HomeMy WebLinkAboutCOM 0354.001 2014-2016 VALERIE T. POINDEXTER ---#117,?!Nth'; Phone: (808)961-8828
Council Vice Chair ;.:4‘,••••.'!%..,.• �%�: '; Fax: (808)961-8912
Council Member . .--�- �e�
District 1 �.� Email: vpoindexter@co.hawaii.hi.us
HAWAII COUNTY COUNCIL c=>
-"
County of Hawai`i
Hawai`i County Building - -7
25 Aupuni Street, Suite 1402 -y
Hilo, Hawai`i 96720 --
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Date: July 14, 2015 9?
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To: Dru Mamo Kanuha, Council Chair
And members of the Hawai`i County Council
From: 4 Valerie T. Poindexter, Council Member
Subject: Request for a presentation from Dr. Kimo Alameda on issues regarding the Office
of Aging
Attached is a PowerPoint presentation from Dr. Kimo Alameda, County Executive on Aging,
Office of Aging.
Please have a copy of this presentation distributed to the members of the Human Services and
Social Services Committee on July 23, 2015.
VP/lc
Att.
Comm. No. 3 f. I
Ref. To: P/[-t S
Ref. Date_ JUL 23.5520c-15
Hawaii County is an Equal Opportunity Provider and Employer
7/13/2015
( NOFci
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9 p.qF
Hawaii County Office
of Aging (H C OA)
MN &
Aging and Disability Resource 1111.
Center (ADRC)
Draft(7/10/15)
4,)
Corms*. C.Kimo Alameda,PhD.
OFtC Executive HCOA
�
C3I°
GING
Any Mews or opinions presented in this email are solely those of the author.The content contains
confidential information and is intended only for those identified in the email.It is not meantfor
disseminate,distribution,or copy,but for purposes of discussion regarding the aging issues
and aging network on Hawaii Island.Please notify the sender immediately if you have received
this presentation by mistake and delete this e-mail from your system.
Fil 1111
Disclaimer
1
7/13/2015
Outline
• Why Aging?
• Feds,State,County to the Rescue
• Older American's Act&It's Targeted Funding
11. • Office of Aging and Elderly Activities Division(EAD): Separate but MI
Equal
• HCOA Contract Providers
• EAD Programs
• The Continuum of Care
• Current Issues
• Goals (long and short term)
• Some Sticky Points
• Q and A
fA
Why Aging on Hawaii County? t',9*". •
• 1960s elderly laborers were dying in the Kona coffee fields,
plantation owners were taking their checks,and others were getting
sick.
• Mayor Shunichi Kimura hired Gladys Bowell, a social worker
from New York,to look into the issue. She gathered folks from
every echelon of the community:unions,plantations,heads of state
agencies,and housewives to solve the problem.
• As a result,the Kona Homemakers Program emerged as part of
the Hawaii County Office of Aging(HCOA). In 1973,the HCOA
received federal designation as an Area Agency on Aging,and
Kona Homemakers Program went over to P&R and was renamed
the Coordinated Services for the Elderly. 4
2
7/13/2015•
•Aging In America
• At the same time, in 1965,President Johnson
announced the war on poverty and signed into
legislation the Older Americans Act (OAA). Older 11111
Americans were found malnourished and
marginalized.
• OAA was amended 15 times since then with each
time allowing for another targeted program or focus.
5
OAA (Older American Act)
For Who? and What?
7 Titles:-1.8b in 2014. Help seniors age in place with dignity.
• Title I is the Seniors Bill of Rights.
• Title II establishes the Administration on Aging(now ACT)to carry out the act.
III• Title III provides federal funding for programs to serve those seniors 1111
most in need.This title also mandates the creation of an Area Agency
on Aging(AAA) and makes it a mandated function for AAA to
advocate,plan,coordinate,contract out,and monitor services.
• Title IV provides for training and research.
• Title V establishes a program for employment and volunteerism(STEP and RSVP via EAD).
• Title VI establishes grants for certain Native American Tribes-I lawaiians(Alu Like)
• Title VII creates state grants for"vulnerable elder rights protection" (State Ombudsmen).
3
7/13/2015
0,y04. a f
i
4 f ,�
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.z,<..
�M>_wA3 7.
i:FTY
IN Feds, State, County
FIC F.
to the Rescue
-40% Feds: Title III A-E
-1.5m
Title....
