State plan on aging 2024-2027

Georgia Department of Human Services Division of Aging Services
GEORGIA
STATE PLAN ON AGING
2024 - 2027

Table of Contents

Contact Information

I

Mission, Vision, Values

III

Signed Verification of Intent

IV

Narrative

1

Executive Summary

1

Introduction and Context

2

Core Programs and Services

2

Major Programs and Initiatives

3

Other State Plans

4

ACL and Other Discretionary Grants

5

State Agency on Aging Operations Overview

6

Georgia's Aging Network

7

Georgia Council on Aging

8

Georgia Alzheimer's and Related Dementias State Plan

9

Georgia Memory Net

9

Dementia Care Program

10

Dementia Friends

10

Public Health Workforce

10

Quality Management

11

Assistive Technology Program

12

Georgia Senior Hunger Initiative

12

Conflict-Free Service Delivery Network

12

Person-Centered Planning

12

Behavioral Health

13

Transportation/Access

14

State and Area Plan Alignment

15

Goals, Objectives and Measures

16

Attachments

V

Attachment A: State Plan Assurances and Required Activities

Attachment B: State Plan Information Requirements

Attachment C: Intrastate Funding Formula Requirements and Current Formula

Attachment D: Stakeholder Input Report for the

2024-2027 Georgia State Plan on Aging

Attachment E: Intrastate Funding Formula Feedback and Options Summary

Attachment F: Emergency Planning and Management Policy

Attachment G: Abbreviations

Attachment H: Document Links

2024 - 2027 Georgia State Plan on Aging

Contact Information

Georgia Department of Human Services Division of Aging Services 47 Trinity Ave. S.W. Atlanta, GA 30334 404-657-5258
Area Agencies on Aging 1-866-552-4464

Heart of Georgia Region Toll Free: 888.367.9913 Counties served: Appling, Bleckley, Candler, Dodge, Emanuel, Evans, Jeff Davis Johnson, Laurens, Montgomery, Tattnall, Telfair, Toombs, Treutlen, Wayne, Wheeler, Wilcox

Southern Georgia Region Toll Free: 888.732.4464 Counties served: Atkinson, Bacon, Ben Hill, Berrien, Brantley, Brooks, Charlton, Clinch, Coffee, Cook, Echols, Irwin, Lanier, Lowndes, Pierce, Tift, Turner, Ware

Central Savannah River Region Toll Free: 888.922.4464 Counties served: Burke, Columbia, Glascock, Hancock, Jefferson, Jenkins, Lincoln, McDuffie, Richmond, Screven, Taliaferro, Warren, Washington, Wilkes

River Valley Region Toll Free: 800.615.4379 Counties served: Chattahoochee, Clay, Crisp, Dooly, Harris, Macon, Marion, Muscogee, Quitman, Randolph, Schley, Stewart, Sumter, Talbot, Taylor, Webster

Southwest Georgia Region Toll Free: 800.282.6612 Counties served: Baker, Calhoun, Colquitt, Decatur, Dougherty, Early, Grady, Lee, Miller, Mitchell, Seminole, Terrell, Thomas, Worth

Northeast Georgia Region Toll Free: 800.474.7540 Counties served: Barrow, Clarke, Elbert, Greene, Jackson, Jasper, Madison, Morgan, Newton, Oconee, Oglethorpe, Walton

Three Rivers Region Toll Free: 866.854.5652 Counties served: Butts, Carroll, Coweta, Heard, Lamar, Meriwether, Pike, Spalding, Troup, Upson

Coastal Region Phone: 800.580.6860 Counties served: Bryan, Bulloch, Camden, Chatham, Effingham, Glynn, Liberty, Long, McIntosh

Georgia Mountains Region Toll Free: 800.845.5465 Counties served: Banks, Dawson, Forsyth, Franklin, Habersham, Hall, Hart, Lumpkin, Rabun, Stephens, Towns, Union, White

Northwest Georgia Region Phone: 706.295.6485 Counties served: Bartow, Catoosa, Chattooga, Dade, Fannin, Floyd, Gilmer, Gordon, Haralson, Murray, Paulding, Pickens, Polk, Walker, Whitfield

Middle Georgia Region Toll Free: 888.548.1456 Counties served: Baldwin, Bibb, Crawford, Houston, Jones, Monroe, Peach, Pulaski, Putnam, Twiggs, Wilkinson

Atlanta Region Phone: 404.463.3333 Counties served: Cherokee, Clayton, Cobb, DeKalb, Douglas, Fayette, Fulton, Gwinnett, Henry, Rockdale

2024 - 2027 Georgia State Plan on Aging | I

Statewide Independent Living Council of Georgia Inc. 315 West Ponce de Leon Ave., Suite 660 Decatur, GA 30030
770-270-6860
Centers for Independent Living

Access 2 Independence

Northwest Georgia Center for Independent Living

Phone: 706-405-2393

Phone: 706-314-0008

Serves the following counties in West Central Georgia:

Serves the following counties in Northwest Georgia:

Chattahoochee, Harris, Marion, Muskogee, Quitman,

Bartow, Catoosa, Chattooga, Dade, Fannin, Floyd, Gilmer,

Stewart, Talbot, Taylor, Webster

Gordon, Haralson, Murray, Paulding, Pickens, Polk, Walker,

Whitfield

BAIN (Bainbridge Advocacy Individual Network)

LIFE (Living Independence for Everyone)

Phone: 229-246-0150

Phone: 912-920-2414

Serves the following counties in Southwest Georgia:

Serves the following counties in Southeast Georgia: Bryan,

Atkinson, Baker, Berrien, Brooks, Calhoun, Clay, Clinch,

Bulloch, Camden, Chatham, Effingham, Evans, Glynn,

Colquitt, Cook, Decatur, Dougherty, Early, Echols, Grady, Liberty, McIntosh, Tattnall, Toombs

Lanier, Lee, Lowndes, Miller, Mitchell, Randolph, Seminole,

Terrell, Tift, Thomas, Worth

Disability Connections Phone: 478-741-1425 Serves the following counties in Central Georgia: Baldwin, Bibb, Crawford, Houston, Jasper, Jones, Monroe, Peach, Pulaski, Putnam, Twiggs, Wilkinson

Multiple Choices Phone: 706-850-4025 Serves the following counties in Northeast Georgia: Barrow, Clarke, Elbert, Greene, Jackson, Madison, Morgan, Oconee, Oglethorpe, Walton

Disability Resource Center Phone: 706-778-5355 Serves the following counties in North Georgia: Banks, Dawson, Forsyth, Franklin, Habersham, Hall, Hart, Lumpkin, Rabun, Stephens, Towns, Union, White

Walton Options for Independent Living Phone: 706-724-6262 Serves the following counties in East Georgia: Burke, Columbia, Emanuel, Jefferson, Jenkins, Johnson, Lincoln, Richmond, Screven, Washington

disABILITY Link Phone: 404-687-8890 Serves the following counties in Metro Atlanta: Cherokee, Clayton, Cobb, Coweta, DeKalb, Douglas, Fayette, Fulton, Gwinnett, Henry, Newton, Rockdale

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Mission, Vision, Values
MISSION The Georgia Department of Human Services' (DHS) Division of Aging Services (DAS) supports the larger goals of DHS by assisting older individuals, at-risk adults, persons with disabilities, their families, and caregivers to achieve safe, healthy, independent, and self-reliant lives.
VISION Living Longer, Living Safely, Living Well.
VALUES A Strong Customer Focus We are driven by customer not organizational need. We consider customers' input and preferences in all decisionmaking. Accountability and Results We are good stewards of the trust and resources placed with us. We base our decisions on data analysis and strive for quality improvement. Teamwork We do business through teamwork and collaboration. We practice shared decision-making, and everyone's contribution is valued. Open Communication Our communication is open and responsive. We listen to our customers and partners and provide them accurate, timely information. A Proactive Approach We envision the future needs of our customers and the changing service network. We lead and advocate with innovation. Dignity and Respect We respect the rights and self-worth of all people. Our Workforce Our workforce, including volunteers, is our best asset. We maintain a learning environment with opportunities to increase professional growth, share knowledge and stimulate creative thinking. Trust Compassion and integrity drive what we do and who we are. Diversity We value a diverse workforce; it broadens our perspective and enables us to better serve our customers. Empowerment We support the right of our customers and workforce to make choices and assume responsibility for their decisions.
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Executive Summary
The Georgia Department of Human Services' (DHS), Division of Aging Services (DAS) is the designated State Unit on Aging, in accordance with the Older Americans Act and Georgia Code, Chapter 49-6-2, 5. The mission of DAS is to support the larger goals of DHS by assisting older individuals, at-risk adults, persons with disabilities, their families, and caregivers to achieve safe, healthy, independent, and self-reliant lives. The intent of the Older Americans Act (OAA) was to create a robust continuum of home and community-based services to help older adults maintain independence and age in place. The Division of Aging Services prepares a State Plan on Aging as required by the Administration for Community Living under the U.S. Department of Health and Human Services. The plan guides us to lay the foundation for a robust, equitable continuum of community-based care. DAS partners with a collaborative network of public and private state, local, and community-based providers and agencies that create Georgia's aging services network. The network is made up of Area Agencies on Aging (AAA), Centers for Independent Living (CILs), providers, non-profit organizations, advocates, and stakeholders. In addition, DAS encourages cross collaboration and partnerships with other state agencies, public and private entities, and non-traditional partners to ensure that the network remains nimble, avoids service duplication, and innovates to meet the needs of the aging population. The Georgia DAS goals for FFY 2024 through 2027 are: GOAL 1: Provide long-term services and supports that enable older Georgians, their families, caregivers and persons with disabilities to fully engage and participate in their communities for as long as possible. GOAL 2: Ensure older Georgians, persons with disabilities, caregivers and families have access to information about resources and services that is accurate and reliable. GOAL 3: Strengthen the aging network to enable partners to become viable and sustainable, and develop a robust network of aging service partners. GOAL 4: Prevent abuse, neglect, and exploitation while protecting the rights of older Georgians and persons with disabilities. GOAL 5: Utilize continuous quality improvement principles to ensure the State Unit on Aging operates efficiently and effectively. The goals set forth in this State Plan will continue to advance Georgia's service delivery system and allow for a higher quality of service and potentially increase the number of services available for the growing number of older adults, adults with disabilities, their unpaid caregivers, and their families. DAS will continue to deploy innovative methodologies to expand capacity, foster collaboration, and drive cost efficiencies to deliver a comprehensive system of programs and services to assist Georgians in living longer, living safely, and living well while remaining efficient, effective, and nimble.
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Introduction and Context
As Americans and Georgians live longer and healthier lives, the DAS must commit to strengthening existing partnerships and developing new ones to improve quality of life, reduce disparities, and support family caregivers. The Georgia State Plan on Aging reflects the focus areas outlined by the United States Department of Health and Human Services Administration for Community Living (ACL), including continued COVID-19 recovery, advancing equity, expanding access to home and community-based services (HCBS), and ensuring a robust caregiver infrastructure. In addition, public input sessions identified priorities for health and wellness, aging in place, safety and protection, and workforce. Realizing success in achieving these additional priority areas for the senior and vulnerable adult populations will require multiagency and multidisciplinary collaboration and investment from federal and state funders. Without the participation of a wide network of community members and organizations, including state and local leadership, the private sector, major health care systems, faith-based and non-profit organizations, and older adult advocates, a major risk to addressing the current and future needs of our consumers will widen. DAS is committed to strengthening existing partnerships and developing new ones to improve the lives of older adults, reduce disparities, and support family caregivers.
In 2022, 14.6% of Georgia's population was 65 and over, up from 12.7% in 2019. Georgia ranks seventh amongst states older adults are moving to. According to census.gov, over 75% of older Georgians receive Social Security and more than 2 million older adults (10.7%) live in poverty. In Georgia, 14.3% of the population speaks a primary language other than English, and over 10% are born outside of the U.S. Almost 9% of people in Georgia under age 65 live with at least one disability. According to a 2019 UCLA/Gallup poll, approximately 6% of Georgians over age 65 identify as LGBT.
With the Georgia General Assembly's investment, DAS has been able to focus on addressing caregivers and individuals affected by Alzheimer's and other dementias. According to the Alzheimer's Association, the prevalence of Alzheimer's in Georgia is expected to increase by 26.7% between 2020 and 2025. Additionally, there are 343,000 unpaid dementia caregivers in Georgia, providing 657 million hours of care annually, valued at more than $9 billion. This state plan includes goals and strategies designed for our state to become more dementia capable.
We are increasing access to early and accurate diagnosis, developing a dementia-capable aging network, and ensuring the provision of quality, person-centered programs and services for people living with dementia and their caregivers.
The State Plan on Aging lays out robust strategies to meet the goals and objectives to drive innovation in our aging services network. We have included comprehensive metrics to measure the performance of our network to ensure the best possible outcomes for older Georgians, persons living with disabilities, and their caregivers. Overall, the State Plan on Aging will ensure that all older adults can live with dignity, independence, and the support they need to thrive by advancing equity, increasing access to home and community-based services, becoming dementia-capable, and creating a robust caregiving infrastructure.
CORE PROGRAMS AND SERVICES
DAS serves as the lead on providing programs and services to Georgia's aging population. As the State Unit on Aging (SUA), DAS administers OAA programs and services through funding from ACL. SUAs administering funds under Titles III and VII of the OAA of 1965, as amended, are required to develop and submit to the Assistant Secretary on Aging, a State Plan for approval under Section 307 of the OAA. DAS has adopted a four-year State Plan on Aging for the period extending from October 1, 2023, through September 30, 2027. In accordance with the act, DAS targets persons age 60 and older, with the greatest economic or social need, particularly low-income and minority persons, older individuals with limited English proficiency, and older persons residing in rural areas.
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MAJOR PROGRAMS AND INITIATIVES
Aging & Disability Links seniors and adults with disabilities to resources that promote independence. Resource Connection
Adult Protective Provides investigations of abuse, neglect, and exploitation to adults with disabilities (age Services 18 and older) and older adults (age 65 and older) who are not residents of long-term care facilities.
Assistive Technology Helps clients identify tools and aids that assist them with activities of daily living.
Dementia Capability Drive dementia capability through implementation of the Georgia Alzheimer's and Related Dementias State Plan; development of programs like Dementia Care Specialists, Dementia Friends, Memory Screening, Brain Health Education, and collaboration with other state agencies and partners to create a robust dementia-capable service delivery network.
Elderly Legal Provides legal representation, counseling, and education to seniors. Assistance Program
Forensic Special Provides training, support, and technical assistance to law enforcement, social services, Initiatives Unit medical professionals, prosecutors, victim service providers, and all other local, state, and federal partners who serve elder and disabled adults.
Georgia State Health Provides one-on-one, unbiased Medicare counseling to seniors and their families. Insurance Assistance
Program (SHIP) Options Counseling Provides enhanced planning for long-term care including support and services for
seniors in the community and in nursing homes. Money Follows the Assists older adults and adults and children with physical disabilities and/or traumatic
Person brain injuries in moving out of long-term care facilities and into the community of their choice. (Federally-funded program)
Nursing Home Assists older adults in moving out of long-term care facilities and into the community of Transitions their choice. (State-funded program)
Non-Medicaid Home Provides long-term support and services as specified by the Older Americans Act. and CommunityBased Programs (HCBS)
Caregiver Services Provides support and services for family and informal caregivers of older individuals and Program persons with dementia, as well as for older relative caregivers of children and adults with disabilities.
Senior Employment Serves unemployed low-income persons who (age 55 and older) who have poor Program employment prospects by training them in part-time community service assignments and by helping them learn skills to facilitate their transition to unsubsidized employment.
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OTHER STATE PLANS In addition to managing the State Plan on Aging, DAS is responsible for managing several other strategic plans. These plans were developed with a variety of community stakeholders and are dependent on a collaborative effort to achieve the goals outlined in each plan. DAS plays a major role in coordinating and facilitating those activities. The stakeholders and partners meet on a regular basis to strategize and evaluate their progress. Links to these plans are available on the DAS' website: aging.georgia.gov. Georgia Alzheimer's & Related Dementias State Plan Collaborative Provides a blueprint to address the growing challenge of dementia in Georgia. Read more: aging.georgia.gov/get-involved/georgia-alzheimers-related-dementias-state-plan Georgia State Plan to Address Senior Hunger Provides a framework by which the state can work to address senior hunger through five focus areas outlined in the plan. The plan includes background on senior hunger nationally and in the state with key recommendations to advance senior hunger work in Georgia. Read more: aging.georgia.gov/get-involved/senior-hunger Title V State Plan - Senior Community Service Employment Program Serves low-income persons who are age 55 and older and have poor employment prospects. Eligible individuals are placed in part-time community service positions with a goal of transitioning to unsubsidized employment. Read more: aging.georgia.gov/document/document/scsep-state-plan-2020-2023/download
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ACL AND OTHER DISCRETIONARY GRANTS DAS seeks ACL discretionary grants and other grants to implement new programs, strengthen the aging network in Georgia, and better serve Georgia's elderly and disabled populations. This is a list of current initiatives funded by discretionary grants:
BankSafe Grant Educates frontline bank employees on how to identify red flags for financial exploitation. State Health Provides free, unbiased, and factual information and assistance to beneficiaries and their
Insurance Program caregivers about Medicare, Medicaid, and related health insurance issues including longterm care insurance and prescription drug assistance programs.
Medicare Provides valuable support at the state and community levels for organizations involved in Improvement reaching and aiding people who may be eligible for the Low-Income Subsidy Program (LIS), for Patients and Medicare Savings Program (MSP), and the Medicare Part D Prescription Drug Program.
Providers The National Center Provides technical assistance to DAS and network partners to develop a common
on Advancing operational definition of person-centered service delivery and data points to measure Person-Centered progress.
Practices and Systems
Public Health Aims to increase the number of public health professionals within the State Health Workforce Grant Insurance Assistance Program (SHIP) and aging and disability networks to address
the unique needs of individuals through the support of wages and benefits for these professionals. Professionals supported through this program provide a wide range of public health services and support.
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State Agency on Aging Operations Overview

DAS has developed a comprehensive delivery system of services to older adults, individuals with disabilities, and their families. This delivery system encompasses AAAs and contracted service providers. Key customers, partners, collaborators, and stakeholders have the same key requirements and expectations of DAS.

Key Customer Groups
Older adults People with disabilities Families Caregivers Advocates Pre-retired adults Persons in Long-Term Care
Facilities Persons Under Guardianship

Key Requirements / Expectations
Accurate information and reliable services Consistency of delivery and choice Knowledgeable providers Affordable service options Available/accessible service options Able to live independently in the community Trustworthy service providers and safety
assurances Respectful treatment

Through an annual budget planning process and mid-year review meetings with each Area Agency on Aging, DAS reaffirms the key customers, partner, and stakeholder groups along with market requirements, and then adjusts its plans as needed.

DAS' most important partners are AAAs, CILs, and the provider network. All three entities work in coordination to achieve our common goal: delivering high-quality services to customers. DAS believes that a successful partnership requires a clear understanding of the roles of and benefits to all parties. As such, DAS has specific requirements and expectations of AAAs, and in turn, the AAAs have specific requirements and expectations of providers.

DAS allocates federal and state funds to the Planning and Service Areas (PSA) using an ACL approved Intrastate Funding Formula for most of its contracted services. The weighted funding formula takes into consideration the following eight factors: persons 60 years of age and older; persons 75 years of age or older; low-income minority population 65 years of age and older; low-income population 65 years of age and older;estimated rural population 60 years of age and older; limited English-speaking population 65 years of age and older;disabled adults 65 years of age and older; and living alone 65 years of age and older.

The OAA requires that AAAs provide local matching funds for some programs. DAS ensures that all funds are spent in accordance with applicable state and federal requirements and with sound fiscal management practices. In the last quarter of the fiscal year (FY), if there is the possibility of lapsing dollars which would otherwise benefit key customers, DAS may choose to move funds from one AAA to another through a contract amendment. DAS monitors AAA contracts and provides technical assistance, including a Uniform Cost Methodology (to assist in accurately identifying actual costs for specific services), for providers. Prior to contracting with an AAA, DAS reviews its Area Plan, including its budget. If DAS identifies gaps or problems in an Area Plan, staff work with the AAA to resolve these prior to DAS approval of the Area Plan and execution of the contract.

DAS monitors AAAs annually via monitoring visits and customer satisfaction surveys. Desk reviews were implemented during Covid as well as Temporary Operating Procedures for APS and PGO. DAS works in the field with AAA staff and providers, observing operations, reviewing progress on expenditures, monitoring for potential lapse of dollars, and providing technical assistance to improve the quality of services.

DAS provides AAAs with allocation amendments throughout the year as various funding is received (e.g., federal fund disbursements, grant awards). DAS and AAAs amend contracts as needed to reflect changing needs and expenditures in the Planning and Service Area (PSA).

Providers and partners coordinated through the AAAs determine the needs of the senior and vulnerable adults we serve. They directly provide services to consumers, including meals and other nutrition services, in-home services, legal services, employment assistance, and ombudsman services.

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GEORGIA'S AGING NETWORK
DAS collaborates with a variety of community partners and agencies to deliver services throughout the state. These partners include 12 AAAs, CILs, home and community-based service providers, and other state agencies.

12 10 9 7

AREA AGENCIES ON AGING

REGIONAL COMMISSIONS

CENTERS FOR INDEPENDENT
LIVING

MEMORY ASSESSMENT
CLINICS

4 159 206

UNIVERSITIES

COUNTY GOVERNMENTS

SENIOR CENTERS

In Georgia, DAS has designated 12 Planning and Service Areas (PSAs). All community-based services for older adults are coordinated through the designated AAAs for each specific PSA. Ten of the AAAs are housed within Regional Commissions (RCs), which are units of special purpose local government. The remaining two AAAs are freestanding, private nonprofit organizations, both of which have 501(c)(3) status with the Internal Revenue Service.

The AAAs are responsible for:

Assuring the availability of an adequate supply of high-quality services using contractual arrangements with service providers, and for monitoring their performance.

Local planning, program development and coordination, advocacy, and monitoring.

Developing the Area Plan on Aging and area plan administration, and resource development.

Working with local business and community leaders, the private sector, and locally elected officials to develop a comprehensive and coordinated service delivery system.

Establishing and coordinating the activities of an advisory council, which will provide input on development and implementation of the area plan.

Assisting in conducting public hearings, and reviewing and commenting on all community policies, programs

and actions affecting older persons in the area.

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GEORGIA COUNCIL ON AGING In 1977, the Georgia General Assembly created the Georgia Council on Aging (GCOA). The Governor, Lieutenant Governor, Speaker of the House, and the Commissioner of the Department of Human Services appoint Council members. The Council has 20 members, including ten consumers at least 60 years of age and ten service providers. Members represent all older Georgians and ensure that minorities, low-income, rural, urban, public, and private organizations are included. GCOA's primary mission is to:
Advocate with and on behalf of aging Georgians and their families to improve their quality of life. Educate, advise, inform, and make recommendations concerning programs for the elderly in Georgia. Serve in an advisory capacity on aging issues to the Governor, General Assembly, DHS, and all other state
agencies. Coalition of Advocates for Georgia's Elderly (CO-AGE) is led by GCOA. The coalition is meant to be:
A forum to identify and address concerns of older Georgians. A vehicle for bringing broad-based input on aging issues from across the state. A diverse group of organizations, individuals, consumers, and providers interested in "aging specific" and
intergenerational issues. A unifying force communicating the importance of providing supportive communities and adequate services
and programs for older Georgians.
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GEORGIA ALZHEIMER'S & RELATED DEMENTIAS STATE PLAN

The Georgia Alzheimer's and Related Dementias (GARD) State Plan is designed to ensure that people living with dementia, their families, and caregivers have ready access to reliable information, support, and services that are delivered as effectively and efficiently as possible. The GARD State Plan establishes goals around the state's current and future ability to provide necessary services and programs for Georgians impacted by cognitive decline and recommends strategies to catalyze movement toward dementia capability.

The GARD advisory council and collaborating organizations continue to make advancements in the plan's priority areas. Experts and stakeholders from academia, government, nonprofit, health care, and those with lived experience serve on workgroups in the GARD collaborative. GARD plan goals fall into the following six areas:

Research and Data

Public Safety

Workforce Development

Outreach and Partnerships

Service Delivery

Policy

GEORGIA MEMORY NET
Georgia Memory Net (GMN) is a statewide program developed in partnership with Emory University dedicated to driving early diagnosis and treatment of Alzheimer's and related dementias. The goals of the program are to:
Establish and sustain a network of Memory Assessment Clinics (MACs) across the state to increase patient access to accurate diagnoses.
Engage statewide primary care clinicians to improve screening for cognitive impairment, increase referrals to GMN MACs, and provide support in their ongoing care of Georgians diagnosed with memory loss.
Connect patients to critical community services.
Provide oversight and evaluation of project performance.
During GMN's first year, MACs were established and training for healthcare providers and other professionals was conducted around the state. In state fiscal year (SFY) 2018, over 500 providers were informed about the project, a workflow was established, and MACs began seeing patients. The MACs are currently located at Augusta University in Augusta, Grady Health in Atlanta, Navicent Health in Macon, and Phoebe Putney Health in Albany.
In FY 2023, the Georgia legislature invested an additional $3 million in the GMN program, which will lead to expansion of the number of memory assessment clinics and telehealth capability. By the second quarter of FY 2024 there will be seven Memory Assessment Clinics across the state to include three new clinics to serve the coast, south Georgia, and north Georgia. These clinics will provide state-of-the-art diagnostic assessments of cognitive impairment at Savannah Neurology Specialists in Savannah, Memorial Health Meadows Adult Primary Care in Vidalia, and Northeast Georgia Physicians Group in Gainesville. By adding these new MACs, there will be increased access to early and accurate diagnosis and care planning across Georgia. This strong statewide infrastructure is groundbreaking and will serve as a model to other states as the first disease modifying drugs become available to those who are diagnosed in the early stage of Alzheimer's disease.
Telehealth sites are available in Dooly and Emanuel counties in partnership with the Georgia Department of Public Health.
In efforts to provide patients with community support services, strengthen clinician education, and raise awareness, GMN has engaged numerous partners across the state. Partnerships include the Rosalynn Carter Institute for Caregiving, the Alzheimer's Association Georgia Chapter, and the Area Agencies on Aging.
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DEMENTIA CARE PROGRAM
The Dementia Care Program will fund a dementia care specialist (DCS) beginning in SFY 2023 in each of the twelve Area Agency on Aging (AAA) regions. In addition, the legislation allows for a full-time program lead in the Division of Aging Services to ensure program quality and integrated data collection across the program to maximize impact.
The DCS will:
Drive collaboration among stakeholders in their local communities.
Increase the frequency of memory screenings by reducing stigma.
Support families impacted by dementia by strengthening the capabilities of the aging network.
The DCS will be the local catalyst for dementia care in their communities and, as such, will strengthen existing partnerships and forge new ones as they support their communities in becoming more dementia capable. The result will be greater collaboration throughout the state among partners, stakeholders, and families impacted by dementia.
To increase concern, awareness, and early detection, the DCS will offer community education and memory screenings, thereby promoting efforts to reduce stigma related to memory screening and dementia diagnosis.
Lastly, the DCS will provide targeted dementia-specific case management and support to caregivers while improving care coordination and transitions. As a specialized dementia coordinator within the AAAs, the DCS will ensure a seamless transition among services, including Georgia Memory Net and other health care providers. Overall, the Dementia Care Program will mobilize dementia-specific community resources and support services to better serve persons living with dementia and their families.
DEMENTIA FRIENDS
In 2019, GARD's Dementia Friendly Strategy Group launched Dementia Friends, a dementia information session that teaches attendees signs and symptoms of dementia and tips for communicating with people living with dementia. Since then, over 2,000 Georgians have become Dementia Friends.
PUBLIC HEALTH WORKFORCE
This program aims to increase the number of public health professionals within the State Health Insurance Assistance Program (SHIP) and aging and disability networks to address the unique needs of individuals through the support of wages and benefits for these professionals. Professionals supported through this program provide a wide range of public health services, including provision of culturally affirmative and linguistically accessible information, access assistance for vaccines and boosters, transition and diversion from high-risk congregate settings to community living, provision and connections to health and wellness programs, activities that address social isolation and social determinants of health, provision of education and outreach to ensure access to health insurance and benefits, and other activities that support the public health and well-being of individuals.
DAS was awarded three public health workforce grants that provide for four staff positions: A public health outreach specialist was brought on to support the outreach work of the Georgia State Health Insurance Assistance Program (SHIP) and Aging & Disability Resource Connection (ADRC). The work of the outreach specialist includes: Serving as an organization resource related to COVID-19 testing, vaccine, and booster access. Developing and delivering training related to COVID-19 testing, vaccine, and booster access. Coordinating the dissemination of information and marketing materials related to COVID-19 testing, vaccine, and booster access with Aging and Disability Resource Connection/No Wrong Door System (ADRC/NWD) partners.
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Offering a monthly calendar of outreach and education events for Georgia SHIP and ADRC. Two social isolation program specialists will help develop the telephone reassurance program across the state. Currently, there are four Area Agencies on Aging and one university conducting telephone reassurance. The Division of Aging Services has a goal of all twelve AAAs offering telephone reassurance services, as this has shown to reduce social isolation. The two specialists with the state will provide policies and technical assistance to the AAAs as they develop their programs.
According to the CDC: Social isolation significantly increases a person's risk of premature death from all causes, a risk that may
rival those of smoking, obesity, and physical inactivity. Social isolation is associated with about a 50% percent increased risk of dementia. Poor social relationships (characterized by social isolation or loneliness) are associated with a 29%
increased risk of heart disease and a 32% increased risk of stroke. Loneliness is associated with higher rates of depression, anxiety, and suicide. An epidemiologist will use existing and new data related to the DHS COVID-19 response for analysis, demonstration of readiness and/or gaps in the network's COVID-19 response and prepare recommendations to make the network more ready to respond appropriately in the event of a future public health emergency. Additionally, demographic analysis of who received services related to COVID-19 (i.e. if most clients were OAA target populations, living alone, low-income, rural, etc.) is being conducted and DAS is developing outreach plans to ensure that these populations are better identified/served in a future public health emergency and will propose mitigation strategies targeted to these underserved populations.
QUALITY MANAGEMENT DAS uses the Baldrige Excellence Framework to systematically improve quality throughout the organization. During the next State Plan cycle, DAS will create a conflict-free delivery system. An annual self-assessment and quarterly reviews of performance metrics allow DAS to ensure that key outcomes for both customers and the aging network are achieved and sustained. The Baldrige criteria encompasses an overview of the organization's leadership, strategy, customers, measurement analysis and knowledge management, workforce, operations, and results. DAS uses comparative data as available to examine organizational performance and improvement opportunities. DAS' quality assurance activities include quarterly review of performance measures of operational and service effectiveness and efficiency, quarterly and annual compliance reviews of contractors, and annual customer and workforce satisfaction surveys. DAS has implemented the DAS Data System (DDS) as the statewide information management system for documentation of client and provider data. The DDS compiles service delivery and financial data for all DAS programs. The DDS has enhanced the aging network's ability to collect meaningful data and to demonstrate the need for additional resources to meet the growing demand for long-term services and support statewide. Our continued development of DDS will help improve measures of outcomes for the clients we serve.
2024 - 2027 Georgia State Plan on Aging | 11

ASSISTIVE TECHNOLOGY PROGRAM
The Assistive Technology (AT) program was initiated in SFY 2015. Funding for this program provided each of the 12 AAAs and the Centers for Independent Living with a demonstration lab. The purpose of the AT labs is to showcase commonly used AT devices to assist older adults in living and working independently in the community of their choice. Additional funding was provided to all 12 AAAs in SFY 2019 to expand AT services in Georgia. During the COVID-19 pandemic, funding for AT services included the provision of Claris tablets to older adults to keep them engaged in physical activity and socially connected with their loved ones. Provision of AT devices is used to mitigate and minimize the risk of social isolation and loneliness.
GEORGIA SENIOR HUNGER INITIATIVE
The key goal of this initiative is to raise awareness and seek solutions in addressing senior hunger in Georgia, principally done through the execution of Georgia's State Plan to Address Senior Hunger implemented in December 2017. The plan consists of five focus areas in addressing senior hunger: Today's Seniors, Health Impact, Food Access, Food Waste and Reclamation, and Meeting the Community's Needs. Georgia has accomplished many of the recommendations of the first state plan and broader initiative goals that include:
Annual conference participation to include Senior Hunger sessions (SFY19-SFY22). Hired a Senior Hunger/Nutrition Coordinator (SFY19). Developed 12 regional senior hunger coalitions (SFY19). Established a Senior Hunger Interagency Council (SHIC) (SFY22). Began coordinating data collection and analysis across agencies (SFY21). Began developing and providing education and training (SFY19). Expanded the What a Waste Program (SFY20). Began providing entrepreneurial mini grants (SFY19). Transitioned Senior Hunger Summit Committee to Senior Hunger Advisory Council (SHAC) (SFY22). Developed State Senior Hunger Toolkit and launched on initiative website (SFY22).
CONFLICT-FREE SERVICE DELIVERY NETWORK
In recent years, DAS has redesigned its HCBS case management program to focus on assessment and service planning for consumers with a high risk of institutionalization or who have complex needs that jeopardize their ability to live independently. DAS is currently convening a workgroup with representatives from the AAAs to reimagine Georgia's Access to Services system in light of shrinking resources and a growing population of older adults, persons with disabilities, and caregivers in need. Each AAA has identified the degree to which it operates a conflict-free service delivery system and the firewalls each has in place to mitigate conflict when funding is inadequate to implement a fully conflict-free system.
During the next State Plan cycle, DAS will continue to work to create a more conflict-free system. This will include convening additional workgroups, exploring pilot projects with AAAs, and identifying opportunities to maximize the role of the ADRC while segregating the functions of screening, eligibility determination, and assessment/service planning. DAS will utilize research from the National Senior Citizens Law Center and best practices from other states (including Arizona, Minnesota, Ohio, Vermont, Washington, and Wisconsin).
PERSON-CENTERED PLANNING
Person-Centered Planning (PCP) is a process that develops an individual support plan driven by the goals, strengths, and preferences of the person or client. The goal of PCP is to identify the needs of the client from their own perspective. and/or private pay options.
2024 - 2027 Georgia State Plan on Aging | 12

It affirms that each person is the expert in his/her own life and facilitates an informed choice of public and/or private pay options. This approach to service delivery acknowledges that a person's goals, preferences, strengths, and challenges change over time and that the system of care should support those changes.
The National Center on Advancing Person-Centered Practices and Systems (NCAPPS) awarded DAS a three-year technical assistance grant to support development of an operational definition of person-centered service delivery that can be tracked over time. During the previous state plan cycle, DAS worked with state and local partners, as well as subject matter experts from around the country, to develop a common definition of person-centered service delivery in Georgia that spans multiple service agency systems (including aging, developmental disabilities, and behavioral health) and criteria to regularly evaluate our movement toward promoting person-centered support to individuals across the lifespan. This definition is as follows:
Georgia promotes a person-centered approach in the delivery of services to individuals and families that is based on:
A holistic approach that acknowledges the individual and their loved ones to be the experts in their own lives that centers on the individual/family; that explicitly includes their strengths, interests, values, assets and challenges, and that is trauma-informed and culturally aware and competent.
Flexible and collaborative plans of care that explicitly define roles of all members of the support team that allow for multiple pathways for success and that account for and mitigate challenges.
Intentional conversations and actions that support individuals/families on their journey toward life goals that encourage them to dream and explore possible futures and that build their resilience.
A system of care that aligns services to ensure the individual has maximum access to the benefits of living in the community and that facilitates the individual achieving his/her desired outcomes.
As we continue to promote the use of person-centered practices in all aspects of service delivery, DAS will seek to expand funding and use of consumer-directed services and move from a service-centric waiting list for services (in which waiting lists are maintained by service) to a person-centered waiting list (in which waiting lists are maintained by a consumer's impairment and need).
BEHAVIORAL HEALTH
According to the National Institute of Mental Health, nearly one in five U.S. adults lives with a mental illness, and 4.2% of adults live with a serious mental illness. The prevalence of mental illness in persons aged 50 and older is 15% and the prevalence of serious mental illness in that age group is 2.5%. The Centers for Disease Control and Prevention (CDC) estimates that 20% of people aged 55 years and older experience some type of mental health concern. The most common conditions include anxiety and mood disorders such as depression and bipolar disorder. Older men have the highest suicide rate of any age group. Depression is the most prevalent behavioral health condition affecting older adults and can result in declines in physical health, socialization, and the ability to live and function independently in the community. Behavioral health issues also negatively impact the ability to manage chronic medical conditions.
DHS works with numerous agencies and coalitions to improve access to behavioral health services for older adults, persons with disabilities, and caregivers. These include, but are not limited to, the Georgia Coalition on Older Adults and Behavioral Health, Department of Behavioral Health and Disabilities (DBHDD), Department of Public Health (DPH), Department of Community Health (DCH), NAMI Georgia, Georgia Mental Health Consumer Network, Georgia Council on Substance Abuse, Georgia Council on Developmental Disabilities (GCDD), Statewide Independent Living Council of Georgia (SILC), Georgia Advocacy Officer (GAO), Rosalynn Carter Institute for Caregiving (RCI), Fuqua Center for LateLife Depression at Emory University, and the Carter Center's Mental Health Program.
These partnerships have worked in recent years to expand access to behavioral health resources and services for older adults across Georgia, including:
Improving local and statewide coordination and collaboration among behavioral health services, AAAs, Adult Protective Services (APS), and the Public Guardianship Office (PGO). 2024 - 2027 Georgia State Plan on Aging | 13

Advocating for improvements in service delivery for older adults who experience severe or persistent mental illness.
Facilitating improved access to the continuum of care related to older adults who have a behavioral health diagnosis or substance use disorder.
Developing opportunities for staff and stakeholder agencies to gain knowledge, education, and training in order to provide more effective trauma-informed support for older adults and their caregivers.
In January 2023, the DAS ADRC Program Manager assumed the role of chairperson for the Georgia Coalition on Older Adults and Behavioral Health. Serving in this capacity will enhance opportunities for partner agencies and advocacy organizations will continue to work together with the understanding that social determinants of health impact the screening, diagnosis, and treatment of behavioral health issues in older adults. The Coalition's goals moving forward include increasing screening capacity and competence within the Aging network (training on screening tools, mental health first aid, and suicide prevention), and enhancing coordination and access among local aging and behavioral health services providers. TRANSPORTATION/ACCESS Experts, including the National Association of States United for Aging and Disability (NASUAD), the American Public Transit Association, and the National Association of Area Agencies on Aging, often cite transportation as one of the most pressing issues facing older adults. DHS contracted with the Georgia Health Policy Center at Georgia State University to inform DHS about these issues in Georgia. In its report presented in November 2018, the Center noted that:
Older adults will outlive their driving ability by 11 years for women and six years for men. Based on estimates of the 2016 population, more than 263,000 Georgians aged 70 and older had ceased driving. An estimated 200,000 Georgians aged 70 and older may have unmet transportation needs. Because lack of transportation has a significant effect on quality of life for older adults, including increased depression, increased social isolation, and decreased access to goods and services, DHS is placing high importance on this issue over the next four years. However, DAS believes that the issue is broader than transportation; therefore, DAS will focus its efforts using the broader context of improving access to services for older adults. These strategies will include improving use of scarce resources and implementing creative approaches (like increasing quality of life trips) to both getting seniors to services they need and desire and getting services to the seniors.
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State and Area Plan Alignment
Section 305. (a)(1)(A) of the Older Americans Act, as amended through P.L. 114-144, enacted April 19, 2016, requires that the state agency shall be primarily responsible for the planning, policy development, administration, coordination, priority setting, and evaluation of all State activities related to the objectives of the Act. Section 307. (a)(1) of the Act requires that the state plan mandate that each designated area agency develop an area plan for submission to and approval by the state agency, and that the state plan be based on such area plans. In compliance with both sections, DAS has established a four-year planning cycle such that area plans are developed in the first year and amended as required in the succeeding three years. State plan development is accomplished in the fourth year of the schedule and uses area plan information and performance data as the basis against which compliance with standard assurances, evaluation of regional capacity, effectiveness of service delivery, and the degree to which target populations are served are measured. The state plan establishes statewide goals and objectives for the next area plan cycle to which area agencies must align new area plans developed in the new planning cycle. Area agencies are provided the option to include area specific targets appropriate to serve regional needs absent conflicts with statewide direction.
2024 - 2027 Georgia State Plan on Aging | 15

Goals, Objectives, and Measures

In compliance with the OAA requirements, DAS has developed clear, measurable goals and objectives that meet the ACL's focus areas. The goals embrace person-centered and consumer-directed approaches to improve service delivery, strengthen the aging network and increase safety for older Georgians and people with disabilities.
GOAL 1: Provide long-term services and supports that enable older Georgians, their families, caregivers, and persons with disabilities to fully engage and participate in their communities for as long as possible.
GOAL 2: Ensure older Georgians, persons with disabilities, caregivers, and families have access to information about resources and services that is accurate and reliable.
GOAL 3: Strengthen the aging network to enable partners to become viable and sustainable; and develop a robust network of aging service partners.
GOAL 4: Prevent abuse, neglect, and exploitation while protecting the rights of older Georgians and persons with disabilities.
GOAL 5: Utilize continuous quality improvement principles to ensure the SUA operates efficiently and effectively.

Program Key: ADRD Alzheimer's Disease & Related Dementias
ADRC Aging & Disability Resource Connection
ADMIN DAS Administration
PI Program Integrity
APS Adult Protective Services
FSIU Forensic Special Initiatives Unit
SHIP Georgia SHIP

ELAP Elder Legal Assistance Program
LTCO Long-Term Care Ombudsman
PGO Public Guardianship Office
HCBS Home and Community Based Services
MFP Money Follows the Person
NHT Nursing Home Transitions

2024 - 2027 Georgia State Plan on Aging | 16

GOAL 1

Provide long-term services and supports that enable older Georgians, their families, caregivers, and persons with disabilities to fully engage and participate in their communities for as long as possible.

Objective

Measure

Program Focus Area

1.1 Increase the number of clients

Number of AAA staff who

ADRC

Advancing Equity

who receive Options Counseling have completed the Options

(OC) services from certified

Counseling certification

Options Counseling staff by 5% statewide.

each year.

Strategies Identify roles at each AAA that need OC certification and enroll staff needing OC certification in Boston University
training Ensure certified OCs participate in OC certification refresher courses Ensure workflow identifies clients needing options counseling and those clients are then referred to certified OCs

Objective

Measure

Program Focus Area

1.2 Develop a more dementia capable Assess the number of active

ADRD

Building a Caregiving

aging network.

clients with a formal or self-

Infrastructure

reported dementia diagnosis

and establish a baseline to

measure the number of memory

screenings per year per AAA.

The memory screenings will

take place at the local level (at

the AAA/in the community).

Strategies Establish the workflow for the dementia care specialist (DCS) role Assess the number of active clients with a formal or self-reported dementia diagnosis and establish a baseline to
measure the number of memory screenings per year per AAA DCS will provide quarterly dementia training for AAA staff, providers, and partners 75% of AAA staff will participate in at least two Dementia Care Specialist and two Georgia Memory Net training
sessions annually Have 1-2 AAA staff members attend the annual GMN Summit, Quarterly CSE Education Webinar, and/or other
GMN-related events

Objective

Measure

Program Focus Area

1.3 After receiving meals, the number Food security impact report will HCBS

Advancing Equity

of clients with low or very low

show how many clients have

food security will decrease by 5%. a food security survey score of

2 or more beginning on July 1,

2021 (SFY22). Establish baseline

in 2022. By 2027, the goal will

be to decrease baseline by 5%.

Strategies Develop and expand targeted efforts to increase access to food and financial resources for vulnerable seniors to
reduce senior hunger in Georgia. Target reasons for why clients are low or very low food security (share info about SNAP education/application
guidance, nutrition counseling, increase meal provision, etc.)

2024 - 2027 Georgia State Plan on Aging | 18

Objective

Measure

Program Focus Area

1.4 Decrease the number participants Number of AAA staff who

NHT

Supports Advancing

who are reinstitutionalized in the have completed the Options

Equity

Nursing Home Transition Program Counseling certification

each year.

statewide.

Strategies AAAs will participate and engage in training and technical assistance opportunities provided by Division of Aging
Services staff for the NHT program. Facilitating a discharge meeting to assess the broader needs of the client and anticipate risks for
reinstitutionalization Develop report in DDS

Objective

Measure

Program Focus Area

1.5 Reduce social isolation of HCBS Increase initial assessments and HCBS

COVID-19 Recovery

clients in Georgia.

service referral documentation

in DDS data %.

Strategies Establish policy/guidance for AAA network Baseline number clients who are socially isolated by SFY 2024 By 2025, increase opportunities for social engagements with internal and external entities (I.e. home delivered
meals, universities' telephone reassurance programs, etc.) Institute a multi-disciplinary advisory group that includes relevant divisions and strategic system-level stakeholders
to provide support and guidance on matters related to activities and services within the aging community Provide data, technical assistance on systems processing information, and staff training under DAS (Lubben
6-itemand UCLA 3-item Assessment Scales)Increase initial assessments and service referral documentation in DDS data

Objective

Measure

Program Focus Area

1.6 Increase the number of

Number of completed

MFP

Supports Advancing

participants completing 365 days transitions

Equity

in the MFP transition program.

Strategies AAAs will conduct meaningful outreach to organizations, agencies, professionals, and other individuals that
serve older adults and individuals with disabilities (i.e. hospitals, nursing homes, senior centers, Long-term Care Ombudsman, etc.) in order to provide information and education on the MFP program AAAs will participate and engage in training and technical assistance opportunities provided by Division of Aging Services staff for the MFP program Use Data Source: MFP/NHT Enrollment Report (reviewed weekly) and the Monthly Transition Reports (submitted monthly by AAAs)

Objective

Measure

1.7 Increase the length of time older Length of time in HCBS service

adults remain in their homes while

receiving HCBS services.

Strategies Focus on targeting assistive technology to individuals Encourage more home modification services using Title IIIB funds

Program HCBS

Focus Area Supports Expanding Access to HCBS

2024 - 2027 Georgia State Plan on Aging | 19

GOAL 2

Ensure older Georgians, persons with disabilities, caregivers, and families have access to information about resources and services that is accurate and reliable.

Objective

Measure

Program Focus Area

2.1 Develop a more dementia capable Year 1: define the metrics for a ADRD

Supports Building a

aging network.

dementia capable network.

Caregiver Infrastructure

Year 2: establish baseline.

Years 3 and 4: measure utilizing

PDCA model.

Strategies Establish the workflow for the DCS role Assess the number of active clients with a formal or self-reported dementia diagnosis and establish a baseline to
measure the number of memory screenings per year per AAA DCS will provide quarterly dementia training for AAA staff, providers, and partners AAA staff will participate in at least two Dementia Care Specialist and two Georgia Memory Net training sessions
annually Have 1-2 AAA staff members attend the annual GMN Summit, Quarterly CSE Education Webinar, and/or other
GMN-related events

Objective

Measure

Program Focus Area

2.2 To widen access by OAA priority Years 1-4: translate two existing ELAP

Expanding Access to

client groups.

publications to languages other

HCBS

than English each state fiscal

year.

Year 2: establish a baseline

for utilization (downloads in

specific languages, requests for

printed booklets, distribution by

providers) of education booklets

in languages other than English.

Years 3 and 4: assess how many

OAA priority client groups

receive education booklets in

languages other than English

through specific outreach.

Strategies Update existing ELAP publications SLSD will review and improve publications to decrease access barriers Per FY, the SLSD will have two existing publications translated to languages other than English

Objective

Measure

2.3 After receiving meals, the number Number of first-time contacts

Program ADRC

Focus Area Expanding Access to

of clients with low or very low

HCBS

food security will decrease by 5%.

Strategies AAAs will conduct meaningful outreach to organizations, agencies, professionals, and other individuals that serve
older adults and individuals with disabilities (i.e. hospitals, nursing homes, senior centers, faith-based organizations, etc.) to provide information and education on the resources available through ADRC AAAs will utilize their ADRC Advisory Council as a resource for building new partnerships and for expanding access to ADRC resources

2024 - 2027 Georgia State Plan on Aging | 20

Objective

Measure

2.4 Increase referrals to the AAAs to Increase by 10% each year

provide services to clients with through SFY 2027

unmet needs.

Strategies Training will be provided to the AAAs and APS staff Managers will check monthly the referral status to the AAAs

Program APS

Focus Area Advancing Equity

Objective

Measure

Program Focus Area

2.5 Increase the number of Georgia Number of client contacts

SHIP

Supports Advancing

SHIP client contacts by 3%

Equity

statewide.

2.6 Increase the number of individuals Number of individuals served at SHIP

Supports Advancing

served at Georgia SHIP outreach outreach and education events

Equity

and education events by 3%

statewide annually.

2.7 Increase the number of Georgia Increase the number of hard to SHIP

Supports Advancing

SHIP low-income, rural, and non- reach contacts

Equity

native English clients served by 3%

statewide annually.

2.8 Increase the number of first-time Number of first-time contacts ADRC

Advancing Equity

contacts to ADRC by 5% each

successive year.

Strategies AAAs will participate and engage in training and technical assistance opportunities provided by Division of Aging
Services staff around data entry in the DDS AAAs will ensure that ADRC staff receive ongoing education and skill-building opportunities around motivational
interviewing to improve the quality of intakes and screenings that are completed

2024 - 2027 Georgia State Plan on Aging | 21

GOAL 3

Strengthen the aging network to enable partners to become viable and sustainable; and develop a robust network of aging service partners.

Objective

Measure

Program

3.1 The aging network will have a

All 12 AAAs will have a conflict- HCBS

conflict-free service delivery

free service delivery system by

system by SFY 2028.

SFY 2028

Strategies Convene statewide workgroup inclusive of all AAAs Each AAA will develop operational plan to ensure assessment process is conflict free Ensure provider networks are prepared to participate in conflict free delivery system SUA provide technical assistance and training and the AAAs will follow/do the same

Focus Area Advancing Equity

Objective

Measure

Program Focus Area

3.2 Ensure legal information

Years 1 and 2: develop new

ELAP

Advancing Equity

and services are available to,

community education booklets

accessible by, and tailored to OAA that address the unique legal

priority client groups

issues faced by OAA priority

client groups.

