Loading...
HomeMy WebLinkAboutCOM 0483.000 2004-2006 qtr or Harry Kim c~ V6,~; Alan R. Parker Mayor Executive nn Aging . ~f Ol:'M~~ County o~ Hawaii OFFICE OF AGING Hilo lagoon Centre, ]OI Aupuni Street, Sui[e 342, Hilo, Hawaii 96720-4262 Phone (808)961-8600 Fax (808)961-8603 Hanama Place, 75-5706 Kuakini Highway, Suite I06, KaiVua-Kona, Hawaii 96740-17SI Phone (808) 327-3597 Fax (808) 327-3599 MEMORANDUM TO: County Councl Members FROM: Ale on Aging DATE: October 4, 2005 SUBJECT: Acing and Disability Resource Center Attached is a binder to provide you with information regarding our recent grant award to establish an Aging and Disability Resource Center (ADRC) in Hawaii County. I hope you find the information informative as well as encouraging. I would like to have the opportunity to discuss this issue with all of you personally. Please call me if you have any questions or would like to discuss this or other aging issues with me. I look forward to working with all of you on this very important issue as well as other issues that impact on our elder population and family caregivers. Thank you. AP Attachment Comm. No. ~10 3 Ref. To: Raf. i`o;a ~C Hawaii County is an Equal Opporluntty Provider anct Employer. An Area Agency on Aging Press Release -Print Friendly Page Page 1 of ] 0 5~ p. Department of Health and Human Services Administration on Aging Back to Previous NEW GRANTS WILL HELP FAMILIES IN 19 STATES FIND NEEDED LONG TERM CARE SERVICES CMS Administrator Mark 13. McClellan, M.D., Ph.D., and Administration on Aging Administrator Josefina Carbonell today announced $15 million in grants to 19 states to create a single source of information and assistance for families navigating the often confusing array of long-term care services available in their communities. The Aging and Disability Resource Center (ADRC) grants are part of the New Freedom Initiative, an administration effort to help overcome barriers to community living for the elderly and disabled. The ADRC grants are jointly administered by CMS and HHS' Administration on Aging. "Resource centers are a tremendous help to families who need to find effective long-teen care for a loved one, often with little time to prepare," said Dr. McClellan. "Chew grants will help these states integrate their varied long-term support programs into a single, coordinated system that will make it easier for families to get the most effective care for their loved ones, usually right in their own communities." Currently, a broad range of programs and services ranging from home-and-community based care to -~titutional support are available to assist older adults and individuals with disabilities. These services are sponsored and supported by numerous agencies and have diverse and sometimes complex eligibility requirements. Individuals and their families who are seeking support services often have difficultly sorting through or even locating community-based services. The result may be unnecessary and costly institutionalization. The ADKC grants are designed to give states flexibility in the development and administration of their programs. Some states may utilize a single agency as the entry point to long-term support while other states will establish centers with multiple sites that may work together to ensure uniform access to long-term care support options. "Aging and Disabihty Resource Center grants offer states the opportunity to create `one stop' entry points to long-term support services," said Administrator Carbonell. "These centers can serve as visible and trusted places for information on long-term care options, to help seniors and people with disabilities get long- term care where they want it_ Our goal is to make ADRCs the foundation for community-based care." States and territories receiving the grants referenced in today's announcement are: Alabama, Arizona, Colorado, District of Columbia, Guatn, Hawaii, Idaho, Kansas, Kentucky, Michigan, Mississippi, Nevada, Ohio, Tennessee, Texas, Vermont, Virginia, Washington and Wyoming. All together, 43 states have received the ttuee-year grants with awards of up to $800,000. For more information on the Aging and Disability Resource Centers Grant program, go to [he AoA web e at hupa/~~~~~~.aoaso~-, the CMS web site at ~~~w.cros.hhs.gov/neti~frcedom/defautr.asp or the Aging and Disability source Center Technical Assistance Exchange at ww~,~.achc-tae.org. Aging and Disability Resource Center Grant Program htto://www.aoa.gov/pres5'pr,~2005/OS_ nog/08_18_OS~r.asp 8/18/2005 Aging and Disability Resource Center Background Information September 12, 2005 In an effort to improve services to our islands caregivers, the Mayor directed the Hawaii County Office of Aging to pursue establishment of a resource center for caregivers and seniors capable of providing in a one-stop setting, information and counseling on long term care issues. "A non-threatening environment needs to be established where any caregiver or senior, regardless of income and/or background, will feel comfortable going to for needed assistance, information and training. As many services as possible should be available there, or brought there, to eliminate the need for referral to numerous agencies. Follow up and continuous monitoring of cases must also be made a part of this service structure" said the Mayor. There is an old maxim that says "timing is everything." It is certainly true in this situation as numerous factors make the otherwise daunting request very exciting. First of all, the Office of Aging is in the process of moving and has been planning a new home to serve as a caregiver resource center. In looking at ways to expand on this concept of a resource center incorporating the Mayor's vision, the Office of Aging entered into a partnership with the State Executive Office on Aging to pursue grant funding for establishment of an Aging and Disability Resource Center (ADRC). The resource center model represents a collaborative effort of the federal Administration on Aging (AoA) and the Centers for Medicare & Medicaid Services (CMS). The ADRC Grants Program supports state efforts to develop "one-stop shop" programs at the community level that will help people make informed decisions about their service and support options and serve as the entry point to the long-term service and support system. The Hawaii County Office of Aging (HCOA) has received notification that the State Executive Office on Aging (EOA) received approval for its grant application to CMS and AoA for establishment of Aging and Disability Resource Centers (ADRC's) in the State of Hawaii. Hawaii County will be the major beneficiary of this three year grant totaling $800,000.00. A single, coordinated system of information and access for all persons seeking long term support will minimize confusion, enhance individual choice and support informed decision-making. It will also improve the ability of state and local governments to manage resources, and to monitor program quality through centralized data collection and evaluation. ADRC programs are required to provide the following services at the community level: Public Education; Information and Counseling on available options; Access to Public Programs, including Medicaid nursing facility care and waiver services; Coordination with Other Programs (e.g., disease prevention, nutrition, transportation, housing); and Prospective Planning to help people to plan ahead for their long term service and supports needs. It is envisioned that the center will also provide: day respite, resource libraries, caregiver resource center, video/conference rooms, interagency office space, office space for AARP volunteers and SAGE Plus volunteers (Medicare/Medicaid counseling) as well as housing key agencies such as the Hawaii County Office of Aging (Area Agency on Aging), Hawaii Center for Independent Living (lead agency for disabilities community), State Department of Human Services, East Hawaii Adult Community Care Services Section (State Medicaid, Social Services lead agency), Services for Seniors (Case Management Agency - Elderly), and others. This is a very exciting undertaking, and the Office of Aging is looking forward to working with all our Partners in Eldercare to make the Aging Network in Hawaii County a model for the rest of the nation. County Finance Director, Bill Takaba, has had discussions with the new owners of the former Sun Sun Lau facility who have expressed interest in working with the county to establish such a center. The facility is ideally located and would provide a very good structural base for development of such a facility. The thought is that the county would lease the facility, and sub-lease to key agencies willing to participate in this endeavor. AGC.?4. 2006 10~14AM ~^~ICE OF AGING (KONA) No~9368 P. 1 ~ T`~ ~ H ~ ~ CD O v ~ '-1 c r. ~,6.'.a x` t~ nU 3 ~n ~r~ ~ ~ o coo' ~ • ~ ~ ~C !4.2 q. ~ ~ ~ cv ~ T. A ~~~~yy -,~`rM1~/ m ~ i~ T WdST IW ~ ^y l~ •1.. ` ~ ~ ~ ~ ~ ~ ~:~.u. V, Aging & Disability Resource Center Steering Committee April 19, 2005 Alan Parker Karleen Yoshioka Executive on Aging District Health Administrator Hawaii County Office of Agirtg Department of Health 101 Aupuni Street, Suite 342 75 Aupuni Street Hilo, HI 96720 Hilo, HI 96720 Ph: 961-8600 Ph: 974-b006 Fax: 961-8603 Fax: 974-6000 amarker(a,gte.net kkyoshio(a~mail.health.state.hi.us William Takaba Chris Ridley Director of Finance Program Coordinator County Department of Finance Alzheimer's Association 25 Aupuni Street 944 West Kawailani Street Hilo, HI 96720 Hilo, HI 96720 Ph: 961-8234 Ph: 981-2111 Fax: 961-8248 Fax: 981-5900 wtakaba ,co.hawaii.hi.us cridley~a,alzhi.org Roy Takimoto Laura Tobosa Deputy Director Neighbor Island Program Director County Planning Department Hawaii Center for Independent Living 101 Pauahi Street, Suite 3 400 Hualani Street, Suite 16D Hilo, HI 96720 Hilo, HI 96720 Ph: 961-8288 Ph: 935-3777 Fax: 961-9615 Fax: 961-6737 ro~takemoto(a~co.hawaii.hi.us cileh a,interpac.net Edwin Taira Debra Nakaji Administrator Director Housing & Comm. Development Services for Seniors 50 Wailuku Drive 101 Aupuni Street, Suite 219 Hilo, HI 96720 Hilo, HI 96720 Ph: 961-8379 Ph: 935-1144 Fax: 961-8685 Fax: 925-1143 ohcd(cFinter~cc.net dishado(a~ihawaii.net Timothy Kitagawa Gerald Takase Administrator Assistant Corporation Counsel Dept. of Human Services Office of Corporation Counsel 224 Haili Street 101 Aupuni Street, Suite 325 hlilo, HI 96720 Hilo, HI 96720 Yh: 933-8820 Ph: 961-8251 Fax: 969-4917 Fax: 961-8622 tkitaaawa(c~dhs.hawaii.i;ov takase c co.hawaii.hi.us a U.S. Department of Health and Human Services ~ - J Administration on Aging Aging and Disability Resource Centers A Joint Program of the Administration on Aging and Centers for ~ Medicare & Medicaid Services -Overview BACKGIZOUNll Resource Center programs will provide In September 2003 IIHS Secretary Tommy information and assistance to both public and Thompson announced the funding of 12 state Private pay individuals. Resource Center programs must also serve as the entry point to grants to develop Aging and Disability publicly administered long term supports Resource Center (ADRC) programs to help including those funded under Medicaid, the consumers to learn about and access long-term Older Americans Act and state revenue supports ranging from in-home services to programs. nursing facility care. Twelve additional ADRC state grants were announced in April 2004, AoA and CMS jointly perfornr the day-to-day bringing the total to 24 states developing Federal administrative responsibilities for the innovative Kesource Center models. ADRC Grant Program including grant- 'fhe ADRC Program represents a collaborative monitoring activities. effort of the Administration on Aging (AoA) WHO IS THE PROGRAM DESIGNED TO and the Centers for Medicare & Medicaid ASSIST? Services (CMS). The initiative builds on existing "one-stop shop" programs in Stales must target Resource Center services to Wisconsin and other states. Twenty-four grants the elderly population and at least one of up to $800,000 have been issued as additional population (i.e., individuals with cooperative agreements for athree-year period. Physical disabilities, serious mental illness, and/or mental retardation/developmental This fact sheet summarizes this initiative of the disabilities). AoA and the CMS to improve access to long- term care support options for persons with WHAT IS THE AoA/CMS V 1S10N FOR disabilities of all ages and their caregivers. RESOURCE CENTERS? WIIAT IS THE AGING AND llISABILITY The goal of the ADRC Program is to empower RESOURCE CENTER GRANTS individuals to make informed choices and [o PROGRAM? streamline access to long-term support. Long- term support refers to a wide range of in-home, The ADRC Grants Program supports state community-based, and instihrtional services efforts to develop "one-stop shop" programs at and programs [hat are designed to help the community level that will help people make individuals with disabilities. informed decisions about their service and support options and serve as the entry point to The vision is to have Resource Centers in every the long-term service and support system. community serving as highly visible and States can use these funds to better coordinate trusted places where people can loin for and/or redesign their existing systems of information on the full range of long term infomation, assistance and access, which support options. currently involve multiple fedora], state and local programs. In many communities, long-term support services are administered by multiple agencies and have complex, fragmented, and often duplicative intake, assessment, and eligibility configuration, states will have to ensure functions. Figuring out how to obtain services consumers are provided with uniform is difficult A single, coordinated system of information and a standardized process for information and access for all persons seeking accessing programs and services. long term support will minimize confusion, WHO WILL BE INVOLVEll IN THE enhance individual choice and suppott informed decision-making. It will also improve DESIGN AND IMPLEMENTATION OP the ability of state and local governments to RESOURCE CENTER PROGRAMS? manage resources and to monitor program States are required to involve consumers and quality through centralized data collection and other stakeholders at Che state and local level in evaluation. the planning, implementation and evaluation of WHAT SERVICES WILL BE PROVIDED? their Resource Center programs. In addition, states will be encouraged to develop public- ADRC programs are required to provide the private partnerships to carry out their programs. following services at the community level: Public Education; Information and Counseling HOW WILL PERFORMANCE BE on available options; Access to Public MEASURED? Programs, including Medicaid nursing facility care and waiver services; Coordination with States must establish performance goals and Other Programs (e.g., disease prevention, indicators that will allow them to measure their nutrition, transportation, housing); and progress in helping consumers make informed Prospective Planning to help people to plan decisions, streamlining access to services and ahead for their long term service and supports supports, and achieving system efficiency and needs. cost-effectiveness. IS THERE ROOM FOR FLEXIBILITY IN To support the local grant projects, AoA and PROGRAM DESIGN? CMS are funding a complementary technical assistance program. This technical assistance States have broad flexibility in determining the will be tailored to the specific needs of each configuration of their programs. Any state grantee and will allow for peer support between agency can be the lead state agency for the projects. ADRC program, although State Units on Aging and State Medicaid agencies must be involved ADDITIONAL INFORMATION in planning and implementation. For additional information on the grants program States will also decide how best to organize including application instn~ctions, please visit the Resource Center functions at [he local level. AoA website at For example, some states may operate all local htto:/fwww.aoa~ovlproflagin~ dlsJagine dis.asp or functions in one agency while others may use a the CMS web site at decentralized approach involving multiple sites htto://www.cros.hhs.KOV/newfreedom. and organizations. Regardless of the The ADRC Technical Assistance Exchange website is located at www.adre-tae.ora. 1' 1' 1' 1 AoA recognizes the importance of making information readily available to consumers, professionals, researchers, and students. Our website provides infom~ation for and about older persons, their families, and professionals involved m aging prog-ams and services. Pur mare information about AoA, please contact: US Dept of Health and Human Services, Administration on Agmg, Washington, DC 20201; phone: (202) 401-4541; fax (202) 357-3560; Email: aoainfo(o)aoa.gov; or contact our website at: wunv.aoa.gov - 2 - Adrninisiraiion on Aging ~ Fad Sheet Last Updated: 4I2b104 DEPARTMF,NT OF HEALTH AND HUMAN SERVICES (HHS) Administration on Aging (AoA) and Centers for Medicare & Medicaid Services (CMS) Catalogue of Federal Domestic Assistance (CFDA) #s: AoA - 93.048 and CMS - 93.779 FY 2003 Program Announcement and Application Instructions (AoA-03-OS and CMS-2185-N) I. BACKGROUND AND PROGRAM DESCRIPTION A. Background 1. Summary. The Administration on Aging (AoA) and the Centers for Medicare & Medicaid Services (CMS), announced in the March 29, 2003 Federal Register that they will jointly hold a competition for grants to be awarded as cooperative agreements for projects that support the development of state Aging and Disability Resource Center (Resource Center) programs. The word "grant," as used in this solicitation, refers to a cooperative agreement. Resource Center programs will provide citizen-centered "one-stop shop" entry points into the long terns support system and will be based in local communities accessible to people who may require long term support. Resource Centers will serve individuals who need long tenn support, their family caregivers, and those planning for future long term support needs. They will also serve as a resource for health and long term support professionals and others who provide services to the elderly and to people with disabilities. The accompanying materials comprise the application kit for preparing and submitting a gran[ proposal to compete for these project awards. 