2010-2011 Progress Report
Goal:
To become fully functional Aging and Disability Resource Centers (ADRCs) throughout the
State of Utah using criteria developed by the Administration on Aging and the ADRC Technical
Assistance Exchange:
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6.
Information, Referral and Awareness
Options Counseling and Assistance
Streamlined Eligibility Determination for Public Programs
Person-Centered Transition Support
Consumer Populations, Partnerships and Stakeholder Involvement
Quality Assurance and Continuous Improvement
Information, Referral and Awareness
Outreach and Marketing/Information and Referral
The ADRC continues to update and improve its website at www.utadrc.org, while working with an
outside company, Universal Solutions Advertising, to create a statewide I & R database. The ADRC I &
R Subcommittee has been working to insure that the database will effectively raise awareness of our
state communities’ long term supports and services options while considering all populations served, so
that individuals can be linked to both public and private services and supports. When launched, the I &
R database will have the capacity for all operating partners, as well as the public, to use the database.
The database will be user-friendly, person-centered, searchable and 508 compliant.
The ADRC now has a monthly newsletter, dedicated to educating our ADRC sites on topics of interest,
as well as informing our partners about upcoming events. Training is provided via quarterly webinars,
which are broadcast live and archived for future viewing. Topics so far include:
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Elder Legal Issues
VA Long-Term Care Programs
Employment Personal Assistance Services (EPAS)
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Affordable Care Act/What it Means for our Consumers
Importance of Data Collection
I & R Professionals Online Training
Options Counseling and Assistance
Options Counseling
……is an interactive decision support process whereby individuals, family members and/or others are
supported in their deliberations to determine long-term support choices in the context of the
consumer’s needs, preferences, values and individual circumstances.
…..is successful when:
•
•
•
•
•
The individual defines the goals and is invested in achieving goals
The individual feels valued and understood
The individual is motivated to make changes
The individual is satisfied with the decisions and the plan
The options counselor has explained all options
The ADRC Evaluation Team met with the individual options counselors from the pilot sites who had
provided taped options counseling sessions. After analysis of the tapes, the options counselors were
provided feedback on their:
•
•
•
Core competencies: (person-centeredness {motivational interviewing techniques, pace, selfreflection})
Factual knowledge base
I & R expertise
The majority of the scores fell in the “excellent” range; the options counselors consistently underrated
their abilities; quality listening was identified as one area that needs improvement. (Attachment )
The Options Counseling Steps and Flow Chart, as well as the Options Counseling Protocol, were
revisited and revised, based on lessons learned and differences among organizations and communities.
(Attachments ) One step shown to be challenging has been explaining the nature and goals of options
counseling. Consideration of discrepancies between current needs and supports and goals also needs
improvement. More reflection on the part of the options counselors is necessary.
Streamlined Eligibility Determination for Public Programs
Intake and Screening
The ADRCs have a standard intake process for helping individuals access all publicly-funded long term
supports and service programs. The ADRCs provide certain publicly-funded services or make a referral.
2
The Department of Workforce Services under the Utah Department of Health provides a standardized
online process (E-Rep) for helping individuals access long-term care and waiver programs. The ADRC
and the Department of Workforce Services are currently working on a MOU that will formalize the
cooperation that is already occurring between the two entities.
Tracking Eligibility Status
MyCase is an online program that allows customers of Department of Workforce Services (DWS) to
access their case information 24/7, without speaking with a representative. Benefits of myCase include:
more information at the customer's fingertips, no wait times online to view case status and benefit
information due to real time information available through myCase. The customers can view case
summary, EBT balance, notices, make payments, etc. DWS is currently working on a plan to allow
ADRC options counselors third party access to myCase. This would allow the ADRC to track individual
consumers’ eligibility status throughout the process of eligibility determination and redetermination, as
well as obtain information to allow for follow-up to ensure that people receive the services for which
they are eligible.
Person-Centered Transition Support
The ADRC Administrative Office, along with HealthInsight, Utah’s Medicare QIO partner, is currently
assisting interested eligible entities within the ADRC network to apply for CMS’ Community Care
Transitions Program. This will allow people in transition to end up in the settings that best meet their
individual needs and preferences, which is often in their own homes. It can also break the cycle of
readmission to the hospital that often occurs when a chronically impaired individual is discharged to the
community without the social services and supports they need.
