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Aging & Independence Services

TRANSMITTAL LETTER

AREA PLAN 2012-2016 (PSA #23)

Four-Year Area Plan

2012-2016

AAA Name: Aging & Independence Services PSA 23

This Area Plan is hereby submitted to the California Department of Aging for approval. The Governing Board and the Advisory Council have each had the opportunity to participate in the planning process and to review and comment on the Area Plan. The Governing Board, Advisory Council, and Area Agency Director actively support the planning and development of community-based systems of care and will ensure compliance with the assurances set forth in this Area Plan. The undersigned recognize the responsibility within each community to establish systems in order to address the care needs of older individuals and their family caregivers in this planning and service area.

1. RON ROBERTS

____________________________ _______________ Governing Board Chair 1 Date 2. JACK DUFF

3. PAMELA B. SMITH

1 Original signatures or official signature stamps are required.

AREA PLAN 2012-2016

AGING & INDEPENDENCE SERVICES

PSA #23

TABLE OF CONTENTS

Transmittal Letter

PART ONE Section 1. Mission Statement………………………………………………………………………………… ….1

Section 2. Description of the Planning and Service Area (PSA) ....…………………………………………2

Section 3. Description of the Area Agency on Aging (AAA) ...….……………………………………………8

Section 4. Planning Process / Establishing Priorities ……………………………………………………….18

Section 5. Needs Assessment Activities ..……………………………………………………………………22

Section 6. Targeting ……………………………………………………………………………………………27

Section 7. Public Hearings ..…..………………………………………………………………………………32

Section 8. Identification of Priorities …………………………………………………………………………37

PART TWO

Section 9. Area Plan Narrative Goals and Objectives

Goal 1: Outreach and Access …………………………………………………………………….41

Goal 2: Health, Fitness and Nutrition ……………………………………………………………..46

Goal 3: Caregiver Support …………………………………………………………………………49

Goal 4: Protection, Safety and Advocacy ………………………………………………………51

Goal 5: Enrichment and Involvement ……………………………………………………………..55

Goal 6: Veterans Services …………………………………………………………………………59

Goal 7: Help in the Home and Long Term Support Services …………………………………..61

Section 10. Service Unit Plan (SUP) Objectives

TITLE III/VII …………………………………………………………………………………………63

TITLEIII (Other) …………………………………………………………………………………….71

TITLE III-D (Health Promotion) ……………………………………………………………………73

TITLE III-B / VII A (Ombudsman) …………………………………………………………………74

TITLE VII-B (Elder Abuse Prevention) ……………………………………………………………83

TITLE III-E (Contracted & Direct Services) ………………………………………………………87

SENIOR COMMUNITY SERVICE EMPLOYMENT ROGRAM (SCSEP) ……………………..91

HICAP ……………………………………………………………………………………………….93

TABLE OF CONTENTS (cont.)

Section 11. Focal Points ………………………………………………………………………………………98

Section 12. Disaster Preparedness …………………………………………………………………………..99

Section 13. Priority Services …………………………………………………………………………………101

Section 14. Notice of Intent to Provide Direct Services ……………………………………………………103

Section 15. Request for Approval to Provide Direct Services

Nutrition Education (Registered Dietition) …………………………………………………….106

Personal Care (through SOAR) ……………………………………………………………….106.1

Homemaker (through SOAR) ………………………………………………………………….106.2

Assisted Transportation (through SOAR) …………………………………………………….106.3

Section 16. Governing Board ………………………………………………………………………………...107

Section 17. Advisory Council ………………………………………………………………………………...108

Section 18. Legal Assistance ………………………………………………………………………………..111

Section 19. Multipurpose Senior Center Acquisition or Construction Compliance Review …………….115

Section 20. Family Caregiver Support Program ……………………………………………………………116

Section 21. Organization Chart ……………………………………………………………………………….118

Section 22. Assurances ………………………………………………………………………………………..119

APPENDICES List of citations incorporated at the end of the Area Plan Document

A. Survey of Older Americans Living in San Diego County 2012, Excerpt a. Executive Summary b. Introduction c. Summary of Results d. Methodology: Survey Tool

B. AIS Strategic Plan 2009-2012 C. Area Plan Feedback Questionnaire D. Awards & Recognitions E. AIS Disaster Plan-COOP Annex F. References

AREA PLAN 2012-2016 – PSA 23 Aging & Independence Services: PSA #23 County of San Diego

Area Plan 2012-2016, Section 1 1 Aging & Independence Services: PSA #23 County of San Diego

SECTION ONE MISSION STATEMENT

AIS The leader in Advocacy, Information & Safety to foster dignity and enhance the quality of life for seniors and persons with disabilities.

Aging & Independence Services (AIS) is an Area Agency on Aging (AAA). Therefore it is understood that AIS will, along with the California Department of Aging and the other AAA’s in the aging network, strive:

“To provide leadership in addressing issues that relate to older Californians; to develop community-based systems of care that provide services which support independence within California’s interdependent society, and which protect the quality of life of older persons and persons with functional impairments; and to promote citizen involvement in the planning and delivery of services.”


SECTION TWO DESCRIPTION OF THE PLANNING AND SERVICE AREA (PSA)

Physical Characteristics PSA 23 serves all of San Diego County. The county encompasses 4,261 square miles. There are three distinct geographic areas: the 78-mile long coastline and the coastal plain, the interior uplands and mountains, and the deserts of the Salton Basin. The region is relatively arid. The topography is marked by valley/mesa landforms. Most of the region’s urbanization is located in the western third of the county. The more rugged uplands and mountains and the deserts are sparsely populated. Incorporated areas encompass only 689 square miles, while unincorporated areas account for the balance of 3,572 square miles.

Demographic Characteristics The following figures are based on 2011 population estimates (unless otherwise noted), and the 2030 Regional Growth Forecast, produced by the San Diego Association of Governments (SANDAG) (See Appendix F- References). Eighty-four percent of the county’s total population lives in incorporated areas in the western half/coastal section of the county. Population density in these areas is 3,853 persons per square mile, as compared to 138 persons per square mile in unincorporated areas. There are 18 incorporated cities in the county. The 2010 Census ranked the City of San Diego as the eighth largest in the nation (See Appendix F-References). The county is the fifth largest residential population in the nation. It is ranked second in population within the state, behind Los Angeles County. The county’s population is 3,095,313, a decrease of 39,239 since 2008. The median age is 34.7 which is similar to the median age in 2008 (34.9). The median age for San Diego County is increasing and will continue to rise, reaching 38.7 by year 2050. Females and males are evenly split in the County, with 50% each. Of the total population (across all ages) in 2010, 48.5% is non-Hispanic White, 32.0% Hispanic, 11.0% Asian and Pacific Islander, 4.7% African-American, 0.5% American Indian and 3.3% Other (including 2 or more races). By 2050, these numbers are projected to be 35.3% non-Hispanic White, 42.9% Hispanic, 12.0% Asian and Pacific Islander, 5.2% African-American, 0.4


American Indian, and 4.1% Other (including 2 or more races)., Total population of San Diego County is projected to reach 4,384,867 by 2050. The growth rate of minority populations in San Diego County has surpassed that of the non-Hispanic White population. Between 2010 and 2050, the non-Hispanic White population will increase by 3.3%, while the population of minorities will increase by 77.8%. Hispanics will increase by 89.8%, African-Americans will increase by 56.8%, and the other remaining groups will increase by 58.4%. The San Diego region has one of the largest older populations in the nation. In 2010, there were 351,425 persons 65 years and older, which represented 11.4% of the total population. According to the Census 2010, San Diego County’s 65+ population was slightly below the nations’ in the year 2010 (13.0%). The growth rate for older persons will continue to accelerate since Baby Boomers (those born between 1946 and 1964) are turning 60 years of age. The magnitude of the older adult population is illustrated by the fact that 18 states (including the District of Columbia) had fewer persons 65+ than San Diego County in the year 2010. Between 2010 and 2050 older age cohorts in the San Diego Region are expected to increase by 118.3% for the 60+ group, 145.8% for those 65+, 186.7% for persons 75+, and 244.6% for those 85 and older. The age groups have the highest likelihood of functional disabilities and chronic conditions, and will represent the biggest challenges to the County in terms of service demands. Characteristics of the Older Population There were 500,736 persons 60 years and older living in San Diego County in 2010, an increase of 96,704 since 2000. Data also reflects a disparity in population between males and females with the advancement of age: over three-fifths (63%) of the county's population 85 years and older are women. According to the Census Bureau's 2010 American Community Survey, 36.3% of those 65+ living in San Diego County have some type of disability. Additionally, 8.0% of those 65+ are below the poverty level. Twenty-nine percent speak another language than English at home.

San Diego's Older Population by Region All Ages 55 +

Central 18% East County

1% North County East 14%

North County West 14%

East Suburban 17%

North City 25%

South Suburban 11%

Central North City South Suburban East Suburban North County West North County East East County


The estimates for 2010 by age cohorts were: 60-64 (149,377); 65-69 (103,241); 70-74 (77,313); 75+ (170,871). By comparison, numbers for the same age groups in 2000 were: 60-64 (90,282); 65-69 (81,763); 70-74 (78,296); 75+ (153,691). An estimated 176,714 minority individuals 60 and over live in San Diego County, representing 35.3% of the 60+ population. An estimated 15% of the total population 60 and over is Hispanic, 11% is Asian, 4% is African American, 1% is Native American/Alaskan Native, and 4% is Other. Persons age 65 and over whose income is below the poverty level are generally located in areas with the highest concentration of minorities. The two Major Statistical Areas (MSAs) with the highest poverty rates among those 65+ are Central (10.1%) and South Suburban (9.8%), which also have the greatest proportion of minorities 65 and over. The average poverty rate for those age 65+ countywide is 6.8% (2000 Census). Minority older persons are unevenly distributed throughout the county. The South Suburban MSA has the greatest concentration of 65+ minority individuals with 63.2%, followed by Central MSA (55.2%), North County East (28.1%), North City MSA (26.8%), East Suburban (26.7%), East County (25.5%), and North County West (23.8%) (SANDAG, 2012). The percentage of 65+ persons who belong to a minority racial/ethnic group has been rapidly increasing across all areas of San Diego County in the past decade. Of the low-income minority individuals living in San Diego County, 25% live in rural areas. (East County and North County East are considered rural.) (2000 Census). Resources and Constraints Constraints The size of San Diego County, 4,261 square miles (3,572 square miles of unincorporated area), and the distances to services in the large rural area, presents difficulties to the senior population. Lack of effective public transportation throughout the region is also a cause for concern, with many seniors living in remote locations. Testimony at the 2012 Area Plan Public Hearings underscored this contention. Lack of affordable housing is a serious issue for seniors in the county. If funding remains stable, given the expected increase in the senior population, it will impact the ability to provide services. Limited revenue constrains many innovative and progressive ideas for services to San Diego County seniors and persons with disabilities. Resources In addition to AIS-administered programs, there is a rich fabric of senior and disabled services throughout the county. Most cities provide support for local and neighborhood programs through city-sponsored senior centers and/or recreation programs. In addition, cities typically have assigned advisory responsibilities to “senior commissions” appointed by mayors and city councils. Six of the cities in the PSA partner with AIS to provide nutrition and social services. Unique Service Characteristics The "Community Action Networks" are community-based groups in each region of the county and serve as the entities where ideas and solutions to regional needs are implemented through specific projects. The goals for these projects are determined through a strategic planning process with the full participation of agency and individual partners who then help carry out the


plan. As a coordinator and participant in this process, Aging & Independence Services launched the planning process and provides staff support for the Action Networks and their subcommittees. In addition to solution-oriented projects, the networks are vital links for partners to communicate information. There are county wide organizations providing important services in local communities. A prime example is The Salvation Army, which provides an array of social services, and contracts with AIS for several nutrition programs. Another example is the Union of Pan Asian Communities (UPAC), which serves the Asian communities throughout the county. UPAC provides nutrition and social services, through contract with AIS, at five different locations. AIS has been an active partner in the development of the 2-1-1 project since planning began in 2001. AIS and 2-1-1 have a Memorandum of Understanding that will provide for sharing of information, statistics, and training opportunities. AIS and 2-1-1 cooperate on educating the public on 2-1-1.

Significant to the well being of vulnerable older adults and the disabled are the sixteen Project Care sites spread throughout the county. Operated as a cooperative across the County through 16 public and private agencies, the program provides health and safety assurance by targeting side effects of isolation. Core components include computer-based telephone reassurance calls and “Vials of Life” emergency forms. Volunteers, agency staff, law enforcement, emergency responders, postal, and utility workers act as a team to form a safety net ensuring regular contact with the community. The system is an important gateway for vulnerable adults to access other protective health and safety services. The great majority of aging and disabled service providers are community-based organizations. Most of these agencies have developed their capacity to service older adults and the disabled through private funding, e.g., foundations, grants and fund raising activities. The faith communities also play a key role in safeguarding older adults. Interfaith organizations are regularly invited to participate with AIS in developing program initiatives and many religious organizations are providers of older adult services. Edgemoor Hospital is a “distinct part” skilled nursing facility (SNF) and currently provides services to elderly residents and residents with multiple and serious diagnoses such as traumatic brain injury, advanced stage AIDS and Huntington’s Chorea; and the Board of Supervisors directed that a new skilled nursing facility be constructed. The original structure was built in the nineteen thirties, and construction began in February 2005 on a 192 bed facility to replace the current, aging Edgemoor Hospital. The new facility began service in March of 2009. Since our last Area Plan document, Edgemoor is no longer a part of the AIS organizational chart, but shares a common project with AIS under the Community Gardens project. California Senior Legislature (CSL) – one-hundred and twenty (120) elected members represent seniors in their geographic areas. CSL members identify senior concerns and develop and submit legislative proposals to the State Legislature in response to those concerns. Eight CSL members represent San Diego Region seniors to the Legislature.


The “Cool Zones” project has been serving seniors and persons with disabilities since the summer of 2001. The project began with a proposal from Supervisor Dianne Jacob to provide a safe and comfortable place for seniors and persons with disabilities (who could not afford air conditioning) to go in hot weather. The Board of Supervisors designated AIS to develop and operate the project. AIS staff coordinate the project. Almost one hundred Cool Zones in all regions of the county have been identified. In a cooperative effort with the City of San Diego and San Diego Gas and Electric (SDG&E), fans were purchased and given to qualified persons. Funds area also used to purchase bus passes for qualified persons to travel to a Cool Zone. Disaster Preparedness San Diego County is comprised of 18 cities and unincorporated areas, and is vulnerable to a host of both natural and man-made disasters. Disasters that may occur include earthquakes, flooding, fires, and as a result of being home to several military facilities and having international border access, terrorism. It is estimated that 274,573 of San Diego County residents are disabled (U.S. Census) and 351,425 are over the age of 65 (SANDAG). Given the significant number of elderly and disabled residents in San Diego County and the county’s hazards and vulnerabilities, in 2006 Aging & Independence Services (AIS) established a disaster plan, the Continuity of Operations Plan (COOP), to address the needs of these vulnerable groups. The COOP identifies AIS’ most critical services that maintain the safety and well being of the population served and/or sustains the economic base of the community. The plan details how these services will be operational within 12 hours of an emergency event or disaster and will be sustained for up to 30 days (See Appendix E). In addition, as a result of the unique and credible connection that the County’s Office of Emergency Services (OES), Public Health Services (PHS) and Aging & Independence Services (AIS) have with vulnerable populations, a partnership between these three County departments was forged in January 2007. Since its inception, this Vulnerable Population Partnership has; created the San Diego County Preparedness Wheel distributed over 175,000 Wheels to persons with medical and functional assistance

needs; hosted a Special Needs Population Shelter Forum in April 2007; participated in the Care and Shelter Subcommittee of the Unified Disaster Council’s

revision of Annex G of the Care and Shelter Operations of the Operational Area Emergency Plan, which now includes provisions for sheltering vulnerable populations during a disaster;

conducted workshops on disaster planning for persons with special needs at numerous conferences;

established the role of Vulnerable Populations Coordinator in the Care and Shelter Branch of the Emergency Operations Center;

worked collaboratively with the California Association of Health Facilities (CAHF) to plan two events, a Special Populations Forum and a Special Populations Summit, in 2009.

Participated in Golden Guardian exercises

The Vulnerable Population Partnership continues to meet to plan and implement preparedness, response and recovery activities to assist persons with medical or functional needs during an emergency or disaster.


Because of AIS’ established relationships with organizations and agencies that support the needs of the elderly and persons with disabilities, advocacy groups and persons with special needs, AIS staff have been appointed to serve as the Care and Shelter Branch’s County Shelter Team Unit Leader in the Emergency Operations Center during a disaster. In that capacity, AIS staff will ensure that specialized services are provided as required for the care of special needs population groups in American Red Cross and County shelters.


SECTION THREE DESCRIPTION OF THE AREA AGENCY ON AGING (AAA)

The federal Older Americans Act, enacted in 1965, provided direction for community involvement in addressing the needs of older persons. State and area agencies on aging constitute the administrative structure for programs under the Act. The County of San Diego Area Agency on Aging was one of the first planning and service areas to be designated by the California Department of Aging, in December 1973. The number of Area Agencies on Aging in California now totals 33. Characteristics of AIS As a public agency within the County of San Diego, AIS is governed by the Board of Supervisors. In addition, AIS is supported by the structure of the County of San Diego Health and Human Services Agency and a network of community partners numbering in the hundreds. This system gives credibility to the activities of AIS and creates an environment in which AIS can take a leadership role in the development of community-based systems of care. AIS provides forums for assessing needs, planning for the future, and developing strategies to provide solutions to present concerns. The San Diego County Board of Supervisors has a tradition of support for aging issues and of the needs of seniors in this PSA. In addition to setting policy for the County, major functions of the Board of Supervisors include approving the annual operational plan (budget), any mid-year changes to the operational plan, and authorizing/approving operational activities (such as contract procurements) as required.

In September 1997, the San Diego County Board of Supervisors created the Health and Human Services Agency (HHSA) and included the Area Agency on Aging (AAA) as one of its


components. As an integrated division in HHSA, the AAA has been given the responsibility for several related services in addition to Older Americans Act programs, including Adult Protective Services, In-Home Supportive Services, and Veterans Services. In February 1999, the AAA’s new name, Aging & Independence Services (AIS), was introduced. The name now reflects the mission and purpose of the division which includes serving both seniors and persons with disabilities. In July of 2010 the Board of Supervisors approved a comprehensive 10-year strategy called “Live Well, San Diego!” to promote a San Diego County that is healthy, safe and thriving for all ages, including seniors. In 2010 AIS headquarters was offered new office space and now occupies the third floor of the building seen below. AIS staff are also housed at five other locations around the county.

AIS Headquarters: 5560 Overland Avenue, Suite #300. San Diego California 92123

The councils and committees that assist AIS in its efforts to serve seniors, persons with disabilities, and the various committees in PSA 23 include: AIS Advisory Council – comprised of persons who represent the older adult and disabled community, one third of whom are appointed by the Board of Supervisors (detailed information about the Council is in Section 17). The Advisory Council oversees all aspects of AIS. The Council is active. It has participated in the various housing commissions in San Diego County to develop solutions to the shortage of affordable, appropriate housing for seniors and persons with disabilities. The Council receives overviews, progress reports and updates on initiatives from representatives of all AIS programs and services and in return offers comments providing the community perspective. Caregiver Coalition – a provider collaborative led by AIS, whose mission is to identify and address the needs of family caregivers, and to improve the overall quality of life for caregivers, their families, and the community. It serves as a cooperative committee whose role includes assisting family members who are caring for vulnerable adults at home. Through education and training, agencies provide mutual support to reduce the burden of caregiving and enhance the ability of families to provide the best possible care for infirm loved ones in need. Health Promotions Committee – represents professionals and seniors involved in the provision of health and social service programs for seniors, including fitness programs, health education, retirement communities, senior centers, and disease associations.


• Fall Prevention Task Force – represents professionals involved in fields related to fall prevention, including geriatric medicine, physical therapy, occupational therapy, home care, home modification, fitness, and health education.

• Five evidence-based Health Promotion Programs have been implemented since 2007 to address chronic disease, fall prevention, and diabetes: Stanford Chronic Disease Self-Management Program, Stanford Diabetes Self-Management Program, Matter of Balance, Stepping On, and Tai Chi: Moving for Better Balance. AIS partners with hospitals, community health centers, independent physician associations, senior centers, nutrition sites, and other community groups to offer these programs. Over 1,000 older adults have completed the workshops to date.

