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Home My WebLink AboutHCOA Area Agency on Aging (AAA) 4-year Plan HCOA Vision Age with Honor HCOA Mission Help older individuals live Office of Aging independently with dignity. With these data trends in mind, we will do our best to maintain the range of services along the aging continuum and ensure that our services are consumer -centered and culturally responsive. To do this, we will rely on collaborative partnerships and on evidence -based models. We will track our progress using nationally -recognized data indicators and we are confident that our seamless system of care will continue to make the Hawaii County a great place to live, work, and play for older adults and people with disabilities. Based on the Administration on Aging's (AoA) initiatives, the State Executive Office on Aging (EOA), Area Agencies on Aging (AAA), and Hawaii County's unique community and geographical makeup, we are pursuing the following goals for this planning period: well Goal 1.Age Well: Maximizing opportunities for older adults to age well, remain active, and enjoy quality lives while engaging in their communities. Goal 2. Forge Partnerships: Forging partnerships and alliances that will give impetus to meeting Hawai'i's greatest challenges of the aging population. Goal 3. Enhance the ADRC: Developing a statewide ADRC system for older adults and their families to access and receive Long Term Support Services (LTSS) within their respective counties. Goal 4. Live at Home with Dignity: Enabling people with disabilities and older adults to live in their community through the availability of and access to high-quality Long Term Services and Supports, including supports for families and caregivers. Goal 5. Keep Kupuna Safe: Optimizing the health, safety, and independence of Hawai'i's older adults. Part III: Goals and Objectives A. Summary of Goals 75 B. Goal 1 80 C. Goal 2 87 D. Goal 3 91 E. Goal 4 97 F. Goal 5 103 Part IV: Funding Plan A. Previous Year Expenditures for Priority Services (FY 2010) Title 111 Part B Federal Funds Only B. Minimum Percentages for Title 111 Part B Categories of Services C. Planned Service Outputs and Resources Allocation Levels Part V: Evaluation Strategy Appendixes Appendix A. Area Agency on Aging Staffing Functions Appendix B. Focus Groups Survey and Information Appendix C. Public Hearing Notice Appendix D. Public Hearing Protocol Appendix E. Public Hearing Minutes Appendix F. Public Hearing Powerpoint Presentation Appendix G. Assurances Appendix H. Acronyms and Glossary Appendix I. Elder Care Appendix J. References 106 107 108 110 112 HCOA- ADRC East Hawaii Intake U 2 3 previous year's expenditures of public funds. Part V reviews the evaluation strategy. The Appendix includes assurances made by the Area Agency on Aging, issues and areas of concern, glossary, and other pertinent information. The Area Plan on Aging, as a planning document, has three major purposes: 1) To serve as the planning document that identifies needs, goals, objectives and the activities that will be undertaken by the Area Agency on Aging relative to programs for the older persons in the Planning and Service Area. 2) To represent a formal commitment to the State Agency which describes the manner in which the Area Agency on Aging plans to utilize the Older Americans Act funds, including how it will carry out its administrative responsibilities. 3) To be the "the blueprint for action" which represents a commitment by the Area Agency on Aging that it will fulfill its role as the planner, catalyst, and advocate on behalf of older persons in the Planning and Service Area. 2015 Outstanding Older Americans Janet Murokami & Robert Ferolano 4 B. An Overview of the Aging Network The National Aging Network In 1965, Congress passed the Older Americans Act which established social service and nutrition programs for America's older adults. The purpose of Title III of the Older Americans Act (OAA) is to aid older adults in maintaining independence in their homes and communities by providing appropriate supportive services and promoting a continuum of care for the vulnerable elderly. The OAA laid the foundation for the current nationwide aging services network. The National Aging Network is headed by the U.S. Administration on Aging (AoA) under the Administration for Community Living (ACL), a division of the U.S. Department of Health and Human Services. It is dedicated to policy development, planning, and the delivery of supportive home and community-based services to older persons and their caregivers. Directed by the Assistant Secretary on Aging, it is the agency that awards Title III funds to the states that monitors and assesses the state agencies which administer these funds. State and Area Agencies on Aging were created thus establishing a nationwide "Aging Network". This "Network" assists older adults in meeting their physical, social, mental health, and other needs in order to maintain their well-being and independence. The AoA Aging Network includes 56 State Units on Aging (SUA's), 629 Area Agencies on Aging (AAA's), 263 Tribal and native organizations including 1 organization serving Native Hawaiians. (See Chart 1) The AAA's are responsible for the planning, development, and coordination of a wide array of home and community-based services within each state under Title !Hof the OAA. Chart 1: National Aging Services Network Administration for Community Living (ACL) Administration on Aging (AoA) Tribal Organizations (263) Native Hawaiian (Alu Like) 5 State Units on Aging (56) Area Agencies on Aging (629) Local Service Provider Organizations CONSUMERS 6 7 8 Advisory Councils The Mayor of Hawai'i County and HCOA have established several advisory councils, the Committee on Aging and the Committee on People with Disabilities. The Committee on Aging serves as an advisory council to advise HCOA on the development and administration of the area plan, conduct public hearings, represent the interests of older persons, and receive and comment on all community policies, programs, and actions which affect older persons of Hawai'i County. The Committee on Aging is a mandated function by the Older Americans Act and a requirement for this plan to be approved and funding to be released. HCOA also spearheads the Mayors' Committee on People with Disabilities which purpose is to advise the Mayor on all matters related to persons with disabilities. As its' primary goal, the committee reviews and recommends actions and provides guidelines to improve the quality of life for all people with disabilities. This is a new function for HCOA and attributes to the goal of having a fully functioning ADRC which also provides information, assistance, and referral services to people with disabilities who are looking for long-term services and supports. As its' primary goal, the committee reviews and recommends actions and provides guidelines to improve the quality of life for all people with disabilities. Committee on Aging Members Talking Story After Their Monthly Meeting Committee on Disability Members Smile for a Photo 9 The County of Hawai'i Organizational Structure The Hawaii County Office of Aging is one of 19 departments within the County of Hawai'i organization. As an Area Agency on Aging, HCOA operates under the umbrella of the County of Hawai'i with the majority of agency positions funded by the County. The two primary county programs that serve the elderly are the Parks and Recreation Elderly Activities Division for active seniors and the Office of Aging for seniors who need additional supports to maintain their quality of life. (See Chart 3) Chart 3: Office of Aging and Elderly Activities - Organizational Placement County of Hawaii Mayor Deputy Director Parks and Recreation Elderly Activities Division Executive on Aging Committee on Aging Committee on Disability P&R Director Clayton Honma & Elderly Activities Division Director Roann Okamura NIG Aso 10 1 Hawaii County Office of Aging The Office of Aging falls organizationally under the Mayor's office headed by an Executive on Aging. The HCOA has an East and West Hawai'i office and will provide outreach to South and North Hawaii starting in 2017. HCOA is staffed by an Executive on Aging, three Aging Program Planners, two Access Managers, five Aging and Disability Specialist, an Accountant, a Computer Programmer/Analyst, and three Information and Assistance Clerks. (See Chart 4) Chart 4: Office of Aging — Position Organizational Chart — 2015 Committee on Disability Executive on Aging EM -03 CIMayor T- Administration Services Division / N Admin. Services Assistant I SR -22 Information and Assistant Clerks Hilo — SR -11 Hilo — SR -11 Kona — Sr -11 rstem nformation Analyst IV S R-22 1 Computer Operator 1 SR -15 Vacant r Access Division Committee on Aging Planning and Program Development Division a. / \ .. Aging & Disability Service Manager SR -24 II L. Aging &Disability Service Manager SR -24 lim_ase Management Aging Program Planner III SR -24 Vacant Aging Program Planner II SR -22 Aging & Disability Specialist II SR -20 ADRC 1 Aging & Disability Specialist I SR -18 ADRC-East HI Aging & Disability Specialist I SR -18 ADRC-West HIJ Aging Program Planner II SR -22 *Aging & Disability Specialist 1 k SR -18 ADRC-1/2 North Vacant *Aging & Disability Specialist I SR -18 ADRC-1/2 South Vacant *Note: Given the statewide data consolidation emphasis, HCOA is considering a re -organization of the ADRC half-time positions in exchange for a full time data -entry clerk position. The intent of the North and South ADRC concept will be fulfilled by ADRC specialists providing outreach options counseling to the north and south districts on an as needed basis. 