Consumer Populations, Partnerships and Stakeholder Involvement
Consumer Populations
The ADRCs serve individuals with all types of disabilities through a single operating organization or
through close coordination with multiple operating partners (Centers for Independent Living, Area
Agencies on Aging, Social Security, Medicaid, VA, etc.)
The ADRC staff is competent to serve people of all ages and types of disabilities and their families.
There are representatives from both the aging and disability sides on the Steering Committee, the
governing board of the ADRC.
Medicaid
The ADRC is currently negotiating a Memorandum of Understanding with the Department of
Workforce Services that will describe the role of each partner in the eligibility determination process
and information sharing policies.
3
ADRC staff are currently planning a Long-Term Care Summit that will bring together key state agencies
and legislators to discuss a plan to plan for state long term support and services system reform.
Aging and Disability Partners
The Department of Human Services, the Division of Services for People with Disabilities, and State
Medicaid have all formally approved the ADRC five-year plan. A representative from each of these
entities serves on the ADRC Steering Committee. These agencies have provided cross-training to the
ADRC staff.
Stakeholders
ADRC staff members are trained on the State Health Insurance Assistance Program (SHIP). One of our
ADRCs has a long-term care ombudsman who is also an options counselor. The evaluator of our ADRC
cooperative agreement is the Director of the Center for Persons with Disabilities at Utah State
University. We are currently serving on the Advisory Committees for 2-1-1 and the Utah Coalition for
Caregiver Support. We also partner with the Kelly Benson Resident Board under the Housing Authority
of Salt Lake County.
Quality Assurance and Continuous Improvement
Staffing
The ADRCs have adequate capacity to assist consumers in a timely manner with long term support
requests and referrals; however, budget constraints remain an issue. Cutbacks to state funding will
have a detrimental effect on the ADRCs.
IT/MIS
Each ADRC employs its own data management information system to track their customers and
services.
Continuous Improvement
The ADRC Evaluation Team is piloting a survey to customers who have received options counseling
within the last six months. These surveys include measurable performance goals and indicators related
to the ADRC’s visibility, trust, ease of access, consumer responsiveness, efficiency and effectiveness.
(Attachments IV & V)
Performance Tracking
The ADRCs track service delivery and consumer outcomes and can demonstrate that they serve people
in different age groups, with different types of disabilities and income levels. The options counseling
provided by the ADRC options counselors enables people to make informed, cost-effective
decisions about long-term care services.
4
ADRC Development
The ADRC launched four pilot ADRC sites on September 7, 2010. The four sites cover about 1/3 of
Utah’s population:
Ability First Center for Independent Living (Utah, Sanpete, and Juab Counties)
Active ReEntry (Grand and San Juan Counties)
Bear River Area Agency on Aging (Cache, Box Elder, and Rich Counties)
Mountainland Area Agency on Aging (Utah, Summit, and Wasatch Counties)
The ADRC is in the process of establishing two additional pilot sites to come on board during the
upcoming funding year:
Salt Lake County Area Agency on Aging (Salt Lake County)
Tri-County Center for Independent Living (Davis, Weber, and Morgan Counties)
Over two-thirds of the State of Utah will be covered when these two sites are functional ADRCs.
5
Problems, Challenges, Lessons Learned:
Funding is a serious challenge to establishing fully-functioning ADRCs statewide. All funding is federal.
We are working to develop an ADRC model that integrates functions into existing agencies through
alternative funding sources or without additional funding. Data collection and reporting have also been
a challenge, as there is no central database. The ADRC is taking steps to effectively use the data as a
management tool, as well as evaluating the effectiveness of options counseling. Tracking information
will contribute to continuous quality improvement so that options counselors can improve their skills
based on feedback from individuals and families.