• Feeling Fit Clubs is an award-winning program of the AIS Health Promotions section. In the

thirteen years since the Feeling Fit Clubs got underway, the wellness initiative has made fitness accessible to low-income older adults who traditionally would have few opportunities to take part in physical activity programs. Developed in June 1999, the health promotion program targets culturally diverse, low-income older adults at the senior nutrition sites and other venues. Twenty-six different classes that meet two to three times per week are offered throughout the county. There are 710 regular participants for a total of over 60,000 contact hours per year. By offering a comprehensive program that addresses both the physical activity and the socialization components of wellness, AIS aims to improve the physical function of primarily sedentary, at-risk individuals who participate in senior nutrition programs. Evaluation results show that participants have improved energy levels, outlook on life, and ability to do activities of daily living. The Feeling Fit initiative is also viewed by AIS as a means of enhancing its senior nutrition system.

Feeling Fit Club Participants

In-Home Supportive Services (IHSS) Advisory Committee - was established in 1998 in response to the many critical issues facing both the consumers and providers of IHSS. Comprised largely of consumers and providers, the Advisory Committee has provided AIS with valuable information and recommendations about home care issues. Most recently, the committee staged a series of Town Hall Meetings, reviewed testimony, and will prepare an update for the County Board of Supervisors indicating the current issues faced by consumers and providers in the IHSS Program. Recent legislative action resulted in this committee coming under the management auspices of the Public Authority. It remains in a network connection to AIS and the AIS Advisory Council.


Intergenerational Program -- created as a result of Aging Summit 2000 recommendations. Since February 2001, AIS has strongly supported intergenerational programming as a means of positively impacting the serious social problems that affect our community. AIS is determined to infuse intergenerational approaches within all areas of its influence. The County of San Diego has assumed a position of leadership as County staff interface with the local community as well as nationally in building a "community for all ages". AIS has received many awards for its intergenerational programming (See Appendix D). Long-Term Care Integration Project Planning Committee – comprised of more than 800 consumers, providers and other key long-term care stakeholders across the array of services and throughout the care continuum working together to design an integrated system of care. LGBT -- AIS has established a committee to address the special issues of the aging Lesbian, Gay, Bisexual, and Transgender population of the San Diego Region. The committee is made up of representatives from the San Diego LGBT Community Center (The Center) and AIS. Representatives from AIS include those working in the Community Unit, the Call Center, In-Home Supportive Services (IHSS), Adult Protective Services, and Administration. The committee has several goals that include: Cross training on our various resources and services, Training Ombudsman staff on how to be sensitive to issues involving this population in

Skilled Nursing Facilities and board and care homes, Training AIS staff specifically on how to work effectively with this population, Sharing information about opportunities to incorporate the needs of this population as

part of the Mental Health funded Peer Counseling program for seniors and, Coordinating with the Caregiver Coalition to target efforts to benefit caregivers who may

be faced with unique issues or themselves may be part of the LGBT community. Educating providers and community members on the unique issues facing this

population Including LGBT representation on the AIS Advisory Council

Nutrition Project Managers – comprised of each of the managers of the Title III-funded programs, this group meets on a monthly basis to discuss the operations of their respective sites. Additionally, it is the expectation that nutrition providers have Program Councils or other advisory bodies comprised of senior participants who provide input on program operations. Outreach and Education Team - is the section of AIS which educates the community and other organizations about AIS programs and services and Adult Protective Services. Having representation in each region of the county, this section keeps the public informed and returns valuable information from the community to AIS. The members of the Outreach and Education Team coordinate the Community Action Networks. O&E is instrumental in the effort to develop collaborative efforts with other agencies and services throughout the county. The team makes hundreds of visits to agencies, presents at conferences and fairs, and provides training for law enforcement, city councils, regional collaboratives and many other entities. These presentations are designed to provide a clearer view of the role of AIS and the network of community organizations that serve seniors, and to provide a forum for developing a more closely-knit coordination between agencies and organizations serving older adults and the disabled. The Team members were instrumental in the development of the Community Action Networks (CAN), and the members coordinate the CAN meetings and activities.


Retired and Senior Volunteer Program (RSVP) Advisory Council – is committed to promoting volunteerism. The members actively engage in an ongoing effort to assess changing community needs and help RSVP meet the identified needs.

RSVP Manager & Volunteers

Veterans Advisory Council – advises the Board of Supervisors regarding issues that are important to veterans (including their dependents) of San Diego County. This includes legislation (federal and state), equal justice before the Veterans Administration and the California Department of Veterans Affairs, and promoting equity in health, housing, education and employment for San Diego County veterans

Veterans Staff & Volunteers


ACTIVITIES

AIS Bulletin - is a monthly publication that is sent to seniors, persons with disabilities, city and county officials, senior centers, and professionals in the fields of aging and social services. The Bulletin reports on activities and events that concern the senior and disabled community and the “Aging Network.” The Bulletin also serves as a vehicle for informing the community about opportunities to be involved in planning and the needs assessment process. Services for Persons with Disabilities A wide range of services and programs are available to seniors and persons with disabilities in San Diego County. Twenty-nine programs administered by AIS include special help and resources for the most vulnerable in our population. These services include the Multipurpose Senior Services Program (MSSP), the In-Home Supportive Services Program (IHSS), Adult Protective Services, the Mental Health Senior Team, Adults in Crisis, and Case Management programs, including Linkages and a case management program funded with Title III-B revenue. Direct services are provided through contracts with vendors and agencies, and include in-home support, respite care, meals (senior dining centers and home-delivered), health promotions, legal assistance, adult day care, transportation, educational opportunities, employment, money management, and counseling programs. In general, if a San Diego resident is older or disabled, at risk of institutionalization, is low income, and/or needs help in arranging for appropriate services, AIS can help. The array of services available allows the agency to coordinate services effectively. Referrals are made by Adult Protective Services and the other case management programs to other agencies that provide services to persons with disabilities. Referrals to AIS and requests for information and assistance come through the 1-800-510-2020 Call Center phone number. The AIS Call Center Information Specialists carefully screen callers to determine which of the services, or combinations of services, will best answer the needs of the individual. Interested parties can also learn about AIS services on the Network of Care Website at: www.sandiego.networkofcare.org or at the County website at: www.sdcounty.ca.gov. Formed to serve older Americans in response to the Older Americans Act, the scope of the County of San Diego Area Agency on Aging has since expanded to encompass case management, adult protective services and in home supportive services. Populations now served also include persons with disabilities. The County of San Diego Area Agency on Aging has experienced considerable growth over the past 35 years. It began as an office within the County of San Diego with a staff of three and an annual budget of under $100,000. Today, it is a major division within the County’s Health and Human Services Agency, staffed by 300 employees and including approximately 2,000 volunteers, with an annual budget of more than $300 million. In addition to Older Americans Act funding, AIS-administered programs are also funded by various federal, State, County, and other entities, over forty funding sources in all. The gateway to AIS services is through the agency’s Call Center that provides initial assessment and channeling to appropriate services and information. Calls are screened to determine eligibility for AIS programs and/or referred to other appropriate community programs.

http://www.sandiego.networkofcare.org/

http://www.sdcounty.ca.gov/


The Call Center has merged the efforts of information and referral, case management and IHSS program intake, and the elder abuse reporting function, providing AIS the opportunity to implement a “no wrong door” model. The 1-800-510-2020 toll free telephone number provides immediate access to anyone calling within San Diego County, as does the website found at www.sandiego.networkofcare.org. Professionals are able to make electronic web-based referrals to both IHSS and case management. AIS was one of the first Aging & Disability Resource Connections (ADRC) in the nation. Weaknesses of the AAA structure Flat and/or reduced funding in the face of increased demand for services has challenged the resources of contracted service providers, AIS and other organizations serving older adults and persons with disabilities in the county. This is further exacerbated by the increase in expenses for contractors, such as the cost for food and gasoline for the nutrition providers. The fact that there are more needs than can be met with available funds will inevitably result in limits to services. With increased demand, but fewer services available, waiting lists for some programs will become more prevalent. This has been demonstrated in the need for respite services for caregivers as well as for case management services. Presently there is a waiting list to receive these services. Additionally, the State budget crisis has dramatically impacted local government. As a result AIS has sustained program reductions in key programs such as Ombudsman and Adult Protective Services. With the growth of the aging population, there will be corresponding growth in the number of older adults in need of services, but the growth will not be spread uniformly. For instance, attendance at congregate meal programs at some senior centers is declining, while demand for home-delivered meals is rising in some areas. The aging services network, both public and private, faces the challenge of redesigning programs to ensure improved accessibility and relevance to the evolving needs of older adults. Many variables impact the use of services. Research consistently indicates that ethnic/cultural background, literacy, language skills, level of assimilation, and even a preference for informal resources (family, friends, and neighbors) rather than "official" government programs, all impact usage. AIS is challenged to develop strategies to overcome these barriers and effectively find ways to reach out to underserved populations. The most often cited reason seniors and their caregivers fail to access available services is a lack of awareness that such services exist. Families and individuals tend not to be concerned about such programs until confronted with an immediate or imminent need. Marketing of services is an important component to reduce the gaps in service delivery due to the lack of knowledge about service availability. Marketing frequently does not occur because under-funded providers are hard pressed to accommodate their current client base. Balancing needs and resources will be an ever-growing issue in the coming years as the Baby Boom generation ages and adds to the demand for long-term care services. The Baby Boom generation - those born between 1946 and 1964 - will make their mark by the growth in the number of older adults with disabilities who need long term care and on the amount of resources required to pay for it. Finding ways to develop and finance additional service capacity that meets needs, allows choice, and ensures quality care will be a challenge for AIS and other

http://www.sandiego.networkof/


local agencies in years to come. To meet these challenges AIS will continue to be the leader for strategic planning, collaboration and partnership with the broad spectrum of service providers for the large senior population in San Diego County. Changing Face of Aging in San Diego

One of AIS’ most significant challenges has been working within a fragmented system of care. All of the programs AIS operates are funded by different funding sources with different requirements. AIS has worked hard for the past 14 years to create a continuum of care while still meeting all the funding and programmatic requirements of these different sources. AIS currently answers to four different State agencies (Health, Veterans, Social Services and Aging), as services for our target population are not integrated at the State level.

In order to begin efforts to overcome this challenge, we formed an initiative 13 years ago entitled “The Long Term Care Integration Project.” Our goal was to spearhead change by integrating funding and services for our target population to create a seamless system of care that was consumer-focused. We have logged over 30,000 hours, included 800 stakeholders, and received more than $750,000 in State, federal and endowment funding to work to create this seamless system. Unfortunately, we were never able to gain needed legislation and State support to fulfill this goal, however, we did achieve other important goals during this time period utilizing the energy and enthusiasm of our stakeholders and staff. However, this has recently changed with the introduction of the dual eligible demonstration project, now spearheaded by CMS, and including 15 states, of which California is one. The County of San Diego, specifically four local health plans, were notified in April 2012 that they have been selected as one of the first four counties to begin the demonstration project, currently anticipated to start in March 2013. Health plans will be contracting back with the county for certain core long-term care services and supports, specifically for In-Home Supportive Services and the Multi-Purpose Senior Service Program. This demonstration represents the first time that health and social services will be integrated, both at the funding and service level, and offers a new opportunity to AIS to play a significant role in working with new partners to make this an effective integration.

Another area of change and opportunity has been the opportunity to initiate Care Transitions activities, first as a pilot program in one local hospital with federal funding, and now as part of a partnership with the Beacon Community serving three hospitals. As a result of these efforts, AIS has submitted an application for the “Community Based Care Transitions” program and has joined with 11 hospitals in our community to apply for this new program which would serve almost 24,000 Medicare fee-for-service patients each year with the goal of changing standards of practice to assure safe transitions and enhance the activation and self-management of patients and caregivers in our community.

AIS continues to look for ways to leverage the experience and knowledge of the community-based care continuum for seniors and persons with disabilities in a new environment focused on evidence-based practices, the merging of health and social services, and cost-effectiveness. The agency’s strong, proactive commitment to health promotion activities and preventative programming helps seniors and persons with disabilities to stay healthy and independent. In addition, AIS’ long-standing history of innovation and willingness to embark in new areas has helped position the agency as a leader in the field, ready to explore new partnerships and opportunities to best serve our target population in this time of change.


Leadership Challenges Providing leadership in the community in relationship to the development of new programs to deal with ongoing transportation and housing issues is made more difficult by the lack of funding for such programs and the fact that the AAA does not receive the funding or authority to administer these programs. AIS began to address the impact of aging Baby Boomers several years ago. In Aging Summit 2000, the issue of the Age Wave was discussed. At that time a committee was formed from the Summit participants to address this important issue. The committee’s findings were recorded and continue to assist AIS in planning for the future. The demographics on the growing senior population are obtained regularly from SANDAG, and are available to staff as well as members of other organizations. During the coming years AIS will continue to take the lead in planning for the needs of seniors who will number over half a million by the end of this decade, and almost one million by the year 2030. Policy Setting Process The Board of Supervisors sets policy for the County of San Diego. AIS frontline employees provide insight and input into the policy development process; supervisors and managers also contribute, as does County Counsel. The AIS administrators and Director make recommendations to the Board via the Health and Human Services Agency Director and the Chief Administrative Officer. All of the programs and functions of AIS benefit from the wisdom and guidance of the AIS Advisory Council. Originally established in 1973 in response to Older American Act requirements, the council consists of 30 members selected by the Board of Supervisors and by the Advisory Council. Advisory Council leadership and support has been key to the development of the Area Agency on Aging, and Aging & Independence Services, as a leader in providing older adult services and services for persons with disabilities. Through its vigorous support, promotion and testimony, the Advisory Council has helped to define AIS’ mission, and pushed AIS’ to do its best, while always remaining firmly committed to the interests of San Diego’ s older adult population. AIS Application Suite

In 2004-2005 AIS introduced a new automation system called the AIS Application Suite. This automation reflects our continued commitment to integrating senior services within the county of San Diego. It serves the needs of the AIS Call Center in completing intake for IHSS, APS, MSSP, Linkages, Title III Case Management (SOAR), and Senior Team (Mental Health Geriatric Assessment). The suite provides for appropriate client case assignment by the intake worker, with managerial review. The suite provides for full automation of the APS and Senior Team programs for its assessments, service plans, notes, and records. It provides for state required reporting for APS and Senior Team. Hard copies of the client profile can also be printed at the program-end of the other named programs; the case can be built for the paper file or manually entered into other program appropriate software. The AIS Application Suite provides for a central automated intake approach that is reflective of the program integration design that makes up the Area Agency on Aging of San Diego County


that is Aging & Independence Services. AIS has also added a web-referral option for professionals to use to make referrals to IHSS and the Case Management Programs. This feature integrates new referral data directly into the AIS Suite. Title V There is one Title V Program in the county providing part-time community service employment for low-income persons 55 and older. According to Title V program staff, employment opportunities for older adults at low to middle wage levels are below average given the economic downturn. There are fewer opportunities for full-time employment at higher wage levels. Community-Based Service Programs (CBSP) CBSPs, formerly administered by California Department of Aging and Long Term Care, and then transferred to the area agencies on aging in the state for program management and delivery, were in fact fully integrated into the AIS service array in years prior. During the current fiscal year, CBSPs have not been funded but remain in the CA Welfare & Institutions Code. The forecast for resumption of program funding is not known and therefore program reintroduction to the community is uncertain. The one exception to this funding situation is the Linkages case management program. Its CBSP funding is no longer available but the format and service outcomes of this program remain open due to other internal funding arrangements that make it possible.


SECTION FOUR PLANNING PROCESS / ESTABLISHING PRIORITIES

Strategic planning by AIS is conducted within a policy framework established by the County Board of Supervisors, and is an ongoing effort involving and drawing upon several sources, including: AIS staff AIS Advisory Council Older adults Professionals in the aging network Persons with disabilities Contractors/Providers Health and Human Services Agency staff Other interested individuals Aging Summit Events Seven biennial Aging Summits have been held since 1998. Hosted by Board of Supervisors members Pam Slater-Price and Dianne Jacob, the summits have provided a forum for a wide spectrum of stakeholders to come together and propose new approaches for strengthening and enhancing the quality of life for the aging population and those with disabilities. Attendees included seniors, persons with disabilities, service providers, community leaders, and members of the AIS Advisory Council. A summary of the Aging Summits can be found in Section 2. Seven Aging Summits have been held in San Diego County. Hosted by Supervisors Pam Slater-Price and Dianne Jacob, the Summits began in 1998 with two hundred participants. The First Summit -- dealt with the daunting issues of the rapidly aging population and increasing need for services. Issues discussed were:

Outreach and education to the senior and disabled communities Community-based long-term care Transportation and access to health and social services Older volunteer opportunities in community services

Aging Summit 2000 -- Attended by over three hundred participants (300). Primary topics: Health and longevity Baby Boomer awareness Transportation and access to health and social services Intergenerational programs

Aging Summit 2002 -- Attended by more than four hundred participants (400). Primary topics:

Family Caregiving Housing Life Options

Aging Summit 2004 – Attended by over six hundred participants (600). Primary topics:

Aging Well Rethinking Retirement Marketing a Positive Image of Aging


Aging Summit 2006 – Attended by over eight hundred (800) participants. Primary topics: Maturing Workforce Older Adult Obesity Older Adult Mental Health

Aging Summit 2008 – Attended by over 2,400 participants at two sites. Lifelong learning was the theme of this Summit, with a particular focus on the following four subtopics:

Volunteerism, Personal Enrichment, and Civic Engagement Improving Access to Learning and Information Retraining for Work Learning to Advocate for Health and Wellbeing

Aging Summit 2010 -- Attended by 2,000 participants and dealt with the issue of Technology with the following subtopics:

Tech tools and devices Tech 101 Beneficial Technology for Healthcare & Caregivers Social Uses of Technology

The seven Aging Summits have resulted in several key developments for AIS. With support from the Board of Supervisors, AIS has been able to make significant progress on a variety of programs and services for older adults and persons with disabilities:

Expansion of the Call Center and establishment of the 800-510-2020 number Creation of the Outreach and Education staff One-time funding to enhance local transportation for older adults and persons

with disabilities Authorization for AIS to develop Community Action Networks (CANs) Expansion of media outreach to seniors Introduction of a television program on health and fitness for seniors Weekly call-in radio program on senior and disabled issues Symposia on intergenerational programs Expansion of health and fitness programs for seniors Creation of Life Option Centers to provide new opportunities of seniors in their

communities Initiation of Intergenerational programs within the region Baby Boomer awareness programs integrated into various AIS programs, senior

centers, intergenerational programs, and County publications Participation in community partnerships including the Caregiver Coalition, the

Senior Homeless Prevention Collaborative, and the South Bay Life Options Center

Development of the Mature Workforce Initiative to address challenges older workers face in the workplace

Collaboration with Public Health to review the Childhood Obesity plan and determine appropriate actions to take to address older adult obesity

Partnership with the National Alliance on Mental Illness (NAMI) to create a video on depression/suicide in seniors

Launching the TEAM SAN DIEGO initiative, in conjunction with George Mason University, and the University of California at San Diego (UCSD) Extension, which educates health and social service providers on the need for a team-


based, integrated model of health and social service delivery for older adults and those with chronic conditions

Development and planning of a month-long “learning festival” event in partnership with county libraries to generate enthusiasm for learning and to introduce seniors to new possibilities for staying mentally and physically engaged

Continued partnership with county libraries to host events, share resources, and increase publicity regarding programs and services available to seniors

Development of a Technology Coalition to help increase educational opportunities for older adults pertaining to computers and other technologies

2012 Survey of Older Adults Living in San Diego County - The San Diego Association of Governments (SANDAG) conducted the survey and submitted a report to AIS. The methodology, summary of results, and issues of concern may be found in Appendix A. Public Hearings – Four Public Hearings were held in February and March 2012. A fifth hearing was held at the May 2012 Advisory Council meeting. The hearings were conducted by the AIS Advisory Council representatives of the Area Plan Workgroup, AIS Assistant Deputy Directors, and other AIS staff. AIS Strategic Planning – Aging & Independence Services developed a five-year Strategic Plan beginning in 2009 to coincide with the Goals and Objectives in the 2009-2012 Area Plan. Five workgroups were created to address the following topics: Access, Care & Treatment, Preparedness & Response, Prevention, and Protection. Baselines performance measures were set up in FY 08-09. The Strategic Plan includes existing Mission and Vision Statements, mandated services, and results of a recent environmental scan and SWOT analysis. The Strategic Plan is another tool that helps AIS identify needs and priorities and monitor outcomes (See Appendix B). Information for ongoing planning purposes and establishing priorities is gathered from several groups, including: Long-Term Care Integration Project Planning Committee – comprised of more than 800 consumers, providers, and other key long-term care stakeholders across the array of services, and throughout the care continuum. LGBT -- As part of the needs assessment process for this Area Plan, AIS has consulted with staff from The Center who shared a copy of their recent needs assessment for San Diego’s LGBT senior population, LGBT San Diego’s Trailblazing Generation: Housing and Related Needs of LGBT Seniors. AIS planners and administration also have the 2011 California Lesbian, Gay, and Bisexual Population Report from the Williams Institute for use in the planning process for 2012-2016 (See Appendix F-References). Grandparents Raising Grandchildren Initiative Over 24,000 grandparents in San Diego County are responsible for meeting their grandchildren’s daily needs. Grandparents, along with other kinship caregivers, face unique challenges as they take on the task of being a parental figure later in life. The County of San Diego’s new Grandparents Raising Grandchildren Initiative seeks to educate and inform grandparents about available services as well as obtain input about the unmet needs of this population. The Initiative began with an educational event on April 21, 2012. At that time, a new “toolkit” for grandparents and other kinship caregivers was unveiled. In the months to come, efforts will focus on identifying the needs of this population and working together with a diverse group of government and community organizations to develop solutions.