11 The HCOA Aging Services Network HCOA through its ADRC has developed an array of home and community-based services throughout it's' history. Consumers can access services directly or through agency referrals. After an initial pre-screening, the ADRC intake staff determines the level of care that is most appropriate for the consumer, their caregiver, or the respective contact person making the inquiry. As a result of the determination of level of care, information and assistance is provided or a referral for services are made to the appropriate program, agency, or service. (See Chart 5) Chart 5. Office of Aging Spectrum of Service Continuum of Care Conceptual Flow Elderly Activities / Senior Centers -Independent Seniors Office of Aging / ADRC -Dependent Seniors Long Term Care / Hospital -Seniors in Nursing Homes Least Restrictive Moderately Restrictive Most Restrictive HCOA Team Discussing Senior Services 12 HCOA-ADRC Operational Flow /New RckrrxisCals'... ' xab ,rakrrA krrns wcium3 mama) LgJ LISS crnpicrily Lz Carrplea 11„ 1 rriarrnalm and RaJerral 11, /grfry / Lckal Mcrc Canlolm Proposed Model or Operating the ADRC in Hawaii County &uric Shar. 1.4c suRzai , 1 In.Hcrna : Bask . AssearrtcrA .,..11. ! ._11,. Ccrnarchernrea Ccrichicbd by HCOA Legend Cardiabd Carrradad AElarcY (Sa. *Cierr a OM nava% WI ha ci-mi•ad 63-i, DMObakra soramal b perabb IVaciGid bih5c Candudadbj C.crr.racud Apn:y i!SPS inp.arsai 13 Authcriaidn 4. ! Fkossossrnera East Hawaii ADRC 14 o Focus Groups o Key Informant Surveys 2. Identify Areas of Concern 3. Evaluate Effectiveness of Existing System of Services 4. Develop Area Agency Goals 5. Develop List of Possible Alternative Approaches 6. Investigate Alternatives and Other Funding Sources 7. Establish Priorities 8. Develop Plan Public Hearings Public hearings are a requirement and play an essential role in the planning process. Public hearings afford the general public an opportunity to comment and provide needed input to proposed Area Plans. Public hearings were held in East and West Hawai'i in August, 2015. Public informational meetings were planned in the major districts of the island where the public can gain information on the plan and submit public comment, if desired. These meetings were scheduled in the second quarter of 2015. For details of public hearings, see Appendix. Public Hearing — West Hawaii 2015 15 16 Figure 2. Hawai'i County 60+ Population Growth 100,000 80,000 60,000 40,000 20,000 40,376 26,122 61,384 79,406 2000 2010 2020 2030 Source: WHFarr Kupuna Care Report 2014 Life expectancy in Hawai'i is the highest in the nation, with women outliving men by an average of six years (See Figure 3). Yet, it's important to note that not all ethnic groups are living equally as long. Native Hawaiians have the lowest life expectancy at 74.3 years (figure 4), eight years less than the average age consumer receiving case management services through HCOA. Source: The Institute for Health metrics and Evaluation at: www.healthmetricsandevaluation.orq retrieved on January 16, 2014 The population over the age of sixty in Hawai'i County is expected to triple from the years 2000 to 2030 to almost 80,000 older adults (See Figure 2). Moreover, people are staying active longer as evidenced by the average age of HCOA's case management consumer being 82yrs old. This is longer than the life average expectancy for Hawaii county residents at 80yrs. HCOA estimates that consumers in need of services will grow 3% each year. Figure 3. Hawai'i County Life Expectancy 84.0 82.0 80.0 W 78.0 < 76.0 74.0 72.0 76.6 L 82.6 Male Female Figure 4. Life Expectancy by Ethnicity Life expectancy at birth by ethnidty, 1920-2000 1970 trio t9.0 1.100 MOO 1910 tIa0 1990 7003 �• Caucasian t Chinese -a- FA One. -r Hawaaan 1! lapar.esc • Cshcr Soarer': For data lrarrt 1910.1990, Hawn OBEY, Far data kora 2000 Park, Shaun, Hcrazia, Totlan and Coma 120091. Lor gmty c pan - nes 1n MOHO/int Hawes: An Analis of 2000 Ldr Tables Pubic Health Reports, tule-A4gra1 2009, Vol. S20. p.5110 17 Figure 5. Hawaii County 60+ by Gender Older Adult Vulnerable Population Male Female In Hawai'i County, older women represent 51% of the older population. As the population grows, women will continue to represent a larger percentage of the general older population. (See Figure 4) Source: U.S. Census Bureau, 2008-2012 American Community Survey 5 -Year Estimates There are several demographic indicators that Area Agencies on Aging use to determine service and program needs in the community. They include: seniors living alone, income levels (at or below Federal Poverty Level), limited English speaking ability, ethnic distribution, disabilities, living with grandchildren, health status and chronic conditions, living in rural areas, social isolation, and family caregivers, among others. Note: Data for Figures 5, 6, and 7 obtained from U.S. Census Bureau, 2008- 2012 American Community Survey 5- year Estimates. Figure 6. 60+ Living Alone Hawaii County Figure 7. 60+ Poverty Level Hawaii County Living Alone Live with Others Below 100% FPL 100% to 149% FPL At or Above 150% FPL According to a 2011 study by AARP, nearly 90% of people over age 65 wish to remain in their home for as long as possible. Although studies have shown that the impact of loneliness and isolation can shorten a persons' life, staying in familiar surroundings may offer benefits to seniors' emotional well-being. In HCOA's 2015 data sets, we find 249 out of 726 (34%) seniors receiving cluster 1 services living alone. Economic stability is a major concern for the elderly. National studies show that as people age, the more likely they are to have reduced incomes. According to a report by the Economic Policy Institute, the average family income of people aged 80 and older is less than half the income of adults between 18 and 64 years of age. Issues commonly experienced by the elderly such as living on a fixed income, increased medical expenditures, and death of a spouse can lead to limited income available for basic needs. The Federal Poverty Level measures sufficient income for the most basic level of subsistence. 18 Figure 8. 60+ Limited English Proficiency, Hawai'i County 8% 18% 82% English Only Language other than English Speak English less than "very well" Figure 9. 60+ Population by Race (2012) Hawai'i County 1.5% 6.3% 33.3% 11.6% 0.4% J\0.4% Older adults who experience limited English proficiency are at risk for greater economic insecurity and inequality of access to services. People who do not speak English well face barriers in their ability to communicate within the society in which they live. Often eligible seniors do not receive benefits and services due to barriers of language and culture. Limited English speaking older adults are twice as likely to fall below the FPL as other older adults. Government programs must make special efforts to ensure that limited English speaking populations have equitable access to services. White Black or African American American Indian and Alaska Native ■ Asian Native Hawaiian and Other Pacific Islander Some other Race Two or More Races Race remains an important social factor in understanding disparities in the well-being of older adults in many important areas of life including: employment, health, income, housing, and criminal justice. Although older adults in general are healthier as a result of technological advances in medicine and broader access to health care, some racial and ethnic groups receive poorer care, are less healthy, and have shorter life expectancy and lowered quality of life. Source: U.S. Census Bureau, 2008-2012 American Community Survey5-Year Estimates 2015 Maqic of the Season County Holiday Special I Departments of Housing and Aping Helping Out 19 Many older adults experience challenges in daily living due to chronic illness or disability. According to the Center for Disease Control and Prevention (CDC), about 80% of older adults have one chronic condition, and 50% have at least two. The CDC also states that infectious diseases (including influenza and pneumococcal disease) and injuries (often due to fall) disproportionately affect older adults. Physical and health related conditions can lead to difficulties that restrict the ability to perform basic self-care, or activities of daily living (ADL's) and Instrumental Activities of Daily Living (IADL's). ADL's include: eating, dressing, bathing, toileting, transferring, and walking. IADL's include: cooking, housekeeping, shopping, managing money, ability to use transportation, medication management, and using the telephone. Figure 10. Percent of 65+ with Health Conditions State of Hawaii 100.0% 60.9% 0.0% 43.9% 5.8% 0 3.0% 6.7%9.2°419°49% X5.0%7.5%7.6°A- �3.5/� ,;4e. �\y �`�'y.. ,,oseN P��r Pyr �O ca�0\a10 ��a��Qa\ Q O e`�� rto O`' see stir P Source: BRFSS 2012; Hawaii Health Matters.orq Note regarding Pneumonia Vaccination: Pneumococcal pneumonia is a serious condition characterized by high fever, cough, shortness of breath, and meningitis. Because it's the leading cause of vaccine -preventable death and illness in the United States, it is recommended that older adults over 65 get vaccinated. Hawaii county has a much higher number of older adults over 65 getting vaccinated at 68% (BRFSS, 2015)but more can be done to increase vaccinations among older adults in Hawaii county. Figure 11. 