1. 0 Training Session: An Overview of the Aging and Disability Resource Center Program Empowering Consumers to Navigate their Long-Term Support Options in Challenging Economic Times Aging and Disability Resource Centers

2. 1 TRAINING COURSE Welcome Introductions Logistics Follow-up Overview of ADRCs

3. 2 Understand the purpose and vision of the ADRC program Explain the five operational components of ADRC programs: oInformation & Awareness oOptions Counseling oStreamlined Access oPerson-Centered Hospital Discharge Planning oQuality Assurance & Evaluation Examine strategies for developing sustainable ADRC programs in the current financial climate Overview of ADRCs Learning Objectives

4. 3 Overview of ADRCs ADRC - Aging and Disability Resource Center CLP – Community Living Program VDHCBS – Veterans-Directed Home and Community Based Services Program SEP - Single Entry Point NWD - No Wrong Door AoA - Administration on Aging CMS - Centers for Medicare and Medicaid Services SHIP – State Health Insurance Counseling Program CIL – Center for Independent Living SILC – Statewide Independent Living Council AIRS – Alliance of Information and Referral Systems Acronyms

5. 4 Course Modules  Module IBackground & Purpose of the ADRC program  Module IIADRC Core Operational Components  Module IIISustainability Overview of ADRCs Course Modules

6. 5 LTC System Challenges Fragmented Institutional bias Lacks focus on consumer Confusing Increase in population = $$$$$ ADRC Reform Strategy Purpose and Background of Aging and Disability Resource Centers

7. 6 AoA/CMS Systems Change Vision Purpose and Background of Aging and Disability Resource Centers

8. 7 AoA’s Strategic Priorities Empower older people and their families to make informed decisions about, and be able to easily access, existing health and long-term care options. Enable seniors who are at high-risk of nursing home placement to remain in their own homes and communities for as long as possible if that is their preference. Empower older people to stay active and healthy through evidence-based disease and disability prevention programs. Ensure the rights of older people and prevent their abuse, neglect and exploitation through adequate Elder Rights Programs. Promote effective and responsive management of AoA human capital resources and grants funds through implementing a system of sound financial controls. Purpose and Background of Aging and Disability Resource Centers

9. 8 ADRC Place in LTC Reform History 1990 – 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 – Community Living Program 2008 – Veterans-Directed HCBS 2009 – Year of Community Living Purpose and Background of Aging and Disability Resource Centers

10. 9 Community Living Program Diversion Strategy Home/Community Low-Risk of NH Placement & Spenddown to Medicaid Medium-Risk of NH Placement & Spenddown to Medicaid High-Risk of NH Placement & Spenddown to Medicaid Nursing Home/Medicaid Diversion Nursing Home Spend-down to Medicaid

11. 10 Veteran Directed Home and Community-Based Service Program (VDHCBS)  Package of services that the VA purchases from AAAs on behalf of eligible veterans  Opportunity to self-direct long-term supports and services that enable them to avoid institutionalization and continue to live independently at home  AAAs will assist with assessment and care planning, arrange fiscal management services, and provide ongoing options counseling and support

12. 11 Aging and Disability Resource Centers… every community in the nation highly visible and trusted people of all incomes and ages information on the full range of long term support options point of entry for streamlined access to services AoA Vision for ADRCs Purpose and Background of Aging and Disability Resource Centers

13. 12  Seamless system from consumer perspective  High level of visibility and trust  Proactive intervention into LTC pathways  Integration of aging and disability service systems  Formal partnerships across aging, disability and Medicaid  All income levels served More a process than an entity Defining Characteristics of ADRCs Purpose and Background of Aging and Disability Resource Centers

14. 13 How ADRCs Operate Home and Community Based Services Nursing Homes/ Institutions Options Counseling Health Promotion Employment Services Peer Counseling Private Services Public Programs One-Stop Access Purpose and Background of Aging and Disability Resource Centers

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16. 15 Key Partners Purpose and Background of Aging and Disability Resource Centers Area Agencies on Aging Centers for Independent Living/SILCs Public & private aging and disability service providers State Health Insurance Assistance Program (SHIP) Long term supports and service providers (e.g., home health agencies, nursing facilities) Critical pathway providers (e.g., hospital discharge planners, physicians) 2-1-1 Adult Protective Services Medicaid

17. 16 Effective ADRC partnerships  Regular communication  Written agreements  Written referral protocols  Co-location of staff  Regular cross-training of staff  Compatible IT systems  I&R resources are shared  Collaboration on client services  Client data are shared  Joint marketing and outreach activities Purpose and Background of Aging and Disability Resource Centers

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19. 18 ADRC fit in your state’s LTC reform? 1980s - Medicaid Waiver Programs 1999 – Olmstead Advisory/Planning Committees 2001 –Real Choice Systems Change Grants 2003 – Aging and Disability Resource Centers 2006 – Older Americans Act Reauthorization 2007 – Community Living Program 2008 – Veterans-Directed HCBS Others? Purpose and Background of Aging and Disability Resource Centers

