State plan on aging FY 2000-2003 [Aug. 1999]

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Georgia Division of Aging Services

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State Plan on Aging

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FY 2000 - 2003

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Department of Human Reso,urces

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Verification of Intent

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The State Plan on Aging for Fiscal Years 2000 through 2003 is hereby submitted for the State of

Georgia. The plan covers the period October 1, 1999, through September 30, 2003. It includes

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all assurances aIxi plans to be conducted by the Department of Human Resources (DHR.) Division
of Aging Servi4es under the provisions ofthe Older Americans Act, as amended, during the

period identified. The State Agency named above. has been authorized to develop and administer

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the State Plan qn Aging in accordance with all requirements of the Act, Le., the development of comprehensive1and coordinated systems for the delivery of sUpportive services, including

multipurpose ~nior centers and nutrition services, and to serve as the effectIve and visible

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advocate for theI eld. erly in the State.

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This State P~ is hereby approved by the Governor and constitutes authorization to proceed with

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activities under; the State Plan upon approval by the Assistant Secretary on Aging. I 1 I

The State Plan ion Aging for Fiscal Years 2000 through 2003 hereby submitted has been

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developed fu accordance with all Federal statutory and regulatory requirements.
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(Signed)

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(Date)

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(State Agen irector, where applicable)

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I hereby approye the State Plan on Aging and submit it to the Assistant Secretary on Aging for

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approval. :
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(Date) .

(Signed~ (o~

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Table of Contents

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Public Comments

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Introductionl ! I

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Georgia's Aging Network

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The Divisio~ of Aging Services

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Area Agencl.ies on Agl.ng

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Georgia's Funding and Services for the Elderly

Stewardship

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Fee for Service

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Pt-ogrammatic Guidelines
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Title III Older Americans Act

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Title V Older Americans Act

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Title VII Older Americans Act Alzheimer's Services

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. C,ommunity Care Services Program ......................... 26

Elderly Legal Assistance Program

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Health Insurance, Assistance and Referral for the Elderly

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L'ong-Term Care Ombudsman

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Non-Medicaid Home and Community Based Services

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Snior Nutrition Program

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S~nior Community Service Employment Program

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Demographic Profile of Georgia's Elderly

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~ging Trends In Georgia

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~ajor Age Groupings for Persons Age 55+ by PSA

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Dow Income Persons Age 60 and Above

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Uow Income Minorities Age 65+

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P,ersons 65+ Who Speak English "Not Well" or "Not at All"

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Persons 65+ With a Mobility or Self-Care Limitation

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Funding Alit-cation Plan

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I~trastate Funding Formula

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Intrastate Funding Formula Assumptions and Goals

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~llocation of Title III Resources - Agency Administration

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Table of Contents - Continued
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Program Allocations by Planning and Service Area

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Older Americans with Greatest Economic or Social Needs ....... 70

Minimum Percentage of Part B Allotment for Priority Services ~ .. 72

Low Income Minority Individuals and Older Individuals Who

Reside in Rural Areas .................. '

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Activities to Increase the Access of Older Native Americans

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Additional Costs to Provide Services to Rural Areas ............ 73

Maintenance of Effort for Long-Term Care Ombudsman

.... Program

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Title VII . '............................................... . 75

Needs Assessment of Elderly, Programs and Services

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Program Plan

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Issue Elder Rights - Protect the Rights of

Vulnerable, Older Adults (Elder Rights Plan)

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Long-Term Care Ombudsman Program

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'Legal Assistance

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Health Insurance and Pension Benefits

'Assistance and Counseling

93

Elder Abuse Prevention

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, Advocacy and Protection of Rights

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TraD~portation

99

Managing Using Data

102

Home Delivered Meals

105

Uniform Cost Methodology

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Home and Community Based Services

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Long-Term Care

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Gateway

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Assurances

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General Assurances

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Program Specific Assurances

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Assurances Prescribed by the Assistant Secretary on Aging

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Area Plan Requirements

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State Agency Organization

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State Allotment Assurances .. "

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State Agency Responsibility

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Charts and Tables.

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Chart 1 Georgia's Aging Network ........,..................... 7

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Chart 2

Georgia Department of Human Resources Orgaitizationa~Chart

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Chart 3 Table 1

~ap of Planning and Service Areas (PSAs) ......... 15 Listing of Area Agencies on Aging .. ~ . . .. . . . . . . . . .. 16

Table 2 Fund Sources Available to the Division .. '. . . . . . . . .. 20

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Chart 4 Increased Alzheimer's Services .................... 24

Chart 5 Alzheimer's Units of Service. . . . . . . . . . . . . . . . . . . . 25

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Chart 6 Chart 7 Chart 8

Cost Comparison Nursing Facilities vs CCSP ......... 26 Average Cost Per Person: Waivered Programs ....' ...... 26 Number Served: Medicaid Waivered Programs .......... 27

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Chart 9 CCSP Clients Served . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Chart 10 Elderly Legal Assistance Program .... ~ . . . . . . . . . . .. 28

Chart 11 Clients Served -IDCARE ........................... 30

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Chart 12 Program Savings - HICARE . . . . . . . . . . . . . . . . . . . . .. 31

Chart 13 Number of Complaints

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Chart 14 .People Served - Ombudsman Program .......... 33

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Chart 15 Population Ages 60+ ........................... 35 Chart 16 Mobility & Self-Care Limitation ..................... 35

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Table 3

~utrition Interventions ............................... 38

Chart 17 S,CSEP Participant Demographic ............... 39

Chart 18 ~xceeding Unsubsidized Employment Goals ,.......... 40

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Table 4 Table 5

:Qefinitions of Service ............................ 42 Summary of Units of Service and ~lients Served ......... 48

. Chart 19 Georgia's 65+ Population Growth .............. 51

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Chart 20 Georgia and U.S. Population 1990-2020 ............... 51

Table 6 Major Age Groups for Persons Age 55+ by PSA

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. Chart 21 Statewide Distribution of Elderly ..................... 53

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Chart 22 <:;oncentration of Elderly in Each PSA .................. 54

Table 7

~ow Income Persons Age 60 and Above ............ 55

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Chart 23 Uow Income Persons 60+ by PSA ............... 56 Table 8 Low Income Minorities Age 65+ ............... 57

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Chart 24 Statewide Distribution of Low Income Minorities ....... 58

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Table 9

Eersons 65+ Who Speak English "Not Well"
or, Not At All" ........... ~ ............ '.. 59

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Charts and Tables - Gontinued
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Chart 25 Persons 65+ Who Speak English Not Well or Not at All ................... ~ .. "... '. . . 60

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Table 10 Chart '26 Table 11

Persons 65+ with a Mobility or Self-Care Limitation .'. ~ . . 61 Persons 65+ With a Mobility or Self-Care 'Limitation ... 62 , Intrastate Funding Formula Factors and Weights ...... 66

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Table'l2 " Allocation of Title IIIResources : . . . . . . . . . . . . . . . . . .. 67

Table 13 SFY 2000 State Program Allocations by PSA . . . . . .. . . 68 Chart 27 Determination of Need for Home and CoilimunityBased

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Table 14

Serv-ices

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Per Unit costs of Providing Services i'n Urban and Rural

Areas ................................ ~ . . . 73

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Table 15 Maintenance of Effort - Long-Term Care Ombudsman

,Program

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Table 16 Comparison of Demands and Trends ...............'..... 83

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Public Comments

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The Division of Aging Services, through the Area Agencies on Aging held various public

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meetings and f09uS groups to solicit the public to provide input into the development of the State Plan on Aging for the FY 2000 - 2003 period. Comments were submitted either in writing to the

Area Agencies dn Aging, or by voicing comments at the various public forums. Additional

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efforts to solicit 'consumer input are described in the Section entitled "Needs Assessment of Elderly Prograrrls and Services." Below is a listing of the Public Hearings held by location and

date.

'I January 12, 1999

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, Public Hearing ll:00AM

Toombs County Community Center

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January 14, 1999 Public Hearing

3715 Northside Parkway

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200 Northcreek, Suite 300 Atlanta, Georgia 30327

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March 25, .1999

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Public Hearing Newnan, Georgia

Southern Cre'scent Area Agency on Aging

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Introduction

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I, Georgia State Plan on Aging FY 2000 - 2003

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Introduction

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State agencies; on aging administering 'funds under Titles III and VII of the Older Anlericans Aqt of 1965 are required to develop and submit to the Assistant

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Secretary on Aging a State plan for approval under Section 307 of the Older'
Americans Att. The Division of Aging Services has adopted a four-year State

Plan on Aging for the period extending from October 1, 1999, to September 30,

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2003. The Plan provides specific information concerning:

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*I The a1l6cation and impact of Title III and Title VII funds for services to the elderly fn the State of Georgia. .

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*! A descqption of the coordination of Older Americans Act programs,

service& and initiatives with community organizations, agencies and

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resourcs in the State of Georgia. I
*I A demclgraphic profile of Georgia's elderly.
* Program assurances as required by the Older Americans Act.

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The State Plan is based, in part, on area plans developed by the 12 Area Agencies

on Aging within the State designated under Section 305(a)(2)(A). These area

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plans were de-Veloped from a uniform format developed by the State agency, in coordination with the Area Agencies.

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In administerirtg, managing and coordinating programs and services for the elderly

in Georgia, the Division of Aging Services assures that preference will be given to

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the provision Pf services to older individuals with the greatest economic need and older individuals with greatest social need, with particular attention to low-income

minority individuals.

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Georgia State Plan on Aging FY 2000 - 2003

This four-year plan provides specific information on the aging network - services available to Georgia citizens, distribution of funds to support services for the elderly, challenges and futu!e directions to meet the demands that confront Georgia's elderly and the system of services to assist elders and their families.

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Concurrent with the development of this plan, Georgia has elected a new

Governor, Roy Barnes. A new Commissioner of Human Resources, Audrey W.

Home, was appointed effective July 16, 1999, to lead the Department into the new

millennium. The new leadership understands the importance of this plan and the

need to serve older Georgians.

. The State Plan on Aging is based on recommendations and information received from a variety of sources. Community and consumer involvement was obtained though a variety of public forums, public hearings and meetings held during the year. In addition, the State Plan incorporates information gathered through contacts with senior citizens, interested individuals and groups, public and private . service programs, data generated internally, and planning activities over the past four years.

This document serves as a blueprint governing the future path of aging services within the State. The plan reflects, through the issues addressed, the areas of need expressed by elderly Georgians and their families, advocates, and agencies serving the elderly. The needs expressed are shaping the future course of programs and services provided.

A wide array of services are offered through Georgia's Aging Network. The Division of Aging Services fully complies with the requirements of the Older Americans Act to insure that services are properly and effectively administered to meet the needs of the elderly population. Our mission and vision reflect our dedication to achieve these goals.

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I Georgia State Plan on Aging FY 2000 ;. 2003

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The Strategic Planning Process

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The Official Gode of Georgia Annotated (O.C.G.A.) 45-12-73 & 175 requires that

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State GoveITIJilent develop a State Strategic Plan and that state agencies develop strategic plans.

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While the State Strategic Plan guides the overall work of state government, agency plans guide th,e unique work of individual organizations that make up state

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government.lpformationsubmitted through agency plans is incorporated into the annual state p~an. Ideas published in the state strategic plan are used to guide

work of agenqies. Each plan informs the other, making strategic planning a

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cyclical process that includes an exchange of information and greater learning about how th~ parts contribute to the whole of state government.

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A strategic o~jective is a measurable statement of what is to be achiev~d over a

specific term period to implement a strategic direction/goal. The process to

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develop viabl~ goals is accomplished through Results-based Budgeting.
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The implementation of Results-based Budgeting in state government has created a focus on pro~am results. At the heart of performance management is a set of

measurable e~pectations which express the direction or intent of the delivery

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system, the pr:ogram, or service to be managed. These expectations provide the focus for matiageIllent and, as such, are indispensable tools for management.

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In the Georgi~ State Aging Network, perf~rmance expectations are expressed in

both our Agency Strategic Plan and in Results-based Budgeting goals and

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objectives. TPese tools provide a framework upon which we focus our efforts to better serve our elderly population.

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Georgia State Plan on Aging FY 2000 - 2003'
Georgia's Aging Network

Divi~ion.ofAging Se~ices

The Division of Aging Services (DAS) is one of five' Divisions within the Georgia Department of Human Resources, the state department charged with the responsibility for administering human service programs for the State of Georgia. The Division of Aging Services provides state leadership, manages contracts with lead agencies (AAAs), administers federal and state funding, and provides programmatic direction, regulations/guIdelines and continuously seeks to improve the effectiveness and efficiency of the services provided.to elderly Georgians and their families.

State Urnt on Aging . (SUA)
a. . A state organizational unit designated by the Governor.

b. . Responsible for statewide planning; program development; training and

technical assistance; advocacy; coordination; programmatic and fiscal

monitoring and evaluation; oversight and administration of Area Plans.

c. Responsible f<;>r the qevelopment of an Intrastate Funding Formula which is

approved by the Administration on Aging and which is used to allocate funding to

Area Agencies on Aging (AAAs).

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d. Responsible for the development and promulgation of additional necessary state

policies and procedures.

e. Responsible for the designation of planning and service areas (PSAs) and AAAs.

-f. In Georgia: the Department of Human Resources (DRR) Division of Aging,

Services (DAS) is the designated ~tate Unit on Aging.

Area Agencies on Aging
Area Agericies on Aging (AAAs) are designated by DAS to provide local responsibility for the implementation of services.. Currently, twelve Area Agencies are identified by DAS across the State ofOeorgia by geographical boundaries called Planning and Service Areas (PSAs). The AAAs are the primary focal points for aging services within the State. All community based services for the elderly are coordinated through these agencies. The Area Agency on Aging is responsible for the quality of service through its contractual arrangements with service providers, and for monitoring their performance.
a. Responsible for lo~al planning, program development and coordination, advocacy, monitoring, area plan administration, and resource development.
b. Responsible for area plan development process: identification of the needs of older persons in the area; evaluation of existing services and gaps; development of objectives and priorities; and identification of the services which will be
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I Georgia'State Plan on Aging FY 2000 - 2003

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provided to meet the needs of elderly citizens and their caregivers.

c. Responsible for developing contracts with local providers, using a competitive

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procurement process, which will result in the delivery of services (unless the
A.AA is a free-standing, non-profit entity which has received a waiver from the

State Unit on Aging to provide services directly).

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d. Responsible for working with local leaders, the private sector and local elected I officials to develop a comprehensive coordinated service delivery system.

e. Responsible for establishing and coordinating the activities of an Advisory

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Council which will provide input on development and implementation of the Area Rlan; assist in conducting public hearings; review and comment on all

c'ommunity policies, programs and actions affecting older persons in the area.

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The Unique Roles ofthe Area Agency on Aging

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a. Catalyst - The primary entity in the community which addresses aging issues:

b. ~lanner - Assesses, analyzes, facilitates and continuously improves the existing

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srvice system.

c. C::oordinator - Encourages and facilitates linkage of local service providers and

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. i~sources, enhancing individual capacities to provide services.
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d. Advocate - Assures access for older persons to comprehensive systems of care in
tlle community through educating policy makers and the community on the needs

qfthe elderly.

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Direct Service Providers

Direct service providers are approved to provide services to the elderly population and funded

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through contracts with AAAs, and through reimbursement for services through the Community
Care Services Program. These approved providers supply the array of services available to I
Georgia's elderl.,y..

a. Responsible for the delivery of services funded by various sources, including the

Area Agency.

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b. Responsible for the collection of data and the submission of appropriate

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programmatic and fiscal reports to the AAA, using the required forms/formats.

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~esponsible for submitting to the AAA updated proposals for service delivery on

the basis determined by the procurement process.

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Georgia State Plan on Aging FY 2000 - 2003

d. Responsible for advocacy for the elderly at the community level.

Georgia Council on Aging

The Georgia Council on Aging's primary mission is to serve 'in an advisory capacity to the Governor, the General Assembly, The Board of Human Resources, and all other state agencies
, on aging issues, and to advocate with and on behalf of aging 'Georgians and their families to
improve their quality oflife. CO-AGE (Coalition of Advocates for Georgia's Elderly) is convened by the Georgia Council on Aging. The CO-AGE Committee, which is comprised of members of the Board of the Georgia Council on Agiilg,serves as liaison between the Council and the CO-AGE network. CO-AGE is a forum through which the concerns of older Georgians are identified and addressed. CO-AGE is a diverse coalition, comprised of both, consumers and providers from throughout the state. The Coalition is based on voluntary participation, with almost 3000rganization.s and individuals actively participating., Quarterly meetings are held at different locations around the State~ The Council on Aging supports collaboration between all departments and councils of the State, not just in the interest of the elderly but to prepare all ages
. for long life. The Council has developed strategic goals and plans to support the elderly'.
Advocates

The Aging Network is working to increase the level 'of advocacy on behalf of Georgia's elderly.

Through Area Agencies on Aging, meetings are held for seniors ~o talk with and educate their

elected officials. Newly elected lo'cal officials are onented about aging issues, and advocates

help educate the community about aging concerns.

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Older Consumers and Their Families:

Older Georgians and their families are both recipients of services and key elements in the

network. The voices of these individuals help shape the aging agenda, and these individuals are

. primary spokespers~ns for the Aging Network.'

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CHART 1

I ,Georgials Aging Network
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Georgia Department of Human Resources

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Georgia Council on Aging

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Division of Aging Services

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Director

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Elc:ler Rights and
Advocacy

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Planning and
Evaluation

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Community Care Sorvices Program
(CCSP)

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Social Services and
Employment

Advocates

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Area Agencies on Aging

I Direct Service Providers
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Older Georgians and Their Families

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Georgia State Plan Qij }1'ging FY 2000 - 2003
The Division of ~ging Seo/ices, .
The Division of Aging Services is structured into four functional sections: Elder Rights and Advocacy, Community' Care Services Program, Planning and Evaluation, and Social Services and Employment. The manager of each section has !iirect reporting responsibility to the Division Director. As the state agency responsible for programs and services for the elderly, the Division continuously seeks means to improve the effectiveness and efficiency of services provided to the elderly. The Division has adopted Continuous Quality" Improvement (CQlrtechniques for the development of its internal strategic planningtproces,s .and program management. This . internationally acclaimed management approach has been effectively utiliz~d throughout the Department of Human Resources and wi~9- the Division of Aging Services as a grass roots methodology for assessing the prionties and needs of the statewide community and for improving current_administratiye processes. The Division has adopted a mission; vision and values statement which functions as a directional beacon for the organization in,its day-to-day.operation and management and strategic planning activities.
Mission
To assist older Georgians inal;hieving healthy, independeilt,andself- sufficient lives.
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I Georgia State Plan on Aging FY 2000 - 2003
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Vision

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The Division ofAging Services will be the leader

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ilfa customer driven aging services network

known for its exemplary teamwork, quality"

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I innovation, and accountability.

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Values of the Division

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A Strong Customer Focus: We are driven by customer, not organizational, need.

Our decjsions involve our customers and include choice. We recognize that our

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customers include people of all ages with disabilities.

A Positive Work Environment: Work should be an enjoyable experience. To

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that end~ we are a compassionate group with a sense of humor. We like being with one another and atteinpt to make work a nurturing environment. Above all, this is

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a place ~o come and learn.

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Accoun~ability and Results: We are good stewards of the trust and resources that

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have beyn placed with us. We recognize that this trust can be withdrawn. Our decisions are based on data and analysis; our services produce the desired results. Weare efficient and can prove it; we make every dollar count.

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Teamwork: Teamwork is the way we do business. Our decision-making is shared

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and everyone's opinion counts and is valued. From teamwork comes innovation, creativity, and opportunity.

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Open C;ommunication: Communication is the lifeblood of organizations. Ours is open, tWo-way and timely. Our customers receive accurate, timely and responsive

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information from us. You can trust that what we say is true.

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Georgia State Plan lOll AgingFY 2000, - 2003

':A Proactive Approach: We have"a strong sense of urgency about whom we serve \md are aggressive in our efforts !to'h~lp and serve them. We are respons'ive. We

welcome change as that opportunity that it always is.

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yv :nignity: e respect o.uri~trinsi~ ,self-\\orth..~nd. tha~R(~)1 people. We are driven 'to preserVe the human dignity. of all older Georgians.

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~Our Workforce:, \6>ut workfqrce is this. organizationsrs,best asset. Therefore, we .~place a high value on one another and treat one another with fairness and equity.

'W pur w9,~kfor~.eis.fMJIY~8jI:>&~l!~a.tP~~~~.}!~,eu~t~rn7r~". ~ a~~. a "can-d~"

group who get thmgs done and done well. Everythmg that we do IS at the hIghest

possible standard...everything.



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Trust: Honesty is the best policy and we are honest witH one another and with our

customers. Integrity, our adherence to these principals and values, underlies what

we can do and who we are. .,
'Diversity: We valu~ a djver:~~ wor~(.f,' orce that ,refleGts tJw needs of our diverse customers.



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Ertll)()werment: 'We

beJieve

ill.~v.e

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right to

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self-determInation

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for all

our

pt customers. We suppo#)he rig.~t 6~rr~ustomers imdworkforce to make choices

and assume responsibility for th~i~ own decisions.

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Chart 2
Georgia Department of Human' Resources

Policy and Government Services
Office of Adoption
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Office of Regulatory Services

Office of the Governor
Board of Human Resources
Commissioner's Office

Administrative Offices

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Division of Aging Services

Division of Family and
Children Services

Division of Mental Health, / Mental Retardation and Substance
Abuse

Division of Public Health

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Division of Rehabilitation
Services

August 1999

Georgia State Plan on Aging FY 2000 - 2003

Area Agencies on Aging

Local responsibility for the implementation of Older Americans Act programs resides with the twelve Area Agencies on Aging in the State. These Area Agencies are distributed across the State of Georgia and are defined by geographical boundaries called Planning and Service Areas (PSAs). Some of the Planning and Service Areas are aligned within the State of Georgia Regional DevelopJ;11ent Center territory definitions. The number of Agencies has been changed since the last plan (from 17 to 12) as a result of the establishment of common service areas for all Divisions/Offices of the Department of Human Resources (DHR). This action was instituted to enhance the management of aging services, to better serve customers, to unify a common service area for all services within the Department, and to enhance access to and coordination of services between DHR Divisiqns.

Area Agencies are responsible for providing services to the elderly within their respective PSAs. The Area Agencies have unique roles as catalyst, planner, coordinator, and advocate. The primary responsibilities of the Area Agencies:

.. to serve as the 'advocate and focal point for older individuals within the community by monitoring, evaluating, and commenting upon all ,policies, programs, hearings, 'levies, and community actions which will affect older individuals;

.. to prepare a multi-year plan which identifies the needs of older persons, existing services and, gaps in service; sets objectives and priorities; specifies which services will be provided to meet the needs of the elderly; and develop an Elder Rights Plan;

.. Development of a comprehensive community-based service delivery system (focal point role)

.. Planning, contracts and grants management

.. Monitoring and assessment of the area plan and the work of direct service providers

.. Developing and informing consumer's and the general public about advocacy issues.

.. Program development

) Coordinate a comprehensive coordinated service delivery system



Promote public/private partnerships to enhance and/or expand existing services.

Page 12

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Georgia State Plan on Aging FY 2000 - 2003

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Coordinate public/private partnerships to enhance and/or expand existing services;

I



qoordinate and maximize the use of existing limited funds;

I



Promote non-traditional approaches to providing social services;

I



Work effectively with boards and advisory committees; .

I



Manage the political role:' external relationships;

i

,.



Provider/manager of services if other providers are not available.

I

I
Other Area Agency functions and responsibilities include:

I

The Area Agency conducts annual evaluations of all programs and services provided through the I
contracting process. An important part of the process is reviewing the established goals and

objectives ofthe services provided and determining the status of each one.

I

I
Area Agencies are effective advocates for the needs of the aging population regarding local, state

and federal issues. Usually a designated staff member participates in the Coalition of Advocates

I

for Georgia's Elderly (CO-AGE) to discuss issues, develop action steps, educate consumers about issues affecting the elderly and their caregivers, and provid;e information to elected

officials. The Agencies also endorse the Senior Day at the Capitol and offer administrative and

I

logistical support. This activity not only educates legislators on local needs, but it also gives participants an 9Pportunity to observe government in action. Although the Silver Haired

"

Legislature is no longer an activity sponsored by the Division of Aging Services, the Area

I

Agency suppo~s the delegates through facilitating elections, providing staff support, through
training, and involving delegates in regional activities. These activities yield a better-educated

consumer, train~d advocates and informed legislators, who will in turn bring about positive

.1

change for oldet Georgians.

Area Agencies on Aging share information about the Area Agency and its programs in many

I

settings: church~s, senior centers, civic clubs, advisory council meetings and service provider agencies. Inforr.p.ation is disseminated through handouts and often emphasized with visuals.

Topics have included resources, the aging network, and the various community programs. In

I

addition Area Agencies on Aging dispense various media (magazines, newsletters, announcemenWin the local paper) to educate the public about aging issues and services.

I

I

The Area Agency on Aging surveys providers annually to identify their needs for training. Based on the results of the surveys, training is organized through tapping local resources or is provided

by Area Agency staff. Many providers have very capable staff and often plan excellent training

I

sessions for theIr employees. If space allows, they are encouraged to open the training to other agencies within the aging network. Area Agency on Aging staff have an opportunity to express

I

Page 13

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Georgia State Plan on Aging FY 2000 - 2003
their needs and desires for training and technical assistance during planning retreats and regular staff meetings. Based on each staff member's job responsibilities, training sessions, conferences and meetings are made available barring budget constraints..
The Area Agency will update and maintain an emergency mariagement plan, in accordance with the Red Cross, Georgia Emergency Management Agency and the Division of Aging Services guidelines, to assure that elderly clients' needs are identified and communicated to appropriate authorities during periods of natural disasters or other emergency conditions. The document will be distributed and reviewed with all providers of services to the elderly population.
All Area Agencies on Aging have established an Advisory Council on Aging to carry out advisory functions which enhance the Area Agency's mission of developing and coordinating community-based systems of services. The Council meets at regular intervals to advise the Area Agency on Aging relative to developing and reviewing its area plan and amendments; administering the plan, conducting public hearings, representing the interest of older persons and reviewing and commenting on policies, programs, and actions which affect older persons. State Unit program staff provide technical assistance to Area Agencies in the ongoing development . and operation of the Councils. Each advisory council is made up (actual number varies by- Agency) of voting members, including individuals ~d representatives of community organizations who will assist in enhancing the leadership role of the Area Agency on Aging in developing a community based system of services. Usually the council consists of: 1) more than 50 percent of older persons including individuals who are participants or who are eligible to participate in programs; 2) representatives of older persons; 3) representatives of health care provider organizations, including providers of veterans' health care, if appropriate; 4) representatives of supportive services providers organizations; 5) persons with leadership experience in the private and voluntary sectors; 6) local elected officials, and 7) the general public.
Page 14

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. Chart 3

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if) Division of Aging Services

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DGHER_
DEP~CW
HU""" IIESOUIICD

Planning and Service Areas (PSA)

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PSAs 1 .Northwest Georgia

2 Georgia Mountains

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3 Atlanta Region 4 Southern Crescent

5 Northeast Georgia

I

6 West Central Georgia 7 Middle Georgia 8 Central Savannah

River Area

I

9 Heart of Georgia Altarnaha 10 Southwest Georgia

11 .Southeast Georgia

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12 Coastal

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Agency Name
Northwest Georgia AAA Coosa Valley Regional Development Center 2 Legacy Link, Inc.