65+ with a Disability Hawaii County 30.0% - 25.0% - 20.0% - 15.0% - 10.0% - 5.0% - 0.0% - 24.4% 17.4% • Hearing difficulty • Vision difficulty Cognitive difficulty • Ambulatory difficulty Self -Care difficulty Independent Living difficulty Many older adults experience some level of diminished physical capacity. Visual impairment, reduced motor skills, hearing and memory loss are common in the progression of aging. Many elderly adults live with a comorbidity of physical and health related conditions that make self-care more difficult. Through the Older Americans Act grants and the State's Kupuna Care funding are available for programs that aid in the promotion of independence for those who may be experiencing difficulties in performing activities of daily living and their caregivers. They include: supportive home and community-based services, nutrition programs, disease prevention campaigns, health promotion services, and caregiver support programs. Source: U.S. Census Bureau, 2008-2012 American Community Survey 5 -Year Estimates 20 Office of Aging Planners Keola Kenoi-Okajima and Debbie Wills discuss provider contracts with ADRC Manager Nic Los Banos 21 Figure 12. Hawaii County 60+ Population Distribution Map County of Hawaii Population Distribution by Judicial District U.S. Census Bureau 2013 American Community Survey Total Population (All Ages) —190,821 (13.6% of State of Hawaii 's Total Population) and Total Older Individuals (60+) Population — 47,285 (22.1 % of Hawaii County's Total Population) 5,934 (3.2%) 1,242 (3%) 16,925 (9.1% 3,110 (7.6%) NORTH KOHALA 7,346 (4%) 1,036 (2.5%) Hawaii NORTH HILO 2,269 (1.2%) 437 (1.1%) 42.392 (22.9%) 9,009 (22%) SOUTH HILO LOWER PUNA PUNA UPPER PUNA 52.827 (28.5%) 13,626 (33.3%) 30,363 (16.4%) 6,482 (15.8%) SOUTH KON 10,395 (5.6%) 2,277 (5.6%) KAU 22 7,203 (3.9%) 1,761 (4.3%) 9,745 (5.3% 1,934 (4.7%) Prepared by Hawaii County Office of Aging DLW-1114 , 23 24 25 26 27 President Johnson Signs the Older Americans Act of 1965 28 29 30 Services for Seniors Office Team 31 32 33 34 35 36 37 38 39 40 Pahoa Senior Center 41 42 43 East Hawaii ADRC 44 45 46 47 1. 2. 3. 4. 48 Table 2. The Prioritization of Services for Funding- HCOA CORE PROGRAMS: Adult Day Care Caregiver Support Case Management 49 Elder Abuse Prevention & Awareness Health Promotion /Disease Prevention Heavy Chore Home Modification Homemaker Information & Assistance Legal Assistance Meals- Congregate Meals-Home Delivered Nutrition Education Outreach Personal Care Transportation DISCRETIONARY GRANTS: Hospital Discharge Grants Community Development Consumer Directed HCBS 50 Financial Management Housing Interpreting Translating Senior Training & Employment Wandering Locator System OTHER: Network Education & Training Public Education Senior Companion Program Volunteer Opportunities Priority Measures: 3 = Highest 2 = Moderate 1 = Slight 0 = Lowest Ranking: Lower number indicates higher priority with 1 as highest ranking. Chris Ridley Presents at the 2015 Annual Caregiver Conference 51 52 53 From left to right: Maile David, County Council S. Kona & Kau; Debbie Wills, HCOA; Pam Punihaole & Joshua Pratt New Members Karen Eoff, County Council N. Kona 54 55 56 Coordinated Services for the Elderly Coran Kitaoka visits with Billie Keawekane-Beere Coordinated Services for the Elderly West Hawaii Civic Center 57 Figure 14--HCOA-ADRC Operational Flow 1—s Tcv Coil Lag Los nIc /ErnpitoilirJ y '•F� Inkornoiai and Rc4rol 11! • 11 Ern ClLc Proposed Model for Operating the ADRC in Nadel County ranf Shan 1.6k Sumo S•'.cry Rol .. IriHar.c cr6 Mao Cam:ilea Legend Conimbi by Contr.:led •oemFLy P:4 ' Cho -6 LTES requests Ail bo thorico:1r,, EObir1i intko soured Orr parable Liociaid oligioihyc rErrhaerl Croons:I AgmcfPcS) . in:Erma-I • Ca-nprdicrwo arix r. Prbnizzion •-111' EIy pADRC Manager Nic Los Banos share's his views to representatives from the Committee on Aging & the State Office on Aging (9/23/15) 58 59 60 61 62 63 64 65 66 67 68 69 70 Table 3. Outputs (FY 2014 Oct, Period of 2013-Sept. 2014) lations were too inconsistent to draw meaningful conclusions. Number of Persons Served Number of Persons Served Number of Persons Served ** No data to support field. NB = Federal Funds (Title III-Part B) NC-1 = Federal Funds (Title III-Part C-1) NC-2 = Federal Funds (Title III-Part C-2) ND = Federal Funds (Title III-Part D) NE = Federal Funds (Title III-Part E) NO = Federal Funds (Other) A = State General Funds (General Funds) S = County Funds (Cash only) PI = Includes all income generated by the program including client voluntary contributions money raised by the program through fund raising activities (such as bake sales, etc.) proceeds from the sale of tangible property, royalties, etc. O = Other funds used directly by the program including but not limited to trust funds, private donations, etc. (cash only) XS = County In-kind XO = Other In-kind 71 Figure 15. Hawaii County Targeting Performance Indicators N=188(5.9%) POV=17 8% RURAL=100% LIM=14.7% FRAIL=12.2% LEP=16 2% N=198 (6.2%) POV=12.7% RURAL=100% LIM�.9% FRAIL=15.4% LEP=17.7% N= 254 (8.0) POV= 30.3% RURAL=100% LIM=13.7% FRAIL=37.0 LEP=7% County of Hawaii Population Distribution by District PY 2014-2015 U.S. Census Bureau, 2013 American Community Survey Total Older Individuals Served (Unduplicated) -3187 NORTH KOHALA N=222 (7.0) POV=22.5% RURAL=100% LIM=16.6% FRAIL=22.0 LEP=20.7% awaii NORTH HILO N=126 (4.0) POV= 23.0 RURAL=100% LIM=19.0% FRAIL=13.5% LEP+2.3 SOUTH HILO LOWER PUNA PUNA UPPER PUNA N=1220 (38.3%) POV=22.5 RURAL=16.7 LIM=17.8 FRAIL= 30% LEP=14.3 N=170 (5.3%) POV=22.3 % RURAL= 100% LIM=16.5% FRAIL= 28.8% LEP+13.1% SOUTH KON KAU Legend N- Older individuals served =(3184) POV- Poverty= (23.1) RURAL- Rural Residence = LIM- Low income minority =(66.8) FRAIL- Unable to perform 2 ADLs or more=(15.3) LEP- t *(96) - Targeting Performance for Hawaii County 72 N=265 (8.3%) POV=28.3 % RURAL=100% LIM=14.3% FRAIL=11.7% LEP=15.2 N-=256 (8.0) POV= 23.8 RURAL=100% LIM=11.3 FRAIL=28.1 LEP=17.4 N=285 (9.0) POV= 23.1 RURAL=100% LIM= 16.1 FRAIL=26.7% .EP+17.4 Prepared by Hawaii County Office of Aging (Area Agency) JDIRECT PROVISION OF SERVICE For the period beginning __________ through __________ Service Title III Reference Funding Source Title III State County Other Total Justification This Exhibit must be renewed annually for each year the Area Agency wishes to provide any service directly. 73 (Area Agency) JUSTIFICATION FOR WAIVER PRIORITY CATEGORIES OF SERVICES For the duration of the Area Plan (2015-2019) The Area Agency on Aging is required to spend at least 40 % of its Title III-B allotment in the priority categories of services, with some expenditures occurring in each category. If the Area Agency on Aging wishes to waive this requirement, it must identify the category of service which will be affected and provide a justification and documentation as required by Section 306(b). If the waiver is granted, the Area Agency on Aging certifies that it shall continue to expend at least 40 % of its Title III-B annual allocation for the remaining priority categories of services. Priority Service Check Category Affected Access (Transportation, Outreach, and _____ Information and Assistance, and Case Management Services) In Home Services (including supportive _____ Services for Families of Older Individuals who are related disorders with neurological and organic brain dysfunction). Legal Assistance _____ Justification 74 75 76 77 78 79 80 1970 Vintage Photo of Elderly Activity Division Director George Yoshida and Staff Working Hard 81 82 83 84 85 st 1975 Vintage Photo of 1 RSVP Director Alan Parker with TV Host Bob Barker 86 HCOA Weekly Staff Meeting 87 Vintage Photo 1980s Handi-Lift Services 88 89 90 91 92 93 94 95 96 97 (LtoR) Debbie Nakaji, Myrtle Kahana, & Layne Narimatsu with then Mayor Bernard Akana 98 99 100 101 102 103 104 - Caregiver Conference 2015 105 In accordance with the Older Americans Act \[Section 306 (a) (2)\] the Area Agency is disclosing the amount of funds expended for each category of services during the fiscal year most recently concluded. Service Budgeted Compliance FY 14 Actual % for Title III Amount (Dollars) Expenditures Categories Access Info & Assistance Outreach 33,592 33,592 Transportation 261,991 261,993 Sub-total 295,583 295,585 82.3% In-Home Home Modification 15,000 14,858 Sub-total 15,000 14,858 4.13% Legal LASH 72,450 48,737 Sub-total 72,450 48,734 13.57% Other Title III Part B Total 390,674 381,526 100% 106 Categories of Services ___%____ Access* 0.6597 In Home 0.0373 Legal 0.1799 Total % 0.8769 *Includes transportation, outreach, information and assistance services. 