FINAL

VERMONT STATE PLAN ON AGING

for Federal Fiscal Years 2011- 2014

October 1, 2010 through September 30, 2014

AS REQUIRED BY THE OLDER AMERICANS ACT OF 1965

AMENDED THROUGH 2006

Prepared by: Marie L. Bean, MSW, Aging & Disabilities Programs Administrator

State Unit on Aging Division of Disability and Aging Services

Department of Disabilities, Aging and Independent Living Vermont Agency of Human Services

July 2010

Vermont Agency of Human Services (AHS) Department of Disabilities, Aging and Independent Living (DAIL)

Division of Disability and Aging Services (DDAS) State Unit on Aging (SUA)

103 South Main Street Waterbury, Vermont 05671-1602

Telephone: 802.241.4534

To receive this document in an alternate format contact the State Unit on Aging at 802.241.4534 or TTY 802.241.3557 Email: Janet.Merrill@ahs.state.vt.us

This State Plan on Aging can also be found on the DAIL website:

www.dail.vermont.gov

With special thanks to the members of the DDAS State Plan on Aging Workgroup for their collaboration, dedication and wise counsel in the development of this

Vermont State Plan on Aging:

Camille George, Director, State Unit on Aging (SUA) Merle Edwards-Orr, Consumer Direction Manager, SUA

Maria Mireault, Elder Mental Health & Emergency Planning Specialist, SUA Mary Woodruff, Nutrition & Health Promotion Specialist, SUA

Al Urpsis, Quality Management Specialist, SUA Adele Edelman, Director, Adult Services Unit

Bard Hill, Director, Data & Planning Unit (DPU) Debra Tighe, Systems Developer, DPU

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TABLE OF CONTENTS TOPIC PAGE Verification of Intent 1 Mission Statement 2 Purpose of the State Plan on Aging 3 Executive Summary 4

• Vermont State Unit on Aging Goals and Objectives for 2011-2014 7 Vermont’s Older Population 9

• Demographics of Vermont’s Aging Population 9 • Population Trends 9 • Rurality 10 • Poverty 10 • Minority Older Adults 11

What is the Vermont Aging Network? 13 What Are the Issues and Trends? What Are the Challenges and Opportunities? 19

• Aging and Disabilities Resource Connection (ADRC) 22 • Choices for Care (CfC) 23 • Emergency Preparedness 24 • Empowering Older Vermonters to Stay Active and Healthy 25 • Mental Health, Dementia and Substance Abuse Services 26 • Supporting Family Caregivers and Older Relative Caregivers of Children 26 • Increasing Participation of Older Vermonters in the Workforce 27

Strengthening Older American Act Title III and Title VII Services 28 • The American Recovery and Reinvestment Act (ARRA) Communities

Putting Prevention to Work, Chronic Disease Self Management Program (CDSMP) 28

• Community Living Program (CLP) 28 • Veteran’s Directed Home and Community Based Services (VDHCBS) 29 • Older Americans Act (OAA) Nutrition Program 29 • Case Management Services 29

Promoting the Rights of Older Vermonters, Including those with Disabilities and Preventing Abuse, Neglect and Exploitation 31

• Adult Protective Services 31 • State Long Term Care Ombudsman Program 32 • Legal Services 32

How will Vermont’s Aging Network Meet the Needs of Older Adults? 33 • Goals, Objectives, Outcomes, Strategies 33

Summary of Public Hearing and Comment Process 43 Guide to State Plan on Aging Acronyms 46 VT State Unit on Aging Monitoring Guide (Section: DAIL Progress on FFY 2007 – 2010 State Plan on Aging Goals) 47 Method of Distribution For Title III and State Funding 51 Population Data and “Old, Alone and Poor” Data 52 Older Americans Act Allocations to Area Agencies on Aging 53 State Agency and Area Agency Information 55 Assurances 56