Georiga Division of Aging Services Area Agencies on Aging Table 1

Aging Director

Mailing Address

Debbie Studdard AAA Director

P.O. Box 1793 Rome, GA 30162

Pat Viles Freeman P.O. Box 2534

AAA Director

Gainesville, GA 30503

3 Atlanta Regional Commission
4 Southern Crescent AAA Chattahoochee-Flint Regional Development Center
5 Northeast Georgia AAA NE Georgia Regional Development Center
6 West Central Georgia AAA Lower Chattahoochee Regional Development Center

Cheryll Schramm AAA Director
Bobby Buchanan AAA Director

3715 Northside Parkway 200 Northcreek, Suite 300 Atlanta, GA 30327
P.O. Box 1600 Franklin, GA 30217

Floretta B. Johnson 305 Research Drive .

AAA Director

Athens, GA 30610

Jewel Fuller .AAA Director

P.O. Box 1908 Columbus, GA 31902

7 Middle Georgia AAA Middle Georgia Regional Development Center

Amy Tribble AAA Director

175-C Emery Highway Macon, GA 31217

Phone Number 706-295-6485 1-800-544-6299 770-538-2650
404-364-2527
706-675-6721 770-854-6026 (ATL)
706-369-5650
706-649-7468
912-751-6160

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_f .' I. :... _...

.. _

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Georiga Division of Aging Services Area Agencies on Aging Table 1

- -AgencyName- ------- --Aging Director- ----

Mailing-Address

8 Central Savannah River CSRA Regional Development Center

Jeanette Cummings P.O. Box 2800

AAA Director

Augusta, GA30904

9 Heart Of Georgia Atlamaha AAA Gail Thompson

Heart Of Georgia Atlamaha

AAA Director

Regional Development Center

P.O. Drawer 1260 Baxley, GA 31515

10 Southwest Georgia Council on Aging, Inc.
11 Southeast Georgia AAA
SE Georgia Regional Development Center

Kay Hind

308 Flint Avenue

Executive Director Albany, GA 31701

Wanda Hankla AAA Director

3395 Harris Road Waycross, GA 31503

12 Coastal Georgia AAA Coastal Gerogia Regional Development Center

Rhonda Jones AAA Director

P.O. Box 1917 Brunswick, GA 31521

Phone-Number 706-737-1823 912-367-3648 912-432-1124 912-285-6097 912-264-7363 Ext 228

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Georgia's Funding and I Services for the Elderly
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Georgia State Plan on Aging FY 2000 - 2003

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Georgia's Funding and Services for the Elderly

J

Stewardship

Below is a list of the fund sources and programs which are available to the Division of Aging

I

Services. The Division of Aging Services has taken numerous steps and actions to assure that funds entrusted to it are used in both an appropriate manner and as efficiently and effectively as

possible. New it}itiatives are underway to enhance community service settings to serve as focal

I

points for servic,es. Preference is given in allocation of resources to serving those of greatest economic or social need, with emphasis on low-income minorities. An extended system of information and,referral is in place to reach all areas of the State. Proportional funds are

I

expended for. access, in-home and legal assistance. Assessments are conducted annually to determine what programs and services must be refined to insure client needs are being met. Area

Agency Advisory Councils are a crucial part of each Area Agency on Aging and provide a forum

I

for consumers apd advocates to give feedback on the Aging Network. Monitoring and evaluation of prbgrams and services are an on-going and essential part of operations. The

Division of Aging Services, as the designated State Unit on Aging, assumes the stewardship role

I

with responsibilIty and dedication to serve. In addition to providing emphasis to AAAs on the collection of voluntary contributions for Older Americans Act services, the Division has ,

undertaken a specific initiative to leverage Federal and State funds through the implementation

I

of a fee-for-service system.

Reasons for hnplementing a Fee-for-Service System

I,

The funds available for serving older Georgians are not sufficient to meet their needs. Growth in

the amounts of ~tate and federal revenues available to fund programs for the elderly has not kept

I

pace with the pqpulation growth over the last decade. Additionally the implications for increased demands on the aging services delivery system are clear, especially with the "graying"

of the "Baby Bo.omers."

I

The Older Americans Act, which serves as the base for AAAservices, prohibits charging fees for

service and prohibits denying services to individuals who cannot or will not pay for services.

I

However, it does allow for the collection of voluntary contributions. The program income derived from these contributions is a valuable resource, but success in developing this resource

varies from area to area within the state. Irrespective of the many reasons for low rates of

I

program incomt; collection, it is clear that it is not a reliable source of revenue for program

growth.

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Page 18

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Georgia State Plan on Aging FY 2000 - 2003

In addition to the demographic changes and the statutory constraints confronting us noted above, it is apparent that the AginiNetwork is experiencing the challenge of moving into a competitive arena of service delivery. There are new client "markets", and AAAs and providers alike are being called upon to increase public education activities and to serve persons beyond our traditional targeted populations of persons in greatest social and economic need.

Implementing a system of collecting fees for services, based on both client income and the cost of the services, gives us the opportunity to improve community-based services several ways:

o

We can do a better job of targeting our federally funded services to low-income

persons, while at the same time offering the same needed services to other persons

who can and would pay for the service if it were available.

o

We can generate revenues in addition to those obtained from voluntary

contributions.

o

We can expand services and reduce the reliance on public funds.

o

We can multiply the impact of the limited state dollars for community based

services.

Although we are using state funds as a base of support for the fee-for-service system, it is important to note that weare not employing a "means test" to detennine eligibility for services. An individual's income will be used only to detennine the amount of his/her share of the cost for the service. The detennination of eligibility will continue to be consistent with the requirements of the Older Americans Act.
Programmatic and Fiscal Guidelines for Use of Community Based Services Funds

o

Coinmunity Based Services funds may be, used to supp<;>rt/expand such services as

the following:

Congregate meals, Transportation, Home Delivered Meals, Homemaker/Chore

Services, and Adult Day Care Services.

o

Funds may be used to support/expand services in the following ways:

to serve eligible persons currently on waiting lists; to increase services in under-served areas; to reduce unmet need by increasing units of services provided to underserved clients; to reduce unmet need by expanding into unserved areas. to initiate one or more of the above service(s) for which there is a known need, but which currently is not available due to lack of resources.

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I Georgia State Plan on Aging FY 2000 - 2003
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Tabl 2 - Fund Sources Available to the Division of Aging Services

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Fund Source

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Service/Activity

Source/

Federal State Local

Authority

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Title III-A i

Area Agency Administration

OAA (1)

Yes

No

Yes

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Tittle III-B

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Title III-C I

Supportive Servic;es Nutrition Services

OAA

Yes

Yes

Yes

OAA

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C(1) I C(2)

Congregate Meals Home Delivered Meals

OAA

Yes

Yes

Yes

OAA

Yes

Yes

Yes

I

Title III-D I

In-Home Services to Frail Elderly

OAA

Title III-F

Health Promotion

OAA

Yes

Yes

Yes

Yes

Yes

Yes

I

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Title V '
I

Senior Community Employment Service Program (SCSEP)

DOL (2)

Yes

No

No

Title VII

Elder Abuse Prevention and LTCO

OAA

Yes

Yes

Yes

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Activities

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Social Services Block Supportive, In-Home and Nutrition Title ~ Social

Yes

Yes

Yes

Grant (SSBG) .

Services

Security Act and

OBRA (3)

I

Community Bas~d

Supportive, In-Home and Nutrition

State

No

Yes

No

Services (CBS):

Services

appropriation

State SupplementIal

LTCO

State

No

Yes

No

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appropriation

Indigent Care Trust Home/Community Based Services,

State

No

Yes

No

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Fund (ICTF) I

CCSP, Legal, Alzheimer's

appropriation

Georgia Caregivers' Alzheimer's Caregiver Respite and

State

No

Yes

Yes

Resource Cente~

Day Care Services

appropriation

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(GCRC)

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Health Resources lznd Alzheimer's Caregiver Respite and Federal Grant

Yes

No

Yes

I

Services Administration (HRSA)
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Day Care Services

I Page 20
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Georgia State Plan on Aging FY 2000 - 2003

Fund Source
State Health Insurance Advisory Grants Program
Community Care Services Program

Service!Activity
Benefits Counseling for Medicare/Medicaid Beneficiaries
In-Home and Community Based Services for Medicaid Eligible Persons

Source! Authority
HCFA (4)

Federal State Local

Yes

Yes

' No

Title XIX, HCFA Yes

Yes' No

(1) Older Americans Act

(2) Departmen(ofLabor funds the program, but the Title is part of the Older Americans Act

(3) Omnibus Budget Reconciliation Act of 1980

(4) Health Care Financing Administration

Title III - Older Americans Act

The Georgia Division of Aging Services receives an annual allotment of funds from the Federal Administration on Aging under Title III of the Older Americans Act (OAA) of 1965. In Georgia, these funds are distributed to 12 Area Agencies on Aging based on an approved il1trastate funding fonnula.

Area Agencies on Aging

The Area Agencies on Aging plan for, develop and implement a system of programs and services for older Georgians (age 60 and over) in each of the 12 Planning and Service Areas (PSAs) in the State. The Area Agencies contract with provider agencies to obtain supportive services, in-home services for frail, older individuals, and congregate and home-delivered nutrition services. They also oversee multi-purpose senior center activities. This comprehensive system of services is described in detail in each of the Area Plans for each Area Agency. Services are targeted to those elderly with greatest social or economic need with particular emphasis placed on minority elderly with low Incomes. Title III Older Americans Act programs administered by the Division of Aging services include:



Title III A Administration



Title III B Supportive Services



Title III C Nutrition Services



Title III D In-home Services for Frail and Older Individuals

"

Title III F Disease Prevention and Health Promotion

Page 21

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Georgia State Plan on Aging FY 2000 - 2003

Social Services Block Grant (SSBG)

I

This fund source is utilized to supplement the following .older Americans Act Title III priority services: Adult Day Care, Homemaker/Chore, Transportation, Home Delivered Meals, and Case

I
Management. :

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Georgia Fund Jor Children and Elderly (Income Tax Checkoff)

I

Georgia taxpayers may support services to the elderly by contributing their State income tax refunds to the Georgia Fund for Children and Elderly. Fifty percent of the total receipts into this

fund are distributed to aging programs which provide home delivered meals and transportation

.1

services to the elderly.

I

Title V, Older :Americans Act - Senior Community Services Employment Program (SCSEP)

,

I

Title V is a Federal and State funded program which provides subsidized employment in the public and private sectors for those age 55 and over who meet income criteria. Training and job

search guidance is also provided with the program. Program counselors assist workers in locating

I

work in the priv~te sector, .following their extended training and work experience period in the public and private sector jobs. The Division contracts with Area Agencies to provide, through

subcontracts, setvices to over 300 older workers.

"

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Title VII - Older Americans Act

I

Title VII, vulnerable elder rights protection activities of the Older Americans Act, as amended, requires the state agency to develop a coordinated system that ensures that the Long-Term Care

Ombudsman program, programs for the prevention of elder abuse, neglect, and exploitation, state

I

elder rights and ~egal assistance programs, outreach, counseling; and assistance programs all work together to protect elder rights.

I

Health Resources and Services administration Grant (HRSA)

Since its inception in 1986, the Alzheimer's Program in Georgia has grown to include forty-two

I""

community programs, a statewide Care Giver Resource Center and a Health Resources and Services Administration demonstration grant The Health Resources and Services Administration grant monies prdmote Alzheimer's pilC,)t programs for innovative service delivery models

I"

"

targeting unserv~d populations, and education and training activities throughout the State. The . Division continu~s to support the HRSA grant funded programs, subsequent to their transfer to

the Administration on Aging in FY 1999. These grants are now known as the AOA Alzheimer's

I

Demonstration Grants-to-the-State Program.

I Page 22
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Georgia State Plan on Aging FY 2000 - 2003
Health Insurance Counseling, Assistance and Referral for the Elderly (HICARE)
The Health Insurance Counseling and Referral for the Elderly (HICARE) program was initiated in FY 1994 through a grant from the U.S. Health Care Financing Administration. The purpose of this program is to provide information and assistance to Medicare recipients who have questions or problems regarding Medicare coverage, Medicare supplemental policies (Medigap), Medicaid, long-term care insurance, and other programs such as the Qualified Medicaid Beneficiary Program. Additional state funding supports Home and Community Based Services, Long-Term Care Ombudsman Programs, Alzheimer's Programs, and the Health Insurance C.ounseling, Assistance and Referral for the Elderly Program. Federal grants from the Administration on Aging support programs to prevent Medicare fraud, waste and abuse. Following is a discussion of the major programs which provide services to elderly Georgians.
Page 23

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I Georgia State Plan on Aging FY 2000 - 2003

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Alzheimer's Services in Georgia

I

Alzheimer's Disease (AD) is a progressive, degenerative disease of the brain, and the most common form of dementia. Approximately four million Americans have Alzheimer's Disease,

and it is the fourth leading cause of death among adults. AD costs the United States

I

approximately $~0-$1 00 billion a year.

By the year 2000, the number of persons in Georgia with Alzheimer's Disease is expected to have

I

grown to 97,841, an increase of 18.9% within a decade. Georgia's population aged 85 and older will increase by 127% between now and the year 2010. Almost one half of all Georgians 85 and

older have Alzh~imer's Disease (AD) or another dementia.

,I

Alzheimer's Dis~ase costs American business over $33 billion per year in employee absences and lost productivity. Employed caregivers are among the 19 million Americans who have a family

member with Alzheimer's Disease. On average, a full time employed caregiver of an Alzheimer's

J

patient misses 23 days of work per year.

Because more than seven often people with AD live at home and 75% of home care is provided

I

by family and friends, Georgia provides cost effective services to AD patients, enabling them to continue living ~t home for as long as possible, delaying more costly nursing home placement.

These vital services include:

I



In-homeRespite: Relief for the caregiver of a person with Alzheimer's Disease,

I

providing respite on a short term or intermittent basis. Respite care may be provided in an

I

individual's home or in an approved facility away from home.



Adult day care: Personal care for persons with AD, in a facility outside their own homes

during a portion of a 24-hour day. Adult day care includes personal care services, nursing

,I

services, transportation, nutritious meals, assistance in obtaining health services, and therapeutic activities.

I



Additional support services:

Transportation, home modifications and

Chart 4

education/training activities.

I

Increased Alzheimer's Services
Georgia, SFY 95 and SFY 98

The number of hours of respite/day care, and the units of additional support services provided,

220.000,.---,--------.,.

increased by 13.5% between SFY95 and SFY98.

I

'" 215,000 f------------::l~-
u
...'".~ 210,000 I---'---'------::;.",e-------

During the same four years, the number of persons served increased by 28%.

I

u
"E 205,000 f----....,--....,--~-----
u
'"
; 200,000 f - - - - - r - - - - - - - -

The increased numbers of clients, units of service, and new programs from SFY 95 - SFY 98 resulted from a federal Alzheimer's demonstration grant

I

",;
t=2 195,000 f r - - - - - - - - - "o
:I:

from the Health Resources and Services Administration (HRSA), funding from the

190,000 ' - - - - - - - - - - - -

SFY 95

SFY 98

I Page 24

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.---------------------------~~-~~~~~~~~~~----------- --

Geor ia State Plan on A in FY 2000 - 2003
Chart 5

Alzheimer's Units of Service
; Georgia, SFY 98

Brookdale Foundation, and funding from the Georgia General Assembly in SFY 98.

I I Day Care (HIs)

FromSFY 95 to SFY98, the number of Respite

programs grew from 17 to 19 and Day Care

programs increased froin 10 to 20.

.

""-

.

During the past two years, the Division ofAging

Services has placed additional emphasis on

Alzheimer's education/training aCtivities'

throughout the state. These activities have

included partnering with the Rosalynn Carter

Caregiving Institute of Georgia Southwestern State

University, the Southwest Area'Chapter

Alzheimer's Association in a caregiving

conference" the Southern Gerontological Society

, \.

in an Alzheimer's Summit with attendees from 14

states, a nutrition conference with Georgia State

University, an Alzheimer's Conference at the -

Carter Center, and congregational respite

seminars, where churches and synagogues were trained to provide various models of respite to

members andothers in their communities.

'

~

Where Are Alzheimer's Services Headed?

Georgia continues to develop new and innovative ways to meet the needs of both caregivers and

persons with Alzheimer's Disease.

~':

- Mobile day care is an innovative approach to providing social day care in rural communities that may not have th.e resources to develop their own, full-time day care program~ 'Leaving each morning from a central location, program staff travel with' materials needed for 'the day to a rural site. The Mobile day care model allows rural communities to have their own day care program by sharing staff and 'resources that move from location to location. The Health Resources and Services Administration has selected Mobile day care. as a program worthy of replication, and will feature this service model at the 1999 American, Society on Aging's Annual Conference.



.A self-directed care model, which empowers Alzheimer's caregivers to choose and make

arrangements for services that best meet their needs, was funded by the Division in

SFY98. This model, which promotes the Administration on Aging's priority of consumer

empowerment, emphasizes the role of older persons as consumers by encouraging their

participation in planning, managing, and delivering the services they need.

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Georgia State Plan on Aging FY 2000 - 2003

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Community Care Services Program (CCSP)

I

CCSP is a statewideprogram that offers Medicaid-eligible, functionally impaired citizens the option to remain in their homes and communities instead of entering nursing facilities.

I

,

~

CCSP promotes independence and self-sufficiency for senior citizens.

~

Individuals served through CCSP must first meet the medical and functional criteria for

I

placeme~t in a nUrsing facility.

Potential CCSP clients are screened by telephone to determine their appropriateness for

I

the program.

Area Agency on Aging care coordinators conduct a face-to-face assessment on potential

I

CCSP. clients.

A physician must certify that the needs of the individual can be met by CCSP and other

I

availabl~ community resources.

91 % of individuals ass~ssed chose to

I

enter CCSP instead of a nursing facility in SFY9~.

CHART 6 - COST COMPARISON
Nursing Facilities and CCSP

SUI.DDD

I

Dollars Saved ~

'14.000

~

In SFY98 the CCSP helped keep 14,194 "2.000

"0.000

Georgians out ofmore costly nursing

11,000

I

facilities~

".000

~

CCSP s~ved taxpayers $11,904 per

$.t,DGO

12.000

I

Chart 7 - Avera~~ Cost/Person: Walvered Programs

SFY95 SFY96 SFY97 SFY98

Southeastern States and Oregon

tIJ 0 Nuslng Facility

CCSP

I

individual served in SFY98.

I

Georgia saved a total of $169 million

\in SFY98 through this program.

I

Compared to Oregon and to other

Southeastern states, Georgia is one of

I

the most cost effective waivered programs.

NC OR TN MS AL SC GA FL KY
I Page 26
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Georgia State Plan on Aging FY 2000 - 2003

. People Served

ChartS Number Served: Medicaid Waivered Programs
Soulllelllm Stalll. end Ol'Ogon SFY98
SO,_

.....",DOD
,

10,000

',-

-,-

55% of all CCSP clients are 75 years of age or older.
71 % of all discharges from the program are due to death (34%) or entry into a nursing facility (37%).

Georgia's CCSP serves more persons than

any other waivered program in the

Southeast.

-

CCSP Services
Personal Support Services (PSS) personal and support services in client's home
Emergency Response Systems (ERS) 24-hour electronic medical communication support system
Home Delivered Services (HDS) - skilled nursing services and personal support in client's home

Chart 9 - CCSP Clients' Served
by Service Type
to,ooo
1.000 e,DDa
.....
2....
PSS ERS HOS RC ALS HOM AOH

Respite Care (Re) - short tenn relief for primary caregiver, provided in or out of a client's home

Alternative Living Services (ALS) - personal care and support services in an alternative residence

~

Home Delivered Meals (HDM) - meal delivery service

~

Adult Day Health (ADH) - health and support services in a day center

Directions for the Future .:. More service options to address consumer needs .:. . Consumer directed service delivery
.:. One point of entry for all services .:. Resources follow consumer

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Georgia State Plan on Aging FY 2000 - 2003

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I
The Georgia Elderly Legal Assistance Program

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I

WHO WEL4T& WHERE

J

I

The Georgia Elqerly Legal Assistance Program (ELAP), funded by Title III of the Older

I

Americans Act, provides legal information, education and representation to persons 60 years of age and older throughout the State of Georgia, at no cost to the individual client. Legal assistance

is restricted to matters of civil law only, and no criminal cases are considered.. There are

I

seventeen provi4ers of elderly legal assistance statewide, including private attorneys, legal services programs, and attorneys and paralegals directly employed by Area Agencies on Aging.

I

I

EdCTS & FLOC/RES

From SFY95 to SFY98, the ELAP has provided legal information, education and/or

I

representation t~, over 108,000 Georgians 60 years of age and older. State funding appropriated for the first time:in SFY98 provided much needed training to all ELAP providers in the various

areas of civil law red by the program.

I

I

I

Chart 10 Elderly Legal Assistance Program
Clients Served SFY95 - SFY98

35.000 i

I

30,000, 25,000

I

o...E 20,000. ' 15,000: 10,000 f

5,000'

I

o ,-k:::::'--==;==~--="::""--==:;=~~----:":_....!::::;==~=--:":":-'-J=r=~:"'-/

SFY95

SFY96

SFY97

SFY98

I ELAPSUCCESSES

I

More than 36,000 hours of free legal services provided tangible improvements in the lives of elderly Georgians during SFY98. Below are some of the many results achieved by the Elderly

Legal Assistanc~ Program during the past fiscal year:

I

,,



Reinstatement of benefits to a 10-year nursing home resident terminated from the

Medicaid program after deemed to no longer need nursing home care

I



Rescission of foreclosure on an elderly woman's home



Correction of Social Security mistakes: alleging a $6,000 overpayment in benefits;

securing the release of over $40,000 in Social Security benefits wrongfully withheld from

I

. two clients, oneofwhose benefits had been withheld for five years; and correction of a

Page 28
I

Georgia State Plan on Aging FY 2000 - 2003 .

Social Security underpayment which restored over $1,700 to an elderly client



Award of$4,000, plus refund of interest, to an elderly woman whose home had been

shoddily repaired



Dismissal of Guardianship against a client found not to need a guardian



Reimbursement of$14,000 from a client's private insurance company which had refused

to pay on the spouse's long term care policy'

. A ruling granting the return of loan proceeds by an Alzheimer's Disease patient who the
Court determined was not competent to sign the loan agreement



A $10,000 settlement to two elderly clients in a suit filed for wrongful eviction issued in

retaliation for their reporting to the Postmaster that landlord's management staff had gone

through the clients' mail.

FUTURE CH4T TENGES

M.EETING THE CIL4.LLENGES

Change in the way business is

*

conducted: electronic benefits; .electronic

funds transfer; managed care health

programs

*

Rapidly increasing elderly population
*
Increases in long term health problems of the aging population

* Reductions in various benefits programs
Smaller retirement packages in the hands of seniors result in increased need for information, education and advice about legal issues

More complex cases create need for additional staff and funding

Mandatory training in the current legal issue areas for. all providers
Increased funding requests to hire more staff to provide expanded services
Increased emphasis on the delivery of education for seniors to prevent actions which lead to legal problems
_r
More collaboration with existing resources such as the Georgia Senior Legal Hotline, the Georgia Advocacy Office, the Elder Law Committee of the Younger Lawyers Section of the State Bar, and the Health Insurance Counseling Assistance & Referral f~r the Elderly Program

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Georgia State Plan on Aging FY 2000 - 2003

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Hicare

I

Health. Insurance Counseling, Assistance and Referral for the Elderly

The Health Insw:ance Counseling, Assistance and Referral for the Elderly (HICARE) Program is

I

authorized by the Health Care Financing Administration (RCFA) to provide health insurance I
information, counseling and assistance services for older and disabled Medicare beneficiaries.

Administered by the Department of Human Resources, Division of Aging Services, the program

I

offers a statewid~ toll-free telephone line and twelve community-based programs staffed by over 200 highly trained volunteers throughout the state. Initial funding for HICARE was provided

through a federal HCFA grant. State funding was appropriated in SFY98 to expand services.

I

The goal of the J::IICARE program is to ensure that Georgia's Medicare beneficiaries, their

families and oth((rs understand the rights, benefits and services under the Medicare program, and

I

are informed about choices regarding health insurance and other benefits and services designed to coordinate with Medicare benefits.

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The HICARE ;Program:

Provides consumer information and counseling on Medicare, Medicare supplemental

I

insurance, long term care insurance, employer health insurance plans, Medicaid and Medicare managed care options



Provides community education about health insurance and Medicare, with emphasis on

I

educating individuals on Medicare coverage for preventive services such as mammography and immunizations



Enables ip.dividuals to understand and exercise their rights as Medicare beneficiaries and

I

health insurance policy holders



Assists beneficiaries to evaluate and

compare employer and private

I

health in~urance plans as well as managedicare plans and long term

Chart 11 - Clients Served SFY 1995 -1998

10,000

~

.care insm;-ance plans

8,000

I--

I



Helps Medicare beneficiaries to file

medical claims ahd to appeal denials of cover~geby Medicare, Medicare

.cl:! 6,000
.!!!
U 4,000

4,013

~-

I-I-- >

I

managed'care and private health

insurance



Reduces clients' out-of-pocket costs

Hl- 2,000 -

------ -

I--

I

In SFY98, the HICARE program provided :telephone and person-to-

0
I'

SFY95

SFY96

SFY97

SFY96

person counseling services to over

I

8,700 individuals.

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Georgia State Plim on Aging FY 2000 .. 2003

Chart 12 - Program Savings SFY 1995 - 1998
$200,000 $150,000
.!.".
~ $100,000 "> eInII
$50,000
SFY95 SFY96 SFY97 SFY98
The Faces of HICARE:

SFY95.



Over the last four fiscal years,

HICARE has enabled clients to

save over $660,000 in health

insurance and related expenses.

In SFY98, HICARE educated over 230,000 individuals about Medicare benefits through presentations, health fairs, television programs and direct mail.



Twenty low-income individuals were assisted by HICARE volunteers to enroll in the

Qualified Medicare beneficiary program (which pays for the Medicare Part B premium,

deductibles and co-insurance). Each individual saved an average of over $1,670 in out-

of-pocket costs.



A 79-year-old widow with multiple health problems was being treated by several doctors,

but no one physician was coordinating her treatment and hospital stays. She was covered

by Medicare, Medicare supplemental insurance, and had a medical policy with a

company that would pay no benefits on her claims as it no longer operates in Georgia. A

HICARE volunteer located the company and arranged for benefits to be paid from this

policy, thereby significantly reducing her annual out-of-pocket health care costs.

Challenges for the New Millennium:
Significant changes in the Medicare program, brought about by the 1997 Balanced Budget Act, will have great impact on the need to increase state level capacity to address many thousands of expected telephone inquiries about these changes. Many more HICARE volunteers will be needed to address individual client challenges in selecting affordable and appropriate health care coverage. The Program will enhance its current toll-free information service by expanding hours of operation and by recruiting and training more HICARE volunteers and information/referral specialists at the local level.



As managed care options increase in Georgia, older and disabled Georgians will be faced

with a bewildering array of options in health care. HICARE will plan a series of

educational opportunities throughout the state with other partners in the Medicare

Program to increase awareness of Medicare+Choice arid inform berieficiaries about the

benefits and limitations of plans available in this health system. A web site is also under

development to educate individuals about their choices.

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I Georgia State Plan on Aging FY 2000 - 2003
01
Long-Term Care Ombudsman Program

I

The Long-Temi Care Ombudsman Program improves the quality of life of residents of nursing

homes, as well 'as personal care homes, often called assisted living facilities or residential care

I

facilities.

