Just the facts SFY 2008

Just the Facts
State Fiscal Year 2008
Division of Aging Services Maria Greene, Director

Table of Contents
Aging Trends in Georgia .......................................................................................... 3 Adult Protective Services Program.......................................................................... 4 Caregiver Programs and Services ............................................................................ 6 Community Care Services Program (CCSP)...........................................................10 Elder Abuse and Consumer Fraud Prevention Program .......................................12 Elderly Legal Assistance Program ..........................................................................14 Forensics ................................................................................................................. 17 GeorgiaCares...........................................................................................................18 Home and Community Based Services ................................................................. 20 Kinship Care Services ............................................................................................ 24 Long-Term Care Ombudsman Program ............................................................... 28 Nutrition and Wellness Programs......................................................................... 30 Older Americans Community Service Employment Program .............................. 34
2

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

United States and Georgia, 1980 - 2030

Population Ages 60+

100,000,000 35,637,048

41,857,998 45,797,200

56,922,418

75,487,837

91,129,331

10,000,000

1,000,000 732,600

893,049

1,450,968 1,071,080

2,533,710 2,001,633

100,000 1980

1990

2000

2010

2020

United States Georgia

2030

The aging of our population is one of the most significant trends affecting our society today.
Georgia has the ninth fastest growing 60+ population and the eighteenth fastest growing 85+ population in the United States.
Georgia's population ages 60 and above is expected to increase 62.5% between 1990 and 2010, from 893,049 persons to 1,450,968 persons.

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

1 20 .0%

114. 6%

98 .8 %

80 .0 % 4 0. 0%

62 .5% 3 6.0 %

56 .6 % 4 4.5 %

0 .0%

6 0+

75+

8 5+

United States Georgia

Georgia's population ages 85 and above is expected to increase 114.6% from 1990 to 2010. Those 85 and above are by far the fastest growing group, projected to total 122,818 in 2010.
During the 20th century, the number of Georgians age 60+ increased ten-fold, compared to a fourfold growth in the population overall.

3

Adult Protective Services Program GA DHR-Division of Aging Services
The Adult Protective Services (APS) program is mandated under the Disabled Adults and Elder Persons Protection Act to address situations of domestic abuse, neglect or exploitation of disabled persons over the age of 18, or elders over the age of 65 who are not residents of long term care facilities. The purpose of the APS program is to investigate reports alleging abuse, neglect or exploitation and to prevent recurrence through the provision of protective services intervention. Principles that guide the assessment consider an adult's right to personal autonomy, self-determination and the use of the least restrictive method of providing safety prior to more intrusive methods.
Central Intake
The APS Program receives reports of abuse, neglect and/or exploitation through its Central Intake Unit. Seven agents handle calls through a statewide toll-free number to determine if the referrals meet the criteria for APS to investigate a case. If the criteria are not met, referrals are made to community resources including those in the aging network.

During SFY08, Central Intake

APS Central Intake SFY 08

staff handled a total of 24,442* calls on the toll free hotline.

3500

Twenty four percent of the calls

3000

(5,775) were accepted for APS

2500

Investigation. CI staff provided

2000

Total Calls

limited case management

1500

Accepted for In vestigatio n

intervention services for 3,254

1000

Interv entions

calls (13%) to address issues that

500

did not meet APS criteria. The

0
July Aug Sept Oct Nov Dec Jan Feb Mar April May June

remaining 63% of calls consisted of time spent with call backs to

* Pr oblem s with the Ce ntral Intak e tele phone sys tem incom ple te/m issing data for De c 07 ; Ja n, Fe b. and June 0 8

reporters and coordinating referrals to community resources

and other service providers to ensure that callers' issues were addressed.

APS Field Operations
Adult Protective Services uses a regional-based multi-disciplinary approach to meet the needs of vulnerable disabled and senior adults in the State of Georgia. APS regions are aligned with the aging network planning and service areas and reside in five districts. 155 APS case managers handle both investigations and case management services for the statewide APS caseload.
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APS Case Totals
APS averaged a total of 2,958 cases per month. APS Investigations comprise approximately 39% of all monthly APS cases.
APS Guardianships

S F Y 0 8 A P S C a s e s v s . In v e s tig a tio n s

3500

3000

2500

2000

1500

1000

500

0
July

A ug Sept

Oc t N ov

D ec

Jan

F eb

Mar

A pril

May Ju ne

A ll C a s e s In v e s tig a tio n s

APS provides case management for the incapacitated adults for whom the Department of Human Resources serves as Guardian of Person. APS managed approximately 619 guardianships per month in SFY08.

APS Emergency Relocation

SFY 08 Emergency Relocation Funds Spent*

Funds

$5 0,000

Jul y

$4 5,000

Aug

The APS program receives $400,000 each

$4 0,000 $3 5,000

Sept Oct

year from the legislature to provide

$3 0,000

Nov

emergency relocation services to

$2 5,000

Dec

individuals who need relocation from an

$2 0,000 $1 5,000

Jan Feb

abusive situation. Emergency relocation

$1 0,000

M ar

funds pay for clients to move from unsafe

$ 5,000 $0

April M ay

housing, replacement of personal items

ERF Monthly Expenditures

Jun e

when they have been broken or stolen by

*Dat a for s ome months not pos te d a t tim e of r eport

an abuser as well as items to keep them

safe in their homes.