Mission Statement The Department of Disabilities, Aging and Independent Living’s mission is to make Vermont the best state in which to grow old or to live with a disability – with dignity, respect and independence. To achieve this goal, the Department is committed to fostering the development of a comprehensive and coordinated approach to the provision of community-based systems of services for older adults and people with disabilities. Our goal is to enhance the ability of these Vermonters to live as independently as possible, actively participating in and contributing to their communities. As we approach this work, we are guided by the following core principles:

Person-centered: the individual is at the core of all plans and services. Respect: individuals, families, providers and staff are treated with respect. Independence: the individual’s personal and economic independence are promoted. Choice: individuals will have options for services and supports. Self-determination: individuals direct their own lives. Living well: the individual’s services and supports promote health and well-being. Contributing to the community: individuals are able to work, volunteer and participate

in local communities. Flexibility: individual needs guide our actions. Effective and efficient: individuals’ needs are met in a timely and cost effective way. Collaboration: individuals benefit from our partnership with families, communities,

providers, and other federal, state and local organizations.

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Purpose of The State Plan On Aging In order to plan for the ongoing and future needs of older adults in Vermont and to meet the requirements of Section 307 of the Older Americans Act (OAA), the Department of Disabilities, Aging and Independent Living (DAIL), the designated State Unit on Aging (SUA) for Vermont, has prepared this State Plan for submission to the federal Administration on Aging (AoA). Vermont has opted to present a four-year State Plan for the period October 1, 2010 through September 30, 2014. The State is required by federal regulation to:

a) Develop a State Plan for submission to the Assistant Secretary on Aging; b) Administer the State Plan in accordance with Title III of the OAA, as amended; c) Be responsible for planning, policy development, administration, coordination, priority

setting and evaluation of all state activities related to the objectives of the OAA; d) Serve as an effective and visible advocate for older individuals by reviewing,

commenting on and recommending appropriate action for all State plans, budgets and policies which may impact older Vermonters; and,

e) Provide technical assistance and training to any agency, organization, association or individual representing the needs and interests of older individuals.

This plan reflects the Agency of Human Services’ vision that Vermonters are healthy, safe and achieve their greatest potential for well-being and personal independence in healthy, safe and supportive communities. It also reflects DAIL’s commitment to use this document as the blueprint for what we, as a state, want to achieve on behalf of older Vermonters and the family caregivers who provide the majority of the care delivered in Vermont by:

Increasing investments in community-based systems of long-term services and supports;

Increasing consumer flexibility and choice; Ensuring that older adults and individuals with disabilities have easy access to

well-coordinated services; and Ensuring that services promote healthy aging and independent living.

In addition, the State Plan incorporates the broader vision and goals of the Department into the body of the plan, includes feedback received during the public hearing and comment period. Finally, the State Plan describes the values, available resources, goals and strategies designed to achieve Departmental goals and offers a framework for the ongoing operations of programs funded through the Older Americans Act.