Year 3: establish a baseline for

utilization (downloads, requests

for printed booklets, distribution

by providers) of education

booklets that address the unique

legal issues faced by OAA

priority client groups.

Year 4: assess how many OAA

priority client groups receive

education booklets through

specific outreach.

3.3 Increase the number of staff who 70% of eligible APS staff will be APS

Expanding Access to

have NAPSA Certification.

certified by SFY 2028

HCBS

Strategies New staff will be identified and scheduled for training within three months from hiring Six trainings assigned upon hiring that must be completed during the prior to New Worker Training and one
training assigned every month thereafter Assures that all trainings have been completed by the completion of year 2 of employment Process in place to help determine the progress of each new staff member

Objective 3.4 Increase the number of CACTS
Specialists by 10% annually

Measure Number of CACTS specialists trained

Strategies Conduct focused and targeted marketing Continue offering hybrid training Require all At-Risk Adult MDT members to attend the training Maintain a presence at Prosecuting Attorneys' Council conferences Host informational MDT/Task Force meetings quarterly

Program FSIU

Focus Area Supports Advancing Equity, Expanding Access to HCBS, and Covid-19 Recovery

2024 - 2027 Georgia State Plan on Aging | 22

Objective

Measure

Program Focus Area

3.5 Strengthen and increase

Year 1: identify local partners, ADRD

Building a Caregiver

partnerships among AAA staff and convene, or join a local

Infrastructure and

community partners across the dementia collaborative, and

Expanding Access to

state in dementia programming establish baseline for joint

HCBS

programs offered.

Years 2-4: expand local

dementia collaboratives, host

regular meetings, and increase

number of joint programs

offered.

Strategies Every DCS will initiate and/or participate in a community dementia collaborative All AAAs will submit two progress reports (using form generated by DAS) each year (mid-year and annual review)
detailing efforts/accomplishments All AAAs will ensure at least two staff or community partners serve on two different GARD Collaborative
workgroups each SFY Identify local health department partners, establish working relationships, and create joint programming

Objective

Measure

Program Focus Area

3.6 Develop a more dementia-

Year 1: define the metrics for a Dementia Expanding Access to

capable aging network

dementia capable community.

HCBS

(Communities, including service Year 2: establish baseline.

organizations, businesses, faith Years 3 and 4: measure utilizing

communities, and health care

PDCA model.

providers, that recognize and

understand the signs and impact

of dementia and offer support to

people living with dementia and

their families)

Strategies Year 1: DCS will plan two community or family dementia education programs Years 2-4: add an additional community-based dementia education program each year per AAA Every AAA will identify a staff or volunteer Dementia Friends Champion who will host two Dementia Friends
information sessions a year (to include 1-2 slides on GMN at the end of presentation as resource) to four unique community businesses or organizations

Objective 3.7 Increase the number of

Measure Increase % each year through

outreaches by 10% each year

2027

through 2027

Strategies Outreaches will be recorded in DDS under providers' tab Managers will review the activity log monthly Training is available on how to access and pull the activity log

Program APS

Focus Area COVID-19 Recovery

2024 - 2027 Georgia State Plan on Aging | 23

Objective

Measure

Program Focus Area

3.8 AAAs and providers will document All AAAs will submit to DAS

ELAP

Advancing Equity

collaborative planning, objectives, via the State Legal Services

and strategies for providing

Developer (SLSD) a copy of

services to OAA priority client

the collaborative planning,

groups. All AAAs will submit

objectives, and strategies

to DAS via the State Legal

document.

Services Developer a copy of the

collaborative planning, objectives,

and strategies document.

Strategies Through annual meetings, AAAs and providers will document collaborative planning, objectives, and strategies for
providing services to OAA priority client groups Collaborative planning, objectives, and strategies documents submitted to SLSD for review Annually, SLSD presents to AAAs and providers the outcomes of the objectives and provides technical support for
meeting objectives

Objective

Measure

Program Focus Area

3.9 Develop professional

Number of monthly in-service PGO

Expanding Access to

competencies of Public

trainings

HCBS

Guardianship Office staff

through trainings, meetings, and

conference opportunities.

Strategies PGO staff will participate in a minimum of one monthly in-service training Training will be identified and scheduled by PGO Policy Specialist and Training and Development staff Completed trainings will be recorded in DDS under Activity Log

2024 - 2027 Georgia State Plan on Aging | 24

GOAL 4

Prevent abuse, neglect, and exploitation while protecting the rights of older Georgians and persons with disabilities.

Objective

Measure

Program Focus Area

4.1 Staff a minimum of 20 cases

Number of cases reviewed with PGO

Expanding Access to

with DBHDD and APS a year to DBHDD and APS

HCBS

determine if an alternative to

Guardianship is appropriate or

other persons are involved who

could serve as guardian.

Strategies Submit or provide assistance with filing 10 petitions annually for restoration, successor guardianship Staff will document in DDS when client is assessed and found appropriate for restoration, or a successor found Client's case closure reason will be captured in DDS if restoration or successor guardianship occurs

Objective

Measure

Program

4.2 By SFY 2028, develop basic 1-2 Number of persons trained for FSIU

hour ANE courses for identified each course; number of courses

professionals outside of the aging developed

network (health care, Medical

Examiners, criminal justice-based

victim advocates, and others).

Strategies Build various courses for each specified discipline using state training platform Courses can be accessed on demand Market courses state-wide

Focus Area Covid-19 Response, Expanding Access to HCBS, and Advancing Equity

Objective

Measure

4.3 Increase the number of attendees Number of individuals trained

for the new ANE courses by 10%

annually once deployed.

Program FSIU

Strategies Market training via FSIU newsletter Partner with other local and state agencies to market training opportunities Explore making certain training offerings mandatory

Focus Area Covid-19 Response, Expanding Access to HCBS, and Advancing Equity

Objective

Measure

Program Focus Area

4.4 Increase the number of attendees Number of people who

FSIU

Covid-19 Response,

for REACT Mandated Reporter

complete the course

Expanding Access to

online training by 10% annually

HCBS, and Advancing

Equity

Strategies Partner with colleges and universities to offer course as extra credit for Social Work, Psychology, Public Health,
and Gerontology students Market the course state-wide Partner with the AAAs to offer asynchronous training

2024 - 2027 Georgia State Plan on Aging | 25

Objective

Measure

Program Focus Area

4.5 Increase number of restorations Number of restorations and

PGO

Expanding Access to

and successor guardianships by successor guardianships

HCBS

20%.

Strategies Submit or provide assistance with filing 10 petitions annually for restoration, successor guardianship Staff will document in DDS when client is assessed and found appropriate for restoration, or a successor found Client's case closure reason will be captured in DDS if restoration or successor guardianship occurs

2024 - 2027 Georgia State Plan on Aging | 26

GOAL 5

Utilize continuous quality improvement principles to ensure the State Unit on Aging operates efficiently and effectively.

Objective

Measure

5.1 Implement the Bakas Caregiving Percentage of In-Home Respite

Outcomes Scale (BCOS)

Care and Out-of-Home Respite

assessment for all family

Care clients with a completed

caregivers receiving respite care BCOS assessment in their

statewide.

DDS client record (Building

a Caregiving Infrastructure)

Baseline 2023 81.40%.

Strategies Provide technical assistance to the AAAs on the BCOS assessment State will monitor the data/assessment entry into the DAS data system

Program HCBS

Focus Area Building a Caregiving Infrastructure

Objective

Measure

Program

5.2 By SFY 2028, develop basic 1-2 Number of judicial circuits

FSIU

hour ANE courses for identified

served/MDT and Task Force

professionals outside of the aging meetings attended (COVID-19

network (health care, Medical

Recovery).

Examiners, criminal justice-based

victim advocates, and others).

Strategies Build various courses for each specified discipline using state training platform Courses can be accessed on demand Market courses state-wide

Focus Area Supports Advancing Equity and Expanding Access to HCBS

Objective

Measure

Program Focus Area

5.3 Increase collaboration with

Number of judicial circuits

FSIU

Expanding access to

judicial circuits/Technical

served/MDT and Task Force

HCBS

Assistance for At-Risk Adult MDTs. meetings attended (COVID-19

Recovery).

Strategies Partner with colleges and universities to offer course as extra credit for Social Work, Psychology, Public Health,
and Gerontology students Market the course statewide Partner with the AAAs to offer asynchronous training

Objective

Measure

Program Focus Area

5.4 Senior centers update, modernize, All AAAs will provide annual

HCBS

Expanding Access to

and implement emergency

summary report of plan

HCBS

preparedness plans.

submissions to SUA.

Strategies All senior centers will have a written emergency plan which includes a plan for when older adults cannot get to
the senior center by SFY 2028 All AAAs and senior centers will conduct one emergency drill a year and will submit any after action report
developed after the drill to the AAA and DAS Senior center directors will increase their knowledge of emergency preparedness by participating in SUA
sponsored trainings Senior center manager onboarding including annual review of the plan 100% of senior center directors will complete the Senior Center Community College course on emergency
preparedness by SFY 2028 2024 - 2027 Georgia State Plan on Aging | 25

Objective

Measure

Program

5.5 85% clients served meets at least Number of clients meeting at HCBS

one OAA target criteria by SFY

least 1 OAA target criteria

2028.

Strategies Collaboration between ADRC and HCBS program staff to collect targeting data

Focus Area Expanding Access to HCBS

Objective

Measure

Program Focus Area

5.6 Maintain a 90% accuracy rate

Accuracy Rate Percentage

ADRC

Supports Expanding

on data collection for key

Access to HCBS

demographic data elements

annually.

Strategies AAAs will participate and engage in training and technical assistance opportunities provided by DAS staff around
data entry in the DDS AAAs will ensure that ADRC staff receive ongoing education and skill-building opportunities around motivational
interviewing to improve the quality of intakes and screenings that are completed Data Source: DDS Missing Data Elements Report

Objective

Measure

5.7 Maintain 90% accuracy rate of

Accuracy Rate Percentage

investigation case record reviews.

Program APS

Focus Area Supports Expanding Access to HCBS

Strategies Identify areas for training where reviews indicate a need, to ensure key data elements are documented during the
investigation Managers will provide coaching on key data elements Training will be provided when a need is identified

2024 - 2027 Georgia State Plan on Aging | 27

ATTACHMENTS
2024 - 2027 Georgia State Plan on Aging | V

Atachments
State Plan Guidance Atachment A
STATE PLAN ASSURANCES AND REQUIRED ACTIVITIES Older Americans Act, As Amended in 2020
By signing this document, the authorized official commits the State Agency on Aging to performing all listed assurances and activities as stipulated in the Older Americans Act, as amended in 2020.
ASSURANCES Sec. 305, ORGANIZATION (a) In order for a State to be eligible to parcipate in programs of grants to States from allotments under this tle--. . . (2) The State agency shall--
(A) except as provided in subsecon (b)(5), designate for each such area aer
consideraon of the views offered by the unit or units of general purpose local government in such area, a public or private nonprofit agency or organizaon as the area agency on aging for such area; (B) provide assurances, sasfactory to the Assistant Secretary, that the State agency will consider, in connecon with maters of general policy arising in the development and administraon of the State plan for any fiscal year, the views of recipients of supporve services or nutrion services, or individuals using mulpurpose senior centers provided under such plan; . . . (E) provide assurance that preference will be given to providing services to older individuals with greatest economic need and older individuals with greatest social need (with parcular atenon to low-income older individuals, including low-income minority older individuals, older individuals with limited English proficiency, and older individuals residing in rural areas), and include proposed methods of carrying out the preference in the State plan; (F) provide assurances that the State agency will require use of outreach efforts described in secon 307(a)(16); and
(G)
(i) set specific objecves, in consultaon with area agencies on aging, for each planning and service area for providing services funded under this tle to low-income minority older individuals and older individuals residing in rural areas;

(ii) provide an assurance that the State agency will undertake specific program development, advocacy, and outreach efforts focused on the needs of low-income minority older individuals; (iii) provide a descripon of the efforts described in clause (ii) that will be undertaken by the State agency; . . .
(c) An area agency on aging designated under subsecon (a) shall be--... (5) in the case of a State specified in subsecon (b)(5), the State agency; and shall provide assurance, determined adequate by the State agency, that the area agency on
aging will have the ability to develop an area plan and to carry out, directly or through contractual or other arrangements, a program in accordance with the plan within the planning and service area. In designang an area agency on aging within the planning and service area or within any unit of general-purpose local government designated as a planning and service area the State shall give preference to an established office on aging, unless the State agency finds that no such office within the planning and service area will have the capacity to carry out the area plan.
(d) The publicaon for review and comment required by paragraph (2)(C) of subsecon (a) shall include--
(1) a descripve statement of the formula's assumpons and goals, and the applicaon of the definions of greatest economic or social need, (2) a numerical statement of the actual funding formula to be used, (3) a lisng of the populaon, economic, and social data to be used for each planning and service area in the State, and (4) a demonstraon of the allocaon of funds, pursuant to the funding formula, to each planning and service area in the State.
Note: States must ensure that the following assurances (Section 306) will be met by its designated area agencies on agencies, or by the State in the case of single planning and service area states.
Sec. 306, AREA PLANS (a) Each area agency on aging designated under secon 305(a)(2)(A) shall, in order to be approved by the State agency, prepare and develop an area plan for a planning and service area for a two-, three-, or four-year period determined by the State agency, with such annual

adjustments as may be necessary. Each such plan shall be based upon a uniform format for area plans within the State prepared in accordance with secon 307(a)(1). Each such plan shall--
(1) provide, through a comprehensive and coordinated system, for supporve services, nutrion services, and, where appropriate, for the establishment, maintenance, modernizaon, or construcon of mulpurpose senior centers (including a plan to use the skills and services of older individuals in paid and unpaid work, including mulgeneraonal and older individual to older individual work), within the planning and service area covered by the plan, including determining the extent of need for supporve services, nutrion services, and mulpurpose
senior centers in such area (taking into consideraon, among other things, the number of older individuals with low incomes residing in such area, the number of older individuals who have greatest economic need (with parcular atenon to low-income older individuals, including low- income minority older individuals, older individuals with limited English proficiency, and older individuals residing in rural areas) residing in such area, the number of older individuals who have greatest social need (with parcular atenon to low-income older individuals, including lowincome minority older individuals, older individuals with limited English proficiency, and older individuals residing in rural areas) residing in such area, the number of older individuals at risk for instuonal placement residing in such area, and the number of older individuals who
are Indians residing in such area, and the efforts of voluntary organizaons in the community), evaluang the effecveness of the use of resources in meeng such need, and entering into agreements with providers of supporve services, nutrion services, or mulpurpose senior centers in such area, for the provision of such services or centers to meet such need;
(2) provide assurances that an adequate proporon, as required under secon 307(a)(2), of the amount alloted for part B to the planning and service area will be expended for the delivery of each of the following categories of services--
(A) services associated with access to services (transportaon, health services (including mental and behavioral health services), outreach, informaon, and assistance (which may include informaon and assistance to consumers on availability of services under part B and how to receive benefits under and parcipate in publicly supported programs for
which the consumer may be eligible) and case management services);
(B) in-home services, including supporve services for families of older individuals with Alzheimer's disease and related disorders with neurological and organic brain dysfuncon; and
(C) legal assistance;
and assurances that the area agency on aging will report annually to the State agency in detail the
amount of funds expended for each such category during the fiscal year most recently concluded; (3) (A) designate, where feasible, a focal point for comprehensive service delivery in each community, giving special consideraon to designang mulpurpose senior centers (including mulpurpose senior centers operated by organizaons referred to in paragraph (6)(C)) as such focal point; and
(B) specify, in grants, contracts, and agreements implemenng the plan, the identy of each focal point so designated;

(4) (A)
(i)
(I) provide assurances that the area agency on aging will--
(aa) set specific objecves, consistent with State policy, for
providing services to older individuals with greatest economic need, older individuals with greatest social need, and older individuals at risk for instuonal placement;
(bb) include specific objecves for providing services to low- income minority older individuals, older individuals with limited English proficiency, and older individuals residing in rural areas; and
(II) include proposed methods to achieve the objecves described in items (aa) and (bb) of sub-clause (I);
(ii) provide assurances that the area agency on aging will include in each agreement made with a provider of any service under this tle, a requirement that such provider will--
(I) specify how the provider intends to sasfy the service needs of lowincome minority individuals, older individuals with limited English proficiency, and older individuals residing in rural areas in the area served by the provider;
(II) to the maximum extent feasible, provide services to low-income minority individuals, older individuals with limited English proficiency, and older individuals residing in rural areas in accordance with their need for such services; and
(III) meet specific objecves established by the area agency on aging, for providing services to low-income minority individuals, older individuals with limited English proficiency, and older individuals residing in rural areas within the planning and service area; and
(iii) with respect to the fiscal year preceding the fiscal year for which such plan is prepared --
(I) idenfy the number of low-income minority older individuals in the planning and service area;
(II) describe the methods used to sasfy the service needs of such minority older individuals; and
(III) provide informaon on the extent to which the area agency on aging met the objecves described in clause (i).
(B) provide assurances that the area agency on aging will use outreach efforts that will--
(i) idenfy individuals eligible for assistance under this Act, with special emphasis on--
(I) older individuals residing in rural areas;

(II) older individuals with greatest economic need (with parcular atenon to low-income minority individuals and older individuals residing in rural areas);
(III) older individuals with greatest social need (with parcular atenon to low-income minority individuals and older individuals residing in rural areas);
(IV) older individuals with severe disabilies;
(V) older individuals with limited English proficiency;
(VI) older individuals with Alzheimer's disease and related disorders with neurological and organic brain dysfuncon (and the caretakers of such individuals); and
(VII) older individuals at risk for instuonal placement, specifically including survivors of the Holocaust; and
(ii) inform the older individuals referred to in sub-clauses (I) through (VII) of clause (i), and the caretakers of such individuals, of the availability of such assistance; and
(C) contain an assurance that the area agency on aging will ensure that each acvity undertaken by the agency, including planning, advocacy, and systems development, will include a focus on the needs of low-income minority older individuals and older individuals residing in rural areas.
(5) provide assurances that the area agency on aging will coordinate planning, idenficaon, assessment of needs, and provision of services for older individuals with disabilies, with parcular atenon to individuals with severe disabilies, and individuals at risk for instuonal placement, with agencies that develop or provide services for individuals with disabilies;
(6) provide that the area agency on aging will--
(A) take into account in connecon with maters of general policy arising in the development and administraon of the area plan, the views of recipients of services under such plan;
(B) serve as the advocate and focal point for older individuals within the community by (in cooperaon with agencies, organizaons, and individuals parcipang in acvies under the plan) monitoring, evaluang, and commenng upon all policies, programs, hearings, levies, and community acons which will affect older individuals;
(C) (i) where possible, enter into arrangements with organizaons providing day care services for children, assistance to older individuals caring for relaves who are children, and respite for families, so as to provide opportunies for older individuals to aid or assist
on a voluntary basis in the delivery of such services to children, adults, and families;
(ii) if possible, regarding the provision of services under this tle, enter into arrangements and coordinate with organizaons that have a proven record of providing services to older individuals, that--
(I) were officially designated as community acon agencies or community acon programs under secon 210 of the Economic Opportunity Act of 1964 (42U.S.C. 2790) for fiscal year 1981, and did not lose the

designaon as a result of failure to comply with such Act; or
(II) came into existence during fiscal year 1982 as direct successors in interest to such community acon agencies or community acon programs;
and that meet the requirements under secon 676B of the Community Services Block Grant Act; and
(iii) make use of trained volunteers in providing direct services delivered to older individuals and individuals with disabilies needing such services and, if possible, work in coordinaon with organizaons that have experience in providing
training, placement, and spends for volunteers or parcipants (such as organizaons carrying out Federal service programs administered by the Corporaon for Naonal and Community Service), in community service sengs;
(D) establish an advisory council consisng of older individuals (including minority individuals and older individuals residing in rural areas) who are parcipants or who are eligible to parcipate in programs assisted under this Act, family caregivers of such individuals, representaves of older individuals, service providers, representaves of the business community, local elected officials, providers of veterans' health care (if appropriate), and the general public, to advise connuously the area agency on aging on all maters relang to the development of the area plan, the administraon of the plan and operaons conducted under the plan;
(E) establish effecve and efficient procedures for coordinaon of--
(i) enes conducng programs that receive assistance under this Act within the
planning and service area served by the agency; and
(ii) enes conducng other Federal programs for older individuals at the local level, with parcular emphasis on enes conducng programs described in secon 203(b), within the area;
(F) in coordinaon with the State agency and with the State agency responsible for
mental and behavioral health services, increase public awareness of mental health disorders, remove barriers to diagnosis and treatment, and coordinate mental and behavioral health services (including mental health screenings) provided with funds expended by the area agency on aging with mental and behavioral health services provided by community health centers and by other public agencies and nonprofit private organizaons;
(G) if there is a significant populaon of older individuals who are Indians in the
planning and service area of the area agency on aging, the area agency on aging shall conduct outreach acvies to idenfy such individuals in such area and shall inform such individuals of the availability of assistance under this Act;
(H) in coordinaon with the State agency and with the State agency responsible for elder abuse prevenon services, increase public awareness of elder abuse, neglect, and exploitaon,

and remove barriers to educaon, prevenon, invesgaon, and treatment of elder abuse, neglect, and exploitaon, as appropriate; and
(I) to the extent feasible, coordinate with the State agency to disseminate informaon about the State assisve technology enty and access to assisve technology opons for serving older individuals;
(7) provide that the area agency on aging shall, consistent with this secon, facilitate the areawide development and implementaon of a comprehensive, coordinated system for providing long-term care in home and community-based sengs, in a manner responsive to the needs and preferences of older individuals and their family caregivers, by--
(A) collaborang, coordinang acvies, and consulng with other local public and private agencies and organizaons responsible for administering programs, benefits, and services related to providing long-term care;
(B) conducng analyses and making recommendaons with respect to strategies for modifying the local system of long-term care to beter--
(i) respond to the needs and preferences of older individuals and family caregivers.
(ii) facilitate the provision, by service providers, of long-term care in home and community-based sengs; and
(iii) target services to older individuals at risk for instuonal placement, to permit such individuals to remain in home and community-based sengs;
(C) implemenng, through the agency or service providers, evidence-based programs to assist older individuals and their family caregivers in learning about and making behavioral changes intended to reduce the risk of injury, disease, and disability among older individuals; and
(D) providing for the availability and distribuon (through public educaon campaigns, Aging and Disability Resource Centers, the area agency on aging itself, and other appropriate means) of informaon relang to--
(i) the need to plan in advance for long-term care; and
(ii) the full range of available public and private long-term care (including integrated long-term care) programs, opons, service providers, and resources;
(8) provide that case management services provided under this tle through the area agency on aging will--
(A) not duplicate case management services provided through other Federal and State programs;
(B) be coordinated with services described in subparagraph (A); and
(C) be provided by a public agency or a nonprofit private agency that--
(i) gives each older individual seeking services under this tle a list of agencies that provide similar services within the jurisdicon of the area agency on aging;

(ii) gives each individual described in clause (i) a statement specifying that the individual has a right to make an independent choice of service providers and documents receipt by such individual of such statement;
(iii) has case managers acng as agents for the individuals receiving the services and not as promoters for the agency providing such services; or
(iv) is located in a rural area and obtains a waiver of the requirements described in clauses (i) through (iii);
(9) (A) provide assurances that the area agency on aging, in carrying out the State Long-Term Care Ombudsman program under secon 307(a)(9), will expend not less than the total amount of funds appropriated under this Act and expended by the agency in fiscal year 2019 in carrying out such a program under this tle;
(B) funds made available to the area agency on aging pursuant to secon 712 shall be used to supplement and not supplant other Federal, State, and local funds expended to support acvies described in secon 712;
(10) provide a grievance procedure for older individuals who are dissasfied with or denied services under this tle;
(11) provide informaon and assurances concerning services to older individuals who are Nave Americans (referred to in this paragraph as "older Nave Americans"), including--
(A) informaon concerning whether there is a significant populaon of older Nave Americans in the planning and service area and if so, an assurance that the area agency on aging will pursue acvies, including outreach, to increase access of those older Nave Americans to programs and benefits provided under this tle;
(B) an assurance that the area agency on aging will, to the maximum extent praccable, coordinate the services the agency provides under this tle with services provided under tle VI; and
(C) an assurance that the area agency on aging will make services under the area plan available, to the same extent as such services are available to older individuals within the planning and service area, to older Nave Americans;
(12) provide that the area agency on aging will establish procedures for coordinaon of services with enes conducng other Federal or federally assisted programs for older individuals at the local level, with parcular emphasis on enes conducng programs described in secon 203(b) within the planning and service area.
(13) provide assurances that the area agency on aging will--
(A) maintain the integrity and public purpose of services provided, and service providers,
under this tle in all contractual and commercial relaonships;
(B) disclose to the Assistant Secretary and the State agency--
(i) the identy of each nongovernmental enty with which such agency has a contract or commercial relaonship relang to providing any service to older individuals; and

(ii) the nature of such contract or such relaonship;
(C) demonstrate that a loss or diminuon in the quanty or quality of the services
provided, or to be provided, under this tle by such agency has not resulted and will not result from such contract or such relaonship; (D) demonstrate that the quanty or quality of the services to be provided under this tle by such agency will be enhanced as a result of such contract or such relaonship; and (E) on the request of the Assistant Secretary or the State, for the purpose of monitoring compliance with this Act (including conducng an audit), disclose all sources and expenditures of funds such agency receives or expends to provide services to older individuals; (14) provide assurances that preference in receiving services under this tle will not be given by the area agency on aging to parcular older individuals as a result of a contract or commercial relaonship that is not carried out to implement this tle;
(15) provide assurances that funds received under this tle will be used--
(A) to provide benefits and services to older individuals, giving priority to older
individuals idenfied in paragraph (4)(A)(i); and
(B) in compliance with the assurances specified in paragraph (13) and the limitaons
specified in secon 212;
(16) provide, to the extent feasible, for the furnishing of services under this Act, consistent with
self-directed care;
(17) include informaon detailing how the area agency on aging will coordinate acvies, and develop long-range emergency preparedness plans, with local and State emergency response agencies, relief organizaons, local and State governments, and any other instuons that have responsibility for disaster relief service delivery;
(18) provide assurances that the area agency on aging will collect data to determine--
(A) the services that are needed by older individuals whose needs were the focus of all
centers funded under tle IV in fiscal year 2019; and
(B) the effecveness of the programs, policies, and services provided by such area agency on aging in assisng such individuals; and (19) provide assurances that the area agency on aging will use outreach efforts that will idenfy individuals eligible for assistance under this Act, with special emphasis on those individuals whose needs were the focus of all centers funded under tle IV in fiscal year 2019.
(b)(1) An area agency on aging may include in the area plan an assessment of how prepared the area agency on aging and service providers in the planning and service area are for any ancipated change in the number of older individuals during the 10-year period following the fiscal year for which the plan is submited.
(2) Such assessment may include--

(A) the projected change in the number of older individuals in the planning and service
area; (B) an analysis of how such change may affect such individuals, including individuals with low incomes, individuals with greatest economic need, minority older individuals, older individuals residing in rural areas, and older individuals with limited English proficiency; (C) an analysis of how the programs, policies, and services provided by such area agency can be improved, and how resource levels can be adjusted to meet the needs of the changing populaon of older individuals in the planning and service area; and (D) an analysis of how the change in the number of individuals age 85 and older in the planning and service area is expected to affect the need for supporve services. (3) An area agency on aging, in cooperaon with government officials, State agencies, tribal organizaons, or local enes, may make recommendaons to government officials in the planning and service area and the State, on acons determined by the area agency to build the capacity in the planning and service area to meet the needs of older individuals for-- (A) health and human services;
(B) land use;
(C) housing;
(D) transportaon;
(E) public safety;
(F) workforce and economic development;
(G) recreaon;
(H) educaon;
(I) civic engagement;
(J) emergency preparedness;
(K) protecon from elder abuse, neglect, and exploitaon; (L) assisve technology devices and services; and
(M) any other service as determined by such agency.
(c) Each State, in approving area agency on aging plans under this secon, shall waive the requirement described in paragraph (2) of subsecon (a) for any category of services described in such paragraph if the area agency on aging demonstrates to the State agency that services being furnished for such category in the area are sufficient to meet the need for such services in such area and had conducted a mely public hearing upon request. (d)(1) Subject to regulaons prescribed by the Assistant Secretary, an area agency on aging designated under secon 305(a)(2)(A) or, in areas of a State where no such agency has been designated, the State

agency, may enter into agreement with agencies administering programs under the Rehabilitaon Act of 1973, and tles XIX and XX of the Social Security Act for the purpose of developing and implemenng plans for meeng the common need for transportaon services of individuals receiving benefits under such Acts and older individuals parcipang in programs authorized by this tle.

(2) In accordance with an agreement entered into under paragraph (1), funds appropriated under this tle may be used to purchase transportaon services for older individuals and may be pooled with funds made available for the provision of transportaon services under the Rehabilitaon Act of 1973, and tles XIX and XX of the Social Security Act.

(e) An area agency on aging may not require any provider of legal assistance under this tle to reveal any informaon that is protected by the atorney-client privilege.

(f)(1) If the head of a State agency finds that an area agency on aging has failed to comply with Federal or State laws, including the area plan requirements of this secon, regulaons, or policies, the State may withhold a poron of the funds to the area agency on aging available under this tle.

(2) (A) The head of a State agency shall not make a final determinaon withholding funds under paragraph (1) without first affording the area agency on aging due process in accordance with procedures established by the State agency.

(B) At a minimum, such procedures shall include procedures for--

(i)

providing noce of an acon to withhold funds;

(ii) providing documentaon of the need for such acon; and

(iii) at the request of the area agency on aging, conducng a public hearing concerning the acon.

(3) (A) If a State agency withholds the funds, the State agency may use the funds withheld to directly administer programs under this tle in the planning and service area served by the area agency on aging for a period not to exceed 180 days, except as provided in subparagraph (B).

(B) If the State agency determines that the area agency on aging has not taken correcve acon, or if the State agency does not approve the correcve acon, during the 180-day period described in subparagraph (A), the State agency may extend the period for not more than 90 days.

(g) Nothing in this Act shall restrict an area agency on aging from providing services not provided or authorized by this Act, including through--

(1) contracts with health care payers;

(2) consumer private pay programs; or

(3) other arrangements with enes or individuals that increase the availability of home and community-based services and supports.

Sec. 307, STATE PLANS

(a) Except as provided in the succeeding sentence and secon 309(a), each State, in order to be eligible for grants from its allotment under this tle for any fiscal year, shall submit to the Assistant Secretary a State plan for a two, three, or four-year period determined by the State agency, with such annual revisions as are necessary, which meets such criteria as the Assistant Secretary may by regulaon prescribe. If the Assistant Secretary determines, in the discreon of the Assistant Secretary, that a State failed in 2 successive years to comply with the requirements under this tle, then the State shall submit to the Assistant Secretary a State plan for a 1-year period that meets such criteria, for subsequent years unl the Assistant Secretary determines that the State is in compliance with such requirements. Each such plan shall comply with all of the following requirements:
(1) The plan shall--
(A) require each area agency on aging designated under secon 305(a)(2)(A) to develop and
submit to the State agency for approval, in accordance with a uniform format developed by the State agency, an area plan meeng the requirements of secon 306; and
(B) be based on such area plans.
(2) The plan shall provide that the State agency will--
(A) evaluate, using uniform procedures described in secon 202(a)(26), the need for supporve services (including legal assistance pursuant to 307(a)(11), informaon and assistance, and transportaon services), nutrion services, and mulpurpose senior centers within the State;
(B) develop a standardized process to determine the extent to which public or private programs and resources (including volunteers and programs and services of voluntary organizaons) that have the capacity and actually meet such need; and
(C) specify a minimum proporon of the funds received by each area agency on aging in the State to carry out part B that will be expended (in the absence of a waiver under secon 306(c) or 316) by such area agency on aging to provide each of the categories of services specified in secon 306(a)(2).
(3) The plan shall--
(A) include (and may not be approved unless the Assistant Secretary approves) the
statement and demonstraon required by paragraphs (2) and (4) of secon 305(d) (concerning intrastate distribuon of funds); and
(B) with respect to services for older individuals residing in rural areas--
(i) provide assurances that the State agency will spend for each fiscal year, not
less than the amount expended for such services for fiscal year 2000...
(ii) idenfy, for each fiscal year to which the plan applies, the projected costs of providing such services (including the cost of providing access to such services); and
(iii) describe the methods used to meet the needs for such services in the fiscal year preceding the first year to which such plan applies.
(4) The plan shall provide that the State agency will conduct periodic evaluaons of, and public hearings on, acvies and projects carried out in the State under this tle and tle VII, including evaluaons of

the effecveness of services provided to individuals with greatest economic need, greatest social need, or disabilies (with parcular atenon to low-income minority older
individuals, older individuals with limited English proficiency, and older individuals residing in rural areas).
(5) The plan shall provide that the State agency will--
(A) afford an opportunity for a hearing upon request, in accordance with published
procedures, to any area agency on aging subming a plan under this tle, to any provider of (or applicant to provide) services;
(B) issue guidelines applicable to grievance procedures required by secon 306(a)(10); and
(C) afford an opportunity for a public hearing, upon request, by any area agency on aging, by any provider of (or applicant to provide) services, or by any recipient of services under this tle regarding any waiver request, including those under secon 316.
(6) The plan shall provide that the State agency will make such reports, in such form, and containing such informaon, as the Assistant Secretary may require, and comply with such requirements as the Assistant Secretary may impose to insure the correctness of such reports.
(7) (A) The plan shall provide sasfactory assurance that such fiscal control and fund accounng procedures will be adopted as may be necessary to assure proper disbursement of,
and accounng for, Federal funds paid under this tle to the State, including any such funds paid to the recipients of a grant or contract.
(B) The plan shall provide assurances that--
(i) no individual (appointed or otherwise) involved in the designaon of the State
agency or an area agency on aging, or in the designaon of the head of any subdivision of the State agency or of an area agency on aging, is subject to a conflict of interest prohibited under this Act;
(ii) no officer, employee, or other representave of the State agency or an area agency on aging is subject to a conflict of interest prohibited under this Act; and
(iii) mechanisms are in place to idenfy and remove conflicts of interest prohibited under this Act.
(8) (A) The plan shall provide that no supporve services, nutrion services, or in-home services will be directly provided by the State agency or an area agency on aging in the State, unless, in the judgment of the State agency--
(i) provision of such services by the State agency or the area agency on aging is necessary to assure an adequate supply of such services;
(ii) such services are directly related to such State agency's or area agency on aging's administrave funcons; or
(iii) such services can be provided more economically, and with comparable quality, by such State agency or area agency on aging.

(B) Regarding case management services, if the State agency or area agency on aging is already providing case management services (as of the date of submission of the plan) under a State program, the plan may specify that such agency is allowed to connue to provide case management services.
(C) The plan may specify that an area agency on aging is allowed to directly provide informaon and assistance services and outreach.
(9) The plan shall provide assurances that--
(A) the State agency will carry out, through the Office of the State Long-Term Care
Ombudsman, a State Long-Term Care Ombudsman program in accordance with secon 712 and this tle, and will expend for such purpose an amount that is not less than an amount expended by the State agency with funds received under this tle for fiscal year 2019, and an amount that is not less than the amount expended by the State agency with funds received under tle VII for fiscal year 2019; and
(B) funds made available to the State agency pursuant to secon 712 shall be used to supplement and not supplant other Federal, State, and local funds expended to support acvies described in secon 712.
(10) The plan shall provide assurances that the special needs of older individuals residing in rural areas will be taken into consideraon and shall describe how those needs have been met and describe how funds have been allocated to meet those needs.
(11) The plan shall provide that with respect to legal assistance --
(A) the plan contains assurances that area agencies on aging will (i) enter into contracts with providers of legal assistance which can demonstrate the experience or capacity to deliver legal assistance; (ii) include in any such contract provisions to assure that any recipient of funds under division (i) will be subject to specific restricons and regulaons promulgated under the Legal Services Corporaon Act (other than restricons and regulaons governing eligibility for legal assistance under such Act and governing membership of local governing boards) as determined appropriate by the Assistant Secretary; and (iii) atempt to involve the private bar in legal assistance acvies authorized under this tle, including groups within the private bar furnishing services to older individuals on a pro bono and reduced fee basis;
(B) the plan contains assurances that no legal assistance will be furnished unless the grantee administers a program designed to provide legal assistance to older individuals with social or economic need and has agreed, if the grantee is not a Legal Services Corporaon project grantee, to coordinate its services with exisng Legal Services Corporaon projects in the planning and service area in order to concentrate the use of funds provided under this tle on individuals with the greatest such need; and the area agency on aging makes a finding, aer assessment, pursuant to standards for service promulgated by the Assistant Secretary, that any grantee selected is the enty best able to provide the parcular services.
(C) the State agency will provide for the coordinaon of the furnishing of legal assistance to older individuals within the State, and provide advice and technical assistance in the provision of legal assistance to older individuals within the State and support the furnishing of training and technical assistance for legal assistance for older individuals;

(D) the plan contains assurances, to the extent praccable, that legal assistance furnished under the plan will be in addion to any legal assistance for older individuals being furnished with funds from sources other than this Act and that reasonable efforts will be made to maintain exisng levels of legal assistance for older individuals; and
(E) the plan contains assurances that area agencies on aging will give priority to legal assistance related to income, health care, long-term care, nutrion, housing, ulies, protecve services, defense of guardianship, abuse, neglect, and age discriminaon.
(12) The plan shall provide, whenever the State desires to provide for a fiscal year for services for the prevenon of abuse of older individuals --
(A) the plan contains assurances that any area agency on aging carrying out such services will conduct a program consistent with relevant State law and coordinated with exisng State adult protecve service acvies for--
(i) public educaon to idenfy and prevent abuse of older individuals;
(ii) receipt of reports of abuse of older individuals;
(iii) acve parcipaon of older individuals parcipang in programs under this Act through outreach, conferences, and referral of such individuals to other social service agencies or sources of assistance where appropriate and consented to by the pares to be referred; and
(iv) referral of complaints to law enforcement or public protecve service agencies where appropriate;
(B) the State will not permit involuntary or coerced parcipaon in the program of services described in this paragraph by alleged vicms, abusers, or their households; and
(C) all informaon gathered in the course of receiving reports and making referrals shall remain confidenal unless all pares to the complaint consent in wring to the release of such informaon, except that such informaon may be released to a law enforcement or public protecve service agency.
(13) The plan shall provide assurances that each State will assign personnel (one of whom shall be known as a legal assistance developer) to provide State leadership in developing legal assistance programs for older individuals throughout the State.
(14) The plan shall, with respect to the fiscal year preceding the fiscal year for which such plan is prepared--
(A) idenfy the number of low-income minority older individuals in the State, including the number of low-income minority older individuals with limited English proficiency; and
(B) describe the methods used to sasfy the service needs of the low-income minority older individuals described in subparagraph (A), including the plan to meet the needs of low-income minority older individuals with limited English proficiency.
(15) The plan shall provide assurances that, if a substanal number of the older individuals residing in any planning and service area in the State are of limited English-speaking ability, then the State will require the area agency on aging for each such planning and service area--

(A) to ulize in the delivery of outreach services under secon 306(a)(2)(A), the services of workers who are fluent in the language spoken by a predominant number of such older individuals who are of limited English-speaking ability; and
(B) to designate an individual employed by the area agency on aging, or available to such area agency on aging on a full-me basis, whose responsibilies will include--
(i) taking such acon as may be appropriate to assure that counseling assistance is made available to such older individuals who are of limited English-speaking ability in order to assist such older individuals in parcipang in programs and receiving assistance under this Act; and
(ii) providing guidance to individuals engaged in the delivery of supporve services under the area plan involved to enable such individuals to be aware of cultural sensivies and to take into account effecvely linguisc and cultural differences.
(16) The plan shall provide assurances that the State agency will require outreach efforts that will--
(A) idenfy individuals eligible for assistance under this Act, with special emphasis on--
(i) older individuals residing in rural areas;
(ii) older individuals with greatest economic need (with parcular atenon to lowincome older individuals, including low-income minority older individuals, older individuals with limited English proficiency, and older individuals residing in rural areas);
(iii) older individuals with greatest social need (with parcular atenon to lowincome older individuals, including low-income minority older individuals, older individuals with limited English proficiency, and older individuals residing in rural areas);
(iv) older individuals with severe disabilies;
(v) older individuals with limited English-speaking ability; and
(vi) older individuals with Alzheimer's disease and related disorders with neurological and organic brain dysfuncon (and the caretakers of such individuals); and
(B) inform the older individuals referred to in clauses (i) through (vi) of subparagraph (A), and the caretakers of such individuals, of the availability of such assistance.
(17) The plan shall provide, with respect to the needs of older individuals with severe disabilies, assurances that the State will coordinate planning, idenficaon, assessment of needs, and service for older individuals with disabilies with parcular atenon to individuals with severe disabilies with the State agencies with primary responsibility for individuals with disabilies, including severe disabilies, to enhance services and develop collaborave programs, where appropriate, to meet the needs of older individuals with disabilies.
(18) The plan shall provide assurances that area agencies on aging will conduct efforts to facilitate the coordinaon of community-based, long-term care services, pursuant to secon 306(a)(7), for older individuals who--
(A) reside at home and are at risk of instuonalizaon because of limitaons on their ability to funcon independently;

(B) are paents in hospitals and are at risk of prolonged instuonalizaon; or (C) are paents in long-term care facilies, but who can return to their homes if communitybased services are provided to them.
(19) The plan shall include the assurances and descripon required by secon 705(a).
(20) The plan shall provide assurances that special efforts will be made to provide technical assistance to minority providers of services.
(21) The plan shall--
(A) provide an assurance that the State agency will coordinate programs under this tle
and programs under tle VI, if applicable; and
(B) provide an assurance that the State agency will pursue acvies to increase access by older individuals who are Nave Americans to all aging programs and benefits provided by the agency, including programs and benefits provided under this tle, if applicable, and specify the ways in which the State agency intends to implement the acvies.
(22) If case management services are offered to provide access to supporve services, the plan shall provide that the State agency shall ensure compliance with the requirements specified in secon 306(a)(8).
(23) The plan shall provide assurances that demonstrable efforts will be made--
(A) to coordinate services provided under this Act with other State services that benefit older individuals; and
(B) to provide mulgeneraonal acvies, such as opportunies for older individuals to serve as mentors or advisers in child care, youth day care, educaonal assistance, at-risk youth intervenon, juvenile delinquency treatment, and family support programs.
(24) The plan shall provide assurances that the State will coordinate public services within the State to assist older individuals to obtain transportaon services associated with access to services provided under this tle, to services under tle VI, to comprehensive counseling services, and to legal assistance.
(25) The plan shall include assurances that the State has in effect a mechanism to provide for quality in the provision of in-home services under this tle.
(26) The plan shall provide assurances that area agencies on aging will provide, to the extent feasible, for the furnishing of services under this Act, consistent with self-directed care.
(27) (A) The plan shall include, at the elecon of the State, an assessment of how prepared the State is, under the State's statewide service delivery model, for any ancipated change in the number of older individuals during the 10-year period following the fiscal year for which the
plan is submited.
(B) Such assessment may include--
(i) the projected change in the number of older individuals in the State;

(ii) an analysis of how such change may affect such individuals, including individuals with low incomes, individuals with greatest economic need, minority older individuals, older individuals residing in rural areas, and older individuals with limited English proficiency;
(iii) an analysis of how the programs, policies, and services provided by the State can be improved, including coordinang with area agencies on aging, and how resource levels can be adjusted to meet the needs of the changing populaon of older individuals in the State; and
(iv) an analysis of how the change in the number of individuals age 85 and older in the State is expected to affect the need for supporve services.
(28) The plan shall include informaon detailing how the State will coordinate acvies, and develop long-range emergency preparedness plans, with area agencies on aging, local emergency response agencies, relief organizaons, local governments, State agencies responsible for emergency preparedness, and any other instuons that have responsibility for disaster relief service delivery.
(29) The plan shall include informaon describing the involvement of the head of the State agency in the development, revision, and implementaon of emergency preparedness plans, including the State Public Health Emergency Preparedness and Response Plan.
(30) The plan shall contain an assurance that the State shall prepare and submit to the Assistant Secretary annual reports that describe--
(A) data collected to determine the services that are needed by older individuals whose needs were the focus of all centers funded under tle IV in fiscal year 2019;
(B) data collected to determine the effecveness of the programs, policies, and services provided by area agencies on aging in assisng such individuals; and
(C) outreach efforts and other acvies carried out to sasfy the assurances described in paragraphs (18) and (19) of secon 306(a).
Sec. 308, PLANNING, COORDINATION, EVALUATION, AND ADMINISTRATION OF STATE PLANS
(b)(3)(E) No applicaon by a State under subparagraph (A) shall be approved unless it contains assurances that no amounts received by the State under this paragraph will be used to hire any individual to fill a job opening created by the acon of the State in laying off or terminang the employment of any regular employee not supported under this Act in ancipaon of filling the vacancy so created by hiring an employee to be supported through use of amounts received under this paragraph.
Sec. 705, ADDITIONAL STATE PLAN REQUIREMENTS
(a) ELIGIBILITY. --In order to be eligible to receive an allotment under this subtle, a State shall include in the state plan submited under secon 307--

(1) an assurance that the State, in carrying out any chapter of this subtle for which the State receives funding under this subtle, will establish programs in accordance with the requirements of the chapter and this chapter;
(2) an assurance that the State will hold public hearings, and use other means, to obtain the views of older individuals, area agencies on aging, recipients of grants under tle VI, and other interested persons and enes regarding programs carried out under this subtle;
(3) an assurance that the State, in consultaon with area agencies on aging, will idenfy and priorize statewide acvies aimed at ensuring that older individuals have access to, and assistance in securing and maintaining, benefits and rights;
(4) an assurance that the State will use funds made available under this subtle for a chapter in addion to, and will not supplant, any funds that are expended under any Federal or State law in existence on the day before the date of the enactment of this subtle, to carry out each of the
vulnerable elder rights protecon acvies described in the chapter;
(5) an assurance that the State will place no restricons, other than the requirements referred to in clauses (i) through (iv) of secon 712(a)(5)(C), on the eligibility of enes for designaon as local Ombudsman enes under secon 712(a)(5).
(6) an assurance that, with respect to programs for the prevenon of elder abuse, neglect, and exploitaon under chapter 3--
(A) in carrying out such programs the State agency will conduct a program of services consistent with relevant State law and coordinated with exisng State adult protecve service acvies for--
(i) public educaon to idenfy and prevent elder abuse;
(ii) receipt of reports of elder abuse;
(iii) acve parcipaon of older individuals parcipang in programs under this Act through outreach, conferences, and referral of such individuals to other social service agencies or sources of assistance if appropriate and if the individuals to be referred consent; and
(iv) referral of complaints to law enforcement or public protecve service agencies if appropriate;
(B) the State will not permit involuntary or coerced parcipaon in the program of services described in subparagraph (A) by alleged vicms, abusers, or their households; and
(C) all informaon gathered in the course of receiving reports and making referrals shall remain confidenal except--
(i) if all pares to such complaint consent in wring to the release of such informaon;
(ii) if the release of such informaon is to a law enforcement agency, public protecve service agency, licensing or cerficaon agency, ombudsman program, or protecon or advocacy system; or
(iii) upon court order...

