1. Veterans Directed (VD)- Home and Community Based Services (HCBS) and the State Unit on Aging (SUA) Patricia A. Polansky, Assistant Commissioner Division of Aging and Community Services NJ Department of Health and Senior Services February 24, 2009 Aging Network and Veterans Health Administration Conference, February 24-25, 2009

2. SUA 101  AoA created in 1965 with passage of the Older Americans Act  AoA is part of a federal state, tribal and local partnership called the National Network on Aging  7 million older adults and their caregivers, 56 officially designated State Units on Aging, 233 Tribal and Native Organizations, two organizations that serve Native Hawaiians, 29,000 service providers and thousands of volunteers

3. SUA in New Jersey = Division of Aging and Community Services DEFINITION: An agency of state government that serves as the state focal point for all matters affecting older persons. Responsible to designate and administer the Area Agencies on Aging.

5. States Awarded Nursing Home Diversion Grants AR CT FL GA IL KY LA MD MAMI VT NH MN NJ NY OH VA WV TX WA

6. AR CT FL MAMI NJ NY VA TX WA States Awarded VD-HCBS Program

7. Snapshot of New Jersey  9 th in US in population age 65 & over  8.5 million residents with 1.5 million individuals 60 yrs.+  Age 85+ is fastest growing cohort  880,000 caregivers  NJ’s current population of 1.5 million adults 60+ is projected to reach 2.5 million by 2030  NJ is the nation’s most densely populated state (at 1,134 persons per sq. mile)  Over 70 languages spoken in NJ NEWARK   TRENTON  CAMDEN

8. New Jersey’s Strategic Plan Mirrors AoA Strategic Plan FY 2007-2012 1.Make it easier for older adults to access an integrated array of health and social supports. 2.Help older people to stay active and healthy. 3.Support families in their efforts to care for loved ones at home and in the community. 4.Ensure the rights of older people and prevent their abuse, neglect and exploitation. 5.Promote an effective and responsive management.

9. Veterans & New Jersey: The Numbers  New Jersey has almost 550,000 veterans, half of them over 65.  There are approximately 48,932 veterans classified as disabled in New Jersey by the U.S. Department of Veterans Affairs.  New Jersey Department of Military and Veterans Affairs has over 500 veterans on waiting lists for the three state-run Veterans Memorial Homes.  Department of Veterans Affairs NJ Healthcare System (VANJHCS) served 59,381 veterans resulting in 450,526 outpatient visits and 4,798 inpatients treated during Fiscal Year 2007.

11. ADRC: No Wrong Door Approach  Responsiveness  Consumer Driven  Affordable  Appropriate  Flexible  Reliable  Standardized  Single Point of Entry  Trusted  Visible No Wrong Door…

12. Older Americans Act Medicare/Medicaid ADRC Systems Transformation Grant RebalancingDeficit Reduction Act Chronic Disease Self Management/ Evidence Based Health Promotion and Disease Prevention Nursing Home Diversion Modernization Veterans-Directed HCBS Caregivers

13. That was Then…, This is Now!

14. National Aging Agenda for HCBS Long-Term Care + National Disabled Agenda for HCBS Long-Term Care + National Veterans Agenda for HCBS Long-Term Care = VD-HCBS Program

15. The only people who like change are babies!

16. CHANGE Expectancy Theory Reigns C H A N G E Grits & Guts NEVER Easy Administrative; i.e. MUST be managed Change is Inevitable High Stress

17. Good Leaders!  Leadership  Stewardship  Change Agents

18. “Plans are only good intentions unless they immediately degenerate into hard work” - Peter F. Drucker

19. VD-HCBS Program Partners in New Jersey  DHSS; DHS’ Divisions of Medical Assistance and Health Services and Disability Services; Department of Military and Veterans Affairs (DMAVA); the U.S. Department of Veterans Affairs New Jersey Healthcare System; the Morris County Division on Aging, Disabilities and Veterans; and the Somerset County Office on Aging.

20. Lyons Veterans Administration Campus in Lyons, NJ

21. CONSUMER DIRECTION

22. NHDM Grant 2007-2008: Cornerstone for VD-HCBS Program Flexible Individualized Budget Allocations:  Flexible dollars tailored to individual service needs  Consumers identify services to meet their needs in a setting of their choice  Ability to hire non-traditional providers, including family members or neighbors to provide services  Financial counseling/money management  Cost Share: personal resources used to avoid unnecessary spend down to Medicaid

23. VD-HCBS Program-More Comprehensive Services  Transportation  Care Management  Respite Services  Hospice Care  Home Based Supportive Care  Personal Emergency Response Systems  Environmental Accessibility Adaptations

24.  Provider Agreement  Bundled Services to BE PURCHASED by VA:  HHA  ADHS  Non-Traditional Services  Assessment & Care Management  Administrative Oversight  Fiscal Management Services (FMS)  Reimburse AAAs for Bundled Services VD-HCBS Prototype

27. DON’T Make The Process The Product!

28. You probably should think of the next several months as one sustained “2-MINUTE DRILL.”

29. “Accept challenges, so that you may feel the exhilaration of victory” - George Patton

30. Patricia A. Polansky, Assistant Commissioner Division of Aging and Community Services NJ Department of Health and Senior Services (609) 292-4027 Patricia.Polansky@doh.state.nj.us http://www.state.nj.us/