Program Year (PY)

Transcription

1 Microsoft Program Year (PY) Strategic Area Plan for Programs on Aging 1 P age

2 PY Strategic Area Plan Table of Contents Signature Page... 3 Mission & Vision Statements... 4 Top Three Outstanding Goals from PY Strategic Area Plan... 5 Environmental Scan... 8 Census Information... 9 Targeting Underserved Populations SWOT Analysis (Strengths, Weaknesses, Opportunities & Threats) Service Needs & Gaps Strategic Goals for Goal 1: Goal 2: Goal 3: Goal 4: Goal Operational and Budget Narrative Appendices Appendix 1: Request to Transfer Funds Appendix 2: Application for Waiver Request Appendix 3: Request for Variance from Prescribed ODA Service Taxonomy Appendix 5: Use of Funds for MPSC Capital Improvements Appendix 7: Waiver of Title III-B Priority Services Assurances Section 306 Older Americans Act Certification Regarding Department Suspension, Ineligibility and Voluntary Exclusion Certification for Contracts, Grants, Loans & Cooperative Agreements Department of Health and Human Services Assurances of Compliance with Section 504 of the Rehabilitation Act of 1973, as Amended Assurance of Compliance with the Department of Health and Human Services Regulations under Title VI of the Civil Rights Act of Older Americans Act Programs Non-Discrimination Policy Verification of Intent Attachments P age

3 Signature Page 1. Council on Aging of Southwestern Ohio Inc. Area Agency on Aging (AAA) Name 175 Tri County Pkwy Street Address Cincinnati, OH City, State and ZIP 2. Ken Wilson Name and Telephone Number of AAA Contact I certify that I am authorized to submit this Strategic Area Plan on behalf of the designated grantee agency and that a public hearing (summary attached) was held to assist in the development of this Strategic Area Plan. The Advisory Council has reviewed and commented upon this plan and the Board has approved its submission. AAA Director Date Board Chairperson Date 3 P age

4 PY Strategic Area Plan Mission & Vision Statements Mission Statement: Council on Aging`s mission is to enhance people's lives by assisting them to remain independent at home through a range of quality services. Vision Statement: Every individual in our region shall have a choice and a range of services and programs that will assist them to remain independent in their chosen environment. 4 P age

5 PY Strategic Area Plan Top Three Outstanding Goals from PY Strategic Area Plan Briefly summarize the status of the top three outstanding Goals from your PY Strategic Area Plan, including the outcomes and impacts, and when each goal is expected to be completed. Also indicate how your AAA will measure goal success. (500 words or less per goal) Goal 1: Develop effective aging and disability resource connections Status: In Progress with completion in Impact: Increasingly, COA s front door our Aging and Disability Resource Network (ADRN) is being pressed into service to respond to community need. In 2013, the number of inquiries coming into our call center and web site increased by nearly 20% over the previous year to more than 35,000 contacts. In 2014, implementation of our contracts for the Ohio Home Care waiver and MyCare Ohio, have greatly impacted the call center as confused and concerned clients and providers seek information, reassurance, and connection to services. They turn to their AAA because they know about us, trust us, and expect to be able to talk to a real person. Some of the objectives of our plan have now been completed but other objectives are underway to help us develop the most effective front door possible. All that said, this community service lacks funding sources that are sufficient for the growing expectations and demands placed upon it. Outcomes: Continue to participate in the development and implementation of processes to support the Balancing Incentives Plan Initiative, resulting in tools needed to implement a universal screen and assessment process. Help caregivers, older adults, families, and professionals (including our own staff) have 24/7 access to information and community resources via our online Resource Directory. This is a superior product with more than 1,600 local, state, and national resources. In , we worked with our web developer to complete the objective to improve the Resource Directory s functionality to make it more user-friendly and interactive. We reorganized sections and added many disability resources for the under-60 population. We helped the state with public education and enrollment for MyCare Ohio. Working with our local ombudsman program (ProSeniors) and Center for Independent Living Options (CILO), COA s Communications and ADRC departments planned five informational forums over a five-month period that reached more 600 people. We contracted with CILO and with an outside Medicare/Medicaid consultant to provide one-on-one enrollment assistance. We developed informational materials for care managers to share with clients who needed extra help selecting a health plan. We have recently hired a consultant to help us develop efficiencies in ADRC that will enable us to meet increasing demands with the same resources. Measurements: 5 P age

6 Development and adoption of departmental improvements and efficiency measures to reduce on-hold time and manage call volume Successful implementation of BIP Goal 2: Develop new models for integration of community-based services and health care systems. Status: In Progress with completion in 2014 Impact: For nearly two years, COA has been working with the state on planning and preparation for the Integrated Care Delivery System known as MyCare Ohio. If successful, this demonstration project will improve health outcomes, enhance consumer experience of care, and reduce costs. Approximately 19,000 dual-eligible individuals in our region are affected by MyCare Ohio. Outcomes: We have successfully completed contracts with the two health plans in our region: Aetna and Molina. As part of our preparations, we are building on our self-directed team model by creating Interdisciplinary Care Coordination (ICC) teams which combine staff members with different skills and job assignments into a care management/waiver services coordination team accessed via a single phone number and address. This model enhances flexibility, teamwork, and customer service. Part of this goal includes expansion of COA services to new populations. We are doing this via contract with Ohio Department of Medicaid to provide care management to consumers of the Ohio Home Care waiver. We sought and won this contract which went into effect in January, When one of our subcontractors backed out, we took on responsibility for their service area and opened a satellite office in Dayton. The addition of Ohio Home Care means we are now serving a younger population, in addition to seniors. This is requiring changes to our branding and messaging. Measurement: Performance on MyCare Ohio contracts Full and successful deployment of ICC model with resulting team and customer satisfaction Goal 3: Build a strong organizational culture within COA. Status: In Progress, will be completed in 2014 Impact: 6 P age

7 To evolve as an organization and take advantage of opportunities arising from health care reform, we must develop new skills in our existing workforce and recruit new employees who will meet our changing needs. To retain our best employees and provide opportunities for all staff, we must offer superior onboarding and training as well as career advancement paths. Benefits and compensation must be competitive in an environment where we are seeking many of the same types of employees as large health plans and hospital systems. Outcomes: Four employees have participated or are participating in the Management in Training program Two employees have gone to the Leadership Challenge workshop facilitated by Camp Joy Six employees have gone to trainings at Employer s Resources Association Eleven teams have gone through self-directed team trainings Eight teams have gone through conflict-resolution training We have certified more than 25 employees as Team Educators Research and implement Payroll and HRIS system that aligns with strategic direction and flexibility needed in organization. We have certified seven employees as Team Quality Representatives Research and implement Payroll and HRIS system that aligns with strategic direction and flexibility needed in organization. Compensation review completed of all positions to align salaries with external markets Measurement 90% of new managers document understanding and application of training. HR&T has created a development portfolio for the Team Educator and Team Quality Representative position that provides succession planning into other key areas. Curriculum developed. Self-directed teams have training modules based upon new team dynamics 90% of self-directed teams have received training and are prepared to conduct conflict resolution with peers. Agency retreat completed. 85% of staff report satisfaction Teams are operating utilizing all roles appropriately as identified in survey Effective team profile has been identified and COA is hiring to profile. New applicant management and hiring system integrated or current system corrected to meet needs 7 P age

8 PY Strategic Area Plan Environmental Scan Describe the current environment faced by the region and how it will impact the AAA and aging network. The environment should be viewed from both internal and external perspectives. Please refer to the Glossary for further clarification. (800 words or less) ECONOMIC FACTORS The percentage of our older population living in poverty has decreased dramatically over the past 50 years. Today, children are more likely to be poor than seniors. Still, approximately one in ten older adults lives in poverty and many more live in near-poverty with annual incomes of $25,000 or less. COA s levy-funded Elderly Services Programs do not have means-tested eligibility, but the average annual income of individuals enrolled in these programs in 2013 was $20,736 too low for them to afford private-pay in-home care. As of April 2014, the unemployment rate in Ohio was 5.7% which is below the national average of 6.3%. The average for all five counties in AAA1 in April 2014 was just 5.2%. These rates have fallen steadily since In 2013, COA helped 19,831 people to remain independent in their homes through programs such as PASSPORT, Assisted Living Waiver, and county-based Elderly Services Programs. The Care Transitions program assessed 5,283 highrisk, hospitalized Medicare patients for an intervention designed to help prevent the need to return the hospital. Nearly 200 provider organizations that deliver services such as meals, homemaking and personal care were contracted with and monitored. The Aging and Disabilities Resource Connection responded to 35,203 requests for information and referral, a 20% increase over COA funding is comprised of 48.26% state Medicaid; 40.43% local governments; 7.85% federal; 1.93% consumer contributions; and 1.5% state government; with the remaining.03% coming from other sources. The total revenue administered by COA in FY 2013 was $101,077,339. POLITICAL FACTORS Issues relevant to our mission, including long-term care reform, appeal to people of all political persuasions because they are good for taxpayers, families and communities. There is a growing concern over escalating government deficits and spending. This provides both an opportunity and a threat to senior service programs. Community-based long-term care saves money that would otherwise be spent on more expensive institutional care. Voters in our region have a history of supporting senior service levies. The most recent round of levy votes (2010, 2011 and 2012) passed with margins in the range of 65-76%. This was due in part to the fact that recent levies in Butler, Clinton, Hamilton, and Warren counties were all renewals and did not raise taxes. Increasing levels of political accountability and administrative effort are required before senior service levies can be placed before the voters. Local funding limits are significant factors in the development of waiting lists for the Elderly Services Program. SOCIAL FACTORS Health care reform is a partisan issue that poses opportunities and threats. The Affordable Care Act indirectly impacts long-term care via initiatives that seek to save money and deliver better care by better integrating the acute and longterm care systems. Poor care transitions between health care and long-term care settings lead to unnecessary re- 8 P age

9 PY Strategic Area Plan hospitalizations, and negatively impact patient health through poor communication, lack of medication management and other issues. Integrating medical care with home and community-based care is needed in order to improve outcomes, reduce costs and build a better infrastructure for Ohio s aging population. In our area, caregiver burnout was identified as one of the top five risk factors that will impact how and where people age. Resources for services to help caregivers are not able to meet the demands of the aging population. Lack of transportation options challenges seniors and caregivers. In to a survey conducted by COA in June 2014, medical transportation was listed as the fourth most important service to help a person with a disability maintain independence. It followed closely behind personal care services, home-delivered meals, and homemaker service. Current transportation resources are limited by: restricted service area, eligibility criteria, cost, lack of coordination, apprehension among seniors about using public transportation, and few options for people with limited mobility. The Cincinnati area is home to 165 grocery stores. Of the 52 neighborhoods in Cincinnati, not one is completely food secure. Thirty-one neighborhoods do not have a single grocery store within their boundaries and significant portions of the Cincinnati metro area could be defined as a food desert. DEMOGRAPHIC FACTORS Four of our five counties saw a significant increase in the number of individuals ages 60+ years between 2000 and 2010 (Warren 40%, Clermont 33%, Butler 23%, Clinton 20% and Hamilton 2%) The percentage of seniors in each county in our region varies from 15.8% to 19.4% with an average of 17.62%, which is close to the national average of 18.5%. Within AAA1, the percentage of minority seniors in each county ranges from 5% to 32%. The distribution of minority seniors is heaviest in Hamilton County, with the remaining counties maintaining a much smaller range of 5% to 15.3%. According to the US Census, AAA1 has 2,434 (.85%) seniors age 60 and older who reported limited English proficiency (LEP). Language Line and informational materials written in non-english languages are available. Although AAA1 has relatively few seniors of Hispanic origin with LEP, we are aware that this may change. There is a local sub-population of elderly Russian-speaking individuals. Of Ohio residents aged 60+ living in AAA1, 37,459 live in a rural area and 250,178 in urban areas. The rural seniors have fewer community resources and greater difficulty accessing them due to few transportation options. 9 P age