0

Governed by the federal Older Americans Act and by the Georgia Long Term Care Ombudsman Act,

I

the program is administered by the Division ofAging Services and Area Agencies on Aging through contracts with 15 community Long Term Care Ombudsman Programs located throughout the state.

I

What does t~e Long-Term Care Ombudsman do?
Investig~tes and works to resolve problems or complaints affecting long-term care residents.

I



Visits lon, g-term care facilities routinely to talk to residents and monitor conditions.



Provides' in-service training for facility staff about resident rights and other issues.

!



Identifies problem areas in long-term care and advocates for change.

I



Provides information and educates the community about the needs of long-term care

residents.

I



Promotes resident, family and community involvement in long-term care issues.



Coordinates efforts with other agencies concerned with long term care.

I

During State Fiscal Year 1998, Long Term Care Ombudsmen:

I



Acted on 6,337 complaints, an increase of56% since fiscal year 1995.

I

I



Resolved 74% of all complaints.

Chart 13 - Number of Complaints

I



Made 9,901 routine visits to long- 7,000

term care facilities.

6,000

,

I



Advocated for:

5,000 4,000

..... more affordable long-term care options, 3,000

I

I
2,000
.,. elimination o,f discrimination against -

Medicaid clients in nursing home

1,000

I

admissions, ;

O--"'--'-.,...-L---'----'--.----"---'--'-.,...-L---'--'--.----"--/

SFY95

SFY96

SFY97

SFY98

I

[lffiJ) Personal Care Homes
D Nursing Homes

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Georgia State Plan on Aging FY 2000 - 2003

Chart 14 - Number of People Served
By Activity Type FY 1998
I I F.clllty VI.1ta 100,701

V' increased staffing in nursing homes,
V' improved monitoring of personal care homes, and

V' funding for emergency relocation of per~onal care home residents.



Focused on the problem of

mamourishrneminnursing

homes.



Provided services to over

156,548 individuals, a 59%

increase since fiscal year 1995.



Developed a program to train the aging network, caregivers, and beneficiaries to identify

and prevent health care fraud and abuse.

Program Challenges' Maintaining Ombudsman Services to Residents
Demand for Ombudsman Program services has outpaced available resources. Since 1995 the number of beds in licensed personal c8;fe homes has increased by 52% to 20,834, and the number of complaints has increased dramatically. Without adequate funding, ombudsmen cannot make visits to facilities on a regular basis or respond to resident complaints in a timely manner.
Increasing the Use of Volunteer Ombudsmen
Volunteers playa vital role in Georgia's Long Term Care Ombudsman program. In state fiscal year 1998, 81 volunteers --- 16 certified, 45 volunteer visitors, and 20 who performed other services--- assisted the Ombudsman Program. Growing demand for ombudsman services will only increase the future need for volunteers statewide.
Demand for' Expanded Long Term Care Ombudsman Services
Currently, Georgia's Long Term Care Ombudsman Program provides services to residents of nursing homes and personal care homes. However, there is increasing discussion of the need to expand advocacy services to other groups, including consumers of managed health care plans and individuals who receive long-term care services in their own homes.
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I Georgia State Plan on Aging FY 2000 - 2003

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Program Strategies

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I
Every level of the Ombudsman Program will face challenges to meet the everyday demand for

ombudsman seIiices, much less to increase services to meet growing needs. In addition to

I

continued advocacy for increased funding, the Ombudsman Prograin continues to work toward expanding the use of volunteers throughout the state. In calendar year 1998, the state office

provided a Volunteer Development Project Coordinator to assist community ombudsman

I

programs stren~hen and develop volunteer efforts. I

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Georgia State Plan on Aging FY 2000 - 2003

Non-Medicaid Home and Community Based Services'

The legacy of the Non-Medicaid Home and Community Based Services Program in Georgia derives from the Older Americans Act of1965, which established the national, state, and local infrastructure for a broad-bas~d system of care and services for the elderly. Consistent with the mission of the Department of Human Resources and the Division of Aging Services, the goal of these services is to promote health, self-sufficiency and independence so that elderly Georgians can continue living in their homes and communities for as long as possible.
Several factors contribute to the continued increase in demand for key home and community based services:

the rapid growth of Georgia's elderly

Chart 15 Population Ages 60+

population age 60 and above, from

Georgia, 1990 - 2010

13.8% of the total population in 1990 to

16.0%

an estimated 15.7% by 2010; Georgia has the fourth fastest growing elderly population in the United States the large number of older Georgians with limitations in mobility and selfcare, with 21.3% of all persons age 60

15.5%
'E 15.0%
Gl
l:!
Gl
Q. 14.5%

/'
/"
//
//
//

years and older, and 57.4% of persons

14.0% ,//

age 85 and older, with some type of

13.5%

functional limitation

1990

2010

the decline in the number of potential

care givers in proportion to the aging

population needing care, from a ratio of 11 care givers per elderly person in 1990 to a

projected ratio of 4 care givers per elderly person in 2050

one fourth of Georgia's elderly live alone and have incomes under $10,000 a year

Chart 16 - Mobility & Self-Care Limitations Georgia, 1990

60.0% '50.0%

40.0%

30.0% 20.0% 10.0%
0.0% 10<:-_ _,----_ _-'--_ _. - _ - - '

60+

85+

~ Georgia

III United States

These trends contribute significantly to the continuing demand on services and resources managed through Georgia's Aging Network. In addition to the Division of Aging Services, the Aging Network includes twelve regional Area Agencies on Aging and numerous public and private provider agencies. These organizations deliver services under Purchase of Service Contracts with the Area Agencies and the Division. Services are provided in a variety of settings, from senior centers where hot, nutritious meals are served, to the homes of elderly people and their caregivers.

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I Georgia State Plan on Aging FY 2000 - 2003

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Core services wh,ich help maintain older people in their homes and communities include:



Information and Assistance: Information and assistance, provided at both the Area

I

Agency and service provider agencies, often serve as the gateway to the long term care system by providing to elderly people and their caregivers information about how to get

community services.

I

~

Transportation Services: For older people living in the community, the ability to continue

moving about that community to manage personal business, take care of medical needs,

and partitipate in social activities is vital.

I

~

Senior Center/Congregate Meals and Home Delivered Meals: In addition to hot,

nutritious meals served in senior centers or delivered to the homes of home bound

elderly, the Elderly Nutrition Program provides the opportunity for social contacts for

I

many cOplIIlunity-dwelling elderly. Nutritional status of the elderly has been linked directly to substantial health care cost savings.

~

Adult Daycare: Daycare services provide assistance and support in a community setting

I

to frail older adults who need help with activities such as bathing and grooming, changing bandages~ obtaining a nutritious meal, or those who benefit from social contacts with

others. '

I



Respite Care Services: Respite care offers temporary substitute supports allowing family

members ;or other caregivers brief opportunities for rest or relief from care giving.

~

Homem4er/Chore Services: People with limitations in mobility and self-care depend on

'I

the assistance of homemaker/chore aides for help in daily living which enables them to remain at; home, including help with bathing, dressing, preparing meals, maintaining their

homes inSide and out, or managing finances.

.

I

Supporting the elderly to continue living in their homes and community settings as long as possible has bee~ shown for many to be a cost-effective alternative to institutional care. While

the Aging Network provided key services to almost 39,000 elderly in SFY 98, another 5,000

I

remained on wai#ng lists statewide at the end of the fiscal year. We know that we can provide

.services to eight people in the community for a year at the same cQst to taxpayers of caring for

one person in a nursing home for a year.

I

,I

Our direction and challenges...

~

Continue developing strategies to leverage federal, state and local funds to meet the

I

growing demand for services, through both public and private partnerships

~

Continue ideveloping a consumer-centered care system with a single point of entry to a

community based service system

I

. Increase the emphasis on disease prevention and health promotion

, .

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Georgia State Plan on Aging FY 2000 - 2003

Georgia's Senior Nutrition Program

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Aging Trends in Georgia'

o



Older people are increasing in number faster than any other age group'in Georgia's

population. Those age 85 and older are the fastest growing group.

.

..

Georgia's population age 60+ is expected to increas~e by 52.6 percent, growing from

o

893,049 persons in 1990 to 1,362,845 persons in 2010.

'

~

Georgia has the fourth fastest growing elderly population in the United States.

~

During the 20th century Georgians aged 60 and over increased eight-fold, compared to a

'three-fold growth in the population overall:

o

o

o o

o

Who are we serving?

{"



In SFY 98, the statewide aging network provided l:ipproximately 4.1 million meals to

o

46,114 people.

Sageeve7n0tyto-fi7v9e.

percent

of

our

program

partici~ants arewomen,
.' .

42.8

percent of " '.

,
whom .

.. .'.,...
are,

o

Fifty-four percent receive meals 5 days a week.

".

! 'i~

o

t"

.

Over 2,500 people were on waiting lists for meals statewide at the en~ ofFY 98.

o

Impo'rtant Facts

"~

,.

Adequate nutrition is a particularly important factor in the.health and well-being of older people. Recent national studies have shown that a significant number of elderly people are at high risk

o

for malnutrition. Eighty-five percent of the older population have one or more chronic conditions that could be

o

improved or alleviated through nutrition interventions. It is estimated that as many as 15 percent of elderly living in the community are malnourished. The rate rises to 35 to 65% of older people hospitalized for acute illnesses. And 25 to 60 % of residents of long term care facilities are

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I Georgia State Plan on Aging FY 2000 - 2003

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believed to be malnourished.

A 1994 Georgia'study revealed that, of 12,000 people who received senior nutrition services

I

during the studyiyear, 75% were found to be at moderate to high nutrition risk. We also know that one fourth df our senior population live alone and have annual incomes of less than $10,000,

I

placing them at higher potential risk of inadequate nutrition and poor health status.

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Cardiovascular diseases are the leading causes of death in Georgia, which has 10% higher death

rate for these conditions than the rest of the country. Cancer is the second leading cause of death

I

in Georgia. Nutrition interventions can directly impact the cost of care for these and other illnesses.

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.

Cost Saving~ Through Nutrition Interventions -- As shown in national studies,

as illustrated in the table below, nutrition interventions result in fewer hospitalizations, shorter

hospital stays, fewer complications, less medication, fewer surgeries, and less intravenous

I

feeding.

ir

.

Table 3

I

I
Disease

Savin~s per case*

Reason for Savin~s

:

I

Heart Disease !
I
r

$9,134.00 Specialized nutrition care can reduce the need for drugs and other artery-clearing procedures and/or surgery.

i High Cholesterol

$2,709.00 Reduces need for drugs.

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, Hypertension I /
, i

$4,075.00 Reduces drug use and can prevent complications such as stroke.

I

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Cancer

I

,i

$10,535.00 Enhances the effectiveness of chemotherapies and radiation treatments.

* Annual or one tune net savmgs

I

What Servi~es Are Available Through the Elderly Nutrition Program?
i

Nutrition Scree:ning and Assessment -- The evaluation of nutrition and health status of older

I

persons and dev~lopment of individual care plans by Registered Dieticians or other health
professionals.

Nutrition Supp~rt - Congregate and Home Delivered Meals -- Nutritious meals providing at

I

least one third of an adult's daily nutritional requirement and complying with United States

Dietary Guideliries.

/

Nutrition Educ~tion and Counseling -- Educational sessions designed to promote better health

I

through improv~d nutrition, physical fitness, and better health information. Individual plans for improving health provided by Registered Dieticians to individuals identified as being at nutritional risk ~ecause of health or nutritional history, dietary intake, or chronic illness.

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Georgia State Plan on Aging FY 2000 - 2003

Senior Community Service Employment Program

What is the Senior Community Service Employment Program (SCSEP)?

The Senior Community Service Employment Program (SCSEP), funded under Title V of the

Older Americans Act, has a dual purpose:



to provide useful part-time community service assignments for low-income persons age

55 or older; and to help participants obtain employment.

Communities benefit from the work performed by senior participants. Each program participant

benefits by developing marketable job skills while earning minimum wage. After a period of

community service and skills development, participants are hired by the agency to which they

were assigned or by another public or private sector employer. This program is a partnership,

with 90% of the funds derived from the federal government and 10% coming from the state and

from regional providers. The Division of Aging Services administers 271 positions annually, in

nine SCSEP projects in seven regions of the state. Six national SCSEP sponsors also receive

federal funds to provide an additional 1,056 SCSEP positions in Georgia.

/

Who is eligible?

The applicant must

..



be 55 years of age or older



be a resident of Georgia upon enrolInlent -



have a family income ~ 125% of federal

poverty leveL

Older persons having poor employment prospects are

given preference.

How do communities benefit?

SCSEP participants provided over 280,000 hours of serviceto, Georgia communities in SFY 98.

Chart 17 - SCSEP Participant Demographics
Georgia, SFY 9S SFY 98
100.o%.-------------111ll

80.00/0 ..,.,-

60.00/0 W

40.00/0 20.00/0 0.00/0

1:11

!jl
-~'~{.
:jl
:J!

l-
~

SFY9S

IBJ Po.ony
~ Millority

,,'
'I.."",
,)I,
~!
~~ ,\,:-:
SFY96

1i~:"!i;
;~I
';.j~
I~l~ 'i~
~n.'1
in
~rt SPY 97

Ii
\\
:;,H
"~ r-
~;n lJ
~~j
SFY 98

II AJo6l>+ 0 HiP School Dropo1lll

Participants served in host agencies, such as:



health and recreation centers



day care and senior centers



schools and libraries



homemaker services



home delivered meals programs



Community Action Agencies



Boys and Girls Clubs



Chambers of Commerce



County Departments of Family and

Children Services

Participants worked as:



clerical aides and receptionists



bookkeepers



custodial and maintenance aides



cooks and food servers



drivers



senior center aides

'long term care ombudsman assistants



public school paraprofessionals

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I Georgia State Plan on Aging FY 2000 - 2003

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How do SCSEP participants benefit?

ar
Exceeding Unsubsidized Employment Goals

I

I
The SCSEP assikts participants to develop
marketable skills and obtain employment.

Georgia SCSEP, SFY 98 C 70

II

I

Participants wh~ need classroom training co-

E
~ 60

enroll in Job Training Partnership Act (JTPA) Q.

or community ac,lu1t education programs. The

~ 50

SCSEP helps paiticipants assess their skills,

c :;; 40

I

find suitable job openings, complete

II II

applications and:deve10p resumes. Job and

.! 30
Q.

CI

personal counseling are available, and

C 20

I

CI

participants who' need additional supportive services to overcome barriers to employment

l:l.
:t2: 10
III

are referred to appropriate community

Q. 0 ""'--==

I

resources.

SFY98

D Actual Performance

Goal

In SFY 98:

I



388 persons received on-the-job training

I



Georgia's participants earned an estimated $1.5 million to supplement their retirement

income a, h, d thereby improve their standard of living

I



63 persons (23.3%) were placed in 'unsubsidized employment, reducing dependence on

public assistance

I

Senior Com~unity Service Employment Program goals for the future

I

According to theiUi-ban Institute, the demand for employment and training services for older workers will increase as baby boomers age. The number of economically disadvantaged persons

between the ages, of 55,and 70 will increase by 1.4 million nationwide between 1995 and 2005.

I

Our goals m, ust bIe to

I



Increase the number of participants who are able to obtain employment



Increase participation of minorities



Increase co-enrollments with JTPA and other job training and community adult education

I

programs!



Participate in One-Stop Career Centers in the seven regions we serve



Continue coordination and collaboration with the six national SCSEP sponsors in

I

Georgia'



Obtain ad~itiona1 federal and state funds to expand the Experimental Project

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Georgia State Plan on Aging FY 2000 - 2003

"The Experimental Project," a federal pilot project, proposes placing participants with private

o

sector employers for a negotiated short term training period at minimum wage. Contracts with

employers stipu!ate thatat t1}eend of the training period participants who successfully complete

training will be hired.

.

o

The Senior CommunityServ.iGe Employment Program mustrespond in innovative ways to

increase the labor force~N"aIticip~tion of Georgia's older workers and lessen the likelihood of

labor shortages in our stafe~~uiingthe earlytwenty-first century.

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. TAi XONOMY OF SERVICE DEFINITIONS

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Table 4

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,

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Service Name

Unit of Service

Division of Aging Services Definitions of Service Table 4 - Service Definitions
Individual or Group Service Definition

Personal Care (PC) Personal Support - CCSP Extended Personal Support CCSP

1 Hour .5 One Half Hour

Homemaker

1 Hour

Individual Individual

Chore

1 Hour

Individual

NUTRITION Home Delivered Meals

1 Meal

Individual

Adult Day Care Adult Day Health Adult Day Health - CCSP
Case Management Care Coordination -CCSP

1 Hour ADH Level 1-3 Hours Minimum ADH Level II - 5 Hours Minimum
1 Hour

Individual Individual

Community/Public Education
NUTRITION Congregate Meals

1 Contact 1 Meal

Group Individual

Providing personal assistance, stand-by assistance, supervision or cues for persons with the inability to perform one or more of the following Activities of Daily! Living (ADLs): eating, dressing, bathing, toileting, transferring in/out ofbedichair or walking. Extended Personal support Services funded by CCSP only will aiso include relief to persons normally providing care and/or oversight
Providing assistance to persons with the inability to perform one or more of the following IADLs: preparing meals, shopping for personal items, managing money, telephoning, light housework.
Providing assistance to persons having difficulty with 1+ of the following Instrumental Activities of Daily Living (IADLs): heavy housework, yardwork, or sidewalk maintenance.
Provision to an eligible client or other eligible participant at the client's place of residence, a meal which complies with Dietary Guidelines for Americans, provides at least 33 V3 % of the RDA for one meal; 66% % of the RDA for two meals, or 100 % of the RDA for three meals.
Provision of personal care for dependent adults in a supervised, protective, congregate setting during some portion of a twenty-four hour day. Services Offered ill conjunction with Adult Day Care and Adult Day Health (ADH) typically include social and recreational activities, training, counseling, meals for adult day care and services such as rehabilitation, medications assistance, and personal care services for Adult Day Health.
Assistance either in the form of access to or care coordination in circumstances where the older person and/or their caregivers are experiencing diminished functioning capacities, personal conditions or other characteristics which require the provision of services by formal service providers. Activities include assessing needs, developing care plans, authorizing services, arranging services, coordinating the provision of service among providers, follow-up and reassessment as required.
Contacts with several current or potential clients/caregivers to inform them of service availability or'provide general program information.
Provision to an eligible client or other eligible participant at a nutrition site, senior center or some other congregate setting, a meal which complies with Dietary Guidelines for Americans, provides at least 33 % % of the RDA for one meal, 66% % of the RDA for two meals, or 100 % of the RDA for three meals.

CJ

CJ

C=:J

CJ

-------------------

NUTRITION Nutrition Screening

I Hour

Individual

NUTRITION Nutrition Counseling

I Hour

Individual

Assisfed T~ansportation---- TOne-Way Trip . _. __ .Individual

Transportation

lOne-Way Trip.

Individual

Legal Assistance Legal Community Education Legal Infonnation Legal Counseling

I Hour I Session
1 Contact I Hour

Long Term Care Ombudsman Service: - Ombudsman Complaint Handling -Information & Assistance - Community Education - In-Service Education
-Routine Visitation Nursing Homes -Routine VisitationPersonal Care Homes
-Resident/Family Council Activity
- Participation in Surveys -Advocacy -Volunteer Management

I 1 Hour
1 Hour/l Contact 1 Session I Session 1 Houri 1 Contact
1 Houri I Contact
1 Houri 1 Contact
I Houri I Contact 1 Houri 1 Contact 1 Houri 1 Contact

Individual Group Individual Individual
Individual

Administration and interpretation of the Level I or Level II Nutrition Screen by a Registered Dietician for the purpose of developing individualized plans of advice and guidance to persons identified as being at moderate to high nutrition risk through the NSI DETERMINE Checklist.

Provision of individualized advice and guidance to person who are at nutritional

risk, because of their health or nutritional history, dietary intake,medications use or

chronic illness about options and methods for improving their nutritional status,

perfonned by a health professional according to state laws and policy.

--.- _.-.. _---- - ---- - - -------- --

----

Provision of assistance, including escort to a person who has difficulties, physical or

cognitive, using regular vehicular transportation.

Provision of a means of going from one location to another. Does not include any other activity.

Provision of legal advice, counseling and representation by an attorney or other person acting under the supervision of an attorney.

Provision of services which protect and improve the quality of care and quality of 'life for residents of long-tenn care facilities through advocacy for and on behalf of residents and through the promotion of community involvement in long-tenn care '. facilities.

NUTRITION Nutrition Education

I Session

Individual or Group

A program to promote better health by providing accurate and culturally sensitive nutrition, physical fitness, or health (as it relates to nutrition) information and instruction to participants or participants and caregivers in a group or individual setting, overseen by a dietitian (R.D).

Information and Assistance I Contact

Individual or Group

Outreach/Individual

I Contact

Individual

Respite Care In-home Out-of-Home
Home ModificationIHome Repair

I Hour I Hour

Home Health Home Delivered Services CCSP

I Visit

Health RelatedlHealth Screening

I Session

Individual Individual Individual Individual or Group

Health Promotion! Wellness

I Session

Individual or Group

A service for older individuals that: (a) Provides them with current information on opportunities and services available within their corrununities, including information relating to assistive technology; (b) assess the problems and capacities of individuals: (c) links individuals to opportunities and services that are available; (d) to the maximum extent practicable ensures that the individuals receive the. services needed, and are aware of the opportunities available, by establishing adequate follow-up procedures. Group services are reported as CorrununitylPublic Education.
Interventions initiated by an agency/organization for the purpose of identifying potential clients or their caregivers and encouraging their use of existing services and benefits. Note: refers to one~on-one contacts between a service provider/area agency and an elderly client or caregiver. Group services are reported as C?rrununitylPublic Education.
Provision of temporary substitute supports or living arrangements for older persons in order to provide a brief period of rest or relief for family members or other caregivers.
Provision of housing improvement services designed to promote the safety and well-being of adults in their residences, to improve internal and external accessibility, to reduce the risk ofinjury; and to facilitate in general the ability of older individuals to remain at home. Can include the provision and installation of assistive technology and devices.
Provision of basic medical services under medical supervision to individuals who can be cared for 'at home. Includes care provided by a licensed health professional subsequent to assessment and diagnosis or'a physical, oral, mental problem or condition, and monitoring of treatment plans. Includes nursing care and rehabilitative care, such as physical, speech,/hearing, and occupational therapies.
Administering standard examinations, procedures, or tests for the purpose of gathering information about a client to determine need for healthcare services. Information collected may include health status, financial status, status of basic Activities of Daily Living (ADLs/IADLs), nursing home pre-admission screening, as well as routine health screening (blood pressure, hearing, vision, diabetes). Also supports the purchase of health/medically-related supplies and equipment.
Provision of information programs promoting wellness, healthy lifestyles, disease prevention in a group setting. May include activities/topics related to healthy food preparation, lifestyle changes which promote good health, topical information such as osteoporosis prevention, smoking cessation, breast health, prostate health, etc. May' also support the purchase of materials, equipment, and supplies related to program activities.

CJ CJ CJ CJ c=J C] c=J CJ CJ c.=l c=J CJ C) CJ c:=J CJ CJ CJ c::J

- - - - - - - - - - - - - - -,- - - -

Exercise/Physical Fitness

I Session

Individual or Group

Emergency Response/ Medical Alert

, I Installation I 'Month's Service Monitoring Service

Consumer Protection/Crime I Session Prevention Services

Individual

Group

--

Recreation Friendly Visiting

I Session I Visit

Group Individual

Telephone Reassurance InterpretinglTranslating

I Call I Hour

Individual Group

Volunteer Development! Opportunities/Service
Home Sharing /Roommate Matching

I Volunteer Recruited/Placed I Volunteer Setting Arranged I Volunteer Service Hour
I Match

Group Group Individual
Individual

Placement Services

I Hour

Individual

Provision of activities which promote health, wellness, and mobility, such as low impact aerobics classes, walking clubs, resistance training, and specialized exercises/workouts for persons with disabilities or mobility limitations in a group setting by a group leader. May also support the purchase of materials, equipment and supplies related to program activities.

Installation of an in-home electronic support system which provides two-way

communication to geographically and socially isolated individuals, enabling them to

remain in their own homes, The electronic system provides 24-hour-a-day access to

. - .. a me~i~a! co.ntrol center on a daily basis.

~

...

- --_. -- ~

Provision of information to inform and educate individuals about their rights as ' consumers of goods and services; how to exercise rights authorized by specific consumer protection laws; provision of referrals to organizations/agencies whos'e primary function is advocacy and/or direct legal representation; coordination with community coalitions, task forces, commissions, councils, et.a\. on activities aimed at protecting the rights of consumers,

Promoting socialization by participation in activities, such as sports, performing arts, games, and crafts, facilitated by a provider, either as a spectator or performer.

Reducing social isolation by visiting a person in his/her home in oider to comfort or

help the person. Can include letter writing and reading, which is to assist by . -

reading, writing, interpreting and or translatingbusiness and personal

-

correspondence,

7 ';-- ~

Interaction with individuals by telephone to reduce social isolation, provide support;' and ensure health and safety.

To explain the meaning of oral and/or written communications to non-English

....: ;-.'

speaking and/or persons with disabilities who are unable to perform the functions

due to linguistic, visual, hearing or cognitive impairments or limitations.

Activities related to the recruitment, training and placement of volunteers; activities related to the identification of placements for volunteers; the provision of volunteer service hours by a volunteer.

Provision of services which facilitate the matching of older persons with suitable, appropriate individuals, who will live together in a residential setting, each person having private space and sharing common areas such as kitchen, living and dining rooms,
Assisting a person in obtaining a suitable place or situation, such as employment, housing or institutional care.

Employment Assistance: Employment Counseling Employment Placement Employment Development

1 Hour 1 Hour 1 Job Identified

Material Assistance/ Material Aid

1 Contact

Individual Individual Group
Group

Skilled Nursing -CCSP

1 Visit

Individual

Health Insurance/ Benefits Counseling HICARE Community Education HICARE Information and Assistance
Alternative Living Services

1 Contact I Session
,.
1 Contact
. I Day

Individual

Gr~mp

,.

Individual

Individual

Provision of services to assist older persons with subsidized employment opportunities and to obtain unsubsidized employment. May include assessment of skills and abilities, upgrading ofjob-seeking skills, employability training, individual development plans, job placement into unsubsidized employment and follow-up activities.
Assistance with or payments to (or on behalf of) an older person for housing/shelter, utilities, food/meals or groceries, clothing, eyeglasses, dental care, etc. May also include the purchase and installation of assistive devices and security devices, such as locks, smoke detectors, lighting, etc.
Provision of skilled nursing services by a Registered Nurse to Medicaid-eligible individuals who are Community Care Services Program (CCSP) clients. Services are rendered to those recipients who meet all the requirements for Home Health Skilled Services with the exception of homebound status.
Provision of information to individuals regarding their eligibility for benefits. Assistance with pursuing claims or benefits and advocacy on behalf of the beneficiary.

-

Provision of 24-hour supervision and health"related support serviCes in state-

licensed facilities, either group or family models, to Medicaid eligible persons who

are Community Care Services (CCSP) clients and who can no longer remain ,

independent in their own homes.