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Executive Summary

It is the mission of the Vermont Department of Disabilities, Aging and Independent Living (DAIL) to make Vermont the best state in which to grow old or to live with a disability – with dignity, respect and independence. The State Plan on Aging is required under the Older Americans Act; however we also use this document as the blueprint for what we, as a state, want to achieve on behalf of older Vermonters and the family caregivers who provide the majority of the care delivered in Vermont. We will do this by working collaboratively with older Vermonters, family caregivers, the network of Vermont community agencies, and our federal and state government partners. In these challenging fiscal times it is essential to continue to move forward together. The State Unit on Aging (SUA) worked with staff across the Division of Disability and Aging Services (DDAS), as well as with DAIL’s Advisory Board, Vermont’s Area Agencies on Aging (AAA), the State Long Term Care Ombudsman, the Community of Vermont Elders (COVE), and also gathered information through a statewide telephone survey conducted by AARP to identify trends, challenges and opportunities impacting older Vermonters. Vermont’s SUA, community partners and consumers voiced common themes regarding trends, challenges and future implications for promoting a comprehensive, flexible and responsive system of service, which will make Vermont the best state in which to grow old and/or live with a disability. In a 2010 Survey of AARP Vermont Members Age 50+ on Health and Livable Community Issues, 65% of AARP Vermonters said they would prefer to receive long-term care services in their own homes, 18% would like to receive care in an assisted living facility and only 3% would like to receive care in a nursing home setting.1 The two most common concerns expressed in the survey were being able to afford high quality long-term care and access to as well as affordability of health care. While Vermont is the first state in the nation to equalize access to long-term care services among home and community based and nursing home settings, there is still room to improve access to affordable home and community based options and thereby reduce the reliance on nursing home care. In addition, Vermont’s fiscal crisis is challenging us to find new ways to meet the needs of an ever increasing older population. Recently passed legislation calls upon the State, working with community partners, to find new, creative and more cost-effective ways to provide services. In the months ahead, the SUA will be working with community stakeholders, including people who participate in services, to:

Increase consumer choice and capacity for home-based services through outcome and performance based contracting;

Develop an adult family foster care program; Improve the timeliness of Choices for Care service availability; Create incentives for community-based care; and Better serve Vermonters with co-occurring mental health and other disability/medical

needs.

Community partners expressed the need for the Vermont Aging Network to work collaboratively to maintain effective and responsive management in aging services with mutually clear 1 2010 Survey of AARP Vermont Members Age 50+ on Health and Livable Community Issues.

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communication and information sharing. In a time of fiscal challenges, the SUA will strive for efficiencies through performance-based contracting and grants as well as increasing quality outcomes through the use of performance measures and indicators. A fully functioning and sustainable system of Aging Disabilities Resource Connections (ADRC) will be a key resource for Vermonters preparing for their future long term care needs, by providing information regarding a full range of long term care programs, financial planning and creative options such as the purchase of long term care insurance. For the first time, Vermont’s five AAAs collaboratively conducted a statewide needs assessment for their Area Plans FFY 11-14 with regional breakdowns of findings. Key findings identified the following areas of unmet need: assistance with heavy home chores; upkeep and maintenance of homes; shopping; housing expenses; more exercise programs; and respite for caregivers. Individual AAA Area Plans include strategies to facilitate the development of services to meet the needs identified through their needs assessment process, to collaborate in the further development of Aging and Disability Resource Connections and options counseling, to assure and improve the quality of services provided and to advance implementation of evidence-based health promotion and disease prevention programs. All AAA area plans also commit to supporting the use of local foods in nutrition services and include goals targeted to respond to the needs of family caregivers. Consumers and community partners identified other common challenges: empowering older Vermonters to stay active and healthy through Older Americans Act services; accessing prevention benefits under Medicare; increasing access to quality mental health, dementia and substance abuse services; supporting family caregivers of older Vermonters and older relative caregivers of children; increasing participation of older Vermonters in the workforce; maximizing State and community resources to promote the rights of older Vermonters, including those with disabilities; and preventing abuse, neglect and exploitation. Through the public comment process, SUA also heard about the importance of ensuring access to transportation for those who need it and for supporting the development of a range of affordable and accessible housing options. Demographics of Vermont’s aging population indicate that Vermont’s older adult population is growing at a rapid pace. Vermont has the lowest birth rate in the nation. The fastest growing segment of the population is now 85 years and older with projections for 2030 showing a 149% increase over 2000 census numbers. The SUA and Vermont AAAs are particularly aware of Vermont’s growing 85 years and older population and the need to plan for and provide services to this growing segment of the population. Projections for 2030 show the population of Vermonters ages 0-44 will continue to decline. According to US Census Bureau, Interim Projections: Ranking of States By Projected Percent of Population Age 65 and Older, Vermont ranked 26th in the nation, but is projected to rank 8th in the nation by 2030. The current economic environment has presented the SUA with continued challenges in meeting the goal of balancing the long term care system in the state. Management of the budget and identifying a course of action within this restrictive fiscal environment has required making difficult decisions. Vermont continues to pursue innovative remedies to address the increasing needs of our elders and individuals with disabilities while maintaining fiscal responsibility. The SUA and community aging network partners recognize that “future planning needs to take into account the continuum of health and financial means of all Vermonters and not focus exclusively