107 11 , A -- 2 O AAAAAAA- NB NON NBNBNBNBND NCNC NC Source Code 2019 8,6978,697 67,74936,060 77,42452,18248,70440,35439,01428,99095,45915,000 538,059125,818350,086353,681347,882 2018 8,2788,278 65,77635,010 73,69549,66946,35838,41137,13527,59490,86115,000 512,145119,758333,225336,647331,128 2017 Total Amount 7,8797,879 63,86033,990 70,14547,27744,12536,56135,34626,26586,48515,000 487,478113,990317,176320,433316,578 2016 7,5007,500 62,00033,000 66,76745,00042,00034,80033,64425,00082,32015,000 464,000108,500301,900305,000304,000 or case management. TripTrip Hour Unit MealMeal Issue HourHourHourHourHour Session Person Request Various lf of the request for day care is to provide respite for the caregiver. 00 5 420, 186 12 36 , , 219 399 2019 88,2771,6392,6236,447 2,2952 92,50071,00070,00010 195 12 36 , 212 387 2018 88,0361,5912,5466,259 2,2282,122 90,00069,00067,13510,200 108 966 12 36 , 206 376 2017 77,8021,5452,4726,0779,900 2,1632,060 87,50067,00063,750 Units of Service 740 12 36 , 200 365 2016 77,5751,5002,4005,900 2,1002,000 85,00064,00060,5009,600 00 2 33811390 80 370137415340 875109 2019 1,4201,1994, 2,295 00 2 228 32791286 76 360133405320 850106 2018 1,3801,1664, 2, 00 2 163 31771183 74 350129395310 825103 2017 1,3401,1334, 2, 00 2 Unduplicated Persons 100 30751080 72 340125385 800100300 1,3001,1004, 2, *2016 Modification Adult Day Care Case Management *Case Management of HCOA clients are also provided by State Public Health Nurses. In 2014, 107 referrals were made to PHNs f**Adult Day Care of HCOA clients are also captured under Title III funds for Respite Caregiver. For it is true that almost ha Programs, Services and ActivitiesKupuna Care:***Assisted TransportationHeavy ChoreHomemakerPersonal CareTransportationCongregate Meals Congregate Meals Home Delivered Meals Home Delivered Meals Nutrition Education Public EducationOutreach Home LegalHealth Promotion & Disease NENENENENENENE NE, A Source Code 679 2019 5,0956,1744,357 17,60453,34325,339 646 2018 4,9575,8774,147 16,75650,77324,355 615 2017 Total Amount 4,8205,5943,947 15,94948,32823,409 682 , 585 2016 45,3253,757 15,18146,00022,500 ions, etc., (Cash Only) HourHourHour Unit Trips Session Activity Request 4 565097 14 ,, 111247105 2019 12 tions, money raised by the program through fundraising activities (such as 4 519036 14 ,, 108247105 2018 12 109 4 475977 14 ,, 105240102 2017 11 Units of Service 4 432919 9914 ,, 102240 2016 11 73 33264016 436 2019 63 32253916 424 2018 63 31243815 412 2017 1)2) -- C 63 Unduplicated Persons 30233715 400 2016 Part B)Part CPart Part D)Part E) ----- : Kind - Kind - Federal Funds (Title III)Federal Funds (Title IIIFederal Funds (Title IIIFederal Funds (Title IIIFederal Funds (Title IIIFederal Funds (Title IIIFederal Funds (Other)State General Funds (General Funds)County Funds (Cash Only)Includes all income generated by the program including client voluntary contribubake sales, etc.), proceeds from the sale of tangible property, royalties, etc.Other funds used directly by the program including, but not limited to, trust funds, private donatCounty InOther In 1:2: -- N: NB:NCNCND:NE:NO:A:S:PI:O:XS:XO: Programs, Services and ActivitiesNFCSP Program:CounselingRespite:Adult Day CarePersonal CareHomemakerSupplemental ServicesAssisted TransportationHome ModificationInformation Services RSVP Recognition Day Elderly Activities Division 110 Table 5. SERVICE OUTPUTS: COUNTY OFFICE OF AGING Programs, Services and Activities Unduplicated Persons Units of Service Unit Area Actual Percent Area Actual Percent FY 2014 Plan Served Achieved Plan Served Achieved Case Management 300 340 113% 11,000 6431 58.5% Hour Adult Day Care 25 28 112% 5,000 4782 95.6% Hour Assisted Transportation 20 75 375% 750 1132 177.6% Trip Heavy Chore 5 10 200% 150 234.50 156.3% Hour Homemaker 50 82 164% 1,200 1824.33 152% Hour Personal Care 125 88 74% 6,500 3766.50 57.9% Hour Transportation - CSE 1,100 1,142 103.8% 34,000 37,224 109% Trip Transportation - HCEOC 400 241 60.25% 54,000 30,503 56.5% Trip Transportation - HCNP 150 191 127.3% 17,000 17,944 105.5% Trip Congregate Meals 1,000 1,029 103% 64,000 61,499 96% Meal Home Delivered Meals 220 315 143% 41,116 41.129 100% Meal KC Home Delivered Meals 180 * 252 140% 26,664 26,863 100% Meal Nutrition Education 1,000 * 627 62.7% 180 * 180 100% Session Public Education 4,100 4,100 100% 12 * 12 100% Issue Outreach 2,900 * 2,584 89% 1,584 2,590 164% Person Community Partnerships 70 % 40 Meeting Home Modification 220 100 45.5% 600 354 59% Person Legal 260 365 140% 2,066 1,998 97% Hour Caregiver Program Counseling 20 30 150% 60 102 170% Hour 115 73 63.5% 3,400 3660.25 107.7% Hour Caregiver Program - Respite Caregiver Program - Supp Svcs 30 9 30% 175 103 58.9% Various Caregiver Program - Access Asst 170 1 .6% 1,025 1 .09% Contact 950 417 43.9% 4 9 225% Activity Caregiver Program - Info Services 111 112 113 Focus Group July 15, 2014 Facilitators: Pauline Fukunaga M. Keola Kenoi-Okajima Nicolas Los Baños Shelly Ogata Evaluation Things that went well Things that could be changed Organized Introductions of participants Small groups Lengthen the time of the meeting Good information Consider reconvening Personal input Trash can in the room Positive sharing f/up with speaker for each topic Productive sharing Have the group decide on the topics Facility is good for meetings like this Felt rushed Tried to stay within time limits Good facilitators Facilitator: Shelly Ogata Goal 1. Maximizing opportunities for seniors to aging well, remain active, and enjoy quality lives while engaging in their communities. APA issue: Nutrition Congregate Meal site An ideal meal site would . . . Feed the whole person fellowship activities programming expanded hours 114 provide spectrum of auxiliary services blood pressure checks balance checks nutrition counseling day care be an experience comfortable seats neighborhood senior club place to hangout normalcy transfer excitement with staff of food Atmosphere Location: larger area, sheltered from weather, permanent meals will be flavorful and presentation matters culturally appropriate variable portion sizes cooked vs raw veggies have a marketing plan to combat stigma renaming multi-function FREE Increase accessibility to transportation Advocate at federal level for updating guidelines Feel safe and nonjudgmental obligated to make donations Facilitator: Nicolas Los Baños State goals are followed by issues Office of Aging will focus on during the next four years. Goal 2. greatest challenges for the aging population. Goal 3. Developing a statwide ADRC system for Kupuna and their ohana to access and receive Long Term Support Services (LTSS) Information and Resources within their respective counties. 115 APA issue: Aging and Disability Resource Center (ADRC) Marketing Plan QUESTION 1: What are some strategic partnerships for the Aging and Disability Resource Center (ADRC)? denotes multiple suggestions * Government Agencies - - - - - - - - - - - - - - - - - - - - - - - - - - - - 116 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 117 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Facilitator: M. Keola Kenoi-Okajima 118 State goals are followed by issues Office of Aging will focus on during the next four years. Goal 4. Enable people with disabilities and older adults to live in the community through the availability of and access to high-quality Long Term Services and Supports, including supports for families and caregivers. APA issue: Elder Justice and Elder Abuse Awareness and Prevention (EAAP) Education Who would benefit from Elder Abuse Awareness and Prevention education? 1. Everyone; families and children 2. Caregivers 3. Diverse Cultures, those who English is a second language. 4. 55/60+ population and their caregivers. 5. Financial institutions, banks 6. Government 7. Police/first responders 8. Hospitals 9. Service Providers 10. Educational Facilities 11. Some Concerns brought up in regard to need for education: What is the definition of Elder Abuse? Types of abuse both physical and mental caring for grandchildren: special needs group Youth and family members need to understand the special needs of aging family members and sensitivity to disabilities of aging population. Service providers and other groups should have yearly training to identify and understand EA. A current major issue has to do with scams, phone, computer and junk mail. Is there a mandate on reporting Elder abuse? ________________________________________ Are Elder Abuse Awareness and Prevention efforts worthwhile? Yes Any prevention to support awareness and prevent premature death. Education to families, children and caregivers with support of government and institutions. What is the definition of Elder Abuse? When does it become Elder Abuse? What are signs of Elder Abuse? Understanding Adult Protective Services and its role with this population. Need to understand diagnosis of care recipient and how to care for them Vulnerable population, care recipient and caregivers. What if the Elder recipient is cognizant and refuses prevention Inquiry? Types of Abuse, physical/mental Finance is a large concern: Role that Hospitals play, Emergency Room, hospital stays, transitions. Lower Recidivism What happens when an Older Adult has a lack of connection with family members and children? 