'-

C) c=J CJ c=J c=J ic=:J c=J C) CJ CJ C) CJ c=J CJ CJ CJ C) CJ CJ

.,- - ------,

I
, II
I

Table 5 - Summary of Units of Service and Clients Served In SFY 1998

I

I
Service Category

Units

Clients

I

I

Adult Day Care Alzheimer's Foamily Support

50,035

591

58

122

I

Alzheimer's

Care Management - Assessment

I

Chore

Congregate Meals

I

Continuing Education

Counseling ,

I

Education / Training

35 18,666
1,028 1,616,075
124 797 1,932

5 7,330
38 17,730 3,809 20,643 65,002

I

Emergency / Supplemental Food Emergency Response - Monthly

11,578 368

1,394 37

I

Escort Friendly Visiting

4,596

163

5,532

463

I

Health Related

Home Delivered Meals

I --------- Home Health

~

~

~

Home Management

1,881

- 2,525,270

~

5,663

1,277

I

Homemaker'

197,418

Homesharing - Placements

I

I
Information and Referral

36 38,694

48,331 28,384
115 45 6,378 35 34,915

Legal & Related Counsel (Cases)

I

Legal & Related Counsel (Hours)

3,449 31,814

3,414 16,534

I

Legal Commu~ityEducation Legal Information

838 6,051

20,773 4,669

I

Leisure Time / Recreation

Material Aid

I

23,272 31,255

348,932 42,552

I

o

o

........

.5. - Summary of Units of Service and Clients Served In SFY 1998

o

- Service Category

Units

Clients

..' :;ation

1,863

55,190

o

-

r.

, '-.

8,209

65,836

226

283

o

'_.

..,

,nair

"

.. , '-

. 6,792

102,251

107

92
''

o

'. in Home ..........
-0ut Home .~-'

14,206 1,497

191 19

o

:.',tance

I: "for En~'

/"

'---~

~,jor E.:

~,

~.

vment CounSt~._,-o.g
......,.

.-yment Develo!~::ii1ent ....~

ior 1;

:"uent Placem:-3.t

465 1;049

1,845 92

o

62 84

89 70

o

, 'phor!

,'"

m,!..:...

.-;surance

.""",

27,164

l,311

o

i . ' 'Jon Tr:'

.:-mand Respol1:.~:e
,
-

56,048

2,911

1,433,734

11,142

o

Trar

:. - Group Ch~Hter

61,524

59,860

'ices - Hours

--~O llP-.151

-_

_

_

_

75
~--.,

61.~".:pl-;;.'

1 Volunt-e:.t,

.ices - Volunteers

35,234

24,574

o

. "Iprised of 1998 data, since SFY 1999 data was not available at the time this was compiled.

0

o
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o
o

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I

I

I

I

I

Demographic Profile

I

I

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I Georgia State Plan on Aging FY 2000 - 20003

I

Introduction

I

Demographic Profile

According to the 1998 American Association of Retired Persons "Profile of Older Americans"

I

the following demographic infonnation cited that the biggest change our population will undergo is the growth of our elderly population..

I

I

The older population, persons 65 years or older, number 34.1 million in 1997. They represent 12.7% of the U.S. population, about one in every eight Americans. The number of older

Americans increased by 2.8 million or 9.1 % since 1990, compared to an increase of7.0% for the

I

under 65 population.

In 1997, there were 20.1 million older women and 14.0 million oldermen, or sex ratio of 143

I

women to every 100 men. The sex ratio increased with age, ranging from 119 for the 65-69 group to a high of248 for persons 85 and older.

I

The older population will continue to grow significantly in the future. This growth slowed somewhat during'the 1990's because of the relatively small number of babies born during the

Great Depression of the 1930's. But the older population will burgeon between the years 2010

I

and 2030 when the "baby boom" generation reaches age 65. By 2030, there will be about 70 million older persons, more than twice their number in 1997. People 65+ are projected to

represent almost 13% of the population in the year 2000 but will be 20% by 2030.

I

Older people accounted for 40% of all hospital stays and 49% of all days of care in hospitals in

1995. The average length of a hospital stay was 7.1 days for older people, compared to only 5.4

I

days for people under 65. The average length of stay for older people has decreased 5.0 days since 1964. Older persons averaged more contacts with doctors in 1995 than did persons under

65 (11.1 contacts vs. 5.0 contacts).

I

Over 11 million older persons received services under the Medicaid program in 1995. While the

average vendor payment for all Medicaid recipients was $3,311, that for,persons aged 65 and

I

over was $8,868.

Clearly, the above facts reflect a growing elderly population which will require additional

I

services and programs to meet their needs. Georgia's population growth parallels the nation's, but Georgia has one of the fastest growing elderly populations in the country. Georgia is ranked

I

as having the foun:h fastest growing elderly population in the nation. The Division of Aging Services is working to expand the resource base and continue to enhance the array of programs and services to meet the needs of the elderly. The following pages provide more detailed

infonnation regarding Georgia's demographic profile.
I

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Page 50

I

Georgia State Plan on Aging FY 2000 - 20003
Aging Trends in Georgia

Chart 19

Georgia's 65 + Population .Growth

86+ Population Georgia va U.S.

40% -r

-,=3.;:,8.;:.8,%~:,,,.---1

35% -+-------------h~':~i~i;,+---I
CD 30 % - t - - - - - - - - - - - - - J ' , : \ ' ! , I i : : : . i f - - - 1
at
...: 25% -+---,,---F.
-u
.520% -+--
c:
8... 15 % ---+---
CD
Q. 10% ---+---
5% ---+--0% -1-_ _

Georgia's older' population ages 60+ is expected to increase 52.6% between 1990 and 2010, from 893,049 persons to. 1,362,845 persons.
Georgia has the fourth . fastest growing elderly population in the .United States.

1980-1990



U.S.

1990-2000 [] . Georgia

.Chart 20

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

During the 20th century, the number of Georgians age 60 and above increased eight-fold, compared to a three-fold
growth in the population . overall.
'...
Older persons are increasing in number

120%

100%

80%

60%

40%

20%

r"

0% -I<::_=;:==---:'_==;==---:'_==;==--/

60+

65+

85+ .

Georgia

illfillJ United States

Page 5i

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GEORGIA STATE PLAN ON AGING SFY 2000 - 2003

TABLE 6 - MAJOR AGE GROUPINGS FOR PERSONS AGE 55+ BY PSA

PSA

PSAName

1 Northwest Georgia

2 Georgia Mountains

3

Atlanta Region

4 Southern Crescent

5 Northeast Georgia

6

West Central Georgia

7 Middle Georgia

8 Central Savannah River

9 Heart of Georgia Altamaha

10 Southwest Georgia

11 Southeast Georgia

12 Coastal

State Total

Total Population
548,220 304,462 2,514,066 373,003 277,962 332,111 389,361 421,229 263,720 315,351 320,427 418,304 6,478,216

55+
114,635 66,726 361,192 74,965 50,643 66,114 75,651 79,673 56,966 63,436 66,743 76,040 1,152,784

60+
88,872 52,331 269,837 58,953 39,915 52,548 58,379 62,587 45,597 50,247 53,288 60,495' 893,049

65+
65,044 38,452 191,970 44,239 30,085 38,931 42,542 46,208 34,647 37,608 39,894 44,650 654,270

75+
26,395 15,425 76,148 18,888 12,997 16,174 16,757 18,738 14,674 15,891 16,755 17,377 266,219

% 60+ to

% 60+ to

PSA Total State Total

16.21%

9.95% '

17.19%

5.86%

10.73%

30.22%

15.80%

6.60%

14.36% 15.82% 14.99%

4.47%
,
5.88% ,"
6.54% "

14.86%

7.01%

17.29%

5.11%

15.93%

5.63%

16.63%

5.97%

14.46%

6.77%

13.79% 100.00%

SOURCE: 1990 Census of Population and Housing, Summary Tape File lA

o

.CHART 21

o

STATEWIDE DISTRIBUTION OF ELDERLY

o

0
o
o

O
o
o

o

o

o

o

ELDERLY

.6

0
.

+

AS

A

PERCENT

OF

STATEWI.DE

60+

POPULATION

o

U.

4.0% - 5.0%

o

I:~:>:U

6.0% - 7.0%

I:"::::~:I

8.0% - 9.0%

o



10.0%+

o

o o

1

I

CHART 22

I

CONCENTRATION OF ELDERLY IN EACH PSA

1

1

I

1

1

I

1

1

1

1

1

PERCENTAGE OF 60+ ELDERLY TO TOTAL POPULATION IN EACH PSA

1

D

10.0% - 12.0%

0

1::::-- :--1

13.0% - 14.0%

1

00 0
10: : 0:::1

15.0% - 16.0%

17.0% +
I

1
01

GEORGIA STATE PLAN ON AGING SFY 2000 - 2003

TABLE 7 - LOW INCOME PERSONS AGE 60 AND ABOVE

_. .

PSA
,

PSAName

1

Northwest Georgia

2

Georgia Mountains

3

Atlanta Region

4

Southern Crescent

5

Northeast Georgia

6

West Central Georgia

7

Middle Georgia

8

Central Savannah River

9

Heart of Georgia Altamaha

10

Southwest Georgia

11

Southeast Georgia ...~

~

12

Coastal

State Total

60 - 64
3,098 1,671 7,318 2,227 1,533 2,355 2,147 2,832 2,067 2,365 2,250 1,916 31,779

65 -74
6,875 3,652 12,259 4,028 2,868 4,547 4,071 5,576 5,022 4,962 5,555 4,091 63,506

75+
6,472 3,907 12,344 4,503 3,539 4,562 3,726 5,597 4,634 4,592 5,311 3,513 62,700

Low Income 65+ PSA Total
16,445 9,230 31,921 10,758 7,940 11,464 9,944 14,005 11,723 11,919 13,116 9,520 157,985

% of Low Income60+ to
PSA Total 10.41% 5.84% 20.21%
-. 6.81%
5.03% 7.26% 6.29% 8.86% 7.42% 7.54% 8.30% 6.03% 100.00%

SOURCE: 1990 Census of Population and Housing, Summary Tape File 3A

I,

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CHART 23

I

LOW INCOME PERSONS 60+ BY PSA

II

I

I

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I

I

I

I

I

I

I,

PERCENTAGE OFLOW INCOME 60+ ELDERLY TO PSA'S TOTAL 60+ POPULATION

I

D

5.0%-6.0%

'::.::::':::1

7.0% - 8.0%

I

Ij:::j

9.0% - 10.0%



11.0%+

I

I

I

GEORGIA STATE PLAN ON AGING SFY 2000 - 2003

TABLE 8 - LOW INCOME MINORITIES AGE 65+

PSA

PSA Name

White 65-74

White 75+

Black 65-74

Black 75+

Amer. .Amer. Ind. Ind. 65-74 75+

Asian PI
65-74

Asian PI 75+

Other 65-74

Other 75+

Total Minority

% of State

1 Northwest Georgia

6,294 5,925

574

533

5

14

2

0

0

0

1,128

2.20%

2 Georgia Mountains

3,350 3,694

272

188

30

25

0

0

0

0

515

1.01%

3 Atlanta Region

5,951 7,083 6,161 5,185

25

30

100

36

22

10 11,569 22.60%

4 Southern Crescent

2,285 2,990 1,738 1,513

2

0

3

0

0

'0

3,256

6.36%

5 Northeast Georgia

1,854 2,566

998

973

14

0

2

0

0

0 . 1,987

3.88%

6 West Central Georgia

1,801 2,037 2,718 2,523

5

0

7

0

16

2

5,271 10.30%

7 Middle Georgia

1,630 1,758 2,433 1,962

0

0

8

6

0

0

4,409

8.61%

8 Central Savannah River

2,407 2,518 3,153 3,067

14

0

2

0

0

12

6,248 12.21%

9 Heart of Georgia Altamaha . 3,179 3,091 1,836 1,543

0

0

7

0

0

0

3,386

6.61%

10 Southwest Georgia

3,190 3,084 1,772 1,505

0

3

0

0

0

0

3,280

6.41%

11 Southeast Georgia

12 Coastal

--

2,607 2,605 2,926 2,698

22

4

0

4

0

0

5,654 11.05%

1,521 1,596 2,528 1,915

22

0

7

0

13

2

4,487

8.77%

State Total

36,069 38,947 27,109 23,605 139

76

138

46

51

26 51,190 100.00%

SOURCE: 1990 Census of Population and Housing, Summary Tape File 3A

I

I

CHART 24

,I

STATEWIDE DISTRIBUTION OF LOW INCOME MINORITIES

I

I I I,

I I

I

I

I

I

I

LOW INCOME MINORITIES (65+) IN EACH PSA AS A PERCENTAGE OF STATEWIDE LOW INCOME MINORITIES (65+)

I

D

1.0%-4.0%

L::::::::I

5.0% - 8.0%

I

1.::::1

9.0% - 12.0%



13.0%+

I

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I

GEORGIA STATE PLAN ON AGING SFY 2000 - 2003

TABLE 9 - PERSONS 65+ WHO SPEAK ENGLISH "NOT WELL" OR "NOT AT ALL"

PSA

PSAName

,

1

No~thwest Georgia

2

Georgia Mountains

3

Athinta Region

4

Southern Crescent

5

Northeast Georgia

6

West Central Georgia

7

Middle Georgia

;

8

Central Savannah River

9

Heart of Georgia Altamaha

10

Southwest Georgia

11

Southeast Georgia

12

Coastal

State Total

Spanish 10 28
524 12 36 37 4 39 7 31 21 50
799

Asian 15
. 28 668
0
~
16 41 23 75
0 0 0 18 884

Other 59 72
501 29 37 27 61 84 42 8 50
102 1,072

Total 84
128 1,693
41 89 105 88 198 49 39 71 170 2,755

% of State 3.05% 4.65%
61.45% 1.49% .3.23% 3.81% 3.19% 7.19% 1.78% 1.42% 2.58% 6.17%
100.00%

SOURCE: 1990 Census of Population and Housing, Summary Tape File 3A

I

I

CHART 25

I

PERSONS 65+ WHO SPEAK ENGLISH NOT WELL OR NOT AT ALL

I

I

I

I

I

,I

I I'

I
,I

I

ELDERLY (65+) WHO SPEAK ENGLISH NOT WELL OR NOT AT ALL TO STATEWIDE TOTAL

I

.D

1.0% - 3.0%

1::.:::.:::1

4.0% - 6.0%

I

1:.:. 1

7.0% - 9.0%



10.0%+

I

I'

I

GEORGIA STATE PLAN ON AGING SFY 2000 - 2003

TABLE 10 - PERSONS 65+ WITH A MOBILITY OR SELF-CARE LIMITATION

PSA

PSAName

1

Northwest Georgia

2

Georgia Mountains

3

Atlanta Region

4

Southern Crescent

5

Northeast Georgia

6

West Central Georgia

7

Middle Georgia

8

Central Savannah River

9

Heart of Georgia Altamaha

10

Southwest Georgia

11

Southeast Georgia

12

Coastal

State Total

Total 15,745 8,600 41,973 10,476 7,152 9,547 9,875 12,327 8,668 9,305 10,039 9,307
153,014

% of State 10.29% 5.62% 27.43% 6.85% 4.67% 6.24% 6.45% 8.06% 5.66% 6.08% 6.56% 6.08%
100.00%

SOURCE: 1990 Census of Population and Housing, Summary Tape File 3A

I

I,

CHART 26

I,

PERSONS 65+ WITH A MOBILITY OR SELF-CARE LIMITATION

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I

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ELDERLY (65+) WITH A MOBILITY OR SELF-CARE LIMITATION TO STATEWIDE TOTAL

I
I I

D

4.0% - 6.0%

FT:ITI
LJjjJ

7.0% - 9.0% 10.0% - 12.0% 13.0% +

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.Funding Allocation

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Plan

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Georgia State Plan on Aging FY 2000 -2003

,:1 .

Funding .Allocation Plan

.1

I'

Intrastate Funding Formula - Section 307(a)(33)

The Older Americans Act, as amended, requires at Section 305(a)(2)(C) that the State Unit on

,I

Aging:

"....develop a fonnula in consultation with area agencies, in accordance with guidelines

I

issued by the Commissioner, and using the best available data, develop and publish for review and comment a fonnula for distribution within the State of fullds received under this title that

takes into account.. ..

,I

"(i) the geographical distribution of older individuals in the State; and

I

"(ii) The distributionamong 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;" .

I

Further, Section 305(a)(2)(D) states that the State Unit on Aging shall:

I

"Submit its fonnula developed under subclause (c) to the Commissioner for approval;"

I.

In compliance with the above the State Unit on Aging for Georgia developed an Intrastate Funding Fonnula for use of Title III funds. This has been the basis for funding since the basic requirement has been established. The indicators selected for incorporation into the Intrastate

Funding Fonnula (IFF), the data source, and the rationale for their selection are outlined below.
.1

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Page 63

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GeorgiaState Plan on Aging RY 2000 -2003, .
Intrastate Funding Formula Assumptions and Goals
60+ population .The number of persons in the age group 60 and above. Rationale: This factor should be included in the formula because it is the basis for the Older Americans Act and its inclusion is'fequited, by the \act

Low income minority 65+ populatioD
Numbers ofgersons in the age grouP$65an(t~bov,e who are minoqties (non-white) andare below the poverty,level,asestablish~d by tlle Qffice ofanagementand Budget in Directive 14 as the standard to be used by Federal agencies for statistical purposes. The Census data did not contain information on the number of low income minorities in the age group 60-64. The data were available only for age groups: 65 and abo;ve. Therefore, the 65+ data were determined the. "best data available". .
Rationale: This factor is e~peci.ally signi.ficant because it represents "special attention to low income minority older individuals" as required by the Older Americans Act at Sec. 305(a)(2)(E). Further, this factor is included because it represents both economic and social need as defined by the Older Americans Act at Sec. 302(20) and (21).

Low income 60+ population

,

.

Numbers of persons,in the age groups 60 andl~bove who .are below the p~)Verty level as

establish,ed by the Office of ManCigement ,and Budget in Directi:ye 14 as the standard to ,be used

by Federal agencies for' statistical purposes.

Rationale: This factor is included because it represents economic need as defined by the Older AmericansAct at Sec. 302(20).

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I Georgia State Plan on Aging FY 2000 -2003 .

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Estimated rural 60+ population

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Numbers of persons in the age groups 60 and above who reside in a rural area as defined by the Census Bureau. The Census data did not contain an age breakdown of individuals residing in

these rural areas. Therefore, the percentages of the age breakdown as listed in the 60+ population

,I

were applied to the numbers of persons residing in rural areas. This makes the assumption that the 60+ population is evenly distributed among the urban-rural areas. While recognizing that this

may not necessarily be true, it was agreed that these were the "best data available" for use in the

I

fonnula and was fairly applied to all areas of the State.

Rationale:

I

This factor is included because it represents the social need factor of "geographic isolation" as defined by the Older Americans Act at S~c. 302(21).

,I Limited English speaking 65+ population

I

Numbers of persons in the age groups 65 and above who speak a language other than English

and speak English "not well" or "not at all." The Census data did not contain infonnation on the

I

number of these persons who are in the age group 60-64. The data existed only for age groups 65 and above. Therefore, the 65+ data was detennined the "best data available".

I

Rationale: This factor should be included because it represents the social need factor of "language barriers" as defined by the Older Americans Act at Sec. 302(21).

I.

Disabled 65+ population

I

Numbers of persons in the age groups 65 and above who have a "mobility or self care limitation" as defined by the Census Bureau. The Census data did not contain infonnation on the number of

persons who have a mobility or self care limitation in the age group 60-64. The data is only for

.1:

age groups 65 and above. Therefore, ~e 65+ data ~ere detennined the "best data available" .

Rationale: This factor is included because it represents the social need factor of "physical and

,I

mental disability" as defined by the Older Americans Act at Sec. 302(21).

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Page 65

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Georgia State Plan on Aging FY 2000 -2003
TABLE 11 Intrastate Funding Formula
Factors and Weights

Factors
Population 60+

Weights'
"
50%

Low Income Minority 65+

10%

Low Income 60+

15%

Rural 60+ (estimate)

13%

Disabled 65+

10%

Limited English Speaking 65+

2%

The above factors have been incorporated into a mathematical formula for administration as reflected below.
Intrastate Funding Formula

y:{.50(X)(%60)J+L10(X)(%LIM)J+[.15(X)(%LI)W.13(X)(%RUR)J+[.10(X)(%DIS)W.02(X)(%LES)]

Factors:

y=

x

=

%60 =

%LIM =

,'
%LI ,,,;

%RUR= %DIS = %LES =

The service allocation for a Planning and Service Area (PSA) The, total services allocation amount for the State , The PSA percentage of the total State population age 60 and above. The PSA percentage of the State total population age 65 and above who are low income and are minorities.
The PSA percentage of the State total population age 60 and above who
are low income. The PSA percentage of the State total population age 60 and above who 'live in. rural areas. The PSA percentage of the State total population who are age 65 and above and are disabled. The PSA percentage of the State total population age 65 and above and have limited English speaking ability.

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I Georgia State Plan on Aging FY 2000 -2003

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In addition, each area agency receives a minimum of$100,000 base funding level for area plan

I

administration. Once the base has been allocated, each area agency then receives its proportionate share 'ofthe remaining area plan administration funding based on its percentage of

the service funding as distributed through the intrastate funding formula.

I

I

Table 12 - Allocation of Title III Resources

I

,I

State Agency Operating Budget for SFY 00

I

Total Resources to be used for State Agency Administration

Fund Sources

Title III Match to Other Agency

Total

I

Funds

Title III

Resources

Agency Resources

Title III: State

I

Administration

$737,114

$737,114

Title Ill: Part B- Long-Term $179,282

I.

Care Ombudsman

$179,282

Other Federal Funds

$562,244

$562,244

'I

State Funds

$196,080

$717,333

$913,413

Totals
I,

$916,396 $196,080

$1,279,577

$2,392,053

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.1 I,

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Page 67

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GEORGIA STATE PLAN ON SFY 2000 - 2003

- AGING

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

TABLE 13 - SFY 2000 STATE PROGRAM ALLOCATIONS BY PSA

.

PSA

PSAName'

Title IIITotal

Title VII Elder Abuse

Title VII LTCO

Title V SCSEP

',-
Title III
PartF

Other Funds Total*

Title III Services

Title III Area Plan
Admin.

Grand Total

1 Northwest Georgia

$1,459,444 $8,953 $5,292 $444,142 . $31,547 $8,125,720 $1,321,867 $137,577- $11,534,542

2 Georgia Mountains

$921,624 $5,565 $4,229

$25,05? $5,423,600

$821,624 $100,000

$7,301,701

3 Atlanta Region 4 Southern Crescent

$3,718,269 $23,002 $15,106 $943,762 $5,715 $3;827

$183,017 $28Q;168

$58,443 $18,205,388 $25,347 $5,518,382

$3,395,946 -
$843,762

$322,324 $100,000

$25,921,495 $7,720,963

5 Northeast Georgia

$825,412 $4,913 $3,787 $253,565 $23,812 $5,255,731

$725,412 $100,000

$7,192,632

6 West Central Georgia

$964,453 ' $5,855 $4,664

$25;615 $7,337,066

$864,453 $100,000

$9,302,106

7 Middle Georgia

$976,128 $5,934 -$4,665 $193,675 $25,766 $6,595,749

$876,128

~100,000

$8,778,045

8 Central Savannah River

$1,187,905 $7,265 $9,306

. $28,313 $10,989,083 $1,072,537 $115,369 $13,409,778

9 Heart of Georgia Altamaha

$803,138 $4,763 $5,133

$23,523 $7,021,544

$703,138 $100,000

$8,661,239

10 Southwest Georgia

$1,030,713 $6,287 $6,276 $339,534 $26,442 $6,891,516

$928,201 $102,512

$9,331,481

11 Southeast Georgia

$939,697 $5,688 $6,604 $199,691 $25,294 $7,604,586

$839,697 $100,000

$9,121,257

12 Coastal

$1,039,903 $6,344 $5,657

'$26,551 $6,494,005

$936,640 $103,264 $10,062,014

State Total

$14,810,44~ $90,284 $74,546 $i,893,792 $345,712 $95,462,370 $13,329,405 $1,481,046 $128,937,253

Note: Other funds includes SSBG, Community base~ services, Irdigent Care Trust Fund, Alzheimer's, LTCO state supplemental, CCSP care coordination and client service benefits, Income tax check off, HICARE and Matching funds.' Amounts for Income tax check off, Title III Part F, and HICARE are fUlided by federal fiscal year and reflect SFY 1999 figures.

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Georgia State Plan on Aging FY 2000 -2003

.1. Older Americans Act Requirements
I:

Under the Older Americans Act, State Agencies must, in addition to requirements outlined in

I

Sec. 307(a)(33):

I



Sec. 306 (a)(S)(B) identify individuals eligible for assistance under this Act, with

special emphasis on older individuals with greatest economic need and older individuals

I

with greatest social need (with particular attention to low-income minority individuals).



Sec. 307 (a)(22) specify a minimum percentage ofthe funds received by each area

,I

agency on aging for part B that will be expended, in the absence of the waiver granted under Sec. 306(b)(1), by such area agency on aging to provide each of the categories of services specified in Sec. 306(a)(2).



Sec. 307 (a)(23) identify the number oflow-income minority older individuals in the

State, and describe the methods used to satisfy the service needs of such minority older

I'

individuals.



Sec. 307 (a)(29) describe the methods used to satisfy the service needs of older

I

individuals who reside in rural areas.

I,



Sec. 307 (a)(3S)(B) specify way in which the State agency intends to implement

activities to increase access by older individuals who are Native Americans.



Sec. 307 (a)(37) provided the actual and projected costs of providing services under this

I

title, including the cost of providing services to older individuals residing in rural areas in the State (in accordance with a standard definition of rural areas specified by the

Commissioner).

