Driving Change: ADRCs as the Cornerstone to Long Term Care Transformation Cathy Cope, Centers for Medicare and Medicaid Services Joseph Lugo, Administration on Aging Heather Johnson, Massachusetts and Vermont ADRCs September 21, 2009 HCBS Conference – Denver, Colorado

Provide national vision for ADRCs as integral components of states’ LTC systems Positioning ADRCs to facilitate and drive other programs Hear specific examples of state activity Discuss your strategies for sustainability and expansion Purpose

Where does HCBS fit in ? 21 Mining 22Utilities 23Construction 31-33Manufacturing 42Wholesale Trade 44-45Transportation and Warehousing 48-49Information 51Finance and Insurance 52Real Estate and Rental and Leasing 53Professional, Scientific, Technical Services 54Management of Companies and Enterprises 55Administrative and Support and Waste Management and Remediation Services 61Educational Services 62Health Care and Social Assistance 71Arts, Entertainment, and Recreation 72Accommodation and Food Services 81Other Services (except for Public Administration)

What is the size and scope of this industry? Health Care & Social Assistance - 62

What is the size and scope of this industry? Social Assistance - 624

What is the size and scope of this industry? Individual Family Services

What is the size and scope of this industry? Services for the Elderly and Persons with Disabilities Represents a 69% increase from 1997 to 2002 (Receipts) Entire Industry (62) grew 36.8% from 1997 to 2002 (Receipts)

LTC System Challenges Fragmented systems of I&R, access points, services, agencies, eligibility criteria and funding sources – navigating the system is difficult The number of long term support service options has increased dramatically over last 2 decades – with choice can come confusion A professional, friend or family member may refer an individual to one known service – consumer may never reach an objective and comprehensive source

South Carolina Lt. Governor’s Office on Aging

– Americans with Disabilities Act (ADA) 1999 – Olmstead Decision 2001 – New Freedom Initiative (NFI) 2003 – Aging and Disability Resource Centers 2006 – Older Americans Act Reauthorization 2007 – Nursing Home Diversion / Community Living Program 2009 – Year of Community Living History of AoA’s Systems Change Initiatives

 In every community in the nation  Highly visibletrusted  Highly visible and trusted places all incomes and ages  Serving people of all incomes and ages full range  Providing information on the full range of long term support options AoA Vision for ADRCs ADRCs build consumer trust by enhancing individual choice, supporting informed decision- making and streamlining access to services.

Expectations for ADRCs 1.Seamless system of services 2.Integrated access – streamlined eligibility 3.Shift of institutional bias – from institutions to communities 4.Meaningful involvement of consumers & other stakeholders 5.Partnerships among aging, disability, public and private LTC service networks 6.Investment in MIS that supports ADRC activities 7.Performance measurement – CQI, outcomes 8.Sustainability

Hawaii Alaska MT ID WA CO WY NV CA NM AZ MN KS TX IA WI IL KY TN IN OH MI ALMS AR LA GA FL SC WV VA NC PA VT RI ME NH OR UT SD ND MO OK NE NY CT MA DC ADRC Coverage as of Spring 2009 DE Guam Northern Mariana Islands 0-25% of state population 25-50% of state population 50-75% of state population % of state population

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Success: Increased Demand without Significant Staff Increases Total clients served (Fall 2008) = 218,000

Click to edit Master title style Click to edit Master subtitle style ADRCs are not about replacing existing organizations and networks. It’s about building a better, more coordinated network.

How Do You Make the Case for the ADRC? Consumer satisfaction Ease of access Informed decision making Trust Cost Savings Potential Increased use of HCBS Decreased nursing home use Streamlining efficiencies Lewin’s ADRC Cost Savings Calculator

FunctionProgress Resource database 25 states -- statewide web-based directories available to consumers and service providers Functional eligibility40% of ADRCs have co-located FuE staff Financial eligibility25% of ADRCs have co-located FiE staff Medicaid application34 states – application available on-line Medicaid application submission 7 states allow applications to be completed on-line and submitted electronically Consumer decision tool Available on-line in 16 states; 15 states developing technology Portable technology 8 states use laptops in the field; 3 include portable document scanners and photography ADRC Success in Streamlining: Significant Use of Information Technology

Sustainability Strategy: Positioning ADRCs Position the ADRC so that it is the logical choice to carry out new programs in LTC reform. Requires action at all levels: Federal State Local ADRCs can be the driving change.

Driving Change in Federal Programs ADRCs have partnered with… Other AoA Initiatives Community Living Programs Veterans Health Administration Veteran Directed Home and Community Based Services Programs Centers for Medicare and Medicaid Services Money Follows the Person Dept. of Housing and Urban Development HUD-Reverse Mortgages

Veteran Directed Home and Community-Based Services

Driving Change through Better Use of Private Resources Private Pay Indiana, Florida, and other states are actively serving private pay consumers through a mix of free services, sliding scale, and fee-for-service offerings to help them handle their resources wisely Care Transitions Oregon, Kansas, and other states are developing models for involving the ADRC in transitions in care, such as from a hospital or nursing home, to ensure maximum health and safety and avoid Medicaid spend-down Senior Risk Reduction Demonstration 4 ADRC/Aging I&A sites involved in CMS SRRD to demonstrate the value of community organizations in linking older adults with wellness resources and other support services

Need Leadership in the Broader Community ADRCs need leaders who are willing to break down bureaucratic barriers View the ADRC as a catalyst for positive systems change Be sensitive to political climates Encourage Board members and other stakeholders to become champions of the ADRC States and pilot sites should work in collaborative partnership Establish pilot site organizations with functions, missions, and priorities that match the federal vision Meld grant activities with other community initiatives