2. Statutory Authority. The statutory authority for grants under this program announcement is contained in section 411 of the Older Americans Act and section 1 110 of the Social Security Act. 3. Application Due llate. The deadline date for the submission of applications under this program announcement is July 28, 2003. Potential applicants are encouraged to submit a letter of intent to apply for a grant no later than June 19, 2003. AoA and CMS will conduct an Applicant's Teleconference. Information regarding the time and call-in number for this open teleconference call will be available on the AoA Web site at httpa/www.aoa.2ov and on the CMS Web site at http://www.ems.hhs.gov/newfreedom/default.asp. Additionally, AoA and CMS staffwil] be available for questions and answers on an on-going basis. All "Questions and Answers" resulting from inquires fi'om the field will be posted ou these two websites. 4. Project Fundine, lluration and Match. AoA and CMS plan to fund up to 16 projects nationwide for a period of up to 3 years. The maximum total Federal award for the entire 3-year project period is $800,000. We reserve the right to disqualify applications submitted in excess of the maximum award ($800,000) and to return such applications without review to the applicant. Grantees are rcquired to make anon-Snancial or cash recipient contribution (match) of five percent (5%) of the total grant award. Non-financial recipient contributions may include the value of goods and/or services contributed by the Grantee (e.g., salary and fringe benefits of staff devoting a percentage of their time to the grant not otherwise included in the budget or derived from Federal funds). Recipient contributions must be included in the applicant's budget in Item 15 (Estimated Funding) on Standard Fonn 424A and described in the budget narrative/justification section of the application. The non-financial match requirement may also be satisfied if a third party participating in the grant makes an "in-kind contribution," provided that the Grantee's contribution and/or the third-party in-kind contribution equals five percent (5%) of the total grant award (including all direct and indirect costs). Third- party "in-kind contributions" may include [he value of the time spent by citizen task force members (using appropriate cost allocation methods to the extent that non- Federal funds are involved) who specifically contribute to the design, development, andnnplementation of the grant. While the five percent (5%) recipient contribution is not included as a screening criteria, it is a requirement that a five percent (5%) match of the total award be included in all funded projects. All funds will be awarded by 9/30/2003. Applicants are required to submit one project budget (SF424A) and budget justification. However, AoA and CMS are both providing funding for this program. As a result, successful applicants may receive an award from each agency that, when combined, will total the Federal award for the project. AoA and CMS reserve the right to request a revised budget to reflect these determinations. These grants will be issued as cooperative agreements because AoA and CMS anticipate having substantial involvement with the recipients during performance of funded activities. This involvement may include collaboration, participation, or intervention in the funded activities. AoA and CMS will also be involved in the development and implementation of the funded projects by way of conducting a joint review of the applications and providing technical assistance, training, guidance, and oversight throughout the project period. More specifically, applications may be submitted to AoA and CMS through the AoA "single point of application" address listed in this solicitation. AoA will ensure that all appropriate parties in both AoA and CMS receive the application. AoA and CMS will make final decisions on the grant awards jointly. AoA and CMS project officers will jointly perform the day-to- day Federal responsibilities. Grantees will be expected to keep in contact with AoA and CMS project officer staff on a regular basis. Grantees will also be expected to share all significant products that result from their projects with AoA and CMS. 5. Gli2ible Applicants. Only a state agency or instrumentality of a state may apply for a Resource Center grant The applicant agency must have the support and active participation of the Single State Agency on Aging and the Single State Medicaid Agency. Only one application per state will be funded. "State" refers to the definition provided under 45 CFR 74.2. Executive Order 12372 is not applicable to these grant applications. 2 6. Tareet Groups. Resource Centers supported under this program must, at a minimum, include the elderly population and at least one of the following major target groups by the first quarter of the second year: (a) individuals with physical disabilities, (b) individuals with serious mental illness, and/or (c) individuals with mental retardation/developmental disabilities. States may elect to develop distinct entry points for different target groups as long as they are a coordinated part of the single state Resource Center program. Individuals with traumatic brain injury tnay be classified by the state in the target group that best conforms with the state's service delivery system and historical practice. The same principle applies to any other condition that ofen spans target group boundaries. For the definition of "elderly" i? this solicitation we use age 60 and above as specified in the Older Americans Act. 7. Further ]nformation. Contact Kari Benson, AoA, (202) 357-3461, kari.benson@aoa.gov or Mary Guy (410) 786-2772, RealChoiceFY03@cros.hhs.gov. B. Program Description 1. Background. The AoA/CMS Resource Center grants program reflects and supports the values of individual choice, independence, and community living inherent in President Bush's Freedom Initiative, including the President's "Money Follows the Persou Initiative to Rebalance Long term Support Systems." The grants awarded under this program will be another tool the Federal government is making available to help states tear down barriers to community living and redirect their systems of support to be more consumer-driven and more supportive of home and community- - based service options. 2. Goal and Vision. The goal of the Aging and Disability Resource Center Program is to empower individuals to make informed choices and to streamline access to long teen support. Long term support refers to a wide range of in-home, community- based, and institutional services and programs that are designed to help individuals with disabilities. AoA and CMS share a vision for the Resource Center program. The vision is to have Resource Centers in every community serving as highly visible and trusted places where people can tum for information on the full range of long [enn support options and a single point of entry to public long term support programs and benefits. The Centers will be a resource for both public and private-pay individuals. They will serve elderly persons, younger individuals with disabilities, family caregivers, as well as persons plamting for future long term support needs. The Centers will also be a resource for health and long term support professionals and others who provide services to the elderly and to people with disabilities. AoA and CMS believe Resource Centers are a key component of an effectively managed, consumer-driven system of long term support. In many communities, long term support services are supported by nwnerous funding streams, administered by multiple agencies, and have complex, fragmented, and often duplicative intake, assessment, and eligibility functions. Figuring out how to obtain services is difficult both for persons who qualify for publicly-funded supports and for those who can pay privately. These barriers lead to institutional long term support as the default outcome. A single, coordinated system of information and access for all persons seeking long term suppon will minimize confusion, enhance individual choice and 3 support informed decision-making. It will also improve the ability of state and local governments to manage resources and to monitor program quality through centralized data collection and evaluation. Resource Centers will enable policy makers and program administrators to more effectively respond to individual needs, address system problems, and limit the unnecessary use ofhigh-cost services, including nursing home services. Making information and counseling available to private-pay individuals is a central element of the AoA/CMS Resource Center vision. Reaching people before they become Medicaid-eligible, and helping them to learn about low-cost options and programs such as private long term support insurance, can help individuals make better use of their own resources and help to prevent or delay spend-down to Medicaid. The AoA/CMS vision is for Resource Centers to: • Actively promote public awareness of both public and private long term support options, as well as awareness of the Resource Center, especially among underserved and hard-to-reach populations. • Provide information, and counseling as needed, on all available long term support options. • Help people assess their potential eligibility for public long term support programs and benefits. • Determine programmatic eligibility for public long term support programs and benefits, including level of care determinations for Medicaid nursing home and HCBS waiver programs. • Assist people with the Medicaid eligibility determination process (in collaboration or coordination with Medicaid eligibility determination staff). • Provide short-term assistance or case management to stabilize long teen support individuals and their families in times of immediate need before they have been connected to ongoing support (e.g., enrolled in a home and community-based waiver). • Provide information and referral to other programs and benefits that can help people remain in the conununity, such as disease prevention and health promotion programs, transportation services, and income support programs. • Help people plan for their future long teen support needs. • Organize, simplify, and ensure "one-stop shopping" for access to all public long teen support programs. Resource Centers may also provide on-going case management to public- and/or private-pay individuals. The operational configuration of Resource Centers will vary from state to state. In most states, Resource Centers will involve astate/local partnership, where the state will provide oversight and guidance, but may asange for responsibility for the operation of Resource Center functions to be vested in local entities. In some communities, all Resource Center functions may be performed in a single location. However, in some localities, Resource Centers may be decentralized and have multiple sites and organizations involved in perfornring the information and access functions. Some communities may even have different access points for different 4 populations, provided they perform all functions of a Resource Center. Regardless of the configuration, the functions of the Resource Center will be coordinated and standardized to ensure that al] individuals are provided with unifornr information and access to long term support. Resource Centers will create formal linkages between and among the major pathways to long term support, including preadmission screening programs for nursing home services, hospital discharge planning, physician services, and the various cormnunity agencies and organizations that serve the Resource Center's target populations. These linkages will ensure people have the information they need to make informed decisions about their support options as they pass through critical transition points in the health and long term support system. Resource Centers will gather and manage infornation from individuals in a way that ensures their confidentiality, but limits repeated collection of the same information throughout their long term support careers. The individual-level data will be used, in part, as the foundation of a management information system that will track client intake, needs assessment, service plans, utilization, and costs. The management information system will support on-going program analysis, planning, budgeting, quality assurance, program evaluation, and continuous improvement as well as state and local policy development. AoA and CMS recognize that not all states can immediately implement the ideal Resource Center described above. However, the vision indicates the latitude of design possibilities for Resource Centers and our long-range expectations. We believe implementation of the full vision can achieve success in meeting individual needs and preferences and in effectively managing public resources, while implementation of too few of the elements will limit the success of a Resource Center program. 3. Overview of the Proeram. AoA and CMS will award competitive grants to assist states to implement new, or significantly expand existing, Resource Center programs. Building on previous state efforts, Resource Centers will move beyond information and assistance and will assume the role of primary entry point into the long term support system. People who are eligible for Medicaid long term support, including HCBS waiver services or Medicaid funded nursing home services, will access those programs through the Resource Centers. Several states have initiated groundbreaking programs that have proven successful in informing and empowering individuals by bringing long temr support services to individuals in one easy location. (For information on these programs, go to: http://www.cros.hlrs.gov/states/dis-~ine.asn or http://www.hcbs.orQ.) Potential applicants are also encouraged to read, Navigating the Lone term Care Maze: New Approaches to Information and Assistance in Three States at: htfp://research.aarn.org/health/2001 12 maze.html. AoA and CMS will jointly review grant applications and issue grants to a lead state agency that will be responsible for administering the Resource Center program in the state. Regardless of which state agency is the lead agency, plaiming and implementation must substantially involve both the Single State Agency on Aging and the Single State Medicaid Agency. 5 Applicants that received a grant award in fiscal year 2001 and fiscal year2002 under "Systems Change Grants for Community Living" for access and educational activities may be eligible for additional funding under this initiative. However, the new proposal must significantly expand the scope of work consistent with the Resource Center program vision. Grantees wil] be required to collaborate with AoA and CMS to develop a minimum data set and processes for data collection. Evaluation and analysis of these data will result in increased understanding of outcomes and strategies that are effective in serving people with a disability. 