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on a very small portion of the older population”; moreover, future planning must “be attentive to the broader population with a focus on prevention and function.”2 A brief summary of the Vermont State Plan on Aging Goals and Objectives FFY 11-14 follows below, with additional information in the body of the plan, pages 33-42. The SUA wishes to express gratitude to all Stakeholders for their work on behalf of older Vermonters. We are proud to share a common vision: “Vermonters have more choices and control, are receiving what they need in their own communities, and are treated with dignity and respect.”3 With the Vermont State Plan FFY 11-14 as our roadmap, we will continue to work together to achieve our goals and objectives, unified by our mission to make Vermont the best state in which to grow old or to live with a disability – with dignity, respect and independence.

2 Vermont Long Term Care Forum, February 8, 2010, convened by the Community of Vermont Elders 3 Ibid.

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Vermont State Unit on Aging Goals and Objective for 2011-2014 Goal 1 – Maintain effective and responsive management in Aging Services. Objective 1.1: Make State Unit on Aging (SUA) policies, procedures, guidelines and publications readily available and understandable for community partners. Objective 1.2: Implement performance-based contracts and grants. Objective 1.3: Develop plans for the continuity of operations that address the needs of older Vermonters in the case of a disaster or other emergency. Objective 1.4: Promote the development of personal emergency preparedness plans by older Vermonters. Objective 1.5: Improve the completeness and accuracy of required Older Americans Act State Program Reporting. Goal 2 – Promote a comprehensive, flexible and responsive system of service. Objective 2.1: Increase understanding of the strengths and mental health needs of older Vermonters among the Departments within the Agency of Human Services (AHS). Objective 2.2: Improve the quality, flexibility and responsiveness of Older Americans Act services, through the use of technology, performance measures and indicators. Goal 3 – Empower older Vermonters, their families, and other consumers to make informed decisions about, and to be able to easily access, existing health and long-term care options. Objective 3.1: A fully functioning and sustainable Aging Disabilities Resource Connection (ADRC) will exist in Vermont by 10/1/2012. Objective 3.2: Older Vermonters, their families and other consumers will have ready access to information from a variety of sources, including the ADRC, about financial planning for long-term care, including long-term care insurance. Objective 3.3: Ensure Choices for Care (CfC) participants in nursing facilities receive on going options education on the efficacy of home and community based services. Objective 3.4: Develop mechanisms within CfC to improve timeliness of access. Objective 3.5: Promote awareness of CfC and information for the general public. Goal 4 – Empower older Vermonters to stay active and healthy through Older American Act services and prevention benefits under Medicare. Objective 4.1: Create opportunities for older Vermonters to stay healthy and active. Objective 4.2: Promote broader use of preventive services by older Vermonters. Objective 4.3: Expand the use of locally procured foods in the Older Americans Act Nutrition Program.

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Goal 5 – Older Vermonters have access to quality mental health, dementia and substance abuse services.

Objective 5.1: Increase access to quality mental health, dementia and substance abuse services for older Vermonters. Goal 6 –Resources to support family caregivers of older adults and older relative caregivers of children are available and accessible.