• A. Not related to funding-General Provisions1111
III
• B. Transportation, In-Home services like Personal Care,
Homemaker, Chore, and Legal Services,Adult Day Care.
• C. Meals at a site and Home Delivered&Nutrition Education.
• D. Education on Disease Prevention
• E. Caregiver Support Program (Respite,Training, Home Mod)
a
4
7/13/2015
—35% State: Funding Source
-1m
• State of Hawaii: Kupuna Care Program
• Enacted in 1999 with a similar mission of OAA.
• Variable Funds target keeping people at home through case
management and home/community based services (-57-800k per
year)
ADRC
• Variable Funds(—1-300k per year)given to implement the Aging and
;;„�hi;--- Disabilities Resource Center (ADRC) for Marketing,Training,and
the basic function of Info,Assistance,Options Counseling,and
,PANC Referral.
—25"/u County: Funding Source
—620k
• Hawaii County
• 17 Positions
• 15 (1.0 FTEs);2 (.5 FTEs) positions
• I I County Funded——S620,000.
• 6 Unfunded
• 1 Data Assistant(civil service-vacant)
• 3 ADRC Staff(civil service-via state funds)
• 2 half-timers(civil service—vacant state funds)
5
7/13/2015
Who Manages the Funds? Eilia
197„s
40f 35s, 25c) larDA G.Yoshida
B.Takaba
N
• $ from the Feds to the State then the
I
State runs it through a formula based on Tit, L , ..1111 �.'I'ulang
60+ population and the number of
vulnerabilities,then they award HawaiiI,
County$$$via the Office of Aging. 1
998 h
Jane Testa
ii.Bugado
• HCOA E=>Drafts RFPs,Solicit provider 2000.h 0
interests,Review and Award Contracts, ,.. „',,,‘,,'',:',7„,
Execute Contracts, then Monitor and -5 , ,%-1-.),,
provides Training and Technical ljt i
Assistance.... _ ,R.411.'' �i.... 11
1.Parker
Aging and EAD: Separate but Equal
• Separate....because according to OAA, HCOA cannot award
a contract to an entity that it has direct control over&it
cannot advocate for seniors if those who are providing the
ill
services are under HCOAs direct authority.Also,there are
III
separate budgets, separate supervisors,and a slightly different
mission(80/20 active EAD; 20/80: frail HCOA).
• Equal....because both employed by the County and there is a
check and balance of power. HCOA funnels the funds and
thus provides monitoring and oversight,yet no other
contracted provider to date can provide the quality of
services that EAD provides for the price they provide it.
1
6
7/13/2015
Organizational Flow
_—� Com on:\}nng..
State Ieceunec
ffict
P&R Ill U 1 � ,
tlnn on
D,abilm
It S'I;Cor,rdurated /
Services for rhe
I Idcrlt;51"1 1', EAD
�utn""n (STEP,RSVP, Fed Cycle(Title D)-2015
Recrcanon,Senux _Nutrition,CSF.) State Cycle-2015 =T3B.Legal kid,CSE
Centers,Savor ID, , . -20 Coutraeted -SFS Trans(EAD),I&A,Out
f:upumi Softball, Ynroidecs _IIIAC Reach(EAD),etc.
I luta,Karaole. Ho'onani Place -T3C.HCNP(EAD)/
tvalent Stases,(oIt -Mastercare HCEOC
Tournament, -Metrocare -T3D-ItCBH
Classes,Senior -Nurse Procare -T3F.Caregiver Respite
\dcisory Council. -Seniors Helping =r V.STEP(EAD) is
Club-end Vurn6on -Aloha Maiden /RSVP(EAD)
!'residents,Senior Care Resouree
Trans,etc
Aging Continuum of Care
7
r,
J
a I
1Y ii(1 �{
fi
-4.fhTi 3.2n1180m
--12,000/S300/ *$25 —1,600/S2000/ *$166 *$5-15000 per month
• r . sli
Il
1 J
*If you were to Just look at the budget/consumers served you'd get a
— rough estimate average per consumer$per month=Total served/
average budget(past 3 vrs)= $x per year /12=*$per month.