Examples of Outstanding Accomplishments
APS staff were successful in reaching the initial contact timeliness target in 95.7% of investigations in support of Wildly Important Goal(WIG).
APS staff were successful in 95% of new investigations determining whether Abuse/Neglect/Exploitation (A/N/E) occurred within the 30 business day standard in support of WIG.
APS Safety Team implemented a variety of strategies and initiatives directed at ensuring staff safety in the field in support of WIG.
Finalized Quailty Improvement Standard Case Review Guide tools and process.

5

Caregiver Programs and Services
GA DHR-Division of Aging Services and the Aging Network
Overview
Georgia's aging network continues to expand the array of services needed to support family caregivers. During SFY 2008, services to caregivers included day care, in-home respite, information and assistance, caregiver education/training sessions, information and assistance, support groups, material aid (help with purchasing transportation, food or groceries), home modification, and care management (helping assess needs of caregivers and developing care plans enabling them to keep loved ones at home).
Caregivers Served
Individual services documented included: Adult Day Care provided to 847 persons Respite Care provided to 2482 persons Other Support Services to 865 persons
Caregiver # of Individual Units by Service
20,857
243,739
407,253
Adult Day Care (hours) Respite Care (hours) Other Caregiver Support (hours or units)
Caregiver Group Services documented to over 355, 000 duplicated persons included:
Information and assistance which links caregivers with needed resources 6

Community public education sessions events Support groups Education/training for caregivers

Caregiver % of Group Activites

3%

2%

12%

Support Groups
Information & Assistance Events
Training
83%

Success Stories
The Division of Aging Services and its partners, the Area Agencies on Aging, launched a new program for family caregivers, called Powerful Tools for Caregivers, which is described below. The following comments were received from caregivers who completed the first course held in Georgia in Augusta, co-led by class leaders from the CSRA Area Agency on Aging, and the Alzheimer's Association, Georgia Chapter:
My life has changed It's O.K. to ask for help; I won't keep trying to do this alone This has changed my life, given me more confidence, the ability to
assert my needs and not feel guilty I encountered a situation this week--before this class I would have
just given up...using the tools I was able to come up with a solution-- it worked I wish every caregiver could take this class I will thrive not just survive

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Accomplishments Highlighted
The Division of Aging Services and participating partners have completed phase one of an evidence-based research project on caregiver assessment. Funded by the U. S. Administration on Aging at $434,000, the project implemented a caregiver assessment tool and protocols to assist care managers to more effectively provide the kinds of services caregivers need to continue in their caregiving role. Partners in the project are the University of Wisconsin at Milwaukee, the Atlanta Regional Commission Area Agency on Aging, Coastal Georgia Area Agency on Aging, Southeast Georgia Area Agency on Aging, and the Alzheimer's Association, Georgia Chapter.
In partnership with the University of Georgia Cooperative Extension, the Division of Aging Services (DAS) and participating Area Agencies on Aging launched Powerful Tools For Caregivers, a six week educational program to provide family caregivers with tools to increase their self-care and confidence. During the course, caregivers develop a variety of self-care tools to reduce personal stress, change negative self-talk, communicate their needs to family members and healthcare service providers, and to make tough caregiving decisions. Three published research studies have found significant reductions in health-risk behaviors and improvement in self-care and psychological well-being for caregivers who have taken the course. Fifty-nine class leaders were trained during the year to conduct the course for family caregivers across Georgia.
Georgia was in the spotlight for a national Satellite Broadcast, Supporting Family Caregivers, which took place in March. Presented by the Centers for Medicare and Medicaid Services and the U.S. Administration on Aging, two Georgia programs were highlighted during the broadcast: Mobile Day Care, which provides day care to rural communities with staff that travel between locations, and Consumer Directed Care, a program where consumers are allowed to hire family, friends, and neighbors to provide some of the services they need. Consumer directed care programs are particularly helpful in rural areas where families have access to a smaller number of community- based services.
Future Directions and Opportunities
The Division of Aging Services received a $384,000 grant from the U.S. Administration on Aging to conduct a longitudinal study on Tailored Care (TCARE), a caregiver assessment. The project will examine the impact of TCARE on caregiver stress, burden, and on nursing home placement (successful diversion from placing family members in a nursing home), through the provision of services selected to support and enable the caregiver to continue to keep their loved ones at home.
The Division of Aging Services, the Middle Flint Council on Aging, Lower Chattahoochee Area Agency on Aging, and the Alzheimer's Association, Georgia
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Chapter, are collaborating partners with the Rosalynn Carter Institute at Georgia Southwestern State University (RCI) in implementing the Reach II project, an evidence-based multi-component caregiver intervention in rural Georgia. Goals of the project are to reduce caregiver burden and depression, improve caregivers' ability to provide self-care, and help caregivers learn how to manage difficult behaviors of their care receivers. The Division of Aging Services will expand the Powerful Tools for Caregivers project in Georgia by training an additional 60 Class Leaders across the state. Georgia also will be certifying its own Master Trainers, which will make it easier to train additional class leaders.
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Community Care Services Program (CCSP)
GA DHR-Division of Aging Services and the Aging Network
The Community Care Services Program (CCSP) has successfully served eligible consumers in Georgia for 26 years. By providing home and community-based Medicaid services to nursing home eligible consumers, the CCSP gives consumers the choice of remaining in the community.

