Question

Define and explain the role of each of the following terms. How would each term impact you, as a leader, and your residents in an assisted/independent living environment?

Older Americans Act

National Eldercare Locator Service

Area Agencies on Aging

Aging and Disability Resource Centers

Medicaid HCBS waivers (Home and Community Based Services)

National Council on Aging

Programs of All-Inclusive Care for the Elderly (PACE)

Money Follows the Person

State Balancing Incentive Program

It cant get any clearer than that.

Answer 1

a)

The Older Americans Act (OAA), originally enacted in 1965, supports a range of home and community-based services, such as meals-on-wheels and other nutrition programs, in-home services, transportation, legal services, elder abuse prevention and caregivers support. These programs help seniors stay as independent as possible in their homes and communities. In addition, OAA services help seniors avoid hospitalization and nursing home care and, as a result, save federal and state funds that otherwise would be spent on such care.

Who Benefits from the Older Americans Act?

The intent of the OAA is to promote the dignity of older adults by providing services and supports that enable them to remain independent and engaged citizens within their communities. The original OAA established the Administration on Aging (AoA) and the aging services network that provides essential home and community-based supportive services. AoA is now part of the Administration for Community Living (ACL) within the Department of Health and Human Services (DHHS). OAA funding is distributed to 56 state agencies, over 200 tribal organizations, two native Hawaiian organizations, more than 600 area agencies on aging and 20,000 local service providers. While the program is open to older individuals, generally defined as 60 and older, it focuses on offering assistance to persons with the greatest social or economic need, such as low-income or minority persons, older individuals with limited English proficiency, and older persons residing in rural areas. Most services do not require means testing or copayments, but donations may be requested and some newer programs may have cost sharing on a sliding scale. Unfortunately, years of limited funding have restricted access to OAA services, resulting in waiting lists for many of these essential programs. The benefits of OAA programs are not just for older adults. They also support families by offering services to caregivers, and they provide jobs in the health and long-term care sectors in local communities around the country.

What are the Benefits?

The OAA authorizes a range of services and supports that help older Americans remain as independent and productive as possible in their own homes and communities. The OAA consists of seven titles. Titles I and II declare the Act’s objectives and establish the AoA, the federal coordinating agency for OAA services. Title III – Grants for State and Community Programs on Aging – covers supportive services such as case management, senior center services, in-home services, transportation, and information and referral. Also included under Title III are nutrition programs, such as meals-on-wheels and senior center group meals; family caregiver support; and health promotion and disease prevention services. Funds for Title III programs are distributed based on a state’s proportionate share of either the age 60 or older population or, in the case of caregiver support programs, the age 70 or older population. Each state then has its own formula for allocating OAA funding to area agencies on aging which enables the delivery of services to local areas.

Title IV of the OAA provides support for training, research and demonstration projects while Title V authorizes the Senior Community Service Employment Program (SCSEP). This program, which is managed by the Department of Labor, provides support for part-time employment for individuals 55 and over who are low-income, unemployed and have poor employment potential. Title VI covers Grants for Services for Native Americans and provides funding to tribal organizations, Native Alaskan organizations and nonprofits representing Native Hawaiians.

Finally, Title VII provides support for programs to ensure protection of the rights of older adults, including the Long-Term Care Ombudsman Program and elder abuse prevention services. The Long-Term Care Ombudsman Program is required to investigate and resolve complaints made by or on behalf of nursing facility residents or other institutionalized populations. Title VII funds are allocated based on the state’s proportion of residents age 60 and older.

OAA Funding

The Older Americans Act has a broad and critical mission. However, it is plagued with modest resources to support the service continuum. Over the past 20 years, the OAA has lost ground due to our rapidly-increasing frail, older population, and federal funding that has not kept pace with either inflation or growth in the older population. Eligible seniors face waiting periods for many OAA services in most states.

Annual OAA discretionary funding has declined over the 10-year period from Fiscal Year 2009 to Fiscal Year 2018, and funding levels each year have remained below the Fiscal Year 2010 level when funding was at its highest level ($2.328 billion). Fiscal Year 2018 funding totaling $2.038 billion was eight percent more than Fiscal Year 2017 levels. Congress has passed legislation, now Public Law 115-245, that maintains this increase and further increases funding for some OAA programs. A chart (https://www.ncoa.org/wp-content/uploads/FY19-LHE-final.pdf) from the National Council on Aging shows the allocation of Older Americans Act funds as well as funding for other aging programs.