4. Involvement of Stakeholders, and Public-Private Partnerships. States must meaningfully involve stakeholders in the planning, implementation, and evaluation of their Resource Center program. In addition, we encourage the development of public-private partnerships that make the most effective use of each partner's expertise. Examples of organizations that should be involved include: Alzheimer's Association chapters, Area Agencies on Aging, advocacy groups and organizations, community service providers, Slate Health Insurance Assistance Programs (SHIPS), Long term Care Ombudsmen Programs, Developmental Disabilities Councils, State Mental Health Planning Councils, Independent Living Centers, State Assistive Technology Act Projects (AT Act Projects), housing authorities, volunteer groups, employers, faith-based service providers, private philanthropic organizations, and other community-based organizations. Applicant states must establish or designate an Advisory Board to assist in the development and implementation of their Resource Center program. (Advisory boards established under the Real Choice Systems Change Program may be used for this purpose iu an existing or modified form.) The Advisory Board will advise the lead state agency on: (a) the design and operations of Resource Centers, (b) stakeholder input, (c) the state's progress toward achieving the goal and vision described in this announcement, and (d) other program and policy development issues related to the state's Resource Center program. The lead state agency will have ultimate authority over the program and its Advisory Board. The Advisory Board must be composed of (a) individuals representing all populations served by the state's Resource Center program including individuals who have a disability or a chronic condition requiring Long term support, (b) representatives from organizations that provide services to the individuals served by the program, and (c) representatives of the government and non-govennnental agencies that are impacted by the program. Under this grant program, grantees must meet the provisions for conswner task force participation that apply to the overall Real Choice Systems Change Grants for Conununity Living as administered by CMS. Congress expressed its preference that Real Choice Systems Change Grants applications "be developed jointly by the State and the Consumer Task Force" (H. Conf. Rep. No. 106-1033 at 150 and H. Conf. Rep. No. 107-342 at 101, adopting S. Rep. No. ] 07-84 at 17). "The task force should be composed of individuals with disabilities from diverse backgrounds (including the elderly), representatives from organizations that provide services to individuals with disabilities, consumers of long-teen services and supports, and those who advocate 6 on behalf ofsueh individuals" (H. Conf. Rep. No. 106-1033 at 150 and H. Conf Rep. No. 107-342 at 101, adopting S. Rep. No. 107-84 at 17). In its report accompanying, the "Consolidated Appropriations Resolution, 2003," Pub. L. No. 10807, the conferees stated that they "continue to strongly support the Real Choice Systems Change grants and expect CMS to provide expanded technical assistance for the consumer task forces involved with the program by contracting with a consortium of consumer controlled organizations for people with disabilities," H.R. Conf. Rep. ] 08- 10 at 1107. Applicants tnay elect to use or expand existing Real Choice Consutner Task Forces to meet the consumer involvement provisions of this solicitation. 5. Award Size. As noted above, AoA and CMS plan to fund up to l6 grants totaling up to $800,000 each fora 3-year period. Applicants are encouraged to develop project budgets that reflect annual Federal funding of about $250,000 for each project year. Grantees are required to make anon-financial or cash recipient contribution (match) of five percent (5%) of the total grant award. AoA and CMS are both providing funding for this grants program. A key consideration for AoA and CMS is that the size of the award will correlate with the significance of the proposed endeavors, rather than with the size of the state. AoA and CMS reserve the right to offer a funding level that differs from the requested amount and to negotiate with the applicant with regard to the scope and intensity of effort that would be appropriate and commensurate with the final funding level. AoA and CMS also reserve the right to select alternates from the pool of applicants. Significance will be measured in terms of the breadth of the initiative (i.e., the potential number of people affected and the number of populations served) and the degree of enduring change in the system (i.e., the "intensity" or depth of the improvement, including the range of long term support information and access functions that are effectively integrated and/or coordinated). States that have systems that already include major elements of Resource Centers may apply but may be successful only to the extent that further progress is to be demonstrated (e.g., by adding additional Resource Center functions specified in this solicitation, expanding geographical coverage, expanding target group coverage, etc.). 6. Use of Funds. Applicants must demonstrate that the grant (a) establishes new capacity or significantly enhances existing capabilities; (b) does not duplicate existing work or supplant existing funding; and (c) devotes all funding under the new proposal to endeavors that advance the goal and vision of the. Resource Center Program. Design activities may include, but are not limited to: • Obtaining and analyzing stakeholder input. • Conducting a feasibility and planning study. • Developing an Advance Planning Document (APD). • Completing a fiscal impact analysis. Imnlementation activities may include, but are not limited to: 7 • Hiring or contracting for staff dedicated to the administration and operation of the Resource Center Program (this does not include using these grant funds to pay for staff to perform functions that are mandated and reimbursable under other funding sources.) • Purchasing computers and computer software used specifically for the operation and administration of the center, as well as collecting, analyzing, reporting, and disseminating Kesource Center data. • Performing public awareness and outreach activities to inform individuals of the information and assistance offered ai the Resource Center. • Initial and continuous training, particularly for staff that directly serve individuals. • Evaluation activities. 7. Resource Center Design Issues: A state's Resource Center program must provide information and assistance to both public- and private-pay individuals and must include both public and private programs in its information and assistance functions. A state's Resource Center program must also serve as the entry point to publicly administered long term supports for individuals who are eligible for, or appear to be eligible for, those publicly supported programs. By the end of the third year, an eligible Resource Center must, at a minimum, perform the following functions of "Awazeness, Assistance, and Access": Awareness and Information • Public Education. • Information on Long term support Options. Assistance • Long term Support Options Counseling. • Benefits Counseling • Employment options counseling for people who are interested in, or may be interested in, such counseling. Grantees would be expected to coordinate with other sources funding employment counseling in their state, such as the Social Security Administration andlor the Department of Labor, to ensure access and prevent duplication. • Referral to other programs and benefits that can help people remain in the cormnunity, including programs that can assist a person in obtaining and sustaining paid employment. • Crisis Intervention. • Helping people to plan for their future long term support needs. Access • Eligibility Screening. • Assistance in gaining access to long term support service that may be paid with private funds. • Comprehensive assessment of long ternt support needs and care planning. • Programmatic Eligibility Determination for long term support services (see Section II 1br a definition of Long term Support Services). • ?vlcdicaid financial Eligibility Determination that is either integrated or so closely coordinated with the Resource Center that each individual applicant experiences a seamless interaction. 8 • One-Stop Access to all public programs for community and institutional long term support services administered by the state under Medicaid, and those portions of Older Americans Act programs that the state has determined will be devoted to long term support services (see definition), and any other publicly funded services which the state detenuines should be accessed through the Resource Center. For a description of these functions, see the Definitions, under Section II, below. Grantees must have at least one Resource Center operational at the community level within 12 months of receipt of grant funds that, at a minimum, is providing information and counseling on long term support options, and has a plan in place (that has been approved by the lead state agency) describing how it will put in place the following functions within 24 months of the State's receipt of grant funds: Eligibility Screening, Programmatic Eligibility Determination, and Coordination with Medicaid Financial Eligibility Determination. In the first quarter of the second year the State's Resource Center program tnust include, in addition to the elderly, at least one additional major target groups identified in this solicitation. By the end of the 3-year grant period, the Resource Center must be performing all required functions. Resource Centers must have a management information system that supports the .~'itrictlons proposed under this program. The system should allow for the tracking of -client intake, needs assessment, raze plans, utilization, and costs. The data must be in a transmittable form. CMS and AoA will provide technical assistance to successful applicants in order to assist in creating measures acrd methods of collection of data. It is recognized that Resource Centers will build upon existing state and local information systems. In order to achieve the functional capacity envisioned for Resource Centers in the time available, it will often be necessary to enhance the information system related to the Resource Center without completing a redesign and implementation of the whole state or local information system. In that case, experience gained on the Resource Center information system may be helpful in informing the redesign of the larger system when the necessary funds, time, and consensus are in place. Finally, grantees will be required to evaluate the effectiveness of their Resource Center programs in making progress toward the goal and vision outlined in this Announcement. The evaluation design should include measurable perfomtance goals and support quality assurance and continuous program improvement. 8. Measurable Performance Goals. Grantees must establish measurable performance goals for their programs, along with indicators that can be used to track progress on the perfomtance goals. The measurable perfomtance goals and indicators should be incorporated into the design of the program's evaluation, and be used to measure the success of the Resource Center program over the long run. The goals and indicators must be developed with input from the stakeholders and the advisory board specified for these grants. At a minimum, grantees must establish performance goals and indicators related to their Resource Center program's: (a) Visibility -extent to which the public is aware of the existence and functions of the Resource Center, (b) Trust on the part of the public in the objectivity, reliability, and comprehensiveness of the information and 9 assistance available at the Resource Center, (c) Ease of Access (e.g., reduction in the amount of time and level of frustration and confusion individuals and their families experience in trying to access long term support), and (d) Responsiveness to the needs, preferences, unique circumstances, and feedback of individuals as it relates to the functions performed by the Resource Center. Grantees must also establish performance goals and indicators related to the program's Efficiency and Effectiveness (e.g., reduction in the number of intake, screening, and eligibility determination processes, diversion of people to snore appropriate, less costly forms of support, improved ability to match each person's preferences with appropriate services and settings, ability to rebalance the state's long term support system, ability to implement methods that enable money to follow the person. etc.) II. DErIN1TIONS Aged (or Elderly Person): As defined in the Older Americans Act, "an individual who is 60 years of age or older." Benefits Counseling: The provision of information and assistance designed to help people learn about and, if desired, apply for public and private benefits to which they are entitled, including but not limited to, private insurance (such as Medigap policies), SSI, Food Stamps, Medicare, Medicaid and private pension benefits. For purposes of this program, Benefits Counseling funded under the Older Americans Act that is provided to individuals who need help in order to remain in the community, is included in this definition. Coordination With Medicaid Financial Eligibility Determination: The determination of financial eligibility for Medicaid may take place either at the Resource Center or off-site. Regardless of where it takes place, the Resource Center must assure that the process is coordinated or integrated with the functions of the Center so that it takes place in an expeditious manner that avoids duplication of effort for individuals, their families and agency workers. The result of this coordination should be a seamless system of long term support as experienced by the individual. Counseling and Referral to Help People Remain in the Community: The provision of comprehensive and accurate information on services and programs that can help people to remain at home and in the community. These include (a) direct services (such as hcmte and commmunity-based waiver programs, home health, personal care, case management), (b) generic community sources of help (such as nutrition programs, prescription drug programs, health promotion and disease prevention programs, transportation services, home repair programs, real property tax relief), acrd public or private insurance (such as long term care insurance, Medicare, SSDI, and SSI). For purposes of this program, counseling and referral activities designed to help individuals to remain in the corrnnunity that are funded under the Older Americans Act are included in this definition. Eligibility Screening: Is anon-binding inquiry into an individual's income and assets, as necessary, and other circumstances in order to determine probable eligibility for programs, services, and benefits, including Medicaid. This screening should be provided to all individuals who may be eligible for publicly funded programs. ]0 ;:b"u'~,~~ ,~r-~~Lkg ii~~%ar~ ti C;~-i6v ---~'tiLt!•:~;~ f t-- ~ trL l.Y. ~ ~ C._ b L,5 i ~ I ~~t "Z l-~ ~ ~ V~'E L~~ ~-1 f_ Crisis Intervention: The systemic capability to respond to situations of imm~ediate jeopardy to the health or welfare of an individual, by means of remedy, removal from danger, protective services, or other timely safety measure. Information on Lone term Support Options: The information available must be comprehensive, objective, up-to-date, citizen-friendly, and cover the full range of available options, including in-home, community-based, and institutional services (including nursing home services). The information must cover options that people will use immediately (such as Medicaid services) to long-range options (such as private long term care insurance). The information must also cover programs and services that support family caregivers, as well as any special options in the state to maintain independence or direct one's own long term support services. Lone term Support Services: Long tern support refers to a wide range of in-home, community-based, and institutional services and programs that are designed to help individuals with disabilities or chronic conditions with activities of daily living or instrumental activities of daily living. Public long teen suppari services are those administered by a goverunental entity. For purposes of this program, long tenmm support services under Medicaid include home health, personal care, targeted case management, home and conmmunity-based waivers under section 191 S(c) of the Social Security Act, nursing facility services, and hiternediate Care Facilities for the Mentally Retarded (ICFs-MR). Long term support services under the Older Americans Act include personal care and other in-home services similar to those provided under section 1915(c) of the Social Security Act. Long teen support services under state-only programs include home health and personal care. Finally, for purposes of this program, the state may include in the definition of long teen support services any other publicly-funded service which the state determines should be accessed through the assessment process of [he Resource Center. Lone term Support Options Counseline: Resource Centers will help people make informed decisions by assisting individuals and their families in understanding how their strengths, needs, preferences, and unique situations translate into possible support strategies, plans, and tactics, based on the options available in the community. The counseling includes helping individuals assess their needs and resources, the assessment of the needs of family caregivers, developing a plan, and assisting the individual/family in implementing their long term support choices. Counseling liiilcs individuals to other counseling programs and services, including A~eb-based information and counseling programs. For purposes of this program, Long term Support Options Counseling activities funded under the. Older Americans Act are included in [his definition. One-Stop Access to Public Programs: The organizational ability and authority to provide intake, full access, and comprehensive point of entry to publicly supported long ternt support services for individuals who are eligible for, or appear to be eligible for, publicly supported long term support services, as those services are defined under Section IL A single program performs these functions, along with information and assistance, through a simple, convenient, single contact point. The program may involve more than one entry point (or "site) at the conununity level (e.g., different access points for different populations) so long as (a) each access point is authorized and performs all functions of a single point of entry, (b) the process of access experienced by individuals is uniform across