10 Census Information Basic Demographics: 2010 Census 2 County Rural 60+ Males Females Living Minority LEP Alone 60+ Butler Clermont No data available Clinton No data available Hamilton Warren Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Totals Limited English Proficiency 2 See or 10 P age

11 PY Strategic Area Plan Targeting Underserved Populations Please explain your response in detail and include supporting data and analysis as applicable. 1. Discuss the AAA s proposed method for carrying out preference to (1) older individuals with greatest economic need, (2) older individuals with greatest social need, and (3) low-income minority individuals. All of COA s goals are related to improving access to services, increasing efficiency and decreasing costs. This is all in an effort to develop and plan flexible services for the current and future needs of seniors and caregivers, including older adults with the greatest economic and social need and minorities. As demands for services increase and available resources decrease, COA will focus on providing products and services that provide the most impact for the community and protect the most vulnerable We continue to adapt to community need. Examples: we have extended on-call services to consumers in the Ohio Home Care waiver and expanded our front door/call center hours to 7 a.m. to 6 p.m. (Regular organization hours are 8-4:30) We have added many community resources for persons with disabilities to our online Resource Directory and added resources in counties outside PSA1 that are part of the Ohio Home Care program. We have improved functionality of our online Resource Directory and developed the entire product with databases so individuals may do customized searches, comparisons, and print out their own lists. This is especially valuable in the Housing Search category, which is very popular. These tasks can be carried out by our ADRC specialists for people who do not have internet access or need someone to walk them through. Our Resource Directory now includes more than 1,600 local, state and national resources, along with service explanations, guidance and tips. COA s Title III contracting process gives priority to providers that serve higher proportions of seniors who are minorities, have limited English skills, and/or live in rural areas. Providers that are able to deliver services to these high need seniors receive additional credit on the evaluation of their application. COA funds congregate meal programs and other Title III services in low-income and minority neighborhoods. COA also has a cost-sharing component associated with the Elderly Services Programs (ESP) that is based on income level. Roughly 75% of the participants on ESP have a monthly income of less than 150% of the Federal poverty level and pay no co-payment for services. COA blends Title III dollars with the ESP levies for services such as personal care and homemaker. Only clients without co-payment are charged to Title III. COA provides outreach and services to ethnic groups and individuals with limited English proficiency. COA has informational materials translated into Spanish and Russian. Translator service is provided as needed for assessments and care management. 11 P age

12 2. The 2006 reauthorization of the Older Americans Act (OAA) includes specific emphasis on serving older individuals residing in rural areas. Describe the AAA s plans to ensure compliance with this mandate. In PSA1, Clinton County is the most rural county. In 2014 COA opened an office in Clinton County in Wilmington to establish a more visible community presence. An Integrated Care Coordination Team is based there, serving clients on the Clinton County Elderly Services Program and handling public inquiries. PASSPORT care managers serving Clinton County may also use this office. In designing its Care Transitions program, COA deliberately sought a partnership with Clinton Memorial Hospital and has a health coach based there. For outreach in Clinton County, we have identified every organization that serves older adults and people with disabilities and have met with most of them and provided informational materials. 3. The 2006 reauthorization of the OAA emphasized the importance of reaching groups that have limited English proficiency (LEP). Describe the AAA s plans to improve access to services for those persons identified in this group. For its levy-funded Elderly Services Programs, COA is facilitating client choice in selecting providers based upon quality-ratings and customer satisfaction. We have developed a selection table which care managers share with clients to help them choose providers. This table is available in Spanish, and Russian, in addition to English. It uses an easy-tounderstand star rating system. Other outreach materials, such as fact sheets about our program, are also available in Spanish. Our Communications Department recognizes the need to seek opportunities for speaking engagements and participation in informational events targeted to certain groups that have limited English proficiency. Such groups do sometimes request that we come and speak and we do but we must develop a strategy for a more proactive approach that is within our capacity. 4. The 2006 reauthorization of the OAA emphasized the importance of reaching older individuals with disabilities, with particular attention to individuals with severe disabilities and individuals at risk for institutional placement. Describe the AAA s plans to ensure compliance with this mandate. COA s annual Forum on Aging conference continues to grow every year and provides information, resources, education, and networking opportunities for hundreds of professionals in our region who serve older adults with disabilities and those at risk of institutional placement. More than 400 people attend this two-day event annually and we have increased the level of sponsorships over the past three years, which enables us to reach a wide audience by offering a very affordable price for individuals seeking CEUs. In addition, outreach efforts coordinated by our Communications Department include scores of speaking engagements, individual meetings, and participation in informational events that target older individuals with disabilities. This includes speaking to support groups for individuals with specific conditions such as disability resulting from brain aneurysm and movement disorders, including Parkinson s Disease. In 2013, we spoke at several conferences 12 P age

13 for fire chiefs and emergency medical personnel to help them better understand how to refer individuals to COA for help. We speak regularly to groups of medical residents at University of Cincinnati Medical School and we have assisted care coordinators at physician practices with awareness and connection to community resources. Our Care Transitions staff give presentations to hospital leaders, social workers and other discharge staff. In , we reached more than 600 individuals directly via public informational forums about MyCare Ohio. We continue to reach out on MyCare Ohio via regular newsletter articles, fact sheets for our staff to share with consumers and caregivers, social media, and web site content. COA offers Care Transitions, a free health coaching and intervention program for older adults who have been hospitalized for serious and usually chronic conditions, such as heart failure. It is designed to help frail seniors who have been discharged from the hospital avoid future preventable hospital admissions as well as help patients access the most appropriate postacute medical care and home and community-based services (and avoid the more costly nursing facility placements when not necessary) COA`s Community Transitions Program restores independence by helping eligible older adults and people with disabilities move from long-term care facilities to home and community settings. Our home- and community-based programs help thousands of people receive the services they need to live independently in their homes and communities. These programs are popular choices for seniors and people with disabilities who want to have more choice and control over the services they receive and the setting in which they receive them. Our Government Relations Manager serves on numerous local boards and committees designed to improve safety for individuals with disabilities and increase access to community services such as transportation. These include local TRIAD committees (she chairs the Hamilton County group). She helps plan an annual Emergency Preparedness event targeted at helping older adults and persons with disabilities and serves as liaison to county EMA service. The objective is to ensure that high-risk individuals are included in our region s emergency preparedness planning. The Government Relations Manager and Communications Director are actively involved in community education efforts to protect older adults from frauds and scams. 5. Identify and discuss other significant unserved and underserved populations and AAA plans to assist these groups. Studies have shown that older LGBT adults especially couples face discrimination in housing and may find it difficult to locate retirement communities, apartment complexes with supportive services, and nursing facilities that are welcoming and meet their needs. Through newsletter articles, event promotion, and social media, COA has promoted awareness of the messages and activities of an elder LGBT advocacy group based in Greater Dayton, which serves a small portion of our AAA1 region. No such group exists in Greater Cincinnati. 13 P age

14 In addition, we develop Forum on Aging workshops that provide training on working with certain populations. For example, a 2013 workshop focused on working with LGBT individuals living in nursing facilities. 6. Discuss how the AAA will evaluate the effectiveness of any resources that will be used in meeting the needs of the above consumer groups. Evaluation methods include the following: Attendance at and sponsorship of Forum on Aging and other COA events Evaluations from individuals attending events People reached via our social media efforts and monthly newsletter Requests for speaking engagements and event participation; feedback from participants Feedback from staff who use our materials with consumers and clients in their homes and in hospitals Number of calls and online inquiries to our ADRC Department 14 P age

15 PY Strategic Area Plan SWOT Analysis (Strengths, Weaknesses, Opportunities & Threats) Summarize your AAA s SWOT (500 words or less per category). Please refer to the Glossary for further clarification. a. Strengths Levy program management Through excellent planning, management, quality improvement, advocacy and public education, COA is a driving force behind ongoing support for locally-funded in-home care services for seniors in our region. Services funded by taxpayers at the county level and administered by COA in four of our five counties greatly expand long-term care options for seniors of modest means who are not eligible for Medicaid. Combined, these programs serve nearly 20,000 seniors annually. COA has contracts with four boards of county commissioners to manage these levies and the Elderly Services Programs they fund. Each levy is for five years. All have been renewed or increased by the voters since their inceptions, meaning each levy has been approved by the voters between three and five times. Advocacy COA s Government Relations Manager, our senior leadership team and members of our board of trustees and advisory council provide information, education, and assistance to local, state and federal legislators, as well as information and advocacy support on issues of interest to COA and the aging network. COA asks state and local legislators to come out on home visits with care managers to give legislators an inside look at the people served, the services offered and effectiveness of the funding received. In 2013 COA conducted 114 advocacy meetings and client visits with elected officials. Expertise enabling expansion of customer base Very few organizations in the region have the expertise that COA has in the administration of in-home services and assessment of non-medical needs. This expertise has helped COA expand services to new customers including people under the age of 60 with disabilities (contract with the State of Ohio Department of Medicaid to provide care management for Ohio Home Care Waiver in 21-county region beginning January 2014) and the hospitalized Medicare fee-for-service population with Care Transitions (contract with U.S. Centers for Medicare and Medicaid Services (CMS) beginning late 2011). COA s Care Transitions program has been recognized for effectiveness by CMS and in late 2013, the Cincinnati USA Regional Chamber of Commerce Women Excel program honored Care Transitions as runner up for Best New Product of the Year. Innovation and adaptation to change Innovation and adaptation to change are key elements of COA s business culture. By taking advantage of opportunities arising from health care reform, we have gained new programs, 15 P age

16 customers and payers. These opportunities then spawn additional innovations. For example, COA has developed Integrated Care Coordination (ICC) teams made up of staff with different types of expertise who serve a common pool of clients. This model of care mangers, support specialists and community health workers is more efficient and cost effective than traditional team structures. The model improves customer service because consumers and providers access the team via a single phone number and address and consumers can have basic needs met without having to wait for a care manager. In a related innovation, COA developed self-directed work teams and added new roles including Team Educators, Team Quality Representatives and Managers- In-Training. The culture allows staff to identify areas for improvement and gives the teams the power and incentive to act. These staffing models position COA to compete in a changing health care environment. Communications Since its inception, COA s Communication Department has made great progress in increasing the visibility of COA to the general public, and established professional communication standards, both internal and external to the agency. The department has been expanded and manages all communications functions including outreach, events, public relations, support for program operations and advocacy, and internal communications. Business Intelligence and Quality Improvement. COA has improved its competitive position by investing in staffing and technology that enable us to measure what we do and to act on what we learn. Our funding streams are changing and we have new funders with new requirements. The focus is shifting from measuring process to measuring results. To serve our population, we will need to earn every dollar we get. You cannot do that without being able to identify meaningful outcomes and measuring performance. COA relies on data to drive just about everything: program analysis, financial projections, performance management and quality imperatives. b. Weaknesses Financial limitations While COA s relatively small size is an advantage in adapting quickly to change, it is also a weakness. COA cannot take on the levels of financial risk that can be accepted by health plans or hospital systems. Accurate cost modeling is imperative for COA when considering a new product, service or customer but keeping administrative costs down places a significant strain on staff during times of innovation and expansion. 16 P age

