently 25 local AAAs.

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AAAs Today

• 25 local AAAs serving every county and city in
  the Commonwealth.
• AAAs are designated by VDA in cooperation with
  their local governments.
• Funding comes from Older Americans Act, the state
  General Fund, local governments, private grants,
  voluntary contributions, and fees (cost sharing).
• Each prepares an Area Plan for Aging Services.
  This plan becomes the bases for the contract with
  VDA.

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Virginias 25 Agencies on Aging By
Organizational Structure
(14) Private, nonprofit
(5) Joint-exercise-of-powers
8D
8B
(5) Local government agencies
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8C
8A
8E
(1) Community Services Board
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6
16
22
10
17
18
5
15
11
14
21
2
4
19
12
3
20
1
13
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Agencies on Aging Target Services To

• Greatest Economic Need income at or below the
  poverty line.
• Greatest Social Need noneconomic factors,
  physical and mental disabilities language
  barriers and cultural, social, or geographical
  isolation (rural), including isolation caused by
  racial or ethnic status, that restricts the
  ability of an individual to perform normal daily
  tasks or threatens the capacity of the
  individual to live independently.
• Frail functionally impaired unable to perform
  at least two activities of daily living without
  substantial human assistance, including verbal
  reminding, physical cueing, or supervision.

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Eligibility for OAA Services

• Age 60 and over (except in the employment
  program)
• Not an entitlement like Social Security,
  Medicare, or Medicaid
• Services can be curtailed due to lack of funding
• Not means tested no verification of ability to
  pay, but AAAs must target those in poverty
• Income information maybe asked to determine
  fee-for-service/cost sharing

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VDAs Role with AAAs is Contractual

• Develop Contracts Based upon local Area Plans
• Disburse Federal and State Funds
• Establish Regulations, Service Standards,
  Policies, Guidelines
• Provide Technical Assistance and Training
• Monitor Program and Fiscal Operations
• Collect Unmet Demand Data

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Services Provided through Virginias Local Area
Agencies on Aging

• Each AAA provides services particularly suited to
  the
• needs of the older individuals living within its
  service
• area. Each AAA is required by the Older
  Americans Act
• to provide access services, in-home services, and
  legal
• assistance services.
• Each AAA is also required by the Older Americans
  Act
• to have an advisory council made up of
  knowledgeable
• persons in the community who can help advise
  their
• AAAs governing board and staff on the unique
  service
• needs found in their communities.

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Selected Long-Term Care Services Provided by
AAAs

• Information Referral/Assistance
• Legal Assistance
• Long-Term Care Ombudsman
• Money Management
• Personal Care
• Public Information /Education
• Residential Repair Renovation
• Respite Care
• Socialization Recreation
• Transportation
• Virginia Insurance Counseling Assistance
  Program (VICAP)
• Volunteer Opportunities

• Adult Day Care
• Care Coordination
• Checking (Reassurance)
• Chore
• Congregate (Group) Nutrition
• Disease Prevention Health Promotion
• Elder Abuse Prevention
• Emergency Services
• Employment (Older Workers Program)
• Fan Care Summer Cooling
• Guardianship
• Health Education Screening
• Home Delivered Nutrition
• Homemaker

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Unmet Demand For Services

• The most recent numbers for the single month of
  April, 2006 provided
• the following figures on unmet demand for
  selected AAA services
• Adult Day Care 88 persons unserved
• Home Delivered Meals 894 persons unserved
• Homemaker Services 1,206 persons unserved
• Personal Care Services 309 persons unserved
• Residential Repair Services 627 persons unserved
• Transportation 520 persons unserved

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What Services do Families Tell us they Want?

• VDA conducts community meetings at least every 4
  years to solicit input from older Virginians and
  their families about services and programs.
• The top three issues that come up at these
  sessions are Transportation, support for family
  caregivers, and personal care services.

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Respite Services

• In the Departments taxonomy of services,
• respite care is a conceptnot a service.
• Any of the services listed in the previous
• slide may provide respite to a family
• caregiver.
• The Department funds two specific respite
• programs the Virginia Respite Incentive Grant
• and the Virginia Respite Initiative Program.