aLl entry points, and (c) 11 individuals do not access long term support services through admission points that do not perform all functions of a single point of entry. One-stop access to public programs also ensures that individuals have the information they need to make informed decisions and that individuals reliant on public support are not admitted to service by alternate means or by direct admission through an individual provider of services. Programmatic Eligibility Determination: A determination of the publicly supported benefits or services to which a person is eligible, based on non-financial criteria. This may require a formal assessment to determine the full scope of the individual's needs. li may include a functional assessment of the individual's curent health conditions and provide a situational assessment of the client's enviromnent, available resources, and current support. For Medicaid services, this function includes the "Level of Care" determination process. Public Education and Outreach: Activities related to ensuring that all potential users of long term support (and their families) are aware of both public and private long term support options, as well as awareness of the Resource Center, especially among underserved and hard-to-reach populations. State: Refers to the definition provided under 45 CFR 74.2 any of the several States of the United States, the District of Columbia, the Conunonwealth of Puerto Rico, any territory or possession of the United States, or any agency or instrumentality of a State exclusive of local governments. III. INSTRUCTIONS FOR COMPLETING THE PROJECT NARRATIVE A. Required Format and Length. The Project Narrative must be double-spaced, on single-sided 8 x 11"plain white paper with 1"margins on both sides, and a font size of not less than 11. The maximum length allowed for the project narrative is 25 pages. We will not accept applications with a Project Narrative that exceeds 25 pages. NOTE: The Project Work Plan, Letters of Cooperation, and Vitae of Key Personnel are not counted as part of the Project Narrative for purposes of the 25-page limit, but all of the other sections noted below are included in the 25-page limit. Beginning with the page for the project surmnary description, pages must be numbered sequentially. Please do not use covers or tabs. Do not include extraneous materials such as agency promotion brochures, slides, tapes, film clips, and appendices, etc. It is not feasible to include such items in the review process. Thcy will be discarded if submitted as part of the application. The application should not be bound. A staple is recommended. B. Standard Components. 1. Executive Summary. This section should include a clear and concise summary of your proposal including: the project's goal and objectives; the proposed intervention; target population(s); and anticipated outcomes. (Length: not to exceed one page.) 12 2. Problem Statement. The applicant must provide a general description of its long term support system, including a description of how the current system limits or facilitates individual choice and access for both public- and private-pay individuals in the applicant's target population. The applicant should describe current efforts to address information and access issues and problems. 3. Tareet Population(s) This section should describe the target group(s) to be served and the rationale for focus on the specified group(s). 4. Proaosed Intervention. Describe your overall approach to advancing the vision and goals outlined in this Announcement, including your plans to streamline, coordinate, and/or integrate existing intake, screening, assessment, eligibility determination, and counseling services, and how the project will ensure that targeted populations will utilize the Resource Center to access the long term support system. This section must address coordination with both the Medicaid Level of Care determination process for Nursing Home and other long term support, and the Medicaid eligibility process. You must include a description of the management information system that will be used and/or developed to support the functions and goals of your Resource Center program. Your process for selecting local entities to carry out Resource Center functions at the community level should also be described. You should note any major barriers you anticipate encountering, and how your project will be able to overcome those barriers. This section should also include how the project will improve collaboration between health support and human service agencies (including housing) agencies at the state and local level. 5. Involvement of Kev Stakeholders. Describe the role and makeup of the Advisory Committee and any strategic partnerships you plan to involve in implementing the intervention, including other agencies, organizations, funders, and/or citizen groups. Describe how the Resource Center will coordinate with the State Health Insurance Assistance Program. 6. Performance Goals and Indicators. Provide a description of the initial measurable performance goals and indicators you plan to use to measure the success of your program over the long run, including those related to the program's visibility, trust, ease of access, responsiveness, efficiency, and cost-effectiveness. Also describe how you plan to refine your performance goals and indicators over the course of [he project period, if you plan to do so. 7. Evaluation. describe the approach, methods, and data that will be used to evaluate the program's progress toward achieving its policy goats and objectives, and its measurable performance goals. 8. Dissemination. This section should describe the method that will be used to disseminate the project's results and Endings in a timely manner and in easily understandable formats, to parties who might be interested in using the results of the project to inform practice, service delivery, program development, and/or policy- making, including acid especially thaw parties who would be interested in replicating the project. 9. Protect ManaQenteirt. This section should include a clear delineation of the roles and responsibilities of the involved agencies, project staff, consultants and partner 13 organizations, and how they will contribute to achieving the project's objectives. It should specify who would have day-to-day responsibility for project leadership and the key tasks associated with designing, establishing, and operating a Resource Center program. It should also describe the approach that will be used to track progress on the project's tasks and objectives. 10. Work Plan. The Project Work Plan should reflect and be consistent with the Project Narrative and Budget. It should include a statement of the project's overall goal(s) and objectives, and the major tasks /action steps that will be undertaken to achieve the goal and objectives. For each major task /action step, the work plan should identify the timefratnes involved (including start- and end-dates), and the lead person responsible for completing the task. (See Attachment C for a sample work plan grid you can use for this purpose. 11. Organizational Cauability Statement and Vitae for Kev Proiect Personnel. Each application should include an organizational capability statement and vitae for key project personnel. The organizational capability statement should assure and demonstrate that the lead state agency for the Resource Center Program has the capacity to implement the full Resource Center Goal and Vision described in section I.B. of this announcement. Likewise, local entities designated to implement the operational Resource Centers at the community level should demonstrate that they have this capacity. Include short vitae for key project staff only. Also include information about any contractual organization(s) that will have a significant role(s) in implementing project and achieving project goals. 12. Sustainability: Applicants must describe in the application the steps the State has taken (or will take) to ensure its Resource Center project will be sustained beyond the gran[ period. 13. Letters of Commitment From Kev Participating Organizations and Agencies. Include confirmation of the commitments to the project (should it be funded) made by key collaborating organizations and agencies in this part of the application. Any organization that is specifically named to have a significant role in carrying out the project should be considered an essential collaborator. 14 EXECUTIVE SUMMARY The Hawaii State Executive Office on Aging, in partnership with the Hawaii County Office of Aging and the City and County of Honolulu Elderly Affairs Division, requests $800,000 to develop an Aging and Disability Resources Center (ADRC) in Hawaii. The Center will be established on the Island of Hawaii and with a possible second Center on the Island of Oahu. The Hawaii State Executive Office on Aging (EOA) is the lead applicant of this grant proposal and will provide the oversight and guidance to the local Area Agencies on Aging that will be responsible for the implementation and operations of the Resource Centers on their respective islands. The overall design is to build the ADRC from the core functions of the local Area Agencies on Aging. In collaboration with other aging and disability agencies, Hawaii County will co-locate services and providers in a centralized facility - offering a one-stop shop for information and resources. The Resource Center will offer information, counseling, referrals, assessment and eligibility functions for both publicly and privately funded services targeting two goups: 1) Elderly over the age 60, and 2) People with physical disabilities. Honolulu will participate in the State-wide planning for the long term care access with the goal to establish an ADRC on Oahu. T'he goals for the State of Hawaii are: 1) Establish a highly visible ADRC that serves as a single, point of entry to long term care benefits and programs, 2) Streamline the process for screening, intake, assessment and eligibility determination. The Objectives are: 1) Project planning and development of the ADRC infrastructure, 2) Formalizing partnerships with commwlity goups, govermnent and private agencies and services. Anticipated outcomes include high consumer satisfaction with accessibility to sewice and information, and increase in public awareness and knowledge of community resources and long tent care options. 1 I. PROBLEM STATEMENT Background/Demographics Hawaii's older adult population is increasing at a dramatic rate. According to Census 2000, the number of individuals age 60 and over in Hawaii increased by 11.0 percent between the years 2000 and 2004. hl this same time period, Hawaii's total population increased by 4.2 percent. F,ven more dramatically, Hawaii's 85 and older population saw an increase of 40.4 percent. This increase was over three times the United States 85+ increase of 13.4 percent over this same time period, which ranks Hawaii first among states in percentage increase for this age group. Hawaii ranks fifth overall in the nation, in years 2000 to 2004 in percentage increases among the 60+ age cohort. Older adults are making up a larger proportion of Hawaii's population than they did previously. In 2000, those age 60 and over accounted for 17 percent of the total population and 23 percent of the adult population. Pro}ections from the Hawaii State Department of Business, Economic Development and Tourism estimate that those ages 60+ years will account for almost one-quarter of the local residents by the year 2020. The 85+ years and over age population is expected to almost double between the years 2000 and 2020. 'The state's 60 years and over population is expected to increase by 70 percent -over three times the 23 percent increase expected in the state's total population. These increasing numbers and percentages of older adults will likely create more demand for public and private home and community based services and inforn~ation. Strengths of Hawaii's Current Long Term Care System Facing a rapidly aging population, Hawaii is committed to building a long term care infrastructure that includes home and commm~ity based services, institutional care, advocacy, 2 and information dissemination that can be easily accessed by the public. There is a wide range of public and private resources provided by government, businesses and community organizations. Under the Older American's Act, EOA and the County AAAs offer services which include 1) information and assistance hotline, 2) in-home and community based services called Kupuna Care (Kupuna means "elders" in Hawaiian), 3) congregate and home delivered meals, 4) caregiver support, 5) SagePLUS, a Medicare and health insurance information counseling and assistance program, 6) SageWatch, a Medicare and Medicaid fraud and abuse hotline, and 7) Office of the Long Term Care Ombudsman, The proposed ADRCs will be built upon the strengths of this current system. On Oahu, EAD's Senior Information and Assistance Program (I & A) is already a well established and reliable source of information for aging programs and services. The I & A Program has four staff who answer a Senior Hotline, prints and distributes 60,000 copies of a comprehensive and much anticipated directory of aging services every other year, publishes a quarterly newsletter, and staffs satellite city halls to provide information assistance. In addition, the I & A staff does the intake for the State Kupuna Care Program for frail elders, provides house-to-house outreach in selected neiglrborhoods and to the community-at-large via community fairs, presentations to groups, and media. On the Big Island of Hawaii, the Hawaii County Office of Aging offers similar services that cover a larger geographical area. As the largest island in the State with the lowest population density, HCOA has managed to reach 4,177 seniors through its aging network of service providers, health care organizations, advocacy groups and community groups. (2004, Executive Office on Aging Amrual Report) This community has a strong alliance and partnership among public and private sectors - a necessity when working with fewer resources. Despite their challenges with transportation, shortage of qualif ed health care providers, greater 3 geographical distances and small, rural communities, HCOA and the County of Hawaii have mauaged to address these obstacles with innovative programs, and resilient commitment to its senior population. H ome and community-based services in the State of Hawaii are presently delivered in two major arenas -the Medicaid and non-Medicaid populations. For the non-Medicaid population, many home and community based services often serve both public beneficiaries and private payers. There are adult day carelhealth centers, para-transit transportation companies, legal/advocacy groups, in-home personal and chore services, respite care, senior centers, caregiver support groups, telephone assurances, senior employment and volunteer opportunities, case management, nutrition sites, meals delivery programs, counseling and translation services for Hawaii's multilingual community, health screening and promotion programs, etc. For the Medicaid population, Hawaii's home and community Medicaid waiver programs served 4,257 recipients in need of long term care support in 2004. These include four (4) 1915 waiver programs such as 1) Nursing Home Without Walls; 2) Home and Community based program for Persons with Developmental Disabilities/Mental Retardation; 3) HIV Community Care Program; 4) Residential Alternatives Community Care Program. The State also has the Program ofAlt-Inclusive Care for the Elderly (PACE) on Oahu. The State Medicaid Program, known as QUEST, has served 153,389 recipients as of May 2005. This only includes the general Medicaid population and not the Aged, Blind and Disabled, and the Developmental Disabled groups. In 1993, the State of Hawaii secured one of the first Section 1 1 ] 5 waivers designed to use a managed care delivery system to create enough efficiency in ifs Medicaid program. This enabled the State to extend coverage to individuals who would otherGVise be without health insurance. The State combined its Medicaid program with its 4 then General Medical Assistance program and its innovative State Health Insurance program and offered benefits to citizens with incomes at or below 300% of the federal poverty level (poverty). Low-income women and children, and adults who had been covered by the two state-only programs were enrolled into fully capitated managed care plans throughout the State. This was the start of QUEST. Tn Spring of 2005, the Department of Human Services (DHS), lead agency of the QUEST Program, submitted an amended 1115 waiver to the Centers of Medicare and Medicaid Services (CMS) to revamp and expand the QUEST Program to include the Aged, Blind, and Disabled (ABD) population into the managed care system. This new QUEST will offer a full range of benefits from acute care to home and community based and long term care services in order to assure access to high quality, coordinated, and cost effective care are provided in the recipient's home and/or community. Upon CMS's approval, QUEST will reorganize and transition into the new system. At this time, QUEST is unable to articulate how intake and eligibility assessments will be implemented for the Aged, Blind and Disabled population. However, if the ADRC grant is awarded to Hawaii, these Resource