Objective 6.1: Increase support and knowledge of resources for caregivers of older Vermonters and older relative caregivers of children. Goal 7 – Increase the participation of older Vermonters in the workforce. Objective 7.1: Create opportunities for public education and key partnerships with employment agencies, the Division of Vocational Rehabilitation (DVR) and the business community to increase awareness of the benefits of hiring older Vermonters. Goal 8 – Promote the rights of older Vermonters, including those with disabilities, and prevent abuse, neglect and exploitation. Objective 8.1: Maximize SUA and community resources to prevent abuse, neglect and exploitation. Objective 8.2: Long term care facility residents and their families, and Choices for Care (CfC) participants in home and community based settings, will know they have the right to be free from abuse, exploitation and neglect, including caregiver neglect. Objective 8.3: Vermonters living in residential care homes and assisted living residences will know they have the right to be free from abuse, exploitation and neglect, including caregiver neglect. Objective 8.4: Improve the lives of older Vermonters by providing greater access to comprehensive and coordinated legal services in all areas of the state. Goal 9 – The SUA will Encourage the development of affordable housing options and supportive services for older Vermonters with lower incomes. Objective 9.1: SUA will support efforts to preserve and expand community based affordable housing for older Vermonters.

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Vermont’s Older Population

The population of the United States is aging. In 2000, the U.S. Census Bureau estimated the number of older adults (those 65+) at 35 million, or 12.4% of the total population. Current projections show this number growing to 71 million or 16.5% by 2020. By 2030, 20% of all Americans will be older adults. In addition, we are living longer, much longer than previous generations. For someone born in 2006, the life expectancy for a woman is 80.2; for a man it is 75.1.4 This is 29 years longer than the average life expectancy in 1900.

Demographics of Vermont’s aging population indicate Vermont’s older adult population is growing at a faster than average pace compared to the rest of the country. Vermont has the lowest birth rate in the nation. According to US Census Bureau, Interim Projections: Ranking of States By Projected percent of Population Age 65 and Older, in 2000 Vermont ranked 26th, but is projected to rank 8th by 2030.

Demographics of Vermont’s Aging Population Population Trends5

• The number of Vermonters over the age of 60 grew from 88,432 in 1990 to 101,827 in 2000, an increase of 13,395 or 15.15%. According to current projections there will be 214,964 Vermonters over age 60 in 2030, an increase of 113,137 people.

• The 45 to 64 year old age group is no longer the fastest growing segment of Vermont’s population as reported in Vermont’s State Plan on Aging for FFY 2007 – 2010. The fastest growing segment of the population is now 85 years and older with projections for 2030 showing a 149% increase over 2000 census numbers.

• Projections for 2030 show the population of Vermonters age 0 to 44 will continue to decline, although at a slower rate than previously projected.

Vermont's Projected 10, 20 and 30 Year Population Growth

Change from Census 2000

-12.3%

-0.6%

29.3%

17.6%

40.7%

0.1%

19.7%

76.6% 72.2%

-6.3% -2.4%

13.6%

120.8%

149.0%

-5.8%

-40.0%

-20.0%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%

140.0%

160.0%

0 to 14 15 to 44 45 to 64 65 to 84 85+

Age Range

Gro

wth

%

Projected % Change 2000-2010

Projected % Change 2000-2020

Projected % Change 2000-2030

4 National Center for Health Statistics, Health, United States, 2008 with Chartbook, Hyattsville, MD. 2009. 5 Census information throughout the State Plan has been compiled by Debra Tighe, Division of Disability & Aging Services, using data obtained from the U.S. Census Bureau, 2000 Census, and 2008 American Community Survey.

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Rurality

• For the purpose of this State Plan on Aging, the entire State of Vermont is considered to meet the federal OAA definition for “rural.” Older adults in rural settings are more likely to have less income than those in metropolitan regions.6

• Older adults living in rural areas are less educated, depend more heavily on Social Security for their income and also have a greater demand for medical, social and financial assistance.7

• They are more likely to own their own homes. In fact, it is estimated that 82% of those over age 65 living in non-metro areas own their own homes.8

• Housing for older adults, in rural areas is generally in poorer condition than that in metro areas, including problems with plumbing, heating, electricity, and in need of maintenance.9

• Older adults living in rural areas have less access to health care, including specialized health care, and these services tend to be more costly than those provided in metropolitan areas. Rural older adults usually have to travel farther to access these key resources, and yet at the same time, they have less access to transportation. Consequently, many rural older adults have unmet needs.10

• Based on our projections 10,296 older Vermonters over the age of 60 are living below 125% of the federal poverty level. This represents a 0.6% increase from 2002 (10,230). (Note: Refer to the State funding formula and “Old, Alone and Poor” details on pages 51-52.)