6
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Mountainland AAA
Bear River AAA
Outreach and Marketing
I&R
Short-Term Case Management
Options Counseling
Planning for Future LTC Needs
Skills Training
SHIP Counseling
Peer Counseling
Adult Protective Services
Advocacy
Care Coordination
Care Transition
Nursing Facility Transitions
Screening/Intake for Medicaid or Public LTC Programs
Conducting Level-of-Care Assessments
Assist with Financial Eligibility Applications
HCBS Waiver/Public LTC Program Case Management
Medical or Pharmaceutical Assistance Applications
Caregiver Support Programs
Disease Prevention and Health Promotion
Housing Services or Service Coordination
Assistive Technology/Home Modification
Transportation
OAA Programs
Socialization Programs and Community Integration
Active Re-Entry
Ability First
Services Offered at Utah’s ADRC Sites
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7
ADRC Management Structure
Utah ADRC
Utah Commission on Aging
Director, Project Coordinator, Evaluation Contractors (USU)
Steering Committee
Utah State
Medicaid
DWS
DAAS
DSPD
2-1-1
AAA
CIL
AAA
CIL
AAA
CIL
Member of the
Public representing
Adults with
Disabilities
Member of the
Public representing
Older Adults
Access Utah
Network
AAA
8
ADRC Steering Committee Members, Staff, and Evaluation
Contractors
Michelle Benson, Bear River Area Agency on Aging
Nancy Bentley, Active Re-Entry
Sarah Brenna, Salt Lake County Area Agency on Aging
Rick Hendy, Division of Substance Abuse and Mental Health
Deb Mair, Utah Independent Living Center
Scott McBeth, Mountainland Area Agency on Aging
Anne Smith, Representative of Older Adults
Julianna Preston, HealthInsight
Andrew Riggle, Representative of Adults with Disabilities
Carrie Schonlaw, Five County Area Agency on Aging
Mark Smith, Access Utah Network
Jason Stewart, Utah Department of Health
Michael Styles, Division of Aging and Adult Services
Miguel Gonzalez, Department of Workforce Services
Steve Wrigley, Division of Services for People with Disabilities
Amy Bosworth, 2-1-1
Bill Young, Utah Statewide Independent Living Council
Staff:
Jennifer Morgan, Program Assistant
Louise Tonin, Project Coordinator
Maureen Henry, Director
Evaluation:
Judith Holt, Utah State University
Gina Cook, Utah State University
Marilyn Hammond, Utah State University
9
Attachment I – OC Call Listening Feedback
As part of the continuous process improvement plan, options counselors were asked to tape 2-4 of their
interviews in July and again in October, 2011. The July interviews were evaluated for content and
motivational interviewing techniques using ADRC Call Listening Feedback Form from the ADRC
Technical Assistance Web Site http://www.adrc-tae.org/tikiindex.php?page=Guidelines&catx=268&filter=grantee .
For the first round of calls we received 4 recordings from OC#1, 3 recordings from OC#2, 2 recordings
from OCs #3 & #4, and 1 recording from OC#5 for a total of 12 recordings. Below is a summary of the
items and the average rating they received across the group (Excellent, Excellent to Satisfactory,
Satisfactory, and Satisfactory to Needs Improvement).
Overall average score of Excellent on the following items (high to low):
• Summarizes what caller presents as issues
• Does not use only one resource but is objective
• Allows caller to communicate in their own style
• Explores beyond presenting problem
• Is creative in finding options
• Asks permission before proceeding
• Gives several options but prioritizes
• Gives specifics on eligibility
Between Excellent and Satisfactory:
• Highlights strengths instead of all weaknesses
• Helps caller look at the problem from many perspectives
• Encourages caller to do for themselves
• Identifies and clarifies callers needs
Overall average scores of Satisfactory on the following items:
• Uses OARS effectively
• Listens for and encourages “change talk”
• Assists caller in getting connected with resource
• Professional Greeting (Many of the calls were not recorded until after the greeting and
permission was received to record the call)
• Builds rapport
The following item received an average score of Satisfactory but also had the lowest score overall and
received a Needs Improvement score for most of the Options Counselors.
• Guides instead of leads or offering advice or judgment
10
Attachment- Options Counseling Protocol
Procedure
1. Determine, from the inquirer, the purpose of the contact. Assess the situation, asking such
questions as:
o
o
What kind of help are you looking for?
What is the underlying problem?
2. Determine where options counseling will take place. Schedule options counseling.
3. Explain the nature and goals of options counseling. Query further to find out all the needs of
the individual. Ask the inquirer the following about the individual in need; this information can
help find specific programs that meet the needs mentioned. Discuss inclusion of individual if
call is from a caregiver.
o
o
o
o
o
o
o
Individual’s goals and motivations
Demographics (name, address, phone number)
Location (home, facility, hospital, etc.)
Age
Physical Disabilities
Mental Disabilities
Support System (family, friends, neighbors, etc.)
4. After a good understanding of the needs involved, discuss and educate about the pros and
cons of the following options, and if that option is applicable for the individual in need, proceed
with the following step(s):
A. In-Home Services
Including, but not limited to: Home Health Aide, Homemaker, Bath Aide,
Attendant Care Aide, Friendly Companion and Home Care Nurse. See the
Funding Home Care Options SOP to proceed with any one of these options.
