Just the facts SFY 2001

eA-
HeooA4
SI F3
01001
Just the Facts
SFY 2001 Accomplishments
GA DHR-Division of Aging Services
Maria Greene, Director

Table of Contents

Aging Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3

Caregiver Programs and Services

.

4

Community Care Services Program (CCSP) . . . . . . . . . . .

.

6

Elderly Legal Assistance Program (ELAP) . . . . . . . . . . . . . . . . . . . .

8

Health Insurance Counseling Assistance and Referral for the Elderly (HICARE)

10

Home and Community Based Services (HCBS) . . . . . . . . . . . . . . . . . . .

12

Long-Term Care Ombudsman Program (LTCO)

.

14

Senior Community Service Employment Program (SCSEP)

16

Wellness Program . . . . . . . . . . . . . . . . . . . . . .

18

2

Aging Trends in Georgia
GA DHR- Division of Aging Services and the Aging Network

Georgia and United States, 1990 - 2010 % Increase in Population, by Age Group
120.0%-

The aging of our population is one of the most significant trends affecting our society today.

100.0%80.0%60.0%-1 40.0%

Georgia has the fourth fastest growing 60+ population and the third fastest growing 85+ population in the United States.

20.0%-

0.0%- - - - -

60+

65+

_ 85+

United States .Georgia

United States and Georgia, 1980 - 2010
Population Ages 60+
100,000,000 - - - - - - - - - - - - - - - , - 55,623,000

Georgia's population ages 60 and above is expected to increase 52.6% between 1990 and 2010, from 893,049 persons to 1,362,845 persons.
Georgia's population ages 85 and above is expected to increase 118.4% from 1990 to 2010. Those 85 and above are by far the fastest growing group.

100,000 1980

1990

2000

United States Georgia

During the 20th century,

the number of Georgians

age 60 and above

increased eight-fold,

compared to a three-fold

growth in the population

2010

overall.

GA DHR Division of Aging Services

Demographics SFY 2001 3

Caregiver Programs and Services
GA DHR-Division of Aging Services and the Aging Network
Georgia is intensifying its efforts to develop programs and services to support family caregivers. During SFY 2001, these services included adult day care, respite and other support services for persons with Alzheimer's Disease, enabling caregivers to keep their loved ones at home as long as possible.
Persons Served

SFY 2001 800 600 400

A total of 1,244 persons with Alzheimer's Disease received respite and day care services provided by Georgia's aging network during SFY 2001.
An additional 298 persons were provided help through caregiver community education sessions.

200

o-'------'
I_ 1 Day Care 0 Respite 0 Community Ed

Services Provided

Units of Service SFY 01

226,141 hours of day care were provided, offering consumers health services, personal care and therapeutic activities in a day center.
Respite Care -- shortterm relief to the care giver in the client's home -- accounted for 113,294 hours of service.

100,000 -l----
50,000 ~--
o
Day Care Hours

Respite Care Hours

4

Innovations in Day Care for Caregivers
Through funding received from an Alzheimer's demonstration grant, Georgia developed an innovative program called mobile day care, which provides caregivers a period of respite from their 24 hour-a-day caregiving responsibilities.
Mobile day care enables rural communities to "share" staff that travels between locations. Though the term mobile day care conjures images of a facility that moves, it is actually the staff, along with materials and supplies needed for the day, who are mobile.
During SFY 2001, information and videos regarding mobile day care were provided to organizations in 14 states. Presentations on the program have made in Biloxi, Mississippi; Long Beach, California; Chicago, Illinois; and Washington, D.C.
Caregiver Focus Groups
In response to feedback received from six caregiver focus groups: The Division conducted a Plenary Session at the Georgia Gerontology Society for 250
persons, including aging service providers, Area Agency on Aging staff, legislators, advocates, and older persons. At the planning session, we presented recommendations from the caregiver focus groups, which involved suggestions to improve information, direct services, and training. The aging network will use these recommendations as we strengthen our programs and services for caregivers.
Directions for the Future
One-day forums for family and professional caregivers are planned in various locations throughout Georgia.
The Georgia Division of Aging Services has been awarded an Innovative Program grant from the U.S. Administration on Aging. Funded under the National Family Caregiver Support Program, the project will increase service options by developing five self-directed voucher projects in rural areas of the state. Self directed care voucher programs are designed to maximize consumer choice, enhance consumer empowerment, and promote efficiency.
The project will also evaluate the effects of caregiver support and satisfaction, comparing responses of those caregivers using vouchers to those receiving services through more traditional methods. The evaluation will assist policy makers and program administrators in developing new options for service delivery.