17 The relatively small organizational size also presents a challenge for COA in retaining its workforce. Health plans and hospital systems are competing with us to attract and retain talented employees. These organizations have in recent years experienced increased demands for positions like care management and health coaching. It is challenging for COA to compete with the compensation and benefit packages offered by these organizations Level of engagement with COA by health care leaders Another weakness is that health care leaders do not understand how COA can help achieve their critical outcomes such as reducing readmission rates. COA needs to engage health care leaders via additional partnerships, sharing of outcomes data, and persuasive messaging so that they understand and experience COA s value. Developing partnerships with competitors is tricky business. Health care professionals lack of understanding of the home environment of patients is also a contributing factor. Patients may present in the doctor s office or at the hospital in a way that is not consistent with how they actually live at home. COA has the burden of persuading healthcare leaders that assessing and addressing the home environments of their patients will affect health outcomes and the institution s bottom line. Technology capacity COA s growing number and types of payers is placing demands on our technology capacity that are very difficult to meet in terms of cost, staff training demands, and various breakdowns and complexities. We have more systems that require data input, each in unique ways. These systems are not capable of talking to each other, thereby increasing our need to duplicate data entry and making meaningful data analysis extremely challenging. This difficulty comes at a when it is critical to our future as an organization to demonstrate accountability and performance to our payers. c. Opportunities Expansion of customer base (types and geography) Growth opportunities exist for COA in the form of new customer types and payers. COA has already added two new customer bases with the addition of the Medicare fee-for -service hospital discharge patients in the Care Transition program and the under-60 population of people with disabilities with the Ohio Home Care waiver. COA has been able to increase its geographic service area with these programs, including seeing Care Transition clients in Ohio counties outside the five county service area as well as seeing patients in Kentucky and Indiana. With the Ohio Home Care Waiver, COA is serving clients in a 21-county area in Ohio. Changes in payment models also offer COA an opportunity for growth. COA s infrastructure for providing in-home services places us in a good position to deliver products that save money by diverting and transitioning people from costly institutional settings for care. 17 P age

18 Enhancement of care management function to attract new payers A new culture supports the notion that patients are at the center of their decision-making as they grow old, and a seamless system supports both their health and their overall well-being. Integrating home care services with medical care is a growing area of opportunity for COA, particularly in the coordination and management of complex cases that cross multiple health care and social service agencies. Connecting primary care physicians to COA care managers will allow PCPs to see in the home and identify hazards that are preventing people from living independently or resulting in recurring medical costs, ER visits, and/or hospital admissions. Efforts such as the CMS Comprehensive Primary Care (CPC) Initiative need access to the home to succeed. COA is evaluating ways to work with CPC and medical home practices in the area. Partnering with local emergency service providers to leverage paramedics can extend the breadth (number of clients we can see) and depth (services we can perform) of care management. A partnership such as this can offer a win/win situation. Fire departments can deploy their paramedics to serve a wider audience and community need beyond emergencies and COA gains medical assistance that can be combined with other in-home care services to divert individuals from costly care settings. Locally, fire/ems departments have shown a strong interest in partnering with COA to provide care to COA consumers. Work is underway to lift restrictions in the Ohio Revised Code that limit our ability to fully leverage the two systems. COA recognizes that there are complex cases that need strong inter-agency collaborations and solutions. COA is committed to finding the opportunities that will allow this to happen. d. Threats Competition Threats exist for COA in the form of competition from health plans, private care management groups, and hospital systems. COA must work consistently to build its position in a complex and volatile market and demonstrate the value that we can offer. Demand outpacing funding While the region is fortunate to have local levies, the demand for the services is increasing at a rate that property tax funding cannot sustain. Two of the counties have already revised eligibility criteria and/or have waiting lists. The two other counties will need to follow suit at some point. With the increasing population of older adults with chronic health problems and disabilities work must be done to address how the region will respond to growing demands on its long-term care system. Lack of awareness and preparation by public To add to this complexity is the lack of personal preparation for long-term care needs by the general public. COA contracted with the Powers Agency to conduct research, including focus groups, and 18 P age

19 results showed that, in general, people want to remain in their homes as they age, but are in denial about their limitations/potential limitations and are not planning for the likelihood that they will need long-term care. Much national research also supports this conclusion. Furthermore, the research showed that older adults generally do not want to pay for services and/or lack understanding of what services cost. This lack of awareness and planning will put a significant burden on family caregivers as well as on the capacity of publicly-funded services and resources. 19 P age

20 PY Strategic Area Plan Service Needs & Gaps Prioritize and describe in detail the top five service needs or gaps that exist in your region (500 words or less for each service need or gap). Please be sure to include in your response: A detailed explanation of how these service gaps were identified; and The AAA methods or criteria for determining priority of services funded with Title III dollars. 1. Service Need/Gap Reduce unnecessary emergency department visits, hospital admissions, and premature nursing home placements The number one service need is identifying ways to avoid unnecessary emergency department visits, hospitalizations and premature nursing home placements. Because these events significantly affect elders ability to age in place, it is critical to address them to help improve our system of long-term care. In an Area Plan needs assessment survey conducted by COA in June 2014, nearly 100% of the respondents identified this service need as Somewhat to Very Important for our region s older adults., According to a study by Truven Health Analytics, 71% of emergency department visits are unnecessary or could have been avoided. Truven analyzed insurance claims data for more than 6.5 million ED visits in 2010 based on data in the commercial Truven Health MarketScan database. Only 29 percent of ED visits required emergency care and were not preventable, according to the study. Of the remaining 71 percent of ED visits, 42 percent required immediate attention for conditions that could have been safely treated in a primary care setting, 24 percent did not require immediate attention and 6 percent required emergency care that could have been avoided with appropriate primary care. In 2010, the average cost of an ED visit was $1,316 and the average cost of an office visit was $145, according to the study. The U.S. Centers for Medicare and Medicaid estimates that hospital readmissions among older adults cost Medicare$15 billion annually, $12 billion of which could have been prevented. Clearly, these preventable events offer opportunities for AAA initiatives. For example, consistent and coordinated interventions are needed to empower older adults and their families to better manage their chronic health conditions. These evidence-based interventions such as medication management, follow-up with primary care physician, caregiver support, and connection to community resources - help prevent the need for ED visits and hospitalizations, which are not only costly, but are a root cause of nursing home placement. 20 P age

21 In COA s vision, care management is evolving into a self-directed team structure in which team members facilitate person-centered integration of medical care, transitional care (such as medication management), and home and community-based long-term care services all with the goal of helping older adults stay in their homes for as long as possible. 2. Service Need/Gap Integrate medical care with home and community-based care in order to improve outcomes, reduce costs and build a better infrastructure for Ohio s aging population. This service gap is closely tied to the need described above and is necessary to building a regional infrastructure for Ohio s aging population. In 2013 COA hosted a Healthcare Summit (and follow-up meetings) for local leaders and stakeholders. Participants identified that our current medical and long-term care systems are not sustainable in face of the growth in the population of older adults who have a disability. Our region needs a better system of care which should include the following visions: The frail elderly and their caregiver(s) are informed, empowered, and receive care in the setting of their choice. People have access to comprehensive and integrated care management.. Individuals experience smooth transitions between care settings. Comprehensive assessments and care plans include medical and social needs and preventative care. Shared information spans the entire system of care. Processes are simplified. Planning for long-term care and end-of-life is as accepted as financial planning. Funding streams support a more efficient, reliable and cost- effective system of care for frail elders. A new culture supports the notion that patients are at the center of their decision-making as they grow old, and a seamless system supports their health and well-being. Person Centered Care Plans Funding Information Culture Planning 21 P age

22 In October 2013 through February 2014, COA worked with Kaiser Permanente to help demonstrate the value of home and community-based services to local health care leaders. A presentation emphasized the fact that medical care plays a smaller role in the daily life of an individual than their level of family support and home and community-based services (or the lack of services). Connecting primary care physicians to COA care managers would allow PCPs to see in the home and identify hazards that are preventing people from living independently or resulting in recurring medical costs, ED visits, and/or hospital admissions. Collaborating with local fire/ems departments could expand benefit the departments and the AAA by enhancing their social work capacity and our medical capacity to better serve individuals who are straining the system and putting themselves at risk. While people recognize the need for system integration, it is hard to accomplish. As primary care, health plans and inpatient coordinators jockey for position in the new environment of health care reform, we are confusing patients and duplicating service. That was the topic at Care About Your Care, an event held in October 2013 by The Greater Cincinnati Health Council and the Health Collaborative with support from the Robert Wood Johnson Foundation. The event brought together more than 150 individuals from organizations across the care spectrum, including hospitals, primary care, nursing homes and payers, in an effort to improve the coordination of care provided to patients in our community. The consensus was more work needs to be done in our community to coordinate care across multiple social service agencies and medical settings and there is significant perceived value for the PCPs in connecting to community-based care because of the ability of organizations such as Council on Aging to see and share inside the patient s home. The discussion around this critical issue continued with a second Care About Your Care event in June An element of this event included training for care managers to address advance directives and end-of-life planning with consumers and their families. AAAs have a role to play in transforming our culture s attitudes towards end of life. To improve our regional infrastructure for Ohio s aging population, we must support and promote the role of individual responsibility for managing chronic conditions and planning for decisions at end of life. As such, COA has begun work with Hospice of Cincinnati to train COA staff on advanced care planning and is a member of the Greater Cincinnati Health Council Advanced Care Planning Coalition, a group dedicated to developing a community-wide approach to advanced care planning. 22 P age

23 3. Service Need/Gap - Advocacy and the engagement of all stakeholders including local government, health care leaders, social organizations, local business and community members. Advocacy, education and engagement of our stakeholders is an ongoing need that only increases with each new program, initiative, and opportunity that arises. Unrelenting efforts from grassroots outreach to legislator education to community partnerships and collaborations are key to retaining and expanding the array of services and supports for elders and their caregivers in our region. More than 40 years have experience have shown us that the services cannot even be preserved much less expanded unless there is broad community understanding and support for their funding. At our front door this involves adequate staffing and efficient operations in order to provide good customer service and fulfill our promise to the community as the central source of unbiased information and connection to resources. It also involves developing partnerships to expand the coordination capacity of our ADRN, particularly in light of the upcoming implementation of Ohio s Balancing Incentive Program. The future of our region s levy programs all of which receive Title III funding and which together serve more than four times as many people as waiver programs depends on our management performance and our level of engagement with local elected officials, program advisory councils, tax levy review committees, referral sources, providers, and taxpayers. All of our local levies will go before the voters during the Area Plan period. In-home care options for more than 14,000 seniors and support for their caregivers depend on the success of these levies. 4. Service Need/Gap - Caregiver needs especially related to caregiver burnout due to personal and emotional adjustments, stress, illness and financial strain Family caregivers often describe their lives as being on a roller coaster ride. They rise to heights of love, selflessness and sense of purpose and then slide to depths of frustration, resentment and burnout. They find themselves in a new world for which they are unprepared. The stress is compounded when caregivers have other responsibilities, such as children and work. As part of our work with Kaiser Permanente (October 2013 to February 2014) caregiver burnout was identified as one of the top five risk factors that will impact how and where people age. Resources for services to help caregivers are not able to meet the demands of the aging population. 23 P age

24 In the needs assessment survey conducted by COA in June 2014 caregivers identified that personal/emotional adjustments, inconvenience, disturbed sleep, and stress/illness were the top difficulties they faced due to the care they provide. About 60% agreed that there are services and supports for their loved ones that would make things easier for themselves as caregivers. The most important service identified was personal care services, followed by home-delivered meals, homemaker services, and medical transportation. Caregiver issues were also identified in the research conducted by the Powers Agency in the summer of Focus groups showed that caregivers feel a tremendous sense of accountability. They admitted that they are often exhausted and would be interested in outside help. However, many caregivers were hesitant to engage services for fear if something went wrong, they would be responsible. They were also concerned that the senior may be opposed to outside support. Caregivers often don t realize that they are overwhelmed until they have already established a pattern for care that their loved one does not want to change. To prevent burnout, caregivers need to recognize the reality of their role and be educated on how best to take care of their loved one and themselves. This is easier said than done. More public education is needed about the critical role of family caregiving in the healthcare system so that support may be rallied for services that supplement family caregivers efforts. COA prioritizes services based on the greatest economic and/or social need. Community providers are funded to provide caregiver support groups and training but COA also provides a direct service to family caregivers because the need is so vast and the funding so little. Through COA s Title III-funded program, a Registered Nurse conducts a free caregiving assessment in the home. This assessment involves the caregiver, and the care recipient. Following the assessment, the nurse will make any necessary referrals for services, and provide educational materials and resources, hands-on training, and emotional support. COA s Caregiver Education and Support Program has been proven to: reduce caregiver stress, burden and injuries; increase caregiver confidence and knowledge; improve the quality of care; help caregivers balance their lives and caregiving responsibilities. Despite being a brief intervention (30-days), Care Transitions provides COA with an additional caregiver support service apart from in-home care programs. Expansion of Care Transitions to patients at additional hospitals will enable us to empower more caregivers to help their loved ones avoid a revolving door in and out of the hospital. 24 P age