B. Nutrition
Including, but not limited to: congregate meal sites, food pantries, food
banks, food vouchers, food stamps and home-delivered meals. See the
Nutrition SOP to proceed with any one of these options.
C. Housing/Shelter
Including, but not limited to: homeless shelters, low rental apartments,
disabled apartments, subsidized apartments, Section 8, home repair and
weatherization. See the Housing SOP to proceed with any one of these
options.
11
D. Adult Day Services
See the Funding Home Care Options SOP to proceed with this option.
E. Assisted Living
See the Assisted Living Facilities SOP to proceed with this option.
F. Financial Assistance
Including, but not limited to: township trustees, religious organizations,
energy assistance programs, disease-related funding programs,
community- service groups and Medicaid. See the Financial Assistance SOP
to proceed with this option.
G. Respite Services
See Funding Home Care Options and Caregivers SOPs to proceed with this
option.
H. Transportation
Including, but not limited to: senior transportation program, transportation
expense assistance, medical transportation, wheelchair transportation and
mass transportation. See the Transportation SOP to proceed with this
option.
I.
Legal Services
Including, but not limited to, senior legal programs, legal clinics,
guardianship services and power-of-attorney. See the Legal Advocacy SOP
to proceed with this option.
J. Mental Health Services
Including, but not limited to, counseling services, residential services, inpatient services, out-patient services, mental health associations, support
groups and therapies. See the Mental Health Options SOP to proceed with
this option.
K. Health/Dental Services
Including, but not limited to, community clinics, dental programs,
physician- referral hotlines and dental clinics. See the Dental/Medical
Assistance SOP to proceed with this option.
L. Education
Including, but not limited to, GED programs, continuing-education
programs, senior education programs, language programs and literacy
programs. Assist as needed to link the individual with any of the listed
options.
12
M. Recreation
Including, but not limited to, senior centers, senior programs,
developmental disability recreational programs, sports and fitness
programs, arts programs. See the Senior Centers SOP and/or assist as
needed to link the individual with any of the listed options.
N. Nursing Facility Placement
See the How to Choose a Nursing Home SOP to proceed with this option.
O. Assess need for assistance with applications for benefits/services.
P. Assess the need for short-term case management.
5. After the conclusion of the contact, document the plan in your tracking database. All
databases must be referred to and, if the individual’s information is present, then the
database(s) must be updated.
6. If the individual is actively working with a case manager or another department within the
agency, the active case manager and supervisor must be notified about the action taken (i.e.
placed on waiting lists, made a referral, made a Pre-Admissions Screening referral).
7. Follow up for options counseling may be necessary depending on the situation. If follow up is
appropriate to make sure that the information given was appropriately handled, then proceed
with proper follow up. This may include, but is not limited to, calls to family members, a hospital,
the police department or a mental health organization.
Core Competencies of Options Counseling
The Technical Assistance Exchange (TAE) has worked with states implementing options counseling in
their Aging and Disability Resource Center (ADRC) programs to identify six core competencies of
options counseling that should underpin the process:
1) Determining the need for options counseling;
2) Assessing needs, values and preferences;
3) Understanding and educating about public and private sector resources;
4) Facilitating self-direction /self-determination;
5) Encouraging future orientation; and)
6) Following up.
