Assessment of 2003 ADRC Grantee Progress (Year 1 Planning Process) 2004 GSA Meetings November 22, 2004

2 Data Sources u Quarterly grantee calls with AoA/CMS Project Officers u Semi-Annual Reports submitted by grantees u Technical Assistance Requests

3 Assessing Progress: ADRC Core Domains and Program Components u ADRC Core Domains: fundamental ADRC features that remain constant throughout program implementation and operation  Stakeholder Partnerships & Input  Business Operations  Streamlined Eligibility  IT/MIS  Critical Pathways Program Components: elements within domains that act as indicators of progress toward program goals; components vary by state (reflecting state-specific needs and goals).

4 Assessing Progress: ADRC Core Domains & Program Components Cont. u Domain: Stakeholder Partnerships & Input Components include:  State Agency Coordination (Aging/Disability Networks, Medicaid)  State/Local Coordination  Definition of Roles  Consumer Involvement (Advisory Boards)  Communication (e.g., SUA, Medicaid, Disability Agencies, other key stakeholders)

5 Assessing Progress: ADRC Core Domains & Program Components Cont. u Domain: Business Operations Components include:  Staffing level sufficient to carry out ADRC functions  Recruitment/Training/Retention  Provision of Information, Assistance and Referral to comprehensive LT support options (including private pay options)  Marketing and Outreach

6 Assessing Progress: ADRC Core Domains & Program Components Cont. u Domain: Streamlined Eligibility Components include:  Seamless system for consumers (integration/coordination)  Minimal duplication (intake/assessment/screening/application for services)  Standardization of instruments across systems  Shorten eligibility determination process

7 Assessing Progress: ADRC Core Domains & Program Components Cont. u Domain: IT/MIS Technology  Investment in IT/MIS that supports all ADRC functions (client tracking, needs assessment, care plans, case management, utilization and costs)  Comprehensive Resource Database to ensure consumers from all target populations understand their options for long-term support

8 Assessing Progress: ADRC Core Domains & Program Components Cont. u Domain: Critical Pathways Components include:  Linkages to hospital discharge and other critical pathways to institutional care  Serving the Private Pay Sector

Preliminary Findings

10 Progress: Stakeholder Partnerships & Input

11 Progress: Business Operations

12 Progress: Streamlined Eligibility

13 Progress: IT / MIS

14 Progress: Critical Pathways

15 Implementation Barriers & Facilitators Barriers u Sustaining State level support/buy-in u Staff recruitment and retention u Fiscal restraints/budget challenges u Communication across stakeholders Facilitators u Strong partner collaborations—shared vision u Supportive Governor—program seen as a priority u Marketing/Outreach to diverse populations and organizations u Clear delineation of roles/responsibilities (state/local)

16 ADRC Specific Barriers & Facilitators: Medicaid Agency Involvement Barriers u Lack of engagement/support from Medicaid Agency u Linking Medicaid enrollment & eligibility processes with ADRC Facilitators u State Medicaid staff playing early and active role in state/local ADRC planning process u Co-location of Medicaid eligibility workers at ADRC

17 ADRC Specific Barriers & Facilitators: Integration of Different Public/Private Services/Systems Barriers u Agencies agreeing to collaborate but not willing to change from “business as usual” (e.g., IT systems, databases, and intake processes) u Feasibility of integrating I&A, case management, benefits screening and resource directory into one system with limited funding Facilitators u Establish Inter-Departmental team w/representatives from various state depts. to facilitate coordination u Designate “Integrated Intake Team” to assess various instruments that could be used across settings

18 ADRC Specific Barriers & Facilitators: Bridging Aging & Disability Systems/Cultures Barriers u Gaining cooperation of Disability community when ADRC is housed in Aging office u Board composition—establishing sufficient balance among consumers and other stakeholders Facilitators u Cross training staff on disability issues & cultural competency u Connect Aging/Disability networks through IT systems

19 ADRC Specific Barriers & Facilitators: Leveraging ADRC with Other System Reforms Barriers u Sustaining consistent support at state level amidst competing priorities u Turf Issues—state agencies feel threatened by ADRC Facilitators u Building workgroups that cross over various grant/waiver programs u Solid coordination w/Systems Change grants and health promotion campaigns

20 ADRC Specific Barriers & Facilitators: Involving Providers Along Critical Pathways Barriers u Resistance from hospital discharge planners to change normal procedures u Concern that sharing information about potential ADRC clients would violate consumer privacy Facilitators u Ascertain when/where consumers initiate their search for LTC support information u Bring NF representatives to the table for discussion— assure them of role in LTC continuum of care