___________________________________________
MaryLea Boatwright Quinn, Asst. Deputy Commissioner Division of Aging Services

07-13-2023
____________________
Date

State Plan Guidance Atachment B
INFORMATION REQUIREMENTS
IMPORTANT: States must provide all applicable informaon following each OAA citaon listed below. Please note that italics indicate emphasis added to highlight specific informaon to include. The completed atachment must be included with your State Plan submission.
Secon 305(a)(2)(E) Describe the mechanism(s) for assuring that preference will be given to providing services to older individuals with greatest economic need and older individuals with greatest social need (with parcular atenon to low-income older individuals, including low-income minority older individuals, older individuals with limited English proficiency, and older individuals residing in rural areas) and include proposed methods of carrying out the preference in the State plan;
RESPONSE: DAS ulizes its Intrastate Funding Formula (IFF) to ensure preference in providing services to older individuals with greatest economic need and older individuals with greatest social need. In the IFF, emphasis is placed on low-income older individuals, including low-income minority older individuals, older individuals with limited English proficiency, and older individuals residing in rural areas. See DAS' IFF in Atachment `D.'
Secon 306(a)(6)(I) Describe the mechanism(s) for assuring that each Area Plan will include informaon detailing how the Area Agency will, to the extent feasible, coordinate with the State agency to disseminate informaon about the State assisve technology enty and access to assisve technology opons for serving older individuals;
RESPONSE
DAS coordinates with the State assisve technology enty (Ga Tech Tools for Life) to provide assisve technology (AT) opons for older adults in many ways. Tools for Life was an integral partner when DAS set up AT labs in the 12 AAAs and the Centers for Independent Living around the state. Tools for Life also sets up a demo room annually at the Healthy Communies Summit, a statewide conference for those in the aging and disability network. We are



























































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(ii) identify, for each fiscal year to which the plan applies, the projected costs of providing such services (including the cost of providing access to such services); and (iii) describe the methods used to meet the needs for such services in the fiscal year preceding the first year to which such plan applies.
RESPONSE:
(i)For each fiscal year of this State Plan, DAS will not expend less than the amount expended for services for older individuals residing in rural areas than expended in fiscal year 2000.
(ii)During the beginning of each state fiscal year, DAS issues a budget allocaon. At this me, DAS does not project allocaons. However, with each allocaon, older individuals residing in rural parts of each service area receive funding. A key atribute of DAS' IFF is the allocaon of funds for individuals 60 and older residing in rural areas. There is fieen percent weighted variable for individuals who are 60 and older residing in rural areas.
(iii) DAS ulizes several tools to help determine the locaon of the older individuals residing in rural areas in Georgia. Some include mapping, census data and analysis through DAS' data management system. AAAs then target these individuals and ulize a person centered approach to service delivery designed to support older adults and individuals with disabilies to live longer, safely and well.
Secon 307(a)(10) The plan shall provide assurance that the special needs of older individuals residing in rural areas are taken into consideraon and shall describe how those needs have been met and describe how funds have been allocated to meet those needs.
RESPONSE:
DAS' IFF provides a greater weighted variable (15%) for individuals who are age 60 and older and reside in rural areas, in addion to a lesser 10% weighted variable for individuals who are 60 and older. Sixty and older rural for the previous fiscal year numbered 457,199, while populaon ages 60 and older (non-rural) was 1,528,041. Georgians ages 60 and older both in rural and non-rural areas are having their needs met by providing them access to community resources and/or assisng them in idenfying and securing resources or services in order to enhance wellness and remain in the community for as long and as safely as possible.
Secon 307(a)(14) (14) The plan shall, with respect to the fiscal year preceding the fiscal year for which such plan is prepared--
(A) identify the number of low-income minority older individuals in the State, including the number of low-income minority older individuals with limited English proficiency; and

(B) describe the methods used to satisfy the service needs of the low-income minority older individuals described in subparagraph (A), including the plan to meet the needs of low-income minority older individuals with limited English proficiency.
RESPONSE: DAS' IFF breaks this into two separate variables, with differing weights. Total statewide 65+ low income minority populaon considered for the preceding fiscal year was 50,148, and the variable has the assigned weight of 10%. Older individuals with limited English proficiency numbered 34,079, and the variable has a weight of 4%. In an effort to meet the needs of low-income minority older individuals, and individuals with limited English proficiency, DAS and the Area Agencies shall provide them access to community resources and/or assist them in idenfying and securing resources or services in order to enhance wellness and remain in the community for as long and as safely as possible.
Secon 307(a)(21) The plan shall -- (B) provide an assurance that the State agency will pursue acvies to increase access by older individuals who are Nave Americans to all aging programs and benefits provided by the agency, including programs and benefits provided under this tle, if applicable, and specify the ways in which the State agency intends to implement the activities.
RESPONSE:
Two-tenths of one percent (0.21%) of Georgian's aging populaon are reported as American Indian or Alaska Nave, numbering an esmated 2,611 individuals. DAS will purse numerous acvies to assure older Georgians who are American Indian or Alaska Nave will have access to Title III funded services. DAS will provide them access to community resources and/or assist them in idenfying and securing resources or services in order to enhance wellness and remain in the community for as long and as safely as possible. Addionally, they will also have the opportunity to review the DAS State Plan and other documents made available for public comment.
Secon 307(a)(27) (A) The plan shall include, at the elecon of the State, an assessment of how prepared the State is, under the State's statewide service delivery model, for any ancipated change in the number of older individuals during the 10-year period following the fiscal year for which the plan is submited. (B) Such assessment may include--
(i) the projected change in the number of older individuals in the State;

(ii) an analysis of how such change may affect such individuals, including individuals with low incomes, individuals with greatest economic need, minority older individuals, older individuals residing in rural areas, and older individuals with limited English proficiency;
(iii) an analysis of how the programs, policies, and services provided by the State can be improved, including coordinang with area agencies on aging, and how resource levels can be adjusted to meet the needs of the changing populaon of older individuals in the State; and
(iv) an analysis of how the change in the number of individuals age 85 and older in the State is expected to affect the need for supporve services
RESPONSE: DAS does and will connue to monitor annual US Census populaon esmates as well as state research instuon analysis of populaon shis to assess statewide changes in the elderly populaon. Annual aging network needs assessments will also be reviewed to determine gaps in service delivery including informing any new programming requirements.
Secon 307(a)(28)
The plan shall include information detailing how the State will coordinate acvies, and develop longrange emergency preparedness plans, with area agencies on aging, local emergency response agencies, relief organizaons, local governments, State agencies responsible for emergency preparedness, and any other instuons that have responsibility for disaster relief service delivery.
RESPONSE: See DAS' Emergency Planning and Management in Atachment "E."
Secon 307(a)(29)
The plan shall include information describing the involvement of the head of the State agency in the development, revision, and implementaon of emergency preparedness plans, including the State Public Health Emergency Preparedness and Response Plan.
RESPONSE: See DAS' Emergency Planning and Management in Atachment "G." DAS' Division Director is responsible for reviewing and approving all Emergency Preparedness policy and procedures. She or her designee are also responsible for implemenng said policies and procedures.
Secon 705(a) ELIGIBILITY --
In order to be eligible to receive an allotment under this subtle, a State shall include in the State plan submitted under section 307--. . .
(7) a description of the manner in which the State agency will carry out this title in accordance with the assurances described in paragraphs (1) through (6).
(Note: Paragraphs (1) of through (6) of this section are listed below)

In order to be eligible to receive an allotment under this subtitle, a State shall include in the State plan submitted under section 307--
(1) an assurance that the State, in carrying out any chapter of this subtitle for which the State receives funding under this subtitle, will establish programs in accordance with the requirements of the chapter and this chapter;
Response: DAS, in carrying out any chapter of this subtle ((Secon 705(a)(7)) for which it receives funding under this subtle, will establish programs in accordance with the requirements of the chapter;
(2) an assurance that the State will hold public hearings, and use other means, to obtain the views of older individuals, area agencies on aging, recipients of grants under title VI, and other interested persons and entities regarding programs carried out under this subtitle;
Response: DAS will hold public hearings, and use other means, to obtain the views of older individuals, area agencies on aging, recipients of grants under tle VI, and other interested persons and enes regarding programs carried out under this subtle ((Secon 705(a)(7));
(3) an assurance that the State, in consultation with area agencies on aging, will identify and prioritize statewide activities aimed at ensuring that older individuals have access to, and assistance in securing and maintaining, benefits and rights;
Response: DAS, in consultaon with AAA, will idenfy and priorize statewide acvies aimed at ensuring that older individuals have access to, and assistance in securing and maintaining, benefits and rights;
(4) an assurance that the State will use funds made available under this subtitle for a chapter in addition to, and will not supplant, any funds that are expended under any Federal or State law in existence on the day before the date of the enactment of this subtitle, to carry out each of the vulnerable elder rights protection activities described in the chapter;
Response: DAS will not supplant, any funds that are expended under any Federal or State law
(5) an assurance that the State will place no restrictions, other than the requirements referred to in clauses (i) through (iv) of section 712(a)(5)(C), on the eligibility of entities for designation as local Ombudsman entities under section 712(a)(5);
Response: DAS will place no restricons, other than the requirements referred to in clauses (i) through (iv) of secon 712(a)(5)(C), on the eligibility of enes for designaon as local Ombudsman enes under secon 712(a)(5);
(6) an assurance that, with respect to programs for the prevention of elder abuse, neglect, and exploitation under chapter 3--
(A) in carrying out such programs the State agency will conduct a program of services consistent with relevant State law and coordinated with existing State adult protective service activities for-
(i) public education to identify and prevent elder abuse;
(ii) receipt of reports of elder abuse;
(iii) active participation of older individuals participating in programs under this Act through outreach, conferences, and referral of such individuals to other social service agencies or sources of assistance if appropriate and if the individuals to be referred consent; and

(iv) referral of complaints to law enforcement or public protective service agencies if appropriate;
Response: With respect to programs for the prevenon of elder abuse, neglect, and exploitaon under chapter 3, DAS will conduct a program of services consistent with relevant State law and coordinated with exisng State adult protecve service acvies for:
public educaon to idenfy and prevent elder abuse; receipt of reports of elder abuse; acve parcipaon of older individuals parcipang in programs under this Act through outreach, conferences, and
referral of such individuals to other social service agencies or sources of assistance if appropriate and if the individuals to be referred consent; and referral of complaints to law enforcement or public protecve service agencies if appropriate;
(B) the State will not permit involuntary or coerced participation in the program of services described in subparagraph (A) by alleged victims, abusers, or their households; and
(C) all information gathered in the course of receiving reports and making referrals shall remain confidential except--
(i) if all parties to such complaint consent in writing to the release of such information;
(ii) if the release of such information is to a law enforcement agency, public protective service agency, licensing or certification agency, ombudsman program, or protection or advocacy system; or
(iii) upon court order.
RESPONSE: DAS will not permit involuntary or coerced parcipaon in adult protecve services acvies by alleged vicms, abusers, or their households.
All informaon gathered in the course of receiving reports of abuse, neglect and exploitaon, and making referrals shall remain confidenal except:
if all pares to such complaint consent in wring to the release of such informaon; if the release of such informaon is to a law enforcement agency, public protecve; service agency, licensing or cerficaon agency, ombudsman program, or protecon or advocacy system; or
upon court order.

State Plan Guidance Atachment C
INTRASTATE (IFF) FUNDING FORMULA REQUIREMENTS Requirements Applicable to IFF Revisions: OAA, Sec. 305(a)(2)(C) "States shall, (C) in consultation with area agencies, in accordance with guidelines issued by the Assistant Secretary, and using the best available data, develop and publish for review and comment a formula for distribution within the State of funds received under this title that takes into account-
(i) the geographical distribution of older individuals in the State; and (ii)the distribution among planning and service areas of older individuals with greatest economic need and older individuals with greatest social need, with particular attention to low-income minority older individuals."
OAA, Sec. 305(d) (d) The publication for review and comment required by paragraph (2)(C) of subsection (a) shall include--
(1) a descriptive statement of the formula's assumptions and goals, and the application of the definitions of greatest economic or social need, (2) a numerical statement of the actual funding formula to be used, (3) a listing of the population, economic, and social data to be used for each planning and service area in the State, and (4) a demonstration of the allocation of funds, pursuant to the funding formula, to each planning and service area in the State.
Requirements Applicable to all IFFs Generally All IFFs must contain the following: o A descripve statement of the formula.

o A list of the data used by planning and service area. o A descripve statement of each factor (i.e., 70+ living alone number of people who are 70 and older that
live alone) and weight/percentage used for each factor (i.e., 70+ living alone = 5%). o Allocaons of funds by planning and service area based on the IFF segmented by Part of Title III (e.g.,
chart of PSA X, IIIB Supporve Services, $900,000). o States must provide the source of the data used to run in the IFF. States must use the "best available
data." In most cases, the best available data is the most current US Census. A state also may use more recent US Census esmates from the American Community Survey; other more recent data of equivalent quality available in the State also may be considered. o A numerical/mathemacal statement of the formula is required for Parts B, C, D and E. o A separate descripve and numerical/mathemacal statement may be provided for Title III Part D Evidence Based Disease Prevenon and Health Promoon Services, to target the medically underserved and which there are a large number of older individuals who have the greatest economic need for such services, per Secon 362 of the OAA. If a separate formula is used for Part D, a separate descripve and numerical/mathemacal statement is required. o A statement explaining how NSIP funds are distributed. o States may use a base amount in their IFFs to ensure viable funding across the enre state. o Statement that discloses if, prior to distribuon under the IFF to the AAAs, funds are deducted from Title III funds for: State Plan Administraon, Area Plan Administraon, and/or Long-Term Care Ombudsman allocaons. o The IFF should include informaon on how the formula affects funding to each planning and service area.
Requirements Applicable to Single Planning and Service Area States
A numerical/mathemacal statement is not required for Single Planning and Service Area states. However, Single Planning and Service Areas must include a descripve statement as to how the state determines the geographical distribuon of the Title III funding and how the state targets the funding to reach individuals with greatest economic and social need, with parcular atenon to low-income minority older individuals.
The Older Americans Act requires the SUA, in consultation with AAA, to develop a formula for allocation of funds within the State that takes into account the geographic distribution of older individuals within the State and the distribution among PSAs of low-income minority older individuals with the greatest economic and social need.
The Intrastate Funding Formula (IFF) is used by State Units on Aging to distribute funds to AAA for Titles III and VII of the Older Americans Act. The Older Americans Act requires in Title III Section 305(a)(2)(C), 42 U.S.C. that the SUA:

"States shall,
(C) in consultation with area agencies, in accordance with guidelines issued by the Assistant Secretary, and using the best available data, develop and publish for review and comment a formula for distribution within the State of funds received under this title that takes into account--
(i) the geographical distribution of older individuals in the State; and
(ii) the distribution among planning and service areas of older individuals with greatest economic need and older individuals with greatest social need, with particular attention to low-income minority older individuals."
DAS revises the Intrastate Funding Formula decennially (every ten years) based upon demographics and population changes from the most current Census data. The last revision to the DAS IFF was on 2014. Yearly, estimates released by the Census Bureau for factors in the DAS formula are applied to subsequent allocations to account for any funding impact to AAAs related to population changes.
DAS utilizes the following factors to distribute OAA funds by Planning and Service Area (PSA). The current formula provides a specific weight for each of the following populations: persons age 60 years of age and older, persons age 75 years of age or older, low-income minority population age 65 and older, low-income 65 and older population, estimated rural population 60 years of age and older, limited English speaking population 65 years of age and older, disabled adults 65 years of age and older, and living alone 65 years of age and older.
Definitions for each population are indicated below:
60+ population
The number of persons in the age group 60 and above.
75+ population
Number of persons in the age group 75 and above.
Low-income minority 65+ population
The numbers of persons in the age group 65 and above who are minorities (non-white) and are below the poverty level, as established by the Office of Management and Budget in Directive 14 as the standard to be used by federal agencies for statistical purposes. This factor represents "special attention to low income minority older individuals" as required by the OAA.

Low-income 65+ population
Numbers of persons in the age group 65 and above who are at or below the poverty level as established by the Office of Management and Budget in Directive 14 as the standard to be used by federal agencies for statistical purposes. This factor represents economic need as defined by the OAA.

Estimated rural 60+ population
An estimate of the numbers of persons in the age group 60 and above who reside in a rural area as defined by the Census Bureau. This factor represents the social need factor of "geographic isolation" as defined by the OAA.

Limited English speaking 65+ population
Numbers of persons in the age group 65 and above who speak a language other than English and speak English "not well" or "not at all." This factor represents the social-need factor of language barriers as defined by the OAA.

Disabled 65+ population
Numbers of persons in the age group 65 and above who have a "mobility or self-care limitation" as defined by the Census Bureau. This factor represents the social need-factor of "physical and mental disability" as defined by the OAA.

Living Alone 65+ Number of persons in the age group 65 and above who live alone Factors and Weights:

Population 60+ Population 75+ Low Income Minority 65+ Low Income 65+ Rural 60+ Disabled 65+ Limited English Speaking 65+ Living Alone 65+

10% 30% 10% 13% 15% 10% 4% 8%

The above factors have been incorporated into a mathematical formula for administration as reflected below. In addition to these factors and weights, the Division of Aging Services incorporates a 6 percent funding base for parts B, C1, C2, and E of Title III of the OAA, not to exceed $200,000 annually.

Intrastate Funding Formula

Y=((.10(X)(%60))+((.30(X)(%75))+((.10(X)(%LIM))+((.13(X)(%LI))+ ((.15(X)(%RUR))+((.10(X)(%DIS))+((.04(X)(%LES))+((.08(X)(%LA))

Factors:

Y

The service allocation for a Planning and Service Area

(PSA)

(X)

The total services allocation amount for the state.

%60

The PSA percentage of the State total population ages 60 and above.

%75 The PSA percentage of the State total population ages 75 and above

%LIM The PSA percentage of the State total population ages 65 and above who are low income and are minorities

% LI

The PSA percentage of the State total population age 65 and above who are low income

% RUR

The PSA percentage of the State total population age 60 and above who live in rural areas

%DIS The PSA percentage of the State total population who are age 65 and above and are disabled

%LES The PSA percentage of the State total population age 65 and above and have limited English speaking ability

%LA

The PSA percentage of the State total population who are 65 and above and living alone

10/27/2022

Stakeholder Input Report for the 20242027 Georgia
State Plan on Aging
Prepared for the Georgia Department of Human Services Division of Aging Services

2024-2027 State Plan on Aging Stakeholder Feedback

Department of Human Services, Division of Aging Services

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Table of Contents

August 2022

Project Overview.........................................................................................................................................3 Feedback Sessions.......................................................................................................................................5 Feedback Form ..........................................................................................................................................11 Top Issue Summary..................................................................................................................................23 Conclusion .................................................................................................................................................43 Appendix A: Feedback Session Flyer.....................................................................................................45 Appendix B. Feedback Session Facilitator Note Template .................................................................46 Appendix C: Feedback Form Instrument..............................................................................................47

Acknowledgements
Research, analysis, facilitation, and report development by Greg Wilson, Madelyn Cantu, Anna Miller, Rebecca Hunt, Ileeia Smith, Michael Moryc, Bennett Hardee, and Holly Lynde of the University of Georgia's Carl Vinson Institute of Government. Editing by Karen DeVivo.
Thank you to Jean O'Callaghan, Arvine Brown, and Nicole Hodge of the Division of Aging Services for providing project leadership and guidance during the stakeholder engagement project.

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Project Overview
The Older Americans Act of 1965 as amended established the Administration for Community Living's Administration on Aging (ACL's AoA) to oversee state and area agencies on aging (AAAs). This act expanded social services for older individuals and people with disabilities. To receive federal funding, states must develop and implement multiyear state plans. The state plan is a comprehensive planning document that articulates information about innovations in addressing aging society challenges, state long-term care reform efforts, service best practices, and strategies to expand consumer choice and evidence-based prevention. State plans should also include information about current ACL priorities: COVID-19 recovery, advancing equity, expanding access to home and community-based services, and building a caregiving infrastructure. ACL's AoA requires that state units on aging seek feedback during the state plan development process, including from older adults, area agencies on aging, caregivers, Title VI grant recipients,1 and other interested parties.2
Georgia's state unit on aging, the Division of Aging Services (DAS), partnered with the University of Georgia's Carl Vinson Institute of Government to gather stakeholder input for the 20242027 state plan. Feedback sessions were held virtually in each of Georgia's 12 planning and service areas from April to June 2022. Two sessions were held in Atlanta, for a total of 13 sessions. Sessions were facilitated by staff from the Institute of Government and DAS. Session feedback was gathered using Zoom chat logs; Slido, a real-time response software; facilitator notes from small-group conversations; and an online feedback form.
The sessions were advertised via DAS's website, the network of each AAA, and social media to service providers, advocates, caregivers, older adults, and other interested parties in each service region. This report discusses the stakeholder input process and themes that emerged from stakeholder input. This information, along with ACL state plan guidance, will inform the development of Georgia's state plan on aging. Data collected may also be useful in AAAs' regional planning efforts.
The feedback sessions involved a main session that solicited general feedback on DAS, and small-group breakout sessions that focused on top issue areas. The top issues were selected via attendee polling from the following: aging in place, health & wellness, COVID-19, equity, caregiving, safety & protection, and workforce. Session participation ranged from 12 to 73 individuals with more than 400 participants across all sessions. During three listening sessions,

1 Title VI grant recipients refers to ACL nutrition and supportive services for Native Americans. 2 Administration for Community Living. (2021). Guidance for developing state plan on aging. Retrieved from KM_C364e-20180920105928 (acl.gov)

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participants from area senior centers joined as a group. The feedback form allowed room for further top issue commentary.
A total of 135 feedback form responses were received. Common themes arising from the sessions and feedback form include affordability, awareness, and accessibility of aging services in Georgia. Adequate funding and workforce capacity were also discussed due to concerns about continuity of care and waitlists. Program flexibility, particularly in relation to consumer choice in aging services, was another common theme. Overall, stakeholders appreciated the variety of aging programs available in Georgia but would like to see further funding and workforce growth so that services can reach more consumers. Three specific topics emerged frequently as important for consideration over the next four years: affordable housing, transportation, and mental health. The remainder of this report discusses top issues and provides insights from the feedback sessions and feedback form.

2024-2027 State Plan on Aging Stakeholder Feedback

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Feedback Sessions
SESSION OVERVIEW DAS partnered with UGA's Carl Vinson Institute of Government to collect stakeholder and consumer feedback to guide the development of Georgia's next State Plan on Aging. Due to the progression of COVID-19, a total of 13 sessions (one in each area agency on aging [AAA] region and two in the Atlanta region) were held virtually between April and June of 2022. The Institute of Government developed a session facilitation guide and trained Institute and DAS staff who assisted with facilitating small-group conversations during the sessions. The sessions were advertised via DAS's website, the network of each AAA, and social media to service providers, advocates, caregivers, older adults, and other interested parties. See Appendix A for an example of one of the event flyers. The goal was to gather diverse perspectives on how DAS can best support Georgia's older adults in living longer, living safely, and living well over the next four years.
The sessions also aimed to educate stakeholders about DAS's responsibilities and Georgia's aging system. Information was provided about DAS's role in state governance, federal expectations from the Older Americans Act, the funding process, state plan expectations, service awareness, and more. Attendees were able to ask questions and share their experiences with DAS programming. Networking information was also shared with stakeholders seeking additional guidance. Stakeholder feedback was gathered using Zoom chat logs; Slido, a realtime response software; and facilitator notes. See Appendix B for an example of the form used to gather facilitator notes during the small-group listening sessions.
SESSION STRUCTURE Each virtual feedback session began with an overview of the purpose of the session. After that, the facilitators and attendees introduced themselves, including name, role, county, and reason for attendance. A DAS representative then provided an overview of DAS's vision and mission, agency structure, and services. Time was then given to stakeholders to ask the DAS representative questions. After that, the sessions were divided into two periods: DAS service reflections and top issue reflections. The DAS service reflections were done as one large group, during which attendees could respond via the Zoom chat function or Slido. For the top issue reflections, attendees were divided into smaller breakout groups with facilitator leads, who reported the findings to the main group afterward. Lastly, each session included a discussion of DAS funding via the intrastate funding formula, which will be detailed in a later report.

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PARTICIPANT INFORMATION
Session participation ranged from 12 to 73 individuals, with more than 400 participants across all sessions. During three listening sessions, participants from area senior centers joined as a group. Attendees represented 55 of Georgia's 159 counties. Of those that responded to a question about current county of residence, Fulton County was represented most often, followed by Richmond and DeKalb.
Additional information was collected from attendees about the planning and service area (PSA) region in which they currently live and levels of service usage. The responses are presented in the tables below.

Session Participation by PSA Region (N = 392)

PSA Region

Percent

Number of Participants

Southern Georgia

6.9%

27

River Valley

6.1%

24

Heart of Georgia

6.9%

27

Legacy Link

7.9%

31

Northwest Georgia

8.2%

32

Central Savannah River

4.9%

19

Northeast Georgia

10.0%

39

Coastal Georgia

6.6%

26

Atlanta Region (May 26)

6.4%

25

Atlanta Region (June 1)

4.6%

18

Middle Georgia

3.1%

12

Three Rivers

10.0%

39

Southwest Georgia

18.6%

73

Note: N refers to the number of respondents per question. Participants could only choose one response. A total of 392 individuals participated in the Slido polls.

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What is your primary role with aging and adult services? (N = 137)

Response

Percent

Frequency

Consumer (older adult/person with disability)

3.7%

5

Caregiver

2.2%

3

Service Provider

32.1%

44

Advocate

11.0%

15

AAA Staff

29.9%

41

DAS Staff

21.2%

29

Note: N refers to the number of respondents per question. Participants could only choose one response.

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DAS SERVICE REFLECTIONS
During the DAS service reflections portion, stakeholders were asked about their experiences with DAS services. The tables below summarize participant responses to the following questions.
What aging services have you or someone you know used? What does DAS do well with aging and adult services? What might require more attention from DAS in the years to come?

What aging services have you or someone you know used? (N = 134)

Response

Percent

Frequency

Help at home

23.1%

31

Nutrition & wellness

30.6%

41

Caregiver programs

11.2%

15

Protected rights & safety

5.2%

7

Medicare & insurance answers

19.4%

26

Other services

10.4%

14

Note: N refers to the number of respondents per question. Participants could only choose one response.

What does DAS do well with aging and adult services?

Response Themes

Further Explanation

Adaptability

Responses included the following: adaptable to community needs, multiyear plan with accountability metrics, and receptive to new ideas.

Passionate and committed staff

N/A

Variety of service offerings

N/A

In-depth screening tools for levels of care

N/A

assessments

Meals, socialization for seniors, and prevention of Attendees wanted further support for congregate

elder abuse

senior centers and the programs offered there.

Collaborating with partners for variety in expertise N/A

Wellness checks, follow-ups, and emergency management

DAS shows a commitment to outreach and expediting of specialists, Adult Protective Services, and social workers when needed.

Technical assistance, education and advocacy, communication about offerings, and referrals

Attendees specifically mentioned reporting of key aging facts and support for AAAs.

Prioritizing those most in need and a commitment N/A to recognizing the diverse needs of older Georgians

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What does DAS do well with aging and adult services?

Response Themes

Further Explanation

Delivery and management of home- and community-based services

Discussion included in-home services, waivers, caregiver support, equipment support, etc.

Note: Participant text responses to the question were organized into overall response themes. The further explanation column paraphrases attendee comments and provides additional insights about some themes.

What might require more attention from DAS in the years to come?

Response Themes

Further Explanation

Increased attention to mental health

Comments included funding and awareness for services, education about mental health, and ensuring the state has enough physicians and caregivers to provide needed care.

Grandparents raising grandchildren

More and more children are supported by their grandparents. More support is needed for both the aging adult and their management of the home.

Transportation for seniors

Many seniors are limited by lack of vehicle access and struggle to cross county lines. Attendees encouraged multisectoral partnerships as well as more attention given to transportation access for seniors with mobility aids like wheelchairs or walkers.

Pay increase and benefits for direct care staff and funding for caregivers

While there are many committed staff, turnover is still a problem. This impacts continuity and quality of care. Waitlists were a concern.

Resource information hub, legal assistance, and streamlining of applications

While attendees generally had positive remarks about information access once they found the correct contact, they would like a county resource hub, organized by aging issue. Session attendees also wanted simplified applications for service renewals.

More support and awareness for delivery of

N/A

incontinence products, groceries, and Meals on

Wheels

Resources for those who do not meet the age or income requirement
More education and access to affordable housing, intensive in-home services, technology, insurance options, and hospice care

Some seniors are not quite old enough or have an income level that makes service access more complicated.
Suggestions included options for hybrid services for a growing population with limited funds for aging services. Overall, attendees expressed a desire for flexibility in services based on unique client needs.

2024-2027 State Plan on Aging Stakeholder Feedback

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What might require more attention from DAS in the years to come?

Response Themes Rural advocacy

Further Explanation
Overall, attendees suggested that more attention should be directed to service access and funding of rural populations.

Note: Participant responses to the question were organized into overall themes. The further explanation column paraphrases attendee comments and provides additional insights for some themes.

TOP ISSUE REFLECTIONS
To gather additional insights into aging services priorities, attendees at each session were asked to identify two top issues for further discussion. The top issues were selected via polling from the following: aging in place, health & wellness, COVID-19, equity, caregiving, safety & protection, and workforce. Aging in place and health & wellness were the most popular issues selected in the sessions, followed by workforce, caregiving, a tie between safety & wellness and equity, and COVID-19. Thematic insights from top issue reflections are detailed later in the report, as there was significant overlap with the feedback form responses.

2024-2027 State Plan on Aging Stakeholder Feedback

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Online Feedback Form
FEEDBACK FORM OVERVIEW
The Institute of Government created an online feedback form in partnership with DAS to assist in the state plan development process. The purpose of the feedback form was to gather more input, both from feedback session attendees and from people who were not able to attend a session. The feedback form was available between April and July 2022. A total of 135 people filled out and returned the feedback form.
FEEDBACK FORM METHODS
The feedback form was hosted in Qualtrics. The form was advertised on the DAS website and on social media. All feedback session attendees were encouraged to fill out the form and were provided with a link. The feedback form gathered demographic information and asked both prompted and open-ended questions. See Appendix C for the feedback form instrument.
DEMOGRAPHIC INFORMATION
The feedback form collected demographic information, which is summarized below.

Did you attend one of the virtual feedback sessions? (N = 132)

Response

Percent

Frequency

No

35.6%

47

Yes

39.4%

52

I am planning to

25.0%

33

Note: N refers to the number of respondents per question. Respondents could only choose one response.

What is your primary role with aging and adult services? (N = 135)

Response

Percent

Frequency

Consumer (older adult/person with disability)

14.8%

20

Service provider

37.0%

50

Advocate

12.6%

17

Caregiver/paid professional

0.74%

1

Caregiver/family who is unpaid

14.0%

19

Other

20.7%

28

Note: N refers to the number of respondents per question. Respondents could only choose one response.

2024-2027 State Plan on Aging Stakeholder Feedback

Department of Human Services, Division of Aging Services

11

10/27/2022

What is your age? (N = 70)

Response

Percent

Frequency

Under 40

10%

7

4150

24.3%

17

5160

18.6%

13

6170

37.1%

26

7180

8.6%

6

8190

1.4%

1

91+

0%

0

Note: N refers to the number of respondents per question. Respondents could only choose one response.

What is your gender? (N = 70)

Response

Percent

Frequency

Female

90%

63

Male

10%

7

Other

0%

0

Prefer not to say

0%

0

Note: N refers to the number of respondents per question. Respondents could only choose one response.

What is your sexual orientation? (N = 70)

Response

Percent

Frequency

Heterosexual or straight

87.1%

61

Gay or lesbian

0%

0

Bisexual

1.4%

1

Prefer not to answer

11.4%

8

Note: N refers to the number of respondents per question. Respondents could only choose one response.

2024-2027 State Plan on Aging Stakeholder Feedback

Department of Human Services, Division of Aging Services

12

10/27/2022

What is your race or ethnicity? (N = 74)

Response

Percent

Frequency

Caucasian or White

60.8%

45

African American or Black

29.7%

2

Asian or Pacific Islander

0%

0

American Indian or Alaska Native

1.4%

1

Hispanic or Latino

4.1%

3

Other

0%

0

Prefer not to answer

4.1%

3

Note: N refers to the number of respondents per question. Respondents could check all that apply.

What is your highest level of education? (N = 70)

Response

Percent

Frequency

Less than high school

0%

0

High school graduate or equivalent

5.7%

4

Some college (no degree)

10.0%

7

Associate or technical degree

5.7%

4

Bachelor's degree

42.9%

30

Graduate degree (Master's, PHD, MD, etc.)

35.7%

25

Prefer not to answer

0%

0

Note: N refers to the number of respondents per question. Respondents could only choose one response.

What is your current annual income? (N = 70)

Response

Percent

Frequency

$25,000 or less

8.6%

6

$25,001$50,000

30%

21

$50,001$75,000

14.3%

10

$75,001$100,000

14.3%

10

More than $100,000

12.9%

9

Prefer not to answer

20.0%

14

Note: N refers to the number of respondents per question. Respondents could only choose one response.

2024-2027 State Plan on Aging Stakeholder Feedback

Department of Human Services, Division of Aging Services

13

10/27/2022

What is your marital status? (N = 70)

Response

Percent

Frequency

Single

14.3%

10

Married

64.3%

45

Divorced

17.1%

12

Widow

1.4%

1

Prefer not to answer

2.9%

2

Note: N refers to the number of respondents per question. Respondents could only choose one response.

Do you live alone? (N = 69)

Response

Percent

Frequency

No

72.5%

50

Yes

26.1%

18

Prefer not to answer

1.5%

1

Note: N refers to the number of respondents per question. Respondents could only choose one response.

Are you a veteran? (N = 70)

Response

Percent

Frequency

No

90.0%

63

Yes

8.6%

6

Prefer not to answer

1.4%

1

Note: N refers to the number of respondents per question. Respondents could only choose one response.

Do you currently consider yourself to have a disability? (N = 70)

Response

Percent

Frequency

No

60.0%

42

Yes

35.7%

25

Prefer not to answer

4.3%

3

Note: N refers to the number of respondents per question. Respondents could only choose one response.

Geography

Forty of Georgia's 159 counties were represented in the 66 responses to a question asking for the respondent's current county of residence. Two responses were from people residing out of state. The most-common Georgia county was Fulton, followed by DeKalb, and then a tie between Floyd and Dougherty. A total of 58 respondents provided their current zip code, representing 52 different zip codes.

2024-2027 State Plan on Aging Stakeholder Feedback

Department of Human Services, Division of Aging Services

14

10/27/2022
FEEDBACK FORM CATEGORICAL RESPONSES
Respondents answered questions that focused on four categories: top issue reflections, awareness and knowledge, DAS service usage, and suggestions for living longer, living safely, and living well.
TOP ISSUE REFLECTIONS
Feedback form respondents were asked to identify which top three aging priorities DAS should focus on over the next four years. The top issues were selected from the following: aging in place, health & wellness, COVID-19, equity, caregiving, safety & protection, and workforce. Of the 324 responses, 29.6% chose aging in place, 19.75% chose health & wellness, 16.1% chose caregiving, 11.7% chose safety & protection, 11.42% chose workforce, 7.7% chose equity, and 3.7% chose COVID-19. The feedback form included open-ended questions about each of these topics; thematic insights on the top issues are provided in the Top Issue Summary section of this report.

2024-2027 State Plan on Aging Stakeholder Feedback

Department of Human Services, Division of Aging Services

15

10/27/2022

AWARENESS AND KNOWLEDGE
Respondents were asked about their personal awareness of DAS services as well as their perception of DAS's awareness and support of client needs.

How would you rate your awareness of aging and adult services? (N = 115)

Response

Percent

Frequency

I know a lot about available services.

50.4%

58

I know something about available services.

41.7%

48

I know nothing about available services.

7.8%

9

Note: N refers to the number of respondents per question. Participants could only choose one response.

How would you rate your knowledge of who to call if you need information about services? (N = 115)

Response

Percent

Frequency

Very knowledgeable

50.4%

58

Somewhat knowledgeable

41.7%

48

Not knowledgeable

7.8%

9

Note: N refers to the number of respondents per question. Participants could only choose one response.

How would you rate DAS's awareness of the needs of older adults and persons with disabilities? (N = 115)

Response

Percent

Frequency

Extremely aware

47.8%

55

Moderately aware

33.9%

39

Slightly aware

12.2%

14

Not at all aware

6.1%

7

Note: N refers to the number of respondents per question. Participants could only choose one response.

How would you rate DAS's current services to address the needs of older adults and persons with disabilities? (N = 115)

Response

Percent

Frequency

Excellent

21.7%

25

Good

43.5%

50

Fair

27.0%

31

Poor

7.8%

9

Note: N refers to the number of respondents per question. Participants could only choose one response.

2024-2027 State Plan on Aging Stakeholder Feedback

Department of Human Services, Division of Aging Services

16

10/27/2022

CONSUMER SERVICE USAGE
If respondents selected that their primary role with aging and adult services as consumer, they were redirected to the following questions about consumer service usage.

Do you currently use any of the following services? (N = 24)

Response

Percent

Frequency

Senior center

33.3%

8

Adult day care

0%

0

Caregiver support

4.2%

1

In-home support

4.2%

1

Meals (at senior center or delivered)

20.8%

5

Transportation services

8.3%

2

Respite care

0%

0

Do not use any of these services

29.2%

7

Prefer not to answer

0%

0

Note: N refers to the number of respondents per question. Participants could check all that apply. This question appeared if respondents answered "consumer" as their primary role with aging and adult services.

How much assistance does the person receiving aging and adult services require? (N = 18)

Response

Percent

Frequency

No assistance

55.6%

10

Occasional assistance

27.8%

5

Frequent assistance

5.6%

1

Continuous assistance

11.1z%

2

Don't know/unsure

0%

0

Prefer not to answer

0%

0

Note: N refers to the number of respondents per question. Participants could only choose one response. This question appeared if respondents answered "consumer" as their primary role with aging and adult services.

2024-2027 State Plan on Aging Stakeholder Feedback

Department of Human Services, Division of Aging Services

17

10/27/2022

LIVING LONGER, LIVING SAFELY, LIVING WELL

DAS's mission is to assist older individuals, at-risk adults, persons with disabilities, their families, and caregivers in achieving safe, healthy, independent, self-reliant lives. This mission is expressed in the DAS vision statement of living longer, living safely, and living well. Thus, respondents were asked open-ended questions about how DAS can best meet these goals.

In your current aging role, what is your greatest concern regarding the ability to remain independent in aging?

Response Themes

Further Explanation

Caregiving for a spouse

Navigating relationship dynamics, in addition to health needs, can be difficult.

Costs

Respondents expressed concerns about access to flexible payment plans, cost-sharing opportunities, Medicaid waivers, affordable health insurance, housing, nutrition, etc.

Technology

Technology keeps advancing rapidly, and some older Georgians struggle to integrate it into their lives without support.

Access to support groups

Finding community/guidance, whether as a caregiver or recipient of care, is essential.

Health and safety

Modifications are needed to prevent falls and other sources of injury, and access to adequate health care is essential to overall well-being. Large medical bills were a major concern, as was elder abuse and neglect.

Pandemic influences and inflation

Many are worried about the long-lasting impact of COVID-19 on supply chains, service access, financial institutions, and public health in general. Respondents wanted help navigating these changes.

Rising housing costs

Affordable housing was one of the most frequently mentioned issues on the feedback form. Rental assistance and finding extra ways to make income were suggested.

Cognitive and physical impairments

Support for assistive services, accessible applications, and technology is needed. Memory decline and services to navigate it were a major concern. Respondents want ways to support physical activity and mental health amidst aging.

Waiting lists and transportation

Respondents expressed concerns about access to services due to workforce shortages. When services are available, do seniors have access to transportation to appointments?

2024-2027 State Plan on Aging Stakeholder Feedback

Department of Human Services, Division of Aging Services

18

10/27/2022

In your current aging role, what is your greatest concern regarding the ability to remain independent in aging?

Response Themes

Further Explanation

Rural access

Many seniors in rural areas do not have adequate access to services and physicians.

Note: Participant responses to the question were organized into overall themes. The further explanation column paraphrases comments and provides additional insights about the themes.

What do you think would be most helpful in supporting older Georgians remain in their homes or communities?

Response Themes

Further Explanation

Support from government officials

Respondents expressed a desire for an enhanced culture of supporting older Georgians, a goal that needs support from state leaders.

More in-home health care, shopping services, adult day cares, and home modifications

Support for routine tasks and health services should remain a high priority. This support decreases the chance of injury, encourages preventative care, and keeps spaces livable.

More education about elder abuse/neglect and support for investigations

Preventing exploitation is critical to keeping elders safe in their communities. More awareness and intervention are needed.

Subsidized services

Utilities reductions, tax adjustments, a sliding scale for payment services, grants, and more are all very helpful for those most in need.

Affordable housing and transportation

Seniors without transportation cannot access many places. Housing prices are high, pushing some out of communities due to the rising cost of living. Business and government partnerships were suggested to combat these issues.

Caregiver support services and streamlined service applications/assessments/processes

Caregivers (paid and unpaid) can get burnt out. They need funding, mental health support, and assistance in accessing services for clients. Respondents expressed some frustration at the difficulty of finding information on services, application processes, and inflexible home- and community-based service requirements to meet client needs. Respite care for caregivers was also emphasized.

Raising program eligibility requirements based on income

Some individuals are in a coverage gap, making too much for lower-income services but too little to reliably cover aging costs.

Culturally sensitive policies and services

Recognition of the varied backgrounds of older Georgians and how services can be more equitable and inclusive is valuable.

2024-2027 State Plan on Aging Stakeholder Feedback

Department of Human Services, Division of Aging Services

19

10/27/2022

What do you think would be most helpful in supporting older Georgians remain in their homes or communities?

Response Themes

Further Explanation

More access to physical and cognitive specialists N/A
Note: Participant responses to the question were organized into overall themes. The further explanation column paraphrases attendee comments and provides additional insights about some of these themes.

What programs would you like to see in Georgia to meet the aging needs for older Georgians?

Response Themes

Further Explanation

Mental health programming

Respondents encouraged more funding and greater availability of mental health services. COVID-19 heightened social isolation and slowed access to physicians who monitor cognitive and behavioral decline. Support groups for caretakers and elders were suggested.

Homemaking services Education and entertainment

Respondents requested more funding and advertisement of in-home services to help older Georgians manage their homes. Examples include lawn-care services, meals, home delivery services, and house tidying .
Respondents requested more access to educational programs on a variety of topics, such as caregiving, technology, elder abuse, health and wellness, etc.
Respondents also wanted more support of adult day care programs around Georgia and more inperson and virtual programming to keep older adults engaged in activities.

Mobility aids and home modifications

Funding support to help more seniors access mobility aids and home modifications was frequently mentioned. Many leave their communities when their range of movement is limited.

Medical assistance

Delivery and maintenance of medical supplies was emphasized, as was affordability of medications. Respondents encouraged enhanced funding and access to cost-sharing initiatives, waivers, etc. Medicare/Medicaid does not cover some large medical purchases. The need for senior reminder services to order and take medicines and food was also mentioned.

Transportation and housing

Access to affordable housing and reliable transportation was mentioned repeatedly. Respondents encouraged flexible partnerships

2024-2027 State Plan on Aging Stakeholder Feedback

Department of Human Services, Division of Aging Services

20

10/27/2022

What programs would you like to see in Georgia to meet the aging needs for older Georgians?

Response Themes

Further Explanation

with agencies like HUD and Uber to help people remain in their communities.

Note: Participant responses to the question were organized into overall themes. The further explanation column paraphrases attendee comments and provides additional insights about each theme.

For caregivers, what could the state do better to support you in your role as a caregiver?

Response Themes

Further Explanation

Extend programs for longer coverage

Extending program coverage would help maintain continuity of care.

Payment of family members to take care of their family member

Such pay helps older adults remain in their communities and prevents families from going into debt.

More community-based day options

Not everyone is ready for a transition to full-time care, but caregivers still need help for part of the day.

Improve clarity of available services

Respondents wanted explanations of available services to be more comprehensive and easier to access. Some felt that they had to chase information all over the place to support the one they are caring for.

Grant availability and awareness

Grants are useful in supporting the wellness of those being cared for, so the need for further advertisement and more application opportunities was emphasized.

Respite services for caregivers, including those not on Medicaid

Caretakers need the ability to rest so that they can provide the quality of care the client deserves.

Caregiving mentors

Some respondents indicated that understanding all available aging services, how to access them, and some caregiving tasks are quite complicated. Mentorship programs would help with these processes.

Funding support for caregiving

Developing sources of funding was mentioned frequently to support access to caregiving services for elders.

Note: Participant text responses to the question were organized into overall themes. The further explanation column paraphrases attendee comments and provides additional insights about these themes.

2024-2027 State Plan on Aging Stakeholder Feedback

Department of Human Services, Division of Aging Services

21

10/27/2022

Please provide any other comments you may have regarding the needs and priorities of older adults and individuals with disabilities in Georgia?

Response Themes

Further Explanation

Specialist copays and medical purchases

Some respondents were concerned about the cost of seeing medical specialists as well as medical purchases not covered by Medicaid. More support for lower-income access to these areas and for preventative care was mentioned.

Elder abuse

Respondents expressed a need for more education about and prevention of elder abuse/neglect, including cybercrimes.

Disability

Respondents requested more attention to the needs of disabled seniors. Quality of life can be improved by attention to accessibility in DAS services, such as modifications for visual impairments.

Employment of seniors

Some respondents wondered if DAS has a unit dedicated to employment of seniors. Demand for elder employment services is growing.

Note: Participant text responses to the question were organized into overall themes. The further explanation column paraphrases attendee responses related to each theme.

2024-2027 State Plan on Aging Stakeholder Feedback

Department of Human Services, Division of Aging Services

22

10/27/2022
Top Issue Summary
OVERVIEW
DAS and the Institute of Government worked together to identify seven broad categories that encompass aging priorities: aging in place, health & wellness, COVID-19, equity, caregiving, safety & protection, and workforce. The stakeholder input process included both listening sessions and feedback form questions to gather input on each of these key issues. Participants were encouraged to reflect on their previous experiences with aging services, their own aging needs, and how they think each of these priority areas will differ in four years. Feedback from the sessions and details from the feedback form were combined to address three overarching questions.
What is working well? What is not working well? What suggestions were there for the next four years for each topic?

2024-2027 State Plan on Aging Stakeholder Feedback

Department of Human Services, Division of Aging Services

23

10/27/2022

How were each of the top issues described?

Top Issue

Description

Aging in place

Older adults choosing to remain in their homes (or residence of their choice) and able to access activities of daily living
Client direction and choice, services and support, housing, transportation

Health & wellness

Overall goal is to engage in activities that promote human longevity, which are key to good physical, emotional, cognitive, social, and spiritual aging
Mental, behavioral, emotional, physical, cognitive, and social health, wellness education

COVID-19 Equity Caregiving Safety & protection

Virus can cause a variety of symptoms in humans resulting in illnesses ranging from mild respiratory infections like the common cold to serious illnesses, such as pneumonia
Social isolation, services availability, COVID communication/access, mobility and transportation availability
The practice of being fair, impartial, and conscious of the challenges experienced by older adults grounded in race, socioeconomic status, and other forms of discrimination
Cultural awareness and competence, targeting most in-need consumers, access to services and providers
Care provided to people who need some degree of regular, ongoing assistance with everyday tasks provided by individuals who may be paid or unpaid (family, friend, or provider)
Caregiving support, caregiver education, grandparents raising grandchildren
The concern for the physical, mental, emotional, social, and financial well-being of older adults within the areas where they live, learn, work, and play
Elder Justice Act, Elderly Legal Assistance Program, Adult Protective Services, and Public Guardianship

2024-2027 State Plan on Aging Stakeholder Feedback

Department of Human Services, Division of Aging Services

24

10/27/2022

How were each of the top issues described?

Top Issue

Description

Workforce/employment

Paid work for older adults, providing opportunities for inclusion and greater independence within their communities

Availability, turnover of provider staff, turnover of AAA staff

Note: DAS and the Institute of Government identified these areas as top issues to be covered in the feedback sessions and feedback form. This table describes each of these topics.

AGING IN PLACE

The purpose of the aging in place discussion was to collect feedback on how DAS can best support older adults in remaining in their homes or a residence of their choice in their community. The goal is to preserve older adults' autonomy by providing resources necessary to age in place, such as housing access, housing modifications, transportation access, and more.

What is working well? Response Themes Systems in place for in-home care assistance
Screening tools for personal support services via assessments Georgia Money Follows the Person (MFP) Program
Connection to legal services
Matching programs to client needs and continued education to family and seniors
Partnership with the Aging and Disability Resource Center Home-delivered meals

Further Explanation
In-home services help many remain in the home when they otherwise would be in a nursing home or assisted-living facility.
These assessments are beneficial for matching clients with the best support for their needs.
Stakeholders appreciated the flexibility this program provides older Georgians as they transition from in-patient to community-based care. They are less restricted by funding requirements.
Services to help older Georgians manage their assets can prevent exploitation and displacement of older adults.
Stakeholders praised the variety of services and education efforts to match clients with the best programs for their needs. Some shared that education also supports preventative care as clients age in place.
Disabled older adults valued the long-term services and counseling provided by ADRC.
Stakeholders noted these meals are cost-effective and support nutrition for older Georgians who struggle to continue cooking.

2024-2027 State Plan on Aging Stakeholder Feedback

Department of Human Services, Division of Aging Services

25

10/27/2022

What is working well?

Response Themes

Further Explanation

Transportation to congregate senior centers and medical appointments

Access to transportation for some is the difference between living at home and living in a nursing home/assisted-living facility.

Agency staff communication and attentive service providers

Stakeholders noted that communication between upper DAS staff and AAA staff supports overall program efficiency and quality.

Assistance finding housing and waivers for a variety of services/items

This assistance is especially helpful for lowincome Georgia residents.

Note: Participant responses to the question were organized into overall themes. The further explanation column paraphrases participant comments and provides additional insights for each theme.

What is not working well?

Response Themes

Further Explanation

Not enough affordable homes for seniors and disabled Georgians

Older adults are being pushed out of their communities due to inflation, the influx of shortterm rentals, tax hikes, and rising home prices.

Limited options for transportation services

AAAs lack funding for flexible transportation options.

Not enough funding for home repairs and modifications

Some older adults live in dilapidated and inaccessible homes due to lack of funds.

Some areas dropped GeorgiaCares program

Stakeholders noted this was a valuable rural resource.

Not enough preparation for future public health crises

Social isolation makes aging in place especially difficult emotionally and logistically as service availability changes.

Somewhat disjointed contact information for services

Some stakeholders reported that program information can be cumbersome to find, particularly phone numbers.

Not enough mental health services

Social isolation and lack of support for mental health issues makes remaining at home less sustainable.

Not enough funding for supplemental services and This includes items like incontinence products,

waivers

nutrition supplements, fall-prevention monitors,

and low- or no-cost services for vulnerable adults.

Income limits for services

Stakeholders noted a coverage gap among people that make too much money for Medicaid but not enough for private programs.

Rural Georgia transportation and service variety

Fewer programs, service providers, and transportation options are available in rural areas,

2024-2027 State Plan on Aging Stakeholder Feedback

Department of Human Services, Division of Aging Services

26

10/27/2022

What is not working well?

Response Themes

Further Explanation
severely limiting some seniors' ability to stay at home.

Not enough caregivers to provide services and not Inadequate in-home support services means

enough money to pay them well

fewer people are able to age in place.

Not enough attention to the overlap in generational caregiving needs

Some older caregivers struggle to work due to their need to provide total care for an older loved one. Significant financial stress complicates community living.

Note: Participant responses to the question were organized into overall themes. The further explanation column paraphrases participant comments and provides additional insights about each theme.

As the state works to develop its state plan on aging for the next four years, what suggestions or ideas do you have related to aging in place?

Response Themes

Further Explanation

Allow AAAs to use funds allocated to DHS transportation for volunteer programs and private entities like Uber and Lyft

Extra program flexibility helps accommodate more people as they age in place.

Partnerships with Habitat for Humanity, HUD, housing authorities, and other contractors for more senior living options

A greater variety of senior living options based on finances and level of care needs can help people stay in or closer to their communities.

More inspectors for individual and congregate settings for reviews when families are not allowed or available

Stakeholders noted that more inspectors would be helpful during public health events to make sure care quality and client condition remain stable.

More family training and education with seniors

Additional training would provide families with multiple tools for and awareness of different service needs. Feedback from older adults enhances personal choice, which increases the likelihood they will feel empowered to age in place.

Statewide transportation initiative and partner network

Stakeholders noted that accessibility needs to be a top priority for such an initiative, as older adults may have service dogs, mobility aids, and more that they need to transport.

Housing specialist in each region of the state that exclusively works with the AAAs

This position could help with the affordable housing search process, outreach for grants, and housing ordinance oversight.

More mental health screenings and support for treatment

Catching and treating mental health issues or cognitive decline is essential to someone's ability to physically and emotionally remain in their community.

2024-2027 State Plan on Aging Stakeholder Feedback

Department of Human Services, Division of Aging Services

27

10/27/2022

As the state works to develop its state plan on aging for the next four years, what suggestions or ideas do you have related to aging in place?

Response Themes

Further Explanation

A single website that summarizes contacts for service by county and then by aging top issues

Some stakeholders shared that it is difficult to track down the right number and that one central resource hub would be useful.