Medicaid Dollars Spent/ Per Consumer

$30,000 $27,500 $25,000 $22,500 $20,000 $17,500 $15,000 $12,500 $10,000 $7,500 $5,000 $2,500
$0

$22,663

$19,081

$26,077

$26,573

$5,935

e
$7,407

$7,748

$8,550

SFY05

SFY06

SFY07

Nursing Homes CCSP

SF08

Ninety-two percent of eligible consumers choose the CCSP.
Dollars Saved
CCSP saved taxpayers $18,023 per individual served in SFY 2008.*
Georgia taxpayers saved $234,046,678 in SFY 2008 through this program.
In SFY 2008 the CCSP helped keep 12,986 Georgians remain in less costly community settings delaying nursing facility placement.

Consumers Served

Fifty-two percent of CCSP clients were 75 years of age or older; 27% were 85 or older, and clients 100 years of age or older in SFY 2008 totaled 129. Twenty-one percent of consumers were under 60 years of age.
In SFY 2008, effective care coordination allowed clients' needs to be met so that they remained in the community 47 months.

48 50
40 40

45 46 47 47

30

20

10

0 SFY SFY SFY SFY SFY SFY
2003 2004 2005 2006 2007 2008

CCSP Client Average Length of Stay in Community

*This is the average CCSP client service benefits cost and does not include care coordination or

administrative costs.

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CCSP Services

Adult Day Health (ADH) health, therapeutic and support services in a day center Alternative Living Services (ALS) 24-hour personal care, health-related support services and nursing supervision in a licensed personal care home Emergency Response Services (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 care, support, and respite services in client's home. Eligible Consumers may choose the consumer Directed Personal Support Services (PSS) Option. Out-of-Home Respite Care (OHRC) temporary relief for the individual(s) normally providing care (service numbers are included in the PSS total in the graphic below).

10,000 9,000 8,000 7,000 6,000 5,000 4,000 3,000 2,000 1,000 -

Clients Served by Type of Service 1 9,985

6,169

5,081

2,264

746

144

35

PSS ERS HDM ALS ADH SNS OHRC

1 Duplicated client count: clients may receive more than one service.

Seventy-seven percent of CCSP clients use Personal Support Services. The service accounts for 74% of total CCSP expenditures. Alternative Living Services ranks second in expenditures (12%). Forty-eight percent of CCSP clients use the cost-effective Emergency Response Services (accounting for 1% of CCSP Medicaid expenditures).

11

Elder Abuse and Consumer Fraud Prevention Program
GA DHR-Division of Aging Services and the Aging Network

The Elder Abuse and Consumer Fraud Prevention (EAP) program provides services to identify, prevent and treat elder abuse, neglect and exploitation. Program goals are to heighten awareness of abuse of older individuals, increase reporting, and facilitate access to programs and services for victims. The program provides training to professionals and volunteers and community education and program awareness activities to the general public to raise the awareness of vulnerable adult abuse. Program Accomplishments, SFY 2008, the State Office and the twelve Area Agencies on Aging, Elder Abuse Providers:

Training

3500 3000 2500 2000 1500 1000 500
0

3096 2353
S FY 0 7 S FY 0 8

Training was provided to 3006 professionals and volunteers in SFY08. This represents a 32% increase in the number of professionals trained.
Program Awareness

# of professionals and volunteers trained

120,000 100,000

108,079

The EAP program reached approximately 13,000 individuals through statewide and local community presentations. In addition, more than 100,000 individuals were reached through a variety of program awareness activities such as health fairs, media events and informational mailings/

80,000 60,000 40,000 20,000
0

45,282

S FY 0 7

S FY 0 8

# of people reached through health fairs, mailings, and media events

Examples of Outstanding Accomplishments: Participated in collaborative initiatives and community partnerships to address issues faced by older and disabled victims of crime and abuse (i.e., Georgia Commission on Family Violence, State Triad of Georgia, and local SALT (Seniors and Law Enforcement Together) councils across the state, Elder Rights Teams in each region. Several regions across the state coordinated with the Forensic Specialist at the Division of Aging Services to train professionals in their community on "Elder Abuse is Getting Old".

12

Trained Victim Witness Advocates at the 2007 Georgia Victim Assistance Academy on vulnerable adult abuse and accessing resources for older victims. Co-Presented a training entitled "Sexual Abuse in the Family: Perspectives on child and elderly victims" at the Child Abuse Symposium sponsored by Prevent Child Abuse Georgia.
13

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. Services are provided by legal providers throughout the state, who contract with the state's twelve Area Agencies on Aging.

Persons Served

More than 27,647 seniors received legal representation, information and/or education during SFY2008. End-of Life Planning, Debt Collection, and Nursing Home Medicaid Eligibility were the prevailing issues for seniors. In keeping with the tenor of the economic downturn in the state and the nation, ELAP saw a marked increase in seniors experiencing consumer issues related to credit card, housing loans and other consumer debt. While calls

50,000 45,000 40,000 35,000 30,000 25,000 20,000 15,000 10,000
5,000 0

35,478 SFY02

30,440 SFY03

47,180 SFY04

for legal assistance from seniors may

increase, the means by which ELAP has the resources to provide services

continue to decrease.