• In keeping with the requirements of the OAA, Vermont will spend at least the amount expended in federal fiscal year 2000 on services to older adults residing in rural areas.

Poverty

• 2008 Census estimated data show that 15.9% of Vermonters age 65 or older lived at or below 125% of poverty.11

6 Rural Population and Migration:. U.S. Department of Agriculture, Economic Research Service, internet article February 1, 2007. http:www.ers.usda.gov/briefing/population/challenges.htm. 7 Ibid: Rural Population and Migration: Trend 6- Challenges From an Aging Population . 8 Amberwaves Volume 2 Issue 2. U.S. Department of Agriculture, Economic Research Service. April 2004. Http:www.ers.udsa.gov/Amberwaves/April04/pdf/findingsRuralAmerica.pdf. 9 Rural Population and Migration: Rural Older Population, U.S. Department of Agriculture, Economic Service, internet article updated August 24, 2004, Carolyn C. Rogers. 10 Rural Issues and Trends: Socioeconomic Conditions Issue. Volume 8, Number 2,U.S. Department of Agriculture, Economics Division, October, 1997. 11 Source: U.S. Census Bureau, Current Population Survey, 2009 Annual Social and Economic Supplement. http://www.census.gov/hhes/www/cpstables/032009/pov/new46_100125_06.htm.

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Vermont's Elderly Age 65 and Older Poverty Status at or Below 125% in 2008

Living below 125% of Poverty

15.90%

Living above 125% of Poverty

84.10%

Source: U.S. Census Bureau, Current Population Survey, 2009 Annual Social and Economic Supplement

• Many older adults’ incomes are only slightly above the federal poverty level. According to a 2008 survey conducted by the Bureau of Labor Statistics, in older households (age 65 and older) 35.3% of the expenditures were for housing, 15.25% for transportation, 12.7% for food and 12.5% for health care.12 An analysis of spending between 1984-1997 found that spending by older consumers increased significantly, by 14% – 18%, and that spending for health care by older adults comprised almost one third of all health care spending nationwide, with notable increases in spending for health insurance and medications. These expenses bring many close to or below the federally defined poverty threshold. 13

• The risk of poverty is strongly related to one’s living arrangement; 17.1% of older adults who live alone are poor, as compared with 3% of those who live with families. In addition, older women are more likely to live in poverty (11.9%) than older men (6.7%).14

Minority Older Vermonters

• Vermont continues to have one of the lowest percentages of older minorities in the nation, according to the 2000 Census. It represents a mere 1.7 percent of the total population age 60 or older.

12 Consumer Expenditures,2008: Table 3. Age of reference person: Average annual expenditures and characteristics. U.S. Department of Labor, U.S. Bureau of Labor Statistics, October 6, 2009, http://bls.gov/ces/2008/standard/age.pdf.. 13 Paulin, Geoffrey D., “Expenditure patterns of Older Americans, 1984-1997”, Monthly Labor Review, May 2000, obtained from the US Bureau of Labor Statistics web site. 14 A Profile of Older Americans: 2009. U.S. Department of Health and Human Services, Administration on Aging, 2009, http://www.aoa.gov/AoARoot/Aging_Statistics/Profile/2009/6.aspx.

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• Racial and ethnic populations in Vermont are growing at a much faster rate than the

non-Hispanic, white population. Between 2000 and 2005, the total non-white population of Vermont increased 11.5 percent compared to the white, non-Hispanic populations’ increase of 1.7 percent increase.15

• The 2000 Census reports 1,738 people were identified as age 60 or older and members of a minority group, which represents a 253% increase from the 492 minority older adults reported in the1990 census. Of these, 28% were age 75 or older.