Other Means for Obtaining Public Input In addition to the many standing advisory and planning entities affecting the planning process and needs assessment activities, AIS has utilized other vehicles for obtaining public input, seeking the widest possible array of opinions and gathering information about the needs of older adults and disabled individuals. Some of the more significant are: AIS Participation in Community Meetings and Planning - AIS staff are involved in community and committee meetings and other activities that bring input into the planning process. Examples include the Elder and Senior Subcommittee of the Regional Center for Developmental Disabilities, the Long Term Care Integration Program Planning Committee, Citizens Corps Council, Senior Affairs Advisory Board (SAAB) (City of San Diego), Consolidated Transportation Services Agency (CTSA), the Veterans and Retired Senior Volunteer Program Advisory Boards in addition to the AIS Advisory Council and IHSS Advisory Committee. AIS also hosts four regional Community Action Networks as well as coordinating Elder Abuse Councils in the County. Highlights and Accomplishments Please refer Appendix D to see a list of accomplishments.


SECTION FIVE NEEDS ASSESSMENT ACTIVITIES

To ensure complete representation of all populations in the PSA, Aging & Independence Services (AIS) used several methods to gather information to identify needs and resources, and for establishing priorities, goals and objectives. Data sources included: the Survey of Older Americans Living in San Diego County, the San Diego County Senior Health Report (See Appendix F-References), testimony from the public hearings, written testimony, follow-up from the Aging Summits, LGBT San Diego’s Trailblazing Generation: Housing & Related Needs of LGBT Seniors, demographics from SANDAG, input from AIS staff and volunteers, San Diego Region members of the California Senior Legislature, and input from various committees and groups (described in the Planning Process section of this plan). Using these convergent methods gave a more complete picture of the needs and concerns of seniors and persons with disabilities in San Diego County. The AIS Advisory Council, representing a wide range of community interests within the senior and disabled population of San Diego County, and its Area Plan Subcommittee, were active in the planning process. The subcommittee assisted the planner by providing input into the public hearings and the planning process. Members of the Advisory Council participated in the hearings. Survey— Surveys are a useful tool for capturing representative information about a population. The San Diego Association of Governments (SANDAG) conducted the Survey of Older Americans Living in San Diego County in January 2012. The survey was mailed to a random sample of persons 60 years of age and over in San Diego County. Questions were drawn from the core questionnaire developed by the California Department of Aging and the Health Assessment developed by the Social Health Maintenance Organization for the federal government. In addition, members of staff and the AIS Advisory Council participated in shaping survey questions. In addition, questions pertaining to technology use and health behaviors (smoking, substance use, nutrition, and exercise) were added to align with the County of San Diego’s Live Well, San Diego! Initiative (See Appendix F-References). Several questions were reworded from previous years based on a review and consideration of other survey tools. AIS staff and the AIS Advisory Council reviewed and added questions to the survey. More than half (55%) of the survey respondents were female, which is representative of the region’s 60+ population. The vast majority of respondents were white (80%) with the remaining respondents were Hispanic (8%), Asian (6%), Black (3%), or classified their ethnic affiliation as “other” (2%). This compares to a region-wide age 60-and-over population that is 62-percent white, 15-percent Hispanic, 10-percent Asian, four percent Black, and five percent “other.” Twenty-seven percent of respondents lived alone and five percent receive SSI or SSP. The complete report of findings and methodology of the Survey of Older Americans Living in San Diego County is available from AIS and online: www.sandiego.networkofcare.org/aging. There are many tables that will provide the reader with information on the survey results.


Public Hearings – Five Public Hearings were held to gather input for the Area Plan in February and March 2012. The hearings were held in different regions to ensure that the various communities and targeted populations would be able to attend. Public notice about the hearings was broadcast in several ways: through the largest local newspaper, senior newspapers and magazines, email blasts, and by distribution of flyers to all service delivery regions in the county by AIS staff. Notice was given that Spanish interpretation would be available at all hearings. Every effort was made to give homebound and institutionalized persons the opportunity to give testimony in writing, by email and phone. Notice was sent to long-term care facilities, to organizations that represent persons with disabilities, and with home-delivered meals.

Several key issues were raised at the hearings. Lack of accessible and responsive transportation for seniors and persons with disabilities, especially in rural communities, was a repeated theme. Concerns regarding senior mental health issues, such as suicide prevention, also arose. Affordable housing, a topic of great importance in previous years, was not mentioned at this year’s hearings. However, questionnaires indicate that this need is still pressing for those who do not own their own home. Socialization and activities for seniors was mentioned several times, as well as the power of senior volunteers to help address community needs. Testimony was received pertaining to the special fitness needs of physically disabled adults and the lack of specialized programs to address this population. There was also testimony relating to the need for more education around changes to Medicare and effective health care for older adults. Detailed discussion of the public hearing testimony and other written feedback from the community is included in Section 7. Public notice about the hearings was provided in several ways. Legal notices were placed in the region’s largest local newspaper and information was distributed to local and senior publications. The AIS monthly bulletin also featured information on the hearings. The AIS Outreach & Education team sent email blasts to partner organizations, distributed fliers, and spoke to groups about the hearings. The Community Action Networks and the AIS Advisory Council were active in publicizing the hearings as well. All fliers, press releases and articles stated that written, email and phone testimony would be accepted. Every effort was made to give homebound and institutionalized persons the opportunity to give testimony in writing, by email, and by phone. Notice was sent to long-term care facilities, to organizations that represent persons with disabilities, and with home-delivered meals. In addition, brief questionnaires were emailed out to senior dining sites and provided to community partners through email to allow those who were unable to attend the hearings—or uncomfortable speaking in a public venue—to provide written feedback on their needs (See Appendix C).


The persons who participated in the hearings were representative of all populations in the county. Public hearing locations were specifically chosen so that low-income and minority individuals would have the opportunity to testify. Spanish interpretation was utilized by several participants in the South County hearing while Arabic interpretation was used in the East County. All testimony was recorded and reviewed to identify gaps in services and needs of targeted and special populations. A summary of the hearings is presented in Section 7. Outreach Regarding Services – A major barrier to services in minority and other senior populations is the lack of knowledge about the available programs. Cultural and language barriers, as well as limited financial resources, make it very difficult for many to negotiate the complex service system. (Demographics regarding these barriers can be found in Section 2.) Seniors and their caregivers often do not seek social service information until a serious need arises. Also, if people hear about senior services they likely will not regard it as pertinent to them or their family until that need is present, so they do not retain the information. For these reasons, Area Agencies on Aging are encouraged to prioritize services in an attempt to reach and serve those most in need among the elderly population. Maximum effort is given to outreach activities at AIS to assure that seniors and family members are aware of available services and programs. While the needs assessment did not specifically identify duplicated or underutilized services, lack of knowledge about available services is a common theme that arises at the public hearings. This lack of knowledge is the primary reason why this year’s public hearings began with a brief powerpoint presentation outlining the various programs and services offered at AIS. In addition, whenever there was a question or confusion about programs, AIS staff members took the opportunity to provide relevant information. The AIS Outreach and Education Team continues to make a concentrated effort to reach all communities and populations to describe the services that AIS and other organizations provide. Needs of Persons with Disabilities – The various needs assessment activities established that the needs of adults with disabilities and the targeted populations are the virtually the same as the general 60+ population. During the testimony at the public hearings concerns about transportation, housing, in-home support, affordable health care and medications were voiced by persons with disabilities, active seniors, caregivers, and those from both rural and urban areas. A wide range of services and programs are available to seniors and persons with disabilities in San Diego County. The more than thirty programs administered by AIS include special help and resources for the most vulnerable in our population. These services include the Multipurpose Senior Services Program (MSSP), the In-Home Supportive Services Program (IHSS), Adult Protective Service (APS), Adults in Crisis, and Case Management programs. Direct services are provided through contracts with vendors and agencies, and include in-home support, respite care, meals (senior dining centers and home-delivered), health promotion activities, legal assistance, adult day care, transportation, educational opportunities, employment, money management, and counseling programs. In general, if a San Diego resident is older or disabled, at risk of institutionalization, is low-income, and/or needs help in arranging for appropriate services, AIS can help. Some of the identified needs, gaps in service, and areas of concern are outside the immediate purview and authority of AIS. For example, cost of housing was cited as a concern in the 2012 written feedback. Transportation remains a concern for seniors and persons with disabilities in


San Diego County. Public transportation continues to be limited or non-existent in many of the County’s large rural areas. AIS has the responsibility to work toward positive change in all areas identified as problems by older adults and adults with disabilities. The reader will see that the objectives in this Plan reflect an advocacy role. Although the various needs assessment activities did reveal a few new priorities—such as the increasing need for dental care—many of the findings were consistent with previously identified needs and concerns. Title III B Allocations – The 2012 Survey of Older Americans Living in San Diego County did not contradict the Title III B funding percentages that have historically been proven to meet the needs of our population. Testimony in the five Public Hearings did not necessitate any changes in allocation. The percentage of Title III B funds to be expended in the categories of Access, In-Home Services, and Legal Assistance have been determined to be sufficient to meet the need for these services within PSA 23. Aging & Independence Services continually assesses the allocation of funds to services and will make adjustments if needed. Baby Boomers – AIS began to address the impact of the Baby Boomers several years ago. In 1997, a report was issued on the needs of the increasing senior population and the strategies to meet the needs. In Aging Summit 2000, the issue of the “Age Wave” was discussed. At that time, a committee was formed from the Summit participants to address this important issue. The committee’s findings were recorded and are available to assist AIS staff in planning for the future. The Retired Senior Volunteer Program (RSVP) is targeting Boomers as a recruitment source and working to design materials to reach this population as well as identify sites that would be most appropriate for this population. A recent initiative to help meet the needs of potential Boomer volunteers is the the development of a Web site featuring RSVP opportunities and online enrollment. In addition, the past two Aging Summits have featured topics of particular interest to Boomers, including lifelong learning and technology Demographic information on the growing and increasingly diverse senior population is obtained regularly from SANDAG. This information is available to staff, as well as members of other organizations. During the coming fiscal year and beyond, AIS will continue to take the lead in planning for the needs of different cohorts of seniors, from the baby boomers all the way to centenarians. Key Findings – In the Winter of 2011-2012, the 2012 Survey of Older Americans was conducted by SANDAG to learn more about the concerns of the San Diego region’s older adult population, as well as the population’s familiarity with and use of various service programs. Questionnaires were randomly distributed to 4,000 households with a resident over the age of 60. Forty-four percent (1,757 surveys) were returned. Some of the key findings are highlighted below. The complete survey and findings can be found online (See Appendix F-References).


Health 93% of seniors are nonsmokers 10% of seniors eat 5 or more servings of fruits and vegetables daily 57% of seniors engage in 30 minutes of moderate exercise at least 3 times per week

Mental Health 46% of seniors strongly/somewhat agree that isolation/loneliness affects their quality of life

Medical/Dental 38% of seniors are concerned about being able to afford dental care 30% of seniors are concerned about being able to afford medical care 30% of seniors are concerned about being able to afford vision care 26% of seniors are concerned about being able to afford prescription drugs 26% of seniors are concerned about being able to afford hearing care

Activities of Daily Living 22% of seniors have minor difficulty walking 9% of seniors have serious difficulty or are unable to walk

Home Maintenance 24% of seniors are concerned about major home repairs 30% of seniors need assistance doing minor home repairs 30% of seniors need assistance with yard work

Activities 73% of seniors participate in athletic activities at least once a month 61% of seniors participate in recreation activities or hobbies at least once a month 60% of seniors participate in entertainment activities at least once a month


SECTION SIX TARGETING

The Older Americans Act requires that the Area Plan "provide assurances that the AAA will formulate specific objectives for providing services to older adults with the greatest economic or social needs, and to low-income minority individuals." This requirement assumes that certain populations will receive their fair share of services and is commonly referred to as "targeting" services. Targeted Populations This year, AIS has chosen to adopt the California Elder Economic Security Standard Index (Elder Index) as the measure by which to gauge the true extent of poverty in our County. Unlike the Federal Poverty guidelines which are based on outdated cost of living estimates, the Elder Index provides County-specific guidelines for how much income is needed for a retired adult age 65+ to meet basic needs such as housing, food, transportation, medical spending, and other necessities. The Elder Index was developed by the Insight Center for Community Economic Development at UCLA (See Appendix F-References). Some of the key findings presented in the Insight Center’s report for San Diego County include:

•42% of all elders 65+ do not have enough income to meet their basic needs, as measured by the Elder Index. Over 131,000 seniors in San Diego County are struggling to make ends meet.

•According to the Federal Poverty Line (FPL), only 8% (24,000) of San Diego County elders are considered “poor” (annual incomes below $10,210)

•107,000 elders fall within the “eligibility gap” with incomes above the FPL but below the Elder Index. These elders do not qualify for many public benefits programs but still do not have enough money to make ends meet.


Race and Gender According to the Insight Center for Economic Development:

•50% of elder women living alone in the County are struggling to make ends meet

Although elders of all races/ethnicities are struggling to make ends meet in San Diego County, Latinos, African Americans, and Asian elders are most affected:

•75% of elder Latinos have incomes below the Elder Index

•63% of elder African Americans have incomes below the Elder Index

•56% of Asian elders have incomes below the Elder Index


Cultural and language barriers, as well as limited financial resources, make it very difficult for many elders who are minorities to negotiate the complex services system. For these reasons, Area Agencies on Aging are encouraged to prioritize services in an attempt to reach and serve those most in need among the elderly population. Other Populations In addition to low-income and minority seniors, the Older Americans Act designates other groups to be "targeted" for provision of services:

1. Older individuals with the greatest economic need, with particular attention to low-income minority individuals. The term “greatest economic need” means the need resulting from an income level at, or below the federal poverty line.

2. Older individuals with the greatest social need, with particular attention to low-income minority individuals. The term “greatest social need” means the need caused by non-economic factors, which include:

a. Physical and mental disabilities; b. Language barriers; and c. Cultural, social or geographical isolation, including isolation caused by racial or

ethnic status that: (1) restricts the ability of an individual to perform normal daily tasks or (2) threatens the capacity of the individual to live independently.

3. Older Native Americans. 4. Isolated, abused, neglected, and/or exploited older individuals. 5. Frail older individuals. 6. Older individuals residing in rural areas. 7. Older individuals who are of limited English-speaking ability. 8. Older individuals with Alzheimer's disease and related disorders with neurological and

organic brain dysfunction, and their caregivers. 9. Older individuals with disabilities, with particular attention paid to individuals with severe

disabilities. 10. Unemployed low-income individuals who are 55 years of age or older (Title V).

Efforts to identify the targeted populations in PSA 23 include maintaining current demographics on the area and gathering information from the AIS Advisory Council, the California Senior Legislature, the AIS Outreach and Education Team, Community Action Networks, Public Hearings, and the Survey of Older Americans Living in San Diego County. In addition, the AIS Advisory Council strives to maintain a membership that is representative of the targeted populations. (See Section 17, Advisory Council.) As reflected in the testimony from the four public hearings, written feedback from seniors, and the other assessment methods, the needs of this population include, but are not limited to: Affordable, appropriate housing Increased public transportation Providing rural transportation Financial assistance with health care and medication Overcoming language and cultural barriers Socialization and activities Medication management Concern over perceived inequalities in Veterans’ benefits


Every effort was made to allow targeted populations to have input into the needs assessment and planning activities. The Survey of Older Americans Living in San Diego County was sent to a random sample of persons 60 and over. Notification of the Public Hearings appeared in the region’s largest newspaper, several local papers, and the Spanish speaking press. Flyers about the Public Hearings were made and distributed throughout the county by the following methods:

• AIS Outreach and Education Team • Community Action Networks • Congregate Meal Sites • Home-Delivered Meals • Senior Centers • San Diego Center for the Blind • Deaf Community Services of San Diego • Access to Independence • Regional Center for Development Disabilities • AIS Advisory Council • San Diego Region California Senior Legislature

To provide residents of long term care facilities the opportunity to submit written testimony, notification of the hearings and how to send written, emailed or phone testimony was sent to Senior Complexes, Long-Term Care and Skilled Nursing Facilities. Information about written, emailed, or phone testimony was included in all of the flyers and newspapers. Minority older persons are unevenly distributed throughout the county. The South Suburban Major Statistical Area (MSA) has the greatest concentration of 65+ minority individuals with 63.2%, followed by Central MSA (55.2%), North County East (28.1%), North City MSA (26.8%), East Suburban (26.7%), East County (25.5%), and North County West (23.8%) (SANDAG, 2012). The percentage of 65+ persons who belong to a minority racial/ethnic group has been rapidly increasing across all areas of San Diego County in the past decade (See chart below).

Percentage of 65+ who are Minorities (2012)

Percentage of 65+ who are Minorities (2000)

South Suburban 63.20% 49.50% Central 55.20% 40.60% North County East 28.10% 12.50% North City 26.80% 15.90% East Suburban 26.70% 12.90% East County 25.50% 11.40% North County West 23.80% 12.90%

AIS services and programs are offered to the entire senior and disabled population of PSA 23. The AIS Call Center provides access to services and programs through the toll-free number, and translation services are available. Adult Protective Services, IHSS, and Case Management workers are stationed in several areas of the county to provide easy access to prevention and assistive services and programs. Translation services are provided in all languages. The “targeted populations” of PSA 23 are well served.


Methods to Address Needs

AIS has traditionally been at the forefront in addressing the needs of socially and economically needy seniors. The results of two projects in previous planning years, funded by research grants from the Administration on Aging to study special ways to meet the needs of minority elderly, show that there is not a single approach which is sufficient in assuring a proportionate share of services to older needy persons. Therefore, Aging & Independence Services has implemented a regularly monitored, multifaceted strategy that includes:

hiring of older, minority and bilingual staff and volunteers; adequately representing targeted groups in the Advisory Council;

locating senior centers and congregate nutrition sites in areas of minority and low-income concentration;

contracting with minority service providers; including language provisions, terms and conditions in service providers' contracts

requiring minority and low-income targeting; monitoring and reviewing service providers' performance in serving minorities; including minority related objectives in the Area Plan; collecting and disseminating demographic data on the minority elderly in the county; including minority, low-income and refugee populations in outreach efforts; responding to the public via Call Center program intake procedures utilizing multi-

cultural, bi-lingual staff and the Language Line for translation; serving low income, minority seniors in all case management services or programs, In-

Home Supportive Services, and Adult Protective Services; providing access for non-English speakers to information and assistance through the

use of Spanish speaking staff in the AIS Call Center, as well as through the use of the Language Line for interpretation services;

preparing outreach materials in other languages and distributing these in the community developing new initiatives to meet the unique social and economic needs of

grandparents raising grandchildren To assure that older individuals with the greatest need are being served, AIS has included objectives in this Area Plan that specifically address the need for information about services and programs as well as the nutrition needs of low-income minority and other targeted groups.


SECTION SEVEN PUBLIC HEARINGS

At least one public hearing must be held each year of the four-year planning cycle.

CCR Title 22, Article 3, Section 7302(a)(10) and Section 7308, OAA 2006 306(a)

The following must be discussed at each Public Hearing conducted during the planning cycle:

2 A translator is not required unless the AAA determines a significant number of attendees require translation services. 3 AAAs are encouraged to include individuals in LTC facilities in the planning process, but hearings are not required to be held in LTC facilities.

Fiscal Year Date Location Number of Attendees

Presented in languages other

than English? 2

Yes or No

Was hearing held

at a Long-Term

Care Facility? 3

Yes or No

2012-13 2/8/12 George L. Stevens Senior Community Center

50 Spanish Interpretation Available

NO

2012-13 2/16/12 Poway Senior Center 20 Spanish Interpretation Available

NO

2012-13 2/29/12 Kimball Senior Center 65 Spanish Interpretation Available

NO

2012-13 3/7/12 Salvation Army Senior Nutrition Center, El Cajon

34

Spanish and Arabic Interpretation Available

NO

2012-13 5/14/12 Aging & Independence Services 26 NO NO

2013-14

2014-15

2015-16


1. Summarize the outreach efforts used in seeking input into the Area Plan from institutionalized, homebound, and/or disabled older individuals. See Attached

2. Were proposed expenditures for Program Development (PD) and Coordination (C) discussed?

Yes. Go to question #3

Not applicable, PD and C funds are not used. Go to question #4

3. Summarize the comments received concerning proposed expenditures for PD and C

No comments were received concerning proposed expenditures.