119 Or what happens with family members, non-family members are caring for the parent in the home pport the needs of the family/care family/non-family member chooses not to place them in out of home to continue controlling older Is there a l In workshops could tangible tools be used eg. something to put on telephone to remind parent to note if this could be a fraud call? Facilitator: Pauline Fukunaga State goals are followed by issues Office of Aging will focus on during the next four years. Goal 5. APA issue: Family Caregiver Support What do you feel are the biggest challenges for family caregivers? Physical Having enough energy to devote to care giving Stress brings energy levels down Caregivers need respite some have no break in care giving There needs to be a reality check for caregivers caregivers need to be aware of caregiver burnout Emotional Family dynamics Siblings meet to decide on care giving responsibilities (mediated meeting) Daughter-in-law caring for Mother-in-law vs daughter caring for mother; big difference in relationship Caregiver goes thru emotional grieving for parent or spouse. Relationship has drastically changed; role reversal Client challenges caregiver (resource: Chris Ridley) How to decide when to place loved one in a care facility. Medical How do deal with multiple doctors and multiple medications; we need a Gerontologist Doctors and service providers need to be culturally appropriate Pharmacies offer medication evaluation Caregivers need to be informed about insurance benefits; Health Navigator (suggestion made by Cathy Stevens who is familiar with Health Navigator) Insurance providers provide support to caregivers; (suggestion made by Angelina Rushton of United Health Care) Legal Client should have legal matters in order Everyone should have legal matters in order Family have a Caregiver Pre-plan made; could be formal (with lawyer) or informal (just family members). Plan helps determine who does what when. 120 Advance Care Planning should be discussed and formalized Elder abuse is an issue in care-giving. Finances Financial matters Have a plan for who does what when Education Who does caregiver talk to? Where does caregiver start on this care giving journey? What will caregiver have to deal with as a caregiver? How does caregiver learn to be a caregiver Caregivers need more information about services available for client How does the caregiver connect client with others to address the loneliness issue? A checklist for caregivers should be made that addresses Counseling, Communication, shared expenses, etc. Caregivers need to learn hands-on handling of client; transfers, lifting, bathing, etc. Caregivers need information on and access to equipment and assistive technology equipment ADRC should offer use of facility for family gatherings; options counseling Communication with caregivers can be thru newsletter, TV, website, churches, senior groups, etc. ____________________________________________ What information / education do caregivers need? Information needed Reality check for Caregivers regarding progression of care giving Updated list of caregivers both long term and short term; agencies with nurses and certified nurse aides and private individuals willing to work for a few hours) Updated list of respite caregivers Use a website to disseminate information Communication Method be it in person or online; where do people turn to for information, websites, churches, When allowing for face-to-face meetings, need to offer geri-sitting How do we compete with information offered on the WEB.? How do we let others know our information is trustworthy? __________________________________________ How do you find good caregivers? Resources Updated list of caregivers both long term and short term; agencies with nurses and certified nurse aides and private individuals willing to work for a few hours) Updated list of respite caregivers 121 Develop support group(s) Churches are good resource for help 122 123 124 Public Notice Public Hearings on the proposed Area Plan on Aging for the period October 1, 2015 through September 30, 2019. The Area Plan on aging sets forth in detail the development of a service system designed to meet the needs of older persons in County. The Office of Aging utilizes Older Americans Act funds through the State Executive Office on Aging to implement the Area Plan. Draft copies of the proposed plan will be available for public review at the County Office of Aging, 1055 Kinoole Street, Suite 101, Hilo, HI. and at the Office of Aging Kona Branch at the West Civic Center, 74-5044 Ane Keohoklole Hwy., Kailua-Kona. The meeting schedule is as follows: Date Location Time Wednesday West Civic Center 11:00 A.M. August 19, 2015 Community Hale, Building G 74-5044 Ane Keohokole Hwy. Kailua-Kona, Wednesday Aging and Disability Resource Center 1:30 P.M. August 26, 2015 Training Room If you require an accommodation or auxiliary aid and/or services to participate in this meeting please County Office of Aging at 961-8600 or 323-4390 by August 12, 2015. AREA PLAN ON AGING Minutes of Hearing 2015 2019 August 19, 2015 Draft 2015 2019 Area Plan on Aging on -5044 Ane Keohokalole Hwy, Kailua- Staff members present: Kimo Alameda, Ph.D., Executive on Aging; Deborah Wills, Planner II West Information Assistant. Others Present: Judy Bell, Ramona Herlihy, Joseph Kealoha, Paulina Ikeda, Fran Takamiyashiro, Jane Clement, Coran Kitaoka, and Barbara Kossow. Synopsis of the Public Hearing: The Executive on Aging, Kimo Alameda, Ph.D. and Judy Bell, the Committee on Aging Vice-Chair were introduced. Kimo welcomed attendees and opened the public hearing on the Area Plan. Kimo Area Agency on Aging and the development of the 2015 2019 Draft Area Plan on Aging for PSA4, The attendees of the meeting were given an opportunity to ask questions, provide comments, and give feedback on the proposed plan. See Power Point presentation, Comments, and Sign-In Sheet below. COMMENTS: Joseph Kealoha: What does the 2019 date mean? Kimo Alameda: The Plan is a 4 year plan starting date October 1, 2015 that runs through September 30, 2019. Every year we can make adjustments. Based on the feedback that we are getting, we can make the adjustments. We are limited to what issues we can address due to the funding streams and eligibility requirements, but we can always collaborate. Barbara Kossow: Just a thought, I know that statewide we have the homeless issue. What are we doing for the elderly that are homeless that need services? t aware that we had that many elderly homeless adults. That is something that we should look into. Barbara Kossow: We also have the VA population. Some are sleeping outside of the Day Care Center. Kimo: The Veterans and disabled populations are looking to get onto the Aging Networks system of services. They are fragmented too. We are collaborating with Veterans Affairs so we can be a resource to be able to provide information and assistance and referrals to agencies such as Catholic Charities, the homeless shelter. They may need rides to go to those kinds of places. Now that they are part of the discussion, we can try to alleviate part of their burden too. Debbie Wills: One of the issues with homeless population requesting for transportation is that they do not do an actual assessment. Barbara Kossow: Usually there is Hope Services and that could be their contact point. good issue to bring up. We can identify that in the plan as an issue. Coran Kitaoka: We have had situations like this in the past. The important issue in this situation is that they know who to contact, not necessarily them having a contact number. Th, to call. out to wonder what our brochure is up to date. Another action item, update the brochure, do outreach to re the homeless end up. Ramona Herlihy: I was thinking too that updating your brochures and sharing it with all of your contract providers have their brochures so that we have it here in our office and all of your contract providers offices so when peo another place you can go. So really sharing and referring people that way. Connect to the places they are already going to get assistance. We have a Social Security advocate, Paula Boyer mentioned that plan to allocate resources or more funding or more days to make it more easily accessible for residents on this side for elders. Another issue that we thought of that is a general issue for the island is the absence of substance abuse treatment facilities. The programs or facilities to give them treatment and they end up staying in the home with the elderly person fall under Goal 4 or Goal 5 of the plan. And like adding funding