Centers may play a vital role for the new QUEST program. More than ever, a highly visible, single entry point such as the proposed ADRC will be needed especially to assist the elderly and disabled Medicaid recipients in accessing the new managed care system. Challenges in Hawaii's Long Term Care System Like other states throughout the nation, Hawaii is no exception in facing multiple challenges of a fragnnented long term care system, need for more public awareness and education, biases towed institutional care, limited state/county funds, and au increasing demand for services and assistance. The problems are further compounded by the complex cultural and 5 racial diversity of the islands, the geographic diversity of resources spread unevenly among seven distinct Islands, and the economic pressures imposed on families due to the state's high cost of living. There is on-going immigration especially from the Pacific Rim countries and U.S. Territories. While such immigration enriches Hawaii's cultural heritage, the diverse needs of new disadvantaged individuals and families affect the already strained public health and social service resowrces. Traditionally, Hawaii's families have always cared for their elders. Hawaii data from the Behavioral Risk Factor Surveillance System 200 (BRFSS 2000) estimated that fourteen percent of adults provide care to an elderly family member or friend. This may be a relatively low estimate since there are many hidden caregivers in Hawaii -those who do not identify themselves as being a caregiver but actually perform care giving tasks. Unfortunately, this traditional informal support system has been strained by the challenges of the State's economy where two or more incomes are necessary to survive Hawaii's highly cost of living. Smaller households sharing responsibilities for their elders' care, and caregiver burnout have taken their toll on the family safety net. While family care giving is still a predominant factor in Hawaii's social culture, the form of care giving has changed over time to meet the updated expectations of successive generations of adults. Along with estimating caregiver prevalence, Hawaii's BRFSS 2000 also studied where people obtain long term care information. Results show that Hawaii residents obtain long-term care inforniation from many different places. The question asked adults, "Who would you cal] to arrange for short or long-term care in the home for an elderly relative or friend who is no longer able to care for themselves?" The most prevalent response was to ask a relative or friend 6 (29 pcrcent), followed by providing the care themselves (25 percent). 23 percent did not know who to call. The remaining 23 percent would obtain information from a variety of sources including nursing homes (7 percent), home health services (6 percent), their personal physician (4 percent), and their area agency on aging (2 percent). Among those that were not going to provide the services themselves or ask a friend or relative, 5] percent did not know where to tum for assistance. These results point to the need for communities in Hawaii to develop centers where the public knows they can obtain reliable information on long-term support options. These centers must not only serve older adults but also other populations in need of long-term support services and information including younger individuals with disabilities, family caregivers, persons and families planning for future long-term care support needs, and professionals who provide long-term support services. 1. TARGET POPULATION In the first year of the project, Hawaii will target older adults age 60 years and older. This will include not only seniors but their caregivers, as well as providers seeking information and support services for seniors. In the second year, the target group will expand to include people with physical disabilities. The rationale for selecting the physically disabled population as the second target group is because they are the next largest among the 3 remaining groups identified in the grant requirements. The community of individuals with disabilities in Hawaii is not small. Over 18 percent of Hawaii's population lives with one or more disabilities and 60 per cent of these individuals are below age 6Q according to Census 2000. 2. PROPOSED INTERVF,NTION Pilot Site Selection 7 Hawaii's ADRCs will be developed in the Hawaii County on the Big Island of Hawaii, and a possible second site in the City and County oCHonolulu, on the Island of Oahu. These are the two most populated islands in the State. The State of Hawaii has a total population of 1.26 million residents according to Census 2000. Of this population, 876,156 people reside in the City and County of Honolulu which encompasses the entire island of Oahu. Among the Oahu residents, there are 151,051 older adults 60 years and older (17.2 percent of the island population). On the Big Island of Hawaii, there are 148,677 residents of which 26,112 are 60 years and older (17.57 percent). L City and County of Honolulu According to the U.S. Census Bureau, between 1990 and 2000, Oahu's population grew from 836,231 in 1990 to 876,156 in 2000, an increase of 39,925 persons, or about 4.8 percent. Over that same period, the population of the 60+ years and older grew from 127,957 in 1990 to 151,051, an increase of 23,094 persons or 18 percent. According to the local projections based on U.S. Census Bureau data, in the next 10 years, Oahu expects to see a large growth in the 85+ population as well as the 60-64 years old group which includes the first wave of the "Baby Boomers" cohort (those bom between 1946 and 1964). La. EAD's Implementation Plans and Objectives 'Che Elderly Affairs Division (EAD), Honolulu's Area Agency on Agency, serves the most populated island in the State, which justifies the establislunent of an ADRC on Oahu. However, the City and Comity of Honolulu is facing major budgetary constraints in which additional funds from the City and County camrot be immediately committed for a new ADRC site at this time. The City recognizes the importance and need for an ADRC on Oahu, and is committed to work with the State in making a single entry point into long term care a rea]ity for 8 Hawaii. The ADRC grant initiative allows EAD to participate in the State's long term care access plaiming and development with the goal to identify a site that can house the ADRC and the funding to sustain it. In its first year, EAD's objectives are: 1) Participate in the State Advisory Board to plan and develop a long term care access plan statewide; 2) Assess, plan and develop an ADRC upon the strengths of the City's EAD's programs. EAD's planning process will assess: 1) its current aging programs and determine how they will impact and be impacted by the ADRC, 2) the feasibility to locate and establish a new site for the ADRC and its staff (including the funding source for lease/purchase, and center's operating costs). The center staff includes the current EAD's Information and Assistance staff, case managers, community service aides, and future community partners including Department of Human Services (DHS) Medicaid staff. At the beginning of Year 2, assuming that an ADRC can be established and sustained in Honolulu, EAD will hire staff to begin developing the ADRC infrastructure. Year 3 will focus on the continuous development of the ADRC infrastructure and operations. See additional details in EAD's work plan for the Honolulu ADRC. IL Hawaii County The Island of Hawaii is the largest island in the Hawaiian chain. It is the second largest populated island in the State, with 158,423 residents. The island's total area is 5,086 square miles of which 4,028 square miles arc land and 1,058 square miles are water areas. It is a widely dispersed island with rural characteristics. According to the U.S. Census Bureau, between 1990 and 2000, Hawaii County experienced the highest rate of increase (25.9 percent) in the 60+ populations within the State. Maui County came in second with a 24.9 percent increase, and Kauai and Honohdu Counties were almost at 17.9 and 17.5 percent rate increase respectively. ILa. Hawaii County's Implementation Plan and Objectives 9 Hawaii County Office of Aging's proposed one-stop, single entry resource center for information and services on long term care options is deemed a priority of the Hawaii County Mayor's office. The County envisions a centralized facility that will provide resource libraries, day respite, interagency office spaces for key goverrunent and community agencies that can provide a wide range of services and information, training, benefits, counseling for seniors and people with disabilities. HCOA's objective will focus on project planning and development of the ADRC infrastructure on the Big Island in the first year. This includes hiring an ADRC Coordinator who will he charged with formalizing partnerships with community groups, agencies and services that target the elderly population. Another objective is a feasibility study that will be conducted to develop a centralized ADRC facility. Development activities will be implemented in phases during the 3 years of the grant period. This includes architectural designs, floor plans, enhancing the management information systems, marketing and public awareness campaigns, and developing central intake and case management protocols. In Year 2, Hawaii County will include people with physical disabilities as the second target group. In Year 3, programs and services will be co-located in the same facility. See additional details on Hawaii County's work plans. III. Executive Office on Aging Implementation Plans and Objectives As the lead agency of the ADRC grant, EOA will initiate astate-wide strategic planning process to guide the AAAs and aging network. One of the strategic planning objectives is the development of a long term care access plan that acknowledges reorganization and refinement of aging and disability services in the next several years. The access plan will include a) agreements among key aging Medicaid, Medicare, and community partners to commit staffing, funding, and/or materials in support of a single, entry point for long term care resources; and b) 10 identifying innovative approaches and partnerships to meet a growing demand for long term care for which available resources may be modified or reorganized to meet the demands, c) identification of information management system solutions to meet state and local needs for consistent data collection and reporting Other objectives include: 1) Integration of ADRC goals in the State and Area Plan on Aging for 2008-20011; 2) An accessible, affordable, and sustainable site for the Honolulu ADRC will be identified and developed to accommodate State, City and County, and community partners; 3) ADRC efforts will interface, where feasible, with access and services developments in Hawaii relevant to mental health, and services for the developmentally disabled, as well as future developments of ADRCs in other Counties/Islands; and 4) Development of evaluation tools and methodologies for the project. 4. INVOLVEMENT OF KEY STAKEHOLDERS The Executive Office on Aging will establish aState-level ADRC Advisory Board composed of representatives of the aging and disability networks, consumers, government and private sectors, education, financial, health and long term care industries. There is strong emphasis on the role of the consumers and their advocates to have an active voice in the planning and development process of the ADRC. As the primary users of the Centers, consumers will provide input and feedback on its efficiency and effectiveness in meeting their needs for information, access and linkages to long terns care options. Public/private partnership is equally critical to the success of the ADRC. As evident by the list of supporters, the advisory board provides a makeup of members from both sectors. The role of the State ADRC Advisory Board is to support the lead state and local agencies in promoting systems changes by 1) Serving as a working board that will be actively involved in the planning and development of the State-v.~ide Long Ternr Care Access Plan which oversees the ADRC implementation; 2) Identifying and 11 solving issues and barriers to implement ADRCs in Hawaii; 3) Providing resources and expertise in addressing the multi-layered needs of the aging and disability populations, consumers, providers, and government; 4) Promoting and communicating the role/function of the ADRCs to the public, providers, legislature and county councils, policy makers for future sustainability which include political and financial support. The committee will meet on a quarterly basis to monitor the progress of the ADRC implementation accordingly to the timeline and activities indicated in the work-plan, and assist EOA and the AAAs address any issues and bamers. The State ADRC Advisory Board Membership includes but not limited to: State Agencies Governor's Long Temr Living Initiatives Workgroups Hawaii State Health Insurance Program Grant -Sage PLUS Hawaii Senior Medicare Patrol Grant - SageWatch Department of Health, Developmental Disabilities Division Department of Health, Disability and Communications Access Board Department o1' Health, Executive Office on Aging: Member, Department of Health, Adult Mental Health Division Department of'Health, Evidence -Based Practices Project Department of Health, State Health Insurance Assistance Program Department of Human Services, QUEST Expanded Managed Care (Medicaid) Department of Business, Economic Development and Tourism Department of Transportation, Assisted Transportation Grants Management State Housing Authority State Office of Long Term Care Ombudsman University of Hawaii, School of Medicine, Geriatrics Division University of Hawaii, Center on Aging University of Hawaii, Community Colleges University of Hawaii, Center on Families Area Agencies on Aging City and County of Honolulu, Elderly Affairs Division Hawaii County Office of Aging Kauai Aging on Elderly Affairs Maui County Office on Aging Community Organizations/Advocacy Groups/Consumers HARP Alu Likc Alzheimer's Association Kokua Council for Senior Citizens 12 Governor's Policy Advisory Board for Elder Affairs Hawaii Long Term Care Association Hawaii Caregivers Coalition Hawaii Center for Independent Living Healthcare Association of Hawaii Project Dana _ The AAAs have their own advisory committee/steering committee at the local level to assist in the plamring and implementation of the ADRCs in their respective counties. 5. PERFORMANCE GOALS AND INDICATORS The Hawaii State F,xecutive Office on Aging is committed to developing a statewide long term care access plan with at least one ADRC on the Big Island and a possible second center on Oahu. A single ADRC for all of Hawaii is not feasible due to the island geography and the fact that not all seven major islands have the same types or quantity of services, resources and products that factor into long term care needs. However, the successful outcomes of Hawaii's pilot ADRCs can serve as a prototype for additional centers in other counties such as Kauai and Maui as well as neighborhood communities throughout the state. Using the goals of the grant initiatives as guidelines, Hawaii's goals are as follow: 1) Establish highly visible and trustworthy Resource Centers that are easily accessible to the public and responsive to their needs for information and linkages to long term cart options. "Phis includes securing an affordable and sustainable site for the Honolulu ADRC. 2) The process for screening, intake, assessment, and eligibility determination will be efficient and streamlined to reduce redundancy of paperwork, confusion and frustration i? accessing long term care support. 3) Establish and convene a State ADRC Advisory Board to develop a long teen care access plan that aclarowledges reorganization and refinement of aging and 1~ disability services in the next several years. These goals will be accomplished by the end of the 3 year grant period. To mark the progress of the grants, the following milestones have been established for the respective AAAs and EOA: Hawaii County of Aging Year 1: Aging Population will be able to access aging services through centralized point of entry. Other specific milestones include but not limited to: central intake and case management protocols streamlined and coordinated, marketing and public awareness campaigns developed, coordination and formalized relationships with partners and other services groups, completion of feasibility study and plamiing for a centralized site, and completion of management information system enhancement plans. Year 2: Disability Community will be able to access aging and disability services through centralized point of entry. Other milestones include: coordination and formalized partnerships with the disability community services agencies and providers. Year 3: Services will be co-located in Central Facility. Refer to HCOA Plans and Objectives, pages 9-10. City and County of Honolulu Year 1: Completion of the feasibility and planning process to establish an ADRC site in Honolulu and recommendation for decision is reached. Completion of EAD's assessment of current operations and its impact by an ADRC site. Years 2 and 3: If deemed feasible, EAD will proceed to develop an ADRC and aging population will access aging services through a centralized point of entry. if a Honolulu ADRC site caimot be identified and funded, EAD may focus on a virtual connection with other partners and build its current system to have the basic framework and functions for a future ADRC. Refer to EAD Plans and Objectives, pages 8-9. 