4. Attendees were provided the opportunity to testify regarding setting of minimum percentages of Title III B program funds to meet the adequate proportion funding for Priority Services

Yes. Go to question #5

No, Explain:

5. Summarize the comments received concerning minimum percentages of Title III B funds to meet the adequate proportion funding for priority services. See Below

6. List any other issues discussed or raised at the public hearing. See Below


7. Note any changes to the Area Plan which were a result of input by attendees. See Below

NOTIFICATION OF PUBLIC HEARINGS Notification of the AIS public hearings appeared in the region’s largest newspaper and several local papers, including those serving the Spanish-speaking population. Paper and electronic fliers were made and distributed throughout the county by the following methods: AIS Outreach and Education team AIS Advisory Council AIS Bulletin Community Action Networks Senior Centers Congregate Meal sites Home-Delivered Meals San Diego Center for the Blind Deaf Community Services Access to Independence Regional Center for Developmental Disabilities San Diego Regional California Senior Legislature Senior housing complexes

To provide residents of long-term care facilities the opportunity to submit written testimony, notification of the hearings and instructions for written testimony were sent to registered long-term care facilities and skilled nursing facilities in the county. Information about written testimony was also included in fliers and newspaper announcements so that all residents would have the opportunity to provide input regarding senior issues and concerns. In addition, residents were given the opportunity to submit 3-minutes of feedback by telephone voicemail. Email testimony was also accepted. Additionally, a brief feedback questionnaire was sent out to all senior centers and distributed through email networks to allow seniors to provide feedback on their priorities and concerns. Over 300 questionnaires were returned. SUMMARY OF THE PUBLIC HEARINGS Robert Prath, former Chair of the AIS Advisory Council and the Area Plan Subcommittee presided over the first three of the five public hearings. Kathy Randall, Chair of the Area Plan Subcommittee, presided over the fourth and fifth public hearing. All hearings began with a welcome from the presiding Council member and a brief explanation regarding the Area Plan and the reason for the hearings. This was followed by a brief presentation about Aging & Independence Services and a review of the budget, including Adequate Proportion and Program Development and Coordination. Next, the public was invited to give testimony. Topics that arose from verbal public testimony, as well as testimony from feedback questionnaires, letters, email, and voicemail is summarized below.


Transportation: The lack of reliable and flexible transportation remains a challenge in many parts of San Diego County, but particularly in the rural parts of East County beyond Alpine and in communities to the northeast such as Valley Center. Some of these areas lack paratransit as well as regular bus service. Medical transportation was listed as particularly important need, as well as transportation to the grocery store and other essential places of business. Despite the presence of several new innovative transportation services in the more urban areas of the county, many seniors are still in need of affordable and accessible transportation. Funding for Programs: Citizens are concerned about ongoing funding challenges in California, in particular with regards to IHSS. Others noted the need for a continuation of funds dedicated to senior citizen centers rather than to organizations that serve many populations. Several individuals spoke about their hope that some of their favorite programs would continue to receive funding, including the Food for Thought program as well as other library-based educational opportunities. Medicare/Medi-Cal/Social Security: It continues to be a time of great change for Federal and State benefits programming. Seniors expressed their uncertainty regarding how changes on the political and funding fronts would impact programs such as Medicare, Medi-Cal, and Social Security, and how proposed changes to these programs would affect them directly. They spoke about the need to have “listening sessions” in the community to discuss the issues and to have better ways of getting their questions answered. Housing: Verbal and written testimony indicated that housing remains a pressing issue for seniors in San Diego County. Many people expressed concern about rising rents and the need for suitable affordable housing for seniors. LGBT-friendly housing remains a concern for the aging LGBT population and few options currently exist that meet this population’s need. The AIS Advisory Council plans to look further into the issue of housing. Resources for Persons Who are Hard of Hearing: As in previous Area Plan cycles, seniors continue to express concern that resources and programming for those who are hard of hearing are difficult to access. Many seniors have to travel dozens of miles in order to access resources available in the La Jolla region. A continued hope for decentralized, community-based options was expressed. Senior Center Programming: Many seniors wish to see enhanced programming at senior centers including more recreational and fitness activities. Seniors affirmed that senior centers provide them with vital services such as meals, socialization, educational opportunities, fitness, and many other activities that help them to maintain a sense of purpose, independence, vitality, and community.


Fitness Programming: Testimony was receiving pointing out the limited options for physically disabled seniors in the San Diego area. A suggestion was made to provide funding for specialized gyms/health centers similar to the Challenge Center whereby physical therapists could help create customized programs for individuals with special needs. In addition, testimony was received to encourage AIS to have two levels of Feeling Fit classes—a new, more advanced class for more active or younger seniors in addition to the existing classes. Nutrition Center Meals: A surprising number of written comments were received regarding a reduction in meal quality at various nutrition sites. Respondents noted that attempts by the County to cut costs have resulted in less palatable meals. In addition, respondents wanted to see more healthful foods on the menu such as a variety of fresh fruits and vegetables. Some seniors noted the need for weekend and holiday lunchtime meals. Finally, comments were made regarding the low quality of holiday celebration meals at some sites (i.e. turkey luncheon meat at Thanksgiving rather than a roasted turkey). Dental: The need for affordable dental care was mentioned via the 2012 Survey of Older Americans Living in San Diego as well as through written testimony. This need appears to be more pressing than in previous years. In response to this unmet need, the AIS Advisory Council has opted to investigate the issue and explore advocacy solutions. They have committed to making this issue a new objective within the Area Plan. Other Issues Mentioned: Need for more service coordinators at senior housing communities to help connect seniors

with resources More intergenerational learning opportunities Increase access to affordable Internet in seniors’ homes Concern over “chem trails” (the fear that pollutants are being intentionally put into the

atmosphere by planes) Complaints regarding Housing & Urban Development (HUD) and the Department of

Housing More restrooms close to bus lines Desire for Bible study programs Increase in educational programming covering ethnic/cultural activities Putting the skills of seniors to work through paid and volunteer opportunities


SECTION EIGHT IDENTIFICATION OF PRIORITIES

When administering federal funding, some priorities are predetermined by the legislation establishing the programs. This is the case with Older Americans Act revenue. Here is a brief description of the funding categories and programs where monies are allocated: - Congregate Nutrition (Title III C-1): This program receives by far the largest allocation of funding, which includes a reimbursement from USDA and a substantial amount of donated contributions from participants. - Home-delivered Meals (Title III C-2): Self-explanatory, with most programs operating in conjunction with congregate nutrition centers. - Ombudsman Program (Title VII - Vulnerable Elder Rights Protection Activities): Funding in support of residents of long term care facilities. - Supportive Services (Title III-B): - These services include information and assistance, in-home assistance, legal assistance, transportation and other types of supportive services to decrease isolation and help individuals remain in their homes.

"Adequate Proportion Services" (Title III-B): Thus called in the Older Americans Act because it requires that minimum percentages be spent on a regular basis. Reductions in the percentages of funds allocated to these services are only possible after consultation with the community and with a thorough documentation of sufficient services in the area provided by other sources.

The percentage of Title III B funds to be expended in the categories of Access, In-Home Services, and Legal Assistance have been determined to be sufficient to meet the need for these services within PSA 23. Aging & Independence Services continually assesses the allocation of funds to services and will make adjustments if needed. In addition to funding, there are other mandates that the Older Americans Act establishes for Area Agencies on Aging. As part of its requirement, AIS is to "serve as the advocate and focal point for older individuals in the community" and to "establish a comprehensive and coordinated system of services". This second group of priorities relates to the program development, advocacy and coordination activities of the agency. They summarize the ideas expressed in public hearings, in committees and groups and reviewed in meetings between staff and Advisory Council members. Many of these priorities could be better called challenges because they are the result of major increases in the senior population due to the aging of the Baby Boomers and seniors living longer. Funding is expected to decline; therefore, dollars available in relation to numbers of seniors will significantly decrease. Section 9, Goals & Objectives, describes the priorities that have been established through the 2012-2016 Four-Year Area Plan planning process. To address priorities that cannot be adequately funded with existing allocations, AIS staff is involved with community and committee meetings and other activities. The AIS Advisory Council is active in local efforts to address the issue of appropriate, affordable housing for seniors. To meet the challenges, AIS staff and Advisory Council will:


Advocate for new sources of funds Develop funding to supplement existing programs and enable new programs. Explore untried public and private sources for senior grant funds and seek support from private sector community organizations and businesses. Challenge creativity that attracts younger seniors into AIS programs Provide a reason to get younger seniors to help organize and participate in AIS programs. AIS must have "seniors helping seniors" to exist and to grow. Improve the knowledge and community awareness of the existing senior network in our county Increase public relations and community education efforts aimed not only at seniors but also at their caregivers. Support community-based efforts to solve housing issues

Continue Advisory Council collaboration with the County of San Diego Housing and Community Development Department and the Council’s representation of senior issues to housing commissions. Participate in local collaborative efforts to identify and plan for unmet needs and services

Provide support and coordination to four Community Action Networks. AIS will meet Older Americans Act targeting mandates by continuing to provide services in the communities where the target market resides. For example, nutrition services target low income and minority residence areas to provide better access to these services. This is also the case as it relates to the many rural communities that San Diego County has. AIS will also continue to outreach to the targeted populations in their own communities in the language in which they speak. Overall, AIS maintains offices and a presence in all parts of the county, which enables us to reach and provide access to the targeted population that AIS needs to reach. This includes all AIS’ mission services of Advocacy and Protection, Health Independence, Home-Based Services, Enrichment and Involvement and Caregiver Services. Both the needs assessment and public hearings influenced the priorities set out by AIS to meet the target market. As mentioned before, nutrition services, congregate and home-delivered meals, supportive services; caregiver and other Title III services were the identified priorities. These services are set up to provide services to low-income senior and minority consumers where they reside, as well as the rural areas within San Diego County. The factors that influence prioritization in San Diego County are Board of Supervisors policy directives, Federal and State guidelines for revenue utilization, and public input including the Public Hearings, Aging Summits, Community Action Networks, and the AIS Advisory Council and other advisory groups.


AIS uses its knowledge of all programs and services in our PSA to maximize resource allocation. An effective use of this can be seen in AIS development and coordination of the four regional Community Action Networks. These regional aging networks bring together providers, stakeholders and others to identify and provide solutions to the needs of those regions. Having these networks in place amplifies the effects of AIS in meeting the needs of the targeted mandates. Instead of AIS alone providing services to the community, we coordinate with hundreds of organizations, all of which come together to plan and provide for the needs of seniors and persons with disabilities in our county. Additionally, these networks are also representative of the diversity that is San Diego County. This only serves to strengthen the commitment to serve those targeted populations that have been identified.


SECTION NINE AREA PLAN NARRATIVE GOALS & OBJECTIVES


PD -- Program Development C -- Coordination (Unless otherwise stated, these objectives will involve AIS staff time)

GOAL 1 Outreach and Access

Provide information and access to services for older persons and disabled adults to the maximum extent possible and expand upon the existing network of services to enhance communication.

RATIONALE Information about aging and disabled services should be provided to older persons and the community to the fullest extent possible in order to encourage participation in those activities most likely to enhance successful aging. Furthermore, Information & Assistance (I&A) is a core function of an Area Agency on Aging, as prescribed by the Older Americans Act and AIS bears a federal designation as an Aging & Disabilities Resource Connection (ADRC).

# OBJECTIVES PROPOSED

START & END DATES

FUND STATUS

1.1

Provide Information and Assistance through the Aging & Independence Services (AIS) Call Center 800 number, to 1,200 callers per month or greater. The outcome will be measured by the AIS Call Center call management system.

July 1, 2012 to

June 30, 2013

New

1.2

Create a new automation system for AIS that will also allow for web reporting of elder/dependent adult abuse, web referrals for IHSS and Case Management Programs and improved response to information and assistance callers. Outcome will be measured by the deployment of the new system in FY 12-13.

July 1, 2012 to

June 30, 2013

New

1.3

Outreach & Education staff will meet with a minimum of thirty-six community-based organizations providing services to rural, low-income, or minority communities to provide them with information and assistance to enable enhanced services and resources to the communities they serve. Outreach & Education staff will document the number of meetings and the number of minorities, refugees, and low income clients reached through these targeted outreach efforts.

July 1, 2012 to

June 30, 2013

New

1.4 Provide 180 round trips for non-emergency medical and other essential transportation. The outcome will be measured by client records maintained by AIS staff through SOAR.

July 1, 2012 to

June 30, 2013

New




(cont.)

1.5.a

Represent AIS and ensure that the needs of the older adult population are represented by serving as an appointed member to the Social Services Transportation Advisory Council (SSTAC), a body which fulfills the statutory requirements of the California Transportation Development Act (TDA) convened by the San Diego Association of Governments (SANDAG) -- the local Regional Transportation Planning Agency (RTPA) – and is also responsible for the creation and revision of the Coordinated Plan 2012-2016, which qualifies the area for special federal transportation funding.

July 1, 2012 to

June 30, 2013 C New

1.5.b

Participate on SSTAC in the continued formulation of the SANDAG competitive grant program for the Senior-Mini Grant fund and other funds by developing and proposing a three tiered construct into a future Coordinated Plan revision that would (a) budget available funds based upon the prescribed hierarchy priorities on a percent (%) or specific dollar ($) basis; (b) define and recognize multiple distribution models that meets the test of competition; and, (c) introduce one or more funding allocation and dollar distribution methods that achieves inclusion of same-mode service providers [i.e. volunteer-driver programs] based upon performance data, or fixed pricing, to further the goal of efficient use of funds and the outcome of uniform geographic coverage.

July 1, 2012 to

June 30, 2013 PD New

1.5.c

Participate on the Technical Advisory Committee (TAC) of the Consolidated Transportation Service Agency (CTSA) for San Diego County, which is designated by SANDAG, and is known by its incorporation as Facilitating Access to Coordinated Services (FACT). AIS will attend or otherwise participate and assist in a variety of planning functions, including board and community committee meetings to improve systems and services related to mobility and access. This may include participation in strategic planning and business plan implementation of FACT. The overall outcome will be the development of a coordinated system that improves transportation access for seniors and persons with disabilities.

July 1, 2012 to

June 30, 2013 C New




(cont.)

1.5.c (cont.)

This will be measured by the number of private/public (not mass transit) programs working together beyond current jurisdiction, funding, and eligibility confines, and the number of riders that benefit. Special focus and attention will be in fostering growth in the transportation service brokerage serving Escondido & Rancho Bernardo & Poway corridor which was piloted March 17, 2012, which will be subsumed by the MedRide slated for implementation serving a larger scope of San Diego County.

1.5.d

Serve as staff liaison to the AIS Call Center management regarding updates to transportation service developments available through FACT and other offerings that are occurring with SANDAG program awards funded by federal New Freedom, Job Access & Reverse Commute (JARC), and local Senior Mini-Grant funds to enable the outcome of the greatest number of mobility options being made known to caregivers and the older population.

July 1, 2012 to

June 30, 2013 C New

1.5.e

Maintain a posture of education and advocacy at SSTAC and in the community for the non-emergency medical transportation (NEMT) aspect of rides and the means of delivery through either the current SANDAG award made to FACT, to be known as the MedRide brokerage getting seniors to medical and health service site destinations and back, as well as the relation of NEMT and its importance within Long-Term Supports and Services (LTSS) integration component of the State’s Coordinated Care Initiative, which aims to avoid institutionalization and may include reduced hospitalization.

July 1, 2012 to


1.5.f

Serve on the California Department of Aging Mobility Management Workgroup comprising Area Agency on Aging (AAA) and Independent Living Center (ILC) representatives in order to (1) identify transportation needs of older adults and those with disabilities; (2) develop strategies and actions to advance local mobility management capacity; (3) develop statewide plans to implement and sustain these activities; and (4) collaborate with others in the aging, disability, and transportation networks.

July 1, 2012 to





(cont.)

1.5.g

Provide references and analysis as needed or pertinent to the transportation budget allocation process within the AIS contracts section, its fiscal agents, and County contracting representatives to determine alternative recommendations in procuring transportation for seniors to dining sites via new transportation brokerage services being introduced by FACT, (the CTSA). The outcome fulfills the intent of federal Executive Order #13330, which promotes the serving of other populations outside of traditional scopes of work by federally funded providers and contributes to a broader set of transportation options for the community.

July 1, 2012 to

June 30, 2013 C New

1.5.h

Provide appropriate references and analysis as needed or pertinent to the transportation budget allocation process within the AIS contracts section, its fiscal agents, and/or County contracting representatives, to determine the alternative options available to AIS contractors that enable them to procure vehicles directly by utilizing resources competitively available, for example through Caltrans (federal/state funds), enabling the traditional AIS transportation role in capital asset acquisition to be redefined and to transition to a participation via a match to contractors as may be required in pursuit of such awards. The rationale and outcome of this is the improved effectiveness of the AIS transportation and nutrition budget that is encumbered for capital-side support to ensure vehicle availability with cost savings enhancing respectively the operation-side of provision of one-way trips for senior meal participants, or meals served at dining sites, or both.

July 1, 2012 to

June 30, 2013 C New

1.6

Streamline access to services with a primary focus on home and community based alternatives through the Aging and Disability Resource Connection (ADRC). In line with the state’s new designation criteria for ADRCs, the network of core and extended partners will be expanded to collectively facilitate access to core ADRC services.

July 1, 2012 to




GOAL 1

Outreach and Access (cont.)

1.7

AIS will enhance communication among its workforce through the Monthly & Miscellaneous (M&M) newsletters, quarterly leadership team meetings, annual All Staff meetings, and through the AIS SharePoint website. Maintaining a strong and focused management leadership team will benefit both the Agency and community partners. This outcome will be measured by continuing both leadership/all-staff meetings and employee communications.

July I , 2012

to

June 30, 2013

New

1.8

AIS staff will meet with community partners and local governments to address the built environment as an avenue toward improving the health of all constituents. AIS will utilize expertise gained at the MetLife Foundation Partners for Livable Communities training to provide TA to jurisdictions, specifically the City of La Mesa, wishing to make improvements to the built environment, especially those related to assisting older adults to “Age in Place”.

July I , 2012

to

June 30, 2013

New

1.9

Hold annual outreach events for community participants (Aging Summit (even years) & Vital Aging (odd years). Outcome will be measured by attendance at event and action plans created after the events.

July I , 2012

to

June 30, 2013

New

NOTES:



GOAL 2 Health, Fitness and Nutrition

Facilitate a countywide system of health and longevity programs to provide consumer education and access to health promotion, mental health services, fitness classes and nutrition programs.

RATIONALE As the aging population increases in size and longevity, all indicators point to the growing population as a whole, with less physical disability, but with more chronic conditions. Providing nutrition services and educating older adults about mental and physical health promotion and disease self-management, injury prevention, and fitness will be the most efficient and effective means of maximizing the quality of life for the greatest number of older persons. This goal is in concert with “Live Well, San Diego!” a comprehensive campaign involving all divisions of the County Health and Human Services Agency (HHSA), and it is closely aligned with the first phase roll-out known as Building Better Health.


START & END DATES

FUND STATUS

2.1.a

Health Promotion staff will promote, conduct, and maintain attendance at a minimum of 20 Feeling Fit exercise classes offered at senior centers and other locations. Health Promotion staff will track the number of classes offered and the number of participants.

July 1, 2012 to

June 30, 2013 New

2.1.b

Health Promotion staff will educate 250 seniors through delivery of evidence-based health promotion programs including Chronic Disease Self-Management programs and Diabetes Self-Management among others. Health Promotion staff will track the number of participants who complete the established standard minimum number of classes for the program.

July 1, 2012 to

June 30, 2013 C New

2.1.c

Each fiscal year, a minimum of 100 older adults will participate in depression screenings with the goal of being directed to a physician for follow up for those with scores indicating moderate symptoms. AIS staff will track the number of events, the number of participants, and the number of referrals.

July 1, 2012 to

June 30, 2013 C New

2.1.d

Health Promotion staff will lead a collaborative of agencies in monthly Health Promotion Committee meetings and Fall Prevention Task Force meetings to discuss, plan and develop programs directed towards health, fitness, and active independence as a means to improve well being and longevity of older adults, Health Promotion staff will track the number of meetings and programs/initiatives developed.

July 1, 2012 to

June 30, 2013

PD C New



GOAL 2

Health, Fitness and Nutrition (cont.)

2.1.e

Educate seniors and the general community about the health indicators associated with aging, in an effort to promote the benefits of healthy living on the aging process. The outcome will be measured by the production and distribution of the Senior Report Card.