,I



Sec 705 (a)(8) 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 (7).
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Page 69

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Georgia State Plan on Aging FY 2000 -2003
OLDER INDIVIDUALS WITH GREATEST ECONOMIC OR SOCIAL NEEDS
Sec. 306(a)(5)(B)
Area Agencies on Aging and Service Providers use the Detennination of Need-Revised (DONR) Instrument and Comprehensive Geriatric Assessment fonn, part of the screening and . assessment process used to evaluate potential clients. At this time the DON-R is used extensively for screening and evaluation within the Community Care Services Program and optional in the non-Medi<:;aid programs (see the fonn on the following page). DON-R indicators are independent predictors of the need for services. in developing the DON-R over several years' time, the researchers found that, while the need for shopping assistanc'e was addressed by other scales, there really was no need to have a separate category. Four areas predict the need for shopping assistance: money management, the ability to do laundry, the ability to do housework, ap.d mobility outside the home. A person needs to be able to properly identify currency coins to make financial transactions; must be able to reach, bend and lift; and be able to get to the shopping center, etc.; therefore these domains are already addressed. The fonn is used to detennine a social need score for each client based upon established need indicators. Each client is given a score when they are assessed for services. The DON-R individual scores are valuable .in the screening and assessment process, because the instrument is nonned to a nursing home population. Therefore, when assessing an individual's functional impainnent level, and unmet need for care, we are able to know which persons would otherwise be in need of nursing home placement, were adequate and appropriate resources in the community not available. If there is a waiting list for the service, clients are placed on the waiting list in descending order of their social need score, thereby giving preference to those individuals in the greatest social need. Other infonnation recorded for each applicant for services includes minority sUJ,tus, rural, limited-English speaking, and disabled individuals, thereby giving particular preference to these individuals.
.. Econ"mic need is detennined by whether or not the client's stated income level is above, at, or , below the poverty levels established by the Office of Management and Budget. This indicator is used as a "tie- breaker" in cases where two individuals have the same social need score and there is only one opening for service. This method gives p~eference to those individuals in greatest economic need.
In order to assure that Area Agencies on Aging are targeting services to older persons with greatest economic or social needs, they are required to describe their plans for providing services to these groups in their Area Plans and to give particular attention to low income minority individuals. All Area Agencies must adhere to this requirement in setting priorities for Title III service providers to follow.
Page 70

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Chart 27

Determination of Need for Home and Community Based Services

I,

Function I. Eating 2. Bathing

Levelofhnpabrnnent 0 I23 0I23

Unmet Need for Care 0I23 0 I23

Comments

3. Grooming

0 I23

0 I23

I

4. Dressing

0 I 23

0 I23

5. Trarisferring

0 I 23

0 I23

I

6. Continence

0 I 23

0 I23

7. Managing Money

0I23

0 I23

I

8. Telephoning 9. Preparing Meals

0 I23 0 I23

0 I23 0 I23

I

10. Laundry II. Housework

0I23 0I23

0 I23 0 I23

I

12. Outside Home 13. Routine Health

0I23 0I23

0 I23 0 I23

14. Special Health

0 I23

0 I23

I

15. Being Alone

0 I 23

0 I23

Box A - Subtotal

Box A

I

Col. A, Items 1-6

Box C - Subtotal

BoxC

Col. A, Items 7-15

I

Box E - Subtotal

BoxE

Box A and Box C

BoxB BoxD BoxF

Box B - Subtotal Col. B, Items 1-6
Box D - Subtotal Col. B, hems 7-15
Box E - Subtotal Box B and Box D

I

BoxG

Box G - Subtotal Box E and Box F

t

Score:
o

Interpretation: No impairment or no unmet need for care

,I

Greater than I and less than or equal to 1.5 Greater than 1.5 and less than or equal to 2

I

Greater than 2 and less than or equal to 2.5

Greater than 2.5

I

Mild impairment or mild unmet need for care Mild to Moderate impairment or mild to moderate unmet need for care Moderate impairment or moderate unmet need for care
Severe impairment or severe unmet reed for care

I

Georgia State Plan on Aging FY 2000 -2003

MINIMUM PERCENTAGE OF PART B ALLOTMENT FOR PRIORITY SERVICES

Sec.307(a)(22)

In order to comply with Sec. 307(a)(22) of the Older Americans Act, the Division of Aging. Services has established minimum percentages of each Area Agency on Aging Title III B . allotment (based upon pre-shift amounts for ,the total Title III allocation for the current fiscal .year) that must be expended for access, in home services and legal assistance. The minimum percentages are:



12% for access services;



5% for in-home priority services; and



5% of the total Title III, Part B for the current fiscal year, or $40,000, whichever is

greater, for legal assistance

Area agencies on Aging may request a waiver ofthe minimum percentages if they can demonstrate to the Division of Aging Services that progiams are sufficient to meet the needs in the Planning and Service Areas as outlined in the Older Americans Act Sec.306(B)(1).

LOW INCOME MINORITY INDIVIDUALS AND OLDER INDIVIDUALS WHO RESIDE IN RURAL AREAS

Sec. 307(a)(23)

It is estimated that there are currently 51,190 low income minority older persons ages 65 and above in the State of Georgia. In recent years this minority population has become more culturally and ethnically diverse.
\
Each Area Agency on Aging is required to discuss how it will address the needs of these individuals in its Area Plan; Also, in the Area Plan, each Area Agency is required to include a three year analysis of the unduplicated number of older persons served (including white, minority, .low income minority, persons with greatest social needs, and persons who reside in rural areas).

If this service analysis indicates a declining trend that is not in line with the general population of minority, low income, low income minority, persons with greatest social need, and/or persons in rural areas, the Area Agency is required to describe specifically the actions they will undertake to increase services to these groups. If the analysis indicates a stable trend or increasing numbers, the Area Agency is required to address specifically the actions that will be continued to maintain or increase services to these groups.

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I Georgia State Plan on Aging FY 2000 -2003

I

ACTIVITIES TO INCREASE THE ACCESS OF OLDER NATIVE AMERICANS

I

Sec.307(a)(35)(B)

The State agency is required to specify ways in which the State agency intends to implement the

I

activities to increase the access older native Americans have to services provided under Title III. According to the 1990 Census, there are 1,026 older native Americans in the State of Georgia

representing only 0.12 percent of the elderly Georgia population. Each Agency will be asked to

I

increase the outreach efforts toward these individuals in lieu of a major programmatic effort.

I

ADDITIONAL COSTS OF SERVICES IN RURAL AREAS

Sec. 307(a)(37)

I

The State Plan is required to identify for each fiscal year, the actual and projected additional

costs'ofproviding services under Title III, including the costs of providing access to such

I

services to older individuals residing in rural areas of the State. The State Agency has defined rural as a county in which a majority of the population is rural according to the 1990 Census.

For purposes of this analysis, unit cost data was compiled for congregate meals, home delivered

I

meals, and transportation for the most rural Planning and Service Areas and the most urban Planning and Service Areas. We were not able to identify cost differences for other services.

'I

TABLE 14

I,

Per Unit Costs of Providing services in Urban and Rural Areas

FY 1998

FY 1999

I

Service Category

Rural Urban Difference Rural Urban Difference

Transportation

$2.23 $3.12

($0.89) $2.67 $5.92

($3.25)

I

Congregate Meals

$7.26 $5.33

$1.93 $6.60 $5.14

$1.46

Home Delivered Meals $2.74 $1.94

$0.80 $2.62 $2.48

$0.14

I

Note: This comparison is made using SFY 1997 and 1998 data, since SFY 1999 data is not currently

available.
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Page 73

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Georgia State Plan on Aging FY 2000 -2003
Maintenance of Effort for Long-Term Care Ombudsman Program
The Division of Aging Services sets forth the following maintenance of effort for the Long-Term Care Ombudsman Program based on the Administration on Aging Program Instruction (AOA PI _94-02) dated April 4, 1994 utilizing the allocation in Title III, Part B for fiscal year 1991. The Attached chart details the maintenance of effort for each area Agency on Aging.
Table 15
LONG TERM CARE OMBUDSMAN MAINTENANCE OF EFFORT
BASED ON FY 1991 ALLOCATIONS IN TITLE III B

AREA AGENCIES ON AGING

Atlanta Regional Commission AAA

Central Savannah River AAA

Coastal Georgia' AAA

Northwest Georgia AAA

Georgia MountainslLegacy Link, Inc. AAA

Heart of Georgia Altamaha AAA

Middle Georgia AAA

Northe~st Georgia AAA

--

Southeast Georgia AAA

Southern Crescent AAA

Southwest Georgia AAA

-- West Centr.,it Georgia AAA
TOTAL

FISCAL YEAR 1991 TITLE ill B

$66,666

-'

35,691

28,774

66,776

21,792

48,495

30,190

16,477

-

3-6,450

38,413

18,640

57,016

$465,380

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I Georgia State Plan on Agilig FY 2000 -2003

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Title VII

I

Sec.705(a)(8)

Under Title VII Chapter 3, abuse prevention activities include public education, outreach,

I

increased ombudsman activity in personal care homes, receipt of complaints or reports of abuse, and voluntary case referral to appropriate agencies (information and referral).

I

The State Agency requires compliance with the following items of all Area Agencies using Title VII funds:

I



Title VII, Chapter 3 funds must be lised in accordance with the criteria Sf':t forth in the

Older Americans Act (Sec. 721), as amended, with the Administration on Aging and

Division of Aging Services policies and procedures;

I'



Title VII-3 program activities must be coordinated with local Adult Protective Services

and other elder abuse prevention aild protection activities;

I



Title VII-3 program activities must be coordinated with and enhance the capacity of the

substate LTCO Program to address complaints of abuse in long-term care facilities,

I

including personal care homes;



No elder abuse program funded with Title VII-3 funds shall allow involuntary or coerced

I

participation in such programs by alleged victims, abusers, or their households.



All information gathered in the course ofreceiving a complaint or report and in making a

I

referral shall remain confidential unless all parties to the complaint or ~eport consent in writing to the release of such information, or unless the'release of such information is to a

Ii

law enforcement agency, public protective service agency, licensing or certification agency, Ombudsman Program, or protection or advocacy system; and



Funds made available under Title VII, Chapter 3 shall be in addition to, and will not be

I

used to supplant, any funds that are or would otherwise be expended on actiyities relative to the prevention of abuse, neglect, and exploitation of older individuals, including those

in long-term care facilities.

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Page 75

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Needs Assessment of

I

Elderly Programs and

I

Services

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I"

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I Georgia State Plan on Aging FY 2000 - 2003

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Needs Assessment of Elderly Programs

I

and Services

The needs assessment process involves a number of different processes and means by which

I

information is gathered to determine the needs/services of elderly Georgians. The process is a continual one, with input being sought from consumers and advocates all the time. Each year the

Area Agencies on Aging conduct an annual assessment of services and programs to determine

I

needs. Each agency uses slightly different methods, surveys, public forums, telephone surveys, and input from clients receiving services. This systemic and constant updating keeps the needs

assessment process current and focused.

.

I

The information generated through Area Agencies on Aging assessments is used by the Division of Aging Services in process improvement activities and in strategic planning to assUre that any

I

changes are responsive to customer needs and address the evolving challenges that confront

Georgia's elderly.

.

I

Below are some of the methods/results of the needs assessment process conducted by the Division of Aging Services to identify issues addressed in this plan.

I

1995 White House Conference on Aging /

1

1995 Georgia White House Conference on Aging

I

In preparation for the 1995 Georgia White House Conference on Aging, The Division of Aging Services sponsored the 1995 Georgia White House Conference on Aging in March, 1995. The

Conference culminated a year-long process designed to gather information and produce

I

recommendations from as many Georgians as possible. Prior to the final conference, 56 community forums were held around the State to give Georgia's aging citizens, families, care

givers, advocates, health professionals, and other interested parties the opportunity to be heard.

I

Over 8,500 Georgians participated and took advantage of the opportunity to make their opinions known about the concerns of most importance to Georgia's aging community over the next

decade. This conference served as a baseline for developing future issues and community needs.

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Page 76

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Georgia State Plan on Aging FY 2000 - 2003

Customer Focus Groups

The Division of Aging Services conducted extensive customer focus groups in October, 1997. A series of questions was presented to customers seeking their input on services provided by the Division of Aging Services and the Aging Network within Georgia. The following describes this extensive undertaking to gather information from internal and external customers regarding the status and capacity of the Aging Network in Georgia. The information gathered and compiled was used in a strategic planning process that directs the activities and energies of the Division of Aging Services.

Selection ofCustomers

The goal ofthis process was to gather information on the status and capacity of Georgia's Aging

Network. Focus groups were used to identify ''what's working and what's not working." The

purpose of gathering this information was for its use in the Division's strategic planning to

determine and implement a plan of action. To facilitate this process, the Division's Management

Team identified six sets of stakeholders as its primary customers and invited representatives from

those groups to participate in the meetings. Primary customer categories are:

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Area Agencies on Aging Providers of services through the Community Care Services Program Providers of services through other funding sources Older consumers'ofservices and their care givers Other Divisions and Offices of the Department of Ruman Resources Division of Aging Services staff

Method
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Six sessions were conducted in several locations in Georgia. Six to twelve persons comprised each group. Individuals from all PSAs were grouped into identified customer groups and came together to work through a structured meeting agenda designed to elicit feedback which would be used in development and implementation of a strategic plan of action.

Results .

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The results of these customer focus groups provided the Division Management Team information regarding the functioning of service delivery and program needs and barriers. This information was explored and studied, along with national and state trend information, by the Division of Aging Services Management Team as part of a strategic planning process called Roshin Planning. The Roshin Planning process unfolded over the course of a year. The final result of this major undertaking was the identification, development and implementation of a plan that focused Division of Aging Services resources in the design and development of a statewide data collection and reporting system that includes results measures.

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I Georgia State Plan on Aging FY 2000 - 2003

I Area Plans

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Area plans, and the process used to develop them, are one of the primary tools used in the needs

assessment process. All area agencies are required by the Division of Aging Services to

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participate in the Area Plan format/content development process. A critical part of plan development is needs assessment plans developed to meet those requirements. Sources of

planning input and analysis were:

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Public hearings

Waiting lists

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Service data Customer surveys

Focus groups

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Information and referral requests Demographlc information

Program evaluations

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Staff visits Advocacy group observations/input

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A review of the area plans discloses the following major issues:

Transportation

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In-home services Elder rights

Elder abuse

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Home delivered meals Long-term care

Legal assistance

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Home health Community Care Services Program

Information and assistance

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Home and Community Based Services Adequate and affordable health care

Adult day health care services

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Long-Term Care Ombudsman services

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Georgia State Plan on Aging FY 2000 - 2003
Long -Term Care Study Group
The Long-Term Care Project Team was created in 1997 to develop implementation strategies for the Department of Human Resources' Long-Tenn Care Strategic Plan. An extensive review of all Department of Human Resources (DHR) programs revealed that eleven major programs are, consistent with the long-tenn care defInition adopted by DHR. In FY 97, over 214;000 peoplewere served in DHR long-tenn care programs at a cost of over $360 million. Currently there are 13,500 Georgians identifIed as waiting for long-term care services. DHR's Divisions and OffIces project that the number of individuals they will serve will grow to over 322,000 in the next four years, increasing pressure for long-tenn care refonn. Correspondingly, there is wide consensus that our efforts to increase community and home-based long-tenn care services must be accompanied by strong efforts in prevention of conditions which lead to the need for these services. The survey identifIed major issues in the current DHR long-tenn care delivery system. SpecifIcally:
... The system needs a focal point ofunifonn entry, development, delivery and . coordination of long-tenn care services.
.. The system needs a comprehensive link among the Divisions and the programs administered.
.. Infonnation on programs and services must be better disseminated t<? clients.
.. Lack of a true consensus exists regarding quality-based outcome measures for long-term care.
The following signifIcant trends and lessons learned emerged from our surveys of states on the cutting edge oflong-tenn care r e f o n n : -
.. They have pursued managed care demonstration projects which integrate acute and long-tenn care.
.. They have targeted demonstration projects designed to serve older adults and some individuals with disabilities.
.. They have given priority to Home and Community Based services (HCBS) rather than institutional services.
.. They have streamlined their long-tenn care delivery systems through consolidation.
.. State Units on Aging are increasingly serving individuals with disabilities who are under 65 and in half the states are administering adult protective services programs.
.. They have been engaged with long-tenn care refonns over an extended period of time.
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Georgia State Plan on Aging FY2000 - 2003

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Trends and Customer Demands: A Summary ofFindings

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Financial concerns and the need for training appear to dominate the long list of issues that face aging services in Georgia.. They ranked as top concerns when the demands of customers ofthe

Division of Aging Services were compared with the major trends expected to impact the

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Division. Trends most often reflected in customer demands are:

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the expanding elder market may attract more unscrupulous providers;



newly developed information systems will be more sophisticated and more usable at a

relatively lower cost;

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policy makers place more emphasis on results than on complying with rules;



Georgia will need more state and local funds to maintain current levels of service; and

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there will be a need for training and support for caregivers.

The attached table displays the correlations of customer demands with the leading trends.

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Customer Demands. When asked what they most needed from the Division, customer groups discussed the growing numbers of elderly, the increased demand for services and the relatively

static number of dollars available to meet these needs. They wanted higher reimbursements and

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better pay. Following financial increases, they asked for:



data; computer systems

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improved communications;

. training for staff at all levels; and



flexibility for AAAs and providers.

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Strategic Trends. The ten principal trends, taken from a list of sixty-eight trends and issues for

aging service, seem to be:

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managed care and the integration of acute, social and long term care;



shift of long-term. care clients and funds from institutions to home and community based

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servIces



participation of aging service organizations in preventive health measures;



the need for training and support for lay caregivers to assist elderly in their homes;

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the inability of service providers who need to upgrade their skills and knowledge to

secure training;



the likelihood that the expanding elder market will attract more unscrupulous providers;

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more sophisticated information systems, usable at a relatively lower cost;



policy makers placing more emphasis on results than on complying with rules;



the need for State and local funds to compensate for the loss of federal funds; and

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the challenge of maintaining the current level of services in the face of the expected

growth in population, inflation and decreasing federal funds.

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Note: The work group strongly recommends careful review of the full reports of trends and customer demands. Those reports give considerably more detail to }lIany issues which

this summary merely synthesizes.

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Georgia State Plan on Aging FY2000 - 2003

Methods of Analyses
. Customer Demands. Staff of the Plaimingand Evaluation Section, help~d by interns from the
Elder Rights and Advocacy Section, conduCted sessions in Atlanta and Macon. Six to twelve persons comprised each group. Members of the groups responded to six questions. .

The Planning and Evaluation work group recorded the answers to the questions, verbatim. They

created affinity headers; based on customers' statements, for each customer category and for all

groups. They attempted to retain as much of the customers; language'as possible in assimilating

many statements under single headers.

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Themost direct question for eliciting the needs of the custome~s was: "What do you need from

the Division of Aging Services?" Moderators gave participants a stack of ten imitation $10 bills

and asked them to rank their needs by "expending" their funds. The priority list (below) reflects

the outcome ofthis ranking of dollars.

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reirribmsement; finance



data; computer systems

. improved communications;

;.



training for staff at all levels; and .

. flexibility for AAAs and providers.

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Trends and Issues. The entire Divisionparticipated in identifYing' trends andissues facing aging

services. Program specialists contributed items of importance to their fields of specialization.

Staff of the Planning and Evaluation Section conducted' interViews and reviewed current literature.

In orderto narrow the focus of the list, the Planning and Evaluation work group selected ten

leading trends and issues. The group bas~d its selection on the following criteria; each criterion

having equal weight:

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the trend's impacton the Division;

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the ability of the Division to respond to or impact the trend; .

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the cost to the Division ifit does not respond to the trend;

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the cost to the Division of responding to the'trend.

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Georgia State Plan on Aging FY 2000 - 2003
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Comparison ofDemands and Trends. The work group arrayed the trends and demands on a prioritization matrix. By assigning scores (1, 3 or 9) to the level of correlation of each trend with

each demand, it ranked the intensity of the correlation.. Then the group added the scores for each

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relationship to calculate a number that it considers the level of relationship for each demand with all of the trends. The last row of the table shows the level of intensity.

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Table 16 - Comparison of Demands.and Trend Customer Demallds Correlated with Trellds alld Issues

Funding <Jnd training needs expressed by the customers appear to relate most highly with most of the trends and issues. All of the trends and issues showed a relationship with

customers' expressed needs. I

Legend:



High correlation of trend and customer demand (=9)



Modest correlation of trend and customer demand (=3)

0

Low correlation of trend and customer demand (=1)

CUSTOMER DEMANDS ("What do you need from the Division of Aging
Services?")

TRENDS/ISSUES

Funding

1. The aging network is increasingly involved in the integration of acute, social and long term care; managed care will incorporate services traditionally provided by the aging network.



2. Long-term care clients and funds shift from institutions to ~ome and community 1?ased services.



3. The aging network will participate in preventive health measures.



4. Cost and demand will increase the need for trained lay caregivers to assist elderly in their homes.



The need for support for caregivers will increase.

5. Service providers who need to upgrade their skills and knowledge are not always able to secure

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training.

6. The expanding elder market may attract more unscrupulous providers.



7. Newly developed information systems will be more sophisticated and more usable at a relatively lower cost.



8. Policy makers place more emphasis on results than on complying with rules.



9. Georgia will need an average annual increase of $172,641 in state local and private funds to



keep pace with the FY 97 level.

10. Expected growth in population, inflation and decreasing federal funds will challenge the state's ability to maintain the levelof services experienced in past years.



Data .Systems


0




Communication


Training


. Flexi- . bility .


Total
27







27





24







33



0

21



39







39



0

37





33







27

Strength of Customer Demand in Meeting All Trends/Issues

70

55

60

72 50

1 The table shows the results of a correlation between the answers to the focus group question "What do you need from the Division of Aging: Services?" and the top ten trends and issues (see the trends and issues summary).

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Program Plan

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I Geogia State Plan on Aging FY 2000 - 2003

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ISSUE: Elder Rights - Protect the Rights of Vulnerable, Older Adults

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INTRODUCTION

The overriding goals of the Older Americans Act (OAA) are the protection and enhancement of

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the rights, dignity, autonomy and financial security of older Americans. The OAA regulations require the State Unit on Aging, together with the local Area Agencies on Aging (AAAs), to

proactively assert leadership on all issues, affecting older people in the state. In order to assure

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the implementation of coordinated efforts to protect and enhance the rights of older Georgia residents, the State and Area Agencies develop a written Elder Rights Plan as part of their State

and Area Plans.

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It is critically important to sponsor a multi-faceted set of services, supports and protections to

assist older persons in achieving these goals. For some, a simple referral or packet of information

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is all that is needed in order for an older person or care giver to act on their own behalf. At other times, more intensive assistance is required to educate the older person of their rights. Not

infrequently, an advocate is required who can take up the issue and press for the rights ofthe

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older person.

In an increasingly complex society, individual and collective rights are constantly threatened,

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either purposely or as an unintended consequence of such circumstances as changing societal mores, introduction of new technology, a weakened economy and/or difficult new challenges to

governance. Therefore, today, more than ever, elder rights services touch most older persons and

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their families at some point in their lives.

A primary objective of this Elder Rights Plan is the enhancement and growth of a strong elder

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rights movement which links legal services for the elderly, long term care ombudsmen, elder abuse and fraud prevention programs, case management, health insurance counseling programs,

advocates and other members of the aging network in Georgia. As a result of this movement;

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older Georgians will receive protection and enhancement of their dignity, rights, autonomy and financial security. This will be accomplished through the pursuit of legislative, judicial and

administrative reforms.

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The major functions of the Elder Rights Program are as follows:

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Provide understandable, objective information to the public so that individuals can make

informed choices and rational decisions.

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Empower older persons and their caregiver to advocate on their behalf.



Identify issues important to older Georgians.

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Geogia State Plan on Aging FY.2000- 2003



Coordinate with the Georgia Council ori Aging, the Silver Haired Legislature, and the

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Coalition of Advocates for Georgia's Elders.

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Train service providers to promote high quality services. Services include the following:



Elder Abuse and Fraud Prevention

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. . Elderly Legal Services Program

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



Long-Term Care Ombudsman Program ..

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I Geogia State Plan on Aging FY 2000 - 2003

I ISSUE: Protect the rights of vulnerable, older adults.

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Many older Georgians suffer and are vulnerable to physical, mental and/or fmancial abuse,

neglect and exploitation because they lack the information, resources, and the capability to

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protect themselves. In recent years this has been evidenced by:



A 68% increase in the.number of complaints received by the Ombudsman program from

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nursing home residents and an 84% increase in the number of personal carehome complaints between 1993 and 1998.

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A 22.6% increase from SFY 1995 to SFY 1998 in the number of consumers served by

Georgia's Elderly Legal Assistance Program. Consumer issues and housing were the two

most common types of problems elders brought to the legal assistance program.

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Problems with benefits (Medicare, Medicaid, and SSI) accounted for another 40% of all cases.

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From SFY 1995 to SFY 1998 over 72,756 seniors attended legal education sessions

conducted by the Georgia Elderly Legal Assistance Program. Consumers most requested

information on nursing homes, elder abuse, and consumer issues.

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The growth offee-for-service insurance counseling agencies which steer older consumers

to their affiliated insurance providers rather than objectively guiding these consumers to

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the best insurance options to meet their needs.



An increase in the number of elder abuse reports. Approximately 12,000 individuals 60

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years of age or older were helped by Georgia's Adult Protective Services Program in 1997. An estimated one in 14 incidents of elder abuse comes to the attention of

authorities.

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In SFY 1998 more than 500 complaints investigated by the State Long-term Care

Ombudsman Program were for abuse, gross neglect or exploitation.

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The elderly are known targets for various marketing scams.

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Over 50% of all calls received by Georgia's HICARE (Health Insurance Counseling,

Assistance and Referral for the Elderly) Program in SFY 1998 dealt with Medicare and

Medigap questions. Managed care and prescription drugs were also major concerns of

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callers.

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Geogia State Plan on Aging FY 2000 - 2003



During focus groups held in 1997, major issues facing the aging network in the next two

to five years identified by Division of Aging Services customers included increased fraud

and abuse ofthe elderly, the impact of managed care, the need for trained professional

and volunteer staff arid making aging and prevention issues a concern for all people.



Issues identified through community forUms held in 1995 as part of the Georgia White.

House Conference ~n Aging community forums continue to be applicable today; issues

included protection of lega1.rights for seniors and increased options for quality, affordable

long-term care.

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, Although 75% of Americans have favorably embraced the concept of advance directives (e.g., living will, durable'power of attorney for health care) only 20% have executed directives.

e,: The Senior.Legal Hotline handled 5,177 cases in the past year. Most requests for assistance related to wills and estates, consUmer issues, and housing. Of the total cases, 206 or four percent related to financial exploitation or domestic violence.

Objective: Provide leadership in the development of a state elder rights system in Georgia which

includes, but is not limited to, the Long-Term Care Ombudsman Program, Elderly Legal

Assistance Program, th~ Health Insuranc,e and Counseling and Referral for the Elderly

(HICARB) program, elder abuse prevention activities, health care fraud prevention, and

advocacy.

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Strategy 1: Promote elder rights program coordination at the state level with the Elder Rights ,& Advocacy Section and at local levels through the Area Agencies on Aging.

Strategy 2: . Provide technical assistance to Area Agencies on Aging and relevant providers in the development of area elder rights plans.

Strategy 3: Enable older Georgians to access services, benefits, and rights to which they are entitled.'

Strategy 4: Provide outreach, counseling and assistance to older Georgians through state level and local Area Agency on Aging activities.

Strategy 5: Participate in statewide advocacy efforts related to elder rights issues.

Strategy 6: Provide training opportunities to promote and enhance elder rights services, including the Elder Rights 2000 Conference.

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I Geogia State Plan on Aging FY 2000 - 2003

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LONG-TERM CARE OMBUDSMAN PROGRAM: The Long-Term Care Ombudsman

Program serves the residents oflong-term care facilities, i.e. nursing homes and personal care

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homes. The Ombudsman Program seeks to improve the quality of life for these residents who are among Georgia's most vulnerable citizens. Residents of long-term care facilities sometimes

have little or no contact with the outside world. Many feel they lack control over their own lives.

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Ombudsmen are available to help these residents.

Since 1978, the OAA has required state agencies on aging to establish and operate Ombudsman

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Programs. In 1979, Georgia passed its own long-term care ombudsman law, amended in 1995 to reflect the 1992 OAA amendments. The law, which complements the Federal statute, provides

for:

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Training and certification of community ombudsmen by the Office of the State Long-

term Care Ombudsman;

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Duties and powers of the State Ombudsman and community ombudsmen;

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Posting and distribution of Ombudsman Program information in long-term care facilities;



Access by certified ombudsmen to long-term care facilities and residents, and;

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Confidentiality for residents or other persons making complaints or providing

information to ombudsmen.

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In 1981, Congress expanded the responsibilities of the Long-Term Care Ombudsman Program to

include the provision of services to residents of personal care homes. While the number of

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nursing home beds has risen only slightly since the inception of the Ombudsman Program, the number of personal care home beds in Georgia identified by the program has increased by

approximately 296% from 5,534 (1988) to 21,927 (1999). This increase along with sweeping

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changes in the nursing home survey and enforcement process provide a formidable challenge to the Program: to continue to provide .sufficient high quality services to the long-term care

residents in our state with only a marginal increase in the resources available to support our

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efforts.

As authorized by the state and federa1laws, the Division of Aging Services administers a

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statewide Ombudsman Program that is sponsored by the AAAs. Ombudsmen serve all residents of the state's nursing facilities and personal care homes by:

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Investigating and working to resolve problems and complaints affecting long-term care

residents.

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IdentifYing'problem areas in long-term care and advocating for change.

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Geogia Stat~ Plan on Aging FY 2000..; 2003

, Provi4ing infonnation about long-tenn care and related services.