20. 25-50% of state population 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 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 October 2009 DE Guam Northern Mariana Islands 1-25% of state population 100% of state population 75-99% of state population 0% of state population GA 50-75% of state population Puerto Rico

21. 20 Questions: ADRC Background and Purpose Please send questions or comments to: Adrc-tae@lewin.com Or Visit the technical assistance community discussion forum at: http://www.adrc-tae.org/ (scroll over “events” on menu and then click “discussion forum”) Joseph Lugo, Administration on Aging

22. 21 Overview of ADRCs  Module IBackground & Purpose of the ADRC program  Module IIKey Operational Components of ADRCs  Module IIISustainability

23. 22 Overview of ADRCs: Operational Components Information & Awareness Options Counseling Streamlined Access Person-Centered Hospital Discharge Planning (Care Transitions) Quality Assurance & Evaluation Participant Poll

24. 23 Overview of ADRCs: Operational Components Information and Awareness  Outreach and Marketing  Comprehensive Resource Database 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  Marketing to and Serving Private Paying Populations

25. 24 Best Practice State Examples Information and Awareness South Carolina Universally accessible, web-based searchable database Developed and maintained at the state level Web-based client management and services system with electronic exchange of resources and client data among partners Arkansas State-wide 800 number operated by state employees Provide I&R/A, some preliminary options counseling, and can assist callers with beginning the application process for Medicaid and other programs If more in-depth options counseling needed, call center staff connects them to local ADRC partners including AAAs, CILs or regional Medicaid offices.

26. 25 Overview of ADRCs: Operational Components Outreach and Marketing Engage in extensive marketing and community outreach activities  Social marketing strategies  Marketing plans/consumer input  Evaluate success Information and Awareness

28. 27 Overview of ADRCs: Operational Components Quiz Providing quality options counseling includes helping people weigh pros and cons of various decisions. True or False Options Counseling

29. 28 Overview of ADRCs: Operational Components ADRCs Provide Decision Support Options Counseling interactive are supported to determinelong-term support choices... an interactive decision-support process whereby consumers, family members and/or significant others are supported in their deliberations to determine appropriate long-term support choices in the context of the consumer’s needs, preferences, values, and individual circumstances Options Counseling

30. 29 Overview of ADRCs: Operational Components Core Competencies  Determine need for options counseling  Assess needs, values and preferences  Understand and provide information about resources public private  Embed principles of consumer self-direction in practice  Encourage a future orientation  Follow-up Options Counseling

31. 30 Overview of ADRCs: Operational Components Decision Support- Implementing options counseling  Define the parameters of options counseling  Develop standards and protocols for delivering options counseling ● who ● when  Develop competency criteria and train staff  Evaluate and to track outcomes Options Counseling

32. 31 Overview of ADRCs: Operational Components Options counseling provides consumers with the tools and knowledge they need to choose the best path for themselves. Options Counseling

33. 32 Best Practice State Examples Options Counseling Wisconsin Developed options counseling toolkit (14 webcasts, family profiles for practice, 37 minute DVD) to train staff delivering options counseling (available at www.adrc-tae.org)www.adrc-tae.org New Hampshire Employ Long Term Support (LTS) Counselors that provide options counseling to consumers as referred by I&R/A specialists Established minimum education and training standards for these positions including a Master’s Degree in Social Work or equivalent work experience and AIRS certification.

34. 33 -- from the consumer’s perspective  Go somewhere else “no wrong door” or “one stop shop” access to services and supports  Call another organization or agency seamless referral to other agencies; consumers do not need to make another phone call  Repeat same information over and over information systems designed so that information collected at the initial point of contact populates multiple forms  Worry about getting “lost in the system.” follow-up after referrals are made Overview of ADRCs : Operational Components Streamlined Access

35. 34 Streamlined Access Organizational Strategies Single, standardized entry process Coordinated financial and functional/clinical eligibility determination processes Uniform criteria across sites to assess risk of institutional placement in order to target support to individuals at high-risk Comprehensive assessment used to determine eligibility conducted by SEP staff or by seamless referral to partnering organization Financial eligibility determined on-site at SEP, online, or by seamless referral to partnering organization Follow-up provided for individuals on waiting lists Eligibility status tracked and follow-up contact made upon determination Overview of ADRCs: Operational Components

36. 35 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 Best Practices in Streamlining: Use of IT Streamlined Access

37. 36 Best Practice State Examples Streamlined Access New Jersey  Automated MiChoice Community Services Screen  I&R Specialist completes 20-question screen, which identifies level of service need and triggers home visit/assessment  Information from screen populates Comprehensive Assessment Tool  Comprehensive assessments conducted by ADRC case managers  Eligibility automatically calculated, transmitted electronically for approval  Hospital-based pre-admission screen pilot, checklist of “At-risk Criteria for Nursing Facility Placement”

