Illinois Governor's Conference on Aging Jean Wood December 11, 2013

Overview of Presentation State System Overview Older Americans Act Services Managed Care and Health Care Reform Adult Protective Services Minnesota’s Aging and Disability Resource Center

MN Department of Human Services – Continuing Care Administration Continuing Care Assistant Commissioner Aging and Adult Services Elderly Waiver Alternative Care Older Americans Act Nursing Facility Rates and Policy Aging 2030 Disability Services

MN’s Long-Term Services and Supports System A continuum of services Older Americans Act 66,000 Alternative Care 4,700 Elderly Waiver 31,000 Nursing Home 27,000 Increasing Need

Percent of total public LTSS funds for older adults – HCBS vs. institution

EW and AC Impact More older adults receive services in Minnesota’s long-term care programs in their homes instead of going to institutions. In 2007, almost 58% of older adults in LTC received HCBS. By 2011, the overall percentage increased to 64.3%. The percent of older adults in Minnesota’s that receive HCBS in their own homes has increased. In 2007, 74.2% of older adults received services in their own home. By 2011, the percent had increased to 75.4%. The percent of older adults with high needs in Minnesota’s on EW or AC has been increasing. In 2007, almost 60% of older adults with high needs received services through EW or AC in their own home. By 2011, the percent was 63.9%.

Minnesota Board on Aging Separate state agency 25 member governor appointed board Administers $24 million in federal funds; $8 million in state funds; $20 million in local funds and resources Designates a statewide network of Area Agencies on Aging Direct service programs: –Senior LinkAge Line® –Long-Term Care Ombudsman Program

MN Aging Service Providers Nutrition Services: 13 Homemaker: 10 Chore: 33 Transportation: 17 Legal Assistance: 8 Health Promotion: 20 Caregiver Respite: 31 Caregiver Consultation/Training & Education: 20

MN Aging Network ServicePeople Served (FFY 2012) Congregate Meals49,983 Home Delivered Meals11,383 Chore3,633 Homemaker1,296 Assisted Transportation969 Health Promotion2,933 Caregiver Respite730 Caregiver Consultation/Training & Ed 2,685

MN Aging Network Impact MN NAPIS CY2012 Baseline* MN 2010 Census 65+ Population Goal IIIB 44.14% (n=5,303) IIIC % (n=29,942) IIIC % (n=7,149) IIIE 47.07% (n=597) 27%37% Increase the percent of Title 3 program participants who have incomes % FPL to 10% greater than the percent of all MN older adults at this income level.

MN Aging Network Impact MN NAPIS CY2012 Baseline AoA National FFY2011 Comparison Congregate 37.4% Congregate 19.1% Home Delivered 68.4%Home Delivered 51.9% Increase the percent of senior nutrition program participants who have a high nutrition risk score.

Average Units per Participant MN NAPIS FFY 2011 Baseline AoA National FFY2011 Comparison Congregate Meals 36.1*51.4 Home Delivered Meals 94.0*163.3 Homemaker Chore Assisted Transportation Average number of units per participant that is equal to or greater than AoA national average. MN Aging Network Impact

Role of Managed Care Older adults eligible for Medicaid have been required to enroll in Medicaid managed care since 1983: Minnesota Senior Health Options (MSHO). Currently, 92% of EW participants receive their services through a managed care organization. MSHO integrates Medicare and Medicaid primary, acute, drugs, home care and other long-term services and supports as well as Elderly Waiver services the first 180 days of care in a nursing facility.

Health Care Reform in Minnesota Connecting health care homes with LTSS State certification for health care homes CMS Multi-payer Advanced Primary Care Initiative ACL Integrated Systems Grant Developing total cost of care models Pioneer ACOs Medicaid Health Care Delivery System Demos Bringing it to Scale CMS State Innovation Model Grant –Accountable Communities for Health

Adult Protective Services in Minnesota State Policy Protect Vulnerable Adults (VA): Safe Services and Environments Defines: Vulnerable Adult/Maltreatment Reporting: Required/Encouraged Appropriate Cases: Investigation and Protective Services

30,000+ Reports of Suspected Maltreatment of VA 2012 Lead Investigative Agencies Responsible for Reports: 45% MDH 41% County 14% DHS Law Enforcement: Crime Alleged County: Immediate Protective Services Adult Protective Services in Minnesota

Reform 2020: Enhance VA Protections State Maltreatment Report Center under DHS Web Reporting Adult Protection Resource Specialist Staff County Grants Public Awareness Campaign Adult Protective Services in Minnesota

Structured Decision Making (SDM) Tool 2013 Mandated State-Wide Use Minnesota Board on Aging Grant All Reports of Suspected Maltreatment Where County Responsible Establishes Consistency in Assessment and Service to VA’s Adult Protective Services in Minnesota