More trainings and incentives to limit provider turnover and improve service quality

Policy training and rewards improve caregiver confidence, slim service waitlists, and support consistent care quality, which bolsters older adults' ability to age in place.

Note: Participant responses to the question were organized into overall themes. The further explanation column paraphrases participant comments and provides additional insights about each theme.

HEALTH & WELLNESS

The purpose of discussing health and wellness was to gain feedback on how the state can support human longevity, including the physical, emotional, cognitive, social, and spiritual aging of older Georgians.

What is working well? Response Themes Nutrition programs and physical wellness programs
Programs are evidence based
Telehealth opportunities and virtual education about health and wellness subjects When it is available, transportation
Multidisciplinary partnerships and partnerships that promote health initiatives around the state
Program variety

Further Explanation
Diet and exercise are two critical components of overall wellness, and stakeholders highlighted several instances in which these programs have supported older adults in these areas.
Stakeholders appreciated that programs for their loved ones or themselves are based on the latest medical knowledge and technology.
Especially in light of COVID-19, having both virtual and in-person options for health and wellness resources was appreciated.
Stakeholders were strong supporters of services to help older adults get to their appointments and programs.
Examples of such partnerships stakeholders gave include the Department of Behavioral Health and Developmental Disabilities and Aging & Disability Resource Connection (ADRC).
Stakeholders value a holistic approach to wellness and appreciate how aging services attempts to match clients to programs that best fit their needs.

2024-2027 State Plan on Aging Stakeholder Feedback

Department of Human Services, Division of Aging Services

28

10/27/2022

What is working well?

Response Themes

Further Explanation

Vaccination availability

N/A

Note: Participant responses to the question were organized into overall themes. The further explanation column paraphrases participant comments and provides additional insights for some themes.

What is not working well?

Response Themes

Further Explanation

People who need health and wellness services may not be participating

It is difficult to figure out how to further engage older adults in the services.

Public knowledge about services

Awareness and participation are both key parts of statewide health and wellness improvements, and stakeholders felt that more outreach can be done to reach more populations.

Mental health services

Stakeholders felt mental health services in the state are quite limited.

Less robust and lower quality programs in poorer counties and rural areas

Stakeholders felt that poorer and rural communities have worse health and wellness outcomes than their higher-income and urban counterparts.

Not enough preventative medicine

Stakeholders felt that preventative medicine efforts should be expanded to enhance the quality of life for older adults.

Unclear training schedules and certification dates

This feedback was provided by caregivers who have experienced lapses in their ability to provide care.

Not enough transportation to health and wellness People are foregoing care due to their inability to

services

drive.

Not enough primary care physicians or other caregiver points of contact

This leads to long wait lists or simply not accessing services altogether.

Not enough health and wellnessrelated counseling and legal services

Stakeholders noted that health issues can be traumatic and hard to learn how to manage. They also mentioned consistent legal support for insurance issues and power-of-attorney concerns.

Not enough coordination between services providers and public health agencies

Stakeholders specifically spoke of communication breakdowns during the COVID-19 pandemic.

Note: Participant responses to the question were organized into overall themes. The further explanation column paraphrases participant comments and provides additional insights about these themes.

2024-2027 State Plan on Aging Stakeholder Feedback

Department of Human Services, Division of Aging Services

29

10/27/2022

As the state works to develop its state plan on aging for the next four years, what suggestions or ideas do you have related to health and wellness?

Response Themes

Further Explanation

More disease identification training

Prevention and early treatment support longevity and the ability to age in place.

More access to meal services, in-home physical N/A therapy, and expanded transportation for those that do leave the home for services

Recruiting more health care students from colleges to support senior center care

This suggestion addresses workforce shortages in many health care settings.

Insurance transition support

Stakeholders shared that more counseling on options and coverage levels is beneficial.

Technology education

Stakeholders indicated that some older adults need technology education to fully engage with health care resources in virtual formats.

More flexibility to develop health and wellness partnerships in the community

Stakeholders referenced private sources, grants, and referral programs.

Spotlights on communities doing noteworthy work Models of good programs motivate improved

in health and wellness initiatives

services around the state.

More screenings for abuse and increased trauma- Stakeholders raised concerns that elder abuse

related training

increased during the pandemic and went

unreported.

Advertise health and wellness services offered by Examples cited include libraries, places of AAAs in local news and places seniors frequent worship, and senior activity centers.

Offer more support groups

Stakeholders noted that support groups allow more ideas to be shared between providers, caregivers, and clients.

More cognitive programming for those with

N/A

memory issues

Buddy programs

Buddy programs can help older adults consistently access resources and appointments when other programs are not available.

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As the state works to develop its state plan on aging for the next four years, what suggestions or ideas do you have related to health and wellness?

Response Themes

Further Explanation

More attention to accessibility of services for disabled individuals

Several people shared that services would be even stronger if they were consistently accessible.

Note: Participant responses to the question were organized into overall themes. The further explanation column paraphrases participant comments and additional insights about some themes.

COVID-19

COVID-19 was selected for discussion due to its lasting impacts on the health and well-being of older Georgians. Social isolation, service availability, COVID-19 communication, and transportation availability will remain important over the next four years of service delivery.

What is working well?

Response Themes

Further Explanation

Availability of services with walk-in and drive-up N/A options

Availability of vaccines

N/A

Note: Participant responses to the question were organized into overall themes. The further explanation column paraphrases participant comments and provides additional insights for each theme, if any.

What is not working well?

Response Themes

Further Explanation

Workforce

Staffing levels for services still have not recovered, and older Georgians seeking employment have additional health and safety concerns.

Lack of mobile vaccination units and other aging services for home-bound or bed-bound patients

Wait lists, staffing shortages, and additional health and safety concerns were mentioned.

COVID-19 test accessibility for blind Georgians

Some with visual impairments may live alone and do not have technology to assist in test checking.

Lack of transport

COVID-19 significantly disrupted transportation to and from services, appointments, stores, etc.

Social isolation

Stakeholders routinely stressed the toll that social isolation has had on seniors' mental health.

Note: Participant responses to the question were organized into overall themes. The further explanation column paraphrases participant comments and provides additional insights about each theme.

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As the state works to develop its state plan on aging for the next four years, what suggestions or ideas do you have related to COVID-19?

Response Themes

Further Explanation

Brainstorm and implement efforts to address social isolation

Stakeholders were interested in more virtual connection opportunities as well as more inperson opportunities with safety precautions.

More public health preparation

Some stakeholders would like providers to develop clearer service provision plans and trainings in case another pandemic occurs.

Partnerships for public health communications

Stakeholders wanted options other than the internet to find the latest public health resources and statistics.

More service access for home-bound patients

Stakeholders wanted more resources dedicated to adding and retaining service providers, as well as partnerships with disability support services.

Note: Participant responses to the question were organized into overall themes. The further explanation column paraphrases participant comments and provides additional insights about each theme.

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EQUITY

Equity was discussed to determine how the state can best be fair, impartial, and conscious of the challenges experienced by older adults relating to race, socioeconomic status, and other forms of discrimination. The goal was to learn how the state can develop cultural awareness and competence, target most in-need consumers, and expand access to services and providers.

What is working well?

Response Themes

Further Explanation

Considerate providers of services

Several stakeholders expressed that the providers they have interacted with have been fair, impartial, and committed to service delivery.

Expansion of services

Some stakeholders noted that DAS and the AAAs continue to expand access to services and providers.

Support groups based on different factors such as Some stakeholders noted that these groups are

race, age, ethnicity, and more

especially useful in connecting to the correct

aging and caregiving services.

Note: Participant responses to the question were organized into overall themes. The further explanation column paraphrases attendee comments and provides additional insights for each theme.

What is not working well?

Response Themes

Further Explanation

Not enough cultural awareness and competence

Stakeholders indicated that it is hard for seniors to feel systems are fair and impartial if providers have less cultural awareness and tools to expand services in those areas. This includes access to interpreters.

Not enough funding and awareness for accessibility services

Some stakeholders expressed concerns about insufficient funding and awareness for home modifications and accessibility devices.

Distribution of resources to those most in need

Some stakeholders were worried that funding dollars are primarily funneled into high-population communities instead of areas with those most in need. Some areas of concern were those who are uninsured, without broadband, without cars, and low income.

Long wait lists for services

Stakeholders felt that wait lists mean that their challenges are not being addressed. Some even felt that their position on the wait list was not impartially decided.

Note: Participant responses to the question were organized into overall themes. The further explanation column paraphrases participant comments and provides additional insights for each theme.

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As the state works to develop its state plan on aging for the next four years, what suggestions or ideas do you have related to equity?

Response Themes

Further Explanation

More education and training programs

Stakeholders expressed the need for more education and training for cultural competence purposes as well as to maintain staffing levels to expand services.

TV ads and billboards about DAS services in

N/A

different languages

Public education campaign about the aging services website

Some stakeholders noted that the aging services websites are a bit intimidating and overwhelming, and a public overview may help connect more consumers to services.

Broadband everywhere and technology assistance

Stakeholders noted that it is hard in today's world to stay connected to programs without access to technology.

Note: Participant responses to the question were organized into overall themes. The further explanation column paraphrases participant comments and provides additional insights about some themes.

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CAREGIVING
Caregiving was discussed to determine how the state can best support Georgians who need ongoing assistance with everyday tasks, whether provided by a family member, friend, or a paid service. Other important aspects of this issue include grandparents raising grandchildren and expansion of caregiver education.

What is working well?

Response Themes

Further Explanation

Respite care

Stakeholders appreciated the structured ability to have breaks from caregiving responsibilities.

Meal delivery programs

Stakeholders shared that older Georgians consistently having access to meals is essential to maintaining quality of life and remaining in the home.

Continued feedback opportunities, support services, and support groups

It helps stakeholders to have resources to turn to for caregiving needs and avenues to report strengths and weaknesses of services.

Network of caregiving providers

Stakeholders appreciated the variety of service connection points, especially for complex caregiving needs like Alzheimer's Disease.

Online and in-person caregiver education programs

Both providers and consumers benefit from awareness about programming and client needs.

Adult daycare options and assisted living

Stakeholders appreciated these options for intermediate levels of caregiving needs.

Material aid and Home and Community Based Services (HCBS)

Stakeholders strongly supported grants to continue providing caregiving materials to consumers and their caregivers in their communities.

Medicaid Long-term care programs such as EDWP (Elderly & Disabled Waiver Program) and Georgia SOURCE

Resources for vulnerable older adults in Georgia are a priority to many stakeholders.

Support provided by the Georgia Caregivers ActHB1304

Stakeholders valued resources for caregivers to manage the client transition period from hospital back to home care.

Note: Participant responses to the question were organized into overall themes. The further explanation column paraphrases participant comments and provides additional insights for each theme.

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What is not working well?

Response Themes

Further Explanation

Awareness and education

Throughout the feedback sessions and on the feedback form, stakeholders expressed that it is sometimes difficult for older adults and their families to learn about caregiving services in their area. Some individuals do not even realize they are a caregiver or that they need a caregiver. Thus, more education is needed.

Funding

Stakeholders expressed concerns that some older Georgians are falling through the cracks due to not enough financial support for services. Some stakeholders reported there are not enough grants to grow programs.

Grandparents raising grandchildren

Stakeholders expressed that this is becoming more and more prevalent without enough resources dedicated to supporting older adults in these roles.

Limited service hours and options for long-term care programs

Some adults have limited windows in which they can access caregiving services, and limited funds if they are not eligible for Medicaid.

Compensation and not enough respite care for caregivers

Stakeholder expressed concern about insufficient compensation and wellness support for caregivers, which puts stress on the well-being of both the provider and consumer.

Program communication coordination

Some stakeholders remarked that they appreciate the variety of services but that the coordination between programs can be confusing. Specifically, inconsistencies in program communication (verbal and written) can lead to duplications or gaps in both service awareness and ease of program access.

Cultural, mental, and physical fitness

Respondents raised concerns about Georgia not having enough programs for physical activity, mental health care, or cultural heritage.

Note: Participant responses to the question were organized into overall themes. The further explanation column paraphrases participant comments and provides additional insights about each theme.

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As the state works to develop its state plan on aging for the next four years, what suggestions or ideas do you have related to caregiving?

Response Themes

Further Explanation

More hours for services

Extended service hours for programs and caregivers can help improve the lives of older Georgians.

Stricter ramifications for elder abuse, neglect, and abandonment

COVID-19 compounded social isolation, which made some older Georgians more vulnerable to neglect, abuse, and cyber-attacks. Stakeholders would like to see more deterrence.

Continue to grow support systems (financial and emotional) for family caregivers

Aging in place with or near loved ones can be beneficial for seniors, but families need extra help to remain stable. One suggestion was TANF and SNAP benefits.

Work across organizational silos to coordinate services

Better service coordination would help avoid duplications and service gaps.

Limit reporting requirements for those caring for grandchildren who get no income other than SS/SSI

This was suggested to stabilize finances in the home.

More funding for Home and Community Based Services (HCBS)

Stakeholders encouraged continued support of services within older Georgians communities when possible.

More virtual options for caregiving education

Virtual options are useful for those with limited transportation, with busy schedules, or who live in rural areas.

Utilize more partnerships for public awareness

Stakeholders stressed the importance of using a variety of media formats to reach a wider audience: news stations, newspapers, church announcements, radio, congregate centers, etc.

Note: Participant responses to the question were organized into overall themes. The further explanation column paraphrases participant comments and provides additional insights for each theme.

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SAFETY & PROTECTION
The goal of the safety and protection discussion was to reflect on the physical, mental, emotional, social, and financial well-being of older adults within the areas where they live, learn, work, and play. Important connections to this issue include the Elder Justice Act, the Elderly Legal Assistance Program, Adult Protective Services, and Public Guardianship.

What is working well?

Response Themes

Further Explanation

Elder rights education

Resources on the rights of elders help stakeholders keep seniors safe.

Adult Protective Services (APS) partnership

Some stakeholders shared that the AAAs and APS have a solid relationship that supports safety and protection initiatives.

Legal aid

Stakeholders appreciated robust legal aid to prevent elders from being taken advantage of.

Reporting system

When there are concerns about safety/well-being, stakeholders appreciated having a system through which to report those concerns.

Government communication

Stakeholders appreciated when the government communicates to older Georgians about contemporary safety and protection concerns.

Multidisciplinary teams for services

Stakeholders benefit from teams built to address a variety of safety concerns, e.g., social, mental, physical, and more.

Note: Participant responses to the question were organized into overall themes. The further explanation column paraphrases participant comments and provides additional insights about each of these themes.

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What is not working well?

Response Themes

Further Explanation

Staffing for legal assistance

While stakeholders appreciated existing legal aid, some stakeholders felt more accessible and affordable aid is needed to preserve the safety of older Georgians.

Patients being abandoned at hospitals

Stakeholders are concerned about older Georgians being abandoned without repercussions for those responsible.

Lack of a central directory

Especially when it comes to safety and protection, stakeholders wanted to instantly connect with the correct resource instead of chasing information.

Efforts to combat cyber crime

Stakeholders raised concerns about the sheer volume of scams and not enough preventative education and support after attacks occur.

Not enough support with wills, estate planning, getting titles cleared

Some stakeholders were worried about older Georgians being taking advantage of and wanted more help in preserving financial assets and homes.

Not enough staff solely focused on elder rights

Some stakeholders expressed interest in more experts/ advocates for elder rights in each service area. There was a demand for legal, social, and medical support.

Possibly not enough APS resources

Stakeholders expressed a need for potentially more resources, such as staffing and outreach, to guard against elder exploitation.

Not enough volunteers

Stakeholders desired more community involvement in programs that enhance the safety of older adults, in both home and community settings.

Note: Participant responses to the question were organized into overall themes. The further explanation column paraphrases participant comments and provides additional insights about each theme.

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As the state works to develop its state plan on aging for the next four years, what suggestions or ideas do you have related to safety and protection?

Response Themes

Further Explanation

Funding

More funding was requested to expand safety/protective resources, education, and program advertisement.

Clarify and streamline reporting forms

Some stakeholders found reporting safety issues to be confusing and cumbersome.

Partnerships with law schools

One stakeholder suggested partnering with university law schools to connect consumers and caregivers with safety/protection resources.

County-wide cybercrime units

Some stakeholders wanted their immediate communities to dedicate more resources to cybercrime prevention and punishment when applicable.

Streamlining and clarification of emergency protocol

Some respondents wanted support for swift resolutions during emergencies like dementia crises, especially for seniors with no personal advocates.

Advertisements

Stakeholders expressed interest in more advertisement of safety and protection programs in sources older adults tend to use, like radio and newspapers.

More feedback from seniors themselves

Consumers wanted to know that their specific safety/protection concerns were being considered.

Support to expand multidisciplinary teams

Stakeholders talked about county-wide support for the most vulnerable seniors, including more resources for teams that address complex safety and aging needs.

Note: Participant responses to the question were organized into overall themes. The further explanation column paraphrases participant comments and provides additional insights for each theme.

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WORKFORCE

The workforce discussion centered on two issues: (1) turnover of caregiving staff, service provider staff, and AAA staff, and (2) paid work for older adults to provide opportunities for inclusion and greater independence within their communities.

What is working well?

Response Themes

Further Explanation

Passionate AAA staff and service provider staff

The available staff care about what they do and their clients.

Commitment to awareness of workforce deficits

There are gaps in the workforce and in payment, but stakeholders valued opportunities to discuss these issues and potential solutions.

Note: Participant responses to the question were organized into overall themes. The further explanation column paraphrases participant comments and provides additional insights for each theme.

What is not working well?

Response Themes

Further Explanation

Low pay for professional and family caregivers

Low pay is putting a lot of stress on providers who must support their own lives while helping others.

Worker turnover and low staffing levels

Low pay is one factor that leads to consistent worker turnover and low staffing levels, which in turn creates longer waitlists for services. This was considered especially troubling for in-home services.

Not enough forums for caregiver appreciation

Along with limited pay, some stakeholders were concerned about limited emotional support available to caregivers.

Not enough education for older adults who want to work

Some older adults indicated that they do not know how working affects Social Security payments. There were also concerns about finding work placements and skill advancement opportunities that align with shifting culture and technology.

Not enough support for difficulty of work

Some caregivers expressed concerns about the ability to do their job fully due to lack of resources, and consumers and providers alike desired more training for services.

Note: Participant responses to the question were organized into overall themes. The further explanation column paraphrases participant comments and provides additional insights for each theme.

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10/27/2022

As the state works to develop its state plan on aging for the next four years, what suggestions or ideas do you have related to workforce?

Response Themes

Further Explanation

Flexibility and funding at the local level

Stakeholders noted this would be useful for further development of workforce retention programs with a variety of training schedules and working environments (remote, hybrid, etc.) Local funding flexibility could increase efficiency and coordination.

More professional development opportunities and work-from-home opportunities

Such opportunities can help caregivers and older Georgians feel like they are still advancing positively in their lives and work.

Partnerships with hospital associations

Partnerships may be useful to streamline care needs in areas with a limited workforce, such as a certified nursing assistant shortage.

Quality health insurance and paid leave

If salaries are slow to grow, some stakeholders felt that benefits should improve to compensate. This could potentially slow turnover.

Dedicated rural outreach and recruitment

Several stakeholders highlighted the difficulty of attracting talent to rural areas, suggesting that more outreach is needed if services are going to be consistently available to consumers.

More visibility for Senior Community Service Employment Program (SCSEP)

This could help seniors with concerns about reentering the workforce.

Consistent training manuals and policies

Some staff remarked that training information and agency policies sometimes conflict and that changes are not always communicated until a problem has occurred. Stakeholders suggested feedback sessions when policy/training manual revisions occur.

Quarterly events in support/appreciation of caregivers

Such events could boost morale.

A strategic plan for the next spike in retirement

Due to the high number of Baby Boomers retiring or about to retire, dedicated efforts for recruitment and transition were deemed necessary.

Note: Participant responses to the question were organized into overall themes. The further explanation column paraphrases participant comments and provides additional insights for each theme.

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Conclusion
The 13 feedback sessions and response to the online feedback form provided information about the priorities of stakeholders invested in Georgia's aging services. The feedback provided insights from a diverse group of stakeholders, including consumers, caregivers, service providers, aging advocates, AAA staff, DAS staff, and family members. Older adults were well represented in the feedback, with 65.71% of feedback form respondents being 51 years or older. The largest age group was the 6170 age range, or 37.14% of feedback form respondents. Additionally, older adults from three senior centers attended the feedback sessions that were hosted by DAS and the Institute of Government. This feedback will guide the creation of Georgia's next state plan on aging. Overall, the feedback was positive, with most areas for improvement connected to a desire for expansion and refinement of programs.
Five overriding themes appeared consistently throughout the feedback.
Affordability: Stakeholders supported creative efforts to make aging services more affordable, such as grants, community and business partnerships, volunteer programs, and waiver programs.
Awareness of Services: Stakeholders encouraged more advertisement of services, with additional emphasis in locations frequented by older adults, families, and caregivers.
Accessibility: Stakeholders supported streamlined reporting systems and applications to make programs more accessible to consumers. Stakeholders also wanted to see more investments in home modifications and accessibility equipment for disabled older adults.
Continuity of Care: Stakeholders wanted to see more efforts to address workforce shortages and turnover. People are experiencing long waitlists that are interrupting their ability to get care. Stakeholders were interested in grants and resources to increase service availability.
Program Flexibility: Stakeholders valued the variety of aging programs but wanted more flexibility in locations, funding requirements, and partnerships.
Additionally, three specific needs were mentioned so frequently during the sessions and feedback form that they are noted below:
Affordable Housing: A variety of economic conditions are making affordable housing scarce. Stakeholders said that this issue will affect aging in place in the coming years and that heavy investments and multisectoral partnerships will be needed to address it.

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Transportation: Stakeholders supported more investment in transportation services for older adults. They also recommended the creation of a statewide network of partnerships so older Georgians can easily identify a provider in their region. Mental Health: Stakeholders felt that mental health support is one issue that Georgia needs to invest heavily in, especially considering the lingering effects of COVID-19.

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Appendix A: Feedback Session Flyer
Below is an example of a flyer advertising the online feedback sessions. The graphic was customized for each AAA and posted on the DAS website and advertised on AAA social media accounts.

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Appendix B. Feedback Session Facilitator Note Template
During each feedback session, facilitators took notes on participant feedback. After the sessions, they filled out the online form below. The form had space for notes on each of the top issues as well as a miscellaneous option for any additional feedback from the breakout sessions.

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Appendix C: Feedback Form Instrument
DAS Feedback
This is the instrument that was hosted on Qualtrics to garner feedback.
Thank you for your interest in providing feedback on Aging Services in Georgia. The Division of Aging Services has partnered with the University of Georgia's Carl Vinson Institute of Government to assist with collecting aging services feedback statewide. This short form seeks to collect input from Georgia stakeholders to inform the upcoming State Plan on Aging. Your responses will be used to help shape strategies and focus areas for Georgia's Aging Services for the next several years.
Did you attend one of the virtual listening sessions hosted by the Division of Aging Services and the local AAA?
o Yes o No o I am planning to attend one in the near future
What is your primary role with aging and adult services?
o Consumer (older adult/person with disability) o Service provider o Advocate o Caregiver/paid professional o Caregiver/family who is unpaid o Other ________________________________________________

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Consumer Question--The following question was only displayed for respondents selecting their primary role as consumer)

Do you currently use any of the following services? (check all that apply)



Senior Center Adult Day Care Caregiver Support In-home Support Meals (at senior center or delivered Transportation Services Respite Care Do not use any of these services Prefer not to answer

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Consumer Question--The following question was only displayed for respondents selecting their primary role as consumer) How much assistance does the person receiving aging and adult services require?
o No assistance o Occasional assistance o Frequent assistance o Continuous assistance o Don't know/unsure o Prefer not to answer
How would you rate your awareness of aging and adult services?
o I know a lot about available services o I know something about available services o I know nothing about available services
How would you rate your knowledge of who to call if you need information about services?
o Very knowledgeable o Somewhat knowledgeable o Not knowledgeable

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How would you rate the Division of Aging Services' awareness of the needs of older adults and persons with disabilities?
o Extremely aware o Moderately aware o Slightly aware o Not at all aware
How would you rate the Division of Aging Services' current services to address the needs of older adults and persons with disabilities?
o Excellent o Good o Fair o Poor

Caregiver Question--The following question was only displayed for respondents selecting their primary role as a caregiver)

What could the state do better to support you in your role as a caregiver? ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

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________________________________________________________________ ________________________________________________________________

Please select three (3) priority areas you think the Division of Aging Services should focus on over the next four years:



Aging in Place (Client Direction/Support/Choice, Services and Support,

Housing, Transportation, Paid Family Caregiving)



Health and Wellness (Mental, Behavioral and Physical Health, Wellness

Education)



COVID-19 (Social Isolation, Services Availability, COVID Communication/

Access, Mobility and Transportation Availability)



Equity (Cultural Awareness Competence, Targeting most at need Consumers,

Access to Services and Providers)



Caregiving (Caregiving Support, Caregiver education, Grandparents Raising

Grandchildren)



Safety and Protection (Elder Justice Act, Elderly Legal Assistance Program, Adult

Protective Services, Public Guardianship)



Workforce (Availability, Turnover of Provider Staff, Turnover of AAA Staff)

You will be asked to provide additional information regarding the areas you selected on the following page.

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Please tell us more about Aging in Place (Client Direction/Support/Choice, Services and Support, Housing, Transportation, Paid Family Caregiving)
What is working well? ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

What is not working well? ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

What ideas would you like to share about this area? ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

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These same questions were repeated for the following top issues. Health and Wellness (Mental, Behavioral and Physical Health, Wellness Education) COVID-19 (Social Isolation, Services Availability, COVID Communication/ Access, Mobility and Transportation Availability) Equity (Cultural Awareness Competence, Targeting most at need Consumers, Access to Services and Providers) Caregiving (Caregiving Support, Caregiver education, Grandparents Raising Grandchildren) Safety and Protection (Elder Justice Act, Elderly Legal Assistance Program, Adult Protective Services, Public Guardianship) Workforce (Availability, Turnover of Provider Staff, Turnover of AAA Staff)
In your current aging role, what is your greatest concern regarding the ability to remain independent in aging?
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

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What do you think would be most helpful in supporting older Georgians remain in their homes or communities?
________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________
What programs would you like to see in Georgia to meet the aging needs for Older Georgians?
________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________
Please provide any other comments you may have regarding the needs and priorities of older adults and individuals with disabilities in Georgia.
________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

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Please provide some demographic data so we can better understand the needs of our respondents.
How old are you?
o Under 40 o 41-50 o 51-60 o 61-70 o 71-80 o 81-90 o 91-100 o 100+
What is your gender?
o Male o Female o Other o Prefer not to say

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Do you consider yourself to be?
o Heterosexual or straight o Gay or lesbian o Bisexual o Prefer not to answer

Which race/ethnic categories describe you (check all that apply):



Caucasian or White African American or Black Asian or Pacific Islander American Indian or Alaska Native Hispanic or Latino Other Prefer Not to Answer

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What is the highest level of education you have completed?
o Less than high school o High school graduate or equivalent o Some college (no degree) o Associate or technical degree o Bachelor's degree o Graduate degree (Masters, PhD, MD, etc.) o Prefer not to answer
What is your current annual income?
o $25,000 or less o $25,001-$50,000 o $50,001-$75,000 o $75,001-$100,000 o More than $100,000 o Prefer not to answer

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Are you a veteran?
o No o Yes o Prefer not to answer
Do you live alone?
o No o Yes o Prefer not to answer
Do you currently consider yourself to have a disability?
o No o Yes o Prefer not to answer

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What county do you live in? What is your current home ZIP code? ________________________________________________________________
What is your marital status?
o Single o Married o Divorced o Widow o Prefer not to answer

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CHAPTER 2000

FUND SOURCES & ALLOCATION METHODOLOGY

SECTION 2003 Allocation Methodologies

POLICY STATEMENT:
ALLOCATION METHODOLOGIES, OAA:
Title IIIA

The Division of Aging Services (DAS) adheres to federal and state policy, rules, grant requirements and appropriation intent in allocating funds to the Area Agencies on Aging and other contractors The following methodology is used in allocating Older Americans Act funds:
AAA Administration: 10% of total, including part D and is the maximum available for all direct and indirect administrative charges. This fund source requires a 25% local match. No Administration may be charged to Part D.

Title III B, C1, C2, & E

Six percent base or maximum $200,000 annually statewide, allocated equally to all regions. Remainder allocated by approved Intrastate Funding Formula (IFF). There are minimum III-B requirements for Access to Services, In-home Services and Legal Assistance. Refer to Section 2006 of this manual. State funds provide 5% matching funds; 10% local match required.

Title IIIB LTCO Funding distributed to all regions according to the formula used for VII-2 described below in this section.

Title III D Fifty percent base; remainder allocated by approved IFF. State funds provide 5% matching funds; 10% local match required.

Title V

SCSEP: Allocated to AAAs by an equitable distribution formula determined by the U.S. Department of Labor, which authorizes the number of positions (slots) statewide. 10 % local match required.

Not all AAAs receive Title V funding.

Title VII-2 Long-Term Care Ombudsman (LTCO): allocated directly to LTCO contractors

Title VII-3

Elder Abuse Prevention. These funds are retained by the State Unit on Aging for statewide programming. Refer to Section 2006 of this manual for minimum requirements and maintenance of effort. Refer to Section 2002 of this manual for information on the Intra State Funding Formula.

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CHAPTER 2000

FUND SOURCES & ALLOCATION METHODOLOGY

SECTION 2005 Matching Federal Funds

POLICY STATEMENT:
REQUIREMENTS for MATCH:

The Georgia Department of Human Services, Division of Aging Services follows federal requirements regarding the matching of federal funds.

Service Match

In order to fulfill the match requirements of the Older Americans Act, 1965, as amended, Area Agencies and their service providers shall provide a minimum of 10% non-federal match funds for the cost of Older American Act Services. Area Agencies also shall provide local matching funds for allocations from the Social Services Block Grant, in amounts/percentages established by the Division.

The local share of service funding shall be in the form of cash or non-cash (in kind.)

The value of non-cash match shall be based on a fair market value of the services and goods supplied in support of the service or activity provided.

Agencies shall document the value of staff time used as noncash match by time sheets signed by the paid staff or volunteer.

Agencies will report cash and non-cash match by submitting DHS/DAS Form 5215, "Report of Certified Costs" monthly.

Administrative Match

In order to fulfill the match requirements of the Older Americans Act, as amended, Area Agencies shall provide a minimum of 25% non-federal match funds for the cost of administration of area plans.

The non-federal share shall be cash or non-cash.

The value of non-cash match shall be based on a fair market value of the services and goods supplied in support of the service or activity provided.

Agencies shall document the value of staff time used as noncash match by time sheets signed by the paid staff or volunteer.

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FUND SOURCES & ALLOCATION METHODOLOGY

SECTION 2006 Maintenance of Effort

POLICY STATEMENT:
REQIREMENTS for MAINENANCE of EFFORT (MOE)

The Georgia Department of Human Services, Division of Aging Services follows federal requirements for maintenance of effort.

OAA Priority Services Each Area Agency shall provide an adequate proportion of funding received through Title III-B of the Older Americans Act, as amended, for supportive services in the Act.

Calculation of the minimum percent is based on the pre-shift amount of the Title III-B allocation for the appropriate fiscal year.

Adequate proportions of funding for support services shall include each of the following support services categories and their designated services:

Access services. Services associated with access to other services, such as transportation, outreach, information and assistance, and case management services. The Area Agency shall provide a minimum of 12% of funding for this category overall.
In-home services. Supportive services such as homemaker, home health assistance, visiting and telephone assurance, chore maintenance and supportive services for families of older persons with Alzheimer's disease and related disorders with neurological and organic brain dysfunction. The Area Agency shall provide a minimum of 5% of funding for this category overall.
Legal assistance. This includes legal representation, legal counseling, and the provision of information. The area agency shall provide a minimum of 5% of funding, or $60,000, whichever is greater, for this category overall.

NOTE: Of this required minimum for Legal Assistance, the 5% of Title IIIB funds cannot be waived, but the remainder of the minimum funding level may be from any other fund source(s).

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REQIREMENTS for MAINENANCE of EFFORT (MOE), cont.

OAA Priority Services, An Area Agency may request a waiver from the Division for cont. expending an adequate proportion of Title III-B funding for supportive services, if it meets the following criteria:

The Area Agency holds at least one public hearing on the area plan or area plan update or amendment, containing a request for waiver of the adequate proportion requirement. The Agency shall notify all interested parties in the area of the public hearing and provide with an opportunity to testify.
The Area Agency provided acceptable justification to demonstrate that an adequate supply of a specified support service is available to meet the needs of the service area.
The Area Agency will submit separate waiver requests for each category of support service for which a waiver is sought.

LTCO

The State shall meet the requirements for maintenance of effort of funding as defined in the Older Americans Act, 306(a)(11). Title IIIB funds required to meet the maintenance of effort requirement are allocated to LTCO regions per the established LTCO funding formula.

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DRAFT 10/27/2022
Intrastate Funding Formula Feedback and Options Summary
Prepared for the Georgia Department of Human Services Division of Aging Services
October 2022

Table of Contents
Georgia's Intrastate Funding Formula Review Project .....................................................................1 Considerations for Altering Intrastate Funding Formula Factors ................................................... 3 Area Agencies on Aging Leadership Interviews .............................................................................. 5 Consumer Feedback Sessions ............................................................................................................. 9 Options for Revising the Rural Factor ................................................................................................14 Appendix A .......................................................................................................................................... 20
Acknowledgements
Research, analysis, facilitation, and report development by Greg Wilson, Madelyn Cantu, Anna Miller, Ileeia Smith, Michael Moryc, Bennett Hardee, and Holly Lynde of the University of Georgia's Carl Vinson Institute of Government. Editing by Karen DeVivo.

Georgia's Intrastate Funding Formula Review Project
The Georgia Department of Human Services Division of Aging Services (DAS) partnered with the University of Georgia's Carl Vinson Institute of Government to provide technical assistance on the state's Intrastate Funding Formula (IFF). The IFF is used to allocate federal and state funds for aging services to the state's planning and service areas. The state must develop its IFF in accordance with federal statutes and regulations.1 The IFF formula must consider the "geographical distribution of older individuals in the state" and the distribution of "older individuals with greatest economic need and older individuals with great social need, with particular attention to low-income minority older individuals."2 Georgia's IFF comprises eight elements, each with an assigned weight. The current elements are 60+ population, 75+ population, low-income minority 65+ population, low-income 65+ population, estimated rural 60+ population, limited English speaking 65+ population, disabled 65+ population, and living alone 65+.3 Table 1 provides additional details on each IFF element. The IFF project is part of DAS's continuous quality improvement efforts. The main goal of the project was to explore the current IFF processes and identify strengths and areas for improvement. This was accomplished through stakeholder interviews and feedback sessions, compliance research on Older Americans Act and Administration for Community Living guidelines, an IFF data input analysis, data profiles of older adults in Georgia, and a scan of other states' formulas. Additionally, DAS and the Institute of Government developed options for potentially revising the rural element of the IFF.
1 See 45C.F.R1321.37,42 U.S.C.3025, 42U.S.C.3027, 45C.F.R.1321.17, 45C.F.R.1321.19, and 45C.F.R.1321.43. 2 42U.S.C.3025(a)(2)(C). 3 See Attachment D in the Georgia State Plan on Aging 20202023 for additional information on Georgia's current IFF formula: aging.georgia.gov/document/document/2020-2023-state-plan/download
1

Table 1. Georgia Current Intrastate Funding Formula (IFF)

Formula Element 60+ population
75+ population
Low-incomeminority 65+ population
Low-income 65+ population
Estimated rural 60+ population

Weight 10% 30% 10%
13% 15%

Description
The number of Georgians age 60 and older
The number of Georgians age 75 and older
The number of minority (non-white) Georgians age 65 and older whose income falls below the federal poverty level
The number of Georgians age 65 and older whose income falls below the federal poverty level
The number of Georgians that reside in a rural area as defined by the US Census Bureau

Limited Englishspeaking 65+ population

4%

The number of Georgians 65 and

older who speak a language other

than English and speak English not

well or not at all

Disabled 65+ population

10% The number of Georgians age 65 and older who have a mobility or self-care limitation disability

Living alone 65+

8%

The number of Georgians age 65

and older who live alone

Note: ACS = American Community Survey from the US Census Bureau.

Data Source ACS 5-year estimates ACS 5-year estimates ACS 5-year estimates
ACS 5-year estimates
Decennial census (% population residing in rural areas) and ACS 5-year estimates (60+ population) ACS 5-year estimates
ACS 5-Year Estimates
ACS 5-year estimates

2

Considerations for Altering Intrastate Funding Formula Factors
Georgia typically updates its IFF formula (i.e., revising elements and weights) once every 10 years. It was last updated in 2014. In 2022, the state again considered IFF changes and partnered with the Institute of Government to evaluate the current formula. DAS leadership asked the Institute of Government to consider three focus areas:
1. Alignment with Older Americans Act (OAA) requirements and Administration for Community Living (ACL) priorities
2. Data access (regularly collected, ease of access, available at the correct geographic level, reliability)
3. Stakeholder and consumer feedback OAA AND ACL ALIGNMENT The Institute of Government evaluated OAA and ACL requirements for the IFF and found that Georgia's current formula appears to align with the requirements and vision of both. To ensure consideration of key OAA and ACL priorities, the Institute of Government produced two reports as part of the IFF project. The Data Profile on Older Individuals in Georgia examined current and projected demographic and economic trends impacting older Georgians. The second report, the Georgia Intrastate Funding Formula Analysis and Review, details the results of the IFF review project. DATA UPDATE PROCESS To comply with the OAA mandate to utilize the best available data, Georgia periodically updates the formula inputs, which are the various statistics for each formula element. These updates ensure that federal and state dollars for aging services are allocated based on the current data that best reflect the goals of the current IFF formula. The DAS Program Integrity Unit is charged with updating the data inputs for the IFF formula elements. All data utilized for the Georgia IFF rely on US Decennial Census data and five-year US Census Bureau American Community Survey estimates. The Institute of Government recommends consistently using the latest five-year-estimates data, usually released each December, to ensure that the IFF reflects the most recent data. Doing so will avoid large swings in funding distributions that could occur if data are not regularly updated to reflect demographic shifts. As part of Georgia's IFF review process, researchers from the Institute of Government reviewed the current process for downloading, processing, and organizing the data inputs for the IFF formula elements. The research team developed an automated script to enhance data collection efforts in the future. Additional information on the data update process and the Institute of Government's data recommendations are presented in the Georgia Intrastate Funding Formula Analysis and Review report.
3

STAKEHOLDER AND CONSUMER FEEDBACK According to federal statutes, potential changes or updates to the IFF must be guided by the input of Area Agencies on Aging (AAA) leadership, consumers, and other stakeholders with a vested interest in older individuals in Georgia.4 The Institute of Government engaged stakeholders about the IFF through virtual feedback sessions and interviews. In addition, a more general feedback form and feedback voicemail number were mentioned to stakeholders at the feedback sessions where they could provide more IFF feedback if desired. DAS and the Institute of Government began by conducting virtual interviews with leadership from AAAs across the state. The 12 Georgia AAA regions are Southern Georgia, River Valley, Heart of Georgia, Legacy Link Georgia Mountains, Northwest Georgia, Central Savannah River Region, Northeast Georgia, Coastal Georgia, Atlanta Regional Commission, Middle Georgia, Three Rivers, and Southwest Georgia. Due to scheduling conflicts, virtual interviews were not possible for Northeast Georgia, the Central Savannah River Region, or Middle Georgia. During the nine interviews, researchers gathered feedback on the current formula and the formula implementation process. Next, DAS and the Institute of Government held 13 virtual feedback sessions with consumers, providers, and other interested stakeholders. These sessions were held for each of the AAA regions, and included a dedicated feedback portion on the IFF. The next two sections present detailed feedback information from the interviews and feedback sessions.
4 See 42 U.S.C 3015 and 45 C.F.R 1321.37
4

Area Agencies on Aging Leadership Interviews
INTERVIEW OVERVIEW AAAs coordinate and deliver services to older adults in Georgia, putting them on the front lines of IFF funding distributions. Thus, DAS partnered with the Carl Vinson Institute to collect feedback from leadership at each of the AAAs. The goal was to gather leadership perspectives on the current IFF and suggestions for potential needed updates. Nine virtual interviews were conducted in December 2021. The interviews took place on Zoom and were advertised internally to the AAAs by DAS leadership. DAS leadership provided attendees with an overview of IFF expectations from OAA and ACL guidelines, a review of the funding process, and an explanation of the formula and its weights. Attendees could view the formula and ask questions, share their experiences with existing DAS funding levels, and provide specific formula commentary. Feedback was gathered using Zoom chat logs and verbally, which was then converted into notes by session facilitators from the Institute of Government. INTERVIEW STRUCTURE The virtual interviews were attended by one to two leaders from the AAAs, as well as by a few DAS representatives and facilitators from the Institute of Government. Feedback was shared using the Zoom chat function or verbally. Each of the interviews lasted 30 minutes. The interviewees were given Institute of Government contact information if they had additional feedback. Each interview began with an overview of the interview purpose and brief attendee introductions. A DAS representative then provided a PowerPoint presentation that covered the formula's purpose, formal guidance from the OAA and the ACL, a visual representation of the formula, and an overview of how the funding gets allocated to AAAs. After each formula weight was described in further detail, the interviewees could then ask questions and note IFF pros, cons, and areas for improvement. The following three guiding questions were used.
What do you like about the current Intrastate Funding Formula? Where does the current Intrastate Funding Formula fall short? What suggestions do you have for DAS leaders as they review the current formula and
consider any needed updates? AAA leadership responses are presented in the tables that follow.
5

INTRASTATE FUNDING FORMULA REFLECTIONS

What do you like about the current Intrastate Funding Formula?

Response Themes

Further Explanation

Dedicated 75+ factor

Several AAA leaders shared that the 75+ population typically has increased needs and that the AAAs value dedicated funding support at a high percentage for this population.

Dedicated factor for 60+ rural population

Several AAAs serve rural Georgia regions. Though service availability is sometimes limited in rural locations, they appreciated that the rural factor attempted to serve the greatest number of rural older adults by using a 60+ cutoff rather than 65.

2 factors emphasizing low-income populations

Several AAA leaders identified low-income as a key population served in their regions. They valued having two sources of dedicated funding.

Feedback sessions before IFF rollout

AAA leadership appreciated the opportunity to provide input during the formula update process.

Note: Participant responses to the question were organized into overall themes, listed in the left column. The right column paraphrases participant comments and provides additional insights about each of these themes.

6

Where does the current Intrastate Funding Formula fall short?

Response Themes

Further Explanation

Not enough funding for 60+

Some AAA leaders shared that they are starting to see decreased life expectancies and increased needs at ages 60+. Thus, some believed 60+ should receive a higher percentage.

Gaps in rural funding effectiveness

Some AAA leaders shared that while there is dedicated funding for rural populations, the actual availability of services is limited. Additionally, some areas are between rural and metropolitan in size. They wondered if there is a way to more effectively implement the funding to increase service availability.

Unclear rationale for formula weights

Several AAA leaders wanted more transparency about how the IFF factors and weights are decided. They were interested in DAS providing documentation explaining the process and more continuous funding updates.

Specificity of minority factor

Some AAA leaders noted that the current factor focuses on low-income minorities. Thus, some were worried about minorities' ability to access services if they do not meet the low-income qualification.

Note: Participant responses to the question were organized into overall themes, listed in the left column. The right column paraphrases participant comments and provides additional insights about each of these themes.

7

What suggestions do you have for DAS leaders as they review the current formula and consider any needed updates?

Response Themes

Further Explanation

Clear definition for rural factor and increased percentage for rural

Some AAA leaders wanted clarification on the definition of "rural" to better understand which parts of their region were eligible for rural funding distributions. In addition, some shared a desire for increased funding for rural Georgians, particularly to help increase service availability.

Increase the percentage for low-income

The low-income demographic was a key population in AAA discussions. Additional funding was suggested because AAAs experience high demand for affordable services.

Increase the percentage for disabled

AAA leaders shared that disabled and homebound individuals are often at high risk, and extra funding could help improve quality of life for these older Georgians.

Include a more general minority factor

Some AAA leaders were concerned that the current factor focuses too specifically on lowincome minorities. Minorities may have unique needs not being met due to funding being limited to the subset of those with low income.

Factor to address transportation and caregivers

Some AAA leadership discussed the critical need for reliable access to transportation and caregivers/caregiver support. They suggested adding a dedicated IFF factor or a statewide fund for these issues.

More transparency about the formula

The majority of AAA leaders in the sessions wanted more information about the formula decision-making process, access to information on the data used for IFF decisions, the rationale for factor changes, and information about future initiatives to give IFF feedback.

Note: Participant responses to the question were organized into overall themes, listed in the left column. The right column paraphrases participant comments and provides additional insights about each of these themes.

8

Consumer Feedback Sessions
SESSION OVERVIEW DAS partnered with UGA's Carl Vinson Institute of Government to collect stakeholder and consumer feedback to guide the development of Georgia's next State Plan on Aging and Intrastate Funding Formula. Due to the progression of COVID-19, a total of 13 sessions (one in each AAA region and two in the Atlanta region) were held virtually between April and June of 2022. Session participation ranged from 12 to 73 individuals, with more than 400 participants across all sessions. A portion of each of these sessions was dedicated to gathering consumer feedback on the Intrastate Funding Formula. The sessions were advertised via DAS's website, the network of each AAA, and social media to service providers, advocates, caregivers, older adults, and other interested parties. The goal was to gather diverse perspectives on how DAS can best support Georgia's older adults in living longer, living safely, and living well. The sessions also aimed to educate stakeholders about Georgia's Intrastate Funding Formula and DAS's responsibilities pertaining to it. Information was provided about DAS's role in state governance, federal formula requirements from the Older Americans Act, the funding process, the meaning of formula weights, and the formula's relevance to state plan expectations. Attendees were able to ask questions about the formula and share their experiences with existing DAS programming and funding levels. Networking information was also shared with stakeholders seeking additional guidance. Consumer feedback was gathered using Zoom chat logs; Slido, a real-time response software; and facilitator notes. SESSION STRUCTURE Each virtual feedback session began with an overview of the purpose of the session. After that, the facilitators and attendees introduced themselves, including name, role, county, and reason for attendance. A DAS representative then provided an overview of DAS's vision and mission, agency structure, and services. Time was then given to stakeholders to ask the DAS representative questions. Next, the sessions were divided into three periods: DAS service reflections, top issue reflections, and IFF reflections. Additional information about the DAS service reflections and top issue reflections can be found in the Stakeholder Input Report for the 20242027 Georgia State Plan on Aging.
9

The purpose of the IFF reflections portion was to educate the attendees about the formula and to gather feedback on perceived pros, cons, and suggestions for improvement. The formula session began with a PowerPoint presentation from DAS leadership that provided basic information about the formula's purpose and formula guidance from the OAA and the ACL. Then, DAS leadership showed the visual representation of Georgia's Intrastate Funding Formula to stakeholders and explained each of the weights and how they pertained to funding for services. Stakeholders were then given the opportunity to ask questions about the formula and to note pros, cons, and areas of improvement for the formula and its weights. Feedback was shared aloud or using the Zoom chat function. The following three questions were used to guide the conversation.
What do you like about the formula? What do you not like about the formula? How should the State of Georgia fairly and efficiently allocate limited aging resources?
10

INTRASTATE FUNDING FORMULA REFLECTIONS

What do you like about the formula?

Response Themes

Further Explanation

Variety of categories

Stakeholders valued that the formula factors attempted to cover a variety of demographics in the aging population.

Representation Higher percentage for those 75+
Includes limited English factor

Several stakeholders noted the importance of inclusion, particularly the factors for disabled, limited English, and minority populations.
Several stakeholders discussed the increased support needs of adults ages 75+, especially those trying to age in place in their communities. Thus, the extra funding for advanced age support was a plus to many stakeholders at the sessions.
Some stakeholders discussed the importance of making services accessible to those with English as a second language.

Includes living-alone factor Includes rural factor with a larger percentage

Living alone was considered a risk factor to consumers, caregivers, and other service providers during the sessions, so a dedicated funding source was appreciated.
Many stakeholders came from rural areas, and the funding emphasis outside of metropolitan areas was appreciated.

In line with OAA and ACL guidance

Stakeholders liked the references to the OAA and ACL and how DAS incorporated them both in the formula review process.

Note: Participant responses to the question were organized into overall themes, listed in the left column. The right column paraphrases participant comments and provides additional insights about each of these themes.

11

What do you not like about the formula? Response Themes

Further Explanation

Lack of clear definition for the rural factor

Several stakeholders seemed concerned about how "rural" is defined, such as which data sources are used and how that impacts communities at a funding level.

Funding percentage for rural factor too low

While there was limited concern that the funding percentage for rural was too high, far more stakeholders at the sessions were concerned that it was too low. Some suggested that their communities fell between rural and metropolitan sizes.

Funding percentage for living-alone factor too low

Several stakeholders discussed aging in place in their communities with limited caregiver access or support systems. Some felt that this factor could be further funded.

Funding percentage for 60+ population factor too low

Several stakeholders shared concerns about decreased lifespans in some regions and increases in service needs prior to age 65. Thus, some were worried about a significant gap in service access for inneed older adults.

Accuracy of the census data unclear

Some stakeholders were unsure about which census estimates were used. Several stakeholders were concerned that underreporting might lead to deflated population estimates in their regions and thus less funding.

Complicated formula without a detailed key

Several stakeholders wished there had been a comprehensive written pamphlet or key prepared prior to the sessions explaining the IFF and its factors in much greater detail. Some stakeholders found it hard to follow the conversation.

Does not include a factor for clients under age 60 who are disabled and otherwise eligible for services

Some stakeholders discussed the demand from other older adults not yet in their 60s who could benefit from service access.

Funding percentage for disabled factor too low

Stakeholders noted that numbers of disabilities are on the rise and increased funding may help older Georgians.

Currently, no factor captures transportation and caregiver needs

Several stakeholders talked about caregiver burnout, including older adults who are also caregivers. Limited funding for and access to transportation was also a concern.

Note: Participant responses to the question were organized into overall themes, listed in the left column. The right column paraphrases participant comments and provides additional insights about each of these themes.

12

How should the State of Georgia fairly and efficiently allocate limited aging resources?