31,950 SFY05

Monetary Benefits Realized
In SFY 2008 ELAP saved older Georgians $3,991,670 by providing document preparation, legal counseling and case representation.
An additional $2,865,981 was provided through the more than 38,213:08hours of legal counseling provided, calculated at a very conservative $75.00 per hour.
More than $1,391,979 was obtained in benefits and restored funds for older Georgians through the work of ELAP.

14

Top Five Primary Case Types Opened-SFY 2008
Fifty-eight percent (58%) of the cases opened for this fiscal year involved health care, consumer, income maintenance and housing issues and 38% involved endof-life issues.
Administrative Social Security, Food Stamps, Disability -337 Consumer Fraud, Contracts, Debt Relief -666 End of Life Decisions Financial & Health Care Power of Attorney, Living Wills- 1,210 Health Care Medicare, Medicaid, Nursing Home & Personal Care Home Issues - 564 Housing Homeowner, Public Housing & Landlord Tenant - 333

ELAP Community Education Offered
Community education is a method of prevention that helps seniors avoid more costly, time consuming legal problems. In SFY 2008, 17,612 seniors attended 689 legal education sessions conducted by the Georgia Elderly Legal Assistance Program.
The top ten topics covered in community education sessions in SFY 2008 were: 1.Advance Directives = 101 2. Medicare Part D= 75 3. Emergency Disaster Preparation = 50 4. Economic Stimulus = 41 5. Elder Abuse = 39 6. Wills and Estates = 32 7. Consumer = 30 8. Social Security = 30 9. Public Benefits = 27 10.Identity Theft/Consumer Fraud = 27
Number of Sessions - Top 10 Topics
120

100 101
80
60
40
20

75
50 41 39 32 30

30

27

27

0

1

2

3

4

5

6

7

8

9

10

15

Examples of Older Georgians Whose Lives ELAP Impacted
A 72-year-old client sought assistance when he received a discharge notice for nonpayment. The client only speaks Spanish and the nursing home had trouble assisting him in applying for Medicaid benefits, thus his application had not gone forward. A bilingual attorney with ELAP assisted in obtaining the missing information to complete the Medicaid application process and the application was accepted and benefits were received. The facility withdrew the discharge notice. An 82-year-old client sought assistance probating the estate of his wife. Through the year of support offered by ELAP, title to the home place and rental properties was transferred to the client. As the home place was in foreclosure, the rental properties were sold and the proceeds used to pay off a mortgage. A reverse mortgage stalled the foreclosure and proceeds paid the mortgage in full. ELAP represented a 64-year-old client whose husband recently died and whose SS benefits had been denied because he was deemed a "fleeing felon". The charges against the husband were reduced from a felony to a misdemeanor and he paid a fine to satisfy the charge but had not been able to get his benefits reinstated. ELAP assisted the client in obtaining back benefits owed to her husband for $18,249 and ongoing benefits of $252.00 per month. ELAP assisted a 65-year-old client in obtaining custody of her two grandchildren whose mother was deceased. The father had contested custody in an earlier hearing but upon the case being filed again by the private attorney hired by ELAP, the Juvenile Court who received the case in a transfer from Superior Court granted custody to the client.
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Forensics
GA DHR-Division of Aging Services and the Aging Network
The Forensic Specialist provides services to mandated reporters & firstresponders to assist them in recognizing and responding to incidents of abuse, neglect & exploitation of older adults and adults with disabilities. Goals of the Forensic Specialist are to improve professionals' recognition of and response to adult abuse.

2500 2000 1500 1000
500 0

Training
1 2007

2305 Mandated Reporters received ANE training.

Program Accomplishments, SFY 2008

The Forensic Specialist created the Adult, Neglect, and Exploitation Workgroup, which meets bi-monthly to discuss the state of elder abuse in Georgia. Provided training to mandated reporters in health care, law enforcement, & social workers (including 2nd largest law enforcement agency in state) Helped develop policy and procedure for Serious Incident Review Team which reviews serious injuries and unexpected deaths in certain populations Coordinated and facilitated monthly Serious Incident Review Team meetings Provided case consultations as requested by Adult Protection Services and law enforcement Participated in development of Multi-disciplinary Team in metro county to review case of older adult abuse. Serves as an ongoing member of the Multi-Disciplinary Team meeting bimonthly.

17

GeorgiaCares
GA DHR-Division of Aging Services and the Aging Network

GeorgiaCares helps Georgia's Medicare beneficiaries, their families and others understand their rights, benefits and services under the Medicare program and other health insurance options.
Outreach and Media Events

Outreach Events SFY 06 - SFY 08

3,234
3,000

5,244

3,564

0

'06

'07

'08

In State Fiscal Year 2008, GeorgiaCares conducted a total of 3,564 outreach and 385 media events to 18,602,725 individuals regarding health insurance information on Medicare, Medicaid, prescription assistance, Medigap, longterm care services and financing options, other health insurance needs and Medicare fraud prevention.

401 trained volunteers served clients in SFY 2008.

A total of 23,324 clients were served.

Reducing "Outof-Pocket" Costs
Over the last three years, GeorgiaCares has enabled clients to save more than $60 million in health insurance and related expenses.
In SFY 2008, GeorgiaCares saved beneficiaries $11,941,422.90 in out-ofpocket expenses. 2006 was the first full fiscal year of the Medicare Part D enrollment.