OAA Reauthorization

The Older Americans Act Reauthorization Act, S. 192, was signed into law (Public Law 114-144) by President Obama on April 19, 2016. This bipartisan legislation was introduced by Senators Lamar Alexander (R-TN), Patty Murray (D-WA), Richard Burr (R-NC) and Bernie Sanders (I-VT). It reauthorizes the OAA for three years and makes improvements to benefit older Americans and their families. The major provisions of P.L. 114-144 are outlined in a fact sheet from the House Committee on Education and the Workforce at http://edworkforce.house.gov/uploadedfiles/bill_summary_-_older_americans_act_reauthorization_act_of_2016.pdf. It is expected that the 116^th Congress, which convenes in January 2019, will consider the next Older Americans Act Reauthorization.

NATIONAL COMMITTEE POSITION

The National Committee supports increased funding for Older Americans Act (OAA) programs to provide for the needs of our growing elderly population and to make up for past years of cuts in OAA services resulting from federal funding not keeping pace with inflation. The National Committee supported S. 192, the “Older Americans Act Reauthorization Act of 2016,” now Public Law 114-144, which reauthorizes the OAA for three years and provides much-needed assistance to older Americans. In particular, the National Committee supports provisions in the law that:

• Make improvements to the core programs of the Older Americans Act – including congregate and home-delivered meals, assistance for family caregivers, transportation and senior services – which would help ensure economic security and the ability of seniors to receive the supports and services they need to stay healthy and active in their homes and communities.

• Protect against elder abuse and strengthen long-term care ombudsman services. Research shows a direct connection between elder abuse and increased need for costly services, such as nursing home care. Thus, beyond the ethical obligation to protect vulnerable older adults, these changes have the potential to achieve savings in other programs such as Medicare and Medicaid.

• Promote healthy living through programs including fall prevention and chronic disease self-management. These programs improve the quality of life for individuals and prevent unnecessary medical costs.

b)

Elder care, often referred to as senior care, is specialized care that is designed to meet the needs and requirements of senior citizens at various stages. As such, elder care is a rather broad term, as it encompasses everything from assisted living and nursing care to adult day care, home care, and even hospice care.

Although aging in itself is not a reason to consider elder care, it is usually the various diseases and physical limitations that accompany old age that prompt a discussion about elder care.

It is not always an absolute; in fact, some senior citizens never require any type of care to live independently in their later years. However, elder care often becomes an issue when a loved one begins experiencing difficulty with activities of daily living (ADLs), both safely and independently. ADLs may include cooking, cleaning, shopping, dressing, bathing, driving, taking meds, etc.

A general decline in health is often the impetus for the introduction of elder care, as it may indicate a waning ability to independently handle activities of daily living. For example, senility, which usually comes on at a gradual pace, may mean that a person who once remembered to take medication on time is now having difficulty doing so. Failing eyesight may mean your loved one is gradually losing the ability to move safely about the house, or advanced arthritis may mean he or she is having difficulty getting in and out of the bathtub without assistance.

The need for elder care may also happen quickly, as is the case if your loved one is recovering from a broken hip or recently had a stroke and is still suffering the cognitive and/or physical effects.

What is constant, however, is that elder care may be needed when a health condition –whether physical, cognitive, or even emotional – hinders the ability to safely complete activities of daily living.

Family members or a doctor are usually the first to recognize a need for elder care. The type of elder care that is right for your loved one, however, is largely dependent upon the type of health conditions he or she suffers from, the severity of the conditions, and the deficiencies experienced as a result.

It is up to both your loved one’s medical team and the family members closest to them to keep a close eye on any changes that may affect the ability to safely complete ADLs without assistance. There are a number of warning signs your loved one may display or exhibit that may prompt you to seek outside help:

Warning Signs to Watch Out For

• Physical problems
  • Gait, stability (walking problems)
  • Sensory issues (a loss or decline in hearing, seeing, smelling)
  • Chronic health conditions (diabetes, heart disease, arthritis)
  • Temporary or permanent physical limitations that may inhibit the senior’s ability to perform ADLs

• Cognitive problems
  • Confusion
  • Memory loss
  • Attention problems
  • Forgetting to take meds on time, at the right time, or at all
  • Language problems
  • Dementia

• Emotional problems
  • Depression
  • Social withdrawal
  • Loneliness
  • Changes in personality (irritable, angry, moody, etc.)
  • Loss of interest in activities

Physical Problems – Chronic health problems often come about as people age and are unable to perform many of the activities they once could. Their bodies may become more fragile, more rigid, and less resilient. Chronic illnesses may cause secondary impairments, or new illnesses to develop.