GA DRR - Division of Aging Services

Caregiver Services SFY 2001

Community Care Services Program (CCSP)
GA DHR-Division of Aging Services and the Aging Network
By providing home and community-based Medicaid services to nursing home eligible consumers, the Community Care Services Program (CCSP) gives consumers the choice of remaining in the community.

Medicaid Dollars Spent
$17,500 < $15,613
$15,000

$17,760 $17,725

$12,500

$10,000

$7,500

$5,000

2,500 -

$0 SFY97

SFY98 SFY99 SFYOO
ursing Homes CCSP ,

SFY 01

Dollars Saved
CCSP saved taxpayers $13,090 per individual served in SFY 2001.
Georgia taxpayers saved nearly $221 million in SFY 2001 through this program.
In SFY 200 I the CCSP helped keep 16,873 Georgians out of more costly nursing facilities.

People Served
CCSP served 66% more persons in SFY 2001 than in SFY 1991.
Ninety-one percent of individuals given the option chose CCSP over nursing facility services.
Fifty-eight percent of CCSP clients were 75 years of age or older; 15% were 90 years of age or older in SFY 2001.

16,000

12,000

8,000

4,000

O~--------.---------f'"

SFY91

SFYOI

Consumers Served by CCSP

6

13,377
14,000~
12,000"
10,000~
8,000
6,000J
4,000~
2,000
0
PSS ERS

r-----"l
3,459

2,805

HOS ALS HOM

AOH

CCSP Services
CCSP offers seven different services, which are listed below with a brief explanation.
Personal Support Services and Emergency Response System are the most highly utilized servIces.

Adult Day Health (ADH) - health, therapeutic and support services in a day center
Alternative Living Services (ALS) - personal care and health-related support services in a licensed personal care home
Emergency Response System (ERS) - 24-hour electronic medical communication support system
Home Delivered Meals (HDM) - meal delivery services
Home Delivered Services (HDS) - skilled nursing services and personal support in client's home
Personal Support Services (PSS) - personal and support services in client's home
Respite Care (Re) - temporary relief for the individual(s) normally providing care (service numbers included in PSS total in the graphic above).

Examples of Outstanding Accomplishments
Implemented statewide single point of contact ("Gateway") for consumer access to aging services and programs
Streamlined the service authorization process Provided collaborative statewide provider training

GA DHR - Division of Aging Services

Community Care Services Program SFY 2001 7

Elderly Legal Assistance Program
GA DHR-Division of Aging Services and the Aging Network

The Georgia Elderly Legal Assistance Program (ELAP) serves persons 60 years of age and older by providing legal representation, information and education in civil legal matters throughout the state of Georgia.

Persons Served

ELAP - Persons Served

ELAP served 37,995 seniors in SFY 2001.
In SFY 2001, there was a 13% increase in the number of persons seeking legal information from ELAP.
ELAP's efforts in focusing on community education and vital legal information to seniors resulted in a slight decrease in the number of seniors requiring lengthy legal representation.

40,000

30,000

20,000

10,000

0

'98

'99

'00

'01

State Fiscal Years

Primary Case Types - SFY 2001
SFY 2001 Top Five Primary Case Types

Housing 13%

Income Maintenance
9%

End of Life Decision Making
44%

Health Care 14%

Consumer - Fraud, Contracts, Debt Relief Health Care - Medicare, Medicaid, Nursing Home & Personal Care Home Issues End of Life Decisions - Financial & Health Care Power of Attorney, Living Wills Income Maintenance - Social Security, Food Stamps, Disability Housing - Homeowner, Public Housing & Landlord Tenant

End of life planning and consumer issues represented 56 % of all cases handled.
In SFY 2001 ELAP saved seniors over $87,000 in document preparation costs, for a total savings of $491,425 since SFY 1996.
ELAP saved Georgians 60 years of age and older $3,646,984 in legal counseling hourly fees.