13
State Interpretive Guidelines/Additional Comments: (our own interpretation)
Options Counseling is successful when:
•
•
•
•
•
•
•
The individual defines and is invested in achieving the goals
The individual feels valued and understood
The individual is motivated to make changes
The individual is satisfied with the decisions and the plan
The options counselor has explained the relevant options
The individual's circumstances are changed in a positive direction
The individual can take successes and help others
Every person receiving Options Counseling will be:
•
•
•
•
•
Listened to and heard
Treated with respect, empathy, and dignity, and without judgment
Assisted in making decisions about long-term care
Supported in achieving long-term care preferences and choices
Served in a timely manner
The individual receiving Options Counseling is/has:
•
•
•
•
Intelligent
Unique circumstances
Unique needs
Unique personal values
The individual has the ability and right to:
•
•
•
Make independent choices
Take risks
Be responsible and accountable for his/her decisions
14
Ability First
Reporting Period: April 1-September 30, 2011
Total Clients: 547
Over 60: 186
Under 60: 359
Unknown: 2
Disability Types
350
300
250
200
150
100
50
0
327
87
46
0
77
0
10
15
Information & Referrals to Public and Private Services
Number of Clients referred to or given an application for Medicaid or another Public Program: OAA,
Medicare, Food Stamps, TANF, Social Security (SSI or SSDI), Li-Heap, VDHCBS = 51
Number of Clients referred to non-public services or resources = 9
Number of Clients that were not referred to any type of service =66
Number of Unknown Clients (remainder) = 471
Total Number of Clients Provide Options Counseling: 120
Information & Referral
51
9
66
Public Programs
Private Programs
Not Referred
Unknown
471
16
Person-Centered Transition Support
Number of Clients assisted with transition from nursing facility = 5
Number of Clients assisted with transitions from ICF/MR into the community = 1
Number of Clients assisted with transition from other institutional setting = 5
Number of Clients assisted with hospital discharge following an acute care episode = 8
Number of Clients assisted with transition from hospital through formal care transitions program
LTSS Program Enrollment
Number of clients who received comprehensive Level of Care Assessment=7
Number of clients who received Medicaid Financial Eligibility=8
17
Active Re-Entry Moab
Reporting Period: April 1-September 30, 2011
Total Clients: 92
Over 60: 77
Under 60: 15
Unknown: 0
Disability Type
91
81
71
61
51
41
33
31
18
21
11
6
6
6
1
9
5
9
9
2
2
1
** 55 of these Clients had multiple disabilities
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Information & Referrals to Public and Private Services
Number of Clients referred to or given an application for Medicaid or another Public Program: OAA,
Medicare, Food Stamps, TANF, Social Security (SSI or SSDI), Li-Heap, VDHCBS = 76
Number of Clients referred to non-public services or resources = 1
Number of Clients that were not referred to any type of service =14
Number of Unknown Clients (remainder) = 1
Total Number of Clients Provide Options Counseling: 74
Information & Referral
1
14
1
Public
Private
Not Referred
Unknown
76
19
Referrals to Public Programs
Food Stamps
4
TANF
0
Social Security
2
VA
4
Alternatives
6
Medicare
11
Older Americans Act
38
SHIP
10
Medicaid
18
0
5
10
15
20
25
30
35
40
20
Referrals to Long term services and support
90
87
80
70
60
63
50
38
40
34
30
20
10
15
0
18
17
3
Person-Centered Transition Support
Number of Clients assisted with transition from nursing facility =3
Number of Clients assisted with transitions from ICF/MR into the community = 0
Number of Clients assisted with transition from other institutional setting = 0
Number of Clients assisted with hospital discharge following an acute care episode = 5
Number of Clients assisted with transition from hospital through formal care transitions program
21
LTSS Program Enrollment
Number of clients who received comprehensive Level of Care Assessment=38
Number of clients who received Medicaid Financial Eligibility=38
22
Bear River
Reporting Period: April 1-September 30, 2011
Total Clients: 302
Over 60: 162
Under 60: 49
Unknown: 91
Disability Type
140
129
120
100
80
60
52
40
20
20
11
5
4
5
6
13
24
18
10
0
**64 of Clients had Multiple Disabilities
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Information & Referrals to Public and Private Services
Number of Clients referred to or given an application for Medicaid or another Public Program: OAA,
Medicare, Food Stamps, TANF, Social Security (SSI or SSDI), Li-Heap, VDHCBS = 214
Number of Clients referred to non-public services or resources = 35
Number of Clients that were not referred to any type of service =15
Number of Unknown Clients (remainder) = 38
Total Number of Clients Provide Options Counseling: 204
Information & Referral
38
Public Programs
15
Private
35
Not Referred
Unknown
214
24
Referrals to Public Programs
TANF
8
Social Security
17
VA
28
Alternatives
42
Medicare
46
Older Americans Act
46
SHIP
67
Medicaid
91
