1. Looking Back/Moving Forward: National and State Impact of ADRCs Joseph Lugo, Administration on Aging Lois Yellowthunder, Minnesota Help Netork Cindy Gruman, The Lewin Group July 20th, 2009 N4A Annual Meeting

2. 1 Workshop Overview u Joseph Lugo – ADRC Breakthroughs and Growing Pains u Lois Yellowthunder – Minnesota ADRC Experience u Cindy Gruman & Sarah Lash – Technical Assistance and Support Available u Comments and Questions

3. 2 1990 – Americans with Disabilities Act (ADA) 1999 – Olmstead Decision 2001 – New Freedom Initiative (NFI) 2003 – Aging and Disability Resource Center grants begin 2006 – Older Americans Act Reauthorization 2006 – Choices for Independence 2009 – Year of Community Living History of ADRC Program

4. 3 ADRC Characteristics: Systems and Models Why are SEPs Important? 1. Number of long term support service options has increased dramatically over last 2 decades – with choice can come confusion SEPs help eliminate confusion in finding LTC options 2. Array of I&R/access points, services, agencies, eligibility criteria and funding sources – navigating the system is difficult SEPs create one-stop access to LTC services 3. In fragmented service systems, consumers may not have access to information about the comprehensive range of LTC service options available to them SEPs ensure that comprehensive options are provided to consumers so they can make the decisions that best meet their needs

5. 4 South Carolina Lt. Governor’s Office on Aging - 2003

6. 5 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

7. 6 ADRC Fully Functioning Criteria u Awareness and Information u Assistance u Access u Target Populations u Critical Pathways u Partnership and Stakeholder Involvement u IT/MIS u Evaluation u Staffing and Resources

8. 7 Success: Increased Demand without Significant Staff Increases Total clients served (Fall 2008) = 218,000

9. 8 ADRC Successes u Assistance  I&R/A99%  Benefits Counseling91%  Options Counseling86%  Futures Planning84%  MAP/PAP81%  Prevention/Health Promotion75%  Caregiver Supports69%  STCM68%  SHIP Counseling66%  Other OAA Services (MOW, etc)39%

10. 9 Partnerships are Key u Area Agencies on Aging u Centers for Independent Living u Other aging and disability service providers u State Health Insurance Assistance Program (SHIP) u 2-1-1 u Adult Protective Services u Medicaid u Long Term Supports and Services Providers (e.g., home health agencies, nursing facilities) u Critical pathway providers (e.g., hospital discharge planners, physicians) Average # of Formal ADRC Partners at State Level 9 Average # of Formal ADRC Partners at Local Level 8

11. 10 Perspective from the Outside Home and Community Based Services Nursing Homes Options Counseling Health Promotion Employment Services Peer Counseling Private Services Public Programs Inside One-Stop Access

12. What does a good partner look like? What do you look like? Are you prepared for partnerships? Can your board Can your staff How do you protect your core What is the cost of partnership What about compromise

13. 12 u Information and Referral u Online Applications  34 states with internet applications; 7 complete & submit online; 4 in process for online submission) u Client tracking u Integrating IT/MIS databases among departments and across agencies u Developing public websites (all ADRCs have some web presence)  Web-based resource directories (next slide)  Online decision tools – 16 developed; 15 in development u Portable technology  8 states use laptops in the field; 3 use potable scanners and photography ADRC Functions: Role of Information Technology

14. 13 ADRC Functions: Role of Information Technology (con’t) u Comprehensive Resource Databases  Includes information about the range of long term support options, providers, programs, and services available  Established Inclusion/Exclusion policies  Accessible to the public via searchable and accessible website  Consistent and Uniform Information available across sites  Centralized maintenance and statewide coverage are preferable u 25 states with statewide web-based resource directory  17 new  6 significant enhancements  13 developing

15. 14 On the Way to Every Community: Extent of Coverage (Fall 2008) 198 ADRCs In 43 Grantee States & Territories Cover 38% of U.S. Population Population Covered in Original 43 Grantees CT, MO, OR & NY also established ADRCs

16. 15 u Over half of the 43 grantees passed legislation, developed executive guidance, and/or contributed state funds u Approximately $43M in financial support from public and private sectors for program development and expansion u New and unexpected partnerships have been developed to enhance program activities u ADRCs have been expanded to multiple pilot sites and statewide in many states ADRCs are Sustaining