8

ELAP Community Education Offered

Community education is a method of prevention that helps seniors avoid more costly, time consuming legal problems. In SFY 2001 over 23,088 seniors attended legal education sessions conducted by the Georgia Elderly Legal Assistance Program.

The top ten topics covered in group education sessions in SFY 200 I were:

1. Advance Directives 2. Elder Abuse 3. Medicaid 4. Consumer Fraud 5. Public Benefits 6. Wills/Probate 7. Medicare 8. Utilities 9. Medigap 10. Medicare Fraud

Number of Sessions Top 10 Topics
80 ~-------------------70 60 50 40 30 20 10

2

4

10

Examples of Outstanding Accomplishments
An elderly nursing home resident was unable to swallow and had a feeding tube, but could sit in her wheelchair, interact with other residents, watch television and get her hair and nails done. Her nephew from out of state insisted that her feeding tube be removed, and brought her sister and a lawyer to prepare a durable power of attorney for health care. ELAP Staff assisted the client, who did not want her feeding tube removed, to successfully assert her right to keep her feeding tube.
A 65-year-old woman sought 401 K benefits three years after retirement. ELAP staff assisted her in locating the check, willch had been mailed at one time but had been returned to the office. The woman received her check in the amount of$12,000, along with an additional $4,800 in interest.
A 76-year-old nursing home resident was about to be discharged because the guardian failed to pay the nursing home bill or complete a Medicaid application (timely) for retroactive coverage. ELAP appealed the discharge and the guardian was removed. The guardian forfeited ills $25,000 bond and $20,000 was applied to the nursing home bill.
A 75-year-old client had a home repair loan, but the work was never completed. ELAP filed suit against the lender on Truth-In-Lending violation claims as well as various state law claims. The lender canceled the $23,000 loan and refunded the $3,200 payments.

GA ORR - Division of Aging Services

Elderly Legal Assistance Program SFY 2001 9

HICARE
Health Insurance Counseling Assistance and Referral for the Elderly
GA DHR-Division of Aging Services and the Aging Network
HICARE helps Georgia's Medicare beneficiaries, their families and others understand their rights, benefits and services under the Medicare program and other health insurance options.

People Served
Clients Counseled SFY 96 - SFY 01
'96 '97 '98 '99 '00 '01

Over 671,062 individuals received community education on Medicare benefits through presentations, health fairs, direct mail and outreach.
More than 200 trained volunteers served clients in SFY 2001.

Reducing "Out- of-Pocket" Costs

Over the last seven years, HICARE has enabled clients to save more than $2,229,000 in health insurance and related expenses.
In SFY 2001, HICARE saved benificiares $703,884 in out-ofpocket expenses.

Clients' Savings SFY 96 - SFY 01
$750,000
$500,000
$250,000 r'----, r::::::-::::l r::::-::.l
$0 SFY 96 SFY 97 SFY 98 SFY 99 SFY 00 SFY 01

10

Types of Issues Addressed by HICARE r---.:..-------------------------,

In SFY 2001, over 50% of HICARE calls dealt with Medigap questions.
Medicaid and prescription drugs calls also represented areas of major concern for callers.