0
20
40
60
80
100
25
Referrals to Long term services and support
86
90
80
70
60
50
46
40
30
20
10
10
20
52
26
0
Person-Centered Transition Support
Number of Clients assisted with transition from nursing facility = 13
Number of Clients assisted with transitions from ICF/MR into the community = 1
Number of Clients assisted with transition from other institutional setting = 1
Number of Clients assisted with hospital discharge following an acute care episode = 7
Number of Clients assisted with transition from hospital through formal care transitions program
LTSS Program Enrollment
Number of clients who received comprehensive Level of Care Assessment=19
Number of clients who received Medicaid Financial Eligibility=5
26
Utah ADRC
(Ability First, Active Re-entry, Bear River, Mountainland)
April 1 –September 30, 2011
Total Clients: 1288
Over 60: 745
Under 60: 440
Unknown: 103
Disability Type
900
800
795
700
600
500
400
300
200
100
120
154
126
17
37
48
33
0
14
11
16
41
11
70
77
**Multiple Disabilities reflect Ability First as reported
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Information & Referral to Public and Private Services
(**Numbers reflect only one referral per Client**)
Number of Clients referred to or given an application for Medicaid or another Public Program: OAA,
Medicare, Food Stamps, TANF, Social Security (SSI or SSDI), Li-Heap, VDHCBS = 602
Number of Clients referred to non-public services or resources = 181
Number of Clients that were not referred to any type of service =95
Number of Unknown Clients (remainder) = 510
Total Number of Clients Provide Options Counseling: 430
Information & Referral
37%
43%
Public Programs
Private Programs
Not Referred
Unknown
7%
13%
28
Referred to Public Programs
Food Stamps
8
TANF
8
Social Security
35
VA
19
Alternatives
141
Medicare
95
Older Americans Act
158
SHIP
81
Medicaid
159
0
20
40
60
80
100
120
140
160
180
**Numbers reflect clients who may have been referred to multiple Public Programs
**Does not include specific breakdown from Ability First
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Referrals to Long term services and support
120
117
100
89
80
64
60
47
46
34
40
24
20
69
14
18
21
12
15
7
13
0
Person-Centered Transition Support
Number of Clients assisted with transition from nursing facility =34
Number of Clients assisted with transitions from ICF/MR into the community = 2
Number of Clients assisted with transition from other institutional setting = 6
Number of Clients assisted with hospital discharge following an acute care episode = 25
Number of Clients assisted with transition from hospital through formal care transitions program
LTSS Program Enrollment
Number of clients who received comprehensive Level of Care Assessment=80
Number of clients who received Medicaid Financial Eligibility=48
30
Mountainland
Reporting Period: April 1-September 30, 2011
Total Clients: 349
Over 60: 320
Under 60: 17
Unknown: 12
Disability Type
350
306
300
250
200
150
100
79
68
50
7
12
0
**188 of these Clients had Multiple Disabilities
28
39
46
24
21
1
Information and Referrals to Public and Private Services
Number of Clients referred to or given an application for Medicaid or another Public Program: OAA,
Medicare, Food Stamps, TANF, Social Security (SSI or SSDI), Li-Heap, VDHCBS = 261
Number of Clients referred to non-public services or resources = 136
Number of Clients that were not referred to any type of service =
Number of Unknown Clients (remainder) =
Total Number of Clients Provide Options Counseling: 32
Information & Referral
0
Public Programs
Private
136
Not Referred
Unknown
261
Referrals to Public Programs
Food Stamps
4
Social Security
VA
3
Alternatives
93
Medicare
38
Older Americans Act
74
SHIP
4
Medicaid
50
0
10
20
30
40
50
60
70
80
90
100
Referrals to Long term services and support
120
117
100
80
60
40
47
26
24
20
14
18
21
12
26
7
0
Person-Centered Transition Support
Number of Clients assisted with transition from nursing facility = 13
Number of Clients assisted with transitions from ICF/MR into the community
Number of Clients assisted with transition from other institutional setting
Number of Clients assisted with hospital discharge following an acute care episode
Number of Clients assisted with transition from hospital through formal care transitions program
LTSS Program Enrollment
Number of clients who received comprehensive Level of Care Assessment=4
Number of clients who received Medicaid Financial Eligibility=5
Characteristics of older adults who seek
home and community based services
FRANCES WILBY, MSW, PHD
CATHY CHAMBLESS, MPA, PHD
UNIVERSITY OF UTAH
DECEMBER 8, 2011
3 programs provide services to support seniors in
their homes
To prevent nursing home placement
To ensure health and safety
Federal funds with match
Older Americans
Act IIIB – In Home
Services (IIIB)
2. Medicaid Aging
Waiver (Waiver)
1.
100% State funded
3. Home and
Community Based
Alternatives
(Alternatives)
Study questions
 What are the characteristics of individuals who are
referred to each of the 3 programs?
 Are there patterns that will predict placement to
HCBA vs. the Aging Waiver?