Clients' Savings SFY06 - SFY08

40,000,000 35,000,000 30,000,000 25,000,000 20,000,000 15,000,000 10,000,000
5,000,000 0

36,739,725 SFY06

11,814,702 SFY07

11,941,423 SFY08

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Types of Issues Addressed by GeorgiaCares
In SFY 2008, 58% of GeorgiaCares calls dealt with Medicare beneficiaries needing prescription assistance.
Counseling Needs

Long-Term Care 7%
Medicare PDP/MAPD 41%

Fraud and Abuse 4%

Medicare Health Plans 11%

Medigap/supplement 4%

Other 16%

Prescription Needs 17%

Examples of Outstanding Accomplishments
Partnerships expanded to 89 Georgia recognized as being #30 in National SHIP Performance
Standards, up from 43 in 2006. Georgia consistently ranked in the top 6 nationally in assisting
individuals to access needed pharmaceutical medications through Pharmaceutical Manufacturers Assistance Programs Georgia is one of only 14 states authorized to participate in the long term care (LTC)partnership initiative
Challenges for the Future
GeorgiaCares will continue a large scale outreach campaign geared to educating and assisting Medicare beneficiaries regarding their benefits and fraud.
GeorgiaCares will launch a widescale outreach campaign to inform Georgians of the benefits and availability of LTC Partnership policies.
GeorgiaCares provides services to all 159 counties in the state and will focus additional outreach endeavors on reaching underserved populations and the low income Medicare beneficiaries.
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Home and Community Based Services
GA DHR Division of Aging Services and the Aging Network
Overview
The Home and Community Based Services (HCBS) program makes available a variety of services to individual consumers, and to groups of consumers, to support and assist older Georgians in staying in their homes and communities. These services support older persons and their families in living longer, living safely and living well. In SFY 2008, 36,277 individual consumers received at least one HCBS individual service. Services are delivered consistent with the Department's moral imperative that "government is a resource to, not a replacement for, families."
Partnerships
The Division of Aging Services contracts with the 12 Area Agencies on Aging (AAA) for the provision of Home and Community Based Services based on the needs of older Georgians in their planning and service area. AAAs sub-contract for service delivery with a network of approximately 250 organizations including cities, counties, for-profit and non-profit providers in Georgia.
Consumers Served

HCBS Individual Services

11,888

3,394

46,034

283,246

337,537

In Home Services (hours) Case Management (hours) Other HCBS Services (units)

Transportation (trips) Telephone Reassurance (calls)

In-Home Services included Emergency Response System Install and monitoring, Friendly Visiting, Homemaker, Personal Care to 4,940 clients

20

Transportation provided to 2,143 persons Case Management assisted 8,098 persons Telephone Reassurance was provided to 382 persons All other services provided to 757 persons

HCBS Group Services

22,897 32,377

21,862

1,985

64,275

362,437

Transportation (DHR Unified) Volunteer Opportunities (contacts) Senior Recreation (activities) Information & Assistance (contacts) Material Aid (contacts)
Community/Public Education (sessions)

Group services were provided to over 455,135 persons. (Duplicated client count; clients may receive more than one service)
Accomplishments Highlighted
Development and Publication of Policies and Standards for HCBS Tiered Care Coordination: In response to a state budget initiative to redirect state funds for home and community-based services, the Division researched and published policies and standards for a tiered model of care coordination for consumers of non-Medicaid funded supportive services. The model allows AAAs to provide care coordination assistance Gateway/ADRC callers on a short-term basis to help them obtain community resources. While the AAAs are the preferred providers for care coordination services, they also have the option to contract with qualified community organizations that do not also provide supportive services, to provide objective, service neutral care coordination assistance. The target populations may include community-dwelling elders, and their caregivers, and care coordination support may be provided on a more long term basis, according to consumers' need for assistance in obtaining and managing their services. Regardless of organizational placement, the care coordination system uses the basic assessment of functional status and need for care, plus several additional criteria, in determining the consumer's degree of risk of loss of independence and in establishing the level of care coordination needed.
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Care coordinators will then be able to manage their time, according to risk level, and allocate their time spent in service planning, service arrangement, consumer contact, oversight and periodic reassessment, based on each consumer's individual needs. This approach is consistent with the intention to provide all supportive services "at the right time, in the right amounts and for the right duration."
Future Directions and Opportunities
Cost Sharing Initiative: With the 2006 re-authorization of the Older Americans Act came an enhanced emphasis on consumer participation in the cost of long term care and supportive social services. Assuring the highest possible quality of service delivery and marketing these quality services to consumers with the means to participate in cost sharing will generate additional revenues for home and community based services. The Division revised and re-published expanded policies and guidelines for cost-sharing for specified in-home and community based supportive services to stimulate the growth of this revenue source throughout the statewide aging network. The renewed initiative is to be implemented in SFY'08.
AIMS/Technology Development: The next phase of AIMS development will focus on re-designing the "client" screens in AIMS, during which all programs within DAS that have an individual consumer focus will assess their data collection and reporting requirements. The developmental goal is to consolidate consumer data as much as possible, so that program staff through the aging network, including APS, Gateway, Care Coordination, and service provider staff, can access basic client data to identify instances in which consumers are being served by multiple programs/agencies within the network. The desired operational outcomes are 1) improved coordination among all DAS programs and services and 2) elimination of duplication of activities (care coordination activities, data collection and data entry).
Nursing Home Diversion Grant: The Division will be implementing the AoA Nursing Home Diversion Grant during FY '08 and Fy'09, in partnership with the Atlanta Regional Commission Area Agency on Aging. The grant funding supports efforts to identify those community-dwelling elders with potential for out-of-home placement and who are at risk of Medicaid spend-down. The goal is to target these individuals and to provide expanded service options, including that of directing their own services.
22