.Promoting resident, family and community involvement in long-tenn care.



Educating the community about the needs oflong-tenn care resigents.



Coordin,ating efforts with other agencies concerned with long-term care.'



Visiting long-tenn care facilities routinely to talk to residents and monitor conditions.



Educating facility staff about resident rights and other issues.

Objective: Promote the rights and well-being of residents of Georgia's long-tenn care facilities

and attempt to empower residents, their families and communities, to participate more fully in

the actions and decision making that impacts their daily lives.

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Strategy] : Receive, investigate and attempt to resolve, in a timely manner, complaints made
by or on behalf of long-tenn care facility residents.

Strategy 2: . Educate and provide infonnation and assistance to residents, families, and other . interested persons to promote self-advocacy and ongoing participation in policy . and other decision making which impacts the lives of 16ng-tenn care facility residents.

Strategy 3: Promote regular, ongoing training for direct care staff in nursing homes and

personal care homes.

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Objective: Expand. the capacity ofthe Ombudsman Program to ensure the health, safety, welfare and rights of residents of nursing homes and personal care homes.
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Strategy]: Continue to provide the ombudsman certification training and continuing education of ombudsmen staff and volunteers, including participation in the' Elder Rights 2000 Conference.

Strategy 2: , Increase the use of volunteers, and enhance support for their work, by commuriity

ombudsman programs.

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Strategy 3: . Assess .the program's success through the review and compilation of program reports and implementation of new Aging Infonnation Management System (AIMS).

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I Geogia State Plan on Aging FY 2000 - 2003

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Strategy 4: Evaluate all community programs on a regular basis, including site visits.

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Strategy 5: Advocate for additional state funding support to meet escalating needs for ombudsman services by personal care home residents (296% increase in number

of residents in past decade)

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Objective: Monitor the development and implementation of and make recommendations

regarding federal, state, and local laws, regulations and policies affecting residents of nursing

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homes and personal care homes.

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Strategy 1: Continue to advocate for resident-centered laws, regulations and policies related

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to long-term care residents, including the following issues:



access to long-term care services, including community-based services and

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limited nursing services in qualified personal care home settings;



combating malnourishment in nursing homes;



combating Medicaid discrimination in nursing home admissions;

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increased staffing in nursing homes; and



prevent and combat health care fraud, waste and abuse.

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Strategy 2: Complete an annual report as required by the Older Americans Act and submit each report to the Assistant Secretary for Aging, the Governor, the state

legislature, the state agency responsible for licensing or certifying long-term care

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facilities and make such report available to the public.

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Geogia State Plan on Aging FY 2000 - 2003

LEGAL ASSISTANCE: Legal problems facing the elderly are often more critical than for any other segment of our population. The poor elderly are less likely to seek assistance of an , attorney because they either do not have cash resources to pay for services or they do not realize that they have a "legal problem" which requires the assistance'of an attorney.

The overall education level of many seniors is low, especially in'the older age groups, making it diffic~lt for them to comprehend letters regarding benefits termination or changes arid outlining their due process rights to appeal. Another major area of concern is protection from exploitation by individuals and businesses.
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The need for legal services rarelysuifaces through formal needs assessments; 'nevertheless, Area Agencies on Aging are usually able to assess need based on the number of cases opened by the Title III legal staff.during the previous year. Legal assistance for the elderly is expected to continueto be a need in Geotgiaparticularly with the increase in Georgia's elderly population.

The Division ofAging Services coordinates legal assistance programs for people over the age of 60 at the local level throughout the state funded in part by the Older Americans Act. Area Agencies on Agingcon:tract with the Georgia Legal Services Program,'private attorneys or social services agencies, to provide elder legal services at the local Ic:ivel. In many areas of the state, the Private Bar supplements services for the Elderly Legal Assistance Program, staff by providing attorneys for ~ssistance at no cost or reduced~fees,' at the local level. Elderly l~gal assistance program servIces:

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Provide legal and related services designed to advance and protect the personal rights,

benefits, and entitlements of elderly citizens, including the representation at no cost of

older Georgians in administrative hearings and in court;

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Provide information and refer to appropriate legal services; and



Educate the community with respect to legal and advocacy skills. Monthly legal

education programs are conducted at many community sites.

The Older Americans Act requires that the state assign staff to provide state leadership in developing legal assistance programs for older individuals throughout the state. This is accomplished through the legal assistance program in the Division of Aging Services. At the state level, this program provides planning, education /training, technical assistance, specialized research, and policy development to the statewide legal assistance network and to other programs such as the Community Care Services Program and the Long-Term Care Ombudsman Program,

OBJECTIVE: Assist older Georgians with legal problems through the Elderly Legal Assistance Program.

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Strategy 1: Coordinate statewide efforts which address the legal needs of older individuals.

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Strategy 2: . Lead the ongoing development and coordination of a state-wide network of Legal Assistance providers

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Strategy 3: Provide legal support to and ensure the continuous development of the local Elderly Legal Assistance Programs.

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Strategy 4: Supply training support, advice, and technical assistance to providers oflegal assistance for older individuals in Georgia.

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Strategy 5 : Provide technical as,sistance on issues related to legal rights of older persons, to other Division of Aging Services programs.

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Strategy 6: Provide education, technical assistance and training in all areas of Elder Rights.

Strategy 7: Develop, print, and disseminate materials and publications to assist older persons

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in advancing and protecting their legal rights.

Strategy 8: Review standards for any additional changes or modifications.

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Objective: Promote high quality legal services to the elderly and uniform implementation of

Elderly Legal Assistance Program standards.

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Strategy 1: Conduct site visits to all local programs as necessary.

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Strategy 2: Provide needed technical assistance to service providers and AAAs to assure compliance with standards.

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Strategy 3: Provide continuing legal education to legal services providers, including legal issues track of Elder Rights 2000 Conference.

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Geogia State Plan on Aging FY 2000 - 2003

HEALTH INSURANCE COUNSELING, ASSISTANCE AND REFERRAL: The Health Insurance Counseling, Assistance and Referral for the Elderly (mCARE) program was initiated "in SFY; 1994 under a grant from the U. S. Health Care Financing Administration. The purpose of this program is to provide infonnation and assistance to Medicare recipients who have questions
or problems regarding Medicare coverage, Medicare + Choice, Medicate supplemental policies
(Medigap), Medicaid, long-tenn care insurance and other related insurance programs such as the Qualified Medicaid Beneficiary Program. Financial support for the program includes state funding and a special grant to prevent Medicare waste, fraud, and abuse.

The Division of Aging Services' mCARE program operates a statewide toll-free hotline to provide infonnation and assistance by telephone. In addition the Division contracts with the area agencies on aging to provide services locally. Each local organization has a volunteer coordinator and volunteers who assist Medicare beneficiaries with their health insurance related issues by individual or telephone counseling, community education sessions, outreach, and providing general information to the public. Major efforts in the future will focus on educating
Medicare beneficiaries and others about Medicare + Choice, preventing Medicare fraud, and
assuring that Medicare beneficiaries have access to benefits and services.

Objective: Assure that older Georgians and Medicare beneficiaries with disabilities have needed infonnation and assistance about health insurance, and other public benefits.

Strategy 1: Continue to operate the HICARE program.

Strategy 2: Increase the number of HICARE volunteers providing HICARE services statewide.

Strategy 3:

Implement the Medicare Fraud Patrol Project to prevent fraud, abuse and waste in the Medicare program by training professional volunteers to educate the community.

Strategy 4: Increase the outreach capacity of the program, particularly minority individuals and those who are isolated and/or home bound.

Strategy 5: Educate older Georgians regarding Medicare, Medicare + Choice, managed care,
Medicaid, Medigap, long-tenn care insurance, and other health insurance issues.

Strategy 6: Educate professionals in the Aging Network about health insurance related issues by participating in elder rights conferences and through other opportunities.

Objective: Promote high quality HICARE services.

Strategy 1: Provide support to local programs for managing volunteers by assisting with

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recruitment, training, and supervising HICARE volunteers.

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Strategy 2: Provide needed technical assistance to Area Agencies on Aging and/or HICARE subcontractors to promote program excellence.

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Strategy 3: Provide high quality training on an ongoing basis to volunteers and staffwho provide health insurance information to Medicare beneficiaries, their families, and

others.

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Strategy 4: Assess the program's success through the review and compilation of program

reports provided through AIMS, Aging Information Management System.

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Geogia Stilte Plan on Aging FY 2000 - 2003

ELDER ABUSE PREVENTION: The Division of Aging Services is responsible for coordinating programs related to the prevention of abuse, neglect and exploitation of the elderly. The Division provides support to the Division of Family and Children Services (DFCS), Adult Protective Services Program which is administered by the county DFCS offices.. Representatives of the Division participate on the Adult Protective Services Project Team which was chartered by the Divisions of Aging Services and Family and Children Services to make recommendation's to improve protective services for vulnerable adults in Georgia. Furthennore, Division of Aging Services staff have been instrumental in the development and design of policies and procedures for Georgia's new emergency relocation fund.

The Division promotes the prevention of elder abuse inthe comIi1Unity~at~largeby providing leadership and coordinating the delivery of elder abuse prevention services through the Area Agencies on Aging. The Division supports local elder abuse prevention activities by distributing OAA elder abuse prevention funds to the Area Agencies on Aging using the intrastate funding fonnula.

Objective: Increase coordination and cooperation among state departments, DHR Divisions and offices, and other professional groups and organizations to increase the awareness of elder abuse and improve the quality of protective services for older Georgians.

Strategy 1: Participate in the fmplementation of recommendations for improving adult protective services in Georgia.

Strategy 2: Promote and conduct interdisciplinary training on elder abuse including financial exploitation.

Strategy 3:

Work with the Commission on Family Violence, the Council on Elder Abuse, and Neglect, and the victims' network to disseminate infonnation and encourage reporting of elder abuse and neglect.

Strategy 4:

Educate professionals and others in the aging network who work with seniors regarding abuse and neglect and fraud prevention at training events, including the Elder Rights 2000 Conference.

Objective: Reduce and eliminate the number of elder and disabled adult abuse cases and incidents.

Strategy 1: Increase protection, services and resources for those in the community.

Strategy 2:

Educate service providers in the aging network about the various indicators of abuse, their responsibility to report, and resources available to assist vulnerable individuals.

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Strategy 3: Provide the general public and various professional groups with specific, accurate

information about elder abuse, ways to identify and report it, and resources

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available to ameliorate it.

Strategy 4: Advocate for increased resources to support Adult Protective Services.

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Objective: Address issues related to elder abuse, neglect and exploitation.

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Strategy 1: Obtain and share information regarding successful local programs.

Strategy 2: Focus efforts on issues related to the needs of caregivers, both professional and

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Strategy 3:

family caregivers.
of Collaborate with other groups, such as the State Bar Georgia, Younger Lawyers

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Section, Adult Protective Services Workgroups, Commission on Family Violence, Sexual Assault Task Force, and Consumer Fraud Task Force to combat abuse and

neglect.

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Geogia State Plan on Aging FY 2000 - 2003

ADVOCACY AND.PROTECTION OF RIGHTS: Advocacy and representation is provided
on behalf of an: older person to secure his or her rights and benefits. As federal funds diminish
and the elderly population increases, demands for services will also increase. Additionally, seniors are developing a greater sense of identity as a group with their own special concerns and needs.

AAAs are actively working to increase the level of advocacy for Georgia's elderly. They hold meetings for seniors with their elected officials, orient newly elected local officials about aging issues, and help educate the community about aging concerns. The AAAs contnict with the Georgia Gerontology Society for the Senior Citizens Advocacy Project which provides advocacy services on behalf of older persons. These services include daily monitoring of the General Assembly, when in session; training sessions for advocates; technical assistance to advocacy groups seeking to impact elderly issues and concerns; and assistance in the preparation of testimony, comments, legislation, or other documents on ;iging issues identified by advocacy groups.

The Division of Aging Services works with the Georgia Council on Aging, and the Coalition of Advocates for Georgia's Elders (CO-AGE) to advocate for the elderly in Georgia. Specific advocacy activities include tracking legislation, and coordinating with other advocates for the elderly. Most significant are the efforts of:



The Georgia Council on Aging, as an advocate for Georgia's older citizens, was created in

1977 by the Georgia General Assembly to act as an advisory organization to state

government. In that respect the Georgia Council on Aging serves in the advisory

capacity to the Governor, the General Assembly, the Board of Human Resources, and all

other state agencies in matter relating to Georgia's older citizens. It also convenes CO-

AGE.



Senior Week at the Capitol: Senior Week at the Capitol, sponsored by the Georgia

Council on Aging, provides older adults from over the state the opportunity to visit the

State Capitol during the legislative session for the pmpose of meeting with legislators and

to voice their opinions and concerns about legislative issues. The event also offers state

representatives the opportunity to meet with the state's older population.



The Coalition of Advocates for Georgia's Elders (CO-AGE) is comprised of more than

250 organizations and individual participants who represent all of Georgia's 12 Planning .

and Service Areas. The mission of CO-AGE is to provide the Aging Network an

opportunity to prioritize among many competing.and important legislative issues

impacting older Georgians.

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Objective: Develop a comprehensive approach to advocating for key issues affecting the interest

of older persons.

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Strategy 1: Continue providing technical assistance to major advocacy groups.

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Strategy 2: Work toward improving media relationships to increase the amount of television, radio, and newspaper coverage of aging issues.

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Strategy 3: . Continue to track legislation affecting older Georgians and share pertinent information with the Georgia Council on Aging, Area Agencies on Aging,

Division and Department staff, and others.

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Strategy 4: Plan and implement the Elder Rights 2000 Conference on Aging.

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Geogia State Plan on Aging FY 2000 - 2003
ISSUE: Transportation
Lack of transportation IS a'barrier for many Georgians. M~re people with disabiiities are finding
jobs, but their disabilities may keep them .from driving a car. Older Georgians need rides to senior centers and medical appointments.
The Georgia Department of Human Resources provides transportation for these clients, but at the same time it must streamline services and reduce duplication.. In,the past, each ofDHR'S five divisions operates and maintains its own fleet of vehicles for its clients. while some vans sat unoccupied for much of the day, and other vehicles transported only a few clients at a time. Some programs had no' transportation services for clients in certain areas.
A New System
DHR is reorganizing its transportation system by unifying transportation services that currently . serve different groups of clients. Under the new system, one provider will deliver all transportation services in a specific area. A central coordinitor in each ofthe Division's regions will oversee the operation of vans and buses for all clients and will develop alternatives to DHR transportation, such as contracting with private providers, securing grants for transportation services and using existing transit systems. Transportation services for the Division ofAging Services are awarded to the organization that meets the requirements outlined in the request for proposal.
DHR began pilot projects in 15 counties in 1997, and has expanded. to 29 counties, including all of the Griffin and Albany regions. Regions near Rome, Athens and Vidalia began services in September, 1999; Fulton County will follow in October. Other regions are expected to be ready by the first half of the year 2000.
DHR has budgeted $13 million for transportation services in FY 2000 and is expected to add another $6 million to expand services. Once statewide, the system is expected to cost about $45 million and will fund more than 7 million trips per year - about 20,000 trips per day. Existing DHR funds are being redirected to pay for the system, as well as additional local and federal money. Once routes are consolidated and duplicate routes are eliminated, the system will actually save money in the long run.
Local input
Although the system will be administered at the state level, local agencies will help design a transportation plan to meet the needs of clients in their area. A regional transportation coordinating committee, composed of local DHR'staff and representatives from other agencies, will help identify transportation needs in each region and will advise the regional coordinator.
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. DHR will continue to work with other agencies and organizations to develop alternative means,

of transportation.

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The Department of Hurilai1 Resources' unified transportation initiative is a result of efforts by the

Department to redefine human service client transportation in the State. Previously, each

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Division within the Department owned and operated vehicles. Different Divisions were sending vehicles over the same route to transport clients. Unified transportation will end this costly and

inefficient duplication. The revised system will also remove the operating divisions from being

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direct providers and ope~ators of vehicles.

Programs will now receive resources to allocate a fixed block of trips on the network, rather than

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having a specific vehicle available. Programs will also have the right to purchase additional trips on the system. Costs per trip for the program are still under analysis, but overall transportation

costs incurred by programs should remain consistent with past experience and as the system is

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refined costs should decrease due to efficiency.

Objective: In coordination with the overall effort of the Department, develop a coordinated,

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unified transportation system which meets the needs of elderly clients within the State.

Strategy 1: . Assist the Department in design of the new system to meet the specific needs of

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the elderly.

Strategy 2: Promote and educate the elderly citizens throughout the state about the new

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system.

Strategy 3: Work closely with the local Regional Transportation Coordinator in both

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developing and refining the system in each Planning and Service Area.

Strategy 4: Insure all clients will be eligible for inclusion in the new system.

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Strategy 5: Develop Transportation forecasts in coordination with Area Agencies which

accurately relay the need for services for our elderly clients.

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Objective: Develop an evaluation and review process to evaluate the new system to insure the

needs of the client population are being met. .

.

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Strategy 1: Develop a monitoring/feedback system in coordination with the Regional

Transportation Coordinator to identify problem areas and areas when the system

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requires modification to meet client needs.

Strategy 2: Establish a system to take feedback arid evaluate what actions need to be

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accomplished based on the input received.

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Geogia State Plan on Aging FY2000 - 2003

Strategy 3: Establish an Area Agency representative who can be the focal point for Unified

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Transportation issues.

..

Strategy 4: Create a local council comprised of system users, advocates and Agency staffto

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.review and provide recommendations to the Division and Department on system

operation.

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ISSUE: Managing Using Data

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The advent of year 2000 has brought a new set of real and different problems which, although unseen, may have tremendous impact on the ability to provide timely services to our clients.

Current systems are not completely adequate to meet the needs of the agencies tasked to manage

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the programs and services required to meet the needs of the clients and to comply with requirements under the Older Americans Act, as amended. To meet this challenge the Division

of Aging Services has outlined a greatly enhanced information system that will enable it to better

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manage the Aging Network using data. The system will provide the data needed to know customer needs, improve quality, bring about innovation and assure accountability. The

improved data system will be available to staff, decision makers at all levels of the Aging

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Network and data will be available to the general public. The Division will use an improved information system to facilitate accountability to both clients and taxpayers, and to p~omote

management and improvement.

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Objective: Implement a Management Information System which will meet the needs of the

Division, the Area Agencies and the elderly to insure viable programs and services are being

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delivered. The system will:



Enable the Division, AAAs and providers to work effectively and efficiently in

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providing services to their customers.



Provide all federal and state reports, plus a variety of management and ad hoc

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reports.



Be amenable to aging-related collaborative, information sharing projects with

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other DHR divisions and office, e.g., the single intake project. It must comport with the Department's single point of entry and other initiatives.

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Enable all levels of the Aging Network to receive and use information to measure

their performance and efficiency and to improve the quality of services to the

elderly.

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Enable the Division and AAAs to measure the performance of providers and

AAAs.

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Ease the exchange of information within the Division and the Aging Network.

This includes providing access to information to all providers.

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Make aging-related information more readily available to the public. Members of

the public should be able to access information without contacting the staff of the

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Division or the AAAs. Access should be possible not only to those who own computers but also through public computers, such as those in libraries. Public

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Geogia State Plan on Aging FY 2000 - 2003

information should be generated from the systeni~.'s current data not from archives; the public should have access to the most up-to-date information.

-j"



Expedite payment of providers by the Division and the AAA.s;

.; "



Enable providers to submit reports to the AAAs and t~e Divjsion and enable

AAAs to submit reports to the Di,,:ision, Regional D~vel9pment Centers, boards

<'

and the. public. ,

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By their use oqhe system, providers, AAAs, Division and other DHR staff should be able to better manage and improv~ such ~ritical proc~sses as:



Contracting and rendering payme~ts



Communicating

~. J ~

~

.



.Measuring inputs,_ activities, 0l:ltpu!s, results and quality

',,-""



Developing policy and standards

. , ,



Providing and receiving training and ,technical assistance



Collecting and managing data



Managing quality

v



Monitoring and evaluating programs and pr<?cesses '



Planning



Conducting. research.

Strategy 1: Strategy 2:
Strategy 3: Strategy 4:

Evaluate system requirements with both user and customer input. '

.

"

Establish a project team, which uses Continuous Quality Improvement CCQI)

techniques, to refine the system, and develop recommendations to the Division on

an appropriate course of action..

Work

closely

with

the

."
Department's

Informati~n

Technology

S~ction

to

insure

the system is both Y2K compliant and is "state ofthe a:rt." ,

.

-.

.

...; ...

Develop training requirements for all users of the system. Training should

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include Division staff, AAAs, service providers, other agencies, and elderly

clients.

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Strategy 5: Develop a timetable for refinement.

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Strategy 6: Develop hardware needs and funding concurrent to insure all required users can use the system as intended.

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Geogia State Plan on AgingFY2000 - 2003
Issue: Home Delivered Meals

The Home Delivered Meals program is designed to provided temporarily or permanently homebound adults with at least one-third of their recommended daily nutritional requirement. A priority need this program meets is adequate nutrition by providing at least one nutritious meal per day, five days a week. Good sound nutrition is a necessary foundation for good health; consequently, this program also addresses the priority need of health care. Another priority need met by this program is the need for in-home services. The elderly person not capable of going to a nutrition site for a congregate meal can still gain the benefits of sound nutrition by having this meal delivered to his or her home. Still another need being met by this program is valuable outreach to those socially isolated by those who deliver the meals. Volunteers or staffwho have delivered a meal have discovered a client in need of emergency assistance.

The Home Delivered Meals program has grown more than any other program during the last few years through the receipt of Community Based Services, Georgia's Income Tax Checkoff and Indigent Care Trust funding. Priority for home delivered meals will be given to isolated, homebound elderly who are determined to be in greatest economic or social need, with emphasis on low income minority, rural elderly, and older individuals with severe disabilities. Each site will be open approximately 250 days per year. Area agency staff provided technical assistance to providers to make sure programs are operating as efficiently and effectively as possible. More than 2.5 million meals were provided to individuals, and 28,384 persons received meals in their homes in Georgia in 1998. Twenty-six and a half percent more people received Home Delivered Meals over the last four years.

Objective: Promote and improve the health status of older Georgians through good nutrition.

Strategy 1: Assure that high quality home-delivered meals are provided through contracting, monitoring, site visits, technical assistance and training.

Strategy 2: Expand nutrition programs such as counseling, education, and screening.

Strategy 3: Focus efforts on those who are minority, poor, especially those in rural areas of the State.

Strategy 4: Develop a comprehensive plan for expanding the program in the out years to deal with the increasing elderly population within the State. The plan should:



Identify both current needs and future needs for this essential service.



Develop expanded educational material and means to reach this client group,

informing them of the service and how to qualify..



Develop cost estimates and manpower resources to meet future client needs.



Insure that Home Delivered Meals is part of an all-inclusive nutrition program

which addresses the entire problem.

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Strategy 5:

Expa. nd

funding

sources

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population

which

uses

these

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servIces.

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Strategy 6: Promote public programs anq policies which will assure greater access by older

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persons to appropriate food and nutrition services.

Strategy 7: Educate families, communities, health and social services providers, policy

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makers and the private sector about the importance of nutritional status and the Home Delivered Meals program.

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Strategy 8: Support legislation and polici~s which would strengthen and expand food assistance programs such as the Food Stamp Program.

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ISSUE: Cost Effectiveness - Uniform Cost Methodol'ogy

DRR's Division of Aging Services, in partnership with the Aging Network, has instituted a

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unifonn method of detennining service costs which will be used by all provider agencies. Unifonn Cost Methodology is a costing system to be used by all providers in preparing budgets in response to Requests for Proposals for aging services. The purpose of the methodology is to .

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have all providers calculate service cost in the same, fashion, treating costs in a consistent manner. Area Agencies on Aging will then be able to evaluate the cost of programs and services based on consistent treatment of costs by all provider agencies. This process also will assure a

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consistent method for allocating cost to programs and services. The major features ofUnifonn Cost Methodology are as follows:

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Costing Methodology



Means by which costs are moved from the budget/financials to specific services

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Key Cost Variables

o



Time and effort relative to each service



Local labor cost

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Space costs



Ability to generate in-kind/match

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Consistent and Like Treatment of Costs



Cost can't be both direct and indirect

o



Allocation statistics will be similar



Cost pools will be similar .



Cost vs pricing (if looking for best price, could be different for actual cost)

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Costs vs Pricing

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One person's cost is another person's price



Model is cost (expenditure) based, not price (revenue) based



True unit costs level the playing field

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"In-kind costs" don't exist

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Services to be included in the Uniform Cost Methodology

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All services will be subjectto the Uniform Cost Methodology. However, not all services will be reimbursed on a unit cost basis. Area Agencies on Aging have the discretion to reimburse any

service on a unit cost basis, provided the Area Agency follows the methodology and uses

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definitions of service units established by the Division. The following chart outlines services which shall be reimbursed at a unit cost rate and those for which unit cost reimbursement is not

required.

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Services which IDllSt be

Services Dot required to be

reimbursed at unit cost

reimbursed at unit cost

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Congregate Meals

Senior Center Services

Home-delivered Meals

Care Coordination

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Homemaker Services

Information and Referral

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Home Health Transportation

Elder Abuse Prevention HICARE

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Chore

Senior Community Service Employment

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Respite Care Adult Day Care

Advocacy Home ModificationslHome

Repair

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Nutrition Counseling

Material AssistancelMaterial

Aid

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Outreach

Recreation

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Legal

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Ombudsman

Uniform cost methodology is geared towards the procurement process, resulting in accountability

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and quality control.

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Objectives:



."Levelplaying field" - true costs: r.:

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Understand components of cost '

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Justify 'expenses



Deter artificially ~ow b~d





" ~,

c,

;,

~

o



Best delivery system wille~erge based on'true,costs

o

Strategy 1: Upgrade systems to acc.Q.!Pffiodat~ requirements;foi .uJ].iform cost methodology

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Strategy 2: Pro"jide technical assistance and training; as needed, to all users on the system and

its operation.

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Strategy 3: Evah~ate the system toQetelTQ.in~ ~fficiency and effectiveness asUniform Cost

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Methodolo&y,is implem,ented,and used.
., ,

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Strategy 4: Review system operation at regular intervals to'upgrade, modify or-enhance, as

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required, to meet Area Agency andlDivision needs.

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Strategy 5: Compare the uniform costing vs past system methodology to determine if system

p ,"
is improving the process.and by how much.

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Strategy 6: Measure results to insure quality and ~ccountability are outcomes of the system.

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Geogia State Plan on AgingFY 2000 - 2003

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ISSUE: Home and Community Based Services

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Home and Community Based Services (HCBS) are the social and health-related services provided in a person's home or community which delay or prevent persons from needing more

costly care in an institution/nursing facility. Two main programs provide HCBS to elderly

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Georgians, the Community Care Services Program (CCSP), and the non-Medicaid Home and Community Based Services Program. Area Agencies on Aging throughout the state report an

increasin& demand for these services.

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Community Care Services Program (CCSP) utilizes a combination of Federal Medicaid and

state funding to provide an array of health related services for persons who qualify medically and

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financially and would otherwise have to enter a nursing facility. CCSP serVices include: telephone screening; face-to-face assessment; case management; adult day health; alternative

living serVices; emergency response services; home-delivered services such as skilled nursing

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and home health aide; personal support services such as help with meal preparation, housekeeping, bathing and other hygiene activities; respite care; and home delivered meals.

These services are coordinated with Older Americans Act, SSBG services, and other state

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supported services, where appropriate, to provide an efficient and cost effective array of services for persons at risk of premature or unnecessary institutional placement.