Disease-related physical impairments may be easy to spot or may be subtler. For example, senior citizens with glaucoma may not appear to be physically impaired, but their loss of vision may result in accidents and falls that may greatly impact their health or well-being.

Just because your loved one hasn’t reported a physical impairment doesn’t mean he or she doesn’t require care; therefore, a complete physical examination (including vision and hearing) on a regular basis is an important part of an overall health plan.

Cognitive Problems – Although cognitive problems, at least in their mildest form, can be expected as your loved one ages, some cognitive problems may impair a his or her ability to live safely and independently. Cognitive problems may cause memory problems, difficulty with language, difficulty making judgments, and difficulty regulating emotions, just to name a few. Mild dementia may not require elder care, but any type of dementia that is progressive and causes serious safety concerns must be addressed.

Emotional Problems – A decline in health, the loss of a spouse, the inability to do things once enjoyed, or the feelings of unimportance are all issues that may cause your loved one to experience emotional problems.

Emotional problems may manifest themselves in a number of ways. For example, your loved one may become socially withdrawn, moody or irritable, or may even have suicidal thoughts.

Many seniors deny the existence or severity of emotional problems, which makes the thoughtful observations of physicians and family members all the more important.

When to Begin the Discussion about Elder Care

Elder care should become a discussion as soon as changes are noticed, as postponing or delaying assistance could jeopardize your loved one’s well-being and safety.

C)

An Area Agency on Aging (AAA) is a public or private non-profit agency, designated by the state to address the needs and concerns of all older persons at the regional and local levels. “Area Agency on Aging” is a generic term—specific names of local AAAs may vary. AAAs are primarily responsible for a geographic area, also known as a PSA, that is either a city, a single county, or a multi-county district. AAAs may be categorized as: county, city, regional planning council or council of governments, private, or non-profit.

AAAs coordinate and offer services that help older adults remain in their homes - if that is their preference - aided by services such as Meals-on-Wheels, homemaker assistance, and whatever else it may take to make independent living a viable option. By making a range of options available, AAAs make it possible for older individuals to choose the services and living arrangements that suit them best.

D)

The Aging and Disability Resource Center (ADRC) is a trusted source of information where people of all ages, abilities and income levels - and their caregivers - can go to obtain assistance in planning for their future long-term service and support needs. The ADRC is designed to empower older adults and persons with disabilities to make informed choices about their services and supports. Staff at the ADRC provide objective information and assistance to help people access private or publicly funded service programs.

The Kansas Department for Aging and Disability Services has contracted with the Southwest Kansas Area Agency on Aging, which subcontracts with the state’s 10 other Area Agencies on Aging to function as individual parts of the ADRC. "In establishing this statewide network of ADRCs, we are creating a person-centered, community-based environment that promotes independence and dignity for individuals," said KDADS Secretary Kari Bruffett.

ADRC serves the entire state in providing people of all incomes and ages with information on the full range of long-term support options. ADRC provides individual personalized Options Counseling Services through local Community Options Specialists who can meet with you to help you sort through your options and connect you to services based on your own preferences, strengths and values.

E)

Within broad Federal guidelines, States can develop home and community-based services waivers (HCBS Waivers) to meet the needs of people who prefer to get long-term care services and supports in their home or community, rather than in an institutional setting. In 2009, nearly one million individuals were receiving services under HCBS waivers.

Nearly all states and DC offer services through HCBS Waivers. States can operate as many HCBS Waivers as they want — currently, more than 300 HCBS Waiver programs are active nationwide.

HCBS Waiver Program Basics

State HCBS Waiver programs must:

• Demonstrate that providing waiver services won’t cost more than providing these services in an institution
• Ensure the protection of people’s health and welfare
• Provide adequate and reasonable provider standards to meet the needs of the target population
• Ensure that services follow an individualized and person-centered plan of care

F)

The National Council on Aging (NCOA) was founded in 1950 as the first charitable organization in the U.S. that would provide a national voice for older Americans and act as their advocates in dealing with service providers and policymakers.Headquartered in Washington, DC, NCOA brings together various organizations, businesses, and governmental organizations to work toward securing jobs, benefits, health, independent living, and active living among older Americans.