25 5. Service Need/Gap - Community education/awareness regarding personal long-term care needs and potential costs (need to plan for the future). In 2013 COA hired the Powers Agency to conduct market research in our service area. Focus groups were held with seniors who had private insurance and Medicare and with caregivers. One finding was that active seniors tended to deny their own vulnerability when it comes to aging and its potentially incapacitating effects. For those with parents still living, participants saw their parents as needing help, but not themselves. Most recognized the impacts of aging and could easily spot the symptoms in others but admitted they are in denial about themselves. While most of the participants had little trouble living independently, many stated that they would be likely to go as long as possible before asking for help. Numerous national studies by insurance companies, AARP, and various research organizations also support these findings. This state of denial makes it challenging for COA to engage seniors prior to their having an immediate need. The denial also contributes to people s lack of planning for their own long-term care needs. The Powers Agency research found that while seniors agree that maintaining independence is the overall goal when it comes to their ideal long-term aging scenario, very few have taken any steps to ensure they will achieve it. Most seem to be relying on their children to take care of them but also recognize this may not be the reality. As this and other research has found, people tend to seriously underestimate the cost of long-term care, are unclear on how it may be paid for, and are unaware of their own potential for eventually needing Medicaid. As a part the needs assessment survey conducted by COA in June 2014, respondents were asked how well they understand how long term care services are paid for in Ohio. Almost 50% had very little to no knowledge. They were also asked how much planning they have done to prepare for getting older and 40% responded that they do not have a plan. For those that have done some planning the top responses were that they have prepared a will, living will, and health care power of attorney. Very few have purchased long-term care insurance or preplanned for a funeral. All of this research points to the need to educate the general public about their own long-term care needs and to help them prepare to take more personal responsibility for planning. With proper support and education, a certain segment of the public will take action. As noted above, COA is actively participating in efforts to address advanced care planning needs of our clients through training and community-wide partnerships. 25 P age

26 PY Strategic Area Plan Strategic Goals for The first two goals listed are provided by ODA. Goals shall include plans to develop a comprehensive and coordinated system of services that address OAA requirements. The first two statewide goals listed are provided by ODA and mandatory of each AAA. Your agency shall develop an additional three goals based on its priorities for this strategic plan period. For each goal, provide the top two strategies that address service needs in the region. Provide two or three objectives to support each strategy. The AAA shall list an outcome and the impact for each strategy. Also include the AAA s plan to measure overall success of each strategy. Note: Each agency has the flexibility to develop goals that meet needs specific to its region. Goal 1: Ohio s long-term care system will allow elders and their care givers access to a wide array of person-centered and well-coordinated services and supports. Strategy A Educate elected officials and the general public to ensure support and sustainability for publicly funded senior programs. Objective 1 Provide local policy makers with options regarding the eligibility of individuals enrolled in local levy programs to ensure program sustainability and to minimize waiting lists. Objective 2 Meet with citizen groups such as local advisory councils, tax levy review committees, and others with an interest in aging issues and tax funded programs to identify funding concerns for local/state services. Objective 3 Develop strategies for ensuring that the community at large understands the value and importance of local/state investment in aging services. Outcome Elected officials and community members support aging services by continued investment in local resources to allow for the provision of home and community based services. Impact Frail elders can live safely in community-based settings Measurement Elected officials will agree to place senior service levies on the ballot and communities will support local investment by passing local tax levies with a margin of 55% or greater. Strategy B Educate individuals and the community about the importance of planning for retirement and future long term care needs. 26 P age

27 Objective 1 Annually, COA will hold a three-part Own Your Future workshop designed to educate Boomers and other older adults on planning for the long-term care needs of their aging parents and themselves. This workshop will cover legal, financial, long-term care and community resource topics and will include a comprehensive binder of information, forms and planning tools for participants. Objective 2 As part of general grassroots outreach on community resources for long-term care, COA will include information about paying for long-term care to raise awareness that personal resources are required. Objective 3 COA will speak with employee groups, such as City of Cincinnati pre-retirees, about caring for aging parents and planning for personal long-term care needs. Presentations and/or event participation will include legal, financial and community resource information. Objective 4 COA will participate in the Greater Cincinnati Health Council Advanced Care Planning Coalition to drive community-wide improvements in advanced care planning. Outcome Individuals will recognize that they need to plan and invest in their own future long term care needs. For participants in the Advanced Care Planning Coalition, three outcomes have been established: (1) Increase the percentage of patients with an advance care plan; (2) Ensure portability and communication of that plan between care settings; and (3) Honor the plan content when developing the clinical order set. Impact By learning how to plan,, prepare advance directives, manage savings, and familiarize themselves with local long-term care resources, individuals will take more personal responsibility for their needs as they age and reduce their reliance on publicly-funded services for their long term care. Measurement Participate in 100 community group educational meetings and events over 3 years and include information on how long term care services are funded. 27 P age

28 PY Strategic Area Plan Strategic Goals & Objectives Goal 2: AAAs will prepare and build a responsive regional infrastructure for Ohio s aging population. Strategy A Develop relationships with community Fire/EMS departments to identify opportunities for collaboration/partnership. Objective 1 Develop and promote online training presentation for use by Fire/EMS departments educating first responders on aging services available in the community. Objective 2 Develop pilot for a care conference enabling Hamilton County Fire/EMS agencies to bring difficult cases involving seniors to a multi-agency team for development of a person and community-centered plan. Objective 3 Work with community leaders on Community Paramedicine curriculum to identify opportunities for education regarding aging services and to explore opportunities for utilization of EMS personnel in aging care planning models. Outcome Community Fire/EMS departments will be trained on available senior resources and programs and opportunities will exist for Fire/EMS to work with aging services partners to develop community solutions to complex cases. Impact Fire/EMS departments will be able to easily refer individuals to appropriate aging services and local communities will have a vehicle to address issues with aging residents that have multi-system needs (i.e. behavioral health, health department, adult protective services) Measurement Training presentation will be supplied to 50+ Fire/EMS departments. Fire/EMS departments participating in care conference pilot will report satisfactory results in developing an action plan for dealing with complex clients requiring multiple systems. Strategy B COA will utilize quality management, procurement, and contracting processes that will yield the highest quality of services being delivered to elders, at the lowest cost possible, to serve as many as possible with the resources available. 28 P age

29 PY Strategic Area Plan Strategic Goals & Objectives Objective 1 COA will implement a direct award process that provides clients of its levy service program with quality data for COA-contracted providers. With this Client Choice Table, seniors enrolled in the levy programs have the information they need to make informed choices for their home care and home-delivered meals providers based on providers client satisfaction ratings. Objective 2 COA will establish and update performance benchmarks for selected provider services (meals, home care assistance). Objective 3 COA will monitor provider performance against benchmarks utilizing quality action plans and contract sanctions, where required, to improve quality. Outcome Services will be delivered by the highest quality providers at the lowest cost possible. Impact Elders get the highest quality of care and local resources can serve more clients due to the cost effectiveness of services. Measurement By mid 2015, 100% of clients enrolled in the Hamilton County Elderly Services Program will be presented with quality data to help them select their providers for home care and meals. Goal 3: COA will integrate long term care with health care to improve the health outcomes of our community s elders while simultaneously reducing overall health care costs. Strategy A Educate local health care leaders about the opportunity to improve health outcomes for our elders by collaborating and integrating community-based services with health care services. Objective 1 Increase the number of hospitals where COA performs care transition services. Objective 2 Advocate for elders to be included in community planning efforts led by local health care leaders. Objective 3 Advocate locally and nationally about the need to integrate community-based services with health care to improve health outcomes for elders. 29 P age

30 PY Strategic Area Plan Strategic Goals & Objectives Outcome More health care leaders and practitioners consider patients psycho/social needs as a significant factor in their health care outcomes and seek collaborations with COA to develop and act on holistic, person-centered plans of care. Impact Hospitals will experience a decrease in readmission rates. Measurement COA will expand to 9 hospitals (from 5) with targeted transition volume of more than 6,000 annually. Hospital readmissions decrease by 20% or more. Strategy B Evaluate internal delivery systems to identify opportunities for health care integration and improved health outcomes for our elders. Objective 1 Implement a care management team structure that includes a medical focus, advanced care planning, and evidence-based clinical practices. Objective 2 Evaluate options for a new care management system (technology) which will include a portal wherein health care partners can access community-based data. Objective 3 Evaluate ways to coordinate with primary care practices especially with Comprehensive Primary Care Initiative sites and Patient-Centered Medical Home practices. Outcome Health care and community based organizations will work together to address the medical and community needs of our elders in a way that improves health outcomes. Impact Elders have better health outcomes by having an integrated system and costs savings accrue to public funders. Measurement COA develops up to eleven integrated care management teams. Teams have ready access to medical expertise. 30 P age

31 PY Strategic Area Plan Strategic Goals & Objectives Goal 4: COA will build a strong organizational culture. Strategy A Ensure preparedness of workforce through leadership and talent management. Objective 1 Managers receive leadership training and development. Objective 2 Employ self-directed teams to conduct interviews and evaluate each other s performance. Outcome COA has increased management capacity to meet the needs of our clients and employees. Impact COA has strong leadership and employees to meet our strategic outcomes. Measurement 90% of new managers document understanding and application of training. 80% of our self-directed teams report increased ability to interview and evaluate future and current employees. Strategy B Evaluate compensation and benefits structure to ensure competiveness. Objective 1 Research a pension provider that aligns with the strategic direction and flexibility needed to attract and retain staffing. Objective 2 Research and retain a healthcare provider that is flexible towards the needs of an older workforce at a reduced cost to the organization. Outcome Implementation with a pension provider to attract and retain employees and a healthcare provider that provides flexibility to an older workforce. Impact Retention of current employees and attraction of new employees increases. 31 P age

32 PY Strategic Area Plan Strategic Goals & Objectives Measurement Turnover rate of less than 15% Time-to-fill rate of less than 30 days Goal 5: Deploy technology to increase efficiencies and reduce costs and improve the health and quality of life for consumers. Strategy A Partner with one Emergency Response/Electronic Monitoring System provider, to offer services to consumers. Objective 1 Select one provider, through an RFP process, and sign a contract. Objective 2 Transition more than 3,600 consumers to the new provider. Objective 3 Work with the provider to identify continuous improvement in their product and service offerings over their multi-year COA contract. Outcome Consumers will receive state-of-the-art EMS technology from one provider. Impact Consumers and their families experience excellent emergency monitoring service at a reduced cost to local taxpayers, resulting in program ability to serve more people without an increase in funding. Measurement Cost savings are documented at more than 35% versus pricing under the prior contract and client satisfaction surveys show strong results. Strategy B Implement three technology initiatives to reduce cost and increase efficiencies. Objective 1 Replace current care management/client services software to enhance functionality and service to clients. Objective 2 32 P age

33 Replace care management travel planning software with a more effective solution for planning travel routes for community-based staff members and contractors Objective 3 Implement a web-based technology solution for managing RFPs to eliminate the manual process of distributing RFPs, and to enhance the quality and efficiency of the data analysis and overall bid evaluation effort. Outcome New care management software will enhance functionality and service to clients. Care management travel planning software will increase the timeliness and reduce the cost of travel related to community service. Streamlining the RFP process will reduce staff time, increase efficiency and accuracy, and reduce the cost and time devoted to the RFP process. Impact COA will reduce costs and streamline processes to better enhance the quality of its clients lives and to increase the return on its funders investment in serving the elderly and disabled. Measurement COA costs will be reduced or contained while receiving higher customer service scores with new care management software. There will be tangible reductions in staff time spent in cars and COA s community-based travel expense. RFP process will ensure that we consistently identify providers with the highest quality and lowest cost to better serve clients while reducing the on-going financial outlays of funders. 33 P age