July 1, 2012 to

June 30, 2013 C New

2.2.a

Ensure that all targeted populations are provided nutrition services. Compliance will be monitored by the AIS contracts unit. The outcome will be measured by determining compliance of the nutrition contracts held by AIS.

July 1, 2012 to


2.2.b

The More On the Menu (MOM) program will supplement daily home-delivered meals provided by the Title IIIC2 program to homebound seniors with a weekly delivery of fresh fruits and vegetables. Included with the delivery of produce will be healthy cooking tips and nutritional education about the importance of fresh fruits and vegetables in improving health and successful aging. The outcome will be measured by the number of MOM bags distributed to homebound seniors.

July 1, 2012 to

June 30, 2013 New

2.2.c

Utilize Title III C-1 and C-2 funds (when available) for equipment, refurbishment of a senior nutrition site, and/or the purchase of meal-delivery vehicles (Hot Shots) as necessary to provide maximum nutrition services to targeted populations in PSA 23, San Diego County. The outcome will be maintaining and improving nutrition services for low-income and other seniors. Evaluation of the outcome will be monitored by AIS Contracts staff.

July 1, 2012 to

June 30, 2013 New



2.3

Participate in the Older Adult Mental Health System of Care Council (OAMHSOCC) to contribute in all phases of planning and implementation of the Mental Health Services Act, and to ensure that the needs of mentally ill seniors are reflected in program design and service delivery. The outcome will be measured by the inclusion of OAMHSOCC recommendations in the Mental Health Services Act programs and by ongoing input into service delivery.

July 1, 2012 to

June 30, 2013 New

GOAL 2

Health, Fitness and Nutrition (cont.)

2.4

The AIS Advisory Council will lead an investigative initiative that includes local experts and policy makers to determine why dental care for seniors has emerged as a significant need. The outcome will be presenting the findings and issuing a list of recommendations to address the problem to AIS management.

July 1, 2012 to

June 30, 2013 New

NOTES:



GOAL 3 Caregiver Support

Provide a system of family caregiving and community-based care that will assist older adults with chronic physical and/or mental impairments and their families to maintain maximum independence in the least restrictive environment.

RATIONALE Providing long-term care services in the home has been proven to be an effective and efficient alternative to out-of-home placement for older adults, who have chronic conditions and persons with disabilities. It is crucial that we build upon and support this system, with a particular emphasis on assisting and stabilizing the family and caregivers. This goal is in concert with “Live Well, San Diego!” a comprehensive campaign involving all divisions of the County Health and Human Services Agency (HHSA), and is closely aligned with the second phase roll-out known as Living Safely.


START & END DATES

FUND STATUS

3.1

Through Family Caregiver Support Program (FCSP) contracts, provide at a minimum 6,000 hours of support services for Family Caregivers, including assessment, counseling, support groups, and case management. Services will be conducted by persons trained and experienced in the skills required to provide the service. FCSP staff will track the number of hours of support provided and the evaluation of services. At a minimum 70% of caregivers will report satisfaction with these services.

July 1, 2012 to

June 30, 2013

New



3.2

Through FCSP contracts, provide a minimum of 10,000 hours of respite for Kinship Caregivers including both in-home and out-of-home supervision. AIS staff will track the number of hours of respite provided, and evaluate services, and encourage an increase in awareness of community support through partnerships related to grandparents raising grandchildren (GRG). At least 70% of kinship caregivers will report satisfaction with the respite service, and at least 70% will report becoming better acquainted with services through community partnerships and materials such as the GRG Toolkit.

July 1, 2012 to

June 30, 2013

New

3.3

The Family Caregiver Support Program (FCSP) will lead a collaborative network of service providers and participant agency representatives in monthly Caregiver Coalition Meetings, in order to plan activities which will benefit Family Caregivers. The Caregiver Coalition will provide a minimum of six “Art of Caregiving” educational events annually

July 1, 2012 to

June 30, 2013 New

GOAL 3

Caregiver Support (cont.)

3.3 (cont.)

to the community. These cooperatively produced workshops will be attended by an average of 50 community members. FCSP staff will track the number of meetings, “Art of Caregiving” events, and the attendance. A minimum of 70% of participants will indicate satisfaction with the meetings.

3.4

FCSP, in partnership with participating Project Care partner agencies, will hold a minimum two County-wide meetings to promote public/private partnerships that will address the needs of frail residents who are vulnerable to isolation and exploitation. AIS staff will track the number of meetings and evaluate their effectiveness. A minimum of 70% of participants will indicate satisfaction with the meetings and report partnerships that are effective and productive.

July 1, 2012 to

June 30, 2013 C New



3.5

Through the Family Caregiver Support Program, AIS staff will arrange a minimum of 16 “Lunch & Learn” webinars annually on topics related to caregiver issues. These webinars will make it possible for caregivers to receive resource information from remote locations and through archived methods in order to lessen the burden of traveling to receive support information. Goal is to reach a average of 15 attendees per session with at least 70% reporting satisfaction with the information.

July 1, 2012 to

June 30, 2013 New

3.6

In conjunction with community partners, implement the Board-sponsored Grandparents Raising Grandchildren initiative. The outcome will be the dissemination of information and the support of an ongoing program utilizing caregiver funds to assist this population.

July 1, 2012 to

June 30, 2013 New

NOTES:

GOAL 4 Protection, Safety and Advocacy

Ensure that the rights of older adults are protected through information, advocacy, legal services, and public protection.

RATIONALE Older adults are particularly susceptible to fraud and abuse, and those residing is skilled nursing care facilities are among the most vulnerable. In addition, low-income older and disabled adults in San Diego County are at greater risk as they pay for the high cost of housing and utilities with income diverted from food, clothing, prescription drugs and other necessities. This goal is in concert with “Live Well, San Diego!” a comprehensive campaign involving all divisions of the County Health and Human Services Agency (HHSA), and it is closely aligned with the second phase roll-out known as Living Safely.


START & END DATES

FUND STATUS



4.1.a

Conduct at least one comprehensive annual assessment of 75% of all skilled nursing and residential facilities by trained ombudsmen. The outcome is measured through the reporting functions within the Ombudsmanager computer application.

July 1, 2012 to

June 30, 2013 New

4.1.b

Provide at least 12 hours of in-service training to volunteers regarding long term care issues, eldercare and ombudsman practice issues. The outcome is measured by Sign-in sheets and the Ombudsman computer application.

July 1, 2012 to

June 30, 2013 New

4.1.c

Conduct at least one volunteer Ombudsman recruitment campaign and one thirty-eight hour volunteer certification training. Outcome is measured by sign-in sheets, and reported at the end of the year by the Ombudsman Program Coordinator.

July 1, 2012 to

June 30, 2013

New

4.1.d

Provide at least 15 community/facility presentations for the purpose of increasing public understanding on issues that are related to ombudsman practices and the needs of long term care residents. The outcome will be measured from data entered into the Ombudsmanager application.

July 1, 2012 to

June 30, 2013 New

4.1.e

Receive and investigate 500 allegations of abuse, neglect, or exploitation of residents of long-term care facilities. The outcome will be measured by data entered in the Ombudsmanager.

July 1, 2012 to

June 30, 2013 New

GOAL 4

Protection, Safety and Advocacy (cont.)

4.2.a

Outreach & Education staff will provide individual trainings on the mandated reporting of elder and dependant adult abuse to professional mandated reporters, in order to improve compliance with mandated reporting laws. A minimum of 60 trainings will be provided to mandated reporters. Outreach & Education staff will document the number of trainings and the attendance of mandated reporters.

July 1, 2012 to

June 30, 2013 New



4.2.b

Adult Protective Services will complete Quality Assurance reviews of Adult Protective Services cases to ensure that State and County guidelines are being met. The outcome will be met by the completion of quarterly reports documenting the findings.

July 1, 2012 to

June 30, 2013 New

4.2.c

Deployment of a ‘structured decision making’ tool for the AIS Call Center and Adult Protective Services allows for more effective screening and response to reports of elder and dependent adult abuse and neglect. 100% of all APS referrals will be screened utilizing the structured decision making application to determine appropriateness and priority response.

July 1, 2012 to

June 30, 2013

PD New

4.2.d

95% (7,125 of 7,500) of face-to-face contacts are conducted within 10 days of receiving an APS referral.

July 1, 2012 to

June 30, 2013

PD New

4.2.e 91% (6,825 of 7,500) of APS cases are not re-referred within six months of case closing.

July 1, 2012 to

June 30, 2013

PD New

4.2.f

Hold a regional Elder Abuse Council meeting quarterly with Adult Protective Services staff, law enforcement and/or community partners. These meetings will educate and promote collaboration between agencies which are charged with prevention, identification and prosecution of elder abuse. The outcome will be measured by the continuation of the collaborative meetings.

July 1, 2012

to

June 30, 2013

New

GOAL 4




4.2.g

The County of San Diego Elder and Dependent Adult Death Review Team (EDADRT) reviews the circumstances surrounding elder and dependent adult deaths and evaluates the services provided to both victims and perpetrators in an attempt to improve service delivery, close system gaps and decrease the incidence of elder abuse, neglect and suicides in San Diego county. A minimum of five suspicious elder or dependent adult deaths will be reviewed. The EDART will also coordinate joint case reviews with the County of San Diego’s Domestic Violence Fatality Review Team (DVFRT) whenever possible when an elder or dependent adult death involves an intimate partner relationship. A minimum of one joint EDART/DVFRT meeting will be held in FY 12/13.

July 1, 2012 to

June 30, 2013 New

4.3

Retired and Senior Volunteer Program (RSVP) staff will work in partnership with police departments and the Sherriff’s Department, to have a minimum of 400 trained RSVP Volunteers conduct 7,200 annual “You Are Not Alone” (YANA) visits to frail, isolated older adults living at home. RSVP staff will track the number of volunteers and visits through reports from Senior Volunteer Patrol groups.

July I , 2012 to

June 30, 2013 New

4.4

Many of the persons served by AIS programs and services will require special assistance during an emergency or large scale disaster because of their access or functional limitations. AIS staff will participate in disaster planning and exercises to assist the County’s Office of Emergency Services to meet the needs of people with access and functional needs in an emergency or disaster.

July I , 2012

to June 30, 2013

New

4.5

Implement the Dementia Support Program to provide case management, and assistance with health and financial issues for low income older adults with dementia. The outcome will be the creation of a new program in FY 12-13.

July 1, 2012 to

June 30, 2013

PD C New

GOAL 4


4.6 Educate AIS staff, the County’s Health and Human July 1, 2012 C New



Services Agency, and the community about the Elder Economic Security Standard. Support the use of the standard in measuring the poverty level in San Diego County. The outcome will be measured by inclusion of information about the Elder Economic Standard in the Senior Report Card and in the legislative platform for the County of San Diego.

to June 30, 2013

4.7

Identify and submit proposals to advocate for legislation that is consistent with Board of Supervisors policy positions to support the goals of AIS programs. The outcome will be measured by proposals submitted to the Health and Human Services Agency Strategy and Planning Division.

July I , 2012 to

June 30, 2013 New

NOTES:



GOAL 5 Enrichment and Involvement

Enhance the quality of life of older individuals through employment and social interaction programs, and enrich the community by involving older adults with persons of all age groups in community programs and activities, volunteerism, education and leisure.

RATIONALE Involvement and social interaction are among the key variables in successful aging. The tendency in modern American culture is to move away from these factors as older adults also move away from mainstream activities such as full-time employment and raising children. There is a need to develop programs and services that provide opportunities for continuing involvement in the community, develop strategies that promote public/private partnerships, and ensure that all programs and services are sensitive to the needs of persons with disabilities, ethnic and cultural diversity. Publicly funded programs will be unable to keep up with the demand for services, especially in view of the rapidly growing older adult population. It is important that Aging & Independence Services positions itself now to build public/private partnerships, develop fund-raising mechanisms, maintain and expand upon its customer-driven marketing approach and to embrace a philosophy of inclusion. This goal is in concert with “Live Well, San Diego!” a comprehensive campaign involving all divisions of the County Health and Human Services Agency (HHSA).


START & END DATES

FUND STATUS

5.1.a

The Intergenerational Coordinator will support implementation of annual Intergenerational Games designed to increase mutual understanding and respect between generations and to promote life-long healthy and active behaviors. The Intergenerational Coordinator will document the participation of older adults and youth in the events, and track impacts of the events through evaluation surveys.

July 1, 2012 to

June 30, 2013 New

5.1.b

The Intergenerational Coordinator will collaborate with local community-based organizations, government agencies, and other community partners in order to facilitate the implementation of two new intergenerational programs annually. Programs implemented will be recorded and documented by the Intergenerational Coordinator.

July 1, 2012 to




5.1.c

AIS Intergenerational staff will support and promote the development of an intergenerational coalition, whose membership would include current intergenerational service providers, in order to gain knowledge and build capacity through shared projects. This coalition would also promote and encourage groups to meet community needs and solve social concerns through intergenerational approaches.

July 1, 2012 to

June 30, 2013 New

GOAL 5

Enrichment and Involvement (cont.)

5.2.a

RSVP staff will actively promote the wide variety of RSVP volunteer opportunities to non-white ethnic groups, with a goal of increasing the number of other ethnic volunteers by 1% annually. RSVP staff will track the number and percentage of non-white ethnic volunteers.

July 1, 2012 to

June 30, 2013 New

5.2.b

RSVP program staff will improve lives, strengthen communities and foster civic engagement through promotion of service and volunteering in the targeted areas of Disaster Services, Economic Opportunity, Education, Environmental Stewardship, Healthy Futures, and Veterans and Military Families. Annual RSVP Program Progress Report findings will indicate volunteers and their impacts in all the stated areas.

July 1, 2012 to

June 30, 2013 New

5.3

Health Promotion staff will support implementation of events designed to screen and educate, using the services of registered pharmacists. Each fiscal year, a minimum of 150 seniors will be educated on medication management strategies with 75% of participants increasing their knowledge of medication management strategies, as indicated on a questionnaire. Health Promotion staff will track the number of events, the number of participants, and the evaluation results.

July 1, 2012 to

June 30, 2013 New



5.4

Reduce isolation of seniors living in long-term care facilities by linking volunteers (including minor volunteers paired with adult volunteers for an intergenerational component) with isolated seniors currently residing in such facilities, through a contract for the Guardian Angels program. The outcome will be monitored by monthly progress reports and invoices submitted by the contractor.

July 1, 2012 to

June 30, 2013 New

5.5.a

Implement the “Five & Fit” Program in conjunction with Temple University at two pre-school sites in San Diego. The outcome will be measured by the initiation of the program to utilize older adults to educate pre-school students and their families about healthy eating.

July 1, 2012 to

June 30, 2013 New

GOAL 5


5.5.b

Continue expanding upon opportunities for lifelong learning for seniors in San Diego County in response to the recommendations made at the 2008 Aging Summit. The outcome will be measured by the implementation of one or more recommendations resulting from the Summit.

July 1, 2012 to


5.5.c

Expand opportunities for Technology for seniors in San Diego County in response to the recommendations made at the 2010 Aging Summit. The outcome will be measured by the implementation of one or more recommendations resulting from the Summit.

July 1, 2012 to


5.5.d

Continue the Mature Workforce collaborative in conjunction with Senior Community Employment Services (Title V Provider), community colleges, the San Diego Workforce Partnership, AARP and others. The outcome will be measured by the development of a program, or programs in support of the maturing worker.

July 1, 2012 to

June 30, 2013 New



5.6

Continue efforts to better coordinate and improve services to the Lesbian, Gay, Bisexual, and Transgender (LGBT) population in San Diego county. This outcome will be measured by the continuation of regular planning/action meetings between AIS and the Center for LGBT Services

July 1, 2012 to

June 30, 2013 New

5.7

Given the national demographic propensity towards naturally occurring retirement communities, some neighborhood leaders in San Diego Co. have responded by undertaking organizational efforts to structure a formal membership-based solution known as the “village” concept, a customized model of community self-reliance and local empowerment to address aging issues closest to home;

July 1, 2012 to

June 30, 2013

New



GOAL 5


5.7 (cont.)

therefore, in acknowledgement of this growing dynamic, AIS will consider the potential for its role in supporting or otherwise helping to identify resources and opportunities to ultimately replicate this kind of development in various other autonomous locations which would assist new grass roots organizers to identify and develop their market, whether urban, suburban, or rural, and enable communities to better meet the challenge of aging well and aging in place.

NOTES:



GOAL 6

Veterans Services Help veterans and their families to secure state and federal benefits, along with other forms assistance to which they may be entitled.

RATIONALE

The California Department of Veterans Affairs requires the local county jurisdictions in the state to establish an Office of Veterans Affairs. It is the integrated setting of AIS that enables an effective added benefit for veterans services clients, given that a large number of veterans and their spouses are experiencing the same challenges as other aging target groups served by AIS. The factor of disability with a number of veterans is addressed by proximity to AIS operations that served populations with functional impairment.


START & END DATES

FUND STATUS

6.1

The San Diego County Veterans Services Office will conduct a minimum of three outreach presentations per month conveying the benefits and assistance opportunities available to the approximate 235,000 veterans and their families living in San Diego County. The outcome will be improved awareness of eligibility requirements and increase in the number of claims for benefits.

July 1, 2012 to


6.2

Maintain the County of San Diego Veterans Service Office position as the top producing office in the state in reportable workload units based on federal claims, Medi-Cal cost avoidance claims, and college fee waiver approvals. The outcome will be measured by the total Workload Units as provided by the CA Dept. of Veterans Affairs.

July 1, 2012 to


6.3

Obtain a minimum of $40 million in annualized and one-time cash benefits from the United States Department of Veterans Affairs to be used in the local community. The outcome is reported by the Veterans Service Office.

July 1, 2012 to




6.4 Notify 98% (4,900 of 5,000) of customers assisted by Veteran’s Services within 14 calendar days of the result of their college tuition waiver application.

July 1, 2012 to


GOAL 6

Veterans Services (cont.)

6.5

Formulate a Veteran Directed Home and Community Based Service (VD-HCBS) Program serving Veterans of any age who are at risk of nursing home placement, and their family caregivers, which offers the opportunity to receive home and community based services that enable them to avoid institutionalization and continue to live in their homes and communities. Prior to Veteran enrollment and client self-directed service arrangements, system development assess readiness of AIS to implement a partnership with VA Medical Centers (VAMCs) which will purchase a product(s) available in the VD-HCBS from AIS, State Agencies, or entities otherwise known as Aging Network Agencies. The outcome will be fewer inappropriate nursing home placements.

July 1, 2012 to


NOTES:



GOAL 7

Help in the Home and Long Term Support Services Offer care management and other programs for persons experiencing decline to maintain a place in their home in the least restrictive environment, to avoid facing premature out-of-home placement.

RATIONALE

Hoping to age in place, “at home”, is the most familiar and commonly desired sentiment of a person as they grow older and envision themselves in the later years of life. This is the spirit that is at the core of our mission and the force behind many program initiatives that we implement. However, this is a time of change in home and community-based services as some traditional program funding is retracting and other well-recognized program entitlements are under redesign in pursuit of more efficient ways of delivery. Ultimately, the AIS program plan, coupled with its leadership role in the community, will promote a personal and individualized approach in arranging and providing support that is more economical than conventional approaches. This goal is in concert with “Live Well, San Diego!” a comprehensive campaign involving all divisions of the County Health and Human Services Agency (HHSA), and it is closely aligned with both the first phase roll-out known as Building Better Health and the second phase roll-out known as Living Safely.


START & END DATES

FUND STATUS

7.1.a

Successfully Implement the Case Management Information and Payroll System (CMIPS II) for In-Home Supportive Services (IHSS) as one of the initial pilot counties. This will result in improved customer service and a more efficient management of client and provider information. The outcome will be measured by the start-up of the system.

July 1, 2012 to

June 30, 2013 New

7.1.b

Identify, assess and case manage 115 unduplicated at- risk adults with disabilities. Outcome will be measured by the tracking of the unduplicated client count in the Linkages database.

July 1, 2012 to

June 30, 2013 New

7.1.c

Provide case management services to 210 unduplicated frail seniors, at risk of institutionalization. The outcome will be measured by tracking the unduplicated client count served by the SOAR Program in the Q system.

July 1, 2012 to

June 30, 2013 New



7.1.d

Provide 20,000 hours annually of homemaker, personal care, and/or chore services through the SOAR program. Outcome will be measured by the tracking of average number of clients in the Q system.

July 1, 2012 to

June 30, 2013 New

GOAL 7

Help in the Home and Long Term Support Services (cont.)

7.2

Through the Coordinated Care Initiative, the Long Term Care Integration Project (LTCIP), directed by AIS, will work in good faith with the County’s managed care health plans to transition dual eligible beneficiaries into an integrated system of care that pools Medicare and Medi-Cal funding and coordinates care across the full continuum. AIS will support the integration of IHSS and MSSP as managed care health plan benefits and work closely with the selected health plans and the community of health care and social service providers to enhance access to home and community based services for Medi-Cal only and dual eligible beneficiaries.