7
7/13/2015
Long Term Care Costs
fr
oArfp
�''.,i,ya,�'� r, ..... ,'';.... -7,44,-.....1.,,,,,a-7,,v4 "�.� ; ,i�i, -_F . . ,.4Ki;. ::�
9 Nursing 826 514,000 -5168,000 5138,768,000
1111 IIomes
1 .1ssistcd 220 -S6u00 S7,320,000 S15,840,000
1111
hiving
120 Foster 313 --51500 554,000 S16,902,000
Homes
52 Care 235 ..-53500 —S42,000 $9,870,000
I Iomes
1,594 beds 555181m
L
John McDermott State Ombudsman,personal communication 7/6115 �°;r; "is'�`°'
For every $1 spent. . .
For every$1 spent in EAD,government(fed,state,county) save$6 in-
home care costs;and for every S1 spent in HCOA,government saves
S30-S90 in bong Term Nursing Home care costs(i.e,Life Care Center).
n
S ' ' ' ' '''' l'''''4 jt ''' '''4'4111i) — ,,,
f
,.ra
--.1 'In
4.0m -180m
-
1 ,,,,i .„;;=,i *$27 r,Uii $ 000 *5166 *85 ]5,000 IN.] mi,iuh
Keeping Seniors at Home(with supports,if needed) is S well Spent
8
7/13/2015
West Hawa,1 Civic -,..
74-5044 Are Keaho
The ADRC
A Center and a Concept
Usage:
-HCOA: Office of Aging
-P&R EAD: Coordinated Services, Nutrition,STEP,
-Provider:Services for Seniors(SFS)
•
-Adult Protective Services / Aloha Independent Living
-A one-stop-shop,single point entry, providing information and
assistance,options counseling,referral,volunteer opportunities,
training and workshop usage, and direct services.
Why ADRC's?. National push for People with Disabilities who get
to have a place to meet with a team skilled in providing Home and
Community Based Services(HCBS)such as Information,
Assistance,Options Counseling,and Referral(IAOCR).
v- ;- Why the ADRC? e .
There are huge benefits(both, social and financial)of getting expert
Information,Assistance,Options Counseling,and valid Referral Options.
• Example: Person came in wanting meals,upon further questioning,the
options counselor found that the senior simply didn't have transportation
to purchase food. So instead of the daily meals from the county,one ride
to the grocery store a week solved the problem. Information is power!
Example: Person called in asking for the# for county housing. Upon
further questioning,the person wanted to move because his home wasn't
modified to meet his physical needs.The right intervention is here home
modification,not a new home(grab bars,shower hose,shower chair,etc).
Person was found eligible,registered as a client,and didn't have to move
out of his home. Information is power!
9
7/13/2015
The Issues
• •
The Silver Tsunami
rarcanr 0-55 5�-3 60-84 HS— Tnt,l68*
28.49"° 4,I r00 i t 028 1,798 13,6226
31.64°° 3,783 — 664 8,416
3.89"o 750 1,515 246 1,761
28.48°.° 4,634 10,418 8(,8 11,286
9.13°" 1 mo ?829 281 3,110
34i 1.128 114 1,242
• 900 136 1.036
NI
122"" 154 433 3 437
15349 37,110 4.137 41247
41,247
185,399
42,000 seniors: -75%(32,000) Independent(EAD/Caregivers);
-20%(8,000) Dependent Home w/Caregiver or Formal Services(TICOA);
-5% (2,000) Long—Term Care Placement(yet,only get 1594 beds)
HCOAS enimrI,o,of need and�(acemen7
10
7/13/2015
Figure 10. 65+with a Disability
Hawei County
30.0%111
-
25.0/- 2a.4% ■Hearing difficulty
20.4%
•Vision difficulty
2hull
17.4%
MO
cognitive aifbeulry
21
' Ambulatory Care:Outpatient medical care provided on an outpatient basis,including diagnosis,
observation,consultation and treatment
Who Gets Covered by Medicaid
11% make -$14,000(100% Figure 6. 60+Poverty Level
FPL)or less Hawaii County
9%make$22,000-14,000
111
III
(149%FPL)
•Below 100%FPL
•100%to 149%FPL
80%make$22,000 or more •At or Above 150%FPL
and these are the seniors
unlikely to qualify for
Medicaid.Poor but not poor
enough to qualify—called the
Gap group.
l-I
7/13/2015
Areas of Concern-Key informants
Services Ranked by Importance
2015 fi'
s
45
4 ■ NE
al
3.5 ....
1
Ell = Mill siii,„
IIIII
3
T$25 - _.. _--. -_ -
'uo 2 al
• _.. -. IIIII Mil- 11.1 IIII
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Ell INN IIIII =I .
III.