14 Executive Office on Aging Year 1: State Advisory Board and working subcommittees established; a statewide long term care access plan developed which includes agreements among key agencies and partners; identification of a Honolulu ADRC site and funding source. Year 2: ADRC goals will be incorporated in the State and Area Plans on Aging for 2008-2001, and be consistent with the Governor's Long Term Living Initiatives. Year 3: ADRCs will be operating in Hawaii County and possible site in Honolulu, and serve as prototypes for replication in other Counties/Islands. Refer to EOA Plans and Objectives, pages 10-11. The ADRC initiative is a major commitment for EOA and the AAAs. While the State embraces the goals and vision of the ADRC, it is cognizant of the project's responsibilities and magnitude of the work among the AAAs, government agencies and community to collaborate, coordinate and transform the current long term care system. In addition, Hawaii is working in an uncertain environment of major changes with the implementation of Medicare D and its impact on consumers, the State Medicaid's new QUEST managed care program for the Aged, Blind and Disabled, and cutbacks iu County and State budgets. Many unforeseen situations and issues may arise during the course of the project which may require the State to adjust and refine the proposed performance goals and indicators. 5. INDICATORS To measure the performance goals and outcomes, the following indicators will be used: Indicators Goals Structure Process Output Outcome Impact Establish *Develop M[S * Develop * Number of * high user * Public Visible and for marketing and Contacts by satisfaction in knowledge Accessible Resource community source of terms of of ADRC * MIS outreach plan referrals objectivity, location, accessible to * hifomiation * Number reliability, function, other pro~-ams Maintenance and types of comprehensive, website, * launch of and update Outreach usefuLtess and phone website protocols activities currency of numbe~ IS * Establish conducted information among ADRC in consumers Hawaii County and and providers ~ Honolulu _ _ Streamline *Standardized * Reduced * Usefuland * Provider *Lower screening, application number of flexible MIS satisfaction costs of Intake, form and consumer that with Medicaid eligibility assessment contacts to streamlines appropriateness services process to tools access multiple Application of referrals provided reduce * Co-location services and supports * Reduced per user redundancy of Medicaid * Quality amount of time and and eligibility implementation Improvement to complete aggregate maximize worker and of uniform * Pattenrs in intake and efficiency other clinical and complaints referral process Consumers and community financial and * High user perceive effectiveness service eligibility grievances satisfaction, in greater partners process across terms of efficiency programs information being simple and clear, reduced frustration and confusion *Referral source satisfaction *Consumer follow through (as reported by consumer and/or provider) Development *Establishment * Interagency * Analyses * Statewide *Ability of LTC of State-Level agreements and of report on plan for Access Plan Advisory other consumer implemented consumer for State Board and comparative feedback to exercise subcommittees efforts informed * Formulations choices * of new Establishment partnerships to of ADRC in meet demands target counties for services and resources 16 6. EVALUATION The Executive Office on Aging will be responsible for the evaluation process of the ADRC grant project. A Program Evaluation Consultant will be contracted to assist in the evaluation of the grant for the 3 year period. In the first year, the consultant will develop the evaluation design and methodology. The evaluation design will include the development of performance standards, indicators, outcome measures, data management, complaints and grievances data collection tools, consumer and provider satisfaction surveys, quality assurance mechanisms, reporting mechanisms and annual evaluation reports. EOA will comply with the minimum dataset elements requested of grantees which measure the baseline (pre-ADRC), and post-ADRC, characteristics of the target population, the efficiency, effectiveness, responsiveness, visibility/trust, and implementation process. The evaluation will include on-site assessment of the ADRC in the respective counties. Data collections may come from different Management Information Systems (MIS) including the SAMS 2000 program. All four County AAAs are currently using SAMS 2000, a software program developed by Synergy Software Technologies. This system was first introduced to the State in 2003 and each cowrty is still in different stages of system development. The State will examine how the SAMS 2000 and other data systems can interface with the management information systems requirements for the ADRCs. "the State ADRC Advisory Board will form an Evaluation subcommittee to oversee the evaluation process which will also include the MIS system. The subcommittee and Evaluation Consultant will address the need to protect the privacy and confidentiality of client information, and ensure that the ADRC and management infornation system will comply with the Health Insurance Portability and Accountability (HIPAA) policies and regulations. The ADRC project progress will be monitored and reported on a quarterly basis to the Evaluation 17 subconunittee. The evaluation consultant will make specific recommendations as the project progresses through its work plans, objectives and outcomes. Asemi-annual and amrua] evaluation report will be made and submitted to AoA/CMS, State Advisory Board, EOA and the AAAs involved in the project implementation. 7. DISSEMINATION The Executive Oftce on Aging will be responsible to disseminate the ADRC project progress and evaluation findings to the State Advisory board as well as the local advisory committees overseeing the respective AAAs involved in the ADRC implementation. A communication plan will be developed by the EOA office to identify the target audiences, and method of information dissemination. Besides State and local advisory boards, the target audience will include other major stakeholders such as the State Legislature, City/County Councils, the Governor and Mayor's offices, and aging network. Distribution methods may include press releases, newsletters, print materials, public presentations at conferences and workshops, and EOA and AAAs' websites. 8. PROJECT' MANAGEMENT Executive Office on Aging (lead agencVl: As the lead agency and project manager, the role of EOA includes but is not limited to: 1) Provide administrative oversight and assure grant compliance; 2) Assures resources for ADRC evaluation process; 3) Establishes the State level Advisory Board with key stakeholders as outlined in the grant proposal; 4) Organizes and convenes working subcommittccs composed of members from the ADRC Advisory Board and other stakeholders to a) seek and secure resources to support an ADRC site in Honolulu and eventually other Counties in the future; b) secure agreements among departments and community agencies regarding the Resource Center's staffing, funding, and other operational support; 5) is Assures ADRC development is consistent with the Governor's long term living initiatives and State and Area Ptaus on Aging; 6) Develops a statewide communication and marketing plan to promote public awareness of the ADRCs in Hawaii; and 7) Advocates and seeks additional funding resources to further develop the ADRCs in Honolulu, Hawaii and other counties statewide. Sources may include private fiords, legislature and county appropriations, other grants and contributions. State ADRC Advisory Board: The role of the State ADRC Advisory Board is to oversee all grant activities. See description of the Advisory Board under Key Stakeholders. The local advisory boards and steering committees for the AAAs involved in the project will also function in similar roles at the community level. Pilot Sites• Hawaii County of AQ1nE and Honolulu Elder?v Affairs Division Hawaii County Office of Aging and the Honolulu Elderly Affairs Division are responsible for the planning, development and operations of the ADRC in their respective counties. Hawaii County Office of Aging will conduct feasibility studies, hire the local project coordinator, and negotiate the contracts and memorandum of agreements among the services providers and community groups involved in the ADRC operation. As described in the work plan, HCOA will also identify and secure a location site to house the Resource Center and secure the necessary staffing, funding, partners and other components of the ADRC. Elderly Affairs Division in Honolulu will actively participate in the statewide planning in the development of the long term care access plan. In partnership with the State EOA, Department oCHuman Services (DHS) and the ADRC Advisory Board, EAD's goal is to locate a site or office space and funding to establish an ADRC site in Honolulu. If this can be achieved within the first year, EAD witl proceed to develop the ADRC accordingly. As in Hawaii 19 County, EAD will be responsible for the implementation and operations of the ADRC on the Island of Oahu. Key Staff: A State Project Coordinator will be hired with the grant funds to oversee the project activities on behalf of EOA, the lead agency. There will also be a project coordinator in Hawaii County to plan and develop the ADRC project on the Big Island. EAD will not be hiring a project coordinator in the first year until the City and County can determine the feasibility to establish a Honolulu ADRC site. The following individuals will be the primary contact persons responsible for the ADRC grant activities: Patricia Sasaki -Executive Director of the Executive Office on Aging. She is ultimately responsible as the head of the lead agency for the grant and the overall implementation of ADRC activities as outlined. Alan Park -Executive on Aging, Hawaii County Office of Aging. Mr. Parker will oversee the planning and development activities of the ADRC site in Hawaii County. Karen Miyake -Executive on Aging, City and County of Honolulu Elderly Affairs Division. Ms. Miyake will oversee the planning and development activities of the ADRC site in Honolulu County if the long term care planning access plan deems it feasible, Patty Johnson - Administrator of Department of Human Services, Social Services Division, Adult and Community Care Services Branch. Ms. Johnson serves as the liaison and lead representative of the Department of Human Services for the Medicaid (QUEST) program. Other staff' will include the Evaluation Consultant, Facility Design consultant who will be contracted through the grant funds. 9. WORK PLAN: See Work Plan Attachments 10. ORGANIZATIONAL CAPABILITY STATEMENT AND VITAE FOR KEY PROJECT PERSONNEL 20 Lead Agency -Executive Office on Aging: Executive Office on Aging (EOA) leads the Hawaii Aging Network of County Area Agencies on Aging and partners with diverse community resources in preparing for a rapidly growing aging society. EOA advocates, plans, develops, and evaluates policies and programs. It designates and administers funds made available to County Area Agencies on Aging for the delivery of services to older adults and caregivers. The State and County Aging offices annually serve an estimated 15-20 percent of Hawaii's 207,000 adults (i0 years and older, and their family and informal caregivers through federal, state and county programs. EOA works with the County AAAs to assure accurate data collection regarding older adults and caregivers, and also works with the University of Hawaii resources to assure quality and accessible data for policy makers, researchers, and the community. As the lead agency of the ADRC grant, EOA will contract or hire astate-level project coordinator to oversee the pilot project ADRC development, and work closely with the State ADRC Advisory Board to plan and develop the statewide long term care access plan. The key project staff from EOA includes: Patricia Sasaki, Exccutive Director, has an extensive background in health and aging and a leader in developing new programs such as Healthy Aging Project, and the Aging Data Center at the University of Hawaii. She has served as the Public Health Administrator and is an author and educator. Felipe Tan, Accountant, has over twenty years as an accowrtant who will oversee the accounting and financial management of the grant funds. llerrick Ariyoshi, Program Specialist, Sage Watch Program, oversees the Medicare/Medicaid Fraud Prevention Program for the State. His experience and knowledge in 21 Medicare and Medicaid, and other health insurance programs will be instnimental in coordinating trained volunteers to ADRCs for Medicare and Medicaid fraud prevention counseling and education. Pamela Cunningham, Coordinator, Sage Plus Program, is responsible for the State Health Insurance Counseling Program. Ms. Cunningham's knowledge and expertise in the Medicare, Medicaid and private health and long term care insurance will assist in the training and coordination of volunteers for public and private health insurance counseling and enrollment assistance in Medicare. Pilot Site 1 -Hawaii County Office on A~in~: The Hawaii County Office of Aging (HCOA) possesses the organizational capacities to develop and implement future operations of the proposed local Aging and Disability Resource Center. During the 35 years of operating as an Area Agency on Aging, the HCOA proved itself in successfully leveraging relatively small amount of federal resources to create a responsive network of programs and services serving the older population and their caregivers. HCOA led the state in the eldercare delivery fronts: first and most successful RSVP program {1972); establishment of the case management (1981) and led to the development of the first computerized elderly database and client tracking system (1982) and later became a major tool in linking older individuals through the Long Term Care Access Program {1989). During the last decade, HCOA was awarded an AOA grant to implement Project CARE {1991); establishment of the first Caregiver Resource Center in state (l 994); establishment of groups of empowered older residents through Community Planning Councils and later replicated as Community Voices (1996). Most recently, the HCOA developed and implemented a training program through Hawaii Institute on Aging in partnership with the Center on Aging at the University of Hawaii; first to install and fully deploy the SAMS2000 22 software to address federal reporting requirements (2003); and participating with a state initiative to implement. a Healthy Aging program (2005). 'the Hawaii County Office of Aging operates on an annual combined federal, state and county budget of approximately $ 2.5 million while successfully performing its mandated functions and administering, managing and delivering more than twenty eldercare services through qualified local contractors. The current Mayor has provided solid financial commitment to the development of an ADRC by allocating a respectable amount of money in this project. In addition, key directors of the various affected county departments are members of a working committee to insure success on all aspects of the proposed project. To date, a prospective ADRC physical site has been identified and key project partners have been confirmed. Key Project Staff: Alan Parker, Executive on Aging, is a 33 year veteran of government service. His distinguished career reflects his vast knowledge of the different services in the aging network. He has held high level administrative positions which include Director of the Retired Senior Volunteer Program, Deputy Director of the Department of Parks and Recreation, Planner and is the current Executive of the Hawaii County Office of Aging. Lito Asuncion, Program Pla~mer, brings his 15+ years experience in program planning and evaluation, grant writing, research and data analysis, and extensive knowledge in the application of computer technology in human and health services. He has worked extensively with the minority populations in Hawaii and the Pacific Islands. Laverne Omori, Progam Planner, has worked within the aging network for fourteen years. She has coordinated many conferences and workshops to bring information and access to resources to the older adults and their caregivers. 