Response Themes More funding for living-alone factor More funding for disabled factor More funding for low-income factor
Move the minimum age to 60 for each factor

Further Explanation
This was suggested due to increased risks and to provide greater support for aging in place.
Stakeholders noted rising rates of disability and a potential need for greater funding to best meet the needs of these older adults.
Several stakeholders were concerned about the affordability of services for many Georgians and, consequently, funding to keep services available to those with limited financial resources.
This was suggested frequently by stakeholders because of a potential service coverage gap.

Dedicate a portion of lottery funds to aging services

Some stakeholders seemed interested in supplementing IFF dollars with other state dollars such as lottery funds or a dedicated tax for aging services.

Consider factors for transportation, affordable housing, and caregiving support

Several stakeholders felt that transportation, affordable housing, and caregiving support are critical aging issues in need of immediate additional advocacy and funding.

Base the allocations on need in area instead of population

Stakeholders wondered if there is a way to conduct needs assessments around the state to help allocate funds rather than using census population estimates. This was mainly due to concerns about census participation.

Remove barriers to access such as language barriers and complicated forms to access services

Some stakeholders mentioned that some services require program enrollment to receive funding, and there were concerns of accessibility issues limiting enrollment.

Note: Participant responses to the question were organized into overall themes, listed in the left column. The right column paraphrases participant comments and provides additional insights about each of these themes.

13

Options for Revising the Rural Factor
Based on the analysis of data on older Georgians, a scan of other intrastate funding formulas, stakeholder feedback, and guidance from DAS leadership, the Institute of Government developed options for revising the rural factor in the funding formula. The sections that follow outline five calculation options for Georgia's rural factor for review and consideration by DAS senior leadership. Appendix A contains estimates of financial impacts under each of these options.
14

OPTION 1: DECENNIAL CENSUS (CURRENT DEFINITION) The first option is the status quo. "Rural" would continue to be defined based on the decennial census urbanized area measure. However, this option has some unknowns. The Census Bureau has announced a new definition for "urban" in the 2020 census data.5 Additionally, population projections indicate continued demographic shifts in Georgia's 60+ and 75+ populations. These changes will result in Title III funding shifts, even if the formula stays the same. Figure 1 depicts urban/rural areas in Georgia based on the current definition and 2010 data.
Figure 1. Decennial Census Current Definition, Based on 2010 Census Data
5 See www.federalregister.gov/documents/2022/03/24/2022-06180/urban-area-criteria-for-the-2020-censusfinal-criteria for additional information.
15

OPTION 2: RUCC The second option is to use Rural Urban Continuum Codes (RUCC), which is a county-based measure from the US Department of Agriculture's Economic Research Service. This classification system is based on the population of each county. The RUCC codes are generated from a combination of county population size and adjacency to the 2013 census-defined metropolitan areas. (The US Census Bureau last updated its metropolitan area definitions in 2013.) Counties are first distinguished as metro or nonmetro, following Office of Management and Budget guidelines.6 Metro counties are then divided into three categories based on population size. Nonmetro counties are divided first into urban-size categories based on population, and then subdivided by whether the county is adjacent to one or more metro areas.7 For IFF purposes, all nonmetropolitan counties would be classified as rural. Figure 2 shows which counties in Georgia would be considered rural versus urban for IFF distributions.
Figure 2. Rural Urban Continuum Codes (RUCC) Definition
6 See obamawhitehouse.archives.gov/sites/default/files/omb/bulletins/2013/b-13-01.pdf 7 See www.ers.usda.gov/data-products/rural-urban-continuum-codes/documentation/
16

OPTION 3: RUCA1 The third rural definition option is RUCA1, or Rural-Urban Commuting Area Code Option #1. This option uses census-tract-level classifications of urban and rural. RUCA1 defines a tract as urban if 30% of its employed population commutes to a metropolitan urbanized area (e.g., Atlanta, Albany, Chattanooga, Valdosta). This definition is based on the ACL Title III guidance for the OAA Performance System.8 Figure 3 shows which census tracts in Georgia would be considered rural versus urban for IFF distributions.
Figure 3. Rural-Urban Commuting Area Code Option #1 (RUCA1) Definition
8 See www.ers.usda.gov/data-products/rural-urban-commuting-area-codes/documentation/ 17

OPTION 4: RUCA2 The fourth rural definition option is RUCA2, or Rural-Urban Commuting Area Code Option #2. This option uses another census-tract-level classification of urban and rural. However, it differs from RUCA1 in that the urban definition includes only places where the majority of commutes occur within metropolitan or micropolitan urbanized areas. Figure 4 shows which census tracts in Georgia would be considered rural versus urban for IFF distributions under RUCA2.
Figure 4. Rural-Urban Commuting Area Code Option #2 (RUCA2) Definition
18

OPTION 5: RHOAA The fifth rural definition option, RHOAA, is based on the Rural Hospital Organization Assistance Act of 2017. It is a county-level classification of urban and rural based on the definitions in Georgia Code 31-7-94.1 (2019). Counties with a population of at least 50,000 are considered urban, and the rest are rural. Figure 5 shows which counties in Georgia would be considered rural versus urban for IFF distributions.
Figure 5. Rural Hospital Organization Assistance Act of 2017 (RHOAA) Definition
19

Appendix A. Estimated Financial Impacts of Revised Rural IFF Factor
The Institute of Government estimated the financial impacts of options 25 against the current formula (option #1). RUCC IMPACTS
RUCA1 IMPACTS
20

RUCA2 IMPACTS RHOAA IMPACTS
21

CHAPTER 2000
ALLOCATION METHODOLOGIES, OAA, cont.

FUND SOURCES & ALLOCATION METHODOLOGY

Nutrition Services Incentive Program
(NSIP)
ALLOCATION METHODOLOGIES, STATE FUNDS

NSIP funds are allocated according to Regional percentages of the number of meals served statewide in the previous year as reported in the DAS Data System, consistent with federal methodology for allocating NSIP to the states. State and federal funds appropriated to supplement NSIP are allocated in the same way. State funds are used to match federal funds and are also allocated to conform to legislative intent.

Alzheimer's Services

Funds for the Alzheimer's Program are allocated using the East Boston "Harvard Study", with prevalence rate projections updated with the latest census data by the CDC, including prevalence rates of other dementias.

Additional Community Based Services state funds are "set aside" for Alzheimer's Services.

Aging and Disabilities
Resource Connection (ADRC)

State Funds are distributed evenly to the 12 AAAs. Any grant funds are distributed according to grant requirements.

Community Based State funds include "set asides" to reflect legislative intent or Services (CBS) to ensure policy compliance for the following programs:

Alzheimer's Services: allocated via the funding methodology described above in this section.

ELAP: Allocated by the approved IFF

GeorgiaCares: This set aside is to support the SHIP. Refer to GeorgiaCares methodology below in this section.

Respite Services: Allocated by the approved IFF.

Non-Medicaid HCBS Case Management: Allocated by the approved IFF.

The remaining CBS funds are distributed using the six percent base and the IFF.

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ALLOCATION METHODOLOGIES, STATE FUNDS, cont.

LTCO The supplement is distributed to all regions according to the Supplemental formula used for VII-2 described above in this section.

Nutrition Services Incentive Program
(NSIP) Supplemental

State and federal funds appropriated to supplement NSIP are allocated according to Regional percentages of the number of meals served statewide in the previous year as reported in the DAS Data System, consistent with federal methodology for allocating NSIP to the states.

State Nursing State funds appropriated for nursing home transmissions are Home Transitions allocated to sub-recipients. Contracted transitions are funded
at $5,100 per transition for transition services.

ALLOCATION METHODOLOGIES, OTHER FUNDS

GeorgiaCares

GeorgiaCares funding is primarily from the SHIP federal grant. The methodology used for allocating these funds mirrors the approach used by the Centers for Medicare and Medicaid Services (CMS) in allocating to the states. State funds also support this program.

A base of combined CMS and CBS funds is distributed to each of the 12 regions. 75% of the remaining funds are allocated based upon the % of total Medicare beneficiaries in each region and 15% are allocated based on the % of rural Medicare beneficiaries in each region.

Additional grant funds for this program, if available, are allocated according to grant requirements.

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FUND SOURCES & ALLOCATION METHODOLOGY

ALLOCATION METHODOLOGIES, OTHER FUNDS, cont.
Social Services Block Grant (SSBG) Funds are distributed to specified programs as follows:
Home and Community Based Services: Six percent base; remainder allocated by approved IFF; 12% local match required.
Long Term Care Ombudsman (LTCO): Funds are allocated following the methodology for OAA Title VII-2 as described above in this section.
Money Follows the Person Transition Coordination: A base us distributed evenly to all 12 AAAs.
NSIP: SSBG funds appropriated by the General Assembly to supplement NSIP are allocated according to Regional percentages of the number of meals served statewide in the previous year as reported in the DAS Data System, consistent with federal methodology for allocating NSIP to the states.

Income Tax Check off

The Georgia Fund for Children and Elderly "Income Tax Check off" funds are received by the Department of Revenue (DOR). After deducting an administrative fee, the DOR sends 50% of the remainder to the Department of Public Health and 50% to the Division of Aging Services. The funds to DAS are restricted for use on meals and transportation.

DAS distributes to the AAAs a six percent base and the remainder by current IFF.

Nutritional Supplement Incentive Program
(NSIP)

NSIP funds are allocated to the AAAs according to Regional percentages of the number of meals served statewide in the previous year as reported in the DAS Data System, consistent with federal methodology for allocating NSIP to the states.

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CHAPTER 2000

FUND SOURCES & ALLOCATION METHODOLOGY

ALLOCATION METHODOLOGIES, OTHER FUNDS, cont.

Money Follows the Person

The Department of Community Health contracts with DAS to administer a portion of the Money Follows the Person grant from CMS. DAS allocates the funds to the 12 AAAs for specific purposes as follows:

MFP Transition Coordination: 50% of the funding is distributed by AAA based upon the percent of nursing home beds in the planning and service area. 25% of the funding is distributed by AAA based upon the percent of the incoming caseload (pipeline) for the current fiscal year in the planning and service area. 25% of the funding is distributed by AAA based upon the percent of the current caseload for the current fiscal year in the planning and service area.

MDSQ Options Counseling: Funds are distributed evenly between 11 AAAs with the Atlanta Regional Commission receiving a double share.

Non-Medicaid HCBS Case
Management

DAS established a $1.4 million state fund set-aside from existing funds for non-Medicaid HCBS Case Management in the HCBS Manual Transmittal 2007-03 (MAN 5300, April 2007). This set-aside is allocated based on the current Intrastate Funding Formula. This set-aside is reflected in the Allocation Issuances effective with the 2016-01 Allocation. The set aside is intended to be a minimum for non-Medicaid HCBS Case Management; Area Agencies on Aging may additionally fund non-Medicaid HCBS Case Management by any allowable fund source.

PROCEDURES

Allocations are issued in the form of an EXCEL workbook, which is locked. The workbook is locked to limit the opportunity for fraud, since the allocation is the basis for AAA budgets and contracting.

The Allocation workbook contains a summary sheet for each AAA and sub-contractor, a "Consolidated Totals" page which is the statewide allocation and multiple supporting fund source pages. While most of the funds allocated to an AAA are found on their summary page, some fund sources are

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CHAPTER 2000

FUND SOURCES & ALLOCATION METHODOLOGY

PROCEDURES, cont.

only shown on the fund source page. The Allocation Issuance Memorandum, which accompanies the workbook, will indicate where to look for the funds in the workbook.

The Business Operations Section Manager will draft the allocation for review by DHS/Office of Budget Administration, Section Managers, as appropriate, and the Director and Deputy Director. One time fund sources are not included in the planning allocation.

Allocations for each State Fiscal Year are enumerated/named using the four digit state fiscal year and issuance number. The planning allocation is designated with "P". Examples:

Planning Allocation = 2014-P Initial issuance for SFY 2014 = 2014-01 Subsequent issuance for SFY 2014 = 2014-02, 2014-03, etc.

Planning A locked copy of the Allocation workbook and memorandum Allocation is filed on the DAS shared drive in the ALLOCATION
ISSUANCES folder by state fiscal year.

A planning allocation is sent to the AAAs prior to the start of the Area Plan process. This is usually in the second quarter of the current fiscal year. Refer to Section 3021 of this manual for information on the Area Plan.

Initial Allocation The AAA will use the planning allocation to develop their for SFY budget for the upcoming State Fiscal Year. Refer to Section 3022 of this manual for information on budget submission.

The initial allocation for the state fiscal year is sent to the AAAs before July 15.

Subsequent The AAA will submit their budget revision by the deadline set Allocations for SFY forth in the Allocation Memorandum.

Subsequent Allocations for the state fiscal year will be issued at the discretion of the DAS Director. Reasons for subsequent allocations include, but are not limited to:
New or changes in federal funding levels New or changes in state funding levels New or changes in grant funds Redistribution of funds as a result of potential lapse of
funds by a AAA

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CHAPTER 2000

FUND SOURCES & ALLOCATION METHODOLOGY

Subsequent The AAA will submit their budget revision by the deadline set Allocations for forth in the Allocation Memorandum.
SFY, cont.

TITLE III FUND TRANSFERS

AAA Transfer

Area Agencies on Aging may shift up to 30% of their allocation for Title III-C1 or Title III-C2 to the other. The shift must be requested and approved as part of the Area Plan/budget process.

Area Agencies on Aging may transfer up to 20% of their combined budget for Title III-C to Title III-B or 20% of Title IIIB to Title III-C. The shift must be requested and approved as part of the Area Plan/budget process.

SUA Transfer The Division is responsible for final, statewide transfers in a federal fiscal year. Allowable transfers are as follows:

40% between Titles III-C1 and III-C2 30% between Titles III-B and the Nutrition Programs
under Title III-C

The U.S. Assistant Secretary for Aging may disapprove the transfer if it is determined that the transfer is not consistent with the objectives of the OAA, as amended.

REFERENCES

MAN 5600, Section 2002, Interstate Funding Formula

MAN 5600, Section 2005, Matching Federal Funds

MAN 5600, Section 2006, Maintenance of Effort

MAN 5600, Section 3021, Area Plan

MAN 5600, Section 3022, Budget Revisions, Contract Amendments and Reporting Requirements

AoA PI 07-03; Older Americans Act, Sections 308 (b)(4)(A), 308 (b)(4)(B), 308 (b)(5)(A), and 308 (b)(4)(C), As Amended

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Page 2003 - 7

TABLE IV - 6 SFY 2024 State Program Allocations by PSA

PSA
1 2 3 4 5 6 7 8 9 10 11 12

PSA Name
Northwest Georgia Georgia Mountains Atlanta Region Three Rivers Northeast Georgia River Valley Middle Georgia Central Savannah River Heart of Georgia Altamaha Southwest Georgia Southern Georgia Coastal

IFF%
9.8831500% 8.1092400% 32.9455600% 5.7448200% 6.6556500% 4.5806000% 5.7926500% 5.5643500% 4.3107100% 4.9230000% 5.7448200% 6.4367700%

Title III Admin Totals
$412,596 $343,275 $1,320,001 $249,850 $285,670 $204,066 $251,731 $243,194 $193,890 $217,530 $223,103 $277,502

Title IIIB
$943,329 $782,660 $3,032,173 $568,506 $651,003 $463,059 $572,839 $552,160 $438,614 $494,071 $505,891 $631,179

Title IIIC1

Title IIIC2

Title III Part D Wellness

$1,531,712 $1,270,829 $4,923,434
$923,101 $1,057,053
$751,882 $930,136 $896,560 $712,191 $802,239 $821,431 $1,024,864

$781,681 648544
$2,512,584 $471,087 $539,448 $383,709 $474,678 $457,542 $363,453 $409,407 $419,202 $523,020

$52,667 $47,538 $119,345 $40,701 $43,336 $37,337 $40,841 $40,182 $36,556 $38,326 $38,704 $42,703

Title IIIE
$364,786 $307,054 $1,176,940 $219,841 $251,742 $179,064 $221,516 $217,920 $174,012 $191,058 $200,028 $248,476

Other Funds Grand Total Total*
$4,373,329 $8,460,100 $3,672,112 $7,072,012 $12,496,001 $25,580,478 $2,823,714 $5,296,800 $2,984,142 $5,812,394 $2,447,041 $4,466,158 $2,835,126 $5,326,867 $2,303,004 $4,710,562 $2,386,489 $4,305,205 $2,553,733 $4,706,364 $2,641,069 $4,849,428 $3,047,168 $5,794,912

State Total

100.00% $4,222,408 $9,635,484 $15,645,432 $7,984,355

$578,236 $3,752,437 $44,562,928 $86,381,280

NOTE: Other funds includes SSBG, Community based services, Alzheimer's, LTCO state supplemental, Income tax check off, NSIP, and Transition Programs funding. Title VIII funds are not allocated through AAAs.
NSIP funds are allocated according to Regional percentages of the number of meals served statewide in the previous year as reported in the DAS Data System, consistent with federal methodology for allocating NSIP to the states. State and federal funds appropriated to supplement NSIP are allocated in the same way. We will add it to the IFF attachment.

PSA_NAME ARC Aging Division Coastal GA AAA CSRA AAA Heart of Georgia AAA Legacy Link Georgia Mountains AAA Middle Georgia AAA NEGA AAA NWGA AAA River Valley AAA Southern GA AAA SOWEGA AAA Three Rivers AAA Totals

PSA IFF Factors

POP_60 POV_NW_65 POV_65 RURAL_60 DIS_65 LIM_ENG_65 LIV_ALONE_65 POP_75

816382

29635 47168

30959 165890

25207

139708 198385

141846

4365 8878

34601 35875

1048

25501 38658

109645

5022 8003

36266 28689

784

21441 29086

67391

2827 8255

43321 18168

231

13632 19767

163587

1730 9978

78040 40818

2618

24242 47579

112115

4996 9042

39945 29420

277

21045 30674

132195

3607 8732

60961 33269

1156

21187 35732

200513

2203 13813

93437 52118

1966

35301 55151

80489

4736 7943

30188 22799

437

16636 21996

85986

3517 9431

45191 21127

310

17756 24358

81738

4814 8318

38982 22319

522

16217 23398

110777

3004 7746

53259 30352

601

20108 30285

2102664

70456 147307 585150 500844

35157

372774 555069

PSA_NAME ARC Aging Division ARC Aging Division ARC Aging Division ARC Aging Division ARC Aging Division ARC Aging Division ARC Aging Division ARC Aging Division ARC Aging Division ARC Aging Division
Coastal GA AAA Coastal GA AAA Coastal GA AAA Coastal GA AAA Coastal GA AAA Coastal GA AAA Coastal GA AAA Coastal GA AAA Coastal GA AAA
CSRA AAA CSRA AAA CSRA AAA CSRA AAA CSRA AAA CSRA AAA CSRA AAA CSRA AAA CSRA AAA CSRA AAA CSRA AAA CSRA AAA CSRA AAA CSRA AAA
Heart of Georgia AAA Heart of Georgia AAA Heart of Georgia AAA Heart of Georgia AAA Heart of Georgia AAA Heart of Georgia AAA Heart of Georgia AAA Heart of Georgia AAA Heart of Georgia AAA Heart of Georgia AAA Heart of Georgia AAA

COUNTY Cherokee Clayton Cobb DeKalb Douglas Fayette Fulton Gwinnett Henry Rockdale
Bryan Bulloch Camden Chatham Effingham Glynn Liberty Long McIntosh
Burke Columbia Glascock Hancock Jefferson Jenkins Lincoln McDuffie Richmond Screven Taliaferro Warren Washington Wilkes
Appling Bleckley Candler Dodge Emanuel Evans Jeff Davis Johnson Laurens Montgomery Tattnall

IFF CY2023 - County Breakdown

POP_60

POV_NW_65 POV_65

RURAL_60 DIS_65 LIM_ENG_65 LIV_ALONE_65 POP_75

54034

239

2109

9241

11074

365

7577

12825

43449

2241

3040

386

8713

2082

7061

8638

138117

2767

6218

340

27105

3164

21504

33861

137583

7071

8891

362

31213

3605

27311

34687

25000

413

1340

3939

5895

303

3456

5979

30078

370

942

5468

6024

271

4492

8303

181501

10636

13875

1956

36801

3308

40674

46729

146419

4482

8239

711

25476

11317

17690

32951

40184

1002

1645

5567

8692

493

7076

9800

20017

414

869

2989

4897

299

2867

4612

816382

29635

47168

30959 165890

25207

139708

198385

6157

49

322

3223

1762

44

824

1718

13235

420

808

6390

3285

9

2862

3459

10400

267

724

3270

2212

0

1529

2709

63167

2207

3731

2846

16369

779

12165

17888

11108

122

851

7448

2738

0

1416

2559

22830

439

1067

4695

5526

82

4252

6690

8862

643

890

2052

2345

120

1411

2095

2174

34

123

1768

743

14

369

522

3913

184

362

2908

895

0

673

1018

141846

4365

8878

34601

35875

1048

25501

38658

5653

328

488

4240

1320

10

1361

1406

29545

363

1240

4794

7377

456

4479

7619

683

0

75

683

178

0

138

211

2394

311

315

1474

569

0

539

791

3764

211

354

3036

1119

0

772

1111

2618

178

290

1731

733

0

587

578

2672

137

203

2672

719

0

536

765

5466

156

334

3332

1188

49

813

1512

43011

2408

3274

3964

11847

201

9194

10853

3544

140

261

2797

1036

0

730

993

519

73

96

519

174

0

73

245

1621

136

205

1621

383

8

263

500

5158

399

505

3384

1203

60

1046

1419

2997

182

363

2019

843

0

910

1083

109645

5022

8003

36266

28689

784

21441

29086

4503

122

420

3217

1330

0

754

1262

2997

62

200

1546

866

0

492

1005

2589

131

254

1734

697

31

576

769

5068

245

1081

3661

1627

55

861

1452

5001

181

550

3345

1527

0

1022

1382

2353

142

284

1442

454

0

511

675

3096

44

428

2152

859

0

607

836

2436

133

236

1593

773

0

632

653

11652

641

1610

6600

2799

17

2361

3605

1967

100

289

1942

547

0

390

572

4358

268

733

2974

1487

51

1056

1391

PSA_NAME Heart of Georgia AAA Heart of Georgia AAA Heart of Georgia AAA Heart of Georgia AAA Heart of Georgia AAA Heart of Georgia AAA

COUNTY Telfair Toombs Treutlen Wayne Wheeler Wilcox

Legacy Link Georgia Mountains AAABanks Legacy Link Georgia Mountains AAADawson Legacy Link Georgia Mountains AAAForsyth Legacy Link Georgia Mountains AAAFranklin Legacy Link Georgia Mountains AAAHabersham Legacy Link Georgia Mountains AAAHall Legacy Link Georgia Mountains AAAHart Legacy Link Georgia Mountains AAALumpkin Legacy Link Georgia Mountains AAARabun Legacy Link Georgia Mountains AAAStephens Legacy Link Georgia Mountains AAATowns Legacy Link Georgia Mountains AAAUnion Legacy Link Georgia Mountains AAAWhite

Middle Georgia AAA Middle Georgia AAA Middle Georgia AAA Middle Georgia AAA Middle Georgia AAA Middle Georgia AAA Middle Georgia AAA Middle Georgia AAA Middle Georgia AAA Middle Georgia AAA Middle Georgia AAA

Baldwin Bibb Crawford Houston Jones Monroe Peach Pulaski Putnam Twiggs Wilkinson

NEGA AAA NEGA AAA NEGA AAA NEGA AAA NEGA AAA NEGA AAA NEGA AAA NEGA AAA NEGA AAA NEGA AAA NEGA AAA NEGA AAA

Barrow Clarke Elbert Greene Jackson Jasper Madison Morgan Newton Oconee Oglethorpe Walton

NWGA AAA

Bartow

IFF CY2023 - County Breakdown

POP_60

POV_NW_65 POV_65

RURAL_60 DIS_65 LIM_ENG_65 LIV_ALONE_65 POP_75

3164

123

328

1487

561

43

440

899

6271

316

632

3202

2062

33

1671

1916

1627

82

170

958

581

0

355

475

6751

100

471

3911

1517

1

1191

1801

1541

83

327

1541

231

0

353

447

2017

54

242

2017

250

0

360

627

67391

2827

8255

43321

18168

231

13632

19767

4190

46

580

3931

1432

27

727

1138

7263

0

272

5833

1581

29

1223

1847

40799

355

1665

4048

7720

1060

4784

11255

5836

55

575

5190

1905

74

895

1821

11276

44

1037

6626

3625

212

2034

3335

41562

721

2478

8544

10022

1097

5823

12144

7738

272

669

5762

2862

55

1349

2442

7960

2

489

6682

1688

4

1217

2236

6072

17

258

4814

1582

1

954

1928

7141

124

553

4182

2140

50

1270

1890

5290

0

461

5290

1113

0

808

1805

10300

49

685

10300

2911

0

1998

3255

8160

45

256

6838

2237

9

1160

2483

163587

1730

9978

78040

40818

2618

24242

47579

9715

331

818

3414

2806

14

1805

2661

34041

2360

3501

4905

9144

88

6858

9653

3404

114

349

3404

996

1

500

774

30061

864

1406

2995

7472

125

5022

7668

6910

243

615

4679

1820

0

1232

1951

6919

159

408

5551

1555

0

1326

1956

6099

315

686

2331

2108

44

1375

1670

2818

166

292

1880

862

0

475

968

7150

112

397

5788

1306

5

1412

1924

2521

185

269

2521

854

0

532

712

2477

147

301

2477

497

0

508

737

112115

4996

9042

39945

29420

277

21045

30674

14708

124

626

4421

3765

376

2379

3552

20188

874

1513

1183

4964

238

4697

5446

5612

224

586

3963

1585

0

1240

1639

7205

208

376

5962

1469

13

1263

1972

15259

270

992

9158

3614

164

2128

4156

3520

67

317

2878

1009

0

317

932

6703

267

616

6159

1963

90

818

1954

5341

192

332

4025

1370

9

796

1579

20873

934

1380

6522

5565

46

2736

5291

8797

42

304

4426

1885

107

1258

2281

3587

46

209

3560

762

0

619

1068

20402

359

1481

8703

5318

113

2936

5862

132195

3607

8732

60961

33269

1156

21187

35732

21635

363

1662

7622

4902

201

3236

5619

PSA_NAME NWGA AAA NWGA AAA NWGA AAA NWGA AAA NWGA AAA NWGA AAA NWGA AAA NWGA AAA NWGA AAA NWGA AAA NWGA AAA NWGA AAA NWGA AAA NWGA AAA
River Valley AAA River Valley AAA River Valley AAA River Valley AAA River Valley AAA River Valley AAA River Valley AAA River Valley AAA River Valley AAA River Valley AAA River Valley AAA River Valley AAA River Valley AAA River Valley AAA River Valley AAA River Valley AAA
Southern GA AAA Southern GA AAA Southern GA AAA Southern GA AAA Southern GA AAA Southern GA AAA Southern GA AAA Southern GA AAA Southern GA AAA Southern GA AAA Southern GA AAA Southern GA AAA Southern GA AAA Southern GA AAA Southern GA AAA

COUNTY Catoosa Chattooga Dade Fannin Floyd Gilmer Gordon Haralson Murray Paulding Pickens Polk Walker Whitfield
Chattahoochee Clay Crisp Dooly Harris Macon Marion Muscogee Quitman Randolph Schley Stewart Sumter Talbot Taylor Webster
Atkinson Bacon Ben Hill Berrien Brantley Brooks Charlton Clinch Coffee Cook Echols Irwin Lanier Lowndes Pierce

IFF CY2023 - County Breakdown

POP_60

POV_NW_65 POV_65

RURAL_60 DIS_65 LIM_ENG_65 LIV_ALONE_65 POP_75

16267

23

738

4571

4481

31

2759

4779

6251

86

540

3598

1696

64

1596

1821

4243

0

373

3060

1194

0

738

1222

9662

21

733

9662

2911

4

1830

2807

21909

309

1309

8067

5878

52

4274

6483

10120

10

835

8869

2703

37

1651

2815

12161

135

1294

6270

2809

85

2405

3292

6939

62

558

5368

2258

8

1171

1877

8139

40

452

5708

2110

45

1500

2109

26933

429

1161

5401

6185

204

3389

6131

9640

8

579

7047

2417

0

1514

2576

9499

131

591

4885

2914

154

1852

2585

17029

100

1166

7468

5010

59

3356

5199

20086

486

1822

5840

4650

1022

4030

5836

200513

2203

13813

93437

52118

1966

35301

55151

499

0

14

147

123

0

84

133

934

53

83

934

391

0

307

333

5390

125

420

2535

1740

0

1043

1479

3279

104

183

1760

950

0

521

873

9079

72

328

8778

2239

0

1004

2018

3108

278

450

1653

905

0

588

674

2007

106

166

2007

685

0

386

582

39571

2457

4213

1178

10993

306

9326

10876

1012

32

61

740

296

0

215

311

1796

308

340

909

540

0

490

611

955

100

135

955

232

0

135

295

956

89

125

956

278

6

218

348

7112

670

840

2972

1907

92

1287

2089

2078

112

211

1951

677

4

493

559

2197

166

304

2197

646

29

369

635

516

64

70

516

197

0

170

180

80489

4736

7943

30188

22799

437

16636

21996

1639

42

181

1639

478

67

324

356

2268

32

267

1571

834

0

584

649

4144

147

477

1409

990

8

891

1177

4348

72

513

3311

1356

0

818

1239

4278

50

395

4254

716

0

1174

1090

4528

203

508

3217

1037

5

937

1225

2778

164

244

1417

777

6

427

799

1376

81

251

832

411

0

141

401

8393

194

942

5588

2432

75

1735

2056

3855

132

731

2290

1095

0

722

1145

799

63

94

799

221

0

124

225

2335

120

233

1511

423

31

606

772

1858

56

452

1322

415

0

471

554

19704

1228

2016

5360

4291

35

4275

5711

4594

104

380

3645

1367

0

813

1403

PSA_NAME Southern GA AAA Southern GA AAA Southern GA AAA
SOWEGA AAA SOWEGA AAA SOWEGA AAA SOWEGA AAA SOWEGA AAA SOWEGA AAA SOWEGA AAA SOWEGA AAA SOWEGA AAA SOWEGA AAA SOWEGA AAA SOWEGA AAA SOWEGA AAA SOWEGA AAA
Three Rivers AAA Three Rivers AAA Three Rivers AAA Three Rivers AAA Three Rivers AAA Three Rivers AAA Three Rivers AAA Three Rivers AAA Three Rivers AAA Three Rivers AAA

COUNTY Tift Turner Ware
Baker Calhoun Colquitt Decatur Dougherty Early Grady Lee Miller Mitchell Seminole Terrell Thomas Worth
Butts Carroll Coweta Heard Lamar Meriwether Pike Spalding Troup Upson

IFF CY2023 - County Breakdown

POP_60

POV_NW_65 POV_65

RURAL_60 DIS_65 LIM_ENG_65 LIV_ALONE_65 POP_75

8276

348

672

3375

1924

45

1952

2331

2297

124

268

1142

663

0

341

624

8516

357

807

2507

1697

38

1421

2601

85986

3517

9431

45191

21127

310

17756

24358

1072

130

205

1072

278

0

237

229

1279

115

123

1279

346

0

197

345

9562

416

1185

5637

2556

175

2099

2769

6611

256

521

3734

1774

17

1195

1951

19209

1861

2266

2682

5585

55

4585

5311

2757

186

348

1818

643

0

653

844

6131

330

605

3823

1832

62

1437

1973

6213

99

305

2251

1316

95

831

1467

1641

69

233

1641

404

0

365

608

5304

435

702

2891

1364

41

1024

1466

2759

121

316

1891

785

0

378

783

2434

219

324

1267

656

0

521

705

11236

378

744

5171

3226

77

1810

3353

5530

199

441

3825

1554

0

885

1594

81738

4814

8318

38982

22319

522

16217

23398

5396

31

291

4206

1365

27

999

1477

22392

418

1716

9365

6144

101

3919

6007

29151

390

1151

9600

7272

402

4575

7374

2595

27

283

2595

988

0

550

681

4263

213

335

2595

1207

0

1111

1155

5719

206

696

4763

2033

2

1058

1713

3860

50

223

3820

898

0

726

1178

16152

628

988

6722

3948

43

3063

4738

14394

550

1121

6376

4369

17

2450

3951

6855

491

942

3216

2128

9

1657

2011

110777

3004

7746

53259

30352

601

20108

30285

INTRA-STATE FUNDING FORMULA CALCULATIONS USING 2017-2021 AMERICAN COMMUNITY SURVEY (ACS) AND CENSUS (CEN) 2010 DATA 2016 REV-1 FORMULA NEW FORMULA = (10% x %60+ POP)+(10% x %65+ MIN POV)+(13% x %65+ POV)+(15% x
%60+ RURAL)+ (10% x %65+ DISABLED)+(4% x %65+ LIM ENG)+(8% x %65+ ALONE)+(30% x %75+ POP)

WEIGHT: 10%
County
ARC Aging Division Coastal GA AAA CSRA AAA Heart of Georgia AAA Legacy Link Georgia Mountains AAA Middle Georgia AAA NEGA AAA NWGA AAA River Valley AAA Southern GA AAA SOWEGA AAA Three Rivers AAA Total

ACS 60+ POP
816,382 141,846 109,645 67,391 163,587 112,115 132,195 200,513 80,489 85,986 81,738 110,777 2,102,664

% of total 60+ POP

WEIGHT

38.826080%

10%

6.746014%

10%

5.214575%

10%

3.205029%

10%

7.779988%

10%

5.332045%

10%

6.287024%

10%

9.536141%

10%

3.827953%

10%

4.089384%

10%

3.887354%

10%

5.268412%

10%

100%

WEIGHT: 4%
County
ARC Aging Division Coastal GA AAA CSRA AAA Heart of Georgia AAA Legacy Link Georgia Mountains AAA Middle Georgia AAA NEGA AAA NWGA AAA River Valley AAA Southern GA AAA SOWEGA AAA Three Rivers AAA Total

ACS 65+LIM ENG
25207 1048 784 231 2618 277 1156 1966 437 310 522 601 35,157

% of total 65+LIM ENG

WEIGHT

71.698382%

4%

2.980914%

4%

2.229997%

4%

0.657053%

4%

7.446597%

4%

0.787894%

4%

3.288108%

4%

5.592058%

4%

1.242996%

4%

0.881759%

4%

1.484768%

4%

1.709475%

4%

100%

INTRA-STATE FUNDING FORMULA CALCULATIONS USING 2017-2021 AMERICAN COMMUNITY SURVEY (ACS) AND CENSUS (CEN) 2010 DATA 2016 REV-1 FORMULA

County

WEIGHT: 10%

ARC Aging Division Coastal GA AAA CSRA AAA Heart of Georgia AAA Legacy Link Georgia Mountains AAA Middle Georgia AAA NEGA AAA NWGA AAA River Valley AAA Southern GA AAA SOWEGA AAA Three Rivers AAA Total
WEIGHT: 8%

County
ARC Aging Division Coastal GA AAA CSRA AAA Heart of Georgia AAA Legacy Link Georgia Mountains AAA Middle Georgia AAA NEGA AAA NWGA AAA River Valley AAA Southern GA AAA SOWEGA AAA Three Rivers AAA Total

ACS 65+ MIN POV
29635 4365 5022 2827 1730 4996 3607 2203 4736 3517 4814 3004 70,456
ACS 65+ ALONE
139708 25,501 21,441 13,632 24,242 21,045 21,187 35,301 16636 17,756 16217 20,108 372,774

% of total 65+ MIN POV

WEIGHT

42.061712%

10%

6.195356%

10%

7.127853%

10%

4.012433%

10%

2.455433%

10%

7.090950%

10%

5.119507%

10%

3.126774%

10%

6.721926%

10%

4.991768%

10%

6.832633%

10%

4.263654%

10%

100%

% of total 65+ ALONE

WEIGHT

37.477936%

8%

6.840874%

8%

5.751742%

8%

3.656907%

8%

6.503136%

8%

5.645512%

8%

5.683605%

8%

9.469813%

8%

4.462758%

8%

4.763208%

8%

4.350357%

8%

5.394153%

8%

100%

INTRA-STATE FUNDING FORMULA CALCULATIONS USING 2017-2021 AMERICAN COMMUNITY SURVEY (ACS) AND CENSUS (CEN) 2010 DATA 2016 REV-1 FORMULA

County

WEIGHT: 13%

ARC Aging Division Coastal GA AAA CSRA AAA Heart of Georgia AAA Legacy Link Georgia Mountains AAA Middle Georgia AAA NEGA AAA NWGA AAA River Valley AAA Southern GA AAA SOWEGA AAA Three Rivers AAA Total
WEIGHT: 30%

County
ARC Aging Division Coastal GA AAA CSRA AAA Heart of Georgia AAA Legacy Link Georgia Mountains AAA Middle Georgia AAA NEGA AAA NWGA AAA River Valley AAA Southern GA AAA SOWEGA AAA Three Rivers AAA Total

ACS 65+ POV
47168 8878 8,003 8255 9,978 9,042 8732 13813 7943 9431 8318 7746 147,307
ACS 75+ POP
198,385 38,658 29,086 19,767 47,579 30,674 35,732 55,151 21,996 24,358 23,398 30,285 555,069

% of total 65+ POV

WEIGHT

32.020203%

13%

6.026869%

13%

5.432871%

13%

5.603943%

13%

6.773609%

13%

6.138201%

13%

5.927756%

13%

9.377015%

13%

5.392140%

13%

6.402276%

13%

5.646711%

13%

5.258406%

13%

100%

% of total 75+ POP

WEIGHT

35.740602%

30%

6.964540%

30%

5.240069%

30%

3.561179%

30%

8.571727%

30%

5.526160%

30%

6.437398%

30%

9.935882%

30%

3.962751%

30%

4.388283%

30%

4.215332%

30%

5.456078%

30%

100%

INTRA-STATE FUNDING FORMULA CALCULATIONS USING 2017-2021 AMERICAN COMMUNITY SURVEY (ACS) AND CENSUS (CEN) 2010 DATA 2016 REV-1 FORMULA

County

WEIGHT: 15%

ARC Aging Division Coastal GA AAA CSRA AAA Heart of Georgia AAA Legacy Link Georgia Mountains AAA Middle Georgia AAA NEGA AAA NWGA AAA River Valley AAA Southern GA AAA SOWEGA AAA Three Rivers AAA Total
WEIGHT: 10%

County
ARC Aging Division Coastal GA AAA CSRA AAA Heart of Georgia AAA Legacy Link Georgia Mountains AAA Middle Georgia AAA NEGA AAA NWGA AAA River Valley AAA Southern GA AAA SOWEGA AAA Three Rivers AAA Total

ACS/CEN 60+ RURAL
30,959 34,601 36,266 43,321 78,040 39,945 60,961 93,437 30,188 45,191 38,982 53,259 585,150
ACS 65+DISABLED
165,890 35,875 28,689 18,168 40,818 29,420 33,269 52,118 22,799 21,127 22319 30,352 500,844

% of total 60+ RURAL
WEIGHT 5.290780% 15% 5.913185% 15% 6.197727% 15% 7.403401% 15% 13.336751% 15% 6.826455% 15% 10.418012% 15% 15.968042% 15% 5.159019% 15% 7.722977% 15% 6.661882% 15% 9.101769% 15%
100%
% of total 65+DISABLED
WEIGHT 33.122090% 10%
7.162909% 10% 5.728131% 10% 3.627477% 10% 8.149843% 10% 5.874085% 10% 6.642587% 10% 10.406035% 10% 4.552116% 10% 4.218280% 10% 4.456278% 10% 6.060170% 10%
100%

Chapter 300

Individual Service Requirements

SECTION 304 - Nutrition Service Program Guidelines and Requirements

304.1 SUMMARY STATEMENT

This section establishes requirements for Area Agencies on Aging and their subcontractors in the administration and provision of a comprehensive program of nutrition services to older adults.

304.2 SCOPE

These requirements apply to all congregate and home delivered nutrition services contracted and provided through or by the Area Agency on Aging, supported by any and all non-Medicaid sources of funding.

304.3 DEFINITIONS

Nutrition Assessment An evaluation of nutritional status at a given point in time, which may include estimation of nutritional requirements and care plan with measurable goals.
Nutrition Counseling The provision of individualized guidance by a qualified professional on appropriate food and nutrient intakes for those with special nutrition needs, taking into consideration health, cultural, socioeconomic, functional and psychological factors. Nutrition counseling may include: advice to increase, decrease, or eliminate nutrients in the diet, to change the timing, size or composition of meals, to modify food textures, and/or to change the route of administration-from oral to feeding tube to intravenous.
Nutrition Education The provision of information about foods and nutrients, diets, lifestyle factors, community nutrition resources and services to people to improve their nutritional status.
Nutrition Screening The process of using characteristics known to be associated with nutrition problems to identify individuals who are nutritionally at risk.
Therapeutic Diet A diet ordered by a physician as part of treatment for a disease or clinical condition, or to eliminate, decrease, or increase specific nutrients in the diet.

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304.4 LAWS AND CODES

Each nutrition service program site shall be operated in compliance with all federal, state, and local laws and codes that govern facility operations, specifically related to fire safety, sanitation, insurance coverage, and wage requirements.

304.5 NUTRITION PROGRAMS

The congregate nutrition program promotes better physical and mental health for older adults through the provision of nutritious meals and opportunities for social contact.
The home delivered meal program promotes better health for older adults and eligible members of their households through the provision of nutritious meals; nutrition screening, education and counseling; and opportunities for social contact.

Both types of nutrition services shall be part of a system of services that promotes independent living for older adults.

304.6 SERVICE OUTCOMES
304.7 ELIGIBILITY AND PRIORITY FOR SERVICES

At a minimum: To identify persons at nutritional risk and/or with food insecurity and delay the decline in health/nutrition status through nutrition screening, assessment, and referrals;
To reduce identified nutritional risk and food insecurity among program participants through the provision of nutritious meals, education and counseling;
To reduce isolation of program participants through socialization.
Eligible persons are:
Aged 60 and over, or a spouse (regardless of age) of a person aged 60 or over;
Persons with disabilities who are residents of housing facilities occupied primarily by older adults at which congregate nutrition services are provided; or
Volunteers, staff and guests age 60 and above (Approved conditionally upon AAA policies).
AAAs shall give priority to those:
In greatest social and economic need,
Show moderate to high nutrition risk status, as indicated by the NSI

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304.8 REQUIREMENTS FOR MEALS

High functional impairment levels and unmet need, as documented on the DON-R instrument (Home Delivered Meals ONLY)
And as indicated by the Food Security Survey.
Providers may offer a meal to the spouse/caregiver(s) of a homebound eligible person if the provision of the meal supports maintaining the person at home. Providers may also offer meals to the non-elderly or persons with disabilities who reside in the household of an older adult (60 years or older) and are dependent on them for care.
Each meal shall comply with provisions in the Older Americans Act, Title III, Subpart 3, Section 339, concerning compliance with Dietary Guidelines for Americans.
Meals will focus not only on the nutrition content, but also color, texture and flavor.
Variety in the meal pattern is important to meal satisfaction. Therefore, there are no requirements that any specific food be served (example: milk), or any requirements that a meal pattern be followed (example: 3oz meat, 2 -cup vegetables, dessert, roll).
Standardized recipes will be used to analyze and prepare meals. The food that is served will be the same as analyzed, to the fullest extent possible.
A caffeine free and sugar free beverage must be offered as part of a complete meal.
Providers will develop a plan to offer choice in meals.
Providers will be capable of serving a therapeutic diet based on a doctor's recommendation. See 304.3k for further explanation.

304.9 MENU CYCLES

Providers shall follow at a minimum a twenty day (four week) menu cycle, which can be repeated during the quarter.

304.10 NUTRIENT CONTENT

Nutrient content of meals is determined by the application of the Dietary Reference Intakes (DRI) guidelines and the Dietary Guidelines for Americans.
To allow for regional preferences, the nutrient content of meals must:

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Use the targets outlined in Appendix 304-B "Georgia Nutrition Program Nutrient Targets for Meals".

The nutrition analysis will show these targets are met over an average of one menu cycle (minimum of twenty days), within +/-10%.

304.11 NUTRIENT ANALYSIS

The provider shall obtain and maintain documentation of nutrient analysis for each meal per menu cycle. If the AAA allows the use of alternative protein sources, the procurement documents must clearly state how frequently alternative protein may be used on a monthly basis and to what degree.

304.12 MEAL TYPE

Hot, frozen, dehydrated, chilled, and shelf-stable meals shall be prepared and served in accordance with Division of Aging Services requirements. The AAA or provider will be responsible for assessing the ability of the home delivered meal recipient to store and prepare meals. Appendix 304-A contains instructions to determine appropriate meal type.
A hot meal is not required for congregate or home delivered programs. However, each individual should be assessed and given the type of meal that is determined to be the most appropriate, or that the individual requests.

304.13 THERAPEUTIC DIETS

Therapeutic diets shall be provided as required by the participant's special needs and medical condition, providing:
The nutrition service provider obtains a physician prescription for each participant needing a therapeutic meal and maintains documentation of specific guidance on meal modification;
The therapeutic diet is planned in accordance with the Georgia Dietetic Association Manual, is approved by a Registered Dietitian, and is submitted on a quarterly basis along with the regular menu.

304.14 MENU APPROVAL

A qualified dietitian shall certify menus in each cycle as meeting the dietary guidelines and providing recommended dietary allowances. The AAA shall submit copies of certified menus and nutrition analyses to the Division of Aging Services' Chief Nutritionist on a quarterly basis, at least two weeks before implementation.

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304.15 REGISTERED DIETITIANS

Individual Service Requirements
The AAA shall assure that the services of a registered dietitian are available for menu review and certification. This dietitian shall not be employed by the commercial food vendor that provides meals for the planning and service area, if the provider subcontracts meal preparation.
The certified menus are subject to the audit process and are to be retained for a minimum of six years, according to state record retention requirements.
The AAA is responsible for assuring compliance with the Older Americans Act, which states that the nutrition program be administered with the advice of dietitians or individuals with comparable expertise. The AAA may employ directly the dietitian(s) or contract for consultation services.
Nutrition service providers may also employ or contract the services of a dietitian in fulfillment of this requirement.

304.16 DUTIES OF THE DIETITIAN

Duties of the dietitian include, but are not limited to:
1. Menu Planning The development of (or oversight of the development of) regular four week cycle menus (20 day minimum) which will change quarterly with consideration of input from program participants and staff. The dietitian shall convene quarterly menu planning meetings with senior center managers, individual representatives and on-site kitchen staff or commercial food vendor staff. The dietitian shall assure that the menus conform to DAS' nutrient content requirements.
2. Development of Standardized Recipes and Nutritional Analysis The dietitian shall develop, select, and/or approve standardized recipes and provide full nutritional analysis for all proposed menus.
3. Nutrition Screening and Intervention The dietitian shall assist the AAA staff in implementation of the NSI-D, including assisting with developing protocols and mechanisms to provide access to Level I Screening (or higher) and assessments, or referrals to appropriate health care providers for individuals identified as being at high nutritional risk. Upon reassessment, if there is no change to the NSI score, the dietitian will have the option, based on the individual's needs, to provide additional education and/or counseling.
4. Nutrition Education The dietitian shall develop and/or disseminate approved nutrition education materials to food service personnel (for use with kitchen staff) and to senior center managers (for use with congregate and home delivered meals program participants).

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5. Nutrition Counseling The dietitian shall provide, oversee and/or develop resources for the provision of individualized nutrition counseling for persons identified as being at high nutrition risk, including developing protocols for targeting individual groups and priorities for using available resources. The counseling may include referral to other services and assistance and followup. The dietitian shall coordinate service referrals with case managers, if present.
6. Training The dietitian shall develop and/or disseminate quarterly (or more frequently as needed) in-service training to on-site kitchen staff and senior center staff on such topics as: food sanitation and safety, portion control, special nutrition needs of older adults, and health related topics.
7. Program Monitoring, Planning, and Evaluation The dietitian shall oversee or assist as needed with the program monitoring and evaluation; the analysis of programmatic data; oversee or assist in the development of bid specifications; and oversee or assist in developing the Area Plan with regard to meal service and nutrition program initiatives. The dietitian will coordinate with Wellness Program staff, Care Coordinators, and other staff in the implementation and promotion of Wellness Program activities.
8. Technical Assistance The dietitian shall provide technical assistance in the areas of food service management and nutrition program management to AAA staff, nutrition program personnel and food service personnel. The dietitian will provide technical assistance to food vendors to offer flexibility and choices for program participants.
9. Quality Assurance It is the responsibility of the dietitian to assure that:
Meals served in the OAA program meet the dietary standards.
The vendor/provider has used standardized recipes.
The menu items used for nutrient analysis and the food products provided to participants are the same.
Program participants have an opportunity to provide input in the development of menus.

304.17 MEAL PACKING

1. Providers shall use supplies and carriers that allow for packaging and transporting hot foods separately from cold foods.

2. Providers shall use meal carriers of appropriate design, construction, and materials to transport trays or containers of potentially hazardous food, and

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other hot or cold foods. Carriers shall be enclosed to protect food from contamination, crushing or spillage, and be equipped with insulation and/or supplemental sources of heat and/or cooling as is necessary to maintain safe temperatures.
3. Providers shall clean and sanitize meal carriers daily or use carriers with inner liners that can be sanitized.
4. Meals packaging, condiments, and utensils must meet the following criteria:
Be sealed to prevent moisture loss or spillage to the outside of the container while also meeting the current standards for oxygen transfer rates;
Be designed with compartments to separate food items for maximum visual appeal and minimize leakage between compartments; and
Be easy for the participant to open or use. 5. Providers must make every effort to provide assistive devices or modified utensils to persons who need them.
6. Package labeling must be legible and show:
the packaging date,
list of food items,
storage instructions, and
instructions for preparation of safe thawing and reheating, or reconstituting.