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From SFY 1990 to SFY 1998 the Division of Aging Services has seen an increase of 62 percent in the number of persons served by CCSP. In SFY 1998 14,194 persons were served. As of

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January 1, 1999, there are currently 3,941 individuals on the waiting list for Medicaid community services. The service most often used is personal support services which is provided

to 70% of CCSP clients.

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In SFY 1998 the average annual cost to the CCSP for an individual's services was $3,739

compared to $15,643 for nursing home placement. The average annual savings to the taxpayer

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per individual in CCSP was $11,904.

Non medicaid Home and Community Based Services: Non-Medicaid Home and Community

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Based Services, such as home delivered meals, homemaker/chore, adult day care and transportation for older persons who need assistance to remain in the community are funded by .

the Older Americans Act, Social Services Block Grant (SSBG), and other funds. These monies

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are supplemented by state and local public and private monies. Home and Community Based Services are provided throughout the State by the network of Area Agencies on Aging and

service providers. The need for these services is much greater than can be met with the existing

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resources, as evidenced by waiting lists exceeding 5,400.

.

Objective: Enhance the Quality of life, promote independence, and avoid unnecessary

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institutional placement of older Georgians.

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Geogia State Plan on Aging FY 2000 - 2003

.Strategy 1:

Expand Georgia's non-Medicaid Home and Community Based Services in order to reduce waiting lists for services and meet the service needs of older Georgians. In the SFY 2001 budget request, the Division of Aging Services is requestirig an additional $3.8 million in state funds for this program.

Strategy 2: Strategy 3 :

Expand Georgia's Community Care Services Program in order to reduce waiting

lists for services and serve those elderly with the greatest risk of nursing home

. placement. In the SFY 2001 budget request, the Division of Aging Services has

requested an additional $3.8 million in State funds for the Community Care

Services Program.

." .

.

..
Implement of the Aging Information Management System to eJ:.lable managers at. all levels to better assess the need for services and, in response,meet those needs. The timelyavailabiiity of good data \Yill enable both the Division and Area Agencies to match resources with needs.

Strategy 4:

A~vocate for increased reimbursement rates for providers in order to keep pace with increasing service delivery costs and attract and retain quality service providers 'in sufficient rlUmbers to provide these services."

Strategy 5:

Provide adequateCCSP and non-Medicaid HCBS staffing at the local and State levels in ()rder to meet client caseloads, maintain quality and insure training and technical competence is on-hand.

Strategy 6: Streamli.ne administration of CCSP and non-Medicaid HCBS to mak.e it more responsive to clients and reduce unnecessary processes.

Strategy/: ... Generate additional revenues for State funded HCBS, by using a sliding fee scale
to assess a fee, representing part or all. of the unit cost of the serVice, based on
client income and household size.

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Geogia State Plan on Aging FY 2000 .., 2003

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ISSUE: Long-Term Care

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Long-term care encompasses the organization, delivery, financing, administration and coordination of an array of services designed to assist people who are limited in their ability to

function independently over a relatively long period of time. The intensity of the need may vary

I

over time. The long-term care system coordinates health, social, supportive and rehabilitative services across all settings. Long-term care and support services are designed to help individuals

and families:

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Perform basic life functions.

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Improve skills and capabilities to maximize independence and function.



Maintain optimal health status.

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Establish and maintain social and personal relationships in the individual's own

neighborhood and community..

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Care for family members with functional limitations.

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Provide comfort, supervision and support to people with an irreversible illness or

condition when needed.

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These services include (but are not limited to) assessment; care management and coordination of

services and supports; assistance in eating, bathing, dressing, getting in and out of bed, moving

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about the living area, doing housework, managing illness symptoms including taking medications; rehabilitative services; adaptive aids; transportation; nursing homes; and other

residential services. It also includes medical treatment and skilled and therapeutic care for the

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management of chronic and long term conditions.

The number of people with long term care needs is expected to continue growing in the coming

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years, both because many more people are living to very old ages, when the risk of disability is very high, and because advances in medical technology are allowing younger people with

chronic diseases or disabling injuries to live longer.

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Many of these citizens are poor or near-poor. Among older adults, approximately 21.25 percent

have incomes at or below the poverty level. About one-third of these citizens need help with

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three or more basic activities of daily living (bathing, dressing, toileting, eating, or moving from

bed to chair).

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Much of the help that people with disabling conditions receive is provided by families, friends . and neighbors. The formal system of services and support that supplements that care is

composed of institutional facilities (nursing homes and intermediate care facilities for the

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Geogia State Plan on Aging FY 2000 - 2003,

developmentally disabled), community based residential facilities, and community agencies that

manage and provide a variety of services, and other agencies and individual providers of home

health care, personal care, durable medical equipment, specialized transportation services, adult .

day services, work supports, and a myriad of other types of services. For their part, people

needing services must :either research for themselves what options are available to provide the

supports th6)' need, or are referred to a particular provider by a physician, hospital discharge

planner, school counselor, or other professional.

.

Objective: Implement the DHR Strategic Long-Term Care Plan, including the establishment of a long-term care single point of entry system, Gateway, and serve as a focal point for internal/external cross cutting long term care issues.

Strategy 1:

Establish a long-term care committee, with representation from all Divisions and appropriate Offices which would work with the Division of Aging Services in implementation plan actions.

Strategy 2: Improve collaboration between LTC service delivery and funding (Medicaid) agencies: .

Strategy 3: Increase emphasis on preventive health care services.

Strategy 4: Improye services through the creation of consensus on long-term care quality outcomes.

Strategy 5: Increase efforts to support informal caregiving networks.

Strategy 6: Create. more effective p~erships with the private sector and..other governmental agencIes.

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Geogia State Plan on Aging FY 2000 - 2003

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ISSUE: Consumer-Centered Access to Long Term Care Services
"THE GATEWAY"

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Georgia, like most states, is struggling with how to deal with the costs of care and the access to long term care services. The Division of Aging Services has been proactive in its participation in

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all the state wide workgroups that have been working on addressing these issues. As part of this participation the Division has worked with the AAAs to develop their position as the

community's GATEWAY to a coordinated system of services. These services, including long

term care, will promote independence and well-being for older Georgians, their families, and

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their communities.

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Objective: Develop a statewide plan to establish the Area Agencies on Aging as the community's

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"Gateway" to a coordinated system of services, including long-term care, that promote independence and well-being for older Georgians and their families in their communities.

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StratefD/ 1: Involve all stakeholders in developing the plan.

Strategy 2: Identify program constraints which may impede the ability to make the AAAs the

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key element in the "Gateway."

Strategy 3: Identify and coordinate resources needed to implement "Gateway" such as

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staffing, training, hardware, software, forms, materials, etc.

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Strategy 4: Coordinate this plan with other on-going and proposed initiatives for common intake and others which may be underway by the Department.

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Strategy 5: Develop a clear, concise set of outcomes measures by which the plan can be judged when implemented.

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Strategy 6: Determine the impact the plan implementation would have on the current system and needed changes in policies, procedures and resources.

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Strategy 7: Anticipate consumer needs and develop measures of consumer satisfaction prior to implementation.

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Strategy 8: Build community based relationships that increase the number of ways consumers can access servic, es.

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Strategy 9: Implement the plan.

Strategy 10: Evaluate the implementation of "Gateway."

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Strategy 11: Refine the system based on evaluation.

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Page 114

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Assurances

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I Georgia State Plan on Aging FY 2000 - 2003

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I. GENERAL ASSURANCES

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GENERAL ADMINISTRATION

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1. Compliance with Requirements

The State Agency agrees to administer the program in accordance with the Older Americans Act.

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the State Plan, and all applicable regulations, polices, and procedures established by the Assistant Secretary on Aging or the Secretary.

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2. Efficient Administration

The State Agency utilizes such methods of administration as are necessary for the proper and

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efficient administration of the Plan.

3. General Administrative and Fiscal Requirements

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The State Agency's uniform administrative requirements and cost principles are in compliance

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with the relevant provisions of 45 CFR Part 74 except where these provisions are superseded by statute or program regulations.

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4. Training of Staff

The State Agency provides a program of appropriate training for all classes of positions and

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volunteers, if applicable.

5.. Management of Funds

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The State Agency maintains sufficient financial control and accounting procedures to assure

proper disbUrsement of and accounting for Federal funds under this Plan.

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6. Safeguarding Confidential Information

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The State Agency has implemented such regulations, standards, and procedures as are necessary to meet the requirements on safeguarding confidential information imder relevant program

regulations.

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Georgia Stilte Plan on Aging.FY 2000"" 2003.
7. Reporting Requirements
The State Agency agrees to furnish such reports and evaluations to the Secretary or the Assistant Secretary on Aging as may be required.
8. Standards for Service Providers
All providers of services under this Plan operate fully in conformance with all applicable Federal, State, and local fire, health, safety and sanitation, and other standards prescribed in law or regulations.
9. State Plan Amendments
State Plan amendments will be made in conformance with applicable program regulations.

EQUAL EMPLOYMENT OPPORTUNITY AND CIVIL RIGHTS

1. Equal Employment Oppor!~nity

The State Agency has an equal employment opportunity policy, implemented through an affirmative action plan for all aspects of personnel administration as specified in 45 CFR Part 74.

2. Non-Discrimination on the Basis of Handicap.

All recipients of funds from.the State Agency are required to operate each program activity so that, when viewed in its entirety, the program or activity is readily accessible to and usable by handicapped persons. Where structural changes are required, these changes shall be made as quickly as possible, in keeping with 45CFR 84.

3. Civil Rights Compliance

The State Agency has developed and is implementing a system to ensure that benefits and

services available under the State Plan are provided in a non-discriminatory manner as

required by Title VI of the Civil Rights Act of 1964, ~s amended. .

.

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I Georgia State Plan on A{fing FY 2000 - 2003

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PROVISION OF SERVICES

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1. Priorities

The State Agency has a reasonable and objective method for establishing priorities for service

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and such method is in compliance with the applicable statute.

2. Eligibility

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The activities covered by this State Plan serve only those individuals and groups eligible under

the provisions of the applicable statute.

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3. Residency

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No requirements as to the duration of residency or citizenship will be imposed as a condition of participation in the State's program for the provision of services.

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4. Coordination and Maximum Utilization of Services

The State Agency to the maximum extent coordinates and utilizes the services and resources of

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other appropriate public and private agencies and organizations.

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Georgia State Plan on Aging FY 2000 - 2003

II. PROGRAM SPECIFIC ASSURANCES

Sec. 305 (a)(2)(B)

The State agency assures that, satisfactory to the Assistant Secretary on Aging, that the State

agency will take into account, in connection with matters of general policy arising in the

development and administration of the State plan for any fiscal year, the views of recipients of

supportive services or nutrition services, or individuals using multipurpose senior centers

provided under such plan;

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Sec. 305 (a)(2)(C)
The State agency assures that, in consultation with area agencies, in accordance with guidelines issued by the Assistant Secretary on Aging, and using the best available data, develop and L. publish for review and comment a formula for distribution within the State of funds received under this title that takes into account --
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(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;

Sec. 305 (a)(2)(E)
The State agency assures that preference will be given to providing services to older individuals with greatest economic need and older individuals with greatest social need, with particular attention to low-income minority individuals, and include proposed methods of carrying out the preference in the State plan;

Sec. 305 (a)(2)(F)
The State Agency assures that it will require use of outreach efforts described in section (307(a)(24 ); and

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Sec.305 (a)(2)(G)

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(1) The State Agency assures that it will set specific objectives, in consultation with area agencies on aging, for each planning and serVice area for providing services funded

under this title to low-income minority older and individuals;

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(IT) The State Agency assures that it will undertake specific program development,

~dvocacy, and outreach efforts focused on the needs oflow-income minority older

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individuals; and

(Ill) provide a description of the efforts described in clause (II) that will be undertaken by

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the State agency.

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Sec. 306 (a)(2)

The State Agency assures that an adequate proportion, as required under section 307(a)(22), of

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the amount allotted for part B to the planning and service area will be expended for the delivery of each of the following categories of services--

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(A) services associated with access to services (transportation, outreach, information and

assistance, and case management services);

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(B) in-home services (homemaker and home health aids, visiting and telephone reassurance, chore maintenance, and supportive services for families of older individuals who are victims of

Alzheimer's disease and related disorders with neurological and organic brain dysfunction; and

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(e) legal assistance;

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and specify annually in such plan, as submitted or as amended, in detail the amount of funds expended for each such category during the fiscal year most recently concluded;

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Sec. 306 (a)(3)

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The State Agency assures that it will designate, where feasible, a focal point for comprehensive service delivery in each community, giving special consideration to designating multipurpose

senior centers (including multipurpose senior centers operated by organizations referred to in

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paragraph (6)(E)(ii) as such focal point; and

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Georgia State Plan on Aging FY 2000 - 2003
(B) specify, in grants, contracts, and agreements implementing the plan, the identity of each focal point so designated;
Sec. 306 (a)(4)'
The State Agency assures that it will provide for the establishment and maintenance of information and assistance services in sufficient numbers to assure that all older individuals
within the planning and service area covered by the plan will have reasonably convenient access
to such services, with particular emphasis on linking services available to isolated older individuals and older individuals with Alzheimer's disease or related disorders with neurological and organic brain dysfunction (and the caretakers of individuals with such disease or disorders);

Sec. 306(a)(5)(A)

(I) The State Agency assures that the area agency on aging will set specific objectives for .. providing services to older individuals with greatest economic need and older individuals with greatest social need, include specific objectives for providing services to low-income minority individuals, and include proposed methods of carrying out the preference in the area plan; ,
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(II) The State Agency assures that the area agency on aging will include in each agreement made with a; provider of any service under this title, a requirement that such' provider will -- " I:'.',

(i) specify how the provider intends to satisfy the service needs of low-income _

minority individuals in the area served by the provider; ,

: .i

(ii) to the maximum extent feasible, provide services to 'low-income minority . individuals in accordance with their need for such services; and

(iii) meet specific objectives established by the area agency on aging, for providing services to low-income minority individuals 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) identify the number of low-income minority older individuals in the planning and servIce area;

(ii) describe the methods used to satisfy the service needs of stich mi~oritY older .. individuals; and

(iii) provide information on the extent to which the area agency on aging met the objectives described in clause (I);

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Sec. 306 (a)(5)(B)

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The State Agency assures that the area agency on aging will use outreach efforts that will--

(I) identify individuals eligible for assistance under this Act, with special emphasis on--

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(i) older individuals residing in rural areas;

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(ii) older individuals with greatest economic need (with particular attention to lowincome minority individuals);

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(iii) older individuals with greatest social need (with particular attention to low-income minority individuals);

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(iv) older individuals with severe disabilities;

(v) older individuals with limited English-speaking ability; and

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(vi) older individuals with Alzheimer's disease or related disorders with neurological

and organic brain dysfunction (and the caretakers of such individuals); and

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(II) inform the older individuals referred to in subclauses (I) through (VI) of clause (I), and

the caretakers of such individuals, ofthe availability of such assistance; and'

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Sec. 306 (a)(6)

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The State Agency provides that the area agency on aging will --

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(A) conduct periodic evaluations of, and public hearings on, activities carried out under the ar~a plan and an annual evaluation of the effectiveness of outreach conducted under paragraph (5)(B);

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(B) furnish appropriate technical assistance, and timely information in a timely manner, to providers of supportive services, nutrition services, or multipurpose senior centers in the

planning and service area covered by the area plan;

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(C)' take into account in connection with matters of general policy arising in the development

.and administration of the area plan, the views of recipients of services under such plan;

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(D) serve as the advocate and focal point for older individuals within the community by (in

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Georgia State Plan on Aging FY 2000 - 2003
cooperation with agencies, organizations, and individuals participating in activities under the plan) monitoring, evaluating, and commenting upon all policies, programs, hearings, levies, and community actions which will affect older individuals;
(E) (1) where possible, enter into arrangements with organizations providing'day care services for children or adults, and respite for families, so as to provide opportunities for older individuals to aid or assist on a voluntary basis in the delivery of such services to . children, adults, and families; and
(II) if possible regarding the provision of services under this title, enter into arrangements and coordinate with organizations that have a proven record of providing services to older individuals, that --
(i) were officially designated as community action agencies or community action programs under section 210 of the Economic Opportunity ACt of 1964 (42 U.S.c. 2790) for fiscal year 1981, and did not lose the designation 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 action agencies or community action programs; and that meet the requirements under section 675(c)(3) of the Community Services Block Grant Act ,(42 V.S.C 9904(c)(3));
(F) establish an advisory council consisting of older individuals (including minority individuals) who are participants or who are eligible 'to participate in programs assisted under this Act, representatives of older individuals, local elected officials, providers of veterans' health care (if appropriate), and the general public, to advise continuously the area agency on aging on all matters relating to the development of the area plan, the administration of the plan and operations conducted under the plan;
(G) develop and publish methods by which priority of services is determined, particularly with respect to the delivery of services under paragraph (2);
(H) establish effective and efficient procedures for coordinations of --
(i) entities conducting programs that receive assistance under this Act within the planning '. and service area served by the agency; and
(ii) entities conducting other Federal programs for older individuals at the local level, with particular emphasis on entities conducting programs described in section 203 (b), within the area;
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(n conduct efforts to facilitate the coordination of community-based, long-term care services

designed to retain individuals in their homes, thereby deferring unnecessary, costly

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institutionalization, and designed to include the development of case management services as a component ofthe long-term care services;

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(J) identify the public and private nonprofit entities involved in the prevention, identification, and treatment ofthe abuse, neglect, and exploitation of older individuals, and based on such

identification, determine the extent to which the need for appropriate services for such

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individuals is unmet;

(K) facilitate the involvement of long-term care providers in the coordination of

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community-based long-term care services and work to ensure community awareness of and involvement in addressing the needs of residents of long-term care facilities;

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(L) coordinate the categories of services specified in paragraph (2) for which the area agency on aging is required to expend funds under part B, with activities of community-based organizations

established for the benefit of victims of Alzheimer's disease and the families of such victims;

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(M) coordinate any mental health services provided with funds expended by the area agency on

aging for part B with the mental health services provided by community health centers and by

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other public agencies and nonprofit private organizations;

(N) if there is a significant population of older individuals who are Native Americans in the

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planning and service area of the area agency on aging, the area agency on aging shall conduct outreach activities to identify such individuals in such area and shall inform such individuals of

the availability of assistance under this Act;

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. (0) (i) compile available information on institutions of higher education in the planning and

service area regarding-- '

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(1) the courses of study offered to older individuals by such institutions; and

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(II) the policies of such institutions with respect to the enrollment of older individuals with little or no payment of titution, on a space available basis, or on

another special basis; and include in such compilation such related supplementary

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information as may be necessary; and

(ii) based on the results of such compilation, make a summary of such information

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available to older individuals at multipurpose senior center, congregate nutrition sites, and other appropriate places;

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Georgia State Plan on Aging FY 2000 - 2003

(P) establish a grievance procedure for older individuals who are dissatisfied with or denied services under this title;

(Q) enter into voluntary arrangements with nonprofit entities (including public and private housing authorities and organizations) that provide housing (such as housing under section 202 of the Housing Act of 1959 (12 U.S.c. 1701Q)) to older individuals, to provide-- .
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(i) leadership and coordination in the development, provision, and expansion of adequate housing, supportive services, referrals, and living arrangements for older
individuals; and

(ii) advance notification and nonfmancial assistance to older individuals who are

subject to eviction from such housing; .

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(R) list the telephone number of the agency in each telephone directory that is published, by the

provider of local telephone service, for residents in any geographical area that lies in whole or in

part in the service and planning area served by the agency--

.

(i) under the name "Area Agency on Aging";

(ii) in the unclassified section of the directory; and

(iii) to the extent possible, in the classified section of the directory, under a subject heading designated by the Assistant Secretary on Aging by regulation; and

(S) identify the needs of older individuals and describe methods the area agency on aging will

use to coordinate planning and delivery of transportation services (including the purchase of

vehicles) to assist older individuals, including those with special needs,in the area;

.

Sec.306(a)(7)
The State .t:...gency assures that any amount received under part D will be expended in accordance with such part;

Sec.306(a)(8) .
The State Agency assures that any amount received under part E will be expended in accordance with such part;

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I Sec. 306(a)(9) .

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The State Agency assures thatany amount received under part F will be expended in accordance

with such part;

I Sec.306(a)(10)

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The State Agency assures that any amount received under part G will be expended in accordance

with such part;

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Sec.306(a)(l1)

The State Agency assures that the area agency on aging, in carrying out the State Long-Term

I

Care Ombudsman program under section 307(a)(12), will expend not less than the total amount of funds appropriated under this Act and expended by the agency in fiscal year 1991 in carrying

out such a program under this title;

I Sec.306(a)(12)

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The State Agency assures that, at the discretion of the area agency on aging, it will provide for an

area volunteer services coordinator, who shall--

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, (A) encourage, and enlist the services of, local volunteer groups to provide assistance and

services appropriate to the unique needs of older individuals within the planning and

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service area;

(B) encourage, organize, and promote the use of older individuals as volunteers to local

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commumties within the area; and

(C) promote the recognition of the contributions made by volunteers to programs

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administered under the area plan;

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Sec.306(a)(13)

The State Agency assures that it will--

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(A) describe all activities of the area agency on aging, whether funded by public or

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Georgia State Plan on Aging FY 2000 - 2003 private funds; and (B) that the activities confonn with--
(i) the responsibilities of the area agency on aging, as set forth in this subsection; and (ii) the laws, regulations, and policies of the State served by the area agency on aging;

Sec.306(a)(14)

The State Agency assures that the area agency on aging will--

(A) maintain the integrity and public purpose of services provided, and service providers, under this title in all contractual and commercial relationships;

(B) disclose to the As'sistarit Secretary on Aging and the State Agency--

(i) the identity of each nongovernmental entity with which such agency has a contract or commercial relationship relating to providing any service to older individuals; and (ii) the nature of such contract or such relationship;

(C) demonstratethat a loss or diminution in the quantity or quality of the services provided, . or to be provided, underthis title by such agency has not resulted and will not result from
such contract or such relationship;

(D) demonstrate that the quantity or quality of the services to be provided under this title by such agency will be enhanced as a result of such contract or such relationship; and

(E) on the request of the Assistant Secretary on Aging or the State, for the purpose of

monitoring compliance with this Act (including conducting an audit), disclose all sources

and

expenditures of funds such agency receives or expends to provide services to older

individuals; .

.

Sec.306(a)(15)
The State Agency assures that funds received under this title will not be used to pay any part of a cost (including an administrative cost) incurred by the area agency on aging to cany out a contract or commercial relationship that is not carried out to implement this title;

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Georgia State Plan on Aging FY 2000 - 2003 Sec.306(a)(I6)
The State Agency assures that preference in receiving services tinder this title will not be given by the area agency on aging to particular older individuals as a result of a contract or commercial relationship that is not carried out to implement this title;
Sec.306(a)(17) The State Agency assures that projects in the planning and service area will reasonably accommodate participants as described in section 307(a)(13)(G);
Sec.306(a)(18) The State Agency assures that the area agency on aging will, to the maximum extent practicable, coordinate the services it provides under this title with services provided under title VI;
Sec.306(a)(19) (A) The State Agency assures that the area agency on aging will pursue activities to increase access by older individuals who are Native Americans to all aging programs and benefits provided by the agency, including programs and benefits under this title, if applicable; and (B) specify the ways in which the area agency on aging intends to implement the activities; and'
Sec. 306(a)(20) . The State Agency assures that case management services provided under this title through the , area agency on aging will--
(A) not duplicate care management services provided trough other Federal and State programs; (B) be coordinated with services described in subparagraph (A); and (C) be provided by--
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Georgia State Plan on Aging FY 2000 - 2003
(i) a public agency; or
(ii) a nonprofit private agency that--
(I) does not provide; and does not have a direct or indirect ownership or controlling interest in, or a direct or indirect affiliation or relationship with, an entity that provides, services other than case management services under this title; or
(II) is located in a rural area and obtains a waiver of the requirement described in subclause (1).-
.Sec. 307(a)(I)
The State Agency assures that the State plan will be based upon area plans developed by area agencies on aging within the State designated under section 305(a)(2)(A) and that the State will prepare and distribute a uniform format for use by area agencies on aging in developing area plans under section 306.
Sec. 307(a)(2)
The State Agency assures that the ,plan shall provide that each area agency on aging designated under section 305(a)(2)(A) will develop and submit to the State agency for approval an area plan which complies with the provisions of section 306.
Sec. 307(a)(3)
(A) the State Agency assures that the plan shall provide that the State agency will evaluate the need for supportive services (including legal assistance and transportation services), nutrition services, 'and multipurpose senior centers within the State and determine the extent to .which existing public or private programs meet such need. To conduct the evaluation, the State agency shall use the procedures implemented under 'section 202(a)(29).
(B) The State Agency assures that the plan shall provide assurances that the State Agency will spend in each fiscal year, for services to older individuals residing in rural areas in the State assisted under this title,'an amount equal to not less than 105 percent of the amount expended for such services (including amounts expended under title V and title VII) in fiscal year 1978.
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Sec.307(a)(4)

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The State Agency assures that the plan shall provide for the use of such methods of administration (including methods relating to the establishment and maintenance of personnel

standards on a merit basis, except that the Assistant Secretary on Aging shall exercise no

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authority with respect to the selection, tenure of office, or compensation of any individual employed in accordance with such methods) as are necessary for the proper and efficient

administration of the plan, and, where ne<;:essary, provide for the reorganization and reassignment

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of functions to assure such efficient administration.

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Sec.307(a)(5)

The State Agency assures that the plan shall provide that the State agency will afford an

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opportunity for a hearing upon request to any agency on aging submitting a plan under this title, to any provider of a service under such a plan, or to any applicant to provide a service under such

a plan. The State agency shall establish and publish procedures for requesting and conducting

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such hearing.

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Sec.307(a)(6)

The State Agency assures that the plan shall provide that the State agency will make such

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reports, in such form, and containing such information, as the Assistant Secretary on Aging may require, and comply with such requirements as the Assistant Secretary on Aging may impose to

insure the correctness of such reports.
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Sec.307(a)(7)

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(A) The State Agency assures that the plan shall provide satisfactory assurance that such

fiscal control and fund accounting procedures will be adopted as may be necessary to

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assure proper disbursement of, and accounting for, Federal funds paid under this title to the State, including any such funds paid to the recipients of a grant or contract.

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(B) The State Agency assures that--

(i) no individual (appointed or otherwise) involved in the designation of the State

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agency or an area agency on aging, or in the designation 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;
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Georgia State Plan on Aging FY 2000 - 2003
(ii) no officer, employee, or other representative 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 identify and remove conflicts of interest prohibited under this Act.
Sec.307(a)(7) (C) The State Agency assures that the State agenc, y and each area agency on aging wlll--
(I) maintain the integrity and public purpose of services provided, and service providers, under the State plan in all contractual and commercial relationships; (ii) disclose to the Assistant Secretary on Aging~-'
(I) the identity of each nongovernmental entity with which the State agency or area agency on aging has a contract or commercial relationship relating ~o providing any service to older individuals; and (II) the nature of such contract or such relationship; (iii) demonstrate that a loss or diminution in the quantity or quality of the services provided, or to be provided, under this Act by such agency has not resulted and will not result from such contract or suchrelationship; (iv) demonstrate that the quantity or quality of the services to be provided under the State plan will be enhanced as a result of such contract or such relationship; and (v) on the request of the Assistant Secretary on Aging, for the purpose of monitoring compliance with this Act (including conducting an audit), disclose all sources and expenditures of funds the State agency and area agency on aging receive or expend to provide services to older individuals.
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Sec. 307(a)(8)

I

The State Agency assures that the State agency will conduct periodic evaluations of, and public hearings on, activities and projects carried out under the State plan, including an evaluation of

the effectiveness of the State agency in reaching older individuals with greatest economic need

I

and older indi~duals with greatest social need, with particular attention to low-income minority individuals. In conducting such evaluations and public hearing, the State agency shall solicit the

views and experiences of entities that are knowledgeable about the needs and concern of

I Sec.307(a)(9)

I

The State Agency assures that it will provide for establishing and maintaining information and

assistance services in sufficient numbers to assure that all olderindividuals in the State who are

I

not furnished adequate information and assistance services under section 306(a)(4) will have reasonably convenient access to such services.