23 Pauline Fukunaga, Program Planner, recently implemented a Healthy Aging Project and is instrumental in community development. She oversees the Partners in Eldercare Community Councils in six districts and facilitates grassroots planning and development. W iltiam Farr, Computer ProgrammerlAnalyst, will play a key role in the ADRC Management Information System. Working closely with Synergy Software Technologies staff, Mr. Farr migrated the existing 20,000 client demographic records in the Synergy Software Technologies SAMS 2000 data base system. He was responsible for the network design specification, hardware and software acquisitions, installation and deployment for HCOA. Possible Pilot Site 2 -City and County of Honolulu Elderly Affairs Division: The Elderly Affairs Division (EAD) has been a desibmated Area Agency on Aging for the City and County of Honolulu since 1973. Since its inception, the Division has grown to manage a budget of $6.3million. Sources of support include the Administration on Aging, and State funds via the Executive Office on Aging, Department of Justice Victims of Crime Act, City and County of Honolulu, Community Development Block Grant, grants from private foundation and private donations. EAD has a strong Information and Assistance Unit funded primarily with City and County funds. Within the last four years, it has been expanded with an infusion of funds from the State and the National Family Caregiver Support Program. The Unit provides outreach to isolated, frail, and low income elders; caregivers of frail elders; and elderly caregivers of minors. Information is regularly disseminated to well elders at senior centers, senior clubs, senior housing projects, general public and to targeted service providers and senior advocates. EAD Key Staff: Karen Miyake, Executive on Aging has 28 years in the aging nerivork, serving in high administrative positions such as Director of the Nutrition Program, and Chief Planner in 24 EAD. She has served as the Executive of EAD since 1995. She serves on numerous boards, governor's task forces, White House Conference on Aging, and other aging and health related organizations. 11. SUSTAINABILITY For many years, the State of Hawaii has had a vision to establish anone-stop, single point of entry center that directs consumers, providers and families to needed long term care information and resources. The ADRC grant fund provides the State the impetus to move a step closer in realizi~tg its vision and serves as seed money for planning and development of a statewide long term care access plan -the basis of the ADRC infrastructure. The performance outcomes of the pilot ADRC site(s) will provide valuable data and information which can assist EOA and the AAAs leverage their requests for additional funds at the State and County levels. The success of the pilot sites will galvanize strong political and public support. Hawaii County already has strong support and commitment from the Mayor and County Council for funding to absorb the additional staff hired for the new ADRC site. One of HCOA's strategies for sustainability is to collect revenues from the lease/rental of office space from other tenants co- locating at the Hawaii County's ADRC site. Similar strategies are being considered for the Honolulu ADRC site as well as other CountieslIslands. Government agencies collaborating in this effort may also blend resources and funding to sustain the ADRC. Financial support will also be sought from the private sector -philanthropic organizations, private businesses, and other interest groups. The State ADRC Advisory Board and local advisory committees will be instrumental in assisting EOA and the AAAs plan and develop these strategies to sustain and expand ADRCs throughout the State. 25 0 0 0 0 o ~ o ~ O O V M 7 ~ 69 Ef3 T T ~ ~ b b O O ~ M 69 rr VJ x ° ~ ~ N ~ c o ~ R. `y O ~n M U w O v y R. ~ x x b a. ~ ~ T~ O ctl X b ~ V F~I ~ > oA ~ R. w ~ G' C ~ N N bA ~ 7 'c7 X. y y O C~ ti ~ ~ ~ cad '4'' ~ W Q N y y N k •'L. ~ ~ ~QPr GTaO G O ~ F: U WO ce o 0 00 0 00 a ~ o0 7 C o F" O u 0 0 0 0 0 ,may y L U "J 9 C y w~ CA c ~ z 0 ~ o 0 0 ° o° i ~ ~s d ~ F` U e 0 z 0 0 0 ° ° 0 ~o ~ a q w w i N ~ G U L o ~ E y R o C u > ,G V L G L Q' ~L kl ~ W ~ o °o~°o°o° o0 ~ ~ O oo ~ rn C ~ 69 69 ~ M ~ 69 ~ O U O O O O O O O O O O ro ro o 0 0 0 0 0 0 0 0 0 ro o00 ~'b ooo°o~no cvoov,o O O O TJ O O O O O O ~p V'~ N N N cd O O O ~ W cf O O N~ M xi O"~ O M-. ~ Ff3 69 ff36~<369 b9 b4 V?~6969 b9 O N N ~ X sR C CL (f3 69 69 ~ ~ O . C"r N ~ N ~ _ .U. o v ~ ~ 00 O N' ~ ~ .U ~ N .u ~ ~ ~ O ~ X N Fir ~ w 0 .n N CL y O y .N .v' O ~ ~ ~ N c~ ~ X : U C4 X rn ~ .N~. ~ U ~ ti/.. ~ cd iG Q N N ~ N ~ N w a~i o ~ ro ~ ~ v ~ a'"i N h ~ ~ q ~ ~ ~ ~ a' W N ~ O~ k> : CL ~ ~0,, N 4J O. N w O O d o 'b ~ X c N ~ N ti a a i~ a a' a O x ~ ~ U v, ~ ~~N ouG ~~~bU W v~w_°: ~ R" ti ~ o O ~ in ~ o a~ o Q i O ro ~ U o cci ' ~ x ~ ~ d ~ ~ vii F. O sO. ~ vOi R ~ ~ ~ U ~ cd a d ~ i%i bU'O ~ Q, OU N wl~+ L~. V S-n ~ i~.ti• H ~ ~ in O vl ~ X ^y . ~y p, W ~ o o ~ o s`n, ~a ab~ci ~ aWi oA o W W x >dw W O >da ~O,dUU>U O~(~F.F~ Pr UdU H U O N ~ o 0 0 o U ~ W i ~ 7 h h a, O ~ a ~ ~ y 'O ~ ~ w ~O R~ = c o z 0 C v 0 p u c V w w' N N ~ ~ L ~ U ~ n O d L ~ R C ~ ~ O O U 0 0 O v~ o 0 00 ~n r. ~ ~ eC x w o s~ o ~ U ~ M ~ ~ y ~ ~ bD :d 'y O ~ ~o z M a. 0 0 c ° o ~ N ~ ~ U 00 w ~ o 0 ti o on "CS 7 W 0 0 0 N 64 ~ ~ O ~ O V ~ O in O 00 69 m ~ ~ [-i L b r O p ~U H s C v. O U C ~ N QQ ~4d' M v 7 ~ ~ ~ N i ~ b ~ ~ ~y C C {a N ~ ~ .1. 'y ~ v ~ L W 6! w ~ ?l I^~ U ~ M ~ ~ G O ~ ~ d W R ~ U G ~ u ~ ro E X i. u ~ ~ ~ ~ u « O ~ it `.-C ~ <tl O d c a ~ r O b ° i, y Y ~ ~ id ,G O ti h b O ~ ~ p y O a X a O~ T aJ p Q W U cd Lyy. ~ iii ~ E T A ~ N N W N a y N ~v _ ~ ~ ~ Hv ~ ~ a ~ a~ ~ ~ 'N b a~ ~ o b o ~ a R ~ o o U o~ ~ ~ o d " H " 3 ~ ~ ° ~ b a; ° ~ ~ ~ v u~ T~ x b o ~ x a ~ ~ ~ N rYi ~ f1 .fl W ° ~ .'Y m 4. L~. W ~ f-r e~ p O ~ G, ~ O P. ~n ~ N ° ;d ~ ri o C O. O O~ O U O~ Gam' ~ G ~ U~ a o ~ U id ro ~ CG U ~ ° ~ ° ~ aS wm„ w o c ° ~ ~ ~ o m m ~ ytl -d ~ ~ O o ~ ~ ~ V V ~ v u~ m u O b V] O O T ~ U ~ w C/] ~ u W d T~ O~' a p R G 'b 9 a> a~i U a' ~ A. U ~ U ? ~ ~ .b ~ A 'r, v~ rOi~ ni O~ ~ ~ O W ~ N~ N p ~ ~ ~ ~ 'D ~ ~ ~ cy U 1-i N Y ctl N ~ Q! N A ~ U u O td ~ 'd ~tl r.~~ C~ ~ _O = cC G G ~b0 Y ~ O 'O C/] ~ ~ C7 ~ 'D O N q r" Q ~ ~ vii .O xi x xi b U .O in ci y ~ ~ v ~ ~ o N O z o u ~ ~ _ ~ ~ r = O Wes..,, ~ Q R. h v o~ v 0.~ b 0 V ~ ~ v, c~i 0."1 ?ti M - cd ~ d x~WQUxP.U oQQx'v~U a ~.n b ~ ~ ,c ~ ~ ~ o ~ U T ~ ~ ° Q b 8 o 3 0 ~v°J y ao ~ ~ o ~U x b ~a " w 'V 0. . ~ .5 r" ~'d ~ ~ ~ m ,a x ~ o ~ ~ o U G b _al Y ~ ~ w ~ Q ~ aVj O ~ N yT, F, _ O N L ^ p ro G C ~ N ti ~y ~ O C V td W W ?U? U C w ca ~ 'D ~ L tV. N ~ ~ ~ ~ ~ 7 U O" N N 'O rTi ~ ...C" N O V] V] ro > b 3 ~ ~ ~ N 'fl C ti O ~ .b N P. bA ~ ~ V P.: ~ ~ ~ Q ~ ~ ~ O ~ aJ U >C >C ~G v X >C >C ?C SC >G SG ~ x v o~ ~ ~d dU ~b ~b ~b¢ ~ddmp w'Uxv~ x¢aU ina.Uv~d W xv~ ~ N ~ U a ~ N c c~. ~ on ~ G G o p^, _p ° N n a ~ ~ ~ ° qGq G ~ ~ 0"4,~ ¢ G ~ a ~ ~ ~ ~ w p d ~ p cGa C o .3 ~ ~ F~ ~ ~ ~ ~ N w ~ o 'v j,U °G'b ~b U ~b _ I^\ G H 3 0 oq ~ y m ~ ~ ~ G o ~ ~ ~ ~ ~ ~ .b w ~ w° L. G ~ O „N ~ O ~ cd ~ ~ Q" O 0-0 G 'O p ~ V] ~ A. p ~ AG. C C Qa ~ tFd N w ~ 3 ~ N N T~ 4. ~ O N N N Y h > v~ N "^G 0-0 U sue. ~ ~ O G F c~ ~ C N o C ~ " U G UO b ~ ~ X ~ Q. ~ o ~ O O _ pn w ~ N f1 QJ O N N OL GO ~ N ~j ~ N i... ~ ~ b ~ 3 U Q v Q w° ro Q~ x x x x o ~ ow 0 x ~ W U ° c > ? O T U ~ ~ ~ ,3 ~ ~ ~ 0 6, x ~ b ~ ~ o~ b o ' ~ ~ ~ o U w° ..-i ~ A p C ~ A ~ U ~ ~ CG ~ > ~ ~ ~ v ~ w ~o ~ ~ m Q. 0 0 O U A? U V Q ~ _ O ol) cC O ~ a ; 'V l~ W co° d v >t' >C ~ >G >G ~ 7 a ~n >C >t' >S X y ti N w E ti d ~ H r = V f7 ~ 1'\ d N Y, >S X Y DG ti d >G >C >C N O O ~ O ~ y, w ~ ~ ~ w 'j 'b ~ ~j b ,M ~ Q d ~ ~ can} ¢ ~ o, c d a ~ `G r7 O Q id G' ~ "7 ~ ~ ~ O Y ~ ~ O U U yW" 'r1"+ W U .Y'i it] U] 0.1 V] U v7 R~ V] U i. ~ fn ti N ai ~ ~ ~ p Q ° ~ aQ ~ ~ ~ ~ P. :ti ~ U ~ ~ ~a U y o ~ ~ ~ o~ ~ E q U ~ ~ O ~ ~ ~ ~ ~ UO ~ Y VO .O 3 N R. L 3 7 ~ O~ 3 ti RJ ~ ti N a ..k' ~ ^ ctl ~ O. O ~ ~ O N 't} LL 'D O U _V C a~ x' a ~ ~ ~ b P~- p b ro o ~ ~ l~ ~ ~ U ~ m N o. ry ~ ~ .a ~ op c 7 fU~ on ~ o ~ ~ o a, on o, m Q 3 .c a~i ~ o ~ v~ ~ ~ ~ ~ a N b > -o ~ ~Wb U oq U o O U Lam. 7 U ~ ~ Q N 4-. Q N p > O 0. .b x ~ b ~ ~ ~ O ~ Q w N N N o ~ Orb= ;~O a ~O W i~`G` 'm U .""-i .fir' H cC ca V] W ti v) W u c`~n G ~ _T u ~ Y U ti ro L C,J cO O U/a ~ r.' `n t. ~ O ~ ~ y Q 4r ~ Q Q Q V] N W ri x v ~n ADRC TAE Issue Brief Excellent Customer Service in an Aging and Disability Resource Center Produced by Carrie Blakeway To provide good customer service is to satisfy the customers' expectations. To provide excellent customer service is to exceed the customers' expectations, anticipating customers' needs and preferences and surprising them by how well they were served. The purpose of this issue brief is to describe why excellent customer service is important within the context of an Aging and Disability Resource Center (ADRC), to illustrate lessons learned about providing excellent customer service from the private and public sectors, to highlight implications for designing and operating an ADRC that provides excellent customer service, and to recommend steps an ADRC might take to achieve excellence in customer service. i. WHY IS PROVIDING EXCELLENT CUSTOMER SERVICE IMPORTANT FOR AN ADRC? An ADRC is a business with a set of products and a customer base. Customer service is the face the business presents to the public and how the ADRC interacts with its customers defines the organization itself. By providing excellent customer service, the ADRC can demonstrate its commitment to providing services that aze seamless from the - perspective of the consumer, as well as its commitment to the principles of consumer choice and consumer direction. Excellent customer service will help the ADRC gain the trust and loyalty of consumers, providers and community partners. Furthermore, it will be important to attracting both publicly assisted and private paying customers. Customer service is the foundation for building trust with consumers and the lazger community. Public service organizations must achieve a certain level of trust and credibility among public consumers for services to be effectively delivered. Consumer trust is earned by offering access to appropriate services and supports, and by making the process of accessing those services and supports as easy and as pleasant an experience for the consumer as possible. A customer's first encounter with a business is crucial; it may be the only chance the business has to gain the customer s trust.t If customers' expectations aze not met in their first visit, they may not return. And in the case of ADRCs, consumers may fall through the cracks, potentially resulting in unmet needs, functional decline, or unnecessary institutionalization. Building trust and credibility among service providers and partners will be equally important for the ADRC. The providers who come into contact with consumers along the critical pathways of long term caze services, social workers, physicians and their ~ Bruce McClendon, "The five most common mistakes N customer service;' International City-County Management Associafion, 1995. #360907 1 Posted 8/24/05 ADRC TAF Issue Brie staff, discharge planners, government agencies, and community organizations will be important partners to the ADRC, and can also be consumers of ADRC services. These partners, who will be in the best position to recommend the ADRC to consumers, should receive and be able to depend on consistently excellent customer service, also. Excellent customer service will help an ADRC earn consumer loyalty. Providing access to long term services and supports often involves building long term relationships with consumers, serving them through different life stages, and as their circuutstances and needs change. Economist Albert Hirschman writes that loyalty to a business or organizafion can be as powerful a motivator among consumers as price. s Earning the loyally of ADRC consumers over the long term will require particulaz attention to customer service. Consumers who need long term services and supports aze often experiencing difficult or even traumatic Life events. They must be served with sensitivity to their situation and experiences, or they may not be willing to return. Finally, excellent customer service will help to attract a wide range of consumers to the ADRC, including people who are able to privately pay for services. One of the ADRCs purposes is to help private pay individuals plan for their long term caze needs, consider their options, and spend their resources wisely. Asocial marketing campaign might be used to attract private pay individuals to the ADRC initially, but some businesses and organizations have found "word of mouth" to be the most effective form of advertisement a What clients shaze with their friends and neighbors about the services they received may determine the success of an ADRC. Over the long term, as resources aze spent, private pay individuals may require assistance from public programs. Special - attention to customer service will be required to attract individuals to the ADRC while they aze private pay and then retain them as clients when their situation changes. Important Lessons about customer service may be drawn from the private and public sectors and applied to the ADRC business. 11. CUSTOMER SERVICE IN 7HE PRIVATE SECTOR In the private sector, successful businesses have long recognized that providing excellent customer service offers a real advantage over the competition. Better customer service can be the key to success in business for two reasons: it can earn you repeat customers and it can earn you new customers. Repeat customers because satisfied customers come back, new customers because satisfied customers tell their friends and families about you. Significant differences in business outcomes have been observed between excellent and merely adequate customer service. For example, Xerox Corporation found that customers who were "totally satisfied" were six times more likely to become repeat customers than simply "satisfied" customers a Whether a business goal is to attract more customers or simply to keep the ones they have, customer service is a cleaz means s Albert Hirschman, Ezit, Voice and [.oyalty: Responses to Decline in Firms, Organisations and States, Harvard University Press, 1972. 3 Jeffrey Gitomer, "Principle before policy: rules for customer service" Business First-Buffalo, 2000. < Jim Billington, "Five Keys to Keeping Your Best Customers, "Harvard Management Update, 1996. #360907 2 Posted 8/24/05 ADRC TAE Issue Brie] to that end. Besides an increase in profit mazgins, businesses that offer excellent customer service aze often observed to have another quality: their employees tend to be more satisfied with their jobs s Higher employee satisfaction translates into higher productivity and lower turnover. So what does excellent customer service look like exactly? The literature tells us that excellent customer service is not an event, but rather a philosophy.b The best examples of excellent customer service in the private sector come Customer service is: from businesses in which every single person is • an orientafion, not an committed to doing everything it takes to make the event customers happy. • about cultivating personal, caring In some cases, companies have used unique or r+elafionships outstanding customer service to develop a niche in the • about better listening market. By using innovating management strategies that • about empowering promote customer service and by turning a customer your employees focused philosophy into every day operating • about empowering Procedures, businesses like Nordstrom and Southwest your customerst Airlines have become models of customer service in the private sector. These businesses strive to exceed customer expectations on a daily basis. Although their approaches vary, both companies subscribe to the philosophy that creating a positive and rewazding work environment for their employees is a precursor to providing excellent customer service. s Harvard Business Reviev~, "Command Performance: The Art of Delivering Quality Service;' Reprint No. 5622,1944. n Bruce McC7endon, "The five most common mistakes in customer service," International City-County Management Association, 1995. #360907 3 Posted 8/24/Q5 ADRC TAE Issue Brief Nordstrom Department Store Nordstrom opened in 1901 as a shoe store in Seattle and now has over 140 department stores nationwide with 40,000 employees. Philosophy of customer service: The customer is the key to success. Offer the customer the best possible service, selection, quality and value. Innovative policies and service strategies: • Nordstrom hires carefully, focusing more on attitude than on experience, and then gives their employees enormous freedom. In the employee manual, Nordstrom devotes a single page to customer service. The only rule states, 'Use your good judgment in all situations." Employees are further instructed to "Please feel free to ask any manager any question at anytime." • Nordstrom only promotes from within. Yn order to reacts management level, ebery.employee starts out on the selling floor. • Stores hold monthly store-wide meetings, where managers sometimes perform role plays or humorous skits to illustrate customer service technique. • Sales people earn commission on sales over their daily sales tazget. • The store has a "no questions asked" return policy. A customer may return anything, anytime, for any reason for a full refund. The store has even been known to give full refunds for items that were not purchased at Nordstrom. • Sales people often keep records of their customers' preferences and write personal notes to customers thanking them for their business. • If an item cannot be found in a Nordstrom store, sales people will call other department stores to find it. ~ Donna Dick and Peter Capplli, "Nordstrom Department Store,"' Center for Human Resources of the Wharton School of the University of Pennsylvania, 1991. #360907 4 Posted 8/24/05 ADRC TAE Issue Brie Southwest Airlines Southwest Airlines opened in 1972 as a small airline in Texas and is now one of the most successful airlines in the U.S., serving more than 65 million customers a yeaz. Philosophy of customer service: Great service begins at home, by making employees the