NCOA provides a variety of services to older people and caregivers including Benefits Checkup, Economics Checkup, and My Medicare Matters.

G)

Program of All-inclusive Care for the Elderly (PACE) are programs within the United States that provide comprehensive health services for individuals age 55 and over who are sufficiently frail to be categorized as "nursing home eligible" by their state's Medicaid program. Eligibility for PACE requires that individuals be 55 years old or older, certified by the state to need nursing home-level care, reside near a PACE program, and able to live safely in the community.^[1] Services include primary and specialty medical care, nursing, social services, therapies (occupational, physical, speech, recreation, etc.), pharmaceuticals, day health center services, home care, health-related transportation, minor modification to the home to accommodate disabilities, and anything else the program determines is medically necessary to maximize a member's health.

PACE programs are health care providers which directly employ a comprehensive range of health care professionals (physicians, nurses, physical therapists, social workers, etc.) to provide care to frail older adults—they are reimbursed on a fixed per member per month rate (or capitation payment) and, in return for this fixed payment, are responsible for providing all health services, even extending to transportation.

Because PACE programs enroll only the very frail and incapacitated, they are exactly the patient population for whom prevention and health promotion makes a difference. Most PACE patients have multiple diagnoses, with an average of over 7 diagnoses per member. Among the most common are cardiac problems, diabetes, hypertension, and vascular disease. PACE programs have strong incentives to help keep their members as healthy as possible—their patients, if left without care, are likely to require extensive acute and nursing home care, which are very expensive. So PACE programs tend to provide high levels of preventive services, such as very frequent check ups, exercise programs, dietary monitoring, programs to increase strength and balance, etc.

PACE programs organize their services in a "PACE Center". These Centers tend to have a Day Health Center, physician' offices, nursing, social services and rehabilitation services, along with administrative staff, all in one site. Members attend centers from rarely to 7 days a week, depending on their care plans. Care planning is done with the member, his or her care team, and appropriate family members; most members attend about 2 days per week.

H)

Money Follows the Person (MFP) is a state project that helps Medicaid-eligible North Carolinians who live in inpatient facilities move into their own homes and communities with supports.

North Carolina was awarded its MFP grant from CMS in May 2007 and began supporting individuals to transition in 2009. Under the Affordable Care Act, MFP was extended through 2020.

In 2018, NC MFP partnered with Mercer to conduct a transition sustainability analysis. The results of the analysis, and the 58 recommendations for future modifications can be accessed on the Final Report and Recommendation documents.

MFP Program Goals

• Increase the use of home and community-based services (HCBS) and reduce the use of institutionally-based services
• Eliminate barriers in state law, state Medicaid plans, and state budgets that restrict the use of Medicaid funds to enable Medicaid-eligible individuals to receive support for appropriate and necessary long-term services and supports in the settings of their choice
• Strengthen the ability of Medicaid programs to provide HCBS to people who choose to transition out of institutions
• Put procedures in place to provide quality assurance and improve HCBS

I)

The Balancing Incentive Program (BIP) provided financial incentives to States to increase access to non-institutional long term services and supports (LTSS) in keeping with the integration mandate of the Americans with Disabilities Act (ADA), as required by the Olmstead decision and was created by the Affordable Care Act of 2010 (Section 10202). The Balancing Incentive Program authorized grants to serve more people in home and community-based settings, from October 1, 2011 to September 30, 2015. Thirteen states continue to participate in the program by spending the grant funds to increase access to new or expanded services and infrastructure.

The Balancing Incentive Program helped States transform their long-term care systems by:

• Establishing No Wrong Door Systems for people to obtain information on Medicaid LTSS
• Utilizing core standardized assessment instruments to streamline access to LTSS
• Implementing conflict-free case management by ensuring proper firewalls and mitigation strategies are in place to enable access to quality LTSS

The Balancing Incentive Program increased the Federal Matching Assistance Percentage (FMAP) to States that made structural reforms to increase nursing home diversions and access to non-institutional LTSS. The enhanced matching payments were tied to the percentage of a State’s LTSS spending, with lower FMAP increases going to states that needed to make fewer reforms. The BIP state must use the enhanced FMAP only to provide new or expanded home and community-based LTSS and related infrastructure.