Prescription l5%
LTC
Insurance 2%

Examples of Outstanding Accomplishments

The HICARE program assisted a 59-year-old disabled woman to obtain her medicine, after she experienced extreme difficulty trying to obtain it through her health insurance company.
A HICARE volunteer was instrumental in helping an elderly widow sort out the bills she needed to pay, as well as the bills her insurance company should have paid, after a collection agency harassed her for one year about these bills.
A HICARE representative assisted a husband and wife to enroll in the Medicare Savings Program, and also helped the wife receive her medication through the Patient Assistance Program. The HICARE representative helped the older family save $300 per month.
A HICARE representative helped an 88-year-old woman receive the Qualified Medicaid Beneficiaries (QMB) benefit, after the woman's caseworker told the HICARE representative that the client was qualified only for the Specified Low-Income Medicaid Beneficiaries program. The HICARE representative alerted the caseworker to incorrect income limits in her computer; as a result, the caseworker was able to correctly upgrade the client's benefit status to the QMB program.

Challenges for the Future

HICARE will continue to partner with the Georgia Medical Care Foundation and other health care organizations in several health care campaigns to make beneficiaries aware of their Medicare benefits.

HICARE plans to make a concerted effort to inform and enroll more low income Georgia beneficiaries in the Medicare Savings Programs, thereby reducing their out-of-pocket costs for health care. Outreach will target predominately rural areas.

GA DHR - Division of Aging Services

HICARE SFY 2001

II

Home and Community Based Services
GA DHR-Division of Aging Services and the Aging Network

Home and Community Based Services (HCBS) provides 35 individual and group services to support and assist older Georgians in staying in their homes and communities. These social services promote health, self-sufficiency and independence.

People Served
ill SFY 200 I, 39,566 older Georgians were provided one or more HCBS services, responding to their strong preference for receiving care in their own homes and, in some cases, allowing them to take greater charge of managing the services they receive.
In fact, the services that keep people with chronic conditions independent for as long as possible are frequently those that emphasize assistance and caring, not curing.

Persons Served in Primary Services

18,000

12,000

6,000

o~-

o Home Delivered Meals 0 Senior Center Meals

Transportation

Homemaker

OAdult Day Care

Most Used Services in SFY 2001

3,000,000 2,500,000 2,000,000 1,500,000 1,000,000
500,000
o

Home Delivered Meals 0 Senior Center Meals

Transportation
o Homemaker

OAdult Day Care

Senior Center and Home Delivered Meals - Served 4,445,264 meals to 31,718 older Georgians.
Transportation - Provided 946,989 trips to 5,250 persons.
Adult Day Care/Mobile Provided 369,640 hours of service to 814 persons.
Homemaker Services Provided 219,012 hours of homemaker assistance in the home to 4,700 older Georgians.
12

Examples of Outstanding Accomplishments
The "Gateway" system at 12 Area Agencies on Aging improved access to services for older clients and their caregivers.
Of the recorded Nutrition Screening Initiative (NSI-D) scores of clients in the nutrition program, 71 % maintained or improved their nutritional status.
Twenty-five HCBS programmatic and fmancial reports were developed in the Aging Information Management System (AIMS) to assist the aging network to manage more effectively using client and service data.
Seventy-six percent of clients who received home-delivered meals or senior center meals were near or below poverty.
Improved the quality of HCBS data entry in AIMS through a concerted effort by the aging network to validate data on clients and services.
Developed a Train-the-Trainer Manual on "Take Charge of Your Health" and developed a "Placemat Exercise Program" to promote physical activity at senior centers statewide. Published "Nutrition and Physical Activity Profile of Older Adults in Georgia" based on these two programs.
Directions for the Future
Expand the support for non-traditional services and service providers (such as family and friends) to assure needed care to older persons and their caregivers.
Support the Area Agencies on Aging statewide "Gateway" system to provide access to quality home and community based services to those with the greatest social and economic need.
Improve consumer access to HCBS services by developing additional case management assistance for frail older clients and their caregivers.
Create a comprehensive manual for updating program requirements and policies for HCBS services and Area Agency on Aging operations.
Develop and implement consumer satisfaction surveys regarding HCBS aging services to determine methods for improving the quality of and access to needed services.