I

Sec.307(a)(lO)

I

The State Agency assures that no supportive services, nutrition services, or in-home services (as defined in seciton342) will be directly provided by the State agency or an area agency on aging,

except where, in the judgment of the State agency, provision-of such services by the State agency

I

or an area agency on aging is necessary to assure an adequate supply of such services, or where suchservices are directly related to such State or area agency on aging's administrative func-

tions, or where such services of comparable qulity can be provided more economically by such

I

State or area agency on aging.

I

Sec.307(a)(1l)

The State agency assures that subject to the requirements of merit employment systems of State

I

arid local govemments--

(A) preference shall be given to older individuals; and

I

(B) special consideration shall be given to individuals with formal training in the field of

aging (including an educational specialty or emphasis in'aging and a training degree or

I

certificate in aging) or equivalent professional experience in the filed of aging; for my staff positions (full time or part time) in State and area agencies for which such

individuals qualify.

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Georgia State Plan on Aging FY 2000 - 2003
Sec.307(a)(12)
The St",te agency assures that the state agency will carry out, through the Office of the State Long-Tenn Care Ombudsman, a State Long-Tenn Care Ombudsman program in accordance with section 712 and this title.
"

Sec.307(a)(13)

The State agency assures that with respect to nutrition services that--

(A) each project providing nutrition services will be available to 'older individuals and to " their spouses, and may be made available to handicapped or disabled individuals who have not attained 60 years of age but who reside in housing facilitie"s occupied primarily by older
individuals at which congregate nutrition services are provided; , '

(B) primary consideration shall be given to the provision of meals in a congregate setting, except that each area agency on aging

(i) may award funds made available under this title (other than under section 303(b)(3)

to organizations for the provision of home delivered meals to older individuals in"

. accordance with the provisions of subpart 2 of part C, bas'ed upon a deterniination of

need made by the recipient -ofa grant or contract entered into under this title, without ",r;

requiring that such organizations also provide meals to older individuals in a congre- .

'. "gate setting; "an"d

~,~\..; \

i

~.. '

(ii) shall, in awarding such funds, select such organizations in a manner which complies
with the provisions of subparagraph (H); ,",

(C) (i) each project will pennit recipients of grants or contracts to solicit voluntary

contriQutions for meals furnished in accordance with guidelines established by the

"Assistant Secretary on Aging, taking into consideration the income ranges of eligible'

individuals in local communities and other sources of income of the recipients of a

grant or contract; and

.

(ii) such voluntary coritributions will be' used to increase the rturriber of meals ." served by the project involved, to facilitate access to such meals, and to provide . other supportive'services directly related to nutrition services;

(D) in the case of meals served in a congregate setting, a site for such services and for comprehensive supportive services is furnished in as close proximity to the majority of eligible individuals' residences as feasible, with particular attention upon a multipurpose

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senior center," a school, a church, or other appropriate community facility, preferably within

walking distance where possible, and where appropriate, transportation to such site is

I

furnished;

(E) each project will establish outreach activities which assure that the maximum number of

I

eligible individuals may have an opportunity to participate;

(F) each project will establish and administer the nutrition project with the advice of

I

dietitians or individuals with comparable expertise), persons competent in the field of service in which the nutrition project is being provided, older individuals who will partici-

pate in the program, and ofpersons who are knowledgeable with regard to the needs of older

I

individuals;

(G) each project will provide special menus, when feasible and appropriate to meet the

I

particular dietary needs arising from the health requirements, religious requirements, or ethnic backgrounds of eligible individuals;

I

(H) each area agency on aging will give consideration where feasible, in the furnishing of home delivered meals to the use of organizations which

I

(i) have demonstrated an ability to provide home delivered meals efficiently and reasonably; and

I

(ii) furnish assurances to the area" agency on aging that such an organization will maintain efforts to solicit voluntary support and that the funds made available

under this title to the organization will not be used to supplant funds from

I

non-Federal sources;

(1) each area agency on aging shall establish procedures that will allow nutrition project

I

administrators the option to offer a meal, on the same basis as meals are provided to participating older individuals, to individuals providing volunteer services during the

meal hours, and to individuals with disabilities who reside at home with and accompany

I

older individuals who are eligible under this Act;

(J) each nutrition project shall provide nutrition education on at least a semiannual basis

I

to participants in programs described in part C;

(K) each project shall comply with applicable provisions of State or local laws regarding

I

the safe and sanitary handling of food, equipment, and supplies used in the storage, preparation, service, and delivery of meals to an older individual;

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Georgia State Plan on Aging FY 2000 - 2003
(L) the State agency will monitor, coordinate, and assist in the planning of nutritional services, with the advice of a dietitian or an individual with comparable expertise; and
(M) the State agency will--
(i) develop nonfinancial criteria for eligibility to receive nutrition services under section 336; and
(ii) periodically evaluate recipients of such services to determine whether they continue to meet such criteria.
Sec.307(a)(14)
The State agency assures that, with respect to the acquisition (in fee simple of by lease for 10 years or more), alteration, or renovation of existing facilities (or the construction of new facilities in any area in which there are no suitable structures available, as determined by the State agency, after full consideration of the recommendations made by area agencies on aging, to be a focal point for the delivery of services assisted under this title) to serve as multipurpose senior centers, that-- .
(A) (i) for not less than 10 years after acquisition, or not less that 20 years after the completion of construction, the facility will be used for the purpose for which it is to be acquired or constructed, unless for unusual circUmstances the Assistant Secretary on Aging waives the requirement of this division;
(ii) sufficient funds will be available to meet the non-Federal share of the cost of acquisition or construction of the facility;
(iii) sufficient funds will be available when acquisition or construction is ' completed, for effective use of the facility for the purpose for which it is being acquired or constructed; and
(iv) the facility will not be used and is not intended to be used for sectarian instruction or as a place for religious worship;
(B) in the case of purchase or construction, there are no existing facilities in the community suitable for leasing as a multipurpose senior center;
(C) the plans and specifications for the facility are in accordance with regulations relating to minimum standards of construction, promulgated with particular emphasis on securing compliance with the requirements of the Act of August 12, 1968, commonly known as the Architectural Barriers Act of 1968;
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(D) any laborer or mechanic employed by any contractor or subcontractor in the

performance of work on the facility will be paid wages at rates not less than those

I

prevailing for similar work in the locality as determined by the Secretary of Labor in accordance with the Act of March 3, 1931 (40 U.S.C.276a--276a095, commonly known

as the Davis-Bacon Act), and the Secretary of Labor shall have, with respect to the labor

I

standards specified in this subparagraph, the authority and functions set forth in reorganization plan numbered 14 of 1950 (15 F.R.3176; 64Stat. 1267), and section 2 of

the Act of June 13, 1934 (40 U.S.C..276c); and

I

(E) the State Agency will consult with the Secretary of Housing and Urban Development

with respect to the technical adequacy of any proposed alteration or renovation.

I Sec. 307(a)(15)

I

The State agency assures that with respect to legal assiStance--

I

(A) that area agencies on aging will

(i) enter into contracts with providers oflegal assistance which can demonstrate

I

the experience or capacity to deliver legal assistance;

(ii) include in any such contract provisions to assure that any recipient of funds

I

under division (I) will be subject to specific restrictions and regulations promulgated under the Legal Services Corporation Act (other than restrictions and

regulations governing eligibility for legal assistance under such Act and governing

I

membership of local governing boards) as determined appropriated by the Assistant Secretary on Aging; and

I

(iii) attempt to involve the private bar in legal assistance activities authorized under this title, including groups within the private bar furnishing services to older

individuals on a pro bono and reduced fee basis;

I

(B) that no legal assistance will be furnished unless the grantee administers a program

designed to provide legal assistance to older and individuals with social or economic need

I

and has agreed, if the grantee is not a Legal Services Corporation project grantee, to coordinate its services with existing Legal Services Corporation projects in the planning

and service area in order to concentrate the use of funds provided under this title on

I

individuals with the greatest such need; and the area agency on aging makes a finding, after assessment, pursuant to standards for service promulgated by the Assistant Secretary

on Aging, that any grantee selected is the entity best able to provide the particular services;

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Georgia State Plan on Aging FY 2000 - 2003
(C) the State Agency will provide for the coordination of the furnishing oflegal 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) to the extent practicable; the legal assistance furnished under the plan will be in addition to any legal assistance for older individuals being furnished with funds from sources other that this Act and that reasonable efforts will be made to maintain existing levels of legal assistance for older individuals; and .
(E) that area agencies on aging will give priority to legal assistance related to income, health care, long-term care, nutrition, housing, utilities, protective services, defense of guardianship, abuse, neglect, and age discrimination.
Sec.307(a)(16)
The State agency assures that whenever the State desires to provide for a fiscal year for services for the prevention of abuse of older individuals--
(A) that any area agency on aging carrying out such services will conduct a program consistent with relevant State law and coordinated with existing State adult protective service activities for--
(i) public education to identify and prevent abuse of older individuals;
(ii) receipt of reports of abuse of older individuals; .
(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 where appropriate and consented to by the parties to be referred; and
(iv) referral of complaints to law enforcement or public protective service agencies where appropriate;
(B) the State will not permit involuntary or coerced participation in the program of services described in this paragraph by alleged victims, abusers, or their households; and
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(C) all information gathered in the course of receiving reports and making referrals shall

remain confidential unless all parties to the complaint consent in writing to the release of

I

such information, except that such information may be released to a law enforcement or public protective service agency.

I

Sec.307(a)(17)

I

The State agency assures that each State will provide in service training opportunities for personnel of agencies and programs funded under this Act.

I

Sec.307(a)(18)

I

The State agency assures 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.

I Sec.307(a)(19)

I

The State agency assures that with respect to education and training services, that area agencies

on aging may enter into grants and contracts with providers of education and training services

I

which can demonstrate the experience or capacity to provide such services (except that such contract authority shall be effective for any fiscal year only to such extent, or in such amounts, as

are provided in appropriations Acts).

I Sec.307(a)(20)

I

The State agency assures that if a substantial number ofthe older individuals residing in any

planning and service area in the State are oflimited English-speaking ability, then the State will

I

require the area agency on aging for each such planning and service area--

(A) to utilize in the delivery of outreach services under section 306(a)(2)(A), the services of

I

. workers who are fluent in the language spoken by a predominant number of such older individuals who are of limited English-speaking ability; and

I

(B) to designate an individual employed by the area agency on aging; or available to such area agency on aging on a full-time basis, whose responsibilities will include--

I

(i) taking such action as may be appropriate to assure that counseling assistance is made available to such older individuals who are of limited English-speaking ability

I

Page 137

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Georgia State Plan on AgingFY 2000 - 2003 in order to assist such older individuals in participating in programs and recdving assistance under this Act; and (ii) providing guidance to individuals engaged in the delivery of supportive services under the area plan involved to enable such individuals to be aware of cultural sensitivities and to take into account effectively linguistic and cultural differences.
Sec.307(a)(21) The State agency assures that the State agency, in carrying out the State Long-Tenn Care Ombudsman program under section 307(a)(12), will expend not less than the total amount
expended by the agency in fiscal year 1991 in carrying out such aprogram under this title.
Sec.307(a)(22) The State agency assures that it will specify a minimum percentage of the funds received by each area agency on aging for part B that will be expended, in the absence of the waiver granted under section 306(b)(1), by such area agency on aging to provide each of the categories of services specified in section 306(a)(2).
Sec. 307(a)(23) The State agency assures that with respect to the fiscal year preceding the fiscal year for which the p~an is prepared, the State agency--
(A) identify the number oflow-income minority older individuals in the State; and (B) describe the methods used to satisfy the service needs of such minority older individuals.
Sec.307(a)(24) The State agency assures that the State agency will require outreach efforts that will--
(A) identify individuals eligible for assistance under this Act, with special emphasis on-(i) older individuals residing in rural area;
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(ii) older individuals with greatest economic need (with particular attention to

. low-income minority individuals);

I

(iii) older individuals with greatest social need (with particular attention to

low-income minority individuals);

I

(iv) older individuals with severe disabilities;

I

(v) older individuals with limited English-speaking ability; and

I

(vi) older individuals with Alzheimer's disease or related disorders with neurological and organic brain dysfunction (and the caretakers of such

individuals); and

I

(B) inform the older individuals referred to in clasuses (1) through (vi) of subparagraph

(A), and the caretakers of such individuals, of the availability of such assistance.

I Sec. 307(a)(25)

I

The State agency assures that with respect to the needs of older individuals with severe disabili-

ties, the State will coordinate planning, identification, assessment of needs, and service for older

I

individuals with disabilities with particular attnetion to individuals with severe disabilities with the State agencies with primary responsibility for individuals with disabilities, including severe

disabilities, and develop collaborative programs, where appropriate, to meet the needs of older

I

individuals with disabilities..

I

Sec.307(a)(26)

The State agency assures that area agencies on aging will conduct efforts to facilitate the

I

coordination of community-based, long-term care services, pursuant to section 306(a)(6)(I), for older individuals who--

I

(A) reside at home and are at risk of institutionalization because of limitations on their ability to function independently;

I

(B) ate patients in hospitals andare at risk of prolonged institutionalization; or

(C) are patients in long-term care facilities, but who can return to their homes if .

I

community-based services are provided to them.

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Georgia State Plan on Aging FY 2000 - 2003
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Sec.307(a)(27)

The State agency assures consultation and coordination in planning and provision of in-home

o

services under section 341 with State and local agencies and private nonprofit organizations

which adrilinister and provide services relating to health, social services, rehabilitation, and . mental health services.

o

Sec.307(a)(28).

o

The State agency assures that if the State receives funds' appropriated under section 303(e), the State agency and area agencies on aging will expend such funds to carry out part E.

o

. Sec.307(a)(29)

o

The plan shall, with respect to the fiscal year preceding the fiscal year for which such plan is prepared, describe the methods used to satisfy the service needs of older individuals who reside

o

in rural areas.

...

o

Sec.307(a)(30) The State agency assures that it has included the assurances and description required by section

o

705(a)..
o

Sec.307(a)(31)

The State agency assures that--

o

(A) If 50 percent or more of the area plans in the State provide for an area volunteer services coordinator, as described in section 306(a)(l2), the State plan shall provide for a

o

State volunteer services coordinator, who shall-(i) encourage area agencies on aging to provide for are volunteer services

o

coordinators; (ii) coordinate the volunteer seryices offered between the various area agencies

o

on aging; (iii) encourage, organize, and promote the use of older individuals as volunteers to

o

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I Georgia State Plan on Aging FY 2000 - 2003

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the state;

I

(iv) provide technical assistance, which may include training, to area volunteer services coordinators; and

I

(v) promote the recognition of the contribution made by volunteers to the programs administered under the State plan.

I

(B) If fewer that 50 percent of the area plans in the State provide for an area volunteer services coordinator, the State plan (may provide for the State volunteer services

coordinator described in subparagraph (A).

I Sec. 307(a)(32)

I

The State agency assures that special efforts will be made to provide technical assistance to

minority providers of services.

I Sec.307(a)(34)

I

The State agency assures that the State agency will coordinate programs under this title and title

VI, if applicable.

I Sec.307(a)(35)

I

The State agency assures that it will--

I

(A) pursue activities to increase access by older individuals who are Native Americans to all aging programs and benefits provided by the agency, including programs and benefits under

this title, if applicable; and

I

(B) specify the ways in which the State agency intends to implement the activities.

I

Sec.307(a)(36)

I

The State agency assures that if case management services are offered to provide access to supportive services, the plan shall provide that the State agency shall ensure compliance with the

requirements specified in section 306(a)(20).

I

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Sec.307(a)(38)

o

TheState agency assures that funds received under this title will not be used to pay any part of a cost (including an administrative cost) incurred by the State or an area agency on aging to carry

o

out a contract or commercial relationship that is not carried out to implement this title:

o

Sec. 307(a)(39)

The State agency assures that preference in receiving services under this title will not be given by

o

the area agency on aging to particular older individuals as a result ofa contract or commercial

relationship that is not carried out to implement this title.

o

Sec.307(a)(40)

o

The State agency assures that if the State receives funds appropriated under section 303(g) the

State agency and area agencies on aging will expend such funds to carry out part G.

o

Sec.307(a)(41)

o

The State agency assures that demonstrable efforts will be made-(A) to coordinate services provided under this Act with other State services that benefit

o

older individuals; and (B) to provide multi generational activities, such as opportunities for older individuals to

o

serve as mentors or adviser in child care, youth day care, educational assistance, at-risk

youth intervention, juvenile delinquency treatment, and family support programs.

o.

Sec.307(a)(42)

o

The State agency assures that the State will coordinate public services within the State to assist older individuals to obtain transportation services associated with access to services provided

o

under this title, to services under title VI, to comprehensiv~ counseling services, and to legal assistance.

o

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Sec. 307(a)(43)

I

The State agency assures that it shall issue guidelines applicable to grievance procedures required by section 306(a)(6)(P).

I

Sec.307(a)(44)

I

The State agency assures that the State has in effect a mechanism to prqvide for quality in the provision of in-home services lmder this title.

I

Sec.308(a)(3)

I

. (E) The State agency assures that no amounts received by the State under this paragraph will be used to hire any individual to fill ajob opening created by the action of the State

in laying off or terminating the employment of any regular employee not supported under

I

this Act in anticipation of filling the vacancy so created by hiring an employee to be supported through use of amounts received under this paragraph.

I

Sec.705(a)(1)

I

The State agency assures that, 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;

I Sec. 705(a)(2) .

I

The State agency assures that it 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

I

interested persons and entities regarding programs carried out under this subtitle; .

I

Sec.705(a)(3)

The State agency assures that, in consultation with area agencies on aging, will identify and

I

prioritize statewide activities aimed at ensuring that older individuals have access to, and assistance in securing and maintaining, benefits and rights;

I

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Sec. 705(a)(4)

o

The State agency assures that it will use funds made available under this subtitle for chapter in .' addition to, and will not supplant, any funds that are expended under any Federal or State law in

o

existence on the day before the date of the enactment of this subtitle, to carry out the vulnerable

elder rights protection activities described in the chapter;

o

, . Sec. 705(a)(5)

o

The State agency assures 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);

o

Sec. 705(a)(6)

o

The State agency assures that, with respect to programs for the prevention of elder abuse,

neglect, and exploitation under chapter 3--

''

o

(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

o

service activities for -(i) public education to identify and prevent elder abuse;

o

(ii) receipt of reports of elder abuse;

o

(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

o

referred consent; and (B) the State will not permit involuntary or coerced participation in the program of

o

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

o

remain confidential except -- .

(i) if all parties to such complaint consent in'writing to the release of'such

0,

information; (ii) if the release of such information is to a law enforcement agency, public

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I Georgia State Plan on Aging FY 2000 - 2003

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protective service agency, licensing or certification agency, ombudsman program,

or protection or advocacy system; or

I

(iii) upon court order;

I

Sec.705(a)(7)

I

The State agency assures that --

(A) from funds appropriated under section 702(d) for chapter 5, will make funds available

I

to eligible area agencies on aging to carry out chapter 5 and, in distributiing such funds among eligible area agencies, will give priority to area agencies on aging based on --

I

(i) the number of older individuals with greatest economic need, and older individuals with gretest soCial need, residing in their respective planning and service

areas; and

.

I

(ii) the inadequacy in such areas of outreach activities and application assistance

of the type specified in chapter 5;

I

(B) will require, as a condition of eligibility to receive funds to carry out chapter 5, and

area agency on aging to submit an application that --

I

(i) describes the activities for which such funds are sought;

I

(ii) provides for an evaluation of such activities by the area agency on aging; and

(iii) that the area agency on aging will prepare and submit to the State agency a

I

report of the activities conducted with funds provided under their paragraph and the evaluation of such activities;

I

(C) will distribute to area agencies on aging--

(i) the eligibility information received under section 202(a)(20) from the

I

Administration; and

.(ii) information, in written form, explaining the requirements for eligibility to

I

receive medical assistance under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.); and

I

(D) will submit to the Assistant Secretary on Aging a report on the evaluations required to be submitted under subparagraph (B); and

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Georgia, Stat~.pl'an' im~Aging.py 2000\-2003"

a

[j

Sec. 705(a)(8) a description of the manner in which the State agency will carry outthis title in accordance with

a

the assurances described in paragraphs (1) through (7). (b) Privilege -- Neither a State, nor a State agency, may require any provider oflegal assistance

a

under this subtitle to reveal any information that is protected by the attorney-client privilege.
o

o

,"

o

a

o

o

U

D

U

ufll

D

9
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I Georgia State Plan on Aging FY 2000 - 2003

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. III. ASSURANCES AS PRESCRIBED BY THE ASSISTANT SECRETARY ON AGING

I

The State agency assures that:

1. Each area agency engages only in activities which are consistent with its statutory

I

mission as prescribed in the Act and as specified in State policies under Section 1321.11;

2. Preference is given to older perso~s in greatest social or economic need in the provision

I

of services under the plan;

3. Procedures exist to ensure that all services under this part are provided without use of

I

any means tests;

4. All services provided under Title III meet any existing State and local licensing, health

I

and safety requirements for the provision of those services;

5. Older persons are provided opportunities to voluntarily contribute to the cost of services;

I

6. Area plans shall specify as submitted, or be amended annually to include, details of the

amount of funds expended for each priority service during the past fiscal year; .

I

7. The State agency on aging shall develop policies governing all aspects of programs

operated under this part, including the manner in which the ombudsman program operates

I

at the State level and the relation of the ombudsman program to area agencies where area agencies have been designated;

I

8. The State agency will require area agencies. on aging to arrange for outreach at the community level that identifies individuals eligible for assistance under this Act and other

programs, both public and private, and informs them of the availability of assistance. The

I

outreach efforts shall place special emphasis on reaching older individuals with the greatest economic or social needs with particular attention to low income minority

individuals, including outreach to identify older Native Americans in the planning and

I

service area and inform such older Native Americans ofthe availability of assistance under the Act.

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9. The State agency shall have and employ appropriate procedures for data collection from area agencies on aging to permit the State to compile and transmit to the Assistant Secretary

on Aging accurate and timely statewide data requested by the Assistant Secretary on Aging

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in such form as the Assistant Secretary on Aging directs; and

10. If the State agency proposes to use funds received under section 303(f) of the Act for

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services other than those for preventive health specified in section 361, the State plan shall demonstrate the unmet need for the services and explain how the services are

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Georgia State Plan on Aging FY 2000 - 2003

appropriate to improve the quality of life of older individuals, particularly those

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with the greatest economic or social need, with special attention to low-income

minorities.

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11. Area agencies shall compile available information, with necessary supplementation,

on courses of post-secondary education offered to older individuals with little or no tuition. The assurance shall include a commitment by the are agencies to make a

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summary of the information available to older individuals at multipurpose senior centers,

congregate nutrition sites, and in other appropriate places.

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12. Individuals with disabilities who reside in a non-institutional household with and

accompany a person eligible for congregate meals under this part shall be provided a meal on the same basis that meals are provided to volunteers pursuant to section 307(a)(13)(I)

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of the Act.

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13. The services provided under this part will be coordinated, where appropriate, with the

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; services provided under Title VI of the Act.

14..(i) The State agency will not fund program development and coordination activities as

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a cost of supportive services for the administration of area plans until it has first spent 10

percent of the total ofits combined allotments under Title IlIon the administration of area plans, submit, consistent with budgeting cycles (annually, biannually, or otherwise), the

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details of proposals to pay for program development and coordination as a cost of supportive services, to the .general public for review and comment, and certifies that any such expenditure by an area agency will have a direct and positive impact on the

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enhancement of services for older persons in the planning and service area. 15. The State agency will assure that where there is a significant population of older

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Native Americans in any planning and service area that the area agency will provide for outreach as required by section 306(a)(6)(N) of the Act.

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I Georgia State Plan on Aging FY 2000 - 2003

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IV. AREA PLAN REQUIREMENTS

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The State agency assures that the Area Plans of its planning and service areas comply with all requirements found in seetin 306 of the Older Americans Act, as amended. .

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V. STATE AGENCY ORGANIZATION

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The State Agency is the sole agency responsible for the administration of the State Plan on Aging.

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VI. STATE ALLOTMENT ASSURANCES

1. The State Agency assures that from my allotment:

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(A) such amount as the State Agency determines, but no more than 10 percent of

the State's allotment, will be used for paying such percentage as the State determines, but no

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more than 75 percent of the cost of administration of area plans;

(B) such amount (excluding any amount attributable to funds appropriated under section

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303(a)(3) as the State Agency determines to be adequate for conducting an effective ombudsman program under section 307(a)(12) shall be available for conducting such

programs;

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(C) excluding any amount attributable to funds appropriated under section 307(f).

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(D) The remainder of such allotment shall be available to the State only for paying such percentage as the State Agency determines, but not more than 85 percent ofthe cost of

supportive services, senior centers, and nutrition services under this title (TitleIII)

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provided in the State as part of a comprehensive and coordinated system in planning and service areas for which there is an area plan approved by the State Agency.

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2. The non-Federal share shall be in cash or in kind.

3. The State Agency will use'its allotment for State Plan administration to pay not more than 75

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percent of the costs of administering the State assures plan.

4. Any sums available to the State under subsection (b)(1) for part of the cost of the

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adminstration of the State Plan, which the State determines is not needed for such purpose, may be used by the State to supplement the amount available under section 304(d)(1)(A) to cover part

of the cost of the administration of area plans.

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Georgia State Plan on Aging FY 2000 - 2003

VII. STATE AGENCY RESPONSIBILITY ASSURANCES

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1. The State Agency shall:

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(A) develop a State Plan to be submitted to the Assistant Secretary on Aging for approval.

(B) administer the State Plan within the State.

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(C) be primarily responsible foithe coordination of all State activities related to the purposes ofthe Older Americans Act.

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(D) serve as an effective and visible advocate by reviewing and commenting upon State Plans, budgets, and policies which affect the elderly and by providing technical assistance

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to agencies, organizations, associations, and individuals serving the elderly.

(E) divide the State into Planning and Service Areas according to statutory and regulatory

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requirements.

2.The State Agency will receive and consider the views of service recipients or individuals using

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multipurpose senior centers, in connection with matters of generla policy arising in the develop-

ment and administration of the State plan.

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3. The State Agency will, in accordance with guidelines issued by the Assistant Secretary on

Aging develop, publish, and submit to the Assistant Secretary on Aging for review and comment a formula for the.distribution of Title III funds within the State.

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4. Upon request, the State Agency will provide an opportunity. for a hearing to any unit of general

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purpose local government, including units of 100,000 or more, if such unites) make(s) an

appiication for Planning and Service Area designation and is denied designation by the State Agency.

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5. The State Agency assures that Area Agencies on Aging have designated;where feasible, a focal point for comprehensive service delivery in each community, giving special consideration

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to designating multipurpose senior centers as such focal points.

6. The State agency will require area agencies on aging to conduct outreach initiatives to

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facilitate access to services for older Native Americans, where a significant Native American population exists.

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Division of Aging Services
2 Peachtree Street, N.W. - 36th Floor Atlanta, Georgia 303003-3142