34 Operational and Budget Narrative Each AAA must complete the below budget narrative for the PY 2015 Area Plan. Text boxes are provided where applicable for ease of sharing detailed responses. The AAA shall ensure that all responses to the below information are in the text box and in a font clearly distinguishable from the ODA statement. 1. General. Identify and discuss major environmental and/or programmatic changes, which impact historic funding patterns and service delivery within your region. The recession and housing crisis has impacted local revenue from the senior service levies. Revenue is down in every county and has resulted in eligibility changes in Hamilton County and a waiting list in Clinton and Hamilton Counties. The demand for services continues to grow while local funding has declined. These pressures will require changes in how services are delivered in the coming years. We are continuing to utilize competitive bidding to streamline service delivery and driving prices down while increasing the quality of care. In Hamilton County, we are utilizing a triaging policy to ensure seniors most in need receive services first. The expansion of managed care and Ohio s ICDS plan has had and will continue to have a significant impact on funding patterns and service delivery in our region. We anticipate 85% of the PASSPORT and Assisted Living consumers will be enrolled into one of the two health plans. Approximately 20% of our levy population is also dual eligible and will be part of the community well pool. Services will be more complex as we anticipate different provider panels emerging with the two health plans and ESP (local levy) programs which may make service continuity challenging as consumers move between programs The decrease in local revenue has led to waiting lists for the Elderly Services Programs in two counties in our region: Clinton and Hamilton Counties. The waiting lists delay when services can be started for eligible seniors. Clinton County does not have a triaging policy in place. The current policy is no waiting list for eligible people who need meals. All other services are on the waiting list on a first come, first served basis. COA is working to identify opportunities to reduce costs and decrease the waiting. Hamilton County has been using a triaging policy from the beginning of the latest waiting list. Enrollments are based on what the program can afford and the following triaging criteria: 1. All prospective ESP clients that do not meet Institutional Level of Care (ILOC) will be placed on a waiting list based on the date they contacted COA to request services. 2. Individuals meeting ILOC, but do not meet the financial eligibility requirements for services through a Medicaid Waiver program will be placed in the front of the waiting list for all services available through the Elderly Services Program. They will be scheduled for an in-home assessment to verify they meet ILOC. 3. Individuals who are being discharged from the hospital and are determined to be at risk for rehospitalization or nursing facility placement will be immediately enrolled and eligible for all services. 4. Individuals who are leaving or are at imminent risk of placement in a nursing facility will be immediately enrolled and eligible for all services. 5. Consumers requesting and eligible for emergency home delivered meals, emergency dialysis, chemo, or radiation transportation, or services that are funded through a grant or alternate funding source (ex. Minor Home Repair) will be placed in the front of the waiting list for all services available through the Elderly Services Program. The waiting list impacts all services provided through the Elderly Services Program. A few of those services are partially funded by Title III and/or State funds including home-delivered meals, respite, and adult day services. 2. Impact of Funding Levels. Please discuss how anticipated/projected cuts in Title III and local funding levels will impact services to seniors, AAA staffing, the AAA s ability to meet Older 34 P age

35 Americans Act (OAA) requirements, and still continue current programming (i.e., priority services, non-federal match). Older Americans Act funding has become a very small part of the funding for senior services at the local level. The revenue continues to shrink as the needs and inflation diminishing its impact. Requirements that come with the funding have been increasing the burden of administering this funding especially as we try to make it work with local senior service levies that are governed by the local Board of County Commissioners. The trend in our area has been to decrease the number of services that are funded through the OAA, and the number of providers who are receiving funding. In home services are a priority in our area, but is now funded almost exclusively by the senior service levies. OAA continues to be a significant part of funding for our senior centers. Senior Centers need to be evaluated so good decisions can be made about how to fund these services in the future. Our plan for the coming year includes an evaluation of the senior center service delivery system in our region. 3. Appendix 1-Request to Transfer Funds. This appendix must be submitted initially with the Strategic Plan and subsequent dates of April 25, June 25 and July 30, If a transfer is not applicable, indicate 0 and submit the form; no exceptions. Transfers must not exceed percentage maximums allowed by the OAA: a. Not more than 30 percent for any fiscal year between programs under part B (Supportive Services and Senior Centers) and part C (Nutrition Service); b. Not more than 40 percent of the funds received between subpart 1 (Congregate Nutrition Services) and subpart 2 (Home-Delivered Nutrition Services) of part C (Nutrition Service); and c. Identify FY 2014 Title III Carryover, including all ODA approved waivers of Policy 401, Procedure B. 4. Exhibit D-1a Title III Transfers and Base Funding Levels (refer to Budget Pages document). This exhibit shall be updated and included with each Appendix 1 transfer request no exceptions. In the box below discuss how transfers are different than FY 2014: The total amount of Title IIIB being transferred is the same and 2014 but in 2015 more will come from C1 than in 2014 due to the low attendance at congregate meal centers. 5. Exhibit D-1b: Summary of Service Allocations (refer to Budget Pages document) a. Care Coordination Program Costs. Discuss any variances between 2014 and 2015 costs for the CCP program (e.g., number of staff, increase/decrease in service funds pool, expansion or additional services, etc.) and impact on service delivery. No changes 35 P age

36 b. Housing. Discuss any differences between 2014 and 2015 budgets and any changes in scope. We did not receive the Ohio Department of Development Housing Assistance grant for , a reduction of $250,000 per year. c. Access, In-Home, Legal, Disease Prevention & Health Promotion, Other Community Services, Ombudsman, Nutrition Congregate, Nutrition Home-Delivered Services Categories. For each, discuss any allocation differences between FY 2014 and FY 2015 for Title III funds, Alzheimer s Respite and SCS dollars for each service category. Include the reasons for increases or decreases. No allocation differences. 6. Title III-D Fund Allocations. As discussed March 13, 2012 at the ODA/O4A meeting, AoA changed the requirements for allowable uses of OAA Title III-D funding. The requirements were effective February 16, The FY 2012 Title III and Title VII Award Notice forwarded on March 6, 2012 included the federal language Effective with this action for Title III-D section 361 of the OAA for Disease Prevention and Health Promotion may only be used for programs and activities which have been demonstrated through rigorous evaluation to be evidence-based and effective. The definition for evidence-based and FAQ s can be found at AoA s website: Given the above, respond to the following: a. Identify the evidence-based interventions your AAA currently supports with Title III-D funds; be specific as you provide details. Healthy-U- We provide the Site Coordinator position, conduct leader trainings, monitor fidelity, and lead workshops in the community for both Chronic Disease Self Management and Diabetes Self Management. HomeMeds The care coordination teams use the HomeMeds System to complete the risk assessment screening related to the consumers medication lists and events, such as falls, dizziness, confusion and blood pressure, to identify potential medication problems. Medical care coordinators then work with a consultant pharmacist to (1) verify the accuracy and appropriateness of the consumer s current medication list, (2) identify problems that warrant re-evaluation by the physician, and (3) follow through with the client and physician to resolve identified problems. The goal is to give care coordinators a mechanism for identifying and addressing medication-related problems and errors that endanger the lives and well-being of a high percentage of community-dwelling older adults. b. Does your AAA plan to use PY 2015 Title III-D funds contractually or in house to support evidence-based interventions? 36 P age

37 Only $14,203 will be used to fund AAA staff. The remaining $63,369 will be used to fund program partners, contractors and supplies. 7. Funding of Priority Service Categories (Access, In-Home, Legal). Check all that apply: Current Title III-B percentages will be maintained Current Title III-B percentages will change Please explain any significant changes compared to previous years: No significant changes 8. Application for Waiver Request. Each request to directly deliver services and activities shall occur via Appendix 2. Requests for PY 2015 only must be completed and included with this strategic plan submission. Refer to Policy for more details. Note: all current waivers expire December 31, See Appendix 2 9. Direct Services by AAA. Please list all services the AAA plans to provide directly in PY 2015; indicate source of funds. The budget page Exhibit D-2b (refer to Budget Pages document) must be completed for each service that is provided directly by the AAA. 1. Evidence-based Health Promotion- Health Education/Medication Screening Title IIID 2. FCSP Counseling Title IIIE 3. Nutrition Consultation - TitleIIIC1 and C2 4. Information and Assistance Title IIIB and E Note: The AAA does not have to request a waiver to directly provide case management or I&A/R, but must include a completed budget page Exhibit D-2b. 10. Title III Funding Formula. The AAA shall submit a copy of its current Title III funding formula, including a list of data (e.g., 2010 U.S. Census) used to populate the funding formula factors. In the box below, indicate if the formula has changed since 2014 and attach an updated formula. No changes 11. Program Income. Please describe AAA plans to expend the line 17 Program Income balance (for each funding source) if it exceeds the Program Income monthly average listed on line 16 of Exhibit D1-a. Not applicable 37 P age

38 2015 Strategic Area Plan Appendices 38 P age

39 AAA: 1 Strategic Plan Period: Operational Plan Year: 2015 Date Submitted: 8/1/2014 Original Submission: or Revision # Appendix 1: Request to Transfer Funds Instructions Transfers are reviewed based on ODA Policy , Title III Transfers of Funds. Complete a separate Appendix 1 for each transfer activity from: Titles III-B to C1, C1 to B, B to C2, C2 to B, C1 to C2, and C2 to C1. Transfers are not permitted from Title III-C2 if home-delivered meals are funded with ODA s SCS funds. A detailed rationale must accompany each transfer request. A mere statement such as to provide home-delivered meals is not acceptable. Any statement must be supported by information (statistics, figures, etc.) that documents the reason for the transfer. All rationale shall be included on the current Excel spreadsheet Appendix 1-FY 2015 Request to Transfer Funds. If more space is needed to explain transfers, please make additional copies of the worksheet and continue the summary. The worksheet design allows the AAA to include initial as well as all subsequent transfer request data on the same spreadsheet. The worksheet is included with the Budget (D Series) Exhibits. The initial transfer request is due with this Strategic Area Plan. Other anticipated transfer request due dates are as follows: 1. Line 3, First revised transfer request April 30, Line 4, Second revised transfer request June 30, Line 5, Final transfer request July 30, 2015 NOTE: A completed copy of the above mentioned Excel worksheet must be included with Exhibit D- 1a for each transfer request. 39 P age

40 AAA: 1 Strategic Plan Period: Operational Plan Year: 2015 Date Submitted: 8/1/20014 Original Submission: or Revision # Appendix 2: Application for Waiver Request Request is via Annual Area Plan or Emergency Request The Older Americans Act prohibits the Ohio Department of Aging (ODA) from allowing an AAA to provide services directly unless the direct provision of those services are: (1) required in order to ensure an adequate supply of the service; (2) the service is directly related to an AAA administrative function of the AAA; or, (3) the AAA can provide the service more efficiently and effectively than other providers. Note: Responses must be detailed, include current information, and clearly support the waiver request. Incomplete responses will not be accepted by ODA for current review or approval. Please refer to Policy Waiver Request by AAAs for details and additional requirements. Instructions: An Area Plan Appendix 2 and a budget page Exhibit D-2b must be submitted for each service for which a waiver is requested. The waiver request shall address each item listed below: 1. Identify the service category and define the service for which the waiver is being sought per ODA service taxonomy in the Ohio Reporting Requirements. Identify the AAA s preferred internal program name and definition of the service or function. ODA service: Nutrition Consultation (1 Hour) Provision of individualized advice and guidance to individuals, who are at nutritional risk, because of their health or nutritional history, dietary intake, medication use or chronic illnesses, about options and methods for improving their nutritional status, performed by a health professional in accordance with state law and policy. AAA service: Nutrition Consultation (1 Hour) A registered dietician provides individualized advice and guidance in an effort to improve the individual s nutritional status. The service is offered to congregate meal site participants, PASSPORT and Elderly Services Program consumers. 2. Identify the projected dollar amount $_51,200 and the applicable funding source for the service to be provided using Titles III B C1 C2 D E or SCS. 3. Identify the geographic area(s) in which the service will be provided. Butler, Clinton, Clermont, Hamilton and Warren Counties 4. Did your AAA provide this service in the previous year? Yes No a. If no, identify the provider that delivered the service. 40 P age