304.18 MEAL SERVICE REQUIREMENTS

Nutrition service providers shall use procedures that provide for the safety, sanitation, accessibility and convenience of participants, and efficiency of service, and shall include the following:
1. Using correct portion sizes (and utensils) as specified on approved menus;
2. Adherence of staff and volunteers to food sanitation requirements, as prescribed by applicable Federal, State and local rules and regulations. County health departments have the right of amendment to add requirements to State rules and regulations. The higher of the two sets of standards shall apply;

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304.19 ALTERNATIVE MEALS

Individual Service Requirements
3. Taking and recording food temperatures daily to document that safe temperatures are maintained;
4. To prevent cross-contamination, kitchenware and food-contact surfaces of equipment shall be washed, rinsed and sanitized after each use and following any interruptions of operations during which contamination may have occurred;
5. Food shall be available to participants for at least 30 minutes after serving begins;
6. Providers shall make available to people with disabilities food containers and utensils appropriate for their needs;
7. After offering additional servings to participants if appropriate, program providers may donate unconsumed food products to other charitable community social service of public service organizations. Providers that make such donations shall obtain a "hold harmless" agreement from the receiving organization, that protects the provider from any liability (see Appendix 304-C "Hold Harmless Guidance");
8. Providers shall not arrange for or provide covered dish meals at nutrition sites or other locations, using any funds which are administered through the contract with the AAA to support the cost of such activities.
Picnic, special occasion, holiday and weekend meals must meet the nutrient targets outlined in Appendix 304-B; meet temperature requirements for hot and cold foods; and must be prepared in a commercial food service or on-site kitchen.
Shelf-stable, dehydrated, chilled, and frozen meals must meet the nutrient targets outlined in Appendix 304-B; and applicable temperature standards.
Package labeling must be legible and show:
the packaging date,
list of food items,
storage instructions, and
instructions for preparation of safe thawing and reheating, or reconstituting.

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304.20 FOOD STORAGE AND SAFETY

All rules and regulations governing food service stated by the Georgia Department of Public Health (511-6-1) shall apply for congregate and home delivered meal programs.
Refer to references section for web link.

304.21 HOLDING TIME

Providers shall assure that holding times for hot foods do not exceed four (4) hours from the final stage of food preparation until the meal is served to the participants, including delivery to the homes of home delivered meal participants.

304.22 MEAL DELIVERY

Providers shall develop and implement procedures for assuring safe meal delivery in accordance with applicable food service and safety rules and DAS requirements for holding times. Meals shall not be left in coolers or other containers outside the house or dwelling as proper temperatures may not be possible in this environment.

304.23 NUTRITION SCREENING

Nutrition screening begins at the AAA with the administration of the Nutrition Screening Initiative DETERMINE (NSI-D) Checklist as part of the intake and screening process.
The AAA may allow congregate meal sites with no waiting lists to perform initial applicant intake and screening directly. Congregate meal providers shall complete the checklist thirty (30) days after services begin, and at a minimum, annually thereafter, or at any time a change in the participant's condition or circumstances warrants.
The AAA and provider(s) jointly (or case management, if used) shall develop protocols to assure that applicants/recipients whose NSI-D score is 6 or greater receive or are referred for:
a comprehensive nutrition assessment, when indicated;
nutrition counseling, if indicated;
their primary health care provider(s) for follow-up; and
any other assistance or services needed

304.24

Area Agencies and nutrition service providers are to work collaboratively to identify or develop resources for the provision of nutrition assessments for

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NUTRITION ASSESSMENT

Individual Service Requirements
persons at high nutrition risk and/or those with low food security. Registered Dietitians and other qualified professional (example: Dietetic Technician, Registered) may conduct nutrition assessments.

304.25 NUTRITION EDUCATION

Each provider shall develop written nutrition education programming, including a calendar, documentation of subject matter, presenters, and materials to be used, in accordance with requirements below.
The RD may develop a single educational curriculum that may be used by multiple sites. The provider may develop curriculum, however the RD will review and approve all nutrition education content and materials. The RD is not required to approve nutrition education from reliable sources (USDA, Universities, etc.)
Providers shall assure that nutrition education content and materials are developed to be consistent with the nutritional needs, literacy levels, and vision and hearing capabilities, as well as the multi-cultural composition of participating older adults. Providers shall make available print materials that are sufficiently large (14 point or larger), use clear and common typefaces (such as Arial, Verdana, Georgia, or Times New Roman), and in language that is appropriate for the educational levels and cultural backgrounds of the participants.

CONGREGATE

Each nutrition service provider shall maintain written documentation of programs presented to verify that the requirements are met.

Sessions shall be provided at least once monthly consisting of a session of not less than 15 minutes in length.

HOME DELIVERED Education materials will be included with the meal delivery at least once per month.

304.26 NUTRITION COUNSELING

The AAA or provider (or case management, if used) shall develop protocols to determine those participants with special nutrition needs who would benefit from individual counseling and assure that such counseling is made available by qualified professionals.
Individual counseling may not be indicated, regardless of the level of nutritional risk if the person would not benefit from the counseling due to:
cognitive impairments or otherwise could not participate in the development of a nutrition care plan, or

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304.27 SERVICE ACTIVITIES

Individual Service Requirements
the documented opinion of a social service or health care professional that the person would not comply with a nutrition care plan.
In addition to identifying, assessing and referring individuals to a nutrition program, the following service activities are meant to enhance the core services and allow individuals to remain independent in the community.
1. The provision of meals, wellness activities, and nutrition education in a group setting at a nutrition site, senior center, or multipurpose senior center, and ongoing outreach to the community;
2. Access by participants to nutrition screening and assessment, nutrition education, and counseling on an individual basis, when appropriate;
3. Access to the congregate site through transportation services;
4. Shopping assistance, and increasing access to healthy foods;
5. Evidence-based wellness programs, and;
6. Appropriate referrals to other services/resources.

304.28 SCHEDULE OF SERVICE

The service provider shall provide home delivered meals as proscribed by contract and in accordance with the frequency requirements in the Older Americans Act Section 336 (42 U.S.C. 3030f). Individual meal service and frequency shall be based on the determined needs of each individual.

304.29 TEMPORARY HOME DELIVERED MEALS FOR REGISTERED CONGREGATE MEAL PARTICIPANTS

Temporary home delivered meal service may be provided to registered congregate meal site participants who are ill, incapacitated, or temporarily homebound, at the discretion of the AAA. An additional provider assessment for home delivered eligibility is not required for this service. Funding for these temporary home delivered meals should be charged to the congregate meal program. When providing this service, only the meal cost and cost of delivery are to be included. An eligible homebound congregate meal participant may receive up to twenty (20) consecutive home delivered meals.

Receipt of more than 20 consecutive home delivered meals shall require: an assessment of the individual's need for continued home delivered meal service and their corresponding placement on the waiting list (if needed) and/or

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referral to gateway for additional resources (if appropriate).

304.30 WEATHERRELATED EMERGENCIES, FIRES, AND OTHER DISASTERS

The provider agency shall make facilities, equipment, and services available to the fullest extent possible in emergencies and disasters, according to the AAA regional emergency/disaster plan.
The provider agency shall develop and implement written procedures to provide for the availability of food to participants in anticipation of and during emergencies and disasters, including contingency planning for delivery vehicle breakdowns, inclement weather, shortages in deliveries, food contamination, spoilage, etc.

Minimum implementation guidelines include:

1. Creating a functional matrix that plots out key emergency functions and responsible parties.

2. Spelling out actions in the matrix that apply to events and hazards most likely to occur in the service area (natural and human-made events like weather emergencies, chemical spills, major power outages, disease outbreaks, etc).

3. Specifying conditions for adapting the plan as needed to meet unforeseen circumstances.

4. Planning for federal disaster takeover.

The guidelines and sample plan from Meals On Wheels Association of America can be used.
http://www.mowaa.org/Document.Doc?id=38

304.31 FACILITY ACCESS AND SAFETY

All nutrition sites shall comply with the Americans with Disabilities Act requirements, and with any other relevant DAS standards or program requirements relating to access and safety. Facility requirements for senior centers which house congregate meal programs are found in DAS Manual 5300 Section 200, Chapter 206.

304.32 MENU MONITORING

Each nutrition service provider shall retain on file each menu with meals as served, for monitoring purposes. If providing services at multiple sites, each site must have a copy of the menus with meals as served.

304.33

Providers shall conduct outreach activities with emphasis on identifying potential program participants who are among those in greatest social and

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NUTRITION OUTREACH

economic need. Providers shall refer potential participants to the Area Agency for intake and screening, when appropriate, according to the procedures developed by the AAA. Outreach strategies and contacts will be documented.

304.34 CONDITIONS FOR REFERRAL TO OTHER SERVICES

When appropriate, service providers shall work with the AAA (or case management, if available) to refer participants to other service resources that may be able to assist with remaining independent and safe in the home, and/or to assist caregivers with maintaining their own health and well-being.

304.35 ADMINISTRATIVE RESPONSIBILITIES OF NUTRITION SERVICE PROVIDERS

All providers shall comply with all provisions for nutrition services contained in the Older Americans Act, as amended.

304.36 COMPLIANCE WITH OTHER LAWS AND REGULATIONS

Each provider agency shall use procedures that comply with all applicable state and local fire, health, sanitation, and safety laws and regulations. All food preparation, handling and serving activities shall comply with applicable requirements as found at 290-5-14 of the Administrative Rules and Regulations of the State of Georgia (website in References).

304.37 FOOD BORNE ILLNESS COMPLAINTS

The provider shall report to local health authorities within 24 hours of receiving complaints involving two or more persons with symptoms of food borne illness within a similar time frame after consuming food supplied through the nutrition service program. Providers shall report any complaints regarding food borne illness to the contracting AAA within two business days of receipt.

304.38 MANAGEMENT AND OVERSIGHT OF THE NUTRITION PROGRAM

The provider shall identify an individual who is responsible for the overall management of nutrition services and compliance with performance standards, requirements, and procedures. This person, and any other employee(s) responsible to food service management, shall be ServSafe certified, as required by the state.

www.servesafe.com

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304.39 STAFF ORIENTATION AND TRAINING

The service provider shall assure that orientation and ongoing training for administrative and direct service staff and volunteers shall be adequate to5 provide safe, appropriate, and efficient services to older adults, and compliance with all applicable requirements and procedures. Providers shall document and maintain records of all content and dates of orientation and training for monitoring purposes. Providers may offer additional topics.

304.40 HEALTH INSPECTIONS

It is the responsibility of the nutrition service provider to obtain required health inspections and certificates from the appropriate local health authorities, and post the annual certificates in each facility. Any facility that handles food in any capacity (cooking, warming, plating, etc) must have a current health inspection.

304.41 RECORD KEEPING AND REPORTING

Providers shall comply with all record keeping and reporting and retention requirements as prescribed by DAS in MAN5600, Section 3012. Documentation requirements specific to food service include, but are not limited to:

Daily records documenting persons who receive meals;

Perpetual and physical inventory records for all foods, if meals are prepared on site;
Food cost records, including raw food costs for eligible NSIP meals;
Documentation of daily temperature checks for congregate meals and bi-weekly checks for home delivered meals;
Documentation of daily meal reports;
Documentation of participant feedback, and the method used to obtain feedback on a routine basis.

304.42 CONTRIBUTIONS

Providers shall allow participants the opportunity to make voluntary contributions in support of the program, in a manner that protects their confidentiality.
Refer to Manual5600, Sections 2025, 2026, 2027, and 2028 for full guidance.

304.43 NUTRITION SERVICES

The purpose of NSIP in part, is to reduce hunger and food insecurity, promote socialization, promote health and well-being, and delay adverse health conditions for older individuals.

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INCENTIVE PROGRAM (NSIP)

NSIP funding is to be used exclusively to purchase domestically produced food.
AAAs shall use the raw food cost from the uniform cost methodology for reimbursement.
Meals eligible for NSIP funding are those that:
1. Meet the nutrition targets outlined in Appendix B (unless the meal has been modified for medical reasons, as prescribed by a physician);
2. Are served to eligible individuals; and 3. Are served by a nutrition service provider that is under the jurisdiction,
control, management, and audit authority of the State Unit on Aging or the AAA.

304.44 PROVIDER QUALITY ASSURANCE AND PROGRAM EVALUATION

Each nutrition program provider shall develop and implement an annual plan to evaluate and improve the effectiveness of operations and services to ensure continuous improvement in service delivery.
The evaluation process shall include:
A review of the existing program;
Satisfaction survey results from participants, staff, and volunteers;
Program modifications made that responded to changing needs or interests of participants, staff or volunteers; and
Proposed program and administrative improvements
Each provider shall prepare and submit to the AAA annually (no later than September 30th) a written report that summarizes the evaluation findings, improvement goals, and implementation plan for each site.
Providers that also operate senior centers shall incorporate the evaluation of the nutrition program into the annual senior center program evaluation.

304.45 MONITORING BY SERVICE PROVIDER

Each provider will monitor and document daily that temperatures of hot or cold food received from vendors are within acceptable ranges upon delivery to the site. Providers will monitor no less than twice per month and document the temperature of the last meal delivered on a given delivery route to assure that holding times, safe temperatures, and quality of meals are maintained.

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Providers shall select routes randomly for monitoring. Providers will maintain this documentation in accordance with DAS policy, MAN 5600, Section 3015.

304.46 INDIVIDUAL'S RIGHTS AND RESPONSIBILITIES AND COMPLAINT RESOLUTION

Nutrition service providers, including AAAs, if applicable, shall assure that participants, or their caregivers/representatives, receive written notice of their rights and responsibilities upon admission to the program, according to Manual5300, Chapter 202, General Service Requirements. For ongoing participants, the information may be provided at the next re-assessment.

304.47 AAA RESPONSIBILITIES FOR THE NUTRITION SERVICES PROGRAM

The AAA shall develop and implement any necessary additional policies and procedures for the following:
Compliance with the Older Americans Act, with regard to the older adult nutrition program
Program evaluation activities, including conducting periodic evaluations of assessment, reassessment and nutrition risk information for congregate and home delivered meals participants to assure that those persons in greatest need are being served and that desired outcomes are achieved
Verification that all providers comply with NSIP funding rules; only eligible meals are funded through NSIP; and that cash will be used to purchase only food grown or commodities produced in the United States.
The election to allow providers to provide meals to volunteers, guests, and staff

304.48 COMPLIANCE REQUIREMENTS

AAAs are responsible for:
1. Assuring that all meals served meet requirements (see Requirements for Meals earlier in the document);
2. Establishing procedures for consistent AAA management of waiting lists and communications with nutrition providers regarding referrals to and openings in the program;
3. Assuring that service provider staff has made appropriate arrangements for providing meals in emergency situations or disasters, with emphasis on plans for providing services during periods of inclement weather, particularly to people residing in geographically remote areas.

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304.49 STAFFING FOR NUTRITION PROGRAM CONTRACT MANAGEMENT DUTIES

The AAA shall designate one or more staff to manage the nutrition service contracts or obtain the services of consultants to coordinate with staff for the management of nutrition service contracts. The minimum qualifications for staff or consultants shall be:
Satisfactory completion of a DAS-approved course in food safety, food protection, or equivalent (ServSafe); or
Licensure through the state of Georgia as a registered dietitian.
Refer to Manual5600, Section 3014: AAA Contract Management Requirements

304.50 COMPLIANCE MONITORING

The AAA shall monitor each nutrition service provider and individual provider site at least once annually within the first six months of the contract year, placing additional emphasis on monitoring more often those sites that continue to demonstrate substantial non-compliance for the previous year, or new provider(s)/site(s).
Monitoring forms provided from DAS are the preferred tool. If an AAA uses its own forms, all information on the DAS forms must be included.
Refer to Manual5600, Section 3015: AAA Monitoring and Evaluation of Service Providers

304.51 NEGOTIATION OF CONTRACTS

Using the Uniform Cost Methodology and principles or performance-based contracting to procure congregate and home delivered meal services, AAAs shall assure that potential subcontractors establish a base meal cost. AAAs shall base reimbursement rates on actual cash costs, excluding estimates of volunteer time, and the value of contributed goods and services. The base meal cost shall be the basis for negotiation between the AAA and any respondents to requests for proposals.
Area Agencies may waive the use of the Uniform Cost Methodology by food vendors if the vendor provides a meal unit cost with similar food cost categories.
Costs of services other than the base meal rate must be accounted for in other service categories.
The AAA has the authority to renegotiate reimbursement rates during the contract period, based on documentation from the provider that identifies additional costs and the rationale for including any additional costs as necessary and reasonable to the provision of meals.

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304.52 PROGRAM PLANNING AND EVALUATION

Individual Service Requirements
Refer to Manual5600, Section 3014: AAA Contract Management Requirements
On an annual basis, the AAA shall analyze individual and cost data, in addition to compliance monitoring results, to identify necessary program improvements. The AAA shall involve the provider(s) in the evaluation process and provide written feedback regarding required corrective actions or program improvement initiatives.

304.53 AAA QUALITY ASSURANCE AND PROGRAM EVALUATION

Area Agencies shall assure that each nutrition program provider develops and implements an annual plan to evaluate and improve the effectiveness of operations and services to ensure continuous improvement in service delivery.
The evaluation process shall include:
A review of the existing program (including retention rates);
Satisfaction survey results from participants, staff, and volunteers;
Program modifications made that responded to changing needs or interests of participants, staff or volunteers; and
Proposed program and administrative improvements.
Each provider shall prepare and submit to the AAA annually (no later than September 30th) a written report that summarizes the evaluation findings, improvement goals, and implementation plan for each site.
Providers that also operate senior centers shall incorporate the evaluation of the nutrition program into the annual senior center program evaluation.

304.54 FISCAL MANAGEMENT

Contractors providing nutrition services shall practice sound and effective fiscal management and planning, financial and administrative record keeping and reporting. Contractors will use the Uniform Cost Methodology to analyze, evaluate and manage the costs of the program on an annual basis.
Refer to MAN 5600, Appendix G

REFERENCES

http://www.nal.usda.gov/fnic/foodborne/wais.shtml , maintained by the USDA Food and Nutrition Service for information and resources on food safety.

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Websites which may assist in the development of nutrition education materials include http://www.livewellagewell.info/, http://www.uri.edu/ce/ceec/food/consumer.html http://extension.uga.edu/food/
Georgia Department of Public Health Rules and Regulations Governing Food Service http://dph.georgia.gov/sites/dph.georgia.gov/files/related_files/site_page/EnvHealthFi nalFoodRules.pdf
ServSafe http://www.servsafe.com
MOWAA Disaster Planning Sample and Guide http://www.mowaa.org/Document.Doc?id=38
Dietary Guidelines for Americans 2015-2020
http://health.gov/dietaryguidelines/2015/guidelines/appendices/

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Appendix 304-A
Evaluation of Individuals for Appropriate Meal Type
When considering providing a meal to homebound individuals, as either a routine method of meeting part of their nutritional needs or in planning for continuity of services in emergencies, Area Agencies and/or provider staff are responsible for assessing the appropriateness of meal types for each person who will need them. These types include hot, frozen, chilled, or shelf stable meals.
Such meal types may not be appropriate if:
The individual's home lacks proper appliances for food storage and preparation, and adequate space for proper storage of multiple meals, if a supply for an extended period of time is planned.
The individual has physical or cognitive impairments that limit his/her ability to prepare or safely reheat the meals, and/or eat without assistance.
The Determination of Need-Revised (DON-R) assessment at the time of intake provides information about the person's functional abilities, specifically in the area of eating and meal preparation. It also provides indicators of possible cognitive impairment which may affect the person's functional capacity.
The assessor will use this information, as well as additional information on the physical conditions of the home, to determine the appropriateness of the alternate meal type. The assessor will make a home visit to visually inspect the cooking facilities and availability and condition of equipment and utensils.
The assessor will document the evaluation findings in the individual's file, using the following form, or otherwise capturing the required data. Staff responsible for periodic individual reassessment will reverify and document the individual's status and continuing appropriateness for alternate meals, if such meals are part of the ongoing care plan.

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Individual/Home Evaluation for Alternate Meal Types

Individual Name: _______________________________________________ Evaluation Date: ____________

Client ID: _____________________________________________________________________________

Agency Name: ________________________________________________________________________

Evaluation Completed By__________________________________

Eating:

Is the individual able to feed himself/herself? Assess the individual's ability to feed him/herself using routine or adapted table utensils and without frequent spills. Address the individual's ability to chew, swallow, cut food into manageable size pieces, and to chew and swallow hot and cold foods/beverages.

Score 0

The individual can eat, with or without an assistive device.

1 -- The individual can eat, with or without an assistive device, but requires some verbal or physical assistance in some or all components of the activity.

2 -- The individual cannot eat, even with an assistive device, and/or requires a great deal of verbal and/or physical assistance.

3 -- The individual cannot perform any of the tasks of eating.

Availability of assistance with eating.

If the individual scores at least (1) in impairment level, determine whether someone is

available to assist and/or motivate the individual in eating.

Need for assistance with eating

Score 0 --

The individual's need for assistance is met to the extent that there is no risk to health or

safety if current level of assistance is maintained or no other assistance is added.

1--

The individual's need for assistance is met most of the time, or there is minimal risk to the

individual's health or safety is additional assistance is not acquired

2--

The individual's need for assistance is not met most of the time; or there is moderate risk to

the individual's health/safety if additional assistance is not acquired;

3--

The individual's need for assistance is seldom or never met; or there is severe risk to the

health and safety of the individual.

Who, if anyone, is available to provide assistance? ___________________________________________________ How often will assistance be provided? ____________________________________________________________

Preparing Meals
Is the individual able to prepare a meal, including re-heating frozen or chilled meals? Assess the ability to open containers, to use kitchen appliances, and to clean up after the meal, including washing, drying and storing any utensils used in preparing or eating the meal.

Score 0

The individual can prepare a meal, with or without an assistive device.

1 -- The individual can prepare a meal, with or without an assistive device, but requires some verbal or physical assistance in some or all components of the activity.

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2 -- The individual can prepare a meal, even with an assistive device, and/or requires a great deal of verbal or physical assistance.
3 -- The individual cannot perform any of the tasks of preparing a meal.
Be specific about impairments___________________________________________________________________________________

Need for assistance with meal preparation

If the individual scores at least (1) in this area, evaluate the appropriateness of the meal type being proposed.

Score 0 --

The individual's need for assistance is met to the extent that there is no risk to health or

safety if current level of assistance is maintained or no other assistance is added.

1--

The individual's need for assistance is met most of the time, or there is minimal risk to the

individual's health or safety is additional assistance is not acquired

2--

The individual's need for assistance is not met most of the time; or there is moderate risk to

the individual's health/safety if additional assistance is not acquired;

3--

The individual's need for assistance is seldom or never met; or there is severe risk to the

health and safety of the individual.

Who, if anyone, is available to provide assistance? ___________________________ How often?_________________________

Equipment for Meal Preparation and Storage and Utensils

The individual has in proper working condition:

Yes

Refrigerator

_____

Freezer or freezer compartment

_____

Oven

______

Microwave

______

Toaster Oven

______

The individual has an adequate supply of:

Appropriate utensils for serving and eating ______

Towels/Hot pads or mitts for handling hot food items

______

The individual has an adequate amount of refrigerator/freezer space to store multiple meals if needed.

______

No _____ ______ ______ ______ ______

Not Needed for Meal Type ________ ________ ________ ________ ________

______ ______

_________

_______ _

________

Type of meal recommended: Hot______ Shelf stable ____ Frozen_______ Chilled _______

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Appendix 304-B Georgia Nutrition Program Nutrient Targets for Meals

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Nutrient Targets: Targets may be met as a monthly average, +/-10%

Table 304-F-1

Nutrient

Target Value

*Calories

600

*Protein

17 grams

*Fat

Up to 35% of total calories:

*Saturated Fat

Up to 10% of total calories

*Calcium *Sodium *Potassium *Magnesium *Zinc *Vitamin A *Vitamin B6 *Vitamin B12 *Vitamin D *Vitamin E *Folate *Fiber *Vitamin C

400 milligrams 766 milligrams 1566 milligrams 123 milligrams 3.2 micrograms 300 micrograms 0.57 micrograms 0.8 micrograms 5 micrograms 5 milligrams 133 micrograms > 8 grams > 27 milligrams

*Targets based on 2015-2020 Dietary Guidelines for Americans averaged for Females 51+ and Males 51+

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Appendix 304-C Hold Harmless Guidance

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Hold Harmless
You may have a hold harmless provision in a contract presented to you. You may also choose to include a hold harmless provision in a contract you present to others.
Definition of a hold harmless agreement: A contractual agreement whereby one party assumes the liability inherent in a situation, thereby relieving the other party of responsibility.
Purpose of a hold harmless agreement: To save another party from all legal consequences or from the outlay of any money for defense costs, damages, etc.
Ultimately, a hold harmless agreement transfers the risk from one party to another.
You should include a hold harmless provision in most contracts dealing with contractors or vendors.
Hold Harmless Sample: You should consult your attorney for specific language to meet your specific needs. Additionally, you should refer to your general liability policy for any specific requirements.
"To the fullest extent permitted by law, the (contractor/vendor) agrees to defend (including attorney's fees), pay on behalf of, indemnify, and hold harmless the (entity), its elected and appointed officials, employees and volunteers and others working on behalf of the (entity) against any and all claims, demands, suits or loss, including all costs connected therewith, and for any damages which may be asserted, claimed or recovered against or from the (entity), its elected and appointed officials, employees, volunteers or others working on behalf of the (entity), by reason of personal injury, including bodily injury or death and/or property damage, including loss of use thereof, which arises out of or is in any way connected or associated with this contract." -Sample taken from page 16, Risk Transfer Manual, published by C.M. Althoff Co. 1999.
Mutual Hold Harmless Sample Each party shall defend any third party claim against the other party arising from the death of or physical injury to any person or damage to the indemnified party's property to the extent proximately caused by the negligence of the indemnifying party or its agents or employees, and indemnify and hold harmless the other party and its respective officers, directors and employees from and against damages, liabilities and reasonable costs and expenses, including reasonable legal fees incurred in connection therewith.

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State Plan
2020-2023
Prepared by the Georgia Alzheimer's Disease and Related Dementias State Plan Collaborative Members and Advisory Council Version Date: 10/28/2020

Georgia Al heimer s Disease and Rela ed Demen ias State Plan

The GARD State Plan was developed by the GARD Collaborative and GARD Advisory Council and will be housed by the Georgia Department of Human Services as the administrative body.
I, the undersigned, express support for the State Plan for Alzheimer's Disease and Related Dementias. The State Plan's approval by the governor constitutes authorization to proceed with activities under the State Plan.

Lynne Reeves
________________________________________________

12/16/2020 Date____________________________

Lynne Reeves, Director

Area Agency on Aging of Northwest Georgia

Chairman, Georgia Alzheimer's Disease and Related Dementias State Plan Advisory Council

12/16/2020 ________________________________________________ Date____________________________ MaryLea Boatwright Quinn, Director of Government Affairs Alzheimer's Association, Georgia Chapter Co-Vice Chairman, Georgia Alzheimer's Disease and Related Dementias State Plan Advisory Council

________________________________________________ Date___1_2_/1__6_/2_0_2__0________________ Abby Cox, Director Georgia Department of Human Services Division of Aging Services Co-Vice Chairman, Georgia Alzheimer's Disease and Related Dementias State Plan Advisory Council