Focus on Caregivers: As a result of the continuing emphasis on providing support to caregivers, DAS has adopted the policy position that requires a caregiver be identified in AIMS when respite care and other caregiver services are provided. This will require some effort on the part of programmatic and data entry staff at the regional and local levels to revise client data to establish an individual record for the caregivers. The service definitions and budget categories also have been reconfigured to consolidate all caregiver services into one major program area.
Ongoing Development and Integration of the Aging and Disabilities Resource Connection (ADRC) Initiative: As we have moved from a grant-funded development initiative with pilot sites to a state-funded initiative to expand ADRC assistance to all 12 regions, the challenges will be to retain current state funding and attract additional support for expansion efforts. Also there is a need to emphasize the integration of ADRC assistance into the Gateway framework, including assuring the availability of care coordination assistance throughout the home and community based service sector. There are opportunities to extend our emerging caregiver assessment approach to caregivers of adults with disabilities, as well to those who care for the elderly.
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Kinship Care Services
GA DHR Division of Aging Services and the Aging Network
Overview
The term "kinship care" has been used in Georgia to reference relatives who are raising related children due to the temporary or permanent absence of the biological parents. These relatives include great-grandparents and grandparents raising grandchildren (GRG) and uncles raising nieces and nephews, cousins, and other relatives raising children. During SFY 2008, the core supportive services included information and assistance, support groups, and community public education. To expand resources, the aging network also has collaborated with local, public and private organizations.
When a relative caregiver assumes the responsibility of providing full-time custodial and financial care for their grandchildren, they do not always fully anticipate the additional responsibilities and resources needed. It is not until they begin providing care that these relative caregivers realize the physical, financial, and social needs associated with caring for their relative children.
Partnerships
The Division of Aging Services continues to contract with the Atlanta Legal Aid Society, Inc., and the Georgia Legal Services Program to provide an array of legal services to relative caregivers, including the provision of legal advice to and representation of relative caregivers in matters concerning adoption, custody, housing, public benefits, and special education needs of children. In SFY08, 102 volunteer attorneys were recruited to provide kinship care legal services to kinship care families, 45 children were adopted, and 302 relatives were provided guardianship of their relative children.
In partnership with Jewish Family and Career Services, the Kinship Care Navigator Program placed grandparent caregivers in Division of Family and Children Services (DFCS), Division of Public Health, the Office of Child Support (OCSS) services, and the Division of Mental Health, Developmental Disabilities and Addictive Diseases (MHDDAD) Metropolitan-Atlanta and surrounding county offices. Through this program, relative caregivers work part-time to assist other relative caregivers to navigate the requirements of the social service and public benefits systems and to better understand what resources are available. Eight Kinship Care Navigators are currently hired as part-time staff with partnering organizations.
The Georgia Department of Human Resources Grandparents Raising Grandchildren Summit was a partnership between The Division of Aging Services, DFCS, MHDDAD, DPH, Office of Child Support Services (OCSS), and (American Association of Retired Persons)AARP Georgia Office. The purpose of the summit was to enable DHR staff to learn and share kinship care resources in
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their respective service areas as well as to provide further technical assistance to the interagency referral process. The summit also served as a catalyst for relationship-building among DHR entities that work with grandparents raising grandchildren. One hundred and sixty-two participants attended the summit. Three-fourths of attendees were DHR staff members from state or regional offices or DHR contractors. Participants also represented community-based organizations, county agencies, regional organizations, federal agencies, universities, and private organizations.
Dr. Sharon King of the Georgia State University Gerontology Institute developed a Summit Meeting Evaluation Report; which made the following recommendations to DHR:
Fine-tune "One-System-of-Care" (OSC) for improved tracking and followup of GRGs
Directly involve GRGs in all interagency planning meetings Schedule quarterly interagency GRG meetings to sustain networking Enlist support of community organizations to identify GRGs with needs
and publicize OSC Sponsor a GRG Services Summit for GRGs, with provider agency
representatives as presenters
Grandparents & Others Served
Individual services documented include Counseling (85 persons)
Kinship Care # of Units by Service

854

160

Res pite Care - Hours Counseling - Hours

Kinship Care Group provides the opportunity to document all of the group activities and duplicated persons served.
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900 800 700 600 500 400 300 200 100
0

Kinship Care # of Group Activities

785 557 363

106 77

63 44

Community & Public Education Support Groups
Material Aid
Events
Training
Care Receiver Supervision Tutoring