number one priority. Satisfied employees will provide better customer service e Innovative policies and service strategies: • Southwest Airlines "hires for attitude and trains for skills." Because customer service requires empathy, they believe it is most important to hire people who like people and have good interpersonal skills. Technical skills can be acquired later. It's not your .people that set you apart, it's your friendly people9 • Employees snd managers are encouraged.to be themselves, have dirt at work, nat to take themselves too seriously; and do whatever ft takes to serve the - customers well. ' • Leaders are e,.t~corlsaged to lead by example, to serve as inspiration for their team, to "walk the talk." Southwest pilots have. been known to jump down and help unload baggage off the planes they just landed to make up time for a delayed flight. • Management is encouraged to manage in good times for bad tunes, or take the time when things are stable to plan for the unexpected. Each year, employees and managers par6icipate in several "What if.. scenarios to help them plan their response to emerging situations. • To simplify administration and operations, bureaucratic procedures, standing meetings and reports aze regulazly reviewed to ensure they still serve a meaningful purpose. e George Laszlo, "Southwest Airlines -living total quality in a service organization;' Managing Service Quality, 1999. a Jeffery Gitomer, "The rules of the game: are you a follower or a breaker?" Sales Caffeine, Buygitomer.com, 2000. #360907 rJ Posted 8/24/05 ADRC TAE Issue Brief While Nordstrom and Southwest Airlines are private businesses, their philosophies of customer service and the service strategies may be adapted for the public sector. Nordstrom's model of empowering front line service employees to serve customers in creative and individualized ways, according to the customers' needs and the employees' discretion, may be well suited to the purpose of the ADRC. Building flexibility into business protocols of the ADRC may be the key to providing seamless service for the consumer. Southwest's practice of formally planning for extraordinary situations, role playing, and practicing employee responses might be adopted by the ADRC for initial staff training and for ongoing staff and management learning. III. CUSTOMER SERVICE IN THE PUBLIC SERVICE SECTOR Higher productivity, revenue and profit are powerful incentives for providing excellent customer service in the private sector. Why is excellent customer service important in the public service sector? In the private market, it is assumed that consumers have options and that if they are unsatisfied with one business they can go to another. Public service consumers frequently do not have other options_ If consumers aze unsatisfied, they may forgo needed services all together. In the private sector, businesses that do not provide excellent customer service have other ways of athracting business, such as lowering prices. In the public sector, services frequently have no price or the price is fixed. Customer service may be a public organization s only opportunity to gain a "competitive' advantage. How do you go about providing excellent customer service? In their report to the Administration for Cltildren and Families, Robert Horowitz and Tammy Rinehart describe the practical steps a public service agency can take to deliver effective customer service.1e The section below outlines the steps an ADRC might take, adapted from Horowitz and Rinehart's recommendations. Step One: Identify your customers The ADRC should first identify the general populations that will be served, for example, adults over (i5 and adults with physical disabilities. It will also be important to identify those whom the ADRC will not serve and decide how to handle callers and customers who do not fit into one of the target population groups. The ADRC should have a policy in place for responding to the needs of non-tazgeted individuals. ~a Robert Horowitz and Tammy Rinehart, "Delivering Effective Customer Service" Office of Child Support Enforcement, Administration for Children and Families, available online at http://www.acf.dhhs.gov/programs/cse/pubs/reporis/customer_service_reporthtml #360907 6 Posted 8/24/05 ADRC TAE Issue Brie In addition to consumer populations, ADRCs should identify the service providers and community partners who will make referrals to the ADRC and rely on the ADRC for information and assistance for thew own clients. Step Two: Identify your customers' needs and preferences Before the ADRC opens its doors, it will be important for the staff to be familiar with the different target populations they serve, their potential needs and preferences. This might be achieved by organizing staff cross-training among partnering organizarions, or with different state or local service agencies. Members of the ADRC Advisory Boazd and/or Consumer Advisory Board could also offer valuable insight and advice about working with these different populations. Conducting a survey or researching mazketing trends might also help an ADRC determine general customer preferences. Once the ADRC opens, the staff will be responsible for determining the needs and preferences of each customer individually. A standard principle of customer service in the private sector is, "know your product "n This principle has particulaz sigrtificance for an ADRC. The second half of knowing your customers' needs, is knowing how you can meet those needs. To provide excellent customer service, the ADRC staff need to be familiar with a wide range of service and support options. It will important for staff to be kept up to date as programs, eligibility requirements, and enrollment processes change over time. Step Three: Establish internal system and culture focused on customer service Case studies have shown that businesses and organizations that provide excellent customer service aze supported by an internal system and organizational culture that promotes customer service. Customer service is not solely the responsibility of front line workers. The quality of an organization s customer service is also a reflection of the organization s management and culture. These aze not processes that can be established and then ignored. Horowitz and Rinehart found that an organization's culture -its internal policies, management style, and the satisfaction of its employees -will have an enormous impact on whether its customers receive excellent customer service. They describe how an internal structure and culture that promotes customer service can be established and sustained. The following recommendations, adapted from their work, may be particulazly relevant to the ADRC 1z • Identify the employee groups that have high customer interaction, the front-line employees, and include them in the development of customer service standazds. Hal Becker, "Customer Service" Inside-Business.com, 2003. Robert Horowitz and Tammy Rinehart, "Delivering Effective Customer Service" Office of Chid Support Enforcement, Administration for Children and Famines, available online aY. http://www.acf.dhhs.gov/programs/cse/pubs/reports/customer_service_reporthtml, and Bruce McClendon, "The five most common mistakes in customer service," International City-County Management Association, ]995. #360907 7 Posted 8/24/US ADRC TAF Issue Brief • On a daily basis, make sure that front line workers have the tools, information, training, resources, and managerial support they need to successfully perform their job. a Training, in particular, must be an ongoing process. For an ADRC, this might mean offering formal training seminars on topics such as cultural competency, in addifion to holding short regular meetings for staff to Team about new community resources, share customer service tips, and participate in role plays. • Encourage leaders to be flexible to innovative ideas. Empower employees to be creative and make judgment calls, by keeping the number of rules to a minimum. Everyone who has contact with customers should have the discretion to change the rules to meet the customer needs. Customers never want to hear the word „policy:'ia • Facilitate communication between divisions and employees so that customers do not have to repeat information. • Recruit employees who shaze the customer service vision and focus on training and development throughout employment. • Good customer service should be continually rewazded. I.irtk employee compensation, rewazds, acknowledgement and praise to good customer service performance. • Measure employee satisfaction regularly. - An example of an internal system that focuses on employee satisfaction and promotes excellent customer service comes from the San Diego Aging and Independence Services (AIS) agency, an ADRC pilot site for a recent grantee. ALS provides information services and home and community based services to older adults and disabled persons in the San Diego area. AIS rewards excellent employee performance by reco° ring staff achievements in a monthly employee newsletter.14 Step Four: Establish external processes and strategies for providing customer service The final step to promoting excellent customer service is to develop the customer service standards, guidelines, protocols and processes that the customers will experience duectiy. One of the recommendations n1 Step Three was about the importance of providing the necessary tools, training, and information to front line workers. An example of an excellent customer service tool used in the public sector comes from the Minnesota Child Support Enforcement Call Center. The Cente{s call operators and management went through the exercise of categorizing the different types of calls they receive by general caller type, circumstance and attitude. The call operators were i3 Jeffrey Gitomer, "Principle before policy: rules for customer service' Business First-Buffalo, 2000. to County of San Diego, Health and Human Services Agency, Aging and Independence Services available online at http://www2sdcounty.ca.gov/hhsa/DocSeazchResults.asp?DocumentTypelD=4 #360907 $ Posted A/24/OS ADRC TAE Issue Brit trained to recognize the different caller types and mentally assign individual callers into the different categories, for which there were different call protocols. This system put the call operators in a better position to respond quickly and effectively to each caller.ls Going through a similar exercise might help an ADRC develop a "call map" tool or a service flow chart for staff to follow. A call map is based on the concept of a decision tree, where different actions are recommended or follow up questions suggested depending on the responses of the caller. This can be a valuable tool for call operators facing a wide range of possible call scenarios. It can help operators make sure each caller's needs aze responded to appropriately and all the possible options are presented. Going through such an exercise might result in a set of general guidelines for handling different types of calls, a set of talking points, or a suggested script that workers would go through for each call. The ADRC in Richland County, Wisconsin had developed a call map for operators handling information and referral calls. It is available for download on the ADRC Technical Assistance Exchange website at: http://www.adre-tae.org. Conceptual Model of Call Map/ Decision Tree Home visit requiad for functiorul assessment Consumer needs further - - assessment /case Home visit management scheduled Gather more information Further discussion of options Non~rer envy Call Gather more information and resources uired~ Consumer needs referral Use Options Counseling Tool onl Discuss needs, preferences, Ewer en /Crisis CaII priorities and make refertal Follow Emergency Protocol Step Five: Monitor performance Finally, it will be important for the ADRC to set customer service goals and develop internal performance measures that will help it to monitor progress. The ADRCs will be asked to collect and report certain information about customer satisfaction to the Administrafion on Aging and the Centers for Medicare and Medicaid Services. This information can be used and supplemented with additional information to help an rs Robert Horowitz and Tammy Kinehart, "Delivering Effective Customer Service" Office of Child Support Enforcement, Administration for Children and Families, available online at: http:/ / www.acf.dhhs.gov/programs/ cse/pubs/reports/customer_service_report.html k360907 9 Posh~6/24/05 ADRC TAE Issue Bri~ ADRC improve its own processes on a continual basis. Asking for feedback directly from customers regularly and then incorporating those comments back into the system, is the best way to improve performance. This feedback might be solicited systematically, through surveys or focus groups, as well as informally through customer comment cards. Negative feedback, in parficulaz, offers the ADRC an opportunity to improve customer service. Private businesses have found that complaint situations aze opportunities to provide outstanding service The way an organization responds to a complaint will make a lasting impression on a customer. If that impression is positive, the customer may be even more impressed with the organization than if they had been satisfied in the first place.ts The most common indicator of customer service performance is consumer satisfaction, but consumer satisfaction can be measured in a number of different ways. It will be important to consider the customers' satisfaction with the interactions they have with the ADRC. The ADRC will also need feedback on the content of the information and services they provide, how useful was it to the customer. This might be measured by asking customers questions about how "valuable' the service was to them. To the extent possible, ADRCs should try to measure the quality of their services, not just the quantity. Exceeding customer expectations will require giving them something of value, not of volume. Some measures of customer service do not require customer feedback. ADRCs may also gage their performance by looking at measures such as the average time information and referral callers spend on hold or the percentage of calls on hold that were - abandoned. For additional information on customer satisfaction measures and m;r,;mum data set that ADRCs aze encouraged to collect, and for several examples of consumer satisfaction surveys, visit the ADRC Technical Exchange website aY. http: / / www.adre-tae.org. IV. CONCLUSION Excellent customer service is important for an ADRC because it will help the Resource Center to succeed in its mission of becoming a trusted resource for long term supports and services. Customer service will help to earn and maintain the trust and loyalty of consumers, providers and community partiiers, and it will help the ADRC to attract both publicly assisted and private pay consumers. Excellent customer service, itself, can be seen as the mandate of the ADRC program. The ADRC service model is based on the philosophy of self-drrection and consumer choice. In this context, customer service means more than providing basic services to customers; it means serving the customers' preferences as well as their needs. hz addition to providing seamless access to a wide range of information, services and supports, the ADRC must also be sensitive and responsive to its customers' wishes to Dav;d Stauffer, "The Art of Delivering Great Customer Service," Harvard Management Update, 1999. t~ Bruce McC7endon, "Taking Customer Service to the Next Level," International City-County Management Association, 2000. #360407 IO Posted 8/24J05 ADKC TAE Issue Brie] about the kind of services and supports they receive, how, where and when they receive them. Achieving this level of customer service -the baze minimum that is required of an ADRC - would be a challenge for any business or organization. The ADRCs have an advantage, in that they have been established and will be operated by individuals from the aging and disability services networks, people who understand consumer choice and who already make excellent customer service a top priority. #360907 11 Posted 8/24/(15 Support and Services to Elderly and Caregivers Having to share in the emotional and physical stress of being a caregiver, 1 have come to fully realize the important role our county plays in the provision of services to our islands Kupuna and family caregivers. I have always known this, but the full impact was not realized until I came face-to-face with the challenges of being a family caregiver. I have also come to realize that although we have the best network of services in the state, and certainly near the top of the list nationally, this system of services needs to be better coordinated and more easily accessible. As this responsibility rests on the Hawaii County Office of Aging, a federally designated Area Agency on Aging, I directed the office to come up with a plan to address this need. The office has proposed a single access structure through aging resource centers in Hilo and Kona with satellite centers in outlying communities. All calls and inquiries will be directed to one central number where professional staff will answer questions, arrange for services, or make appropriate referrals. follow up and evaluation will be enhanced through special computer programs specifically designed for this purpose. Not only will access to services be made easier, quality of services will also be enhanced.