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The Virginia Respite Incentive Grant

• In 2000, the Governor and the Virginia General
  Assembly established the Virginia Respite Care
  Grant Program to provide up to 100,000 in seed
  money to eligible community organizations for
  the development, expansion, or start-up
  operations of respite care services.
• Grants are targeted to areas that are currently
  unserved or underserved by a respite care program
  or adult day care program. Grants may be used to
  develop a respite care program, to build an adult
  day care facility, to expand an existing facility
  or respite program to serve more clients, or to
  renovate/retrofit a building to accommodate a
  respite program or adult day care program to meet
  the community's unmet needs for these services.
• Communities must provide matching local funds.

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The Virginia Respite Initiative Program

• Established in 1988 by the General Assembly to
  provide respite to families providing
  round-the-clock (24 hour) care for persons with
  Alzheimers disease.
• Limited funding from the General Assembly
  restricts the program to only 14 programs 11 of
  the 25 AAAs plus three additional nonprofit
  community service providers.
• Services are limited to 35 hours per month per
  family.
• Families must provide matching funds.
• 60,579 hours of respite services were provided to
  416 individuals in FY 2005.
• Typical services received through this program
  last year included adult day care, personal care,
  homemaker, and hospice services.

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Fiscal Year 2006 AoA Funds
10.2 Million
Title III-B Support Services

4.2 Million
Title III-C1 Congregate (Group) Meals

5.3 Million
Title III-C2 Home Delivered Meals

0.5 Million
Title III-D Preventive Health

3.4 Million
Title III-E National Family Caregivers Program

0.3 Million
Title VII Ombudsman

0.1 Million
Title VII Elder Abuse

2.1 Million
Nutrition Services Incentive Program (NSIP)

26.1 Million
Total Funds
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Fiscal Year 2006 Federal Funds
26.1 Million

3.3 Million

1.0 Million
Restricted Grants

0.6 Million

Total Federal Funds
31.0 Million
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Fiscal Year 2006 VDA Funds
Federal Funds
31.0 Million

15.4 Million
State Funds

Total Funds
46.4 Million
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Excludes Title V
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Virginias Agencies on Aging Services
For October 1, 2004 September 30, 2005
Service Activity Clients Served Service
Unit Service Costs Home Delivered Meals
13,827 2.63 million meals
10,716,000 Congregate (Group) Meals 16,818
905 thousand meals 7,474,000 Transportation
8,236 529,720 one-way trips 5,065,000 Info
rmation Referral 19,471 150,823
contacts 3,455,000 Care Coordination
2,649 43,682 hours 2,770,000 Homemaker
Services 2,404 159,654
hours 2,385,000 Adult Day Care
375 156,539 hours 2,199,000 Personal Care
1,157 163,958 hours 2,108,000
Source 9/30/2005 NAPIS-SPR Report, 9/30/2005
Aging Monthly Reports (AMR)
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Average Age and ADL Deficits for AAA Clients
For October 1, 2004 September 30, 2005

• Service Avg. Age Avg. ADL
• Home Delivered Meals 79 2.7
• Personal Care 82 3.6
• Care Coordination 80 4.2
• Homemaker 80 2.8
• Chore 78 5.2
• Adult Day Care 81 3.4

ADL (Activities of Daily Living) involve needs
with Bathing, Bladder, Bowel, Dressing, Eating,
Toileting, Transferring
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The Typical AAA Client Receiving An In-Home
Service

• Three out of four are female
• The average age is 80
• 1 out of 2 are in poverty
• 1 out of 2 live alone
• Has difficulty bathing, dressing, or eating
• Has incontinence of bladder or bowel
• Receives a home delivered meal

3 out of 5 individuals receiving Homemaker
services live alone.
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Virginia Clients ServedPenetration Rate
For October 1, 2004 September 30, 2005 For
Selected In-Home Services Census
Clients Percent Population gt age 60
1,065,502 32,468
3.0 Population gt age 60 in rural area
299,605 11,904 4.0 Population
gt age 60 in poverty 94,291
12,691 13.5 Population gt age 60,
minority 37,196 6,240
16.8 in poverty Services Adult Day Care,
Care Coordination, Chore, Home Delivered Meals,
Home Maker, and Personal Care Source
9/30/2005 NAPIS-SPR Report 2000 Census
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ConcludingComments or Questions???