July 1, 2012 to


7.3

To support the national Partnership for Patients: Better Care, Lower Costs initiative AIS will partner with local hospitals to deliver direct care transition services to patients who are at high risk for readmission. Through the Coleman Care Transitions Intervention (CTI) evidence-based practice, patients will be activated to self-manage their health. Through funding from the Beacon Community Collaborative and the Community Based Care Transitions Program (CCTP), AIS will work closely with hospitals to reduce the overall rate of readmissions in San Diego County by 20% by 2015.

July 1, 2012 to


NOTES:


SECTION TEN SERVICE UNIT PLAN (SUP) OBJECTIVES

SECTION 10 - SERVICE UNIT PLAN (SUP) OBJECTIVES PSA 23

TITLE III/VII SERVICE UNIT PLAN OBJECTIVES CCR Article 3, Section 7300(d)

The Service Unit Plan (SUP) uses the National Aging Program Information System (NAPIS) Categories and units of service. They are defined in the NAPIS State Program Report.

For services not defined in NAPIS, refer to the Service Categories and Data Dictionary.

Report the units of service to be provided with ALL funding sources. Related funding is reported in the annual Area Plan Budget (CDA 122) for Titles III B, III C-1, III C-2, III D, VII (a) and VII (b).

1. Personal Care (In-Home) Unit of Service = 1 hour

Fiscal Year

Proposed

Units of Service

Goal Numbers Objective Numbers (if applicable)

2012-2013 3,500

2013-2014

2014-2015

2015-2016

http://www.aging.ca.gov/aaa/guidance/NAPIS_SPR_Form.pdf

http://www.aging.ca.gov/aaa/guidance/Service_Categories_Data_Dictionary_4-2011.xls


2. Homemaker Unit of Service = 1 hour

Fiscal Year

Proposed

Units of Service

Goal Numbers Objective Numbers(if applicable)

2012-2013 17,491

2013-2014

2014-2015

2015-2016

3. Chore Unit of Service = 1 hour

Fiscal Year

Proposed

Units of Service


2012-2013 0

2013-2014

2014-2015

2015-2016


4. Home-Delivered Meal Unit of Service = 1 meal

Fiscal Year

Proposed

Units of Service


2012-2013 437,000

2013-2014

2014-2015

2015-2016

5. Adult Day Care/Adult Day Health Unit of Service = 1 hour

Fiscal Year

Proposed

Units of Service


2012-2013 4,000

2013-2014

2014-2015

2015-2016


6. Case Management Unit of Service = 1 hour

Fiscal Year

Proposed

Units of Service


2012-2013 2,966

2013-2014

2014-2015

2015-2016

7. Assisted Transportation Unit of Service = 1 one-way trip

Fiscal Year

Proposed

Units of Service


2012-2013 360

2013-2014

2014-2015

2015-2016


8. Congregate Meals Unit of Service = 1 meal

Fiscal Year

Proposed

Units of Service


2012-2013 617,500

2013-2014

2014-2015

2015-2016

9. Nutrition Counseling Unit of Service = 1 session per participant

Fiscal Year

Proposed

Units of Service


2012-2013

2013-2014

2014-2015

2015-2016


10. Transportation Unit of Service = 1 one-way trip

Fiscal Year

Proposed

Units of Service


2012-2013 80,040

2013-2014

2014-2015

2015-2016

11. Legal Assistance Unit of Service = 1 hour

Fiscal Year

Proposed

Units of Service


2012-2013 14,000

2013-2014

2014-2015

2015-2016


12. Nutrition Education Unit of Service = 1 session per participant

Fiscal Year

Proposed

Units of Service


2012-2013 15,200

2013-2014

2014-2015

2015-2016

13. Information and Assistance Unit of Service = 1 contact

Fiscal Year

Proposed

Units of Service


2012-2013 14,700

2013-2014

2014-2015

2015-2016


14. Outreach Unit of Service = 1 contact

Fiscal Year

Proposed

Units of Service


2012-2013

2013-2014

2014-2015

2015-2016


15. NAPIS Service Category – “Other” Title III Services

•Each Title III B “Other” service must be an approved NAPIS Program 15 service listed on the “Schedule of Supportive Services (III B)” page of the Area Plan Budget (CDA 122) and the CDA Service Categories and Data Dictionary.

• Identify Title III D/Medication Management services (required) and all Title III B services to be funded that were not reported in NAPIS categories 1–14 and 16. (Identify the specific activity under the Service Category on the “Units of Service” line when applicable.)

• Title III D/Health Promotion and Medication Management requires a narrative goal and objective. The objective should clearly explain the service activity being provided to fulfill the service unit requirement.

Title III B, Other Supportive Services 4

For all Title IIIB “Other” Supportive Services, use the appropriate Service Category name and Unit of Service (Unit Measure) listed in the CDA Service Categories and Data Dictionary. All “Other” services must be listed separately. Duplicate the table below as needed.

Service Category Community Services/Senior Center Support (Guardian Angles)

Service Activity: Visiting Unit of Service 1 Hour

Fiscal Year Proposed

Units of Service Goal Numbers Objective Numbers (if applicable)

2012-2013 100 5 5.5

2013-2014

2014-2015

2015-2016

6 Other Supportive Services: Visiting (In-Home) now includes telephoning (See Area Plan budget).


Instructions for Title III D /Health Promotion and Medication Management: List number of contacts for unit of service being performed to fulfill the service unit requirement. If Title III D Health Promotion funds are designated to support Title III C Nutrition Education and/or Nutrition Counseling services, report the service units under Title III C NAPIS 9. Nutrition Counseling and/or NAPIS 12. Nutrition Education. Add an objective under Title III D Nutrition Education to identify if Title III D funds are used to pay for Title III C Nutrition Education service units.

•Service Activity: List all the specific allowable service activities provided in the definition of Title III D/Health Promotion in the CDA Service Categories and Data Dictionary, i.e., health risk assessments; routine health screening; nutrition counseling/education services; evidence-based health promotion; physical fitness, group exercise, music, art therapy, dance movement and programs for multigenerational participation; home injury control services; screening for the prevention of depression and coordination of other mental health services; gerontological and social service counseling; and education on preventive health services. Primary activities are normally on a one-to-one basis; if done as a group activity, each participant shall be counted as one contact unit.


16. Title III D Health Promotion Unit of Service = 1 contact

NOTE: NUMBERS IN RED ARE THE 2011-12 AP UPDATE PROJECTIONS. PLEASE EDIT.

Service Activities: __Disease Prevention / Health Promotion_________________

• Title III D/Health Promotion: Enter program goal and objective numbers in the Title III D Service Plan Objective Table below.

Fiscal Year

Proposed

Units of Service


2012-2013 2,500

2013-2014

2014-2015

2015-2016

Title III D Medication Management 5 Units of Service = 1 Contact

Service Activities: __Medication Management__________________________

• Title III D/Medication Management: Enter program goal and objective numbers in the Title III D Service Plan Objective Table below.

Fiscal Year Proposed

Units of Service

Program

Goal Number Objective Numbers (required)

2012-2013 250

2013-2014

2014-2015

2015-2016

7 Refer to Program Memo 01-03


PSA 23

TITLE III B and Title VII A: LONG-TERM CARE (LTC) OMBUDSMAN PROGRAM OUTCOMES

2012–2016 Four-Year Planning Cycle

As mandated by the Older Americans Act, the mission of the LTC Ombudsman Program is to seek resolution of problems and advocate for the rights of residents of LTC facilities with the goal of enhancing the quality of life and care of residents.

Baseline numbers are obtained from the local LTC Ombudsman Program’s FY 2010-2011National Ombudsman Reporting System (NORS) data as reported in the State Annual Report to the Administration on Aging (AoA). Targets are to be established jointly by the AAA and the local LTC Ombudsman Program Coordinator. Use the baseline year data as the benchmark for determining FY 2012-2013 targets. For each subsequent FY target, use the most recent FY AoA data as the benchmark to determine realistic targets. Refer to your local LTC Ombudsman Program’s last three years of AoA data for historical trends. Targets should be reasonable and attainable based on current program resources. Complete all Measures and Targets for Outcomes 1-3. Outcome 1. The problems and concerns of long-term care residents are solved through complaint resolution and other services of the Ombudsman Program. [OAA Section 712(a)(3),(5)] Measures and Targets:

A. Complaint Resolution Rate (AoA Report, Part I-E, Actions on Complaints)

The average California complaint resolution rate for FY 2009-2010 was 73%. 1. FY 2010-2011 Baseline Resolution Rate: _41%__

Number of complaints resolved _171__ + Number of partially resolved complaints _511___ divided by the Total Number of Complaints Received 1,654 = Baseline Resolution Rate _41__% 2. FY 2012-2013 Target: Resolution Rate 73 %

3. FY 2011-2012 AoA Resolution Rate ___% FY 2013-2014 Target: Resolution Rate ___%



Program Goals and Objective Numbers:


B. Work with Resident Councils (AoA Report, Part III-D, #8)

FY 2010-2011 Baseline: number of meetings attended _318__

2. FY 2012-2013 Target: 300

3. FY 2011-2012 AoA Data: ___FY 2013-2014 Target: ___

4. FY 2012-2013 AoA Data: ___ FY 2014-2015 Target: ___



C. Work with Family Councils (AoA Report, Part III-D, #9)

1. FY 2010-2011 Baseline: number of meetings attended_24__

2. FY 2012-2013 Target: number_20__






D. Consultation to Facilities (AoA Report, Part III-D, #4) Count of instances of ombudsman representatives’ interactions with facility staff for the purpose of providing general information and assistance unrelated to a complaint. Consultation may be accomplished by telephone, letter, email, fax, or in person. 1. FY 2010-2011 Baseline: number of consultations_374__

2. FY 2012-2013 Target: _150__






E. Information and Consultation to Individuals (AoA Report, Part III-D, #5) Count of instances of ombudsman representatives’ interactions with residents, family members, friends, and others in the community for the purpose of providing general information and assistance unrelated to a complaint. Consultation may be accomplished by telephone, letter, email, fax, or in person.

1. FY 2010-2011 Baseline: number of consultations_2,307__

2. FY 2012-2013 Target: _400__


4. FY 2012-2013 AoA Data: ___ FY 2014-2015 Target: ____



F. Community Education (AoA Report, Part III-D, #10) LTC Ombudsman Program participation in public events planned to provide information or instruction to community members about the LTC Ombudsman Program or LTC issues. The number of sessions refers to the number of events, not the number of participants.

1. FY 2010-2011 Baseline: number of sessions_3__

2. FY 2012-2013 Target: _12__






G. Systems Advocacy • FY 2012-2013 Activity: In the box below, in narrative format, please provide at least one new priority systemic advocacy effort the local LTC Ombudsman Program will engage in during the fiscal year. Systems Advocacy can include efforts to improve conditions in one LTC facility or can be county-wide, State-wide, or even national in scope. (Examples: Work with LTC facilities to improve pain relief or increase access to oral health care, work with law enforcement entities to improve response and investigation of abuse complaints, collaboration with other agencies to improve LTC residents’ quality of care and quality of life, participation in disaster preparedness planning, participation in legislative advocacy efforts related to LTC issues, etc.) Enter information in the box below.

Systemic Advocacy Effort(s)

Under both federal and state law, nursing home residents have rights and protections against improper discharges/evictions. Most residents have no idea about their rights or how to exercise them. Nursing homes are increasingly rid themselves of problematic or unprofitable residents through illegal or improper discharges and are avoiding/ignoring procedures required by law to ensure that resident evictions are safe and deliberate.

Illegal nursing home evictions are one of the most common problems reported to our program locally, and throughout the state. Systemic Advocacy efforts identified as priority for FY 12/13 will be to provide education to residents, families and facilities regarding Discharge Eviction Rights in 100% of local Skilled Nursing Facilities. This goal will be achieved through staff and volunteer Ombudsman efforts during in-person visits with resident/families and facility staff.


Outcome 2. Residents have regular access to an Ombudsman. [(OAA Section 712(a)(3)(D), (5)(B)(ii)]

Measures and Targets:

A. Facility Coverage (other than in response to a complaint), (AoA Report, Part III-D, #6)

Percentage of nursing facilities within the PSA that were visited by an ombudsman representative at least once each quarter not in response to a complaint. The percentage is determined by dividing the number of nursing facilities in the PSA that were visited at least once each quarter not in response to a complaint by the total number of nursing facilities in the PSA. NOTE: This is not the total number of visits per year. In determining the number of facilities visited for this measure, no nursing facility can be counted more than once. 1. FY 2010-2011 Baseline: _90__%

Number of Nursing Facilities visited at least once a quarter not in response to a complaint _46_ divided by the number of Nursing Facilities_92__. 2. FY 2012-2013 Target: _90__%

3. FY 2011-2012 AoA Data: ___% FY 2013-2014 Target: ___%

4. FY 2012-2013 AoA Data: ___% FY 2014-2015 Target: ___%

5. FY 2013-2014 AoA Data: ___ % FY 2015-2016 Target: ___%



B. Facility Coverage (other than in response to a complaint) (AoA Report, Part III-D, #6) Percentage of RCFEs within the PSA that were visited by an ombudsman representative at least once each quarter during the fiscal year not in response to a complaint. The percentage is determined by dividing the number of RCFEs in the PSA that were visited at least once each quarter not in response to a complaint by the total number of RCFEs in the PSA. NOTE: This is not the total number of visits per year. In determining the number of facilities visited for this measure, no RCFE can be counted more than once. 1. FY 2010-2011 Baseline: _83__%

Number of RCFEs visited at least once a quarter not in response to a complaint _151__ divided by the number of RCFEs _658__

2. FY 2012-2013 Target: _85__%


4. FY 2012-2013 AoA Data: ___ % FY 2014-2015 Target: ___ %



C. Number of Full-Time Equivalent (FTE) Staff (AoA Report Part III. B.2. - Staff and Volunteers) (One FTE generally equates to 40 hours per week or 1,760 hours per year) This number may only include staff time legitimately charged to the LTC Ombudsman Program. For example, the FTE for a staff member who works in the Ombudsman Program 20 hours a week should be 0.5. Time spent working for or in other programs may not be included in this number. Verify number of staff FTEs with Ombudsman Program Coordinator.

1. FY 2010-2011 Baseline: FTEs_4.5___

2. FY 2012-2013 Target: _5.0__ FTEs

3. FY 2011-2012 AoA Data: ___ FTEs FY 2013-2014 Target: ___ FTEs





D. Number of Certified LTC Ombudsman Volunteers (AoA Report Part III. B.2. – Staff and Volunteers)

Verify numbers of volunteers with Ombudsman Program Coordinator. 1. FY 2010-2011 Baseline: Number of certified LTC Ombudsman volunteers

as of June 30, 2010 _131__

2. FY 2012-2013 Projected Number of certified LTC Ombudsman volunteers

as of June 30, 2013 _115__

3, FY 2011-2012 AoA Data: ___ certified volunteers

FY 2013-2014 Projected Number of certified LTC Ombudsman volunteers as of June 30, 2014 ____

4. FY 2012-2013 AoA Data: ___ certified volunteers

FY 2014-2015 Projected Number of certified LTC Ombudsman volunteers as of June 30, 2015_

5. FY 2013-2014 AoA Data: ___ certified volunteers

FY 2015-2016 Projected Number of certified LTC Ombudsman volunteers

as of June 30, 2016 ___



Outcome 3. Ombudsman representatives accurately and consistently report data about their complaints and other program activities in a timely manner. [OAA Section 712(c)]

Measures and Targets:

A. At least once each fiscal year, the Office of the State Long-Term Care Ombudsman sponsors free training on each of four modules covering the reporting process for the National Ombudsman Reporting System (NORS). These trainings are provided by telephone conference and are available to all certified staff and volunteers. Local LTC Ombudsman Programs retain documentation of attendance in order to meet annual training requirements.

1. FY 2010-2011 Baseline number of Ombudsman Program staff and volunteers who attended

NORS Training Parts I, II, III and IV __40____

Please obtain this information from the local LTC Ombudsman Program Coordinator.

2. FY 2012-2013 Target: number of Ombudsman Program staff and volunteers attending NORS

Training Parts I, II, III and IV __40__ 3. FY 2011-2012 number of Ombudsman Program staff and volunteers who attended NORS

Training Parts I, II, III, and IV ______ FY 2013-2014 Target ______ 4. FY 2012-2013 number of Ombudsman Program staff and volunteers who attended NORS

Training Parts I, II, III, and IV ______

FY 2014-2015 Target ______ 5. FY 2013-2014 number of Ombudsman Program staff and volunteers who attended NORS

Training Parts I, II, III, and IV ______ FY 2015-2016 Target: _____ Program Goals and Objective Numbers:


PSA 23

TITLE VII B ELDER ABUSE PREVENTION

SERVICE UNIT PLAN OBJECTIVES

Units of Service: AAA must complete at least one category from the Units of Service below.

Units of Service categories include public education sessions, training sessions for professionals, training sessions for caregivers served by a Title III E Family Caregiver Support Program, educational materials distributed, and hours of activity spent developing a coordinated system which addresses elder abuse prevention, investigation, and prosecution.

When developing targets for each fiscal year, refer to data reported on the Elder Abuse Prevention Quarterly Activity Reports. Set realistic goals based upon the prior year’s numbers and the resources available.

AAAs must provide one or more of the service categories below. NOTE: The number of sessions refers to the number of presentations and not the number of attendees

• Public Education Sessions – Please indicate the total number of projected education sessions for the general public on the identification, prevention, and treatment of elder abuse, neglect, and exploitation.

• Training Sessions for Professionals – Please indicate the total number of projected

training sessions for professionals (service providers, nurses, social workers) on the identification, prevention, and treatment of elder abuse, neglect, and exploitation.

• Training Sessions for Caregivers Served by Title III E – Please indicate the total

number of projected training sessions for unpaid family caregivers who are receiving services under Title III E of the Older Americans Act (OAA) on the identification, prevention, and treatment of elder abuse, neglect, and exploitation. OAA 302(3) ‘Family caregiver’ means an adult family member, or another individual, who is an informal provider of in-home and community care to an older individual or to an individual with Alzheimer’s disease or a related disorder with neurological and organic brain dysfunction.

• Hours Spent Developing a Coordinated System to Respond to Elder Abuse – Please

indicate the number of hours to be spent developing a coordinated system to respond to elder abuse. This category includes time spent coordinating services provided by the AAA or its contracted service provider with services provided by Adult Protective Services, local law enforcement agencies, legal services providers, and other agencies involved in the protection of elder and dependent adults from abuse, neglect, and exploitation.


• Educational Materials Distributed – Please indicate the type and number of educational materials to be distributed to the general public, professionals, and caregivers (this may include materials that have been developed by others) to help in the identification, prevention, and treatment of elder abuse, neglect, and exploitation.

• Number of Individuals Served – Please indicate the total number of individuals expected

to be reached by any of the above activities of this program.


PSA 23

TITLE VIIB ELDER ABUSE PREVENTION SERVICE UNIT PLAN OBJECTIVES

Fiscal Year Total # of Public Education Sessions

Fiscal Year

Total # of Training Sessions for Professionals

2012-13 8 2012-13 8

2013-14 2013-14

2014-15 2014-15

2015-16 2015-16

Fiscal Year

Total # of Training Sessions for

Caregivers served by Title III E

Fiscal Year Total # of Hours Spent

Developing a Coordinated System

2012-13 N/A 2012-13 20

2013-14 2013-14

2014-15 2014-15

2015-16 2015-16


Fiscal Year

Total # of Copies of

Educational Materials to be

Distributed

Description of Educational Materials

2012-2013 100

2013-2014

2014-2015

2015-2016

Fiscal Year Total Number of Individuals Served

2012-2013

2013-2014

2014-2015

2015-2016


PSA 23

TITLE III E SERVICE UNIT PLAN OBJECTIVES

CCR Article 3, Section 7300(d)

2012–2016 Four-Year Planning Period

NOTE: Numbers in red are from AP Update FY11-12 and COMBINE BOTH CONTRACTED AND DIRECT SERVICES NUMBERS.

Please revise and project for FY12-13.

This Service Unit Plan (SUP) utilizes the five broad federally-mandated service categories defined in PM 11-11. Refer to the CDA Service Categories and Data Dictionary Revisions Effective July I, 2011 for eligible activities and service unit measures. Specify proposed audience size or units of service for ALL budgeted funds.