Ga. DRR - Division of Aging Services

Home and Community Based Services SFY 200) 13

Long-Term Care Ombudsman Program
GA DHR-Division of Aging Services and the Aging Network
The Long-Term Care Ombudsman Program works to improve the quality of life of residents in nursing homes and personal care homes by acting as their independent advocate. Ombudsman staff and volunteers informally investigate and resolve complaints on behalf of residents.
Complaints Handled

9,000

8,000

7,000

6,000

5,000

4,000

3,000

2,000

1,000
O . f ' & - - -......--_........l. . .L..-_-......111111'"

SFY95

SFY98

SFY 01

10 Nursing Home. Personal Care Homes I

In SFY 2001 the Ombudsman Program received 8,820 complaints, an increase of 118% since state fiscal year 1995.
Ombudsmen resolved 94% of complaints in SFY 2001.

Residents' rights (privacy, freedom from abuse, etc.) and care issues accounted for more than 60% of the complaints received by ombudsmen in SFY 2001.
Another large percentage of complaints received by ombudsmen focused on quality of life issues (good food, pleasant environment, etc.).

Administration 9%
Quality of Life 24%

Types of Complaints

Outside Agency 5%

Resident Rights 29%

14

Persons Served
In SFY 2001:
The Long-Term Care Ombudsman Program served 227,990 persons.
Eighty-one percent of these individuals were served during ombudsman visits to facilities.
More than 28,000 individuals received information and assistance regarding long-term care options, financing, resident rights, etc.

Persons Served by Type of Service Ombudsman Services

Complaint Investigation
5,765

Facility Visits 152,445

Information & Assistance
28,596

Resident / Family
Council 6,192

Facility Staff Training 11,698

Facility Consultation
9,918

Community Education
13,376

Examples of Outstanding Accomplishments

In addition to assisting individual residents, the Ombudsman Program also advocates for systemwide improvements to long-term care:

./ In advocating for more adequate staffIng in long-term care facilities, ombudsmen have supported staffing legislation and funding, served on a legislative committee which made recommendations for improved staffIng, and co-sponsored a forum to study the complex issues of recruiting and retaining long-term care workers.

./ The Office of the State Ombudsman completed a 3-year federal grant, "Operation Red Flag," training 1,672 aging network professionals and 1,651 beneficiaries and their families to prevent and report health care fraud, waste and abuse.

./ In May 2001, Georgia's ombudsmen and the Long-term Care Section of the OffIce of Regulatory Services (which regulates nursing homes and personal care homes) held their first joint training conference. The goal was to enhance protection of residents by improving interagency coordination.

Ga. DHR - Division of Aging Services

Long-Term Care Ombudsman Program SFY 2001

15

Senior Community Service Employment Program
GA DHR-Division of Aging Services and the Aging Network
The Senior Community Service Employment Program (SCSEP) provides useful part-time community service assignments and training for low income older Georgians and helps them obtain paid employment. While participants develop job-related skills and earn minimum wage, the community directly benefits from the work they perform.

Putting a Face on SCSEP
Delores is a single 68-year-old woman whose formal education ended 50 years ago. She worked in the mill until it closed down, and then spent several years caring for her elderly mother. SCSEP provided her training to be a food service worker at a senior center; she was hired by the senior center as a nutrition aide.

Persons Served
Although participants can be as young as 55 years of age, 88% were over age 60. Forty-four percent of participants were over the age of 70.

100%..,

SCSEP Participant Demographics

Eighty-eight percent of persons enrolled in SFY 2001 had incomes below the federal poverty level.

Thirty-eight percent of current enrollees did not complete high school.

Thirty-six percent of enrollees were minorities.

_Age 60+ _ Poverty _ High School Not Completed 0 Minority

Examples of Outstanding Accomplishments
.:. Achieved a 38% job placement rate, exceeding the federal requirement of20% .:. Achieved a 178% total enrollment rate, exceeding federal requirement of 140% .:. Eighty-eight percent of enrollees had family incomes at or below the poverty level

16

Enrollees Placed into Employment
120
80 40
o
SFY 2001 Enrollee Unsubsidized Placements D Federal Placement Goal
I

Participant Benefits
In SFY 2001:
483 older persons received "on the job training"
Participants earned wages estimated at $1.4 million while working in community service positions
102 older persons obtained employment, reaching 188% of the federal job placement goal

Community Benefits
Participant wages contribute to the local economy and reduce dependence on public benefits programs.
In SFY 200 I, participants provided over 281,000 hours of service to community organizations.
The most common job assignments were in organizations providing services to the elderly, followed by social service programs and schools.