20 Evolving the Service MN Board on Aging decision – AAAs Statewide uniformity –Single Brand –One statewide toll free number –Upgraded phone system to zip code routing and then later prefix routing –Desktop Client tracking system –Staff training –Marketing and outreach Minnesota’s Aging and Disability Resource Center (ADRC) Background: Senior LinkAge Line®

Minnesota’s ADRC Making the Shift to a Fully Integrated System It Started in 1999 with a small prescription drug program Establish a Comprehensive Statewide Service in 2001 to prepare for aging of boomers –Move to a system that does “Information and Assistance” – not I and R Longer Calls Higher levels of credentialing of staff –Development “niche areas” or specialties that fill the gaps Helped with Medicare Part D in 2005 And Now: Care Transitions

But the real keys to our success: Branding. Branding. Branding. A People not Programs Philosophy which means simplifications and streamlining for the consumer (not for the programs, government etc) Thinking in a flexible and agile manner and sticking with our core values –Be relevant –Be accessible –Be ready when the student arrives Thinking like a single unit not 7 state units with seven area agencies – we are one to the consumer Minnesota’s ADRC

Minnesota’s ADRC Branding! Branding! Branding!

Minnesota Aging and Disability Resource Center No wrong door approach Four Channels! –Phone –Internet –In person/face-to-face assistance –Print

Minnesota’s ADRC Senior LinkAge Line® Long Term Care Options Counseling Transition assistance for private pay nursing home residents Medicare and other health insurance counseling Prescription drug expense assistance for all ages Application and forms assistance Long Term Care Partnership (2006) Caregiver planning and support Health care waste, fraud and abuse One Stop: State agency related questions, connections to volunteer opportunities and older workers (Spring 2013)

Minnesota’s ADRC Disability Linkage Line® Disability Benefits Accessibility/Modifications Assistive Technology PCA Services Transition Services Accessible Housing Employment Awareness/Rights

Minnesota’s ADRC Veterans Linkage Line™ Veterans Benefits Assistance Reintegration challenges and referrals Reintegration with family life Household finance management Assistance with mental health and stress disorders Understanding, maintaining and transferring among benefits Substance abuse referrals Housing and homelessness Job seeking and employment counseling Understanding education or retraining benefits and options

MinnesotaHelp Network™ Contact Center Locations

Minnesota’s ADRC

31 Simplified, “Google-style” search capabilities with a power user version Search for services statewide or locally by topic or keyword Save, print and searches and plans Interactive decision support tools for aging, youth and people with disabilities View results charted on a map

32 –Step-by-step decision making tool –Interactive –Easy to use –Available at Minnesotahelp.info

Minnesota’s ADRC Disability Benefits 101 – DB101.org DB101.org brings together: benefits information tools resources to make it easier to: understand benefits learn about work incentives plan for work & set goals build financial literacy manage benefits while working

Minnesota’s ADRC A system designed to help YOU … 34 – easily understand benefits and work incentives – demonstrate to the people you serve how work can be a solution – better engage people in work planning overcome fears and barriers explore work as an option make informed choices about work achieve better employment outcomes – have access to, use and provide consistent messaging and resources

Minnesota’s ADRC Print 30,000 printed annually Distributed statewide by the Area Agencies on Aging to Medicare beneficiaries, caregivers, local partners and sites 2013 – mailing of HCC done to clinics, hospitals and health care homes

Minnesota’s ADRC What is the Return To Community Initiative? Passed in 2009 by State Legislature and is based on research conducted by the U of MN School of Public Health & the Indiana University Center for Aging Research which can be found at this link: – Utilizes the MinnesotaHelp Network™ which includes the LinkAge Lines (Senior, Disability and Veterans), the website MinnesotaHelp.info®, and in-person assistance through Senior LinkAge Line staff and volunteers.

Minnesota’s ADRC Why is this service important? It focuses on private pay individuals –Assumption is assistance to transition home but then ongoing follow up in the community will help people avoid spend down Intensive follow-up services are available for people assisted out of the nursing home –Also available for those we don’t specifically assist but who naturally discharge as they are a target group for follow in the assumptions The effort is being evaluated under an AHRQ (Agency for HealthCare Research and Quality) grant by two universities.

Minnesota’s ADRC Experience to Date - Statewide Top 3 Referral Sources for CLS Assisted Discharges –43% Nursing Homes –38% MDS Profile List –6% MDS Section Q Over 988 consumers directly assisted by CLS who discharged to community Over 900 consumers receiving follow-up in community

Questions? Jean Wood Executive Director