that staffed Adult Protective Services investigative report of these types Kimo: grandson addicted to drugs, then the idea of financial fraud. I was thinking of they were taking credit card member. insurance, family member out but they may not have a support system or treatment facility to send them to. Kimo: We see that they senior is being affected by that and then their quality of life is going down. What else did you mention? Social Security? Barbara: I can answer that. SSA comes twice a month. Every second and fourth Thursday of the month. They sit in front of a computer and they connect with Social Security. So before we started this program we were assured by the manager out of Hilo that anyone can call directly to Social Security for We can give you that information and give them the contact name. Ramona: The point of having an actual office there where people could make an appointment in person to be available. Barbara: That would be the Federal government. Ramona: Right, so that would be more of a Federal issue. Not really a county issue. Barbara: What using too. They would also want to include more equipment. We just signed the contract for five years. It took county employees to run that particular service. Kimo: One Memorandum of Agreement? Ramona: Thanks for letting me know. Kimo: This lady from AARP, Barbara Stanton, said that I heard that SSA cannot come to the office anymore, please check on that. And so I talked to Wally and he said we following up so at least they can come to someplace, because was to the point where they could go no place. Jane Clement: Are you guys partners with Office of Language Access for our Kupuna who do not speak English? Kimo: Yes, here is another part of the plan. We need to finish our language Access Plan, which highlights what we would do if somebody comes in that speaks English as a second language. So I throw that to my staff, say somebody come in that speaks Tagalog, An easy one would be if we have a staff member that speaks Tagalog, we would use them to help interpret. But what if someone comes in that speaks Truckese? Do we have anyone on hand that speaks Truckese? How are we going to deal with them? Do we have a list of Truckese interpreters? In Dept. of Health, Language Access is mandated. If anything on cultural competency that is mandated, is Language Access. People have the right for uld be liable. So if somebody go counseling or something, they like em in their language. Thank goodness most people speak English or they get so want it confidential, we gotta make it happen. So we are working on our Language Access plan. I just Island, get Maui, and in Big Island get the around an liable for some legal ramifications. Kimo: Other thoughts? Very good. ty that need the services. So how do you determine if we had additional days the (inaudible) general public? So is there a way through your department that if a senior really needed help and could work on the phone to talk to Social Security? Or come into your office for assistance? Kimo: Why not? That would work. Barbara: All it is, is a phone call. And we have the numbers to the office to talk to the managers there. Ramona: And we do provide that too. Barbara: We do that often. If they speak Filipino or Tagalog, We have a number that we just dialed and make the claim. DW: And we can help them go to the website if they need forms or documents. The only thing that they limited to what they can provide here so we recommend that people always call the 800 # or the Hilo # to make sure that if they come here they are going to get what they are requesting. y 2 days a month. and this is a long line of people waiting just to get a Social Security card. Kimo: This is good questions. Kimo: What was one thing you learned that you never know before? Barbara: Me too, the way I found out about the services is what I needed cause I was a caregiver as well. And I helped out too with the Office of Aging when people needed help we would send them there. Coran: I just wanted to thank you Kimo cause ever since you came on board, never had this close of a Kimo: Thank you Coran. Ramona: All anyone over the age of sixty can get free assistance with many things at our office, Powers of Attorney, Advanced Health Care Directives, Simple Wills, variety of issues we can help with free over the age of Kimo: Ok, thank you so much for coming. Meeting Adjourned at 12:22 p.m. AREA PLAN ON AGING Minutes of Hearing - East Hawaii August 26, 2015 2019 Area Plan on Aging on Staff members present: Kimo Alameda, Ph.D., Executive on Aging; Deborah Wills, Planner II, West -Kauwe, Information and Assistance Clerk. Others Present: Meizhu Lui, Cheryl Pavel, Marichu Paz, George Yoshida, Cheryl Yoshida, Lexi McKay, Christine Namahoe-Loo, Debra Nakaji, Jackie Gardner, Debbie Wills, Sunshine Cake, Jay T. Kimura, Kaui Paleka-Kama, Karen Teshima, Luana Ancheta-Kauwe, Kimo Alameda, Ph. D. Synopsis of the Public Hearing: Dr. Kimo Alameda, the Executive on Aging, and Meizhu Lui, the Committee on Aging Chair were introduced. Kimo welcomed attendees and opened the public hearing on the Draft Area Plan. Kimo asked the group to introduce themselves and state one area of interest or something they would like to take away from the meeting. Jackie Gardner, PHN: I do seniors in their home, if I leave here with anything is that everyone is going to have transportation by next year. Debra Nakaji with Services for Seniors (SFS): SFS is a non-profit, we have a contract with Office of Aging to do Case Management for the frail, homebound elderly. And so, if I had my way, people will have services as long as they need it and most of them need it longer than we are able because we are short-term, which anything to suggest. George Yoshida, my wife Cheryl: we do the Silver Bulletin and we wanted to put mentor for my practice community project which concerns aging. My particular area of interest is in bridging transitions of care, from different levels of care, and from hospital to home. So I thought this coalition or this information would be very per making sure that we get more services that coordinate between health centers and as well as long term -Care. We do in-home services, like personal care services, homemaker, assisted trans. We have been contracted through HCOA since 2007. Debbie Wills: Planner with Office of Aging, I work out of the Kona office. Lexi KcKay: I work with Christine Namahoe-Loo: I work with Coordinated Services under Parks & Rec, Elderly Activities. We are contracted by Office of Aging to do Outreach and Transportation. I hope, and I only dream, that we can the Executive Director for HCEOC and provide transportation to congregate meal sites in our contract. So annually we bid for the contract. Mostly provide transportation for the disabled and (inaudible). Kimo: Thank you. So many of you are actual service providers and I would just like to say thank you for all that you do cause we would not be able to function without you folks. Without getting information out, George Yoshida, SFS, congregate meals sites, the transportation, everything. So we appreciate you folks. The Executive on Aging, C. Kimo Alameda, Ph.D., responsibilities as an Area Agency on Aging and a summary of the 2015 2019 Draft Area Plan on Attendees included representatives from the following agencies: Hawai Aging; Nurse Pro- Division, Coordinated Services for the Elderly Program and Retired and Senior Volunteer Program; The attendees of the meeting were given an opportunity to ask questions, provide comments, and give feedback on the proposed plan. See Power Point presentation, Comments, and Sign-In Sheet below. COMMENTS: Debra Nakaji, SFS: So we have the Case Management contract and for the most par-term. When we started 26 years ago, three months was fine because Public Health Nurses took the more referrals from, that actually come from APS Sometimes these cases take longer to resolve and so you know we try to stick with the three months and complexity, so live alone and when they Management becomes more involved and we really need more time to resolve some of these issues before we can get, maybe finally, family to come in or they may have money that we have to try to get them to, they may need guardianship. And all of that just brings into the plan to get them as safe as 3 % of our cli -term is but I think it would have to be based on Kaui Paleka-m glad someone with your experience my early part of my County career, I was part of a Strategic Plan under Pat Engelhard. So I learned a little bit about, just some general concepts about Strategic Planning for those that were in P&R at that may be able to do a better job on what I saw in previous planning where some of the methodology as far as needs assessment. And so when you define stakeholders, in the previous methods of assessment as I understood it and interpreted from the informational plan that I have, some of the methodology behind the needs assessment was a little fell short. It was somewhat apparent that the term stakeholders was a acquiring all this data, I could readily see the vulnerabilities in the data. And