03 - all MI .-... :.,"
e ct. Gee �, eti z?S cl, �c8, 5�&S
�t�,�4° 4��s°� ��•` ,�' �0e fid` �,`� r -
Educational/Informational Topics
Ranked by Importance
2015
4.4 -.
4.3
421 -
iiiA 4 m iii
I 3.9
' 3.8
3.7 ■ - IIII
3.5 MI
34
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rrss` [ �55�5 X03 ,S�roS �6F ro.V
cs,
°�,y b�Z�Q•do' q L ,ed ,er- �s� �S�L
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i>b PC
12
7/13/2015
AREA PLAN
MI
Long-Term Goals
Short-Term Goals
;f
Long-Term Goals
�,�". -:AD:Nuviann,Rccreat;un,RTP,.`ll:P 7.anspnrtatinn
e.:. 7{505:A1)1251,A,U,&II;t)-scuxe At anagtment'a link pa.
Caregiver t:uunsel{ng and Respite,May and.)Idea A mcmieane
1. Age well,remain active,and enjoy life.., Atonfi-Adult Luncheon.
Government;ent;Hospitals;Long-term Care Facilities;
e
2. Forge strategic partnerships..., Private Agencies;Service Providers;Advocacy
IIII Groups;Community Providers;etc.
Marketing plan,ADPC P&P manual.Language Access
3. Develop the ADRC system..., plan,hire Half.timers forsooth and north Hawaii,
Quality assurance follow-up surveys,etc.
4. Enable people with disabilities and older adults to live in the
community..., Strengthen care-giver services via respite,caregiver
counseling,caregiver conferences;strengthen case
management;build informal support networks,etc.
5. Optimize seniors health,safety,and independence...!
Contract and monitor for legal aide,partner with
Fraud and Elder Abuse Protection advocates,
strengthen disease prevention trainings,etc...
13
7/13/2015
K011.4 h-051YWA
CM 34
' W N_ ry $iWiffA�t dolt siev,15ttlf
Short-Term Goals
yak
1. Increase awareness of the"aging continuum of care" to help
build awareness and preserve the integrity of the Older
Americans Act. ....
2. Finalize and implement a fully functional ADRC...including
"rural outreach and follow-up"at the north and south 11111
points of Hawaii County...,
3. Enhance the design and function of the Hawaii County
ADRC website...,
4. Strengthen HCOA contracted case management and vendor
pool services...,
5. Develop and implement a caregiver-patient hospital
transition project...!
27
Sticky Points with
The State Office of Aging.
State want
• ...HCOA to give up control of our data base by consolidating our data with the other counties.Other counties are
already in the statewide data base because they don't have a robust data base like ours,so they have little to lose.
• "Our business model is very dependent on our access to data and the data elements in our data base have taken over 20
yearsse and Refit where it isnow.need to
onetyohe data
untiiskey.te an show
neehro us tint oimely ur data won't get roourcivil
dears to and our where its n.w.need to safety
rfodare ioes/rheyorecansd tousvideourlyraarontatisolost in the
consolidation".
• ...HCOA to change their business model from contracting direct services to billing the feds for certain services.
• "Our AAA is not a non-profit entity(like much of the AAA across the nation),so our business model is planning,
contracting,advocacy,and monitoring.Om business model is ro keep government(staff)s all so that dollars coming
from the Peds can go directly to the constituents and nor to staffpositions.Instead ofexpanding our office stall;we are
using funds ro generate jobs(via contracting)so the services stay local and go directly to our people.'
• ...HCOA to accept the"no wrong door"model of access which comes with a commitment to have standardized
statewide forms,data,and agreements between Adult Mental Health Division,Developmental Disabilities Division,
MedQuest,Veterans,etc.
• "HOCA feels that this is a'solution looking for a problem'.Oar ARRC is both a center and a concept We are the single
point entry option for people needing information on the array of services available to.seniors and people with
disabilities.We could easily forge MOAs with these collaborating entities as we hate in the past"
• ...HCOA to bring case management in house rather than contract out.
• "Keeping case management as a conemcredprovider allows for a higher standard formoniroeing there work.Also,the
private market pushes them to do their best.And,there are the eon/Herofinterest concerns mentioned cachet.It's
difficult to monitor yourself."
2µ
14
7/13/2015
• ''' -;,',, ' # ' '''''r-
C. Kimo Alameda,PhD.
Executive Hawaii County Office of Aging
Email:Kiroo.Alameda@hawaiicounty.gov
15