1

Success Story
Mr and Mrs S. first made contact with the program through a Back to School supply giveaway where a booth was set up with information. They are raising two grandsons, one of whom has Down's Syndrome, and one who has Attention Deficit Disorder. Since contacting the program, they have been referred to the Department of Family and Children's Services and are now receiving financial assistance through the Department of Family and Children Services, one grandson was able to attend summer camp and they are currently enrolled to receive services through the Senior Farmers Market Nutrition Program. Ms. S is a very sick woman who struggles through every day but she is always so upbeat and gracious. She always brags on how the program has helped them, and her positive attitude is very motivating and uplifting.
Accomplishments Highlighted
The Brookdale Foundation, Rayonier Foundation and United Way have provided additional funding for AAA summer camp scholarships, which provides respite care for relative caregivers. One hundred and forty-one (141) children benefited from summer camp scholarships. Furthermore, local churches and senior centers offered meeting space and donated material aid to AAAs summer camp programs. Two hundred and five (205) families received donated school supplies during SFY08.

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Program outcomes of the kinship care program are measured through the Kinship Care Participant Satisfaction Survey, which is a program measurement and analysis tool for overall program satisfaction and benefit. In SFY08, 454 relative caregivers participated in this survey.
95% of the grandparents agreed that they are better able to cope with caring for the children they are raising since being involved with the kinship care services and activities. 83% of grandparents reported that they agreed they were not as stressed since participated in the kinship care program 87% of grandparents reported they are enjoying life better. Future Directions and Opportunities Continue collaborative staff training between Department of Human Resources divisions and offices in order to expand knowledge of Grandparents raising grandchildren resources Conduct regional educational summits for grandparents raising grandchildren. Increase wellness education and health promotion activities with kinship care program participants.
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Long-Term Care Ombudsman Program
GA DHR- Division or Aging Services and the Aging Network
The Long-Term Care Ombudsman Program works to improve the quality of life of residents of long-term care facilities by acting as their independent advocate. This includes residents of nursing homes, personal care homes (also called assisted living), intermediate care facilities for the mentally retarded (ICF/MR), and community living arrangements (CLAs). Ombudsman staff and volunteers informally investigate and resolve complaints on behalf of residents.
Persons Served
In SFY 2008, the Long-Term Care Ombudsman Program served 242,823 persons. Seventy-six percent of these individuals were served during ombudsman visits to facilities. This represents an average of 2.6 ombudsman visits for each resident bed during the year. Over 15,000 individuals received information and assistance regarding long-term care options, public benefits, residents' rights, etc.
Ombudsmen received an average of 1.8 complaints per complainant for investigation.

Persons Served by Type of Service

Facility Visits 172,681

Complaint Investigation
2,781
Resident / Family
Councils 6,349

Facility Staff Training 7,393

Information and Assistance
15,016

Facility Consultation
9,816

Community Outreach and
Education 17,419

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Complaints Handled by Ombudsmen

5,183

4,676

4,490

1,236

1,212

1,350

In SFY 2008, the Ombudsman Program received 5,905 complaints.
Ombudsmen achieved satisfactory outcomes for 97% of complaints in SFY 2008.

33 20

44 15

33 8

SFY 2006 SFY 2007 SFY 2008

Nursing Homes IC R/M Rs

Personal Care Homes CLAs

Types of Complaints
Residents' rights (30%), quality of life concerns (28%), and care issues (27%) accounted for over 85 percent of the complaints received by ombudsmen in SFY 2008.

Examples of Outstanding Accomplishments

Evaluated our program

Types of Complaints Ombudsmen Handled

effectiveness Local long-term
care ombudsman programs were

Administration 7%

Outside Agency 8%

Residents' Rights 30%

evaluated for their

effectiveness by

experienced

researchers.

This project

confirmed our program strengths in complaint resolution,

Qualityof Life 28%

Resident Care 27%

education, and issues

advocacy for

residents.

It focused our energies on areas for improvement, such as volunteer

development, interagency relations, and responding to populations with

developmental disabilities or mental illness.

Promoted Quality Improvement in Nursing Homes Ombudsmen promoted the Advancing Excellence in America's Nursing
Homes campaign with residents, families, facility staff, and the general public.

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Nutrition and Wellness Programs
GA DHR- Division or Aging Services and the Aging Network
Overview
"Living Longer, Living Well" The Nutrition and Wellness Programs are aimed at increasing the ability of older adults to perform everyday activities and remain living in their own homes. Activities are focused on health promotion and disease prevention. Services are designed to improve nutrition and health status, increase functional abilities, promote safety at home, avoid or delay problems caused by chronic diseases and enhance quality of life.
Partners in Service Delivery System
The Division of Aging Services partners with the Aging Network and other public and private sector agencies to provide nutrition and wellness program services. These partners include; University of Georgia, Area Agencies on Aging, Senior Centers, Diabetes Association of Atlanta, Georgia Extension Service, Georgia Commission on Women, Georgia Osteoporosis Initiative, Division of Public health, AARP, American Cancer Society, Parks & Recreation etc.
Consumers Served
Nutrition Program

# of Meals

Congregate Meals Home Delivered Meals

0

1

2

3

Millions

Home Delivered Meals served to 14,646 persons Congregate Meals served to 14,225 persons Additional 5,612 persons served with these individual services: Exercise and Physical Fitness
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Medications Management Nutrition Counseling Health Related and Health Screening
Nturition and Wellness Group Activities