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18. 17 States Continue to Work Toward Implementing Fully Functioning ADRCs u Over 50% meet criteria for:  Partnership with Medicaid  Partnership across aging and disability networks  Partnership with consumer and other stakeholders  Involving critical pathway providers in advisory boards u 50% partially meet criteria or have significant room for growth in:  Reaching out to private pay  Implementing options counseling  Measuring outcomes –Tracking NF transitions –Tracking NF diversions –Measuring HCBS/institutional placement

19. 18 Consumers……  Don’t have to go somewhere else (e.g. online submission or referral)  Don’t have to call someone else (e.g. warm transfer, call back, or appointment for home visit made on their behalf)  Are followed-up with after referral is made  Can call the organization to which they are referred or call the original organization back and not have to repeat everything (e.g. case notes shared across agencies through secure web- based MIS)  Feel like they’re only dealing with one organization ADRC Functions: Streamlined Access

20. 19 ADRC Successes u Access % ADRC programs  Assist w/ completing and/or submitting85% financial applications  Screening/intake for Medicaid or other80% public LTC programs  Conducting LOC assessments56%  Pre-screening for NH admission37%  Case management for HCBS waiver29%  Conduct financial eligibility determinations26%  Case management for state-funded LTC25%

21. 20 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

22. 21 Access: More Integration & Coordination with Level of Care Eligibility

23. 22 Access: More Integration & Coordination with Financial Eligibility Process

24. 23 Challenge: Serving Private Pay u Shifting organizational culture u Developing specific marketing strategies to reach people with higher incomes u Including private pay services in databases u Exploring cost-sharing, donations, and fee for service arrangements u 50 percent of 34 pilot sites reporting had an increase in referrals to private services between Spring and Fall of 2007

25. 24 Aging/Disability Partner Lessons Learned u Focus on similarities between organizations and where mission, values and goals align. u Pick a specific project to work on together to get started. u Be aware of differences in terminology or interpretation (self-direction, consumer-direction, case management). u Recognize and account for differences in staff and organizational capacity across organizations. u Be as open-minded, transparent and inclusive as possible. u It takes sensitivity, commitment and patience to overcome cultural and organizational differences.

26. 25 Partnerships: Lessons Learned u Partnership is a central activity of the ADRC and partners should be involved in every aspect of the project. u Involve partners early in the planning process. u Set clear and realistic expectations for partnerships. u Remain flexible in determining partners role. u It is important to formalize partnerships through written agreements or protocols to ensure consistency over time and across different staff. u Identify champions in partnering organizations.

27. 26 Technical Assistance Exchange u Technical Assistance Resources  Website www.adrc-tae.org  Resource Materials (e.g. Issue Briefs)  National Meetings  Regular Electronic Newsletters  Grantee Surveys  Examples from the Field  On-line Training Courses u Building a Grantee Community  Monthly Teleconferences/Web casts  Bi-monthly Workgroup Teleconferences  On-line Discussions  Electronic Bulletin Board

28. 27 Technical Assistance Exchange Overview u The U.S. Administration on Aging sponsors the Technical Assistance Exchange (TAE)  The TAE makes information and resources available to states and community organizations that are designing, implementing or expanding Aging and Disability Resource Centers (ADRC) and other types of single entry point systems

29. 28 Technical Assistance Exchange Overview u The U.S. Administration on Aging sponsors the Technical Assistance Exchange (TAE)  The TAE builds a community of stakeholders involved in making changes to their long term care systems to exchange ideas, knowledge and best practices.

30. 29 Technical Assistance Exchange Overview u The U.S. Administration on Aging sponsors the Technical Assistance Exchange (TAE)  The TA Exchange provides a forum for grantee-to- grantee information exchange on policy and program infrastructure development, and direct technical assistance to and between the grantees as they develop, implement, and evaluate their ADRC projects.

31. 30 TAE Homepage

32. 31 TAE Options u Grantee-to-Grantee Discussion Forum u ADRC-TAE Newsletters Archive u Calendar of Events u Online Training u Past Technical Assistance Events

33. 32 ADRC Fully Functioning Criteria u Awareness and Information u Assistance u Access u Target Populations u Critical Pathways u Partnership and Stakeholder Involvement u IT/MIS u Evaluation u Staffing and Resources

34. 33 Readiness Assessment www.adrc-tae.org

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38. 37 Please feel free to contact us! u Cindy Gruman, PhD Senior Consultant The Lewin Group 3130 Fairview Park Drive, Suite 800 Falls Church, VA 22042 (703) 269-5506 (desk) (703) 269-5503 (fax) cindy.gruman@lewin.com u http://www.adrc-tae.org http://www.adrc-tae.org