41 b. If yes, summarize your efforts to develop this service with a provider(s) other than the AAA. Given that the AAA is required to staff a licensed dietician, as defined in ORC Chapter 4759, to coordinate and/or administer nutrition services in the PSA we naturally have the capacity to efficiently offer this service across the area. Our Title III meal contracts do not require sites to have a dietician nutrition educator because we recognize with limited funds available it would not be feasible for each congregate site to be able to offer the services of a dietician to Title III clients. We have worked with OSU extension but they do not have the capacity to meet the Title III requirements adequately across our service area. 5. Was a RFP process used to solicit potential providers of this service? Yes No a. If no, clearly explain and support why the RFP process was not used to solicit potential providers. Our experience shows that the majority of the congregate centers in our region do not have a registered dietician on staff to provide nutrition education. Centralizing a dietician educator for the five county area is the most effective use of resources. We have not identified a provider with the capacity to provide the service adequately across the region. b. If yes, provide a copy of the RFP indicating the date, geographic area(s) where the RFP was distributed and why those areas were chosen; number of providers that expressed interest, and the names of those that submitted a RFP. Note: If this is an emergency waiver request, proceed to statement No.10 after completion of the above information. 6. Why is it necessary for the AAA to provide this service? Check all that apply: To ensure adequate supply. Service is directly related to AAA administrative function. AAA can provide service more efficiently and effectively. Note: Please explain your response in detail and include supporting data and analysis. Use additional pages if necessary. Most congregate centers do not have a registered dietician on staff to provide nutrition consultation. Centralizing a dietician educator for the five county area is the most effective use of resources. This also gives us the capacity to offer individual nutrition consultation to home-bound seniors in our PASSPORT and ESP programs across the area. 7. Was a public hearing held as part of the area plan process and/or a similar public hearing on a related topic held within the last 12 months? Yes No 41 P age

42 a. If no, submit documentation (appropriately labeled) demonstrating how the AAA engaged the provider network to identify the capacity for this service. b. If yes, please provide: Date of last public hearing: July 24, 2014 Name and number of individuals/organizations invited/targeted Name and number of providers in attendance 8. Explain how the AAA will develop/strengthen the capacity for this service in the community within the next six months. At a minimum, submit a detailed plan of action that includes timelines. Older Americans Act funding has become a very small part of the funding for senior services at the local level. The revenue continues to shrink as the increased need in the community and inflation continue to diminish its impact. Requirements that come with the funding have been increasing the burden of administering this funding. Our experience shows that the majority of the congregate centers in our region do not have a registered dietician on staff to provide nutrition. Centralizing a dietician educator for the five county area is the most effective use of resources. Requiring congregate centers to take on this burden is not appropriate and we have been unable to identify a provider with the capacity to provide the service across the region. For these reasons we do not intend to expend resources developing the capacity for this service in the community in the next six months. 9. Complete and include with this document the budget page Exhibit D-2b, for the proposed service to be delivered by the AAA in the next program year. See budget exhibit D-2b Note: If this waiver request is for a direct provision of service, proceed to statement No The AAA has included a copy of the correspondence from the current provider indicating its intentions to cease providing the service. Yes No The AAA has included a copy of its decision to terminate its agreement with the provider. Yes No If correspondence is not included or this is not applicable, the AAA must provide a detailed summary with the following information: a. Explanation to ODA indicating why such a document is not available; and b. Explanation of why the service will no longer be offered by the current provider. 42 P age

43 Note: In the event this request is being submitted because the AAA terminated its agreement with the provider, the requirements in No.10 are still applicable. 11. Specify the timeframe for which this waiver is being requested. Your request may not exceed 12 months. 10/1/2014 to 9/30/2015 Signature of AAA Director Date 43 P age

44 AAA: 1 Strategic Plan Period: Operational Plan Year: 2015 Date Submitted: 8/1/2014 Original Submission: or Revision # Appendix 2: Application for Waiver Request Request is via Annual Area Plan or Emergency Request The Older Americans Act prohibits the Ohio Department of Aging (ODA) from allowing an AAA to provide services directly unless the direct provision of those services are: (1) required in order to ensure an adequate supply of the service; (2) the service is directly related to an AAA administrative function of the AAA; or, (3) the AAA can provide the service more efficiently and effectively than other providers. Note: Responses must be detailed, include current information, and clearly support the waiver request. Incomplete responses will not be accepted by ODA for current review or approval. Please refer to Policy Waiver Request by AAAs for details and additional requirements. Instructions: An Area Plan Appendix 2 and a budget page Exhibit D-2b must be submitted for each service for which a waiver is requested. The waiver request shall address each item listed below: 1. Identify the service category and define the service for which the waiver is being sought per ODA service taxonomy in the Ohio Reporting Requirements. Identify the AAA s preferred internal program name and definition of the service or function. ODA Service: FCSP Counseling 1 Hour Individual counseling to caregivers to assist the caregivers in making decisions and solving problems relating to their caregiving roles. AAA Service: FCSP Counseling 1 Hour - A Registered Nurse visits the home to conduct a caregiving assessment and make any necessary referrals for services, provide educational materials and resources, hands-on training, and emotional support. 2. Identify the projected dollar amount $_44,385 and the applicable funding source for the service to be provided using Titles III B C1 C2 D E or SCS. 3. Identify the geographic area(s) in which the service will be provided. Butler, Clinton, Clermont, Hamilton and Warren Counties 4. Did your AAA provide this service in the previous year? Yes No a. If no, identify the provider that delivered the service. 44 P age

45 b. If yes, summarize your efforts to develop this service with a provider(s) other than the AAA. There are two Title III providers who are also contracted to provide this service but COA is the only one with the capacity for a registered nurse to provide the service in the home. The two providers offer the service at their facilities or via the phone. The COA RN, can respond to caregiver referrals from care managers and the community on an ongoing basis and provide caregiver counseling in the home. The two other providers provide needed information for caregivers but operate in pockets of our service area. The COA Caregiver RN can respond to referrals throughout our five county region. 5. Was a RFP process used to solicit potential providers of this service? Yes No a. If no, clearly explain and support why the RFP process was not used to solicit potential providers. b. If yes, provide a copy of the RFP indicating the date, geographic area(s) where the RFP was distributed and why those areas were chosen; number of providers that expressed interest, and the names of those that submitted a RFP. The RFP was published on July 2, 2012 and distributed in our entire service area: Butler, Clinton, Clermont, Hamilton and Warren Counties. Three providers expressed interest in Caregiver Services and Jewish Family Service and Senior Independence submitted RFPs for FCSP Counseling. Both were awarded contracts for their service areas. As of May 31, 2014 both agencies are projected to only expand fractions of their contracts. Note: If this is an emergency waiver request, proceed to statement No.10 after completion of the above information. 6. Why is it necessary for the AAA to provide this service? Check all that apply: To ensure adequate supply. Service is directly related to AAA administrative function. AAA can provide service more efficiently and effectively. Note: Please explain your response in detail and include supporting data and analysis. Use additional pages if necessary. Caregiver Counseling is provided by two of our Title III providers but neither provides the service in the home and both have a limited coverage area. The COA Caregiver RN can respond to referrals throughout our five county region. As of May 31, 2014 both agencies are projected to only expand fractions of their contracts. For this reason it is essential that COA provide the service to ensure adequate supply of this much needed resource. 45 P age

46 7. Was a public hearing held as part of the area plan process and/or a similar public hearing on a related topic held within the last 12 months? Yes No c. If no, submit documentation (appropriately labeled) demonstrating how the AAA engaged the provider network to identify the capacity for this service. d. If yes, please provide: Date of last public hearing: July 24, 2014 Name and number of individuals/organizations invited/targeted Name and number of providers in attendance 8. Explain how the AAA will develop/strengthen the capacity for this service in the community within the next six months. At a minimum, submit a detailed plan of action that includes timelines. COA used a RFP process to solicit providers. None was able to provide an adequate supply across the region. COA has the capacity to fill the gap for this much needed service. 9. Complete and include with this document the budget page Exhibit D-2b, for the proposed service to be delivered by the AAA in the next program year. See budget exhibit Note: If this waiver request is for a direct provision of service, proceed to statement No The AAA has included a copy of the correspondence from the current provider indicating its intentions to cease providing the service. Yes No The AAA has included a copy of its decision to terminate its agreement with the provider. Yes No If correspondence is not included or this is not applicable, the AAA must provide a detailed summary with the following information: a. Explanation to ODA indicating why such a document is not available; and b. Explanation of why the service will no longer be offered by the current provider. Note: In the event this request is being submitted because the AAA terminated its agreement with the provider, the requirements in No.10 are still applicable. 46 P age

47 11. Specify the timeframe for which this waiver is being requested. Your request may not exceed 12 months. 10/1/2014 9/30/2015 Signature of AAA Director Date 47 P age

48 AAA: 1 Strategic Plan Period: Operational Plan Year: 2015 Date Submitted: 8/1/2014 Original Submission: or Revision # Appendix 2: Application for Waiver Request Request is via Annual Area Plan or Emergency Request The Older Americans Act prohibits the Ohio Department of Aging (ODA) from allowing an AAA to provide services directly unless the direct provision of those services are: (1) required in order to ensure an adequate supply of the service; (2) the service is directly related to an AAA administrative function of the AAA; or, (3) the AAA can provide the service more efficiently and effectively than other providers. Note: Responses must be detailed, include current information, and clearly support the waiver request. Incomplete responses will not be accepted by ODA for current review or approval. Please refer to Policy Waiver Request by AAAs for details and additional requirements. Instructions: An Area Plan Appendix 2 and a budget page Exhibit D-2b must be submitted for each service for which a waiver is requested. The waiver request shall address each item listed below: 1. Identify the service category and define the service for which the waiver is being sought per ODA service taxonomy in the Ohio Reporting Requirements. Identify the AAA s preferred internal program name and definition of the service or function. ODA Service Category: Title IIID Evidence-based Disease Prevention and Health Promotion ODA Service: Medication Screening- 1 individual assessment ODA Service: Health Education 1 Hour AAA Service Category: Evidence-Based Disease Prevention and Health Promotion AAA Service: HomeMeds 1 HomeMeds assessment completed and entered in the HomeMeds online software system - The system addresses medication problems among frail older adults using criteria developed by an expert panel to address four problem types: o Unnecessary therapeutic duplication (e.g., generic and brand name of same drug) o Falls, dizziness, or confusion possibly caused by inappropriate psychotropic drugs (e.g., tranquilizers, antidepressants, sleep aids, diphenhydramine) o Cardiovascular medication problems related to high blood pressure, dizziness, low blood pressure or low pulse. o Inappropriate use of non-steroidal anti-inflammatory drug (NSAIDs) in those with risk factors for peptic ulcer or gastrointestinal bleeding. Agency staff members then work with a consultant pharmacist to (1) verify the accuracy and appropriateness of the client s current medication list, (2) identify problems that warrant re-evaluation by 48 P age

49 the physician, and (3) follow through with the client and physician to resolve identified problems. To enable spread to other agencies serving older adults at home, the HomeMeds intervention has been adapted to enable social workers and other non-medical personnel to implement the system. AAA Service: Health Education-Healthy U 1 completer (participant that attends 4 or 6 workshops) 2. Identify the projected dollar amount $_77,572_ and the applicable funding source for the service to be provided using Titles III B C1 C2 D E or SCS. 3. Identify the geographic area(s) in which the service will be provided. Butler, Clinton, Clermont, Hamilton and Warren Counties 4. Did your AAA provide this service in the previous year? Yes No a. If no, identify the provider that delivered the service. b. If yes, summarize your efforts to develop this service with a provider(s) other than the AAA. Given AoA s requirement that Title IIID funds only be used to fund high level evidence-based programs, it is difficult to ensure the limited dollars can be spread across five counties in a way that would provide an impact and the programs monitored appropriately. Furthermore, although COA is requesting a direct service waiver, the majority of the funds will be used to contract with the Cincinnati VA and AmeriCorps, an independent contractor, a pharmacist and centers that host Healthy U workshops. COA has partnered with the Cincinnati VA and they were selected as a host site for AmeriCorps. The VA has their own license for Healthy U and a Master Trainer but they need assistance to provide for the second Master Trainer as well to help them access community settings to offer Healthy U. The AmeriCorps members will work with COA and COA s independent contractor to coordinate the Healthy U program in the community for veterans and their families. COA and the VA will continue to partner Master Trainers to provide leader trainings two times per year. This partnership will ensure the sustainability of the leader base for the region. HomeMeds has been identified by AoA as high tier program and the AAA is the ideal organization to provide this evidence-based program as it was developed and tested with a Medicaid Waiver case management population. The program is effective because of the ongoing relationship between the care management team and client. The medical care coordinator maintains the information flow from pharmacist to client and provides coaching for the client/caregiver to be more involved and aware of their medications. The medical care coordinator also coaches the client on how to engage with their doctor regarding their medications. 5. Was a RFP process used to solicit potential providers of this service? Yes No a. If no, clearly explain and support why the RFP process was not used to solicit potential providers. 49 P age