Direct and/or Contracted III EServices

CATEGORIES 1 2 3 Family Caregiver

Services

Caring for Elderly

Proposed

Units of Service

Required

Goal #(s)

Optional

Objective #(s)

Information Services # of activities and Total est. audience for above

2012-2013 # of activities: 152 Total est. audience for above: 1,700

2013-2014 # of activities: Total est. audience for above:



Access Assistance Total contacts

2012-2013 400

2013-2014

2014-2015

2015-2016


Support Services Total hours

2012-2013 6,000

2013-2014

2014-2015

2015-2016

Respite Care Total hours

2012-2013 12,000

2013-2014

2014-2015

2015-2016

Supplemental Services Total occurrences

2012-2013 2,000

2013-2014

2014-2015

2015-2016


Direct and/or Contracted III E Services

Grandparent Services

Caring for Children

Proposed

Units of Service

Required

Goal #(s)

Optional

Objective #(s)

Information Services # of activities and

Total est. audience for above

2012-2013 # of activities: 5 Total est. audience for above: 100




Access Assistance Total contacts

2012-2013 20 1

2013-2014

2014-2015

2015-2016

Support Services Total hours

2012-2013 9,000

2013-2014

2014-2015

2015-2016

Respite Care Total hours

2012-2013 4,500 3 3.3

2013-2014

2014-2015

2015-2016


Supplemental Services Total occurrences

2012-2013

2013-2014

2014-2015

2015-2016


PSA 23 6

SENIOR COMMUNITY SERVICE EMPLOYMENT PROGRAM (SCSEP)

List all SCSEP monitor sites (contract or direct) where the AAA provides services within the PSA (Please add boxes as needed)

With the new template, instructions are asking for “Monitor Sites.” The SCSEP program is looking for the places where “intakes” are completed.

Location/Name (AAA office, One Stop, Agency, etc):

South Metro Career Center/Employment & Community Options. Street Address:

4389 Imperial Avenue, San Diego, CA 92113 Name and title of all SCSEP staff members (paid and participant):

Cynthia Hammock-Ellis, Program Manager-Paid

Cathy Sims, Job Developer-Paid

Dorothy Williams, Program Asst.-Participant

Kent Koopman, Program Assist.-Participant Number of paid staff ___2___ Number of participant staff ___2___

How many participants are served at this site? 58


Street Address:

Name and title of all SCSEP staff members (paid and participant):

Number of paid staff ______ Number of participant staff ______

How many participants are served at this site?

8 If not providing Title V, enter PSA number followed by “Not providing”.



Street Address:

Name and title of all SCSEP staff members (paid and participant):

Number of paid staff ______ Number of participant staff ______

How many participants are served at this site?


PSA 23

HEALTH INSURANCE COUNSELING AND ADVOCACY PROGRAM (HICAP)

SERVICE UNIT PLAN

CCR Article 3, Section 7300(d)

MULTIPLE PSA HICAPs: If you are a part of a multiple PSA HICAP where two or more AAAs enter into agreement with one “Managing AAA,” then each AAA must enter State and federal performance target numbers in each AAA’s respective SUP. Please do this in cooperation with the Managing AAA. The Managing AAA is responsible for providing HICAP services in the covered PSAs in a way that is agreed upon and equitable among the participating parties. HICAP PAID LEGAL SERVICES: Complete Section 3 if your Master Contract contains a provision for using HICAP funds to provide HICAP Legal Services.

STATE & FEDERAL PERFORMANCE TARGETS: The Centers for Medicare and Medicaid Services (CMS) requires all State Health Insurance Assistance Programs (SHIP) to meet certain targeted performance measures. To help AAAs complete the Service Unit Plan, CDA will annually provide AAAs with individual PSA state and federal performance measure targets.

Section 1. Primary HICAP Units of Service

Fiscal Year (FY)

1.1 Estimated Number of Unduplicated Clients

Counseled Goal Numbers

2012-2013 2,504

2013-2014

2014-2015

2015-2016 Note: Clients Counseled equals the number of Intakes closed and finalized by the Program Manager.

Fiscal Year (FY)

1.2 Estimated Number of Public and Media Events Goal Numbers

2012-2013 127

2013-2014

2014-2015

2015-2016 Note: Public and Media events include education/outreach presentations, booths/exhibits at health/senior fairs, and enrollment events, excluding public service announcements and printed outreach.


Section 2: Federal Performance Benchmark Measures

Note: This includes all counseling contacts via telephone, in-person at home, in-person at site, and electronic contacts (e-mail, fax, etc.) for duplicated client counts.

Fiscal Year (FY)

2.2 Estimated Number of Persons Reached at Public

and Media Events Goal Numbers

2012-2013 22,081

2013-2014

2014-2015

2015-2016

Note: This includes the estimated number of attendees (e.g., people actually attending the event, not just receiving a flyer) reached through presentations either in person or via webinars, TV shows or radio shows, and those reached through booths/exhibits at health/senior fairs, and those enrolled at enrollment events, excluding public service announcements (PSAs) and printed outreach materials.

Fiscal Year (FY)

2.3 Estimated Number of contacts with Medicare

Status Due to a Disability Contacts

Goal Numbers

2012-2013 1,468

2013-2014

2014-2015

2015-2016 Note: This includes all counseling contacts via telephone, in-person at home, in-person at site, and electronic contacts (e-mail, fax, etc.), duplicated client counts with Medicare beneficiaries due to disability, and not yet age 65.

Fiscal Year (FY)

2.1 Estimated Number of Contacts for all Clients

Counseled Goal Numbers

2012-2013 23,000

2013-2014

2014-2015

2015-2016


Fiscal Year (FY)

2.4 Estimated Number of contacts with Low Income

Beneficiaries Goal Numbers

2012-2013 4,597

2013-2014

2014-2015

2015-2016 Note: This is the number of unduplicated low-income Medicare beneficiary contacts and/or contacts that discussed low-income subsidy (LIS). Low income means 150 percent of the Federal Poverty Level (FPL).

Fiscal Year (FY)

2.5 Estimated Number of Enrollment Assistance

Contacts Goal Numbers

2012-2013 8,697

2013-2014

2014-2015

2015-2016 Note: This is the number of unduplicated enrollment contacts during which one or more qualifying enrollment topics were discussed. This includes all enrollment assistance, not just Part D.

Fiscal Year (FY)

2.6 Estimated Part D and Enrollment Assistance

Contacts Goal Numbers

2012-2013 4,091

2013-2014

2014-2015

2015-2016 Note: This is a subset of all enrollment assistance in 2.5. It includes the number of Part D enrollment contacts during which one or more qualifying Part D enrollment topics were discussed.


Fiscal Year (FY)

2.7 Estimated Number of Counselor FTEs in PSA Goal Numbers

2012-2013 44.26 FTEs/11,675.92 hrs.

2013-2014

2014-2015

2015-2016 Note: This is the total number of counseling hours divided by 2000 (considered annual fulltime hours), then multiplied by the total number of Medicare beneficiaries per 10K in PSA.

Section 3: HICAP Legal Services Units of Service (if applicable) 7 State Fiscal

Year (SFY)

3.1 Estimated Number of Clients Represented Per SFY

(Unit of Service) Goal Numbers

2012-2013 0

2013-2014

2014-2015

2015-2016

State Fiscal Year (SFY)

3.2 Estimated Number of Legal Representation Hours Per SFY (Unit of Service)

Goal Numbers

2012-2013 0

2013-2014

2014-2015

2015-2016

7 Requires a contract for using HICAP funds to pay for HICAP Legal Services.


State Fiscal Year (SFY)

3.3 Estimated Number of Program Consultation Hours

per SFY (Unit of Service)

Goal Numbers

2012-2013 0

2013-2014

2014-2015

2015-2016


SECTION ELEVEN FOCAL POINTS

COMMUNITY FOCAL POINTS LIST

CCR Title 22, Article 3, Section 7302(a)(14), 45 CFR Section 1321.53(c), OAA 2006 306(a)

In the form below, provide the current list of designated community focal points and their addresses. This information must match the total number of focal points reported in the National Aging Program Information System (NAPIS) State Program Report (SPR), i.e., California Aging Reporting System, NAPISCare, Section III.D.

Designated Community Focal Point Address Aging & Independence Services is the Community Focal Point for PSA 23, San Diego County

5560 Overland Avenue, Suite 300 San Diego CA 92123


SECTION TWELVE DISASTER PREPAREDNESS

Disaster Preparation Planning Conducted for the 2012-2016 Planning Cycle OAA Title III, Sec. 306(a)(17); 310, CCR Title 22, Sections 7529 (a)(4) and 7547, W&I Code Division 8.5, Sections 9625 and 9716, CDA Standard Agreement, Exhibit E, Article 1, 22-25, Program Memo 10-29(P)

1. Describe how the AAA coordinates its disaster preparedness plans and activities with local

emergency response agencies, relief organizations, state and local governments, and other organizations responsible for emergency preparedness and response as required in OAA, Title III, Section 310: Please see attached AIS Disaster Plan-COOP Annex.

2. Identify each of the local Office of Emergency Services (OES) contact person(s) within the

PSA that the AAA will coordinate with in the event of a disaster (add additional information as needed for each OES within the PSA): Name Title Telephone email

Floyd Willis AIS Director Executive Assistant

Office: 858-495-5251 Cell: N/A

[email protected]

3. Identify the Disaster Response Coordinator within the AAA: Name Title Telephone email

Brenda Schmitthenner

Aging Program Administrator

Office: 858-495-5853 Cell: 858-386-8339

[email protected]

1. List critical services the AAA will continue to provide after a disaster and describe how these services will be delivered: Please see attached AIS Disaster Plan-COOP Annex.

Critical Services How Delivered? a b c d

a b c d

2. List any agencies with which the AAA has formal emergency preparation or response

agreements. Please see attached AIS Disaster Plan-COOP Annex.

mailto:[email protected]

mailto:[email protected]


3. Describe how the AAA will:

Identify vulnerable populations. Please see attached AIS Disaster Plan-COOP Annex.

Follow-up with these vulnerable populations after a disaster event. Please see attached AIS Disaster Plan-COOP Annex


SECTION THIRTEEN PRIORITY SERVICES

2012-2016 Four-Year Planning Cycle

Funding for Access, In-Home Services, and Legal Assistance

The CCR, Article 3, Section 7312, requires the AAA to allocate an “adequate proportion” of federal funds to provide Access, In-Home Services, and Legal Assistance in the PSA. The annual minimum allocation is determined by the AAA through the planning process. The minimum percentages of applicable Title III B funds8 listed below have been identified for annual expenditure throughout the four-year planning period. These percentages are based on needs assessment findings, resources available within the PSA, and discussions at public hearings on the Area Plan.

Category of Service and the Percentage of Title III B Funds expended in/or to be expended in FY 2012-13 through FY 2015-16

Access: Transportation, Assisted Transportation, Case Management, Information and Assistance, Outreach, Comprehensive Assessment, Health, Mental Health, and Public Information

12-13 _52_% 13-14 52 % 14-15 52 % 15-16 52 %

In-Home Services:

Personal Care, Homemaker, Chore, Adult Day / Health Care, Alzheimer’s, Residential Repairs/Modifications, Respite Care, Telephone Reassurance, and Visiting

12-13 _22_% 13-14 _22_% 14-15 _22_% 15-16 _22_%

Legal Assistance Required Activities:9 Legal Advice, Representation, Assistance to the Ombudsman Program and Involvement in the Private Bar

12-13 _6_% 13-14 _6_% 14-15 _6_% 15-16 _6_%

Explain how allocations are justified and how they are determined to be sufficient to meet the need for the service within the PSA.23

1Minimum percentages of applicable funds are calculated on the annual Title III B baseline allocation, minus Title III B

administration and minus Ombudsman. At least one percent of the final Title III B calculation must be allocated for each “Priority Service” category or a waiver must be requested for the Priority Service category(s) that the AAA does not intend to fund.

²Legal Assistance must include all of the following activities: Legal Advice, Representation, Assistance to the Ombudsman Program and Involvement in the Private Bar.


JUSTIFICATION FOR ADEQUATE PROPORTION

The percentage of Title III B funds to be expended in the categories of Access, In-Home Services, and Legal Assistance have been determined to be sufficient to meet the need for these services within PSA 23.

The 2012 Survey of Older Americans in San Diego County did not contradict the percentages that have historically been proven to be adequate for the needs of our population. Testimony in the six Public Hearings did not necessitate any changes in the allocation of funds to the Title III B services.

Notification of the five Public Hearings was given to the public through newspapers, and flyers distributed through the county. Details on the notifications can be found in Section 7. The transcript of the hearings is also found in Section 7.

Aging & Independence Services continually assesses the allocation of funds to services and will make adjustments if needed.


SECTION FOURTEEN NOTICE OF INTENT TO PROVIDE DIRECT SERVICES

CCR Article 3, Section 7320 (a)(b) and 42 USC Section 3027(a)(8)(C)

If an AAA plans to directly provide any of the following services, it is required to provide a description of the methods that will be used to assure that target populations throughout the PSA will be served.

Check if not providing any of the below listed direct services.

Check applicable direct services Check each applicable Fiscal Year

Title III B 12-13 13-14 14-15 15-16

Information and Assistance

Case Management

Outreach

Program Development

Coordination

Long-Term Care Ombudsman

Title III D12-13 13-14 14-15 15-16

Health Promotion

Medication Management

Title III E 10 D12-13 13-14 14-15 15-16

Information Services

Access Assistance

Support Services

Respite Services

Supplemental Services

10 Refer to PM 11-11 for definitions of Title III E categories.


Title VII A 12-13 13-14 14-15 15-16

Long-Term Care Ombudsman

Title VIIB 12-13 13-14 14-15 15-16

Prevention of Elder Abuse, Neglect and Exploitation

Describe the methods to be used to ensure target populations will be served throughout the PSA. 23


METHODS TO ASSURE THAT TARGET POPULATIONS WILL BE SERVED THROUGHOUT THE PSA

hiring of older, minority and bilingual staff and volunteers;

adequately representing targeted groups in the Advisory Council;

locating senior centers and congregate nutrition sites in areas of minority and low-income concentration;

contracting with minority service providers;

including language, provisions, terms and conditions in service providers' contracts requiring minority and low-income targeting;

monitoring and reviewing service providers' performance in serving minorities;

including minority related objectives in the Area Plan;

collecting and disseminating demographic data on the minority elderly in the county;

including minority, low-income and refugee populations in outreach efforts;

responding to the public via Call Center intake procedures utilizing multi-cultural, bi-lingual staff;

serving low income, minority seniors in all case management programs and in In-Home Supportive Services and Adult Protective Services;

providing access to non-English speakers to information and assistance through the use of Spanish speaking staff in the AIS Call Center as well as through the use of the Language Line for interpretation services;

preparing outreach materials in other languages and distributing these in the community


SECTION FIFTEEN REQUEST FOR APPROVAL TO PROVIDE DIRECT SERVICES

Older Americans Act, Section 307(a)(8)

CCR Article 3, Section 7320(c), W&I Code Section 9533(f)

Complete and submit for CDA approval a separate Section 15 for each direct service not specified in Section 14. The request for approval may include multiple funding sources for a specific service.

Check box if not requesting approval to provide any direct services.

Identify Service Category: Nutrition Education (Registered Dietitian)

Check applicable funding source:11

III B

III C-1

III C-2

III E

VII A

HICAP Request for Approval Justification:

Necessary to Assure an Adequate Supply of Service OR

More cost effective if provided by the AAA than if purchased from a comparable service provider.

Check all fiscal year(s) the AAA intends to provide service during this Area Plan cycle.

2012-13 2013-14 2014-15 2015-16

Justification: Provide a cost-benefit analysis below that substantiates this request for direct delivery of the above stated service12 : The AIS Dietician Is a County contractor, not a County employee. So as far as the County is concerned this is a contracted service, not a direct service. She does not receive a County salary or benefits, and does not generate any County overhead costs. This is a contracted service. There is no financial justification.

13 Section 15 does not apply to Title V (SCSEP). 14 For a HICAP direct services waiver, the managing AAA of HICAP services must document that all affected

AAAs are in agreement.

Area Plan 2012-2016, Section 16 Aging & Independence Services: PSA #23 County of San Diego

SECTION SIXTEEN GOVERNING BOARD

GOVERNING BOARD MEMBERSHIP

2012-2016 Four-Year Area Plan Cycle

CCR Article 3, Section 7302(a)(11) Total Number of Board Members:5 Name and Title of Officers: Office Term Expires: Greg Cox – District 1 2012

Dianne Jacob – District 2 2012

Pam Slater Price – District 3 2012

Ron Roberts – District 4 2014

Bill Horn – District 5 2014

Names and Titles of All Members: Board Term Expires:


SECTION SEVENTEEN ADVISORY COUNCIL

SECTION 17 – ADVISORY COUNCIL PSA 23

ADVISORY COUNCIL MEMBERSHIP 2012-2016 Four-Year Planning Cycle

45 CFR, Section 1321.57

CCR Article 3, Section 7302(a)(12)

Total Council Membership (include vacancies 30

Number of Council Members over age 60 26

% of PSA's % on 60+Population Advisory Council

Race/Ethnic Composition White 65 77 Hispanic 15 4 Black 4 15 Asian/Pacific Islander 11 0 Native American/Alaskan Native 1 4 Other 4 0

Name and Title of Officers: Office Term Expires: Jack Duff, Chairman, Dist. 2 Rep. Supervisor appointed February 2013

Kathy Randall, 1st Vice Chair February 2013

John Batchelder, 2nd Vice Chair February 2013

Camille Cowlishaw, Secretary, Dist. 1 Rep. Supervisor appointed February 2013


Name and Title of other members: Office Term Expires: Ellen Arcadi 7/10/15

Rose Marie Bahmani 5/10/16

Shirley Bard 9/10/14

Malcolm “Hoagy” Carmichael 6/12/15

Virginia Cooke 6/10/16

Dolores “Dolli” Cutler 01/07/13*

Burton Disner 8/31/14

Claudine Duff 4/30/14

Kenneth Featherston 11/12/14

Helena Hyman 4/30/14

Ted Kagan 2/11/15

Abe Krems, Dist. 3 Rep. Supervisor appointed 01/07/13*

Dotty Metcalf, Dist. 5 Rep. Supervisor appointed 01/05/15*

Luis A. Monge, Dist. 1 Rep. Supervisor appointed 01/07/13*

Robert Prath 2/13/15

Albert “Bud” Sayles, General Member; Executive Director, San Diego County Public Authority 2/13/15

Art Serrin, Dist. 5 Rep. Supervisor appointed 01/05/15*

Jonann Siders, Dist. 2 Rep. Supervisor appointed 01/07/13* (2nd term)

June Singer, Dist. 4 Rep. Supervisor appointed 01/05/15*

Roger Sorrell 6/10/16

Cleo Thompson, General Member 1/31/13

Jonann Siders, Dist. 2 Rep. (appointed); Membership Chair 01/07/13* (2nd term)

June Singer, Dist. 4 Rep. (appointed); Chair, Nutrition Committee 01/05/15*

Roger Sorrell, General Member 6/10/16

Cleo Thompson, General Member; RSVP Representative 1/31/13 (2nd term)

Cynthia White-Parks, Dist. 4 Rep. Supervisor appointed 01/05/15*

Estelle Wolfe 6/10/16


*Council Membership expiration coincides with Supervisorial term expiration. Member on Council may be reappointed if Supervisor is reelected and member has only served one term of membership.

Indicate which member(s) represent each of the “Other Representation” categories listed below.

Yes No

Low Income Representative

Disabled Representative Supportive Services Provider Representative Health Care Provider Representative

Family Caregiver Representative

Local Elected Officials

Individuals with Leadership Experience in Private and Voluntary Sectors

Explain any "No" answer(s): Health Care provider—we have not actively recruited, but will seriously consider doing so. Local Elected Official—no current representation, prior members represented state Assemblyman who is no longer in office.

Briefly describe the local governing board’s process to appoint Advisory Council members:

Article III, Membership, Sec. 1.A. Each member of the Board of Supervisors shall nominate and recommend to the Board of Supervisors two (2) individuals for appointment to the Advisory Council. Appointments of the ten (10) Council members appointed by the Board of Supervisors shall be made by majority vote at an open public meeting.

Usually the individuals already showing interest by participating in the activities of the Council are recommended as qualified persons for appointment by the Board when there are openings representing the various five districts of the County of San Diego. An application is completed that may be obtained on the San Diego County Clerk of the Board website. This is then sent to the applicable Supervisorial office for consideration. After appointment, members serve a term coinciding with the Supervisor they represent. Each appointee may serve two terms of membership.


SECTION EIGHTEEN LEGAL ASSISTANCE

2012-2016 Four-Year Area Planning Cycle

This section must be completed and submitted with the Four-Year Area Plan. Any changes to this Section must be documented on this form and remitted with Area Plan

Updates.13

1. Specific to Legal Services, what is your AAA’s Mission Statement or Purpose Statement? Statement must include Title III B requirements: Legal Services is contracted out to a service agency and as such does not maintain a separate mission statement from this PSA’s general mission statement. Title IIB is referenced in the statement of work within the contract as a part of the Title IIIB requirements.