________________________________________________ Brian Kemp, Governor State of Georgia

Date____________________________

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TABLE OF CONTENTS
ACKNOWLEDGEMENTS..................................................................................................................................... 4 EXECUTIVE SUMMARY ..................................................................................................................................... 5 INTRODUCTION ............................................................................................................................................... 8 LEGISLATION.................................................................................................................................................... 9 GUIDING PRINCIPLES...................................................................................................................................... 14 STATE PLAN 2020-2023 .................................................................................................................................. 15
RESEARCH AND DATA .............................................................................................................................................. 16 WORKFORCE DEVELOPMENT .................................................................................................................................. 19 SERVICE DELIVERY.................................................................................................................................................... 23 PUBLIC SAFETY ......................................................................................................................................................... 28 OUTREACH AND PARTNERSHIP................................................................................................................................ 33 POLICY...................................................................................................................................................................... 37 RESOURCES.................................................................................................................................................... 40 GLOSSARY ..................................................................................................................................................... 43 REFERENCES .................................................................................................................................................. 47 APPENDIX: STRATEGY ARCHIVE ...................................................................................................................... 48
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ACKNOWLEDGEMENTS
The Georgia Department of Human Services, Division of Aging Services, would like to thank the many individuals across Georgia who shared their thoughts and opinions about the challenges experienced by individuals living with cognitive decline and dementia and their care partners. We especially want to thank the members of the Georgia Alzheimer's and Related Dementias work groups, who dedicated considerable time and energy over several months to revise and refine the plan contents. This input was invaluable to the development of the 2020 Georgia Alzheimer's and Related Dementias State Plan Update. We also want to acknowledge the members of the Georgia Alzheimer's and Related Dementias State Plan Advisory Council, who participated in and supported the work of the state plan update. Their commitment and leadership are greatly appreciated.
x Commissioner Frank Berry, MS, Georgia Department of Community Health x MaryLea Boatwright-Quinn, LCSW, Director of Government Affairs, Alzheimer's Association,
Georgia Chapter x Representative Sharon Cooper, RN, MSN, Chairwoman, House Human Services and Aging
Committee x Abby Cox, MSW, Division Director, Georgia Department of Human Services, Division of Aging
Services x Commissioner Robyn Crittenden, JD, Georgia Department of Human Services x Commissioner Judy Fitzgerald, MSW, Georgia Department of Behavioral Health and
Developmental Disabilities x Lynne Reeves, MBA, RDN, LD, President, Georgia Association of Area Agencies on Aging x Ruth Lee, Chair, Georgia Council on Aging x Allan Levey, MD, PhD, Director, Goizueta Alzheimer's Disease Research Center x Tony Marshall, President and CEO, Georgia Healthcare Association x John Morgan, MD, PhD, Department of Neurology, Augusta University x Representative Jesse Petrea, Chairman, House Human Relations and Aging Committee x Lynn Ross, LMSW, Person Living with Dementia x Kathleen E. Toomey, MD, MPH, Commissioner and State Health Officer, Georgia Department of
Public Health x Senator Ben Watson, MD, Chairman, Senate Health and Human Services Committee
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EXECUTIVE SUMMARY
Introduction
This is the 2020 update to the Georgia Alzheimer's Disease and Related Dementias (GARD) State Plan. In 2013, the Georgia General Assembly created a multidisciplinary task force to assess the state's current and future ability to provide necessary services and programs for Georgians impacted by cognitive decline and dementia and recommend steps to catalyze movement toward dementia capability. Those recommendations, developed through extensive research and input from diverse experts and stakeholders, formed the foundation of the inaugural GARD State Plan, which was signed into action in 2014 by Gov. Nathan Deal. Established by Senate Bill 444, the task force became the GARD Advisory Council, and the 17-member group continues to lead GARD's efforts today.
The 2014 GARD State Plan identified the following six priority areas, and work within each area is currently carried out by six corresponding work groups:
x Research and Data; x Workforce Development; x Service Delivery; x Public Safety; x Outreach and Partnership; and x Policy.
The initial plan established goals for each area accompanied by potential strategies designed to promote advancement toward each goal. Since the inaugural plan was developed, stakeholders have made significant progress within each priority area, and new opportunities to further the work have arisen. Consequently, GARD leadership determined a need to update the plan and continue to do so on a fouryear cycle.
Update process
The 2014 GARD State Plan was updated through a series of facilitated conversations with each work group, as well as input gathered through asynchronous exchanges with work group chairpersons, members, and GARD leadership. Through this process, progress on the initial goals and strategies was documented, feedback was gathered to inform revisions and identify gaps, and, ultimately, updated goals and strategies were formulated that reflect current needs and align with the groups' capacity and available resources. This updated version then underwent further review by the GARD Advisory Council and leadership and was revised based on this feedback before it was finalized and approved.
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Call to Action
The 2020 GARD State Plan update proposes an ambitious undertaking. Progress on the goals and strategies set forth in this plan are dependent upon multiple factors, including consistent, coordinated efforts and support from stakeholders across sectors; available funding; and the capacity of each GARD work group. The ability of the collaborative to effect timely, meaningful change for all Georgians and reduce health disparities also requires the participation of individuals with a range of experiences. It is critical that many perspectives, especially those representing underserved communities, inform this work to ensure our approach is equitable and culturally responsive. All Georgians are welcome and encouraged to join in this effort.
Goals for 2020-2023
Research and Data RD1: Champion and strengthen existing research and data collection related to cognitive decline and dementia diagnosis, care, and support.
RD2: Identify and pursue opportunities to expand research and data collection of dementia-related surveillance, care, and support.
RD3: Support analysis, translation, and dissemination of available dementia-related research and data for sharing with multiple audiences.
Workforce Development WD1: Develop a person-centered, dementia-capable, culturally responsive workforce.
WD 2: Develop and implement a tiered career and training model for Georgia's direct-care workforce to improve job quality and quality of care.
WD3: Improve job quality and retention of the dementia workforce.
Service Delivery SD1: Increase the availability of health and social services tailored for individuals living with dementia and their families.
SD2: Support efforts that provide training for care partners and volunteers in person-centered care.
SD3: Improve consumer access and experience with the service delivery system, focusing on informal service networks not already captured by the Area Agencies on Aging network, public health departments, and health care systems.
SD4: Improve consumer and care partner access to needed services and information, including identifying eligibility criteria for different services.
SD : Strengthen care partners' (family, professional, and/or volunteer) capacity to deliver high-quality services for persons living with dementia and their families.
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Public Safety PS1: Ensure public safety and financial organizations are prepared to assure the safety of persons living with cognitive decline and dementia who are at risk of abuse, neglect, and/or exploitation. PS2: Reduce rates of injury and enhance legal protections for people living with cognitive decline and dementia. PS3: Ensure the inclusion of people living with cognitive decline and dementia and considerations for their unique needs in the state's emergency preparedness plans. Outreach and Partnership OP1: Initiate and maximize opportunities to disseminate accurate, comprehensive, and timely information about dementia risk factors, protective elements, and management to the public. OP2: Educate the public and organizations to become more "dementia-friendly" and dementia-inclusive across all types of dementia. OP3: Expand Georgia's capacity to promote brain health and address the needs of persons living with cognitive decline and dementia, their care partners, and their families through strategic partnerships and resource sharing, the leveraging of existing funding, and accessing new resources. Policy P1: Inform state budgetary, legislative, and regulatory actions that impact individuals living with dementia and their care partners. P2: Promote awareness and implementation of local-level policies that support dementia inclusion and dementia friendliness.
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INTRODUCTION
During the 2013 session of the Georgia General Assembly, legislators created the Georgia Alzheimer's and Related Dementias (GARD) State Plan Task Force, a multidisciplinary group convened to improve dementia research, awareness, training, and care. Starting in June of that year, the six task force members and dozens of experts in diverse fields formed committees, conducted research, and made detailed recommendations. The recommendations formed the core of the GARD State Plan. The document described current demographics, prevalence statistics, and existing resources; analyzed the state's capacity to meet growing needs; and presented a roadmap to create a more dementia-capable Georgia. In June 2014, Gov. Nathan Deal signed the first Georgia Alzheimer's and Related Dementias State Plan.
The GARD Task Force ultimately became the 17-member GARD Advisory Council with membership specified by Senate Bill 444 and appointed by the governor. The GARD Advisory Council is prepared to call for the early, accurate detection of dementia; willing to battle stigma and misinformation; and able to provide an incomparable web of support to families that need it. To support the work of the GARD Advisory Council and Collaborative, a state plan coordinator position was designated within the Georgia Department of Human Services, Division of Aging Services. Continuing with the recommendations from the task force, Georgia's GARD State Plan addresses research and data, workforce development, service delivery, public safety, outreach and partnership, and policy. And undergirding all of these areas is the importance of partnerships -- creating a deeply coordinated statewide team of agencies, nonprofits, businesses, and organizations.
Since the inaugural plan was developed, considerable work has transpired and new opportunities have arisen. Thus, with an update required by Georgia Code section 49-6-90 and guidance from the GARD Advisory Council chairpersons, it was determined that an update to the GARD State Plan was necessary. Utilizing the experience, wisdom, and guidance of GARD leadership, a process for updating the state plan was developed, guiding principles were carefully chosen, and a four-year renewal cycle was established. Feedback was gathered from the GARD Advisory Committee and Collaborative in February and May 2020. From March to August 2020, the GARD work groups have worked to document accomplishments to date and identify high-level goals and specific strategies that will serve as the guide for their work through 2023.
This plan does not purport to address all of the obstacles experienced by individuals living with cognitive decline and dementia and their care partners or the complexities of the public health issues of early detection, risk reduction, and brain health. The intent was to identify the greatest needs, opportunities, and strategies at this time that will continue to build on the foundation that has been established. At its core, the contributors to the update to the state plan seek to clarify the purpose and strategy for each work group in the short- and mid-term. Ultimately, this is an ambitious state plan that seeks to make transformative change and will need to draw on the active engagement of public and private-sector stakeholders. In some cases, implementation of the identified strategies will be dependent on the availability of resources and collaboration of the many partners that it will take to act on these opportunities.
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LEGISLATION
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GUIDING PRINCIPLES
The GARD State Plan update was guided by six principles: (1) Seek opportunities to optimize and grow resources to ensure access to coordinated, evidenceinformed services systemwide. (2) Recognize the value of a collaborative approach to the work; encourage participation, support, and leadership from public and private entities. (3) Consistently assess progress and make changes to policies, systems, and environments that will transform the way we approach cognitive decline and dementia. (4) Prioritize the needs and desires of persons living with and at risk for dementia and their care partners, and engage them in the design, implementation, and evaluation of the strategies. (5) Embrace a life course and person-centered philosophy that recognizes both social and medical needs and values diversity. (6) Actively seek to include voices that have been left out in decision-making in an effort to create meaningful outcomes for underserved populations.
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STATE PLAN 2020-2023
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RESEARCH AND DATA
GOAL RD1: Champion and strengthen existing research and data collection related to cognitive decline and dementia diagnosis, care, and support.
Rationale: Research, surveillance, and data collection are central to advancing our understanding of dementia, developing and ensuring linkage to effective treatments, and improving the quality of care for people living with cognitive decline and dementia and their families.
Strategies
RD1a: Provide and maintain a database of key referral sources as a resource for community physicians to support screening, diagnosis, and management of cognitive decline and dementia.
Time Frame and Measurable Outcomes: x Complete scan of existing databases to establish whether a referral database is already available for use by January 2021. x Disseminate information about database of key referral sources by May 2021.
Key Stakeholders: Georgia Department of Public Health; Georgia institutes of higher education; Georgia Memory Net; Georgia Primary Care Association; Georgia Division of Aging Services
Cost Implications: Dissemination of communication materials could have a cost if printed.
RD1b: Develop and maintain a catalog of existing surveillance data sources on dementia in the state of Georgia, such as the Alzheimer's Disease and Related Dementias Registry and Behavioral Risk Factor Surveillance System's Cognitive Decline and Caregiver modules.
Time Frame and Measurable Outcomes: Complete initial catalog of data sources on dementia by January 2022.
Key Stakeholders: Georgia Department of Public Health; Georgia institutes of higher education; Georgia Memory Net; Georgia Division of Aging Services; Alzheimer's Association, Georgia Chapter
Cost Implications: None anticipated.
RD1c: Develop a protocol by which to provide guidance on the use of Alzheimer's Disease and Related Dementias Registry data to support the enhancement and adoption of quality reporting.
Time Frame and Measurable Outcomes: Publish Alzheimer's Disease and Related Dementias registry guidance by January 2023.
Key Stakeholders: Georgia Department of Public Health; Georgia institutes of higher education; Georgia Memory Net; Georgia Division of Aging Services
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Cost Implications: None anticipated.
GOAL RD2: Identify and pursue opportunities to expand research and data collection of dementia-related surveillance, care, and support.
Rationale: Enhanced funding and collaboration can accelerate research progress, improve data collection, and create opportunities for testing and adopting service innovations.
Strategies
RD2a: Promote the use of the Behavioral Risk Factor Surveillance System's Cognitive Decline and Caregiver modules data with health-related outcome and/or quality measures.
Time Frame and Measurable Outcomes: Disseminate data briefs using Behavioral Risk Factor Surveillance System's Cognitive Decline and Caregiver modules data to promote increased funding for data collection by November 2021
Key Stakeholders: GARD Outreach and Partnership Work Group; Georgia Department of Public Health; Alzheimer's Association, Georgia Chapter
Cost Implications: Minimal to no cost anticipated.
RD2b: Collaborate with the GARD Policy Work Group to review potential legislative and policy changes proposed to enhance Alzheimer's disease and related dementias data collection, usage, and dissemination among state agencies and engage appropriate advocacy partners as needed.
Time Frame and Measurable Outcomes: Complete review of relevant legislation and policy and identify needed revisions by November 2022.
Key Stakeholders: GARD Policy Work Group; Georgia Department of Public Health; Georgia Council on Aging; Alzheimer's Association, Georgia Chapter
Cost Implications: None anticipated.
RD2c: Develop a process to coordinate existing resources and seek additional resources to expand dementia-related research and evaluation.
Time Frame and Measurable Outcomes: Conduct a feasibility assessment for obtaining funding that will enable expanded data collection using the Behavioral Risk Factor Surveillance System's Cognitive Decline and Caregiver modules.
Key Stakeholders: Georgia Department of Public Health; Alzheimer's Association, Georgia Chapter; Georgia institutes of higher education
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Cost Implications: None anticipated.
GOAL RD3: Support analysis, translation, and dissemination of available dementiarelated research and data for sharing with multiple audiences.
Rationale: Data synthesis and dissemination are critical to informing decision-making, ensuring the infusion of innovations, and promoting the adoption of best practices among stakeholders. This is especially important to identify and serve higher burdened populations.
Strategies:
RD3a: Promote the sharing of surveillance data to state agencies, regional commissions, and other planning agencies to encourage and inform data-driven approaches to prevention and services. Time Frame and Measurable Outcomes: Publish a brief tailored to inform community planning efforts related to dementia by August 2023. Key Stakeholders: GARD Outreach and Partnership Work Group; Georgia Department of Public Health; Georgia regional commissions; Alzheimer's Association, Georgia Chapter Cost Implications: Dissemination of the brief could have a cost if printed. RD3b: Evaluate and advocate for enhancement of the extent to which cognitive decline and dementia content is infused in curricula at secondary and post-secondary institutions of higher education in Georgia. Time Frame and Measurable Outcomes: Collaborate with the GARD Outreach and Partnership Work Group to advocate for enhancement of the extent to which cognitive decline and dementia content is infused in curricula at secondary and post-secondary institutions of higher education in Georgia in 2021. Key Stakeholders: Georgia institutes of higher education. Cost Implications: None anticipated. RD3c: Develop outcome measures to inform the implementation of the GARD State Plan and assess the impact of GARD activities. Time Frame and Measurable Outcomes: Publish and disseminate guidance to key stakeholders by January 2022. Key Stakeholders: Georgia Department of Public Health; Georgia Division of Aging Services Cost Implications: None anticipated.
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WORKFORCE DEVELOPMENT
GOAL WD1: Develop a person-centered, dementia-capable, culturally responsive workforce.
Rationale: A workforce that is designed to proactively work with people living with cognitive impairment and dementia, including Alzheimer's disease, is better poised to serve persons living with cognitive decline and dementia and their care partners.
Strategies
WD1a: Determine the size, education/training level, and capacity of the existing workforce. Time Frame and Measurable Outcomes: Complete determination by August 2022. Key Partners: GARD Research and Data Work Group; Office of Workforce Development; the Georgia Department of Public Health; the Georgia Department of Community Health; the Georgia Department of Behavioral Health and Developmental Disabilities; the Georgia Division of Aging Services Cost Implications: None anticipated. WD1b: Encourage/develop person-centered, dementia-specific continuing education for a variety of occupations. Time Frame and Measurable Outcomes: Ongoing Key Partners: Georgia Department of Labor; Georgia institutes of higher education; Alzheimer's Association, Georgia Chapter; Lewy Body Dementia Association (LBDA), frontotemporal dementia (FTD) advocates; other consumers; appropriate professional societies; Southern Gerontological Society; Georgia Gerontology Society Cost Implications: Supported through partnerships and individual Continuing Education Unit (CEU) fees WD1c: Explicitly develop connection to the GARD Outreach and Partnership Work Group and the GARD Service Delivery Work Group to support cross-pollination and ensure the use of similar language and focus on inclusion of people living with dementia and their care partners. Time Frame and Measurable Outcomes: Ongoing Key Stakeholders: GARD Outreach and Partnership Work Group; GARD Service Delivery Work Group Cost Implications: None anticipated.
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WD1d: Develop a "hospital packet" with education and tips for people living with dementia, their care partners, and long-term services and support workers about prevention and hospitalization. Time Frame and Measurable Outcomes: Complete and disseminate "hospital packet" by August 2022 Key Stakeholders: GARD Outreach and Partnership Work Group Cost Implications: None anticipated with the exception of print materials if determined necessary.
GOAL WD2: Develop and implement a tiered career and training model for Georgia's direct-care workforce to improve job quality and quality of care.
Rationale: Job quality and quality of care remain large issues for Georgia. By developing and implementing a career model that can be used for the direct-care workforce, we will be able to ensure quality in both areas.
Strategies
WD2a: Partner with workforce investment boards to support new entrants to direct-care workforce. Time Frame and Measurable Outcomes:
x Create partnerships by August 2021. x Implement pilot training model by August 2023. x Recommend statewide model by 2024. Key Stakeholders: Georgia Health Care Association; LeadingAge Georgia; workforce investment boards; Georgia community and technical colleges; Alzheimer's Association, Georgia Chapter Cost Implications: Seeking grant funds for pilot; braided resource strategy with workforce investment dollars WD2b: Partner with employers/employer associations to encourage and support use of high-quality dementia education/programming. Time Frame and Measurable Outcomes: x Create partnerships by August 2021. x Promotion and support will be ongoing. Key Stakeholders: GARD Service Delivery Work Group Cost Implications: Supported through partnerships and individual or employer-based fees
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WD2c: Develop statewide registry of high-quality, person-centered, and vetted training. Time Frame and Measurable Outcomes: Statewide registry developed by September 2023 Key Stakeholders: Georgia Division of Aging Services; Georgia Department of Labor; Georgia Department of Community Health; LeadingAge Georgia; Alzheimer's Association, Georgia Chapter Cost Implications: To be determined WD2d: Partner with Dementia Friendly Georgia to support workforce training to build community awareness and dementia inclusive competencies. Time Frame and Measurable Outcomes: Support will be ongoing. Key Stakeholders: Dementia Friendly Georgia; Georgia Gerontology Society; Georgia Division of Aging Services Cost Implications: None anticipated.
GOAL WD3: Improve job quality and retention of the dementia workforce.
Rationale: In order to best serve the dementia workforce, it will be important to improve the quality of jobs and retention efforts, as well as increase the attractiveness of this work to potential new entrants.
Strategies
WD3a: Implement statewide turnover data collection for long-term services and supports in Georgia. Time Frame and Measurable Outcomes: Implement data collection tool by August 2023 Key Stakeholders: Georgia Department of Public Health; Georgia Department of Community Health Cost Implications: $25,000 per year for design of tool to be implemented with annual licensure and analysis. WD3b: Support and disseminate "employer of choice" strategies to help employers improve jobs and increase recruitment and retention ("employer of choice" refers to workplaces that are favored by potential employees due to their advantageous workplace practices). Time Frame and Measurable Outcomes: Support and dissemination efforts will be ongoing. Key Stakeholders: Georgia Division of Aging Services; Georgia Department of Public Health; Georgia Health Care Association; LeadingAge Georgia; long-term care services and supports employers; Georgia
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institutes of higher education Cost Implications: None anticipated. WD3c: Educate Georgia workforce commission within the state-level office of the Department of Labor about person-centered, dementia-capable, culturally responsive workforce across occupational categories. Time Frame and Measurable Outcomes: Share information by August 2021 Key Stakeholders: Georgia Division of Aging Services; Georgia Department of Public Health; workforce investment boards; Alzheimer's Association, Georgia Chapter Cost Implications: None anticipated.
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SERVICE DELIVERY
GOAL SD1: Increase the availability of health and social services tailored for individuals living with dementia and their families.
Rationale: Support for individuals living with dementia should include building support systems for families.
Strategies
SD1a: Assess the current availability of tailored health and social services for individuals living with dementia and their families to determine gaps and needs. Time Frame and Measurable Outcomes: Complete assessment by August 2022. Key Partners: GARD Research and Data Work Group; Georgia Office of Workforce Development; the Georgia Department of Public Health; the Georgia Department of Community Health; the Georgia Department of Behavioral Health and Developmental Disabilities; the Georgia Division of Aging Services Cost Implications: None anticipated. SD1b: Develop a strategy to address identified health and social service gaps and needs that applies best practices. Time Frame and Measurable Outcomes: Strategy defined by September 2023. Key Partners: Georgia Department of Labor; GARD Research and Data Work Group; Alzheimer's Association, Georgia Chapter; Area Agencies on Aging network; Family Caregiver Alliance; Georgia Department of Community Health; Georgia Memory Net Cost Implications: None anticipated. SD1c: Collaborate with the GARD Research and Data Work Group to pursue opportunities to identify and address gaps in dementia-related service capacity, access, and quality in Georgia. Time Frame and Measurable Outcomes: Ongoing Key Stakeholders: GARD Research and Data Work Group Cost Implications: None anticipated. SD1d: Assess the current landscape of dementia-friendly telehealth in the state of Georgia, documenting best practices and identifying opportunities for development.
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Time Frame and Measurable Outcomes: Ongoing Key Stakeholders: Georgia Memory Net; Georgia hospitals; Alzheimer's Association, Georgia Chapter; Georgia Department of Public Health; Emory Goizueta Alzheimer's Disease Research Center Cost Implications: None anticipated.
GOAL SD2: Support efforts that provide training for care partners and volunteers in person-centered care.
Rationale: Optimal support for individuals living with cognitive decline and dementia includes efforts to support volunteers, care partners, and professional caregivers, specifically around person-centered care.
Strategies
SD2a: Guide/support efforts to promote the adoption of and training on person-centered best practices for care partners and volunteers across settings. Time Frame and Measurable Outcomes: Ongoing Key Stakeholders: Georgia Department of Labor; the Alzheimer's Association, Georgia Chapter; Culture Change Network of Georgia; Georgia Memory Net; Area Agencies on Aging network Cost Implications: None anticipated. SD2b: Promote the most effective and current care partner education for care partners of individuals living with dementia. Time Frame and Measurable Outcomes: Ongoing Key Stakeholders: Rosalynn Carter Institute for Caregiving; Eden Alternative; Culture Change Network of Georgia; Alzheimer's Association, Georgia Chapter; Area Agencies on Aging network; Emory Goizueta Alzheimer's Disease Research Center Cost Implications: None anticipated. SD2c: Collaborate with the GARD Workforce Development Work Group to ensure consistent and available person-centered care training for volunteers, care partners, and staff. Time Frame and Measurable Outcomes: Ongoing Key Stakeholders: GARD Workforce Development Work Group Cost Implications: None anticipated.
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GOAL SD3: Improve consumer access and experience with the service delivery system, focusing on informal service networks not already captured by the Area Agencies on Aging network, public health departments, and health care systems.
Rationale: Consumer access and experience with service providers is related to uptake of services. In order to increase customer uptake, access and experience need to be addressed.
Strategies
SD3a: Identify best practices for improved connectivity between organizations within the service delivery system. Time Frame and Measurable Outcomes: Best practices identified and shared within the network by September 2022. Key Stakeholders: Georgia Division of Aging Services; Georgia Department of Public Health; Alzheimer's Association, Georgia Chapter; Area Agencies on Aging network; Georgia Memory Net Cost Implications: None anticipated. SD3b: Identify best practices for ensuring services are accessible for individuals living with dementia. Time Frame and Measurable Outcomes: Best practices identified and shared within the network by September 2022. Key Stakeholders: Georgia Division of Aging Services; Georgia Department of Public Health; Georgia Department of Community Health; Alzheimer's Association, Georgia Chapter; Area Agencies on Aging network; Georgia Memory Net Cost Implications: None anticipated. SD3c: Develop guidance or sample protocols as necessary for service providers that promote improved consumer experience. Time Frame and Measurable Outcomes: Outline for guidance and sample protocols developed by August 2021; delivery of guidance and sample protocols ongoing. Key Stakeholders: Georgia Division of Aging Services; Georgia Department of Public Health; Alzheimer's Association, Georgia Chapter; Georgia Memory Net; Area Agencies on Aging network Cost Implications: Minimal cost anticipated.
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GOAL SD4: Improve consumer and care partner access to needed services and information, including identifying eligibility criteria for different services.
Rationale: Consumer and care partner access to dementia-related services and information continues to be an issue for Georgians. Access can be increased by aligning with current efforts around expanding access, addressing transportation challenges, and assessing current data around service uptake.
Strategies
SD4a: Encourage and support efforts to enhance access to information about dementia and dementiarelated services, and support dementia awareness efforts.
Time Frame and Measurable Outcomes: Identify current efforts around expanding access to information by September 2021; support will be ongoing.
Key Stakeholders: Georgia Division of Aging Services; Georgia Department of Public Health; Alzheimer's Association, Georgia Chapter; GARD Outreach and Partnership Work Group; Georgia Memory Net; Area Agencies on Aging network; Georgia Department of Community Health; Georgia Department of Driver Services; Georgia Department of Transportation
Cost Implications: None anticipated.
SD4b: Examine and respond to transportation challenges that individuals living with cognitive decline and dementia and/or their care partners face in accessing services.
Time Frame and Measurable Outcomes: x Identify transportation challenges for individuals living with cognitive decline and dementia and their care partners by September 2022. x Develop response by September 2023.
Key Stakeholders: Georgia Division of Aging Services; Georgia Department of Public Health; Alzheimer's Association, Georgia Chapter; Georgia Memory Net; Area Agencies on Aging network; Georgia Department of Human Services Coordinated Transportation; Georgia Department of Community Health
Cost Implications: Minimal
SD4c: Collaborate with the GARD Research and Data Work Group to examine and document how many people access services that are funded by Medicaid to help inform future services that could be provided. Identify financial barriers to access.
Time Frame and Measurable Outcomes: Initial collaboration and data pull by August 2021; ongoing collaboration.
Key Stakeholders: GARD Research and Data Work Group; Georgia Department of Community Health
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Cost Implications: None anticipated.
GOAL SD5: Strengthen care partners' (family, professional, and/or volunteer) capacity to deliver high-quality services for persons living with dementia and their families.
Rationale: Care partners are often the first point of contact for persons living with cognitive decline and dementia. By building their capacity to respond to challenges and provide referrals, care partners are better able to care for persons living with dementia and navigate available services.
Strategies
SD5a: Evaluate access to and quality of services available for volunteers and care partners along with issues of access to those services using standardized measures where possible. Time Frame and Measurable Outcomes:
x Identify available services for volunteers and care partners by September 2021. x Document issues of access by August 2023. Key Stakeholders: Georgia Division of Aging Services; Georgia Department of Public Health; Alzheimer's Association, Georgia Chapter; Georgia Memory Net; Area Agencies on Aging network Cost Implications: None anticipated. SD5b: Promote evidence-informed materials that provide additional, informal supports for volunteers and care partners. Time Frame and Measurable Outcomes: Ongoing. Key Stakeholders: Georgia Division of Aging Services; Georgia Department of Public Health; Alzheimer's Association, Georgia Chapter; Georgia Memory Net; Area Agencies on Aging network Cost Implications: None anticipated.
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PUBLIC SAFETY
Goal PS1: Ensure public safety and financial organizations are prepared to assure the safety of persons living with cognitive decline and dementia, who are at risk of abuse, neglect, and/or exploitation.
Rationale: Older adults living with cognitive decline and dementia may be at high risk for abuse, neglect, and exploitation. Implementation of programs to educate and prepare public safety and financial organizations will increase awareness of public safety and financial professionals, enhance collaborative processes, and improve outcomes.
Strategies
PS1a: Support the development of specialized regional multidisciplinary teams to (1) respond to and investigate crimes against at-risk adults, including individuals living with cognitive decline and dementia, and (2) relocate victims when needed.
Time Frame and Measurable Outcomes: x Assess the state and document where multidisciplinary teams exist and where there is particular interest in creating one by April 2021. x Using the expertise of existing regional multidisciplinary teams, share information and support the development of at least one new regional multidisciplinary team by October 2021. x Continue supporting information sharing to develop new regional multidisciplinary teams through 2023.
Key Stakeholders: Local law enforcement; first responders; local elder abuse task forces; financial institutions; Georgia Bureau of Investigation; Area Agencies on Aging network; Georgia Division of Aging Services, Forensic Special Initiatives Unit
Cost Implications: None anticipated.
PS1b: Designate and maintain an at-risk adult subject matter expert in each Georgia Bureau of Investigation region to focus on combating crime and providing technical assistance to local law enforcement.
Time Frame and Measurable Outcomes: x Support training efforts where needed, ongoing. x Provide mechanisms for information sharing related to building awareness and knowledge among public safety organizations, ongoing.
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Key Stakeholders: Georgia Bureau of Investigation; local law enforcement agencies; Georgia Division of Aging Services, Forensic Special Initiatives Unit
Cost Implications: None anticipated.
PS1c: Develop brief, accessible training videos for organizations that may identify and provide assistance to persons living with cognitive decline and dementia who are at risk of abuse, neglect, and/or exploitation.
Time Frame and Measurable Outcomes: x Engage members of the GARD Public Safety Work Group and seek representation from all of the target audiences to serve as advisers by March 2021. x Create a list of training topics that could be addressed with brief videos that includes the target audience by June 2021. Topic examples include Mattie's Call, signs of dementia, how to respond to a person presenting with signs of dementia; target audiences include law enforcement, first responders, financial professionals, and Adult Protective Services staff. x Prioritize the list of topics by July 2021. x Collaborate with the GARD Outreach and Partnership Work Group regarding GARD messaging, process for producing the videos, and funding by July 2021. x Assess available funding from stakeholder agencies and external sources by September 2021. x Monitor and reassess availability of funding on a semiannual schedule based on the topics prioritized. x Video production schedule and production based on available funding by 2023.
Key Stakeholders: Local law enforcement; first responders; financial professionals; GARD Outreach and Partnership Work Group; Alzheimer's Association, Georgia Chapter
Cost Implications: Approximately $2,000 - $6,000 per video.
PS1d: Promote existing and emerging opportunities to educate financial professionals about cognitive decline and dementia; risks, prevention, and mitigation of possible financial exploitation and abuse; their authority to report suspected abuse; and the protections for those who report.
Time Frame and Measurable Outcomes: x Connect with the Georgia Division of Aging Services' financial forensic expert regarding existing training and reach with financial institutions by February 2021. x Promote current training through the GARD collaborative and externally, ongoing. x Identify additional opportunities to support education of financial professionals, ongoing.
Key Stakeholders: Area Agencies on Aging network; Alzheimer's Association, Georgia Chapter; the Governor's Office of Consumer Protection; the Georgia Bureau of investigation; the Medicaid Fraud Control Unit; the U.S. Department of Health and Human Services; the U.S. Office of Inspector General;
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GARD Outreach and Partnership Work Group; and the Georgia Division of Aging Services, Forensic Special Initiatives Unit, Adult Protective Services, and Senior Medicare Patrol project
Cost Implications: None anticipated.
Goal PS2: Reduce rates of injury and enhance legal protections for people living with cognitive decline and dementia.
Rationale: Persons living with dementia are at increased risk of hospitalization if in an automobile accident, unsafe or erratic driving, and victimization. These risks can be mitigated through the prioritization of individual rights and utilization of tools, practices, and regulations known to prevent and avoid injury.
Strategies
PS2a: Evaluate existing policies and practices regarding the assessment of driving ability for persons living with cognitive decline and dementia.
Time Frame and Measurable Outcomes: x Review and assess existing policies and practices regarding the assessment of driving ability for persons living with cognitive decline and dementia by January 2022. x Review policies and practices utilized in other states, evidence-informed recommendations from organizations such as the Centers for Disease Control and Prevention by April 2022. x Work with the GARD Policy Work Group to recommend changes to existing driving assessment policies and practices that would increase safety of the public and reduce injuries of persons living with cognitive decline and dementia by June 2022.
Key Stakeholders: Georgia Department of Public Health; Georgia Department of Driver Services; GARD Policy Work Group
Cost Implications: None anticipated.
PS2b: Evaluate state laws regarding powers of attorney and guardianship and make recommendations that will increase autonomy and decrease fraud, abuse, neglect, and self-neglect of persons living with cognitive decline and dementia.
Time Frame and Measurable Outcomes: x Review and assess the state's powers of attorney and guardianship laws and practices by May 2021. x Review other states' laws and practices regarding powers of attorney and guardianship by August 2021.
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x Review recommendations from organizations such as the American Bar Association and the National Guardianship Association by August 2021.
x Work with the GARD Policy Work Group to recommend changes to existing laws and practices that would support autonomy and reduce the likelihood of abuse, neglect, and exploitation of persons living with cognitive decline and dementia by November 2021.
Key Stakeholders: GARD Policy Work Group; Georgia Division of Aging Services, Adult Protective Services; elder law attorneys; Prosecuting Attorneys' Council of Georgia
Cost Implications: Minimal to no cost
PS2c: Increase awareness and utilization of programs and devices that seek to locate individuals prone to wandering.
Time Frame and Measurable Outcomes: x Review available programs and devices available throughout the state by January 2022. x Develop a compendium of information related to wandering that can be shared with medical providers, people living with dementia, and care partners by June 2022. x Share information with the GARD Advisory Council and relevant stakeholders about identified opportunities or gaps related to the availability of programs and devices in the state by August 2022. x Collaborate with GARD Service Delivery Work Group and GARD Outreach and Partnership Work Group regarding increasing access to programs and devices among medical providers to reduce injuries and deaths related to wandering among individuals living with cognitive decline and dementia by November 2022.
Key Stakeholders: Local law enforcement; Area Agencies on Aging network; local elder abuse task forces; Alzheimer's Association, Georgia Chapter; Adult Protective Services; Georgia Bureau of Investigation; GARD Outreach and Partnership Work Group; GARD Service Delivery Work Group
Cost Implications: None anticipated with the exception of print materials if determined necessary.
Goal PS3: Ensure the inclusion of people living with cognitive decline and dementia and considera ions for heir niq e needs in he s a e s emergenc preparedness plans.
Rationale: There is great diversity and disparity in emergency and disaster preparedness plans and communications. There is a need for intensified outreach efforts educating care partners and persons living with cognitive decline and dementia on how to plan and prepare for disasters. Further, improved disaster preparedness planning and coordination among relevant agencies and organizations is needed.
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Strategies
PS3a: Engage partners to develop guidance for state and local emergency management agencies. Guidance should help to ensure that the needs of individuals living with cognitive decline and dementia will be met during evacuation, transportation, and sheltering during a disaster. Time Frame and Measurable Outcomes:
x Review and document learnings acquired through the response to COVID-19 and other emergencies as it relates to the plans and response related to the unique needs of individuals living with cognitive decline and dementia by February 2021.
x Review best practices and plans from other states by May 2021. x Engage a group of stakeholders that includes representatives from the organizations involved in
emergency management to discuss the opportunity to integrate information into existing plans and develop guidance for emergency management agencies by September 2021. x Recommend changes to emergency management plans and agencies to better address the unique needs of individuals living with cognitive decline and with dementia by December 2021. Key Stakeholders: State and local emergency management planning agencies; Georgia Division of Aging Services; Georgia Department of Public Health; Georgia Department of Community Health; Georgia Health Care Association; Alzheimer's Association, Georgia Chapter Cost Implications: None anticipated.
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OUTREACH AND PARTNERSHIP
GOAL OP1: Initiate and maximize opportunities to disseminate to the public accurate, comprehensive, and timely information about dementia risk factors, protective elements, and management.
Rationale: Enhancing public awareness of cognitive decline and dementia is essential to reducing public misconceptions and stigma, as well as encouraging families to seek assessment, care management, and support resources.
Strategies
OP1a: Conduct an environmental scan to identify and organize information from existing needs assessments of populations that are underserved and not connected to resources in the state.
Time Frame and Measurable Outcomes: x Complete environmental scan by August 2023. x Synthesize and organize data to inform material design and outreach strategy development by November 2023.
Key Partners: GARD Research and Data Work Group; Georgia Division of Aging Services; Georgia Department of Public Health; Rosalynn Carter Institute for Caregiving; Culture Change Network of Georgia; Alzheimer's Association, Georgia Chapter; Georgia institutes of higher education
Cost Implications: Environmental scan could involve a cost if conducted by an external contractor.
OP1b: Catalog, brand, and regularly update existing GARD outreach and educational materials and ensure current versions, as well as links to relevant materials from other entities, are available through the GARD website.
Time Frame and Measurable Outcomes: Complete cataloging, branding, and updating of GARD materials and website by July 2021.
Key Partners: Georgia Division of Aging Services; Georgia Department of Public Health; Rosalynn Carter Institute for Caregiving; Culture Change Network of Georgia; Alzheimer's Association, Georgia Chapter; Georgia institutes of higher education
Cost Implications: Dissemination of communication materials could have a cost if printed.
OP1c: Increase efforts to involve people living with cognitive decline and dementia and their care partners in activities to raise public awareness about risk and protective factors and resources and to reduce stigma.
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Time Frame and Measurable Outcomes: Connect with support groups, senior centers, faith-based organizations, and other potential stakeholders to engage people living with cognitive decline and dementia and their families in outreach and education efforts by December 2022.
Key Stakeholders: Rosalynn Carter Institute for Caregiving; Culture Change Network of Georgia; Alzheimer's Association, Georgia Chapter
Cost Implications: None anticipated.
GOAL OP Ed ca e he p blic and organi a ions o become more demen ia-friendl and dementia-inclusive across all types of dementia.
Rationale: Dementia-friendly and dementia-inclusive communities help to ensure people living with dementia and their families are supported, feel respected and engaged, and experience the highest possible quality of life.
Strategies
OP2a: Conduct an environmental scan to identify learnings from Dementia Friends communities in other states and disseminate learnings to support local planning and implementation efforts.
Time Frame and Measurable Outcomes: Conduct interviews with state, community, and organizational leaders engaged in Dementia Friends initiatives by August 2021.
Key Stakeholders: Georgia Division of Aging Services; Georgia Gerontology Society; Dementia Friends network; Alzheimer's Association, Georgia Chapter
Cost Implications: No cost anticipated.
OP2b: Identify and support opportunities to advance progress in communities engaged in dementiafriendly initiatives.
Time Frame and Measurable Outcomes: Compile a list of the contact information for community leads engaged in dementia-friendly or dementia-inclusive initiatives in Georgia by March 2021.
Key Stakeholders: Georgia Division of Aging Services; Georgia Gerontology Society; Georgia Department of Public Health; Culture Change Network of Georgia; Alzheimer's Association, Georgia Chapter; GARD Policy Work Group; communities implementing dementia-friendly initiatives
Cost Implications: No cost anticipated.
OP2c: Recommend strategies to improve/sustain ongoing work in dementia-friendly communities and address gaps related to the development of new dementia-friendly communities across the state.
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Time Frame and Measurable Outcomes: Produce and begin to disseminate a Dementia Friends brief that includes community success stories by November 2022.
Key Stakeholders: Georgia Division of Aging Services; Georgia Department of Public Health; Culture Change Network of Georgia; Alzheimer's Association, Georgia Chapter; GARD Policy Work Group; Georgia Gerontology Society
Cost Implications: Dissemination of the brief could have a cost if printed.
OP2d: Collect stories that highlight the impact of dementia-friendly and dementia-inclusive communities to inform advocacy and funding efforts within the state.
Time Frame and Measurable Outcomes: x Develop a template to use for the collection of stories by January 2021. x Establish a centralized method of storing collected stories by January 2021. x Complete first wave of story collection by August 2021.
Key Stakeholders: Georgia Gerontology Society; Georgia institutions of higher education; Alzheimer's Association, Georgia Chapter; AARP
Cost Implications: Dissemination of communications materials could have a cost if printed.
GOAL OP E pand Georgia s capacity to promote brain health and address the needs of persons living with cognitive decline and dementia, their care partners, and their families through strategic partnerships and resource sharing, the leveraging of existing funding, and accessing new resources.
Rationale: Building and maintaining strategic partnerships, sharing information and resources, and pursuing new resource opportunities are vital to the progress and sustainability of GARD's work.
Strategies
OP3a: Identify funding opportunities from federal agencies, corporate entities, and foundations to apply for with partners.
Time Frame and Measurable Outcomes: Complete initial scan by September 2021.
Key Stakeholders: GARD Research and Data Work Group; Georgia Division of Aging Services; Georgia Department of Public Health; Rosalynn Carter Institute for Caregiving; Culture Change Network of Georgia; Alzheimer's Association, Georgia Chapter; Georgia institutes of higher education
Cost Implications: None anticipated.
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OP3b: Identify and promote strategies to engage private-sector organizations to assist in implementing GARD objectives. Time Frame and Measurable Outcomes:
x Collect data on dementia-related main objectives and current activities of public and private entities by February 2021.
x Create and maintain a centralized grid of data on relevant entities to identify commonalities and gaps by May 2021.
Key Stakeholders: GARD Research and Data Work Group; Georgia Division of Aging Services; Georgia Department of Public Health; Rosalynn Carter Institute for Caregiving; Culture Change Network of Georgia; Alzheimer's Association, Georgia Chapter; Georgia institutes of higher education Cost Implications: None anticipated. OP3c: Develop an action plan to promote public awareness of the objectives of the state and national plan. Time Frame and Measurable Outcomes:
x Complete action plan by August 2021. x Initiate engagement in promotion activities by December 2022. Key Stakeholders: GARD Research and Data Work Group; Georgia Division of Aging Services; Georgia Department of Public Health; Rosalynn Carter Institute for Caregiving; Culture Change Network of Georgia; Alzheimer's Association, Georgia Chapter; Georgia institutes of higher education Cost Implications: Dissemination of communication materials could have a cost if printed.
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POLICY
Goal P1: Inform state budgetary, legislative, and regulatory actions that impact individuals living with cognitive decline and dementia and their care partners.
Rationale: There is a significant opportunity to address the needs of Georgians living with cognitive decline and dementia and their care partners through state-level public policy efforts.
Strategies
P1a: Develop a selection process for the determination of the annual state-level policy platform.
Time Frame and Measurable Outcomes: x Draft a process by November 2020 for feedback and testing in preparation of the subsequent legislative session. x Share the process with members of the GARD Collaborative during the November 2020 collaborative meeting and receive feedback. x Test the process in preparation of the 2021 legislative session from November 2020 to March 2021. x Refine and update the process by June 2021.
Key Stakeholders: GARD Policy Work Group; GARD Collaborative; Georgia Council on Aging
Cost Implications: None anticipated.
P1b: In partnership with GARD work groups, develop a state-level policy platform that seeks to promote effective interventions and best practices to protect brain health, support individuals living with cognitive decline and dementia, and meet the needs of care partners.
Time Frame and Measurable Outcomes: x Receive policy issues submitted by members of the GARD Collaborative and members of the work groups annually by November. x Utilizing the process developed, select the state-level policy platform annually by December. x In coordination with the GARD Outreach and Partnership Work Group, develop and disseminate communications materials that provide information regarding the state-level policy platform for the GARD website, sharing with stakeholders, and informing policymakers.
Key Stakeholders: GARD Collaborative; Georgia Division of Aging Services; Georgia Department of Public Health
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Cost Implications: Development of communication materials provided by Georgia Department of Human Services, Division of Aging Services staff. Dissemination of communication materials could have a cost if printed.
P1c: Educate state-level policymakers on the basics of cognitive health and impairment, the impact of cognitive decline and dementia on care partners and communities, and the role of state government in addressing this priority issue. Time Frame and Measurable Outcomes:
x Identify policymakers in committees and positions of relevance annually to share information and resources by January.
x Work with committee members and Advisory Council members to educate policymakers throughout each legislative session.
Key Stakeholders: Members of the Georgia General Assembly; GARD Advisory Council
Cost Implications: None anticipated. P1d: Collaborate with GARD work groups to identify and advance state-level budgetary, legislative, and regulatory issues that are identified through the activities of the work groups. Time Frame and Measurable Outcomes:
x Meet with members of other work groups quarterly or on an ad hoc basis to discuss issues that could be reviewed and considered for the annual policy platform or other initiatives.
Key Stakeholders: GARD work groups; GARD Advisory Council; Georgia Council on Aging Cost Implications: None anticipated.
Goal P2: Promote awareness and implementation of local-level policies that support dementia inclusion and dementia friendliness.
Rationale: County and municipal governments have an opportunity to foster dementia-inclusive and dementia-friendly communities in ways that can support individuals living with dementia and their families to thrive.
Strategies
P2a: Review and assess leadership offered by associations and organizations that provide information and resources related to dementia for county and municipal governments.
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Time Frame and Measurable Outcomes: x Complete an environmental scan that includes key associations and organizations to determine the existing availability of information and resources available by June 2021. x Identify and share gaps and opportunities for the work group with the members of the GARD Policy Work Group and state plan coordinator by July 2021.
Key Stakeholders: Organization and association representatives; county and municipal government elected officials and staff; GARD Outreach and Partnership Work Group Cost Implications: None anticipated. P2b: Develop and make accessible materials and guidance that support county and municipal government elected officials and staff in the journey to dementia inclusion and dementia friendliness. Time Frame and Measurable Outcomes:
x Utilizing the information learned through the environmental scan, develop a strategy for sharing existing resources by September 2021.
x Utilizing the information learned through the environmental scan, prioritize and address three gaps that could be addressed quickly through the development of resources such as white papers, model policies, and sample resolution language by November 2021.
x Continue to address additional opportunities to provide guidance through adding three new white papers or model policies annually.
Key Stakeholders: Organization and association representatives; county and municipal government elected officials and staff; GARD State Plan coordinator; GARD Outreach and Partnership Work Group Cost Implications: None anticipated.
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RESOURCES
The following is a brief list of key state and national resources addressing the needs of persons living with dementia, their families, and care partners. In acknowledgement that this list does not include all existing organizations due to the continually changing landscape of dementia research and resources, this list is limited to the most current and relevant organizations.
Aging and Disability Resource Connection (ADRC), State of Georgia https://www.georgiaadrc.com/ Tel: 866-552-4464 (Select Option 2)
The Aging and Disability Resource Connection (ADRC) partners with multiple agencies at both the state and local levels to streamline access to long-term services and supports by serving as a one-stop shop for consumers' aging and disability-related information, counseling, referral, and planning needs.
Area Agencies on Aging (AAA), State of Georgia https://aging.georgia.gov/locations
Designated as Aging and Disability Resource Connections by the Georgia Division of Aging Services, Area Agencies on Aging support individuals and family members who are aging or living with a disability by alleviating the need for multiple calls and/or visits to receive services. AAAs provide a range of options that allow older individuals and people with disabilities to choose home and community-based services and living arrangements that are best for them. There are 12 regional AAAs across Georgia.
American Parkinson Disease Association, Georgia Chapter https://www.apdaparkinson.org/community/georgia/ Tel: 404-325-2020
The Georgia Chapter provides educational programs featuring topics that relate to Parkinson's disease and to caregivers. The organization's target audience is people diagnosed with Parkinson's disease and their caregivers, and its goal is also to serve the medical community and the community at large by raising awareness of the disease and the treatments and support available.
The Association for Frontotemporal Degeneration (AFTD) https://www.theaftd.org/ Tel: 866-507-7222
The Association for Frontotemporal Degeneration (AFTD) is a nonprofit organization that provides information, education, and support to those living with frontotemporal dementia and their caregivers.
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The Al heimer s Associa ion Georgia Chap er https://www.alz.org/georgia?set=1 Tel: 1-800-272-3900 (24-hour helpline)
The Alzheimer's Association, Georgia Chapter, is a volunteer health organization in Alzheimer's disease care serving 159 counties in Georgia, with offices in Atlanta, Augusta, Columbus, Dalton, Macon, Savannah, and Tifton. The chapter has been serving Georgia communities since 1982 by providing local support groups, education classes, and other local resources.
Creutzfeldt-Jakob Disease Foundation https://cjdfoundation.org/ Tel: 800-659-1991
The Creutzfeldt-Jakob Disease Foundation is a nonprofit organization that offers support, information, and guidance to those dealing with Creutzfeldt-Jakob disease.
Family Caregiver Alliance (FCA) https://www.caregiver.org/taxonomy/term/69 Tel: 800-445-8106
The mission of Family Caregiver Alliance (FCA) is to improve the quality of life for family caregivers and the people who receive their care. For over 40 years, FCA has provided services to family caregivers of adults living with physical and cognitive impairments, such as Parkinson's, stroke, Alzheimer's, and other types of dementia. Services include assessment, care planning, direct care skills, wellness programs, respite services, and legal/financial consultation vouchers.
Georgia Department of Community Health (DCH) https://dch.georgia.gov/ Tel: 404-656-4507
As it relates to Alzheimer's and related dementias, this agency of state government provides rules, regulations, and guidelines for facilities and programs serving a wide array of individuals, including those living with dementia. Such facilities and programs include adult day programs, assisted living communities, nursing homes, and home health agencies.
Georgia Department of Public Health (DPH) https://dph.georgia.gov/ Tel: 404-657-2700
The Georgia Department of Public Health (DPH) helps raise awareness and provides education regarding Alzheimer's and related dementias, conducts a survey providing Georgia agencies and other stakeholders with key information to help shape policy and service for those living with Alzheimer's and related dementias, and is a prime coordinator of stakeholders and partners for the Alzheimer's Disease and Related Dementias (ADRD) Registry.
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Georgia Memory Net https://gamemorynet.org/ Tel: 404-727-1568
The Georgia Memory Net is a statewide early diagnosis and treatment program for Alzheimer's disease and related disorders and dementias, supported by the Georgia Department of Human Services (DHS) and Georgia Alzheimer's Project (GAP). The Georgia Memory Net has five regional Memory Assessment Clinics (MACs) to improve Georgians' access to early and accurate diagnosis of Alzheimer's disease and related disorders, and to improve long-term care and outcomes for patients and caregivers.
Huntington s Disease Society of America (HDSA) https://hdsa.org/ Tel: 800-345-4372 or 770-286-1547
The Huntington's Disease Society of America (HDSA) Georgia Chapter provides educational programs featuring topics that relate to Huntington's disease. The organization's target audience is people living with Huntington's disease and their families. Its goal is also to serve the medical community and the community-at-large by raising awareness of the disease, treatments, research opportunities, and support available locally.
Lewy Body Dementia Association (LBDA) https://www.lbda.org/ Tel: 800-539-9767
Lewy Body Dementia Association (LBDA) is a nonprofit organization providing information and assistance to individuals living with the disease, caregivers, and medical professionals. The Rosalynn Carter Institute for Caregiving (RCI) https://www.rosalynncarter.org/
The Rosalynn Carter Institute for Caregiving (RCI) establishes local, state, and national partnerships committed to building quality, long-term, home and community-based services. RCI focuses on providing caregivers with effective supports to promote caregiver health, skills, and resilience. RCI focuses on helping caregivers coping with chronic illness and disability across the lifespan. RCI's overall goal is to support caregivers -- both family and professional -- through efforts of advocacy, education, research, and service.
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GLOSSARY
Georgia Alzheimer's and Related Dementias State Plan glossary of terms as they relate to this state plan.
Aging and Disability Resource Connection (ADRC) -- This statewide coordinated system of partnering organizations is managed by the Georgia Department of Human Services, Division of Aging Services. ADRC provides information about publicly and privately financed long-term supports and services, offers a consumer-oriented approach to learning about the availability of services in the home and community, alleviates the need for multiple calls and/or visits to receive services, and supports individuals and family members who are aging or living with a disability, including those living with Alzheimer's and those who care for them.
Al heimer s Disease Research Cen er ADRC -- The National Institute on Aging funds Alzheimer's Disease Research Centers (ADRCs) at major medical institutions across the United States. Researchers at these centers work to translate research advances into improved diagnosis and care for people living with Alzheimer's disease, and work to find a treatment or way to prevent Alzheimer's and other types of dementia.
Al heimer s disease -- Alzheimer's (AHLZ-high-merz) is a type of dementia that causes problems with memory, thinking, and behavior. Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks. Alzheimer's accounts for 50 to 80 percent of dementia cases, making it the most common form of dementia (Alzheimer's Association, 201 a).
Assisted Technology -- Assisted technology includes person-specific technology or devices that help individuals with activities of daily living. As it applies to those with Alzheimer's or a related dementia, assisted technology can be used to trigger memory or to perform routine tasks.
Creutzfeldt-Jakob disease (CJD) -- Creutzfeldt-Jakob (CROYZ-felt YAH-cob) disease is the most common human form of a group of rare, fatal brain disorders known as prion diseases. Misfolded prion protein destroys brain cells, resulting in damage that leads to rapid decline in thinking and reasoning as well as involuntary muscle movements, confusion, difficulty walking, and mood changes (Alzheimer's Association, 2016a).
Georgia Division of Aging Services (DAS) -- This division of the Georgia Department of Human Services is the State Unit on Aging for Georgia, which carries out service planning functions as detailed in the Older Americans Act of 1965 as amended. DAS performs this function in collaboration with other members of Georgia's aging network -- namely 12 Area Agencies on Aging and numerous service providers throughout the state. As it relates to Alzheimer's and related dementias, the Georgia Alzheimer's and Related Dementias State Plan will be managed by the Georgia Division of Aging Services.
Georgia Department of Community Health (DCH) -- DCH is one of Georgia's four health agencies serving the state's growing population. DCH provides numerous health care programs and services that benefit the citizens of Georgia, including some of the state's most vulnerable and underserved populations. As it relates to Alzheimer's and related dementias, this agency of state government provides rules, regulations, and guidelines for facilities and programs serving a wide array of individuals,
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including those living with dementia. Such facilities and programs include adult day programs, assisted living communities, nursing homes, and home health agencies.
Dementia -- Dementia is a general term for a decline in mental ability severe enough to interfere with daily life. Dementia is not a specific disease. It's an overall term that describes a wide range of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a person's ability to perform everyday activities (Alzheimer's Association, 201 a).
Dementia-Capable -- Dementia-capable means being able to help people living with dementia and their caregivers. More specifically, being dementia-capable means being skilled in identifying people with possible dementia and working effectively with them and their caregivers, being knowledgeable about the kinds of services needed, and being able to inform or refer to agencies and individuals that provide such services (Alzheimer's Association, 201 b).
Dementia with Lewy bodies (DLB) -- Dementia with Lewy bodies is a type of progressive dementia that leads to a decline in thinking, reasoning, and independent function due to abnormal microscopic deposits that damage brain cells (Alzheimer's Association, 201 a).
Georgia Department of Public Health (DPH) -- DPH is a lead agency in Georgia in preventing disease, injury, and disability; promoting health and well-being; and preparing for and responding to disasters from a health perspective. As it relates to Alzheimer's and related dementias, DPH helps raise awareness and provides education regarding Alzheimer's and related dementias. DPH's Epidemiology Section conducts a survey providing Georgia agencies and other stakeholders with key information to help shape policy and service for those living with Alzheimer's and related dementias. DPH is a prime coordinator of stakeholders and partners for the Alzheimer's Disease and Related Dementias (ADRD) Registry.
Down Syndrome -- Down syndrome dementia develops in people born with extra genetic material from chromosome 21, one of the 23 human chromosomes. As individuals with Down syndrome age, they have a greatly increased risk of developing a type of dementia that's either the same as or very similar to Alzheimer's disease (Alzheimer's Association, 201 a).
Earl S age Al heimer s -- The stage of Alzheimer's where a person may function independently. He or she may still drive, work, and be part of social activities. Despite this, the person may feel as if he or she is having memory lapses, such as forgetting familiar words or the location of everyday objects. Friends, family, or others close to the individual begin to notice difficulties (Alzheimer's Association, 201 a).
Younger-Onset -- Younger-onset Alzheimer's affects people younger than age 65. Many people with younger-onset are in their 0s and 0s (Alzheimer's Association, n.d.).
Frontotemporal dementia (FTD) -- Frontotemporal dementia (FTD) is a group of disorders caused by progressive cell degeneration in the brain's frontal lobes (the areas behind the forehead) or its temporal lobes (the regions behind the ears) (Alzheimer's Association, 201 a).
GARD -- This acronym stands for Georgia Alzheimer's and Related Dementias. GARD can refer to the GARD State Plan, the GARD Task Force, the GARD Advisory Council, or the GARD Collaborative.
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Home and Community-Based Services (HCBS) -- HCBS provide in-home and community-based care that allows older adults and individuals with disabilities, including individuals with Alzheimer's disease and related dementias, to stay independent and close to family and friends (CMS, 2006).
Healthy Brain Initiative -- A partnership between the Centers for Disease Control and Prevention and the Alzheimer's Association to examine how best to bring a public health perspective to the promotion of cognitive health. Resulted in the creation of the publication, The Healthy Brain Initiative: A National Public Health Road Map to Maintaining Cognitive Health, published in 2007, with the most recent update being published in 2018. Some of the specific recommendations contained in the state plan come as a result of this publication (Alzheimer's Association & CDC, 201 ).
H n ing on s disease HD -- Huntington's disease dementia is a progressive brain disorder caused by a defective gene. It causes changes in the central area of the brain, which affect movement, mood, and thinking skills (Alzheimer's Association, 201 a).
Long-Term Services and Supports (LTSS) -- A variety of services that help people with health or personal needs and activities of daily living over a period of time. Long-term care can be provided at home, in the community, or in various types of facilities, including nursing homes and assisted living facilities (CMS, 2006).
Ma ie s Call -- Mattie's Call is a safety alert program first established by the city of Atlanta, then subsequently adopted across the country as the Silver Alert. Local public safety agencies send out alerts through A Child Is Missing organization to seek community assistance in finding a missing adult with the goal of returning the individual safely to his/her family.
Mild Cognitive Impairment (MCI) -- Mild cognitive impairment (MCI) causes a slight but noticeable and measurable decline in cognitive abilities, including memory and thinking skills. A person with MCI is at an increased risk of developing Alzheimer's or another dementia (Alzheimer's Association, 2016a).
Mixed dementia -- Mixed dementia is a condition in which abnormalities characteristic of more than one type of dementia occur simultaneously. Symptoms may vary, depending on the types of brain changes involved and the brain regions affected, and may be similar to or even indistinguishable from those of Alzheimer's or another dementia (Alzheimer's Association, 201 a).
Normal pressure hydrocephalus (NPH) -- Normal pressure hydrocephalus is a brain disorder in which excess cerebrospinal fluid accumulates in the brain's ventricles, causing thinking and reasoning problems, difficulty walking, and loss of bladder control (Alzheimer's Association, 201 a).
Older Americans Act (OAA) -- The Older Americans Act (OAA) of 1965, as amended, calls for a range of programs that offer services and opportunities for older Americans, especially those at risk of losing their independence. The Older Americans Act focuses on improving the lives of older people in areas of income, housing, health, employment, retirement, and community services. Individuals with Alzheimer's and related dementias benefit from many of these services targeted at keeping individuals in their communities longer.
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Parkinson s disease PD -- Parkinson's disease dementia is an impairment in thinking and reasoning that many people with Parkinson's disease eventually develop. As brain changes gradually spread, they often begin to affect mental functions, including memory and the ability to pay attention, make sound judgments, and plan the steps needed to complete a task (Alzheimer's Association, 201 a). Person-Centered -- Person-centered care is a mindset that sees the people using health and social services as equal partners in planning, developing, and monitoring care to make sure it meets their needs. This means putting people and their families at the center of decisions and seeing them as experts, and working alongside professionals to get the best outcome. Plans and services are developed with attention to each person's unique preferences, skills and abilities, and needs (HIN, 2016). Vascular Dementia (VaD) -- Vascular dementia is a decline in thinking skills caused by conditions that block or reduce blood flow to the brain, depriving brain cells of vital oxygen and nutrients. These changes sometimes occur suddenly following strokes that block major brain blood vessels. It is widely considered the second most common cause of dementia after Alzheimer's disease (Alzheimer's Association, 2016a). Wernicke-Korsakoff syndrome -- Wernicke-Korsakoff is a chronic memory disorder caused by severe deficiency of thiamine (vitamin B-1). It is most commonly caused by alcohol misuse, but certain other conditions can also cause the syndrome (Alzheimer's Association, 201 a).
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REFERENCES
Alzheimer's Association. Glossary. Retrieved from https://www.alz.org/help-support/caregiving/careoptions/glossary. Alzheimer's Association (201 a). Basics of Alzheimer's Disease: What It Is and What You Can Do. Retrieved from https://www.alz.org/national/documents/brochure_basicsofalz_low.pdf. Alzheimer's Association (201 b). A public health approach to Alzheimer's and other dementia: Module Dementia capable systems and dementia friendly communities [PDF file]. Retrieved from https://www.cdc.gov/aging/aginginfo/pdfs/ALZ-Module4-Dementia-Capable-Systems-DementiaFriendly-Communities.pdf. Alzheimer's Association and Centers for Disease Control and Prevention (2018). Healthy Brain Initiative, State and Local Public health partnerships to address dementia: The 2018-2023 road map. Chicago: Alzheimer's Association. Retrieved from https://www.cdc.gov/aging/pdf/2018-2023-Road-Map-508.pdf. Centers for Medicare & Medicaid Services. (2006). Glossary. Retrieved from https://www.cms.gov/apps/glossary/. Health Innovation Network (2016). What Is Person-Centered Care and Why Is It Important? Retrieved from https://healthinnovationnetwork.com/wp-content/uploads/2016/07/What_is_personcentred_care_HIN_Final_Version_21.5.14.pdf.
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APPENDIX: STRATEGY ARCHIVE
The 2014 GARD State Plan Strategies were examined through facilitated discussion with each work group. Many strategies were revised and included in the update, while those listed below were archived. Strategies were archived to maintain the historical knowledge of the collaborative, commemorate the achievements of the work groups to date, and to preserve ideas for incorporation into subsequent state plan updates. The 2014 strategies laid the foundation for this initiative and can continue to serve as a resource as the work progresses. Minor wording changes were made to some of the strategies to incorporate positive language that includes words and phrases that address people with dignity and respect.
Research and Data Work Group

Archived Strategy

Status

Implement a State Alzheimer's Disease and Related Disorders Registry to be housed in the Georgia Department of Public Health.
Add comorbidities to the death certificate to better enable tracking of dementia incidence.
Destigmatize dementia and encourage individuals to explore concerns about memory problems with their physicians.
Identify and promote culturally appropriate strategies designed to increase public awareness about dementia.
Recognize cognition as a "vital sign" and assess all Medicare patients during the Annual Wellness Visit under Medicare.
Develop a plan to have the diagnosis of dementia routinely recorded in medical records.
Develop a plan for high-risk populations such as persons with mental illness and developmental disabilities to be screened for dementia and, when diagnosed, to have the diagnosis routinely recorded in medical records.
Provide public health awareness, education, and resource information through the Georgia Department of Public Health and other agencies, with website information and media releases.
Pursue public, private, corporate, and philanthropic funding for broad-based statewide educational campaigns.
Promote positive images of people living with dementia and their caregivers to combat stigma.
Identify and promote strategies designed to increase awareness about dementia, reduce conflicting messages, decrease stigma, and promote early diagnosis.
Coordinate efforts to disseminate evidence-based messages about risk reduction for preserving cognitive health.

Completed
Completed Archived for future
consideration
Archived for future consideration
Archived for future consideration
Archived for future consideration
Archived for future consideration
Archived for future consideration
Archived for future consideration
Archived for future consideration
Archived for future consideration
Archived for future consideration

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Ensure that local Aging and Disability Resource Centers as well as Area Agencies on Aging are aware of and promote existing training and informational materials available to family caregivers, especially those located in rural areas.
Integrate Alzheimer's and related dementias awareness training into existing heart, stroke, and diabetes education programs as the risk factors are interconnected -- via managing the numbers (blood pressure, pulse, cholesterol, and blood sugar). Integrate into the training that what is good for the heart is good for the brain.
Adopt the 16 action items from the Healthy Brain Initiative Road Map that are relevant to immediate implementation to assist states in becoming dementia capable.
Develop protocols and a corresponding training module to help ensure professionals recognize the role of care partners in the care coordination of persons living with dementia.
Increase awareness among health care professionals about care partner health and its importance in maintaining the health and safety of the person living with dementia.
Develop and implement quality standards for dementia care in state-funded services such as Medicaid State Plan services, HCBS waivers, personal care, and nursing homes.
Require that all state contracts providing services to older adults, including those with developmental disabilities and/or mental illness and comorbid dementia, include quality measures specific to dementia-capable care.
Review HCBS waivers and modify as necessary to provide person-centered care for people living with dementia as well as to expand caregiver support services to family members providing care to people living with dementia.
Evaluate the cost and feasibility of developing state and/or federally funded caregiver support programs for caregivers who do not currently qualify for Medicaid services.
Provide care coordination to people living with dementia and their caregivers upon diagnosis to improve access to information on options and resources.
Establish quality care measures with system benchmarks for facility- and community-based care for persons living with Alzheimer's disease and other dementias.
Identify and promote wide use of evidence-based practices through the development of an evidence-based practice guide specific to Alzheimer's care.

Archived for future consideration
Archived for future consideration
Archived for future consideration
Archived for future consideration
Archived for future consideration
Archived for future consideration
Archived for future consideration
Archived for future consideration
Archived for future consideration
Archived for future consideration
Archived for future consideration
Archived for future consideration

Workforce Development Work Group

Archived Strategy
Survey professionals, utilizing information on licensed professionals from the secretary of state's office, the Georgia Board for Physician Workforce, and other entities as necessary. Project the future supply of the workforce and estimate future shortages or surpluses.

Status Completed Completed

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Develop and implement an evidence-based training curriculum and implementation strategies for targeted audiences.

Completed

Recognize agencies and/or organizations that work toward enhancing the wages of the direct-care workforce, the professionalization of direct-care workers, effective coaching, the promotion of direct-care workers' vital role in interdisciplinary teams, and the effective engagement of direct-care workers in care transitions and health IT.

Archived for future consideration

Develop residencies or fellowships for the training of geriatric psychiatrists, geriatricians, and other geriatric specialists.

Archived for future consideration

Develop a specific track on dementia and dementia-related diseases for medical students and residents.

Archived for future consideration

Evaluate the feasibility of a "Bucks for Brains" program to recruit and train geriatric psychiatrists, geriatricians, and other geriatric specialists.

Archived for future consideration

Universities and colleges throughout Georgia, including public entities governed by the Board of Regents and the Technical College System of Georgia, should evaluate existing social, health, and allied health curriculums to ensure adequate basic information is provided on an aging population and Alzheimer's disease and related dementias.

Archived for future consideration

Develop emergency-room specific protocols on appropriate treatment for people living with dementia -- including behavior management strategies.
Ensure that these emergency providers understand the role and partnership of the care partner in the emergency care of the person living with dementia.

Archived for future consideration
Archived for future consideration

Public Safety Work Group

Archived Strategy
The Georgia Bureau of Investigation, Prosecuting Attorney's Council, and DAS collaborated on the development of HB 803. The purpose of HB 803 is to prohibit trafficking of an older or disabled adult and to provide for elements of the crime and punishment.

Status Completed

Georgia Bureau of Investigation and Forensic Special Initiatives Unit have conducted multiple classes of "Responding to Alzheimer's for Public Safety" for approximately 300 public safety officials. The class provides information about issues regarding Alzheimer's and other dementias to increase awareness for public safety officials who encounter adults with dementia.

Completed

Create a network of housing options, personal support services, and other needed services for at-risk adults in need of safe emergency housing due to dangerous situations, such as the absence of a caregiver, wandering, or exposure to potential abuse, neglect, and/or exploitation. The system should have an infrastructure to facilitate access to resources 24/7.

Archived for future consideration

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Provide state-approved forms such as the Georgia Advance Directive for Healthcare, Physician Orders for Life Sustaining Treatment (POLST), and other documents at no cost to the consumer via public libraries, resource centers, and easily accessible websites.

Archived for future consideration

Create a 24/7 emergency access line to Adult Protective Services so that law enforcement and other key community safety net agencies/organizations can reach them during the evening, weekends, and holidays.

Archived for future consideration

Implement an educational program for medical providers to increase the use of the STEADI screening tool -- Stopping Elderly Accidents, Deaths, and Injuries. This evidence-based practice developed by the Centers for Disease Control and Prevention reduces falls, driving injuries, and other accidents experienced by persons with dementia and other at-risk individuals.

Archived for future consideration

Increase awareness of driving assessment programs in Georgia -- to both physicians and families.

Archived for future consideration

Promote programs that (1) ensure home safety through falls prevention programs, home safety assessments, and home monitoring devices; (2) help people with dementia and their families prepare for care and services in the event of a disaster or emergency; and (3) develop employer-supported dementia caregiver training and other employer-supported programs.

Archived for future consideration

Educate caregivers on the importance of home modifications to prevent injury. (Recommendation also noted in Outreach and Partnerships section.)

Archived for future consideration

Service Delivery Work Group

Archived Strategy

Status

Fund a pilot to demonstrate expanded person-centered, evidence-based best practices in long-term care and community-based facilities caring for individuals living with dementia, specifically focused on creating small units (six to 10 residents) based on The Netherlands model.

Completed

Establish criteria which define an effective Alzheimer's/related dementias service delivery system, using other state plans as models, and compile a comprehensive statewide catalog and assessment of Georgia's current service delivery which measures the current system against the proposed established criteria. Funding is necessary to conduct the assessment.

Archived for future consideration

Assign/procure dedicated staff persons or consultants to develop and conduct the assessment.

Archived for future consideration

Identify potential recommendations from other states' plans for consideration (including recommendations that could be implemented prior to completion of the assessment). Resources needed include technical and financial resources to analyze the assessment and implement recommendations.

Archived for future consideration

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Raise awareness that individuals with younger-onset Alzheimer's need services targeted to Archived for future

their specific needs.

consideration

Recognize self-determination at all stages and allow persons living with dementia to contribute to and control their lives as much as possible.

Archived for future consideration

Work with professional licensing and certification entities to require dementia-specific training in relevant licensing, certification, and continuing education initiatives for health care providers.

Archived for future consideration

Train facility staff to view behavioral "problems" as behavioral expressions that are a way for a person living with dementia to communicate. Train care providers to identify the root cause of behavioral expression and then address the cause through an individualized approach focusing on the strengths and preferences of the individual.

Archived for future consideration

Work with professional licensing and certification entities to require dementia-specific training in relevant licensing, certification, and continuing education initiatives for health care providers.

Archived for future consideration

Develop and make small-scale adult day programs more accessible by offering them through existing service providers.

Archived for future consideration

Create policy within facilities that serve people living with dementia to enforce best practice in design, color, texture, lighting, air change ratio, and sound, thereby promoting the safety, security, and well-being of persons living with dementia.

Archived for future consideration

Educate architects and engineers about the impact of architecture and engineering, reflected through design, color, texture, lighting, air change ratio, and sound on the safety, security, and well-being of persons living with dementia. Educate these professionals through preservice and in-service training.

Archived for future consideration

Provide funding and implement innovative models to increase caregivers' access to respite that is provided through in-home respite providers, adult day services organizations, volunteer-based respite programs, and other sources.

Archived for future consideration

Assure that an appropriate discharge plan is developed for each patient being discharged from a hospital, skilled nursing facility, or emergency room. The plan should be made in collaboration with the individual and family, the physician, and the provider.

Archived for future consideration

Assure that all discharge planners in hospitals, skilled nursing facilities, and emergency rooms have access to region-specific resources, including websites and written literature.

Archived for future consideration

Ensure that discharge planners provide families with access to resource information before Archived for future

discharge occurs.

consideration

Fund, implement, and enforce adult day services licensure in order to ensure the quality of Archived for future

providers. Legislation must be passed to secure funding for enforcement of licensure.

consideration

Establish and enforce quality care measures related to personalized practices (personcentered care) for facility- and community-based care for persons with Alzheimer's disease and other dementias.

Archived for future consideration

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Outreach and Partnership Work Group

Archived Strategy

Status

Provide training modeled after the Dementia Friends program in Japan and the United Kingdom.
Develop a marketing and media plan with a message that helps reduce stigma and fear related to dementia. Include the developmental disability community in the target population. Determine branding and implement the plan statewide.
Promote advance care planning and advance financial planning to care partners, families, and individuals living with dementia in the early stages before function declines.
Develop a strategic plan that supports faith- and community-based organizations in their efforts to provide early detection, education, and resources for individuals and families experiencing symptoms of memory loss and dementia. Make training programs available for all faith- and community-based organizations.
Engage organizations as repositories that are currently serving in this capacity.
Create funding mechanisms to support family caregivers to keep their family member living with dementia at home longer by providing reimbursement for personal care services, specialized medical supplies, and respite, for example.
Leverage enhanced funding available through the Balancing Incentive Program to increase access to home and community-based services.