so we know that the, especially the old recovering Case Managers is we can only case manage as well as our assessment is. Assessment is key in the process. And so that troubled me earlier, and now fast forward to many years later looking back on that time that Strategic Plan, I gained some understanding of why the office of Aging aside staffing, and setting aside disasters. All those variables that can play into the process I could still came into this elderly network back before 2000, and I come again and we still talking about the same needs assessment in order to readily identify those needs. So that from those assessments standpoints the proper planning and monitoring and evaluation of the goals and objectives can be carried out with a little bit more efficiency. And then in goals setting, I at my time with Dept. of Health, we were that person- centered case management and what sometimes I would do is I would build goals that were either ambiguous or actually two goals in one, which should be two separate goals because the better I build my goals and make them clearer and not overloaded or too wordy, where actually you have two things going on at the same time. not going to be as effective or as efficient or really meeting the need or addressing any gaps in needs do this, HCOA will do that, EAD will do that. Because the previous strategic plan had the goal and than just regurgitating what another program is doing. More so it should be HCOA will support such and such services within the realm that you know that by this date. It is basically those things, is the needs current training and expertise that you have, I hope and am more hopeful that a better needs assessment will be done, that we will have less ambiguous goals, they will be measurable. Kimo responded with a discussion of prevalence rates and how it correlates to the numbers of clients that we serve. Kimo: The average age of HCOA KC clients is cannot measure. ys the statewide ADRC cushion in that. But and a lot of the people that are in Kupuna Care are really being transitioned to Medicaid. If they can qualify, spend down and get them on Medicaid and get them off our books. But beyond that, what is this long term services and supports? Kimo responded with a discussion of strengthening our case management. Kimo: That we have control over. All we have control over is our contracted providers. If we can strengthen Case Management then that would prevent the need to go into long term care. after 3 or 4 months she has to be transitioned out of Kupuna Care. that I know of. u (SFS)? documents in place for them to take advantage of through Legal Aid, access to other programs, if they a long- for somebody to come in and empty their garbage and things like that, can you do it every other week? MOW maybe in there, and some other pair of eyes are in there. Every so often I get calls. Kimo discussed that the Committee on Aging on Oahu had a discussion with insurance companies with policies making it more affordable for older adults for long term care. Kimo: They w was sent to the Leg. And I think they are formulating a plan again to present the same Bill. Because these long term care costs is ridiculous. Meizhu: And that families are not aware of what the costs are going to be so that they end up without may not be hitting right away, but in 10 years it will be here and plan or to help people figure out how to prepare for that, because people are just hoping for the best and to be beefed up and the caregivers. Right exactly, funding for long term care. insurance companies that pitched to her 20 years ago have defaulted. And if you put money in, either they close down, because people are really living a lot longer than they guessed and so they cost too 0 a year. After all those years of paying in you services. people who qualify will be getting a budget. I have no idea what the budget is but when we did the pilot, the most was $800 a month and this allowed them to pay for whatever services, if they needed equipment or whatever , every month they got this money and they could spend it and this allowed them down the pike, now the Cheryl: I was just going to say I used to be a RN Case manager at the hospital, I was actually a Case Manager for patient services. Unfortunately that demographic, that gap group , which your Mom sounds ys looking to achieve that goal but like I say, a multiple approach is needed. this. Kaui: No, no advocacy, no policy, no nothing?. Kimo: Wow. So we really fall short on that area. this in our meeting. To make sure that they really are well qualified and so many people just find somebody, a f care and it opens the door for elder abuse. Kimo: I know the state get one big campaign agenda coming up. Cause the last meeting we went up last month the entire big dollars, they like active seniors start thinking about long term care so use that message to commercials, bulletins, posters, 50ish seniors, they asking for start putting layaway on the side. Kaui: I believe that the tsunami is at the doorway, I here incentives for caregivers because right now in my experience the main incentive for caregivers this ($$). now 15 something years instead of inside putting something that is tax credits or these other things that Kimo: The plan falls short on the advocating now that you mention, we could build that up. Cheryl: I just wanted to say that one of my areas of interest is for my practice improvement project for my programs and the ones who are at the for-front of that gap group is some pilot projects in Maryland. So number on top here. Have a good day. Meeting adjourned at 2:50 p.m. HAWAII COUNTY OFFICE OF GING Hawaii County Office of Aging (HCOA) Aging and Disability Resource Center (ADRC) Draft (12/3/15) C. Kimo Alameda, PhD. Executive HCOA Old Kona Filipinos Dying Like Dogs. Farmer Says • 1 •Why Aging on Hawaii County? • 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. Jan -16 1 ■ 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 Americans were found malnourished and marginalized. • OAA was amended 15 times since then with each time allowing for another targeted program or focus. Feds, State, County to the Rescue HAWAII COUNTY ;OFFICE OF GING Jan -16 2 I 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 ACL) to carry out the act. • *Title III provides federal funding for programs to serve those seniors 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 -Hawaiians (Alu Like) • Title VII creates state grants for "vulnerable elder rights protection" (State Ombudsmen). .1 • -40% *Feds: Title III A-E OF -1.5m Title.... • A. Not related to funding -General Provisions • 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) Jan -16 3 -35% State: Funding Source -1m • State of Hawaii: Kupuna Care Program • Enacted in 1999 with a similar mission of OAA. • Variable Funds: Keep people at home through case management and home/community based services (—$7-800k per year) ADRC • Variable Funds (-4-300k per year) given to implement the Aging and Disabilities Resource Center (ADRC) for Marketing, Training, and the basic function of Info, Assistance, Options Counseling, and �?.Yae=C:3! Referral. ADRC ■ Jan -16 4 4 N7k �Funding 25 64% County: Source Of 438m = .1% • Hawaii County • 17 Positions • 15 (1.0 FTEs); 2 (.5 FTEs) positions • 11 County Funded — —$620,000. • 6 Unfunded • 1 Data Assistant (civil service - vacant) • 3 ADRC Staff (civil service - via state funds) • 2 half -timers (civil service —vacant state funds) Jan -16 4 Organizational Flow RSVP, Coordinated Services for the Elderly, STEP, Nutrition, Recreation, Senior Centers, Senior ID —20 Cimtra.ct Kupuna Softball, Pro de Hula, Karaoke, Talent Shows, Golf Tournament, Classes, Senior Advisory Council, Club and Nutrition Presidents, Senior Trans, etc State Cycle -2015 - SFS - HIAC - Ho'onani Place - Mastercare - Metrocare - Nurse Procare - Seniors Helping - Aloha Maiden Fed Cycle (Title III) -2015 - T-III B. Legal Aid, CSE Trans (EAD), I&A, Out Reach (EAD), etc. - T-III C. HCNP (EAD) / HCEOC - T-III D. BCBH - T-III E. Caregiver Respite - T V STEP (EAD) /RSVP (EAD) - Care Resource 89e well ADRC HAWAII .11_1 1,41111, 11£501.CECEVII, 2015-2019 Goals & Objectives Hawaii County Area Plan On Aging • Jan -16 5 I 1 Keeping Kupuna Active ion Support EAD B Awareness of COC Health Education we Support Blue Zones Support RSVP Arretharg lenrylIdik 1 RSVP Wapiti Jan -16 6 3 Enhance the ADRC State & Fed. Compliance joi ADRC HAWAII ifJi71.lAND MIELEl L RISME! LL); 1 Person -Centered Language Access ■y nrr ESS PLO!. Dementia Capable M r R Jan -16 7 HCOA Vision Age with Honor HCOA Mission Help older individuals live independently with dignity HCOA Core Values Aloha, Access, & Accountability (AAA) ■ 5 Keeping Kupuna Safe Fur 0 E Disaster Response DISASTER PREPAREDNESS Neglect, Abuse, & Fraud Prevention Only ONE In sls Ma o! Elder Muss la Reported. STOP Elder Abuse HCOA "AHA" Customer Service Approach Aloha, Help, A Hui Hou HCOA Core Objectives Customer Service: Everybody is a customer and every staff member is responsible for greeting the customer with aloha, assist with solving their