50 Evidence-based programs require more coordination and oversight to ensure that fidelity to a model is observed. Coordinating evidence based services from the AAA allows for them to be accessed by older adults across the service area. We have pockets of areas where providers are delivering evidence-based disease prevention programs but none that covers our entire service area adequately. b. If yes, provide a copy of the RFP indicating the date, geographic area(s) where the RFP was distributed and why those areas were chosen; number of providers that expressed interest, and the names of those that submitted a RFP. Note: If this is an emergency waiver request, proceed to statement No.10 after completion of the above information. 6. Why is it necessary for the AAA to provide this service? Check all that apply: To ensure adequate supply. Service is directly related to AAA administrative function. AAA can provide service more efficiently and effectively. Note: Please explain your response in detail and include supporting data and analysis. Use additional pages if necessary. Older Americans Act funding has become a very small part of the funding for senior services at the local level. The revenue continues to shrink as the increased need in the community and inflation continue to diminish its impact. Requirements that come with the funding have been increasing the burden of administering this funding. Evidence-based programs require more coordination and oversight to ensure that fidelity to a model is observed. Coordinating these services from the AAA allows for it to be accessed by older adults across the service area. We have pockets of areas where providers are delivering evidence-based disease prevention programs but none that covers our entire service area adequately. ODA s requirement that the AAA provide a Site Coordinator for evidence-based health promotion program gives us the capacity to provide the services most effectively across our five county area. The VA administers the same program and chose to adopt the name Healthy U so that they can coordinate with our efforts. They recognize the need to have multiple organizations with expansive reach working together. The Cincinnati Health Department has also reached out to us to partner with them for a Master Trainer. HomeMeds is an evidence-based, technology-enabled intervention that addresses medication safety among older adults by connecting homecare and other community-based services to health care providers. Simply making better use of the information already being gathered in the home helps unmask potential medication problems so they can be resolved. HomeMeds addresses major gaps in care that leave home-dwelling older adults at risk for adverse medication effects, providing unique information not typically available to prescribers, such as adverse effects, patients' use of over-thecounter medications, duplications resulting from multiple prescribers or hospital stays, and adherence problems. Physicians are more likely to change prescribing behaviors when given this information 50 P age

51 together with recommendations from a consultant pharmacist. Using existing effort and a non-medical workforce, a technology core, and sources of funding outside of Medicare and Medicaid, HomeMeds is affordable and saves healthcare dollars by preventing serious adverse drug events that cause ED use, hospitalization and institutionalization. Medication-related problems and errors endanger the lives and well-being of a high percentage of community-dwelling elders, leaving them with poorly controlled cardiac symptoms, or at risk for falls, dizziness, confusion, or other side effects. Data show that almost 50% of nursing-home eligible Medicaid waiver clients have potential medication problems, such as taking generic and brand name versions of the same drug. HomeMeds is designed to enable community agencies to address this important safety and quality of life issue. Care managers use software and a pharmacist consultant to screen their clients medications for potentially harmful problems and bring these problems to the attention of their physicians. 7. Was a public hearing held as part of the area plan process and/or a similar public hearing on a related topic held within the last 12 months? Yes No e. If no, submit documentation (appropriately labeled) demonstrating how the AAA engaged the provider network to identify the capacity for this service. f. If yes, please provide: Date of last public hearing: July 24, 2014 Name and number of individuals/organizations invited/targeted Name and number of providers in attendance 8. Explain how the AAA will develop/strengthen the capacity for this service in the community within the next six months. At a minimum, submit a detailed plan of action that includes timelines. In October 2014 the work with AmeriCorps will begin. The VA and COA will partner to train the leaders and coordination of workshop efforts will continue. COA will provide $29,000 for stipends for the AmeriCorps members. This will be paid to Partners in Care Foundation who oversee the AmeriCorps program nationally. COA will continue to work with senior centers, YMCA s, community centers, senior housing facilities etc to spread the reach and availability of the Healthy U program. Given that HomeMeds was developed for Medicaid waiver programs we will not be developing another provider for this service. 9. Complete and include with this document the budget page Exhibit D-2b, for the proposed service to be delivered by the AAA in the next program year. 51 P age

52 Note: If this waiver request is for a direct provision of service, proceed to statement No The AAA has included a copy of the correspondence from the current provider indicating its intentions to cease providing the service. Yes No The AAA has included a copy of its decision to terminate its agreement with the provider. Yes No If correspondence is not included or this is not applicable, the AAA must provide a detailed summary with the following information: a. Explanation to ODA indicating why such a document is not available; and b. Explanation of why the service will no longer be offered by the current provider. Note: In the event this request is being submitted because the AAA terminated its agreement with the provider, the requirements in No.10 are still applicable. 11. Specify the timeframe for which this waiver is being requested. Your request may not exceed 12 months. 10/1/2014 to 9/30/2015 Signature of AAA Director Date 52 P age

53 AAA: 1 Strategic Plan Period: Operational Plan Year: 2015 Date Submitted: Original Submission: or Revision # Appendix 3: Request for Variance from Prescribed ODA Service Taxonomy Instructions: Respond to each item listed. Additional pages may be inserted, if needed. 1. Service name 2. Definition of service 3. Detailed description of service to be provided 4. Unit of service 5. Rationale for addition of this service 6. Detailed description of target population to be served by the proposed service 7. Sources and amounts of funds budgeted 8. Amount of OAA funds budgeted 53 P age

54 9. Describe impact on other Title III services caused by diverting these funds to new services, and the impact on other services needed in the community. 10. Projected number of service units next year 11. Identification of service providers for proposed service I certify that the request for variance has been reviewed by the Advisory Council, and approved by the Governing Body and AAA staff and is in concert with the intent of the AAA s current Area Plan. Signature of AAA Director Date 54 P age

55 AAA: Strategic Plan Period: Operational Plan Year: 2015 Date Submitted: Click here to enter a date. Original Submission: or Revision # Appendix 5: Use of Funds for MPSC Capital Improvements Instructions: Complete this exhibit only if the AAA plans to allocate Older Americans Act grant funds for purposes as outlined in Section 321(b)(1) of the Older Americans Act. 1. Respond to the following: A. Project name (MPSC) B. Project address (MPSC) C. Grantee name D. Grantee address E. Approximate total cost of project F. Approximate amount of Older Americans Act funds to be allocated toward the project G. Percentage of Older Americans Act funds in the project H. Indicate which activity is to take place: Acquisition Construction Renovation or Alteration I. Use of these funds with other sources of funds in above activities; list other sources of funds with amounts. 55 P age

56 2. Provide a detailed narrative for each item listed below: A. How does this project fit into the long-range plan of the AAA for provision of services? B. Specify the dollar amount of Older Americans Act funds being utilized by the project; list the services funded by these dollars. C. List other services (identify by using ODA taxonomy standards language) not itemized in #2 above currently being provided by the project to seniors. D. How does this project currently target for delivering service to low-income minorities? E. What is the source of project/senior center operating funds? F. Is this project a focal point? Yes No If it is a focal point, is the project listed as a focal point in the Area Plan document? Yes No G. What is the start date for the project? H. A public hearing was held this date: Attach a summary of the public hearing. Include in the attachment comments not only from those who attended the hearing, but also from those who shared comments outside the hearing. 56 P age

57 3. The AAA Director assures that: A. The need for the project was identified and substantiated through a general needs assessment process which has been conducted within the past two years; B. The needs assessment shows this activity to be a high priority within the planning and service area; C. Public hearings have included specific identification of these funds and for what purposes; D. The AAA has assessed the impact of using these funds for the above purposes instead of spending on services; this assessment must show how services will be maintained if service dollars are used for MPSC capital improvements activity; E. The project and sponsor are either a public or private non-profit agency or organization and comply with Ohio Revised Code in meeting that definition, and are registered with the Secretary of State in that capacity; and F. The project/grantee and the AAA have pursued and applied to other funding sources for the same purpose/project (e.g., local funding, private foundations) and have been unsuccessful in obtaining funds from any specific funding source during the past three calendar years. Signature of AAA Director Date 57 P age

58 AAA: Strategic Plan Period: Operational Plan Year: 2015 Date Submitted: Click here to enter a date. Original Submission: or Revision # Appendix 7: Waiver of Title III-B Priority Services Instructions: Submit a separate Appendix 7 for each priority service category for which a waiver is being requested. (AAA) requests a waiver for PY 2015 of the following: 1. Priority Service category: Access Services In-Home Services Legal Assistance A. The AAA plans to allocate 0 percent, or $ 0 of its Title III-B budget, before transfers, to this Priority Service category for PY Illustrate the mathematical equation used by the AAA in calculating the above percentage. Use the approximate rounded off dollar amounts if actual figures are not available. No Title III B funding is going towards in-home services. B. In accordance with the OAA requirements outlined in Section 306(b), did the AAA hold a public hearing regarding this waiver? No, a public hearing was not held. Please explain Yes, a public hearing was held this date: 7/24/2014 Counties in which the public hearing was held: Hamilton Counties that will be affected by this waiver: Butler, Clermont, Clinton, Hamilton and Warren 2. Include the record from the public hearing held by the AAA regarding its intent to fund a priority service category at less than five percent. 3. Include a copy of the public notice for this hearing. 58 P age

59 4. Include a copy of materials distributed to the public at the AAA's hearing on the waiver request. 5. Rationale that supports the AAA's reasons for requesting the waiver for the Priority Services category: A. Provide a detailed discussion of the AAA's rationale for submitting this request. Please cite environmental factors, funding factors, population needs, etc. Local county senior levies currently exist in all five counties. The levies provide millions of dollars in funding to support homemaker, personal care and in-home respite. The levies have allowed our network to use the Title III B funding to support transportation, wellness and other services predominantly provided by senior centers. B. How will the AAA ensure that activities under this service category are being provided with sufficient dollars to ensure the 60+ population is receiving these services and that they are in adequate supply to meet the need? Identify other funding sources (e.g., local) that support this service. The levy programs in our five counties ensures that adequate funding exists to provide in-home services, such as homemaker, personal care, adult day care, and home delivered meals, to the senior population in AAA-1 service area. OAA funding is insufficient to meet the need if 100% of the funding went toward these services. C. Do the AAA service providers currently have waiting lists for any activities under this service category? If yes, list those services and counties for which waiting lists exist. Waiting lists currently exist in Clinton and Hamilton Counties D. List those counties within the PSA that will not receive Title III dollars in this service category. Butler, Clinton, Clermont, Hamilton and Warren Signature of AAA Director Date 59 P age

60 PY Strategic Area Plan Assurances Assurances 306 Older Americans Act Certification Regarding Department Suspension, Ineligibility and Voluntary Exclusion Pursuant to 45 CFR Part 76 Lower Tier Transactions Certification for Contracts, Grants, Loans and Cooperative Agreements Department of Health and Human Services Assurance of Compliance with Section 504 of the Rehabilitation Act of 1973, as Amended Assurance of Compliance with Department of Health and Human Services Regulations under Title VI of the Civil Rights Act of 1964 Older Americans Act Programs Non-Discrimination Policy Verification of Intent 60 P age