2. Based on your local needs assessment, what percentage of Title III B funding is allocated to Legal Services? 6%

3. Specific to legal services, has there been a change in your local needs in the past four years? If so, please identify the change (include whether the change affected the level of funding and the difference in funding levels in the past four years). See discussion of new trends in #10. New trends impact the utilization of funding to meet new needs.

4. Specific to Legal Services, what is the targeted senior population and mechanism for reaching targeted groups in your PSA? Discussion: The targeted populations are seniors sixty (60) years and older, with priority given to minority clients, and to cases involving public benefits, landlord/tenant disputes, elder abuse, health care problems, consumer fraud and legal protective services. Special priority is provided to homebound and isolated seniors and those with the greatest economic and social needs. Family Caregivers providing care for seniors, age sixty (60) years and older, are also a targeted population. Priority is given to those with the greatest economic and social needs and those providing care for individuals with Alzheimer’s disease.

13 For Information related to Legal Services, contact Chisorom Okwuosa at 916 419-7500 or [email protected]


5. How many legal assistance service providers are in your PSA? Complete table below.

Fiscal Year # of Legal Assistance Services Providers

2012-2013

1 contracted provider in the PSA. Unknown # of service

providers overall in this area.

2013-2014 Same as above



6. Does your PSA have a hotline for legal services? There is not a specific hotline just for these services. This PSA has a Call Center that operates 24 hours/day and provides information and referrals for these and other services.

7. What methods of outreach are providers using? Discuss: The provider uses printed materials describing its range of services and delivery model. Printed materials are distributed in mailings and are also hand-delivered to places frequented by seniors. The provider offers face-to-face services at over 30 established community sites. It is able to collaborate with the sites to distribute outreach materials on an ongoing basis in order to target priority populations such as those in greatest economic need and minorities. Provider’s staff attorneys participate in community education presentations throughout the geographic region, discussing substantive legal topics and describing services. Provider participates in community events such as health fairs in order to reach potential priority populations. Attendees can ask questions about provider’s range of services, make appointments and receive substantive educational materials.

Provider also maintains a website and a blog which describe services and contain content designed to inform target populations of services and educate internet users in substantive legal areas.

Provider utilizes no- or low-cost radio and television advertising and is featured in newspaper and newsletter articles whenever these opportunities are available.


8. What geographic regions are covered by each provider? Complete table below.

Fiscal Year Name of Provider Geographic Region covered

2012-2013 a. Elder Law & Advocacy b. c.

a. All applicable within the PSA. b. c.

2013-2014 a. same as above b. c.

a. b. c.

2014-2015 a. same as above b. c.

a. b. c.

2015-2016 a. b. c.

a. b. c.

9. Discuss how older adults access Legal Services in your PSA: See discussion in #7 regarding outreach and community access.

10. Identify the major types of legal issues that are handled by the TIII-B legal provider(s) in your PSA. Discuss (please include new trends of legal problems in your area): Major types of legal issues handled by the provider include public benefits issues such as: social security denial and overpayment; landlord/tenant disputes including subsidized housing evictions; elder abuse and fraud against elders; healthcare problems including, denials of coverage, quality of care and billing issues; consumer fraud; legal protective services which include collaboration with the State Ombudsman and Adult Protective Services programs; personal rights protection; powers of attorney-financial and healthcare; age discrimination.

New trends: Provider has experienced an increase in the type and frequency of mortgage defaults and loan modification issues, financial elder abuse perpetrated by persons in a position of trust such as paid conservators, trustees, fiduciaries, financial planners and adult children, scam victimization and student loan defaults-collection issues.


11. In the past four years, has there been a change in the types of legal issues handled by the TIII-B legal provider(s) in your PSA? Discuss: Other than meeting the challenges associated with new trends as outlined in 10. above, there have not been any significant changes in the types of legal issues handled by the TIII-B legal provider.

12. What are the barriers to accessing legal assistance in your PSA? Include proposed strategies for overcoming such barriers. Discuss: Possible barriers are getting knowledge to those in need of services. The array of outreach utilized by the provider addresses overcoming those barriers by being visible within the community and collaborating with community partners.

13. What other organizations or groups does your legal service provider coordinate services with? Discuss: Provider and other legal programs in the geographic area regularly cross-refer and cooperate on cases. The provider coordinates services with law school supported legal clinics, the local legal aid program, the district attorney’s and city attorney’s elder abuse divisions, state consumer licensing and enforcement agencies such as those overseeing automotive repairs and contractors, and with other specialty nonprofit legal services providers in the community.

Provider also collaborates with community-based service providers which are part of the “safety-net” for older individuals residing within the geographic location such as nutrition programs, caregiver resource centers and senior housing groups. For example, in the discussion of their legal issues with a staff attorney, clients who indicate that they have little or no funds to purchase food are referred to a meal/nutrition provider for services.


SECTION NINETEEN MULTIPURPOSE SENIOR CENTER ACQUISITION

OR CONSTRUCTION COMPLIANCE REVIEW

CCR Title 22, Article 3, Section 7302(a)(15)

20-year tracking requirement

No. Title III B funds not used for Acquisition or Construction. Yes. Title III B funds used for Acquisition or Construction. Complete the chart below.

Title III Grantee and/or Senior Center

Type Acq/Const

III B Funds Awarded

% of Total Cost

Recapture Period MM/DD/YY

Begin Ends

Compliance Verification (State Use

Only) Name: Address:

Name: Address:

Name: Address:

Name: Address: 16 Acquisition is defined as obtaining ownership of an existing facility (in fee simple or by lease for 10 years or more) for use as a Multipurpose Senior Center.


SECTION TWENTY FAMILY CAREGIVER SUPPORT PROGRAM

Notice of Intent for Non-Provision of FCSP Multifaceted Systems of Support Services Older Americans Act Section 373(a) and (b)

2012–2016 Four-Year Planning Cycle Based on PSA review of current support needs and services for family caregivers and grandparents (or other older relative of a child), indicate what services the AAA intends to provide using Title III E and/or matching FCSP funds for both family caregivers and grandparents/older relative caregivers. Check YES or NO for each of the services* identified below and indicate if the service will be provided directly or contracted. Check only the current year and leave the previous year information intact. If the AAA will not provide a service, a justification for each service is required in the space below.

Family Caregiver Services

Category 2012-2013 2013-2014 2014-2015 2015-2016

Family Caregiver Information Services

Yes No

Direct Contract

Yes No

Direct Contract

Yes No

Direct Contract

Yes No

Direct Contract

Family Caregiver Access Assistance

Yes No

Direct Contract

Yes No

Direct Contract

Yes No

Direct Contract

Yes No

Direct Contract

Family Caregiver

Support Services

Yes No

Direct Contract

Yes No

Direct Contract

Yes No

Direct Contract

Yes No

Direct Contract

Family Caregiver

Respite Care

Yes No

Direct Contract

Yes No

Direct Contract

Yes No

Direct Contract

Yes No

Direct Contract Family Caregiver Supplemental Services

Yes No

Direct Contract

Yes No

Direct Contract

Yes No

Direct Contract

Yes No

Direct Contract


Grandparent Services

*Refer to PM 11-11 for definitions for the above Title III E categories. Justification: For each service category checked “no”, explain how it is being addressed within the PSA. The justification must include the following:

• Provider name and address of agency • Description of the service • Where the service be provided (entire PSA, certain counties, etc.) • Information that influenced the decision not to provide the service (research,

feedback from needs assessment, survey of senior population in PSA, etc.) • How the AAA ensures the service continues to be provided in the PSA without the

use of Title IIIE funds PSA 23 has never provided Supplemental Services for Grandparents using III-E funds due to insufficient funding. PSA 23 continues to track grandparent need and provide and/or add service categories as funding allows. Current services for Grandparents include categories identified as highest unmet need, such as Respite, Support Services, Information Services, and Access Services.

Supplemental Services for Grandparents includes Home Delivered Meals, Minor Home Modification, Transportation, and Legal Services.

Category 2012-2013 2013-2014 2014-2015 2015-2016 Grandparent

Information Services

Yes No

Direct Contract

Yes No

Direct Contract

Yes No

Direct Contract

Yes No

Direct Contract

Grandparent

Access Assistance

Yes No

Direct Contract

Yes No

Direct Contract

Yes No

Direct Contract

Yes No

Direct Contract Grandparent

Support Services

Yes No

Direct Contract

Yes No

Direct Contract

Yes No

Direct Contract

Yes No

Direct Contract Grandparent

Respite Care

Yes No

Direct Contract

Yes No

Direct Contract

Yes No

Direct Contract

Yes No

Direct Contract

Grandparent

Supplemental Services

Yes No

Direct Contract

Yes No

Direct Contract

Yes No

Direct Contract

Yes No

Direct Contract


SECTION TWENTY-ONE ORGANIZATION CHART


SECTION TWENTY-TWO ASSURANCES

Pursuant to the Older Americans Act Amendments of 2006 (OAA), the Area Agency on Aging assures that it will:

A. Assurances

1. OAA 306(a)(2) Provide an adequate proportion, as required under OAA 2006 307(a)(2), 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— (A) services associated with access to services (transportation, health services (including mental health services) outreach, information and assistance, (which may include information and assistance to consumers on availability of services under part B and how to receive benefits under and participate in publicly supported programs for which the consumer may be eligible) and case management services); (B) in-home services, including supportive services for families of older individuals who are victims of Alzheimer’s disease and related disorders with neurological and organic brain dysfunction; and (C) legal assistance; and assurances that the area agency on aging will report annually to the State agency in detail the amount of funds expended for each such category during the fiscal year most recently concluded;

2. OAA 306(a)(4)(A)(i)(I-II) (I) provide assurances that the area agency on aging will -

(aa) set specific objectives, consistent with State policy, for providing services to older individuals with greatest economic need, older individuals with greatest social need, and older individuals at risk for institutional placement; (bb) include specific objectives for providing services to low-income minority older individuals, older individuals with limited English proficiency, and older individuals residing in rural areas; and;

(II) include proposed methods to achieve the objectives described in (aa) and (bb) of subclause (I);

3. OAA 306(a)(4)(A)(ii) Include in each agreement made with a provider of any service under this title, a requirement that such provider will— (I) specify how the provider intends to satisfy the service needs of low-income minority individuals, older individuals with limited English proficiency, and older individuals residing in rural areas in the area served by the provider; (II) to the maximum extent feasible, provide services to low-income minority individuals, older individuals with limited English proficiency, and older individuals residing in rural areas in accordance with their need for such services; and (III) meet specific objectives established by the area agency on aging, for providing services to low-income minority individuals, older individuals with limited English proficiency, and older individuals residing in rural areas within the planning and service area;


4. OAA 306(a)(4)(A)(iii) With respect to the fiscal year preceding the fiscal year for which such plan is prepared— (I) identify the number of low-income minority older individuals in the planning and service area; (II) describe the methods used to satisfy the service needs of such minority older individuals; and (III) provide information on the extent to which the area agency on aging met the objectives described in assurance number 2.

5. OAA 306(a)(4)(B) Use outreach efforts that — (i) identify individuals eligible for assistance under this Act, with special emphasis on—

(I) older individuals residing in rural areas; (II) older individuals with greatest economic need (with particular attention to low-income minority individuals and older individuals residing in rural areas); (III) older individuals with greatest social need (with particular attention to low-income minority individuals and older individuals residing in rural areas); (IV) older individuals with severe disabilities; (V) older individuals with limited English proficiency; (VI) older individuals with Alzheimer’s disease and related disorders with neurological and organic brain dysfunction (and the caretakers of such individuals); and (VII) older individuals at risk for institutional placement; and

(ii) inform the older individuals referred to in sub-clauses (I) through (VII) of clause (i), and the caretakers of such individuals, of the availability of such assistance;

6. OAA 306(a)(4)(C) 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;

7. OAA 306(a)(5)

Coordinate planning, identification, assessment of needs, and provision of services for older individuals with disabilities, with particular attention to individuals with severe disabilities, and individuals at risk for institutional placement with agencies that develop or provide services for individuals with disabilities;

8. OAA 306(a)(9)

Carry out the State Long-Term Care Ombudsman program under OAA 2006 307(a)(9), will expend not less than the total amount of funds appropriated under this Act and expended by the agency in fiscal year 2000 in carrying out such a program under this title;


9. OAA 306(a)(11) 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, the area agency on aging will pursue activities, including outreach, to increase access of those older Native Americans to programs and benefits provided under this title; (B) to the maximum extent practicable, coordinate the services the agency provides under this title with services provided under title VI; and (C) 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, to older Native Americans.

10. OAA 306(a)(13)(A-E) (A) maintain the integrity and public purpose of services provided, and service providers, under this title in all contractual and commercial relationships;

(B) disclose to the Assistant Secretary and the State agency— (i) the identity of each nongovernmental entity with which such agency has a contract or commercial relationship relating to providing any service to older individuals; and (ii) the nature of such contract or such relationship;

(C) demonstrate that a loss or diminution in 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 contract or such relationship; (D) demonstrate that the quantity or quality of the services to be provided under this title by such agency will be enhanced as a result of such contract or such relationship; and (E) on the request of the Assistant Secretary or the 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;

11. 306(a)(14) Not give preference in receiving services to particular older individuals as a result of a

contract or commercial relationship that is not carried out to implement this title;

12. 306(a)(15) Funds received under this title will be used—

(A) to provide benefits and services to older individuals, giving priority to older individuals identified in OAA 2006 306(a)(4)(A)(i); and (B) in compliance with the assurances specified in OAA 2006 306(a)(13) and the limitations specified in OAA 2006 212;

B. Additional Assurances: Requirement: OAA 305(c)(5) In the case of a State specified in subsection (b)(5), the State agency; and shall provide assurance, determined adequate by the State agency, that the area agency on aging will have


the ability to develop an area plan and to carry out, directly or through contractual or other arrangements, a program in accordance with the plan within the planning and service area.

Requirement: OAA 307(a)(7)(B) (i) no individual (appointed or otherwise) involved in the designation of the State agency or an area agency on aging, or in the designation of the head of any subdivision of the State agency or of an area agency on aging, is subject to a conflict of interest prohibited under this Act; (ii) no officer, employee, or other representative of the State agency or an area agency on aging is subject to a conflict of interest prohibited under this Act; and (iii) mechanisms are in place to identify and remove conflicts of interest prohibited under this Act.

Requirement: OAA 307(a)(11)(A) (i) enter into contracts with providers of legal assistance, which can demonstrate the experience or capacity to deliver legal assistance; (ii) include in any such contract provisions to assure that any recipient of funds under division (i) will be subject to specific restrictions and regulations promulgated under the Legal Services Corporation Act (other than restrictions and regulations governing eligibility for legal assistance under such Act and governing membership of local governing boards) as determined appropriate by the Assistant Secretary; and (iii) attempt to involve the private bar in legal assistance activities authorized under this title, including groups within the private bar furnishing services to older individuals on a pro bono and reduced fee basis.

Requirement: OAA 307(a)(11)(B) That no legal assistance will be furnished unless the grantee administers a program designed to provide legal assistance to older individuals with social or economic need and has agreed, if the grantee is not a Legal Services Corporation project grantee, to coordinate its services with existing Legal Services Corporation projects in the planning and service area in order to concentrate the use of funds provided under this title on individuals with the greatest such need; and the area agency on aging makes a finding, after assessment, pursuant to standards for service promulgated by the Assistant Secretary, that any grantee selected is the entity best able to provide the particular services.

Requirement: OAA 307(a)(11)(D) To the extent practicable, that legal assistance furnished under the plan will be in addition to any legal assistance for older individuals being furnished with funds from sources other than this Act and that reasonable efforts will be made to maintain existing levels of legal assistance for older individuals; and

Requirement: OAA 307(a)(11)(E) Give priority to legal assistance related to income, health care, long-term care, nutrition, housing, utilities, protective services, defense of guardianship, abuse, neglect, and age discrimination.


Requirement: OAA 307(a)(12)(A) In carrying out such services conduct a program consistent with relevant State law and coordinated with existing State adult protective service activities for - (i) public education to identify and prevent abuse of older individuals; (ii) receipt of reports of abuse of older individuals;

(iii) active participation of older individuals participating in programs under this Act through outreach, conferences, and referral of such individuals to other social service agencies or sources of assistance where appropriate and consented to by the parties to be referred; and (iv) referral of complaints to law enforcement or public protective service agencies where appropriate.

Requirement: OAA 307(a)(15) If a substantial number of the older individuals residing in any planning and service area in the State are of limited English-speaking ability, then the State will require the area agency on aging for each such planning and service area - (A) To utilize in the delivery of outreach services under Section 306(a)(2)(A), the services of workers who are fluent in the language spoken by a predominant number of such older individuals who are of limited English-speaking ability. (B) To designate an individual employed by the area agency on aging, or available to such area agency on aging on a full-time basis, whose responsibilities will include:

(i) taking such action as may be appropriate to assure that counseling assistance is made available to such older individuals who are of limited English-speaking ability in order to assist such older individuals in participating in programs and receiving assistance under this Act; and

(ii) providing guidance to individuals engaged in the delivery of supportive services under the area plan involved to enable such individuals to be aware of cultural sensitivities and to take into account effective linguistic and cultural differences.

Requirement: OAA 307(a)(18) Conduct efforts to facilitate the coordination of community-based, long-term care services, pursuant to Section 306(a)(7), for older individuals who -

(A) reside at home and are at risk of institutionalization because of limitations on their ability to function independently;

(B) are patients in hospitals and are at risk of prolonged institutionalization; or (C) are patients in long-term care facilities, but who can return to their homes if community-based services are provided to them.

Requirement: OAA 307(a)(26) That funds received under this title will not be used to pay any part of a cost (including an administrative cost) incurred by the State agency, or an area agency on aging, to carry out a contract or commercial relationship that is not carried out to implement this title.


Requirement: OAA 307(a)(27) Provide, to the extent feasible, for the furnishing of services under this Act, consistent with self-directed care.

C. Code of Federal Regulations (CFR), Title 45 Requirements:

CFR [1321.53(a)(b)] (a) The Older Americans Act intends that the area agency on aging shall be the leader relative to all aging issues on behalf of all older persons in the planning and service area. This means that the area agency shall proactively carry out, under the leadership and direction of the State agency, a wide range of functions related to advocacy, planning, coordination, interagency linkages, information sharing, brokering, monitoring and evaluation, designed to lead to the development or enhancement of comprehensive and coordinated community based systems in, or serving, each community in the Planning and Service Area. These systems shall be designed to assist older persons in leading independent, meaningful and dignified lives in their own homes and communities as long as possible.

(b) A comprehensive and coordinated community-based system described in paragraph (a) of this section shall: (1) Have a visible focal point of contact where anyone can go or call for help, information or referral on any aging issue; (2) Provide a range of options: (3) Assure that these options are readily accessible to all older persons: The independent, semi-dependent and totally dependent, no matter what their income; (4) Include a commitment of public, private, voluntary and personal resources committed to supporting the system; (5) Involve collaborative decision-making among public, private, voluntary, religious and fraternal organizations and older people in the community; (6) Offer special help or targeted resources for the most vulnerable older persons, those in danger of losing their independence; (7) Provide effective referral from agency to agency to assure that information or assistance is received, no matter how or where contact is made in the community; (8) Evidence sufficient flexibility to respond with appropriate individualized assistance, especially for the vulnerable older person; (9) Have a unique character which is tailored to the specific nature of the community; (10) Be directed by leaders in the community who have the respect, capacity and authority necessary to convene all interested individuals, assess needs, design solutions, track overall success, stimulate change and plan community responses for the present and for the future. CFR [1321.53(c)] The resources made available to the area agency on aging under the Older Americans Act are to be used to finance those activities necessary to achieve elements of a community based system set forth in paragraph (b) of this section.


CFR [1321.53(c)] Work with elected community officials in the planning and service area to designate one or more focal points on aging in each community, as appropriate.

CFR [1321.53(c)] Assure access from designated focal points to services financed under the Older Americans Act.

CFR [1321.53(c)] Work with, or work to assure that community leadership works with, other applicable agencies and institutions in the community to achieve maximum collocation at, coordination with or access to other services and opportunities for the elderly from the designated community focal points.

CFR [1321.61(b)(4)] Consult with and support the State's long-term care ombudsman program.

CFR [1321.61(d)] No requirement in this section shall be deemed to supersede a prohibition contained in the Federal appropriation on the use of Federal funds to lobby the Congress; or the lobbying provision applicable to private nonprofit agencies and organizations contained in OMB Circular A-122.

CFR [1321.69(a)] Persons age 60 and older who are frail, homebound by reason of illness or incapacitating disability, or otherwise isolated, shall be given priority in the delivery of services under this part.

Area Plan 2012-2016, Appendix Aging & Independence Services: PSA #23 County of San Diego

APPENDIX

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