3,277

3,131

8,239

10,866

Physical Activity
Lifestyle Management
Program Awareness/Prevention Nutrition Education

Physical Activities included chair exercise, dancing, aerobics, walking, weight exercises, water aerobics, yoga, etc. Lifestyle Management included recreation, safety, therapeutic activities, and tobacco cessation Program Awareness/Prevention included community events, distribution of materials, medications management, immunizations and group screening activities Nutrition Education included nutrition and health sessions, menu planning and food preparation, explanation of Dietary Guidelines, eating and feeding information, and food safety

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Success Stories
The Website (livewellagewell.com): The web site's main purpose is to provide information on healthy aging for people aged 50 and older, their families, and their caregivers. The website tracking shows that during 2007-2008, Live Well Age Well web site has had 8051 unique visitors (in 4 months, 2013 average per month) who made 9861 (2465 average per month) unique visits and viewed 20528 pages (5132 average per month).
11th Annual Healthy Aging Summit: The Division and its partners hosted the 11th Annual Healthy Aging Summit. More than 300 health care professionals attended the conference. Service providers, partners and seniors were recognized at the conference for their outstanding contributions in promoting healthy aging.
Live Healthy Georgia Seniors Taking Charge Community Intervention: The Division partnered with UGA in planning, implementing and evaluating the above mentioned community intervention to promote nutrition & physical activity and teach strategies for diabetes self-management, improve heart health, prevent falls, prevent osteoporosis and manage medications wisely.
The Live Healthy Georgia Seniors Taking Charge Community Intervention was recognized nationally as one of the best practice models in the country and the Division's Chief Nutritionist was invited to present information on the intervention at the 2008 South Eastern Area Agencies on Aging (SE4A) and the Georgia Gerontology meetings. The Division's Chief Nutritionist was also invited to serve on the Administration on Aging sponsored National Nutrition Program Evaluation Task Force to provide input in the development of a tool to evaluate the Older American's Act funded Nutrition Program.
Accomplishments Highlighted
More than 7,000 people participated in the "Live Healthy Georgia Seniors Taking Charge" annual kickoff events and learned strategies for healthy aging & healthy living
More than 3000 program participants participated in various physical activity programs such as walking, Tai Chi, chair exercises and other resistance exercise programs and improved their strength, balance and flexibility
More than 15,000 program participants participated in various nutrition education activities and learned ways to prevent/manage chronic diseases by eating healthy, keeping food safe to eat and planning healthy meals on a budget
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The Division was successful in writing a grant to receive $94,000 from USDA to implement the Senior Farmers' Market Nutrition Program. More than 4,200 participants participated in the Senior Farmers Market Nutrition Program and increased their consumption of fresh fruits and vegetables and knowledge regarding the importance of eating safe and healthy foods.
Future Directions and Opportunities
Increase partnerships with the Division of Public Health, Georgia Diabetes Coalition, Center for Disease Control, Food and Drug Administration, Georgia Osteoporosis Initiative, Georgia Commission on Women, hospitals and other public/private sector agencies to expand wellness program activities and resources Coordinate efforts with Department of Public Health and United States Department of Agriculture to increase funding for the Georgia Senior Farmers' Market Nutrition Program. With increased funding, we will be able to increase the number of older adults participating in the SFMNP program and also help improve access to fruits and vegetables.
Develop strategies to plan and implement evidence based health promotion programs Increase coordination between the Wellness Program, Georgia Cares Program and Kinship Care Program for the provision of Wellness Program Services to Medicare beneficiaries and grandparents raising grand children
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Older Americans Community Service Employment Program
GA DHR- Division or Aging Services and the Aging Network
The Older Americans Community Service Employment Program (OACSEP) provides useful part-time community service assignments and training for unemployed, 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.

Persons Served

Although participants can be as young as 55 years of age, 66% were over age 60.
Eighty Three percent of persons enrolled had incomes below the federal poverty level.
Thirty-Three percent of current enrollees were receiving public assistance.
Forty-Seven percent of enrollees were minorities.

SCSEP Participant Demographics

100%

80% 83%
60%

40%

20%

0%
Series1

Age 60+ 66%

Poverty 83%

33%
Public 33%

47%
Minority 47%

Age 60+

Poverty

Public Assistance.

Minority

Examples of Outstanding Accomplishments
Exceeded the 38% job placement rate required by USDOL; achieved 61.2%. Achieved a 179.1% total enrollment rate. Exceeding the USDOL goal 0f 162% Achieved a 78.7% retention rate. Exceeded the USDOL goal of 75%. Exceeded the required Service Level goal of 162% by 180% Program participants provided 291,085 hours of Community Service while training in the OACSEP program.
Community Benefits
Participant wages contribute to the local economy and reduce dependence on public benefits programs.
Participants provided over 224,000 hours of service to community organizations.
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The most common job assignments were in organizations providing social service programs and schools, followed by services to the elderly.
Challenges and Directions for the Future
Newly reauthorized Older Americans Act will change some aspects of the program. U.S. Department of Labor reporting requirements and systems continue in the developmental stages. Increase opportunities for job skills training and employment as follows:
Develop additional partnerships with other workforce development agencies, programs and employers. Develop and implement recruitment strategies and materials that target older job seekers who are most in need and who have poor employment prospects.
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