Completed
Archived for future consideration
Archived for future consideration
Archived for future consideration
Archived for future consideration
Archived for future consideration
Archived for future consideration

Page 53

Georgia State Plan to Address Senior Hunger
Division Of Aging Services
December 18, 2017

Table of Contents

Executive Summary

Page

I

Glossary

1

Brief National Overview of Senior Hunger

3

Growth of older adult population

3

Figure 1

Impact of food insecurity on health

4

Food insecurity national demographics

6

Senior Hunger in Georgia

7

Georgia Senior Hunger Definitions

7

Georgia's Senior Populations and Food Insecurity

8

Figure 2

Health impact of food insecurity in Georgia

10

Cost impact of food insecurity in Georgia

11

Gaining a State Wide Perspective

12

Common themes in each focus area

13

5 Impact or focus areas

15

Today's Seniors

15

Health Impact of Senior Hunger

16

Food Access

17

Food Waste and Reclamation

18

Meeting the Community's Needs

19

Recommendations

20

References

22

Appendices Table of Contents

26

I
Executive Summary Food insecurity is influenced by multiple factors and impacts a person's health, well-
being, and quality of life. A 2016 report places Georgia ninth in the nation for the prevalence of food insecurity among people ages 60 and older. The number of older adults in Georgia who currently face the threat of hunger is more than 300,000.
Georgia defines food insecurity as a person or household facing the threat of hunger, lacking safe and adequate food to sustain health and quality of life, and unsure of the accessibility of or the capability to obtain suitable foods in socially acceptable ways.
Good nutrition is a key factor for older adults to maintain well-being and an independent, healthy lifestyle, and in recovering from an illness or an injury. Reasonably priced, wholesome foods are not always accessible to older adults because of the lack of transportation, health problems and disabilities, and the lack of food stores within close proximity for shopping. Onethird of Georgia is a food desert, which makes it problematic for older adults living in these areas to obtain fresh, nutrient-dense food.
The projected growth of older adults aged 65 and over in Georgia is expected to increase 17% by 2032. This rate of growth will push the state's older adult population to over 2 million, which will place the prevalence of food insecurity at more than 360,000 people if the state maintains its current 17.8% growth in older adults facing the threat of hunger. Food insecurity increases negative health outcomes by contributing to and exacerbating disease conditions, and increases medical costs and hospitalizations.
This issue is worthy of attention considering 80% of older adults have at least one chronic disease and 68% have at least two. A person who is not eating a balanced diet with the recommended amounts of calories, protein and essential micronutrients is at a greater risk of

II
malnutrition, especially if the person has a chronic disease. Adequate nutrition and physical activity are well-documented in the role of the prevention and management of chronic health conditions and malnutrition.
Five areas of impact are selected to address and remedy food insecurity issues in Georgia. These areas are: a) Today's Seniors, b) Health Impact of Senior Hunger, c) Food Access, d) Food Waste and Reclamation, and e) Meeting the Community's Needs. Changing the direction of food insecurity in Georgia requires the coordination, cooperation and communication of health care professionals, faith-based and civic groups, communities, government and other resources all working together for the common good of the state's older adult population.

1
Glossary
Activities of Daily Living (ADLs): Basic activities of daily living refer to those activities and behaviors that are the most fundamental self-care activities to perform and are an indication of whether the person can care for one's own physical needs. The activities and behaviors are; eating, bathing, grooming, dressing, transfer in and out of a bed/chair, and bowel/bladder continence. (Determination of Need-Revised (DON-R) Training Manual 1998 Georgia Training and Deployment)
Chronic health condition: Those conditions lasting a year or more and requiring ongoing medical attention or limiting activities of daily living. (National Blueprint: Achieving Quality Malnutrition Care for Older Adults, p. 10)
Comorbidities: The simultaneous presence of two or more chronic medical conditions or diseases that are additional to the initial diagnosis (Mosby's Medical Dictionary)
Cost-related medication nonadherence: Taking less medication than prescribed by a health care professional due to cost (Bengle, et al, 2010, p. 171)
Disability: A disability attributable to a mental and/or physical impairment that results in substantial functional limitation in one or more of the following areas of major life activity: selfcare, receptive and expressive language, learning, mobility, self-direction, capacity for independent living, economic self-sufficiency, cognitive functioning, and emotional adjustment. (Older Americans Act, Section 102(8))
Food bank: A nonprofit, charitable organization that collects donated or surplus foodstuffs and distributes it free or at a low cost to programs or organizations that are serving people in need of assistance. (Compilation of e-dictionaries)
Food desert: a neighborhood or rural town that lacks access to fresh, healthy and reasonably priced food or in which food sources are not within a reasonable proximity to the resident's home.
Food insecurity (United States Department of Agriculture [USDA]): "Food insecurity is a household-level economic and social condition of limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways." (Economic Research Service of the USDA)
Food insecurity (Georgia's working definition): A person or household is considered food insecure when facing the threat of hunger and lacking safe and adequate food to sustain health and quality of life, and is unsure of access or the capability to obtain suitable foods in socially acceptable ways.
Hunger: "Hunger is an individual-level physiological condition that may result from food insecurity. It refers to a potential consequence of food insecurity that, because of prolonged, involuntary lack of food, results in discomfort, illness, weakness, or pain that goes beyond the usual uneasy sensation." (Economic Research Service of the USDA)
Instrumental Activities of Daily Living (IADL): The more complex activities associated with daily life, which are essential to being able to live independently in the community. The IADLs include; managing money, telephoning, preparing meals, laundry, housework, outside home,

2
routine health, special health and being alone. (Determination of Need-Revised (DON-R) Training Manual 1998 Georgia Training and Deployment)
Malnutrition: A state of deficit, excess, or imbalance in energy, protein or nutrients that adversely impacts an individual's own body form, function, and clinical outcomes. (National Blueprint: Achieving Quality Malnutrition Care for Older Adults)
Obesity: > 30 BMI. Weight that is higher than what is considered healthy for a given height is described as overweight or obese. Body Mass Index, or BMI, is used as a screening tool for overweight or obesity. It is not an indicator of a person's overall health. (CDC.gov)
Quality of Life (QoL): The degree to which a person is able to function at a usual level of activity without -- or with minimal -- compromise of routine activities; QoL reflects overall enjoyment of life, sense of wellbeing, freedom from disease symptoms, comfort and ability to pursue daily activities. (McGrawHill Concise Dictionary of Modern Medicine, 2009)
Seniors/Older Adults: Individuals who are aged 60 years of more are considered older adults for the majority of Older American's Act programs. However, some programs begin this designation at 55 and others at 65. For the purpose of the Georgia Senior Hunger State Plan, 60 years old or older is the designation.
Undernutrition: A form of malnutrition characterized by a lack of adequate calories, protein or other nutrients needed for tissue maintenance and repair.

3 Brief National Overview of Senior Hunger

Growth of older adult population and most common health conditions

It is well-documented that the U.S. population is aging in greater numbers than ever

before in history. By the year 2030, the number of adults age 65 and older is expected to reach

74 million (Avalere & Defeat Malnutrition, 2017). (See Appendix I)

The older adult population is projected to reach 82.3 million (21.7% of the total

population) by the year 2040 (Administration for Community Living [ACL], 2016, p. 6). (See

Appendix II)

The report compiled by ACL, "A Profile of Older Americans: 2016," provides the following

data regarding the growth of the older adult population in the United States:

About 1 in 7 -- or 14.9% -- of Americans are age 60 or older.

Between 2005 and 2015, this population increased 34% -- from 49.8 million to 66.8

million. It is projected to be 98 million by 2060. (See Figure 1)

The number of Americans age 45 to 64 who will reach 65 over the next two decades

increased by 14.9% between 2005 and 2015.

Adults reaching age 65 have an average life expectancy of an additional 19.4 years

(20.6 years for women and 18 years for men.)

This change in demographics is noteworthy, considering that most older adults have at

least one chronic health problem, and many have multiple health conditions. The 2016 Profile

shows that seniors spend a larger proportion (12.9%) of their total expenditures on personal

health care compared with other age groups. A compilation of data and reports indicate the

health problems frequently increased when coupled with food insecurity in the older adult

population are:

Depression (233%)

Diabetes (22%)

Hypertension (Men 72%, Women 80%)

Any cancer (32%),

Figure 1 Profile of Older Americans: 2016, Administration on Community Living (ACL) (See Appendix 2)

4

Diagnosed arthritis (53%)

Asthma (2%),

All types of heart disease (35%)

Poor gum health (68%)

Limitations in activities of daily living (32%)

Malnutrition (46%)

(ACL, 2016; Centers for Disease Control and Prevention [CDC], 2016; Kaiser et al., 2010;

Ziliak & Gundersen, 2014)

The prevalence of food insecurity exacerbates these health problems. Food insecurity

has been linked to inadequate nutrition and worsening of disease. Seniors with low intake of

calories, protein and essential micronutrients are at a greater risk for an increase in

osteoporosis, infections, an undesirable weight, restricted physical activity, cognitive impairment

and malnutrition. The lack of adequate nutrition negatively affects diseases that can be

effectively managed with diet and medication, and it may lead to unforeseen health crises. Heart

disease, high blood pressure and diabetes are examples of conditions that can be managed

with balanced diet and appropriate medication.

Food insecurity often leads to undesirable behaviors such as medication nonadherence,

which in turn may lead to early hospital readmission and extended hospital stays. Food

insecurity potentially has greater consequences for older adults when health status and disease

are considered. Authorities on healthy lifestyle choices recognize and support the role that

nutrition and physical activity play in the management and prevention of chronic health

conditions and malnutrition.

Impact of food insecurity on individual health and health care system Prior to 1995, the terms hunger, poverty and unemployment were used interchangeably
in public policy and public health discussions even though they addressed different problems. The Task Force on Food Assistance appointed in 1983 by President Ronald Reagan concluded that hunger referred to the physiological condition and was separate and distinct from food insecurity. The current standardized measure of food insecurity was developed in 1995 and is

5
used in official publications and most other research on this topic. The Economic Research Service (ERS) of the U.S. Department of Agriculture (USDA) defines hunger and food insecurity as follows:
Hunger is an individual-level physiological condition that may result from food insecurity. It refers to a potential consequence of food insecurity that, because of prolonged, involuntary lack of food, results in discomfort, illness, weakness or pain that goes beyond the usual uneasy sensation. (ERS USDA)
Food insecurity is a household-level economic and social condition of limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways. (ERS USDA)
The number of seniors experiencing food insecurity in 2016 exceeded 15%, more than 10 million people. This was 600,000 more people than in 2013, according to the June 2016 annual report, "Hunger in America in the Senior Population," prepared for NFESH (Ziliak & Gundersen, 2016). (See Appendix IV)
Households with limited resources and food insecurity are forced to choose between the basic necessities of food, housing, medical care and medications. Routine visits to the doctor may be postponed until the individual is in a health crisis, and must therefore be seen in acute care or the emergency room, or potentially is admitted to the hospital. Cost-related medication nonadherence behaviors, such as skipping or reducing doses, delaying medication refills or avoiding filling new prescriptions, can lead to a health crisis for an individual and the exacerbation of disease. These situations result in detrimental health consequences and an increase in health care costs, which place an increased burden on the health care system. The costs associated with food insecurity warrant examination considering three-fourths of people

6
age 65 or older have a chronic health condition (Avalere & Defeat Malnutrition Today, 2017). (See Appendix I, p.10)
Food Insecurity National Demographics Research has identified multiple risk factors associated with senior food insecurity.
These include: race, ethnicity, employment status, age, gender, metropolitan versus nonmetropolitan, income, having a disability, and marital status. Older adults who live alone are at a greater risk for food insecurity. Reports indicate that at least 1.2 million seniors in the U.S live alone. The possibility of an older adult being food insecure increases when the person lives in a rural area. A grandchild living in the household with an older adult increases food insecurity to more than twice that of a household without a grandchild, because the grandchild is given priority for having food. Ziliak and Gundersen's 2014 report revealed that food insecurity among people between ages 60 and 64 are approximately 50% higher than those over age 80. Seniors living in the South and the Southwest are consistently at greater risk for food insecurity. Food insecurity is shown to be 8.3% when at least one member of the household is age 65. Racial or ethnic minorities, people with a high school education or less, households with lower incomes and people with a disability are most likely at risk to be food insecure. However, Ziliak and Gundersen's 2016 report reveals that food insecurity also occurs in households with incomes above the poverty line and is present in all races.

7 Senior Hunger in Georgia
The 2017 Ziliak and Gundersen report "The State of Senior Hunger in America 2015" places Georgia as tenth in the nation for the prevalence of a threat of hunger in older adults. This report compares aspects of hunger and food insecurity across the nation. It has been produced annually in partnership with the National Foundation to End Senior Hunger since 2008. (See Appendix IV, p. 6) Georgia considers food insecurity a priority for current and future public health at large, program developers, health care professionals and policy makers. The state recognizes the consequences of food insecurity and is developing a state plan to end senior hunger in Georgia. At the initiation of this project Georgia was ranked ninth in the nation (Ziliak and Gunderson 2016)
Georgia Senior Hunger Initiative Definitions: Food Insecurity and Seniors The USDA food insecurity definition is just one of many in use by various agencies and
organizations. Here is how the Georgia Senior Hunger initiative defines food insecurity:
A person or household is considered food insecure when facing the threat of hunger and lacking safe and adequate food to sustain health and quality of life, and is unsure of access or the capability to obtain suitable foods in socially acceptable ways.
NFESH annual reports characterize food insecurity into the following categories:
Fully food secure Threat of hunger Risk of hunger Facing hunger

8
The category of food insecurity in a household is determined by the number of affirmative responses to questions on the Core Food Insecurity Module (CFSM). (See Appendix IV, p. 3)
The CFSM is considered the standard tool for measuring household food insecurity rates. Georgia utilizes the CFSM 6-item battery of questions. (See Appendix V). For example, a person who answers yes to one or more questions on the CFSM is in the marginally food insecure category of facing the threat of hunger. Georgia defines the terms "senior" and "older adult" as age 60 and over and uses the threat of hunger throughout the proposed Georgia Senior Hunger plan to designate a person food insecure.
Georgia's Senior Population and Food Insecurity
Georgia currently ranks fourth in growth rate of older adults age 65 and older when comparing the state's population in 2010 with 2015 based on the Census Bureau American Community Survey data. Utilizing the same data source, the projected growth of the same demographic group is 17% by 2032 and 18.9% by 2050. The 2009 Ziliak and Gundersen report that examined hunger in rural and urban areas on behalf of the Meals on Wheels Association of America Foundation (MOWAAF), revealed Georgia as one of the top five Southern states with the highest average rates of food insecurity over a six-year data collection time-period (2001 to 2007). (See Appendix VI, p. 21) (See Figure 2)
When compared nationally with other states in 2015, Georgia's 65-and-older population ranked 14th (9.7%) in poverty, 17th (36.5%) in 65-and-older individuals with at least one disability, and sixth (7%) for 60-and-older grandparents living with grandchildren.
Three risk factors for food insecurity are: low income, disability, and grandchildren living in the household. Combining two or more of these risk factors within a single household has a

Figure 2
Ziliak, J.P., Gundersen, C. (2017). The state of senior hunger in America 2015: An annual report. Report submitted to the National Foundation to End Senior Hunger. Lexington, KY: UK Center for Poverty Research, University of Kentucky.

9
multiplier effect, increasing a person's risk for being food insecure. According to the 2015 American Community Survey (ACS) Census data, 11.3% (191,610) of 60-and-older adults in Georgia live in poverty. Overall, 33% (559,561) of Georgia's 60-and-older population have at least one disability. Seniors who are living below the poverty line and are responsible for grandchildren is 23.7%. Of this population, 34% of grandparents 60 and older have a disability. Disabilities add a special constraint to the ability to gain access to and prepare food.
Social isolation is also recognized as a factor that increases the risk of food insecurity. The 2015 ACS Census data for Georgia indicates that 300,000 adults age 65 and older live alone, more than a quarter of that population. (See Appendix VII). The same report revealed that more than 15.7% (186,900) live in rural areas. In 2017, the percentages of people living below the federal poverty level ranges from 12.3% to 30.3%. The percentage of people living at 100% to 200% of the poverty level were 27.8% and 48.1%, respectively. (See Appendix VII)
The Georgia maps indicate people living in poverty are primarily in the rural areas and not in major cities.
Isolation affects the ability to obtain food, as the area may not have available transportation or an easily accessible grocery store with reasonably priced, wholesome foods. Neighbors or family members may not live close by to assist with food shopping or meal preparation for an older adult who is not well or has a disability and is unable to cook. A person is less likely to prepare food and eat alone if another person who lived in the household has died or no longer lives there. Ziliak and Gundersen's 2008 report reveals that social isolation created by the loss of access to emotional and financial support due to changes in life events increases the "likelihood of being at-risk of hunger that is of comparable magnitude to living in poverty" (p. 41). (See Appendix VIII)

10
Health Impact of Food Insecurity in Georgia Food insecurity influences a person's well-being and health care from multiple
perspectives. Older adults in food insecure households often use medication nonadherence as a coping strategy. Bengle, et al. (2010) conducted a statewide study of low-income food insecure individuals who reported cost-related medication nonadherence, and found that the percentage of adherence range between 42.9% for those with drug coverage insurance and 52.6% among those without coverage. A significant number had a previous diagnosis of diabetes and coronary heart disease. Food insecurity exacerbates these chronic conditions, for which expensive prescriptions and dietary treatments are required.
A balanced, nutritious diet, appropriate exercise, a suitable medication regimen and good medical care affect heart disease and diabetes, both of which are leading causes of death in Georgia. Frequently, obtaining foods that provide the required nutrients is problematic for food-insecure households due to lack of accessibility to grocers and/or reasonably priced wholesome foods. The available low-cost food choices are commonly limited to high-calorie, low-nutrient dense foods. The prolonged intake of high-calorie, nutritionally inadequate foods leads to weight gain and establishes an undesirable food intake pattern. A nutritionally inadequate diet may leave a person without enough energy to exercise or complete routine daily tasks. A consistent lack of exercise combined with steady weight gain can lead to obesity, which is frequently seen in low-income populations. Multiple adverse health conditions such as diabetes, arthritis, hypertension, heart and cardiovascular diseases and physical disabilities are prevalent in persons who are obese. It is important to recognize that obesity does not equate to nutritional adequacy or the overconsumption of food.
The combination of disease and food insecurity can increase the risk of or add to the already existing condition of malnutrition that is frequently seen in the older adult population. Diseases can cause lack of absorption, a decrease in appetite, and a decline in the ability to obtain and prepare food for oneself. Medications can have side effects such as nausea,

11
vomiting and altered taste sensation so a person loses the desire to eat. A person who is malnourished does not have the proper nutrients required to maintain health, to heal from an injury or to recover from an illness. Malnutrition increases the chance of infections, worsening diseases and disability. It also increases the possibility of an emergency room visit or hospitalization.
Cost Impact of Food Insecurity in Georgia A study conducted by Goates, Braunschweig and Arensberg (2016) estimated Georgia's
direct medical cost of disease-associated malnutrition for 65-and-older adults at $125,373,000. Protein/calorie malnutrition increases the cost of a hospital stay by approximately $25,200, based on 2016 prices. A malnourished older adult who is admitted to the hospital has a four- to six-day longer length of stay, more comorbidities, a 50% higher readmission rate, and five times the likelihood of death compared with hospital stays of adults without malnutrition.
Recognizing the rise in costs when a malnourished older adult is admitted to the hospital, the Centers for Medicare and Medicaid Services have proposed to adapt the 2017 recommendations of the Malnutrition Quality Improvement Initiative (mqii.today) into a future Hospital Inpatient Quality Reporting Program. "A Profile of Older Americans: 2016" showed Medicare as the primary method of payment for health-care-related expenditures for adults 65 and older. (See Appendix II, p. 13)
Older adults with chronic diseases and/or malnourishment use Medicare more than people who are healthy. Recent research strongly suggests that "up to one out of every two older Americans is at risk for malnutrition" (See Appendix I, p. 11). Addressing the risk factors that perpetuate food insecurity, a decreased quality of life, malnutrition and escalating health care costs within the state's communities, and improving the programs and policies that influence these risk factors, are necessary measures to bring an end to the detrimental conditions that an estimated 307,983 older adults living in Georgia are facing.

12
Gaining a Statewide Perspective To ensure that this plan reflects Georgia both regionally and as a unified state, four
groups of stakeholders participated in collecting data. Those groups are: the Senior Hunger Summit Planning Committee, the Senior Hunger Fighter Workgroups, the participants in 12 regional listening sessions and conference attendees at two statewide aging conferences.
The Senior Hunger Summit Planning Committee initiated the work. The committee represented multiple areas of the state and different aspects of the provision of nutrition services. The group included meal service providers, food banks, directors of Area Agencies on Aging, advocates, county-based agencies, and staff from the Department of Human Services Division of Aging Services (DHS DAS). This group reviewed the state and national research and decided upon the five primary focus areas:
Access to food Impact of senior hunger on health Food waste and reclamation Today's seniors Meeting the needs of the community
The group also worked to develop the senior hunger summit agenda and ensure that outreach was as broad as possible.
During the first Georgia Senior Hunger Summit, the Senior Hunger Fighter Workgroups convened as the final session facilitated discussion groups, and the information was recorded and disseminated to the group. Meetings and conference calls were held for each of the five workgroups reviewing and developing the information. A final conference call was held to distill the initial information into some actionable recommendations. (See Appendix IX)

13
Following the Senior Hunger Summit in 2016, 12 listening sessions were conducted across the aging network planning and service areas through a partnership with the North Highland consulting group and the Georgia Area Agencies on Aging (AAAs). (See Appendices X, XI, XII). Each AAA publicized and hosted the event. Copies of the five topic areas were provided to the attendees ahead of time. The North Highland consultants conducted the listening sessions using multiple methods to capture the information (computer recording of the conversations, Post-it note collections from the participants and follow-up survey).
The final outreach and data collection was held at two statewide aging conferences -the Aging and Disability Resource Connection (ADRC) Healthy Communities Summit 2017, and the Georgia Gerontology Society Annual Conference 2017. During these two sessions, the five focus areas were presented along with emerging themes from the listening sessions. The session attendees were then able to add their comments, concerns and ideas to the information collected. (See Appendices XIII, XIV) Common Themes in Each Focus Area

Food Access Transportation
Food Deserts

Door-through-door service is needed for more frail seniors.
Transportation availability is lacking in urban and rural areas.
Communication between resources needs improvement.
Some rural counties are lacking grocery stores. Distance to grocery stores for seniors without cars is too great.
Alternatives such as general/convenience markets with healthy options need to be explored.
Food delivery services are an option.

Today's Seniors Food Waste and Reclamations

14
Farmers markets and other agricultural options to meet needs.
We need to have an understanding of who is considered a senior for various programs and what generational differences exist. Many seniors care for grandchildren and may defer to their nutritional needs first. Services tend to be offered during week days. Today's seniors need more options.
Clear and consistent policy is needed. Stronger outreach for food collection agencies is needed. Enhancing partnerships may allow for greater reach.

Meeting the Needs of the Community
Better communication of available services needed to prevent duplication. Better communication and partnership with the faith-based community is needed. Partnerships with schools could be helpful.

15
Five Impact or Focus Areas Five areas of focus were selected by the Senior Hunger Summit Planning Committee.
These areas were selected after review of the national hunger reports with the purpose of creating actionable items for Georgia. They are: Today's Seniors, Impact of Senior Hunger on Health, Food Access, Food Waste and Reclamations, and Meeting the Needs of the Community.
Today's Seniors One significant challenge that communities, agencies and program administrators
working with the older adult population face are the differences in needs/requirements and likes/dislikes among various generations. The young-old (ages 60 to 69) and middle-old (70-79) may have different dietary and health needs than the oldest-old, (80 and older). Advances in health care are allowing people to live longer but not always independently. Even though some of the oldest-old are very active and healthy, many others are dependent on someone for transportation, meal preparation and more. The young-old also may be taking care of an aging parent while continuing to work and run a household.
Rural areas are experiencing a migration of youth away from small towns to larger cities. This creates a shortage of people in rural areas and small towns to take care of and help older adults who are dependent on assistance. Food stores may be in near proximity, but an older adult may not be physically able to grocery shop or to prepare meals if groceries are available.
Georgia's growing cultural diversity also affects food security. Older adults who come from other countries and cultures may not be familiar with available local foods and may not know how to prepare them, creating a situation of food insecurity for them. Food stores catering to a specific culture may not be in the area. Communication can be limited if there is not a common language between older adults and the people helping them. Agencies or

16
organizations distributing food to those in need may not be able to accommodate the culturally diverse needs of the older population.
There are vast differences in interest and skill level in technology among older adults. The younger-old are more likely to have the interest and the skills to utilize computers to order food items online, whereas the oldest-old may not.
Health Impact of Senior Hunger It is well-documented that nutrition affects a person's health. Heart disease, diabetes
and kidney disease are influenced by diet. The only choices a food-insecure person may have available are high-salt, high-fat, high-sugar, low-nutrient dense foods if resources for fruits, vegetables, and quality protein are limited or not accessible in the area. Special dietary requirements are usually recommended by a health care professional as one component of treating the patient. Frequently, the professional does not consider whether the special dietary requirements are within the patient's finances or whether the special items are available where the patient buys food. The professional may not be aware of community resources to recommend to the older adult when assistance is needed in acquiring the proper food.
Disease conditions become more complex when an individual is obese. Georgia ranks 19th in the nation for prevalence of obesity. A food-insecure older adult might be limited to highcalorie, nutrient-deficient foods, which can contribute to obesity. Obesity can lead to arthritis and other joint problems which affects the ability to perform IADLs, such as grocery shopping and food preparation.
Older adults who are food insecure are not eating sufficient amounts of calories, protein and micronutrients, which can contribute to frailty. Calcium, magnesium, vitamin D and iron are micronutrients required to maintain muscle strength and bone integrity. Muscle weakness, osteoporosis and weight loss are often found in frail individuals. This, in turn, can lead to the inability to perform IADLs, an increase in falls, disability, the worsening of diseases and

17
hospitalizations. Frailty and the risk of falling are concerns for older adults. Falls are the leading cause of injury-related emergency room visits, hospitalizations and deaths for Georgians 65 and older. Falls affect quality of life and are costly in terms of well-being, cost and time spent recuperating.
Older adults who are food insecure are 60% more likely to experience depression. Worry, anxiety and stress associated with threat of hunger and lack of suitable foods to sustain health have negative outcomes on well-being, quality of life and mental health for older adults. Seniors who are food insecure self-reported poor or fair health when compared to food-secure seniors. Fruits and vegetables are commonly lacking in food-insecure households. Fruits and vegetables contain the micronutrients vitamin C, vitamin B, iron and a form of vitamin A. These nutrients are known to be effective against depression and to enhance overall well-being.
Food Access The availability of local food sources strongly impacts food insecurity. Neighborhoods
and rural areas with limited access to food make it difficult for older adults to obtain nutritionally rich foods for a healthy diet. Areas that are void of food sources within a reasonable distance to an individual's home are called food deserts. Georgia food deserts occur both in urban and rural settings. A food desert is defined as a neighborhood or rural town that lacks access to fresh, healthy and reasonably priced food, and food sources are not within a reasonable proximity to the resident's home. Georgia considers a half-mile as reasonable proximity. One-third of Georgia is considered food desert.
For older adults, transportation can be a significant barrier to food access. Even when food resources such as congregate meal sites, community gardens, food banks or farmers' markets are in their area, older adults may not be able to drive, and public transportation is often not available in rural or less-populous areas. In a low-income neighborhood or for an older adult who is frail or has a disability, public transportation may be available but not manageable. The

18
cost of a private taxi service or ownership of a vehicle may be prohibitive when there are financial constraints in the household. Many communities do not have services that provide transportation at a reduced cost for older adults.
Many seniors are eligible for the Supplemental Nutrition Assistance Program (SNAP) benefits but do not sign up because the enrollment process for the program can be confusing or difficult to an older adult. Enrollment is available online, but that is not a viable option if the older adult does not have internet access, does not own a computer, or does not have computer skills. Many older adults do not apply for SNAP benefits even if they are eligible because they view them as degrading and a form of dependency.
Food Waste and Reclamation Food is wasted daily in communities. For example, grocery stores that have strict "sell
by" dates throw food away, as do restaurants that have unserved leftovers. Crops are plowed under and left to rot in the fields by farmers who have more than they can sell or personally use. Local schools discard opened cases of canned goods rather than donating the items to foodinsecure households. Each of these sources could provide food to people in need. Unfortunately, businesses and organizations do not have a clear understanding of the laws addressing the donation of food, so they hesitate to do so out of concern for liability.
Federal laws exist to encourage and support the donation of unused food that is kept at proper temperatures and is safe to consume. The Bill Emerson Good Samaritan Food Donation Act provides liability protection to donors of food and grocery products to qualified nonprofit organizations. The Internal Revenue Code 170(e)3 provides tax deductions to businesses that donate wholesome food to qualified nonprofit organizations serving the poor and needy. Gleaning programs can be implemented to collect fresh foods from farms, gardens, and farmer's markets. The food is then distributed to food-insecure households.

19
Communities may have farmers or businesses willing to donate food, but the appropriate transportation may not be available. Certain food items must to be transported under refrigeration to keep them safe for consumption. An appropriate vehicle may be available during "off hours," but the farmer or business may not be aware of the availability.
It is important for individuals, organizations and community groups to work together to support efforts in eliminating senior hunger. Collaboration is also critical to avoid duplication of services to food-insecure households while other people in need of food are overlooked.
Meeting the Community's Needs Addressing food insecurity is a community affair. Communication and coordination
among businesses with food to donate, agencies distributing food, transportation businesses and officials, health care professionals, public safety officials, policy makers and the faith-based community are key in assuring a healthy, food-secure future for older adults. Different types of community organizations may be addressing the same issue while unaware of each other's programs. Faith-based groups, civic groups, colleges, universities, neighborhoods and local government all have resources that may overlap while some areas go unserved. Improved communication and partnerships may be in order to share resources and identify service gaps.

20
Recommendations
Develop Regional Coalitions in 12 regions of the state to bring together the aging network with for-profit, nonprofit, faith-based, civic, health care and other organizations, older adults and their caregivers. These coalitions would address a number of concern areas found during the data collection phase and would track the number of deliverables each year, including but not limited to: o Reduction of duplication of services o Conducting community needs assessments o Shared knowledge of regional and local issues o Shared knowledge of regional and local resources o Locally designed interventions such as community gardens, pantry programs and volunteer transportation services o Hold a minimum of four meetings each year o Annual report o Daylong pre-conference intensive at the ADRC Healthy Communities Summit
Establish DHS DAS Senior Hunger Position to perform the following duties at a minimum: o Coordinate the 12 regional coalitions o Coordinate a Policy Review Council o Develop and disseminate nutrition education and other education resources o Develop toolkits for statewide use Assistive Technology to help with food needs Outreach to community programs FAQs and "How to talk" about the issue o Coordinate with Universities and other partners for data analysis and other hunger prevention projects o Coordinate waste prevention initiatives and ongoing best practice sharing o Coordinate the Senior Hunger Track at the Healthy Communities Summit o Manage implementation of the State Plan for Senior Hunger
Establish Policy Review Council to review policy that impacts a variety of aspects of senior hunger, from food reclamation to information sharing. This recommendation addresses the following concern areas; better communication across programs, consistent policy development to support state plan initiatives, adaptation as needed in a changing environment. This council would include state departments and divisions such as DHS DAS and the departments of Public Health, Community Health and Agriculture o Meet quarterly to review issues that arise in regional coalition meetings o Review current and proposed policy to suggest changes to allow great efficiency in food processes o Share enrollment in state programs to alleviate some of the paperwork for older adults across SNAP, Public Housing, Senior Community Programs, etc.

21
Coordinate Data Collection and Analysis to measure the success of the state plan on senior hunger across organizations o Health Care Utilization Data o The Food Security Survey (expand to other agencies using the six-question survey for consistency) o Total number of food-insecure seniors current vs. projected o Rural vs. urban needs and resources o Return on investment for health impact o Ensuring service delivery to those in the greatest need o Others...
Develop and Provide Education and Training for Agencies, Stakeholders and Individuals across a variety of topics o WebEx trainings and discussions held regularly o Regular nutrition education meetings to develop and disseminate senior appropriate nutrition education o Healthy Communities Summit Pre-Conference Intensive and Senior Hunger Track o Meeting in Macon at the DHS training center to keep conversations moving and idea-sharing open annually o Host workshops Review state statistics Review state and federal policies Develop understanding of the current issue and programs in need of expansion
Continue and Expand the What a Waste Program with the National Foundation to End Senior Hunger. This recommendation addresses the food waste and reclamation focus area and allows better use of the resources already available.
Provide Entrepreneurial Mini-Grants to support creative initiatives that alleviate the issues of senior hunger, food deserts and isolation. These would be small grants designed to stimulate local problem solving at the local level o Food Mobile Ideas o Others...

22
References
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Feeding America and National Foundation to End Senior Hunger (NFESH) (2014). Spotlight on senior health adverse health outcomes of food insecure older americans.
Fingar, K.R., Weiss, A.J, Barrett, M.L., Elixhauser, A., Steiner, C.A., Guenter, P., & Brown, M.H. (2016). All-cause readmissions following hospital stays for patients with malnutrition, 2013. Statistical brief #218. Healthcare Cost and Utilization Project. Retrieved from www.hcupus.ahrq.gov/reports/statbriefs/sb218-malnutrition-readmissions-2013.jsp
Fried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J., ... others. (2001). Frailty in older adults: evidence for a phenotype. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56(3), M146M157.
Goates, S., Du, K., Braunschweig, C. A., & Arensberg, M. B. (2016). Economic burden of disease-associated malnutrition at the state level. PLoS ONE, 11(9), 115. https://doi.org/10.1371/journal.pone.0161833
Grandparents2Teal.pdf. (n.d.). Retrieved on July 20, 2017 from https://dhs.georgia.gov/sites/dhs.georgia.gov/files/related_files/site_page/Grandparents2Teal. pdf
Hickson, M. (2006). Malnutrition and ageing. Postgraduate Medical Journal; London, 82(963), 2. https://doi.org/http://dx.doi.org.ezproxy.gsu.edu/10.1136/pgmj.2005.037564
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Malnutrition Quality Improvement Initiative (MQii) (2017). Retrieved from http://mqii.defeatmalnutrition.today/ on August 8, 2017
Montero-Odasso, M., Muir, S. W., Hall, M., Doherty, T. J., Kloseck, M., Beauchet, O., & Speechley, M. (2011). Gait variability is associated with frailty in community-dwelling older adults. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 66(5), 568576.
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Norwood, J. L., & Wunderlich, G. S. (2006). Food insecurity and hunger in the United States: an assessment of the measure. Washington, D.C.: National Academies Press, c2006.
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Payne, M. E., Steck, S. E., George, R. R., & Steffens, D. C. (2012). Fruit, Vegetable, and Antioxidant Intakes Are Lower in Older Adults with Depression. Journal of the Academy of Nutrition and Dietetics, 112(12), 20222027. https://doi.org/10.1016/j.jand.2012.08.026
Russell, J. C., Flood, V. M., Yeatman, H., Wang, J. J., & Mitchell, P. (2016). Food insecurity and poor diet quality are associated with reduced quality of life in older adults. Nutrition & Dietetics, 73(1), 5058. https://doi.org/10.1111/1747-0080.12263
Sattler, E.L.P. & Lee, J.S. (2013). Persistent food insecurity is associated with higher levels of cost-related medication nonadherence in low-income older adults. Journal of Nutrition in Gerontology and Geriatrics, 32 (1), 41-58. https://doi.10.1080/21551197.2012.722888
Scheir, L.M. (2005). What is the hunger-obesity paradox?. Journal of the American Dietetic Association, 105 (6), 883-4, 886. https://doi.10.1016/j.jada.2005.04.013
Seligman, H. K., Laraia, B. A., & Kushel, M. B. (2010). Food Insecurity Is associated with chronic disease among low-Income nhanes participants. Journal of Nutrition, 140(2), 304 310. https://doi.org/10.3945/jn.109.112573
Stuff, J. E., Casey, P. H., Szeto, K. L., Gossett, J. M., Robbins, J. M., Simpson, P. M., ... Bogle, M. L. (2004). Household food insecurity is associated with adult health status. The Journal of Nutrition, 134(9), 23302335.
Taylor, C. L., Thomas, P. R., Aloia, J. F., Millard, P. S., & Rosen, C. J. (2015). Questions About Vitamin D for Primary Care Practice: Input From an NIH Conference. The American Journal of Medicine, 128(11), 11671170. https://doi.org/10.1016/j.amjmed.2015.05.025
Thomas, K.S., Dosa, D. (2015). More than a meal, a pilot research study. Research project sponsored by Meals on Wheels America.
Vozoris, N. T., & Tarasuk, V. S. (2003). Household food insufficiency is associated with poorer health. The Journal of Nutrition, 133(1), 120126.
Weiss A.J., Fingar, K.R., Barrett, M.L., Elixhauser, A., Steiner, C.A., Guenter, P., Brown, M.H. (2016). Characteristics of hospital stays involving malnutrition, 2013. Statistical brief #210. Healthcare Cost and Utilization Project. Retrieved from https://www.hcupus.ahrq.gov/reports/statbriefs/sb210-Malnutrition-hospital-stays-2013.pdf
Wilkinson, Rachel; Arensberg, Mary E.; Hickson, Mary; Dwyer, Johanna T. (2017). Fraility prevention and treatment: Why registered dietitian nutritionists need to take charge. Journal of the Academy of Nutrition & Dietetics, 117( 7), p1001-1009. DOI: 10.1016/j.jand.2016.06.367.
Wjciak, R. W., Mojs, E., Staniek, H., Marcinek, K., Krl, E., Suliburska, J., & Krejpcio, Z. (2016). Depression in seniors vs. their nutritional status and nutritional knowledge. Journal of Medical Science, 85(2), 8388. https://doi.org/10.20883/jms.2016.103
Ziliak, J. P., Gundersen, C., & Haist, M. (2008). The causes, consequences, and future of senior hunger in America. Lexington, KY: UK Center for Poverty Research, University of Kentucky, 71. Report submitted to Meals on Wheels Association of America Foundation.

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Ziliak, J.P., Gundersen, C. (2009). The causes, consequences, and future of senior hunger in america. Report submitted to the National Foundation to End Senior Hunger. Lexington, KY: UK Center for Poverty Research, University of Kentucky.
Ziliak, J.P., Gundersen, C. (2014). The health consequences of senior hunger in the united states: Evidence from the 1999-2010 NHANES. Report submitted to the National Foundation to End Senior Hunger. Lexington, KY: UK Center for Poverty Research, University of Kentucky.
Ziliak, J.P., Gundersen, C. (2016). The state of senior hunger in America 2014: An annual report. Report submitted to the National Foundation to End Senior Hunger. Lexington, KY: UK Center for Poverty Research, University of Kentucky.
Ziliak, J.P., Gundersen, C. (2017). The state of senior hunger in America 2015: An annual report. Report submitted to the National Foundation to End Senior Hunger. Lexington, KY: UK Center for Poverty Research, University of Kentucky.

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Appendices Table of Contents

I.

Avalere & Defeat Malnutrition, March 2017; National Blueprint: Achieving Quality

Malnutrition Care for Older Adults

II. Profile of Older Americans: 2016, Administration on Community Living (ACL)

III. February 2014, Ziliak & Gundersen; The Health Consequences of Senior Hunger in the United States: Evidence from the 1999-2010 NHANES Report submitted to The National Foundation to End Senior Hunger (NFESH)

IV. June 2016, Ziliak & Gunderson; The State of Hunger in America 2014: An Annual Report Report submitted to The National Foundation to End Senior Hunger (NFESH) and August 2017, Ziliak & Gunderson; The State of Senior Hunger in America 2015: An annual report. Report submitted to the National Foundation to End Senior Hunger. Lexington, KY: UK Center for Poverty Research, University of Kentucky.
V. Core Food Security Module (CFSM) 6-item battery of questions
Research article supporting validity of CFSM: Persistent Food Insecurity Is Associated With Higher Levels of Cost-Related Medication Nonadherence in Low-Income Older Adults Elisabeth Lilian Pia Sattler, BS Pharm & Jung Sun Lee, PhD, RD Journal of Nutrition in Gerontology and Geriatrics, 32:41-58, 2013
VI. September 2009, Ziliak & Gundersen; Senior Hunger in the United States, Differences Across States and Rural and Urban Areas Report submitted to Meals On Wheels Association of America Foundation (MOWAAF)
VII. Georgia maps indicating poverty levels
VIII. 2008, Ziliak, Gunderson, & Haist; The Causes, Consequences, and Future of Senior Hunger in America Report submitted to Meals On Wheels Association of America Foundation (MOWAAF)
IX. Senior Hunger Fighter Workgroups Transcripts
X. Session Summaries of North Highland Consulting Group and Georgia Area Agencies on Aging (AAA) Transcripts
XI. Area Agencies on Aging Map of regions
XII. Map of Georgia Counties
XIII. ADRD Healthy Communities Summit Summaries
XIV. Georgia Gerontology Society Annual Conference Summaries

CHAPTER 3000

AAA ADMINISTRATION

SECTION 3017 Emergency Planning and Management

POLICY STATEMENT: REQUIREMENTS:

Area Agencies on Aging (AAA) are responsible for identifying themselves to and consulting with local (county and regional) emergency management agencies; public utilities; law enforcement authorities; other community service providers; state, county and municipal governments; and any other entities or organizations which have an interest or role in meeting the needs of the elderly in planning for, during and after natural, civil defense or other man-made disasters. AAAs are expected to

Designate a staff person to have primary responsibility for emergency management planning and coordination;

Participate in state, regional, county and/or municipal planning activities with other human service agencies and entities and organizations charged with the responsibility of meeting the needs of disaster victims;

Assist in identifying "at risk" elderly in the planning and service area, including but not limited to current consumers of contracted services;

Require by contract provision that service providers develop plans for emergency management that fit the scope of their individual operations;

Assure by annual review that service providers' policies, procedures and capabilities are adequate to meet the needs of the elderly in their areas prior to, during and after emergencies;

Provide periodic training to providers regarding emergency management resources and activities;

Upon request, provide information to the Division of Aging Services (DAS) regarding the impact of emergencies on the elderly population in the planning and service area;

Provide authorized services to the elderly victims of disasters;

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CHAPTER 3000

AAA ADMINISTRATION

REQUIREMENTS, cont:

Collect data necessary to submit reimbursement requests for services provided during the emergencies, which may be covered by other sources of funding available outside the aging program contract for disaster assistance;

SCOPE OF EMERGENCY PLANS and ACTIVITIES

Participate in initial meetings of FEMA and GEMA on-site teams to assist in establishing recovery operations when appropriate.
AAA plans will address four categories of activity: preparation, immediate response and stabilization, recovery and evaluation.

Preparation AAA emergency plans will address at a minimum:

the types of natural disasters prevalent in the planning and service area (those that reasonably can be anticipated);

the AAA's capabilities and limitations in addressing such incidents;

ongoing maintenance and updating of resource databases;

AAA emergency policies and procedures, including:

o staff duties and responsibilities, including specific chain of command and alternates, if agency leadership is unavailable;
o alert procedures for working and non-working hours;
o procedures for providing for alternate communications channels and equipment;
o locations of operations centers and alternates when primary offices are affected;
o assuring availability of office supplies for alternate locations, staff identification badges, and the like.
o roles of various relief organizations operating in and primarily responsible for relief authority in the area;
o strategies for maintaining contact with staff, local organizations, and the Division if essential public services, such as communications and transportation, are limited or unavailable;

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CHAPTER 3000
SCOPE OF EMERGENCY PLANS and ACTIVITIES, cont.
Preparation, cont.

AAA ADMINISTRATION
o current disaster response systems and the Area Agency's linkages to, for example, county law enforcement and public safety agencies, emergency management agencies;
o community education to alert first responders/other entities to special needs of the elderly and the Area Agency resources;
o identification and mapping, if feasible, of heavy concentrations of elderly, including those residing in institutions, and households in which seniors reside alone, including apartments, and mobile homes;
o demographic profiles of elderly in the area for targeting of specialized recovery assistance.

Response The initial reaction to ensure safety, hygiene/sanitation, and security, either in advance of an impending emergency or immediately following, will include:
initiation of planned communications strategies and determination of impact of disaster on staff;
assignment of duties;
contact with key providers;
initiation of disaster-specific record-keeping, including but not limited to records of :
o staff time, including overtime; o supplies used; o documentation of contacts with seniors; o type and amount of services provided; o personal expenses; o specific telephone logs.

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CHAPTER 3000

AAA ADMINISTRATION

SCOPE OF EMERGENCY PLANS and ACTIVITIES, cont.

Response, cont.

preliminary assessment of scope of impact, including, but not limited to:

o geographic scope and numbers of affected elderly/other target populations and their short and long term needs;
o kinds of services needed, including impact on transportation resources;
o identification of service gaps o provision of information to DAS.

employment, training and deployment of field and outreach workers.

follow-up contacts with all seniors/others initially assisted to determine additional needs which have developed, appropriateness of additional available resources, and need to advocate for additional resources.
Recovery Recovery involves sustained care over a longer period of time, for the purpose of assisting people in re-establishing as normal a life as possible. Recovery includes:

shifting from emergency response to providing answers to more complex, long-range and long term problems, including arranging for psychological/mental health services for disaster victims;

providing access to increased resources that have become available;

participation in long range planning and coordination with other agencies;

maintaining contact and providing services, including meeting non-immediate needs identified during the response phase.

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CHAPTER 3000

AAA ADMINISTRATION

SCOPE OF EMERGENCY PLANS and ACTIVITIES, cont.

Evaluation Evaluation involves analysis of the effectiveness of an

emergency plan once deployed and provision of input and

feedback to staff, volunteers and other community

organization, following response and recovery phases.

Evaluation results will drive improvements in emergency

planning.

EMERGENCY

AAAs and their subcontract service providers are authorized to

MANAGEMENT

provide the following services to manage the emergency needs

SERVICES

of the elderly:

expansion of information and assistance services on a 24-hour basis, including escort assistance;

special outreach activities to encourage elderly disaster victims to apply for benefits at federal emergency disaster assistance centers (DACs) as soon as they are established;

special transportation for elderly disaster victims to DACs, doctors, clinics, shopping and such essential travel in the event that vehicles are not readily available. Since FEMA funds may be available to fund this service, the Area Agency will consult with the onsite federal coordinating officer prior to expending Older Americans Act or state funds on this service;

assistance by case managers acting as disaster assistance advocates to older persons in the DACs in the benefits application process, including follow up to assure older victims receive approved grants and services and are protected from unscrupulous contractors for housing and other repairs;

handyman and chore services, including clean-up, in the event that FEMA cannot provide these services in sufficient volume through volunteer efforts;

licensed appraiser services to assist elderly disaster victims in arriving at realistic estimates of losses incurred;

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CHAPTER 3000 EMERGENCY MANAGEMENT SERVICES, cont.
REIMBURSEMENT PROCEDURES FOR EMERGENCY SERVICES

AAA ADMINISTRATION
legal services, only when scope of the primary elderly legal assistance program must be expanded to address insurance and disaster grant assistance settlements;
assistance to move elderly disaster victims from temporary housing back to their own places of residence;
other Older Americans Act services, including meals, when assessments indicate that disaster related needs are unresolved by federal, state, or voluntary disaster assistance programs.
Reimbursement for the services specified above are authorized by the Older Americans Act, 310, as amended. AAAs shall forward requests for reimbursement to DAS within 30 business days of the date that disaster recovery operations are completed.
AAAs will prepare the reimbursement requests as follows:
Sort the expenses for which reimbursement is requested into categories by service, as listed in the preceding section.
Provide a narrative for each category, which documents the number of units provided and the number of elderly served. This will be the cover page for each set of reimbursement documentation materials.
Enclose the billing documentation, such as paid bills and invoices, with the narrative for each category of service provided.
Attach a description of the cause and scope of the disaster.
Attach the certificate of non-duplication of services provided by the FEMA office, if it is available.
DAS will review all reimbursement requests, seek any additional information or clarification needed, and forward to the Administration on Community Living for payment.

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ATTACHMENT G Abbreviaons

AAA ACL ACT ADRC AIMS ANE APS CCSP CILS CLP CMS CO-AGE CQI DAS DCH DD DFCS/DFACS DHS DON-R DPH ELAP FSIU G4A GCOA HCBS HDM HFR IFF LIS LTCO LTCOP MAPs MDS MFP MIPPA MSP NAPIS NCI AD NH NHT OAA

Area Agencies on Aging Administraon for Community Living Adult Crime Taccs Aging and Disability Resource Connecon Aging Informaon Management System Abuse/Neglect/Exploitaon Adult Protecve Services Community Care Services Program Centers for Independent Living Community Living Program Centers for Medicare and Medicaid Services Coalion of Advocates for Georgia's Elderly Connuous Quality Improvement Georgia Division of Aging Services Department of Community Health Developmental Disabilies Georgia Department of Family and Children Services Department of Human Services Determinaon of Need - Revised Georgia Department of Public Health Elderly Legal Assistance Program Forensic Special Invesgaons Unit Georgia Associaon of Area Agencies on Aging Georgia Council on Aging Home and Community Based Services Home Delivered Meals Georgia Healthcare Facility Regulaon Intra-State Funding Formula Low-Income Subsidy Long Term Care Ombudsman Long Term Care Ombudsman Program Measurement and Analysis Plan (performance indicators) Minimum Data Set Money Follows the Person Medicare Improvements for Paents and Providers Act Medicare Savings Program Naonal Aging Program Informaon System Naonal Core Indicators Aging and Disabilies Nursing Home Nursing Home Transions Older Americans Act

PGO PSA QOL RC RD PSS SCSEP SMP SNAP SFY SLTCO SUA

Public Guardianship Office Planning and Service Area; Personal Support Aide Quality of Life Regional Commission Regional Director Personal Support Services Senior Community Service Employment Program Senior Medicare Patrol (See SHIP) Supplemental Nutrion Assistance Program State Fiscal Year (July 1 through June 30) State Long Term Care Ombudsman State Unit on Aging

ATTACHMENT H Document Links

Georgia Alzheimer's State Plan htps://aging.georgia.gov/document/document/2020-gard-state-plan/download
Georgia State Plan to Address Hunger htps://aging.georgia.gov/document/document/georgias-state-plan-address-senior-hunger/download
Senior Community Service Employment Program State Plan https://aging.georgia.gov/document/document/2021-scsep-directory/download