Study Procedures
 Mountainlands provided researchers with electronic
data from screening of all individuals referred to one
of 3 programs from Jan, 2006 to Dec 2007
 260 adults age 65 and older
 No personal identifiers such as name, SSA#, address,
etc.
 Statistical analyses (t-tests of independent means
and binary logistic regression)
Characteristics observed
 ADL’s
 Transferring
 Bathing
 Dressing
 Toileting
 Eating
 Age
 Gender
 Marital Status
 Race/ethnicity
 Cognitive Impairment
 Yes or No
 Living Situation
 Alone or With others
 IADL’s
 Walking
 Medication management
 Shopping
 Meal preparation
 Using the telephone
 Transportation
 Light housekeeping


Heavy housework
Managing money
 Monthly Income
 Savings
 APS referral
Recipient of IIIB Services
 63% are Female
 Mean age 85
 10% live alone
 90% have cognitive impairment
 Very low income and assets
Typical III B recipient is an 85 year old
female who lives with a caregiver, has a
cognitive impairment, and very low income
and assets.
Recipient of Medicaid Waiver
 65% are female
 Mean age 82
 35% live alone
 8.3% speak Spanish
 54% have a cognitive impairment
 Income and assets well below poverty
Typical Waiver recipient is 82 year old female
with a cognitive impairment who lives with a
caregiver and has income and assets well below
the poverty level.
Recipient of Alternatives
 80% are female
 Mean age is 79
 56% live alone
 43% have cognitive impairment
 Income slightly above poverty level
Typical Alternatives recipient is a 79 year old
female who lives alone and has income at the
poverty level.
Characteristics that predict program placement
ALTERNATIVES
1.Individuals have higher
income.
2.More likely to live alone.
3.Need less assistance
with bathing or heavy
housework
MEDICAID WAIVER
1.More likely to be
very poor.
2.More likely to live
with others.
3.Have dependence
on others for
assistance with
bathing and heavy
housework.
Older
Americans
IIIB
(n=51)
852
84
81
8.79
HCBA
n=137
Medicaid
Aging Waiver
791
79
86
8.98
(n=72)
82
81
69
8.83
$41.
0
0
$280.
$67.
0
0
$293.
$185.
0
0
$791.
Savings Account -
$133.2
0
0
$840.
$599.1,3
0
0
$2,042.
$172.2
0
0
$687.
Monthly Income -
$655.2
0
0
$931.
$1,080.1,3
973.00
0
$935.
$634.2
$645
0
$594.
Age -
Mean
Median
Mode
Standard deviation
Checking account Mean
Median
Mode
Standard Deviation
Mean
Median
Mode
Standard Deviation
Mean
Median
Mode
Standard Deviation
Older Americans
HCBA Program
IIIB
n-137
n = 51
Medicaid Aging
Waiver
n=72
Male
Female
%
37.32
62.7
n
19
32
%
20.41,3
79.6
N
28
109
%
34.72
65.3
n
25
47
Missing
Non-minority
Hispanic
5.9
94.1
0
3
48
0
8.8
83.2
8.0
12
114
11
5.6
81.9
12.5
4
59
9
Unknown
Other
Non-hispanic
Hispanic-Latino
White
5.9
0
94.1
0
0
3
0
48
0
0
5.1
1.5
89.1
4.4
0
7
2
122
6
0
2.8
1.4
86.1
8.3
1.4
2
1
62
6
1
Primary LanguageOther
English
Spanish
0
100
0
0
51
0
.73
98.5
.7
1
135
1
1.42
90.3
8.3
12
65
6
Gender -
Race -
Ethnicity -
Older Americans
IIIB
n = 51
County –
Summit
Utah
Wasatch
Cognitive dysfunction -No
Yes
HCBA Program
n-137
Medicaid Aging
Waiver
n=72
%
15.7
72.5
11.8
n
8
37
6
%
6.6
83.4
9.9
N
12
151
18
%
12.5
80.6
6.9
n
9
58
5
9.82,3
90.2
52
46
56.91
43.1
78
59
45.81
54.2
33
39
APS Referral -
No
Yes
98
2
50
1
99.3
.7
136
1
98.6
1.4
71
1
Homebound -
No
Yes
23.5
76.5
12
39
29.2
70.8
40
97
23.6
76.4
17
55
44
5
2
43.11, 3
56.2
.7
59
77
1
62.51,2
34.7
2.8
45
25
2
Living alone -
No 86.32,3
Yes
9.8
Other
3.9