problem, following up, and wishing them well. Building Bridges: Team members work to secure and sustain partnerships with agencies and departments that interface with older adults and people with disabilities. Team Work: Everyone looks out for each other. Staff members work hard at their job responsibilities while ensuring their role on the team and their contribution to the mission. Jan -16 8 FQ &1 C. Kimo Alameda, PhD. Executive Hawaii County Office of Aging Email: Kimo.Alameda@hawaiicounty.gov Jan -16 9 ASSURANCE OF COMPLIANCE WITH THE DEPARTMENT OF HEALTH AND HUMAN SERVICES REGULATION UNDER TITLE VI OF THE CIVIL RIGHTS ACT OF 1964 (name of applicant) AGREES THAT it will comply with title VI of the Civil Rights Act of 1964 (P.L. 88-352) and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 90) issued pursuant to that title, to the end that, in accordance with title VI of that Act and the Regulation, no person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity for which the Applicant received Federal financial assistance from the Department; and HEREBY GIVES ASSURANCE THAT it will immediately take any measures necessary to effectuate this agreement. If any real property or structure thereon is provided or improved with the aid of Federal financial assistance extended to the Applicant by the Department, this assurance shall obligate the Applicant, or in the case of any transfer of such property, any transferee, for the period during which the real property or structure is used for a purpose for which the Federal financial assistance is extended or for another purpose involving the provision of similar services or benefits. If any personal property is so provided, this assurance shall obligate the Applicant for the period during which it retains ownership or possession of the property. In all other cases, this assurance shall obligate the Applicant for the period during which the Federal financial assistance is extended to it by the Department. THIS ASSURANCE is given in consideration of and for the purpose of obtaining any and all Federal grants, loans, contracts, property, discounts or other Federal financial assistance extended after the date hereof to the Applicant by the Department, including installment payments after such date on account of applications for Federal financial assistance which were approved before such date. The Applicant recognizes and agrees that such Federal financial assistance will be extended in reliance on the representations and agreements made in this assurance, and that the United States shall have the right to seek judicial enforcement of this assurance. This assurance is binding on the Applicant, its successors, transferees, and assignees, and the person or persons whose signatures appear below are authorized to sign this assurance on behalf of the Applicant. Date (Applicant) By (President, Chairman of Board, or comparable authorized official) A-2 Department of Health and Human Services, Assurance of Compliance with Section 504 of the Rehabilitation Act of 1973, as Amended ASSURANCE OF COMPLIANCE ASSURANCE OF COMPLIANCE WITH TITLE VI OF THE CIVIL RIGHTS ACT OF 1964, SECTION 504 OF THE REHABILITATION ACT OF 1973, TITLE IX OF THE EDUCATION AMENDMENTS OF 1972, AND THE AGE DISCRIMINATION ACT OF 1975 The Applicant provides this assurance in consideration of and for the purpose of obtaining Federal grants, loans, contracts, property, discounts or other Federal financial assistance from the U.S. Department of Health and Human Services. THE APPLICANT HEREBY AGREES THAT IT WILL COMPLY WITH: 1. Title VI of the Civil Rights Act of 1964 (Pub. L. 88-352), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 C.F.R. Part 80), to the end that, in accordance with Title VI of that Act and the Regulation, no person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Department. 2. Section 504 of the Rehabilitation Act of 1973 (Pub. L. 93-112), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 C.F.R. Part 84), to the end that, in accordance with Section 504 of that Act and the Regulation, no otherwise qualified individual with a disability in the United States shall, solely by reason of her or his disability, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Department. 3. Title IX of the Education Amendments of 1972 (Pub. L. 92-318), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 C.F.R. Part 86), to the end that, in accordance with Title IX and the Regulation, no person in the United States shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any education program or activity for which the Applicant receives Federal financial assistance from the Department. 4. The Age Discrimination Act of 1975 (Pub. L. 94-135), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 C.F.R. Part 91), to the end that, in accordance with the Act and the Regulation, no person in the United States shall, on the basis of age, be denied the benefits of, be excluded from participation in, or be subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Department. The Applicant agrees that compliance with this assurance constitutes a condition of continued receipt of Federal financial assistance, and that it is binding upon the Applicant, its successors, transferees and assignees for the period during which such assistance is provided. If any real property or structure thereon is provided or improved with the aid of Federal financial assistance extended to the Applicant by the Department, this assurance shall obligate the Applicant, or in the case of any transfer of such property, any transferee, for the period during which the real property or structure is used for a purpose for which the Federal financial assistance is extended or for another purpose involving the provision of similar services or benefits. If any personal property is so provided, this assurance shall obligate the Applicant for the period during which it retains ownership or possession of the property. The Applicant further recognizes and agrees that the United States shall have the right to seek judicial enforcement of this assurance. The person whose signature appears below is authorized to sign this assurance and commit the Applicant to the above provisions. __________________ ______________________________________________________________ Date Signature of Authorized Official _______________________________________________________________ Name and Title of Authorized Official (please print or type) _______________________________________________________________ Name of Healthcare Facility Receiving/Requesting Funding _______________________________________________________________ Street Address _______________________________________________________________ City, State, Zip Code Please mail form to: U.S. Department of Health & Human Services Office for Civil Rights 200 Independence Ave., S.W. Washington, DC 20201 Form HHS-690 1/09 A-3 A-6 A-6 A-6 A-7 A-8 A-9 A-10 A-11 A-12 The certifies that it will subscribe and conform to the provisions and assurances under GENERAL ASSURANCES AND PROGRAM SPECIFIC PROVISIONS AND ASSURANCES displayed in pages 98 through 106. Signature of Mayor or His/Her Designee _________________________________ Date 152 Acronyms/Abbreviations AAA Area Agency on Aging AARP American Association of Retired Persons AD ADC Adult Day Care Program ADLs Activities of Daily Living ADRC Aging and Disability Resource Center AHCD Advanced Health Care Directives AIRS Alliance of Information and Referral Specialists AoA Administration on Aging APS Adult Protective Services CLP Community Living Program CM Case Management CMS Centers for Medicare and Medicaid Services CNA Certified Nursing Assistant CoA Committee on Aging DD Developmental Disabilities DHHS Department of Health and Human Services DHR Department of Human Resources DOT Department of Transportation FFY Federal Fiscal Year (October 1 Sept 30) FTE Full Time Equivalent GrG Grandparents raising Grandchildren HCBS Home and Community Based Services HDM Home Delivered Meals HDS Home Delivered Services HHA Home Health Agency; Home Health Aide I & A Information, Referral and Assistances I & R Information and Referral IADLs Instrumental Activities of Daily Living IFF Intra-State Funding Formula LEP Limited English Proficiency LPN Licensed Practical Nurse LTCF Long Term Care Facility LTCO Long Term Care Ombudsman MFP Money Follows the Person MMA Medicare Modernization Act N4A National Association of Area Agencies on Aging N4A National Association of Area Agencies on Aging NAPIS National Aging Program Information System NASUAD National Association of State Units on Aging and Disability NF Nursing Facility NFCSP National Family Caregiver Support Program OAA Older Americans Act OMB Office of Management and Budget PSA Planning and Service Area; Personal Support Aide SAMS Social Assistance Management System SCSEP Senior Community Service Employment Program SFY State Fiscal Year (July 1 through June 30) SHIP State Health Insurance Assistance Program 153 SMP Senior Medicare Patrol (See SHIP) SPR State Program Reports SUA State Unit on Aging 154 155 156 157 158 159 160 161 162 163