Service Provision by Location SFY 2001

o Services to the

2%-

Elderly, includes

Home Health Care

3%-

_Other

17% 17%

48%

o Social Services
Schools

Employment Assistance
D Health Services

Directions for the Future
Increase opportunities for job skills training and employment through: .:. Partnerships with workforce development agencies and programs .:. Participation in a federal Department of Labor program with private sector employers .:. Recruitment strategies and materials that target older job seekers who are most in need and
have poor employment prospects
GA DHR - Division of Aging Services Senior Community Service Employment Program SFY 2001
17

THE WELLNESS PROGRAM
GA DHR-Division of Aging Services and the Aging Network
"Living Longer, Living Well" - The Wellness Program is aimed at supporting successful aging. Activities are focused on health promotion and disease prevention. Services are designed to improve health status, increase functional abilities and avoid or delay problems caused by chronic diseases.

Profile of Persons Served in SFY 2001
White Black
I Other 11 1%
_116%1 Women Men

A total of9,894 clients (unduplicated count) were served in SFY 2001.
A statewide sampling revealed that the average age of program participants was 76.
Most participants were women and most sites served both white and minority clients.

Client perceptions of their own well being are consistent with the national trend of declining disability rates.
Good to excellent selfreported health correlates with a lower risk of mortality.

Self-Rated Health Status
BE]

o Excellent

Very Good

144 %1 o Good

Fair Poor

Services Provided
Wellness services include: nutrition screening/education/counseling; physical fitness/exercise; medications management; fall prevention; foot/ear care; physical therapy; occupational therapy; massage; stress reduction; home safety inspections; weight control; education/ screening and management of chronic diseases (osteoporosis, diabetes, hypertension, heart disease and cancer); pain assessment and immunization for infectious diseases (influenza and pneumonia).

18

Impacts and Outcomes
In Hall County 75% of the walking club participants increased their physical endurance as measured by the distance walked per minute.
A survey of wellness center participants in Dawson, Habersham, Hall and White counties revealed a 50% reduction in foot care problems for these individuals.
As a result of breast health classes, a woman and discovered a lump in her breast. She went to a doctor for a biopsy, and it turned out to be a malignant tumor. She is now undergoing treatment and has a very good prognosis because of early detection.
In Northeast Georgia 66% of older adults with low bone density who had enrolled in an osteoporosis intervention program reduced their risk for osteoporosis.
Sixty four percent (64%) of consumers in the West Central Georgia AAA Diabetes Control Program improved or maintained their blood glucose levels and 52% lost weight.
Program Milestones and Accomplishments
A statewide training "Take Charge of Your Health" was completed which promoted self advocacy and reduction of chronic disease risks.
A medications management program has been initiated in each AAA. It is designed to avoid incorrect medications and adverse drug reactions.
Collaboration with the Division of Public Health has resulted in new demonstration projects for fire safety, fall prevention and arthritis control.
The Division of Aging Services has been working with the Centers For Disease Control, the Administration on Aging, the Chronic Disease Program Directors Association and the National Association of State Units on Aging on a national project aimed at linking prevention activities for the aging and public health networks.
Future Directions and Opportunities
Link Public Health Chronic Disease Prevention Specialists with Wellness Program Coordinators to better integrate programs at the local level.
Expand early detection, screening and intervention efforts related to colon cancer, breast cancer, prostate cancer and immunizations for influenza/pneumonia.
Explore new program initiatives addressing arthritis, incontinence and oral health. Improve the use of primary care and community settings for detection and treatment of
depression, mental illness and anxiety disorders. Develop a comprehensive, Healthy Aging Plan for Older Georgians.

GA DHR - Division of Aging Services

Wellness Program SFY 2001 19