61 PY Strategic Area Plan Assurance Section 306 Older Americans Act Council on Aging of Southwestern Ohio, Inc. Assures the following: 1. The AAA assures that an adequate proportion, as required under section 307(a)(2) of the OAA and ODA Policy , Priority Services, of the amount allotted for part B to the planning and service area will be expended for the delivery of each of the following categories of services: services associated with access to services (transportation, outreach, information and assistance and case management services), in-home services, and legal assistance. ( 306(a)(2)) 2. The AAA assures it will set specific objectives for providing services to older individuals with greatest economic need and older individuals with greatest social need, include specific objectives for providing services to low-income minority individuals and older individuals residing in rural areas, and include proposed methods of carrying out the preference in the area plan ( 306(a)(4)(A)(i)) 3. Each AAA shall provide assurances that the AAA will include in each agreement made with a provider of any service under this title, a requirement that such provider will: a. Specify how the provider intends to satisfy the service needs of low-income minority individuals and older individuals residing in rural areas in the area served by the provider. b. To the maximum extent possible services to low-income minority individuals and older individuals residing in rural areas in accordance with their need for such services; and c. Meet specific objectives established by the AAA, providing services to low-income minority individuals and older individuals residing in rural areas within the planning and service area. ( 306(a)(4)(ii)) 4. The AAA assures it will use outreach efforts that will identify individuals eligible for assistance under this Act, with special emphasis on: a. Older individuals residing in rural areas; b. Older individuals with greatest economic need (with particular attention to low-income minority individuals and older individuals residing in rural areas); c. Older individuals with greatest social need (with particular attention to low-income minority individuals and older individuals residing in rural areas); d. Older individuals with severe disabilities; e. Older individuals with limited English-speaking ability; and f. Older individuals with Alzheimer s disease or related disorders with neurological and organic brain dysfunction (and the caretakers of such individuals). ( 306(a)(4)(B)) 5. The AAA assures it will ensure that each activity undertaken by the agency, including planning, advocacy, and systems development, will include a focus on the needs of low-income minority older individuals and older individuals residing in rural areas. ( 306(a)(4)(C)) 6. The AAA assures it will coordinate planning, identification, assessment of needs, and provision of services for older individuals with disabilities, with particular attention to individuals with severe 61 P age

62 disabilities, with agencies that develop or provide services for individuals with disabilities ( 306 (a)(5)). 7. The AAA assures it will provide information and assurances concerning services to older individuals who are Native Americans (referred to in this paragraph as older Native Americans) including: a. Information concerning whether there is a significant population of older Native Americans in the planning and service area and if so, an assurance that the AAA will pursue activities, including outreach, to increase access of those older Native Americans to programs and benefits provided under this title; b. An assurance that the AAA will, to the maximum extent practicable, coordinate the services provided under Title VI; and c. An assurance that the AAA will make services under the area plan available to the same extent; as such services are available to older individuals within the planning and service area, whom are older Native Americans. ( 306(a)(11)) 8. The AAA assures it will maintain the integrity and public purpose of services provided, and service providers, under this title in all contractual and commercial relationships. ( 306(a))13)(A)) 9. The AAA assures it will disclose to the Assistant Secretary and the State Agency: a. The identity of each non-governmental entity with which such agency has a contract or commercial relationships relating to providing any service to older individuals; and b. The nature of such contract or such relationship. ( 306(a)(13)(B)) 10. The AAA assures it will demonstrate that a loss or diminution on the quantity or quality of the services provided, or to be provided, under this title by such agency has not resulted and will not result from such non-governmental contracts or such commercial relationships. ( 306(a)(13)(C)) 11. The AAA assures it will demonstrate that the quantity and quality of the services to be provided under this title by such agency will be enhanced as a result of such non-governmental contracts or commercial relationships. ( 306(a)(13)(D)) 12. The AAA assures it will, on the request of the Assistance Secretary of State, for the purpose of monitoring compliance with this Act (including conducting an audit), disclose all sources and expenditures of funds such agency receives or expends to provide services to older individuals ( 306(a)(13)(E)) 13. The AAA assures that funds received under this title will not be used to pay any part of a cost (including an administrative cost) incurred by the AAA to carry out a contract or commercial relationship that is not carried out to implement this title. ( 306(a)(14)) 62 P age

63 14. The AAA assures that preference in receiving services under this title will not be given by the AAA to particular older individuals as a result of a contract or commercial relationship that is not carried out to implement this title. ( 306(a)(15)) Signature of AAA Director Date 63 P age

64 PY Strategic Area Plan Assurance Certification Regarding Department Suspension, Ineligibility and Voluntary Exclusion Pursuant to 45 CFR Part 76 Lower Tier Transactions Name of AAA certifies by submission of this proposal, that neither it nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency. Where the AAA is unable to verify to any of the statements in this certification, such as AAA shall attach an explanation to this proposal. Signature of AAA Director Date 64 P age

65 PY Strategic Area Plan Assurance Certification for Contracts, Grants, Loans & Cooperative Agreements The undersigned certifies, to the best of his or her knowledge and belief, that: 1. No federal appropriated funds have been or will be paid, by or on behalf of, the undersigned to any person for influencing or attempting to influence an officer or employee of any agency, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress in connection with the awarding of any federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement. 2. If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress in connection with this federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit the form, Disclosure Form to Report Lobbying, in accordance with its instructions. 3. The undersigned shall require that the language of this certification be included in the award documents for all sub-awards at all tiers (including sub-contracts, sub-grants, and contracts under grants, loans, and cooperative agreements) and that all sub-recipients shall certify and disclosure accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Statement for Loan Guarantees and Loan Insurance The undersigned states, to the best of his or her knowledge and belief, that if any funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a member of Congress, an officer or employer of Congress, or an employee of a member of Congress in connection with this commitment providing for the United States to ensure or guarantee a loan, the undersigned shall complete and submit the form, Disclosure Form to Report Lobbying, in accordance with its instructions. 65 P age

66 Submission of this statement is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required statement shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Signature of AAA Director Date 66 P age

67 PY Strategic Area Plan Assurance Department of Health and Human Services Assurances of Compliance with Section 504 of the Rehabilitation Act of 1973, as Amended The undersigned (hereinafter called the recipient ) HEREBY AGREES THAT it will comply with Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. 794), all requirements imposed by the applicable HHS regulation (45 C.F.R. Part 84), and all guidelines and interpretations issued pursuant thereto. Pursuant to 84.5(a) of the regulation [45 C.F.R. 84.5(a)], the recipient gives this Assurance in consideration of and for the purpose of obtaining any and all federal grants, loans, contracts (except procurement contracts and contracts of insurance or guaranty), property, discounts, or other federal financial assistance extended by the Department of Health and Human Services after the date of this Assurance, including payments or other assistance made after such date on applications for federal financial assistance that were approved before such date. The recipient recognizes and agrees that such federal financial assistance will be expended in reliance on the representations and agreements made in this Assurance and that the United States will have the right to enforce this Assurance through lawful means. This Assurance is binding on the recipients, its successors, transferees, and assignees, and the person or persons whose signatures appear below are authorized to sign this Assurance on behalf of the recipient. This Assurance obligates the recipient for the period during which federal financial assistance is extended to it by the Department of Health and Human Services or, where the assistance is in the form of real or personal property, for the period provided for in 84.5(b) of the regulation [45 C.F.R. 84.5(b)]. The recipient [check (a) or (b)]: a. Employs fewer than fifteen persons b. Employs fifteen or more persons and, pursuant to 84.7(a) of the regulation (45 C.F.R. 84.7(a)], has designated the following person(s) to coordinate its efforts to comply with the Health and Human Services regulations: 175 Tri County PKWY Cincinnati, OH Street Address or PO Box City, State & ZIP Code IRS Employer Identification Number I certify that the above information is complete and correct to the best of my knowledge. Signature of AAA Director Date 67 P age

68 PY Strategic Area Plan Assurance Assurance of Compliance with the Department of Health and Human Services Regulations under Title VI of the Civil Rights Act of 1964 Council on Aging of Southwestern Ohio, Inc. hereinafter called the Applicant, HEREBY AGREES THAT it will comply with Title VI of the civil Rights Act of 1964 (P.L ) and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 C.F.R. Part 80) 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 receives 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 with 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 who signatures appear below are authorized to sign this Assurance on behalf of the Applicant. Council on Aging of Southwestern Ohio, Inc July 30, 2014 AAA Name (type or print) Date AAA Director or Authorized Agent 175 Tri County Pkwy Cincinnati, OH Applicant s Mailing Address City, State & ZIP Code 68 P age

69 PY Strategic Area Plan Assurance Older Americans Act Programs Non-Discrimination Policy It is the policy of Council on Aging of Southwestern Ohio, Inc. to provide services to all persons age sixty and above and employment services to all persons aged 55 and older as mandated by the Older Americans Act, as amended, State statutory law, and their applicable rules and regulations pursuant thereto without regard to race, color, national origin, religion, sex, ancestry, marital status, physical or mental handicap, unfavorable military discharge, or age. The AAA Name. does not discriminate in admission to programs or activities or treatment of employment in programs or activities in compliance with the State statutory law, Title VI of the U.S. Civil Rights Act, as amended; Title VII of the U.S. Civil Rights Acts, as amended; Section 504 of the Rehabilitation Act, as amended; the Age Discrimination Act, as amended; the Age Discrimination in Employment Act, as amended, their applicable rules and regulations pursuant thereto; the Constitution of the United States, and the Constitution of the State of Ohio. Subject to the Older Americans Act, as amended, and the requirements of the merit employment system, preference shall be given to individuals age sixty or older for any staff positions in the State and Area Agencies (excluding sub-grantees and contractors) for which such individuals qualify. All Area Agencies on Aging and all other provider of services receiving funds under the State or Strategic Area Plans are required to comply with and provide notice of this policy. The persons designated to coordinate compliance with the Civil Rights Program is: Jacqueline Hutsell Typed or Printed Name (513) Area Code & Phone Number (XXX)XXX-XXXX Approved and agreed to on behalf of Council on Aging of Southwestern Ohio, Inc. Signature of AAA Director Date Strategic Area Plan Assurance 69 P age

70 PY Strategic Area Plan Assurance Verification of Intent The Strategic Area Plan on Aging hereby submitted for the: Council on Aging of Southwestern Ohio, Inc. Area Agency on Aging 10/1/2014 to 9/30/2015 It includes all assurances and plans to be followed by the Council on Aging of Southwestern Ohio, Inc. (AAA Name) under provisions of the Older Americans Act, as amended during the period identified, the Area Agency identified will assume full authority to develop and administer the Area Plan on Aging in accordance with all requirements of the Act and related State of Ohio policy. In accepting this authority the Area Agency assumes major responsibility to develop and administer the Area Plan for a comprehensive and coordinated system of services and to serve as the advocate and focal point for older people in the planning and service area. The Strategic Area Plan on Aging has been developed in accordance with all rules and regulations specified under the Older Americans Act and is hereby submitted to the Ohio Department of Aging for approval. Signature of AAA Director Date The Area Agency Advisory Council on Aging has had the opportunity to review and comment on the Strategic Area Plan on Aging. (Please attach any comments). Signature of Advisory Council Chair Date The governing body of the Area Agency has reviewed and approved the Strategic Area Plan on Aging. Signature of Governing Body Chair Date 70 P age

71 Strategic Area Plan Attachments Attachment 1 Public Hearing Summary - Notice and Meeting Minutes (Required) Attachment 2 AAA Grievance Policy (Required) Attachment 3 Table of Organization (Required) Attachment 4 Consumer Testimonials Appendix 1 Request to Transfer Funds (Required) Appendix 2 Application for Waiver Request/Applicable Budget Page Exhibits D-2b Appendix 3 Appendix 5 Request for Variance from Prescribed ODA Service Taxonomy Use of Funds for MPSC Capital Improvements Attachment 7 Waiver of Title III-B Priority Services 71 P age