38. 37 Person-Centered Hospital Discharge Planning (Care Transitions) Create linkages that ensure people have the information -- to make informed decisions -- to understand their support options as they pass through critical health and LTC transition points -- hospital discharge -- nursing or rehab facility admission or discharge Overview of ADRCs: Operational Components

39. 38 Person-Centered Hospital Discharge Planning (Care Transitions) Quiz Which strategy have ADRCs used most frequently to engage critical pathways providers (hospitals, nursing facilities, physicians, etc.)? -CCP representation on ADRC advisory boards -Conducting outreach and training -Developing formal referral protocols - Partnership on formal care transitions interventions Overview of ADRCs: Operational Components

40. 39 Person-Centered Hospital Discharge Planning (Care Transitions) Overview of ADRCs: Operational Components Working with critical pathway providers: create formal linkages relationship + transition process + informed decisions = Success!

41. 40 Best Practice State Examples Person-Centered Hospital Discharge Planning (Care Transitions) Central Texas ADRC Implemented Coleman-type intervention with Scott and White hospital system Shared employment of hospital LTC specialists so they have access to hospital records and credibility with other hospital staff LTC specialists assist families through discharges and link with community resources New York Local sites established collaborative relationships with hospitals and nursing facilities ADRC staff participate in care transition planning rounds and state- wide Discharge Planning Work Group Service ID card system

42. 41 Quality Assurance and Evaluation Measure: consumer outcomes system efficiencies costs Use results: improve services identify and meet needs strengthen programs Overview of ADRCs: Operational Components

43. 42 Quality Assurance and Evaluation ADRCs establish and track performance goals and indicators related to their ADRC activities. Overview of ADRCs: Operational Components GoalIndicator TrustConsumers rate the assistance they receive as reliable, objective and comprehensive. VisibilityPeople in the community are aware of the ADRC. Ease of AccessPeople are able to access ADRC services in multiple ways – in person, by phone, by e-mail, through a website. ResponsivenessStaff listen to consumers’ concerns and take into account their unique needs and circumstances. EfficiencyConsumers report a reduction in the number of times they had to repeat information when accessing services. EffectivenessConsumers report that they receive the services they need help them remain in the community.

44. 43 Quality Assurance and Evaluation Consumers have consistently reported high levels of satisfaction with ADRCs Services Responsiveness Staff knowledge Information Capacity to make informed decisions Overview of ADRCs: Operational Components “I never knew that this could be so easy and pleasant. I was expecting something far more bureaucratic and difficult.”

45. 44 Best Practice State Examples Quality Assurance and Evaluation Wisconsin Extensive evaluation of customer satisfaction Large sample size (interviews, telephone surveys, focus groups) Constructive feedback process with local ADRC sites Idaho Called random sample of callers – “check back” calls Michigan Evaluator found that ADRCs (going forward) could be expected to achieve cost savings to support their operations

46. 45 Overview of ADRCs  Module IBackground & Purpose of the ADRC program  Module IIKey Operational Components of ADRCs  Module IIISustainability

47. 46 Questions: Sustainability Please send questions or comments to: Adrc-tae@lewin.com Or Visit the technical assistance community discussion forum at: http://www.adrc-tae.org/ (scroll over “events” on menu and then click “discussion forum”) Joseph Lugo, Administration on Aging

48. 47 Facilitators Connection to broader community/system change efforts Leadership Partnership Infrastructure and procedure Staffing Funding The Lewin Group, ADRC Profiles in Sustainability, 2007 Sustainability

49. 48 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 Care Transitions Prevention Sustainability

50. 49 Over half of the 43 original grantees passed legislation, developed executive guidance, and/or contributed state funds. Received approximately $43M in financial support from public and private sectors for program development and expansion. Some ADRCs exploring Federal Financial Participation (FFP) Developed new partnerships to enhance program activities. Expanded to multiple pilot sites and statewide in many states. Sustainability ADRC Successes

51. 50  ADRCs are more a process than an entity  Formalized partnerships really make up the ADRC  ADRCs can serve as a hub for LTC reform supporting other initiatives such as CLP and VDHCBS  Sustainability of ADRC programs depends on how well the ADRC is integrated into state priorities and planning for reform Overview of ADRC Program Main Points Today

52. 51 1.Think across programs at all levels - state, local, individual 2.Embed processes in systems across programs, especially IT 3.Include all disability groups from the start of planning, even if you will not serve them immediately 4.Seek out partnerships, both obvious and less obvious 5.Develop metrics by which you know your programs are operating efficiently and you are achieving your goals - measure against those metrics Overview of ADRC Program Five Key Lessons Learned for New ADRCs

53. 52 What is the muddiest point about ADRCs? adrc-tae@lewin.com Overview of ADRC Program Email your questions

54. 53 Technical Assistance Exchange Technical Assistance Resources  Website  Resource Materials  Weekly Electronic Newsletters  Grantee Surveys  Examples from the Field Grantee Community  Teleconferences/Web casts  Trainings  National Meetings  On-line Forum Thank you for listening!