• The greatest proportion of the minority population can be found in Chittenden County. Of Vermont’s 19,619 total minority population of all ages, 7,125 (36.3%) reside in Chittenden County. The majority of Vermont’s minority older adults also reside in Chittenden County (n = 456, or 26.2%).

• One hundred ninety-five older Vermonters were identified in the 2000 Census as Native Americans. This comprises only 0.2% of older adults age 60 and older in Vermont. According to the 1999 Population and Housing Estimates published by the Vermont Department of Health, the highest concentration of people who identify themselves as Native Americans are found in Franklin County.16

• In May 2006 Vermont’s Abenaki population received formal state recognition.17 However, Vermont’s Abenaki population does not receive tribal aid because they lack federal designation as Native Americans. This increases the risk that older Abenakis, compared with other minorities, are likely to live at or below poverty.18

15 Office of Minority Health Strategic Plan 2007-2009, Vermont Department of Health, December 1, 2007. 16 “1999 Population and Housing Estimates”, Vermont Department of Health, Burlington, VT, 1999. 17 Hallenbeck, Terri. Abenaki Celebrates Recognition, Burlington Free Press, May 4, 2006 via burlingtonfreepress.com, Burlington, VT. 18 U.S. Department of the Interior, Bureau of Indian Affairs, internet listing of federally recognized tribal goverments, Spring, 2009. http://bia.gov/idc/groups/public/documents/text/idc-001866.pdf.

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What is the Vermont’s Aging Network?

The following description of Vermont’s Aging Network provides important contextual information regarding the pivotal role each component plays in addressing the needs of older Vermonters and in supporting their family caregivers, including the SUA’s role as part of this network. For the purposes of this document, the term, “Aging Network” refers to services and organizations across the full spectrum of long-term services and supports, from home-and community-based settings to nursing homes. Each component of the Aging Network serves a unique and important role in meeting the needs of older Vermonters and family caregivers. Each link in the broad and diverse Aging Network helps meet the needs of older Vermonters, wherever they may choose to live. Vermont’s Aging Network is comprised of a wide variety of consumer organizations, service providers, and government agencies. The SUA works in concert with Vermont’s Aging Network which includes, but is not limited to, the following:

Five Area Agencies On Aging (AAA), 14 Adult Day Services Providers (16 Adult Day Centers statewide), Senior Centers and community meals providers, Home Health Agencies (HHA), Private Home Care Agencies, Nursing Homes, Private Home Care Providers, Residential Care Homes (RCHs), Assisted Living Residences (ALRs), Housing and Supportive Services Providers (HASS), Homesharing Providers, Public Housing Authorities and Nonprofit Housing Providers, Public Transit Providers and private transportation agencies, Seniors Aging Safely at Home (SASH) pilot, Program for All-Inclusive Care for the Elderly (PACE) Vermont , The Vermont Ombudsman Project (VOP), The Elder Law Project of Vermont Legal Aid, The Community Of Vermont Elders (COVE), AARP Vermont, Volunteer and Community Service Programs, and University of Vermont Center on Aging

Vermont’s Department of Disabilities, Aging and Independent Living (DAIL) serves as the State Unit on Aging and is the sole state agency responsible for the administration of the State Plan on Aging. DAIL is comprised of 4 divisions, each responsible for different areas of service:

• Division of Disability and Aging Services: The Division of Disability and Aging Services (DDAS) is responsible for all community-based long-term care services for older Vermonters, people with developmental disabilities, people with traumatic brain injuries, and people with physical disabilities. DDAS contracts with a variety of local service providers to provide services and supports. Vermont’s reporting of Older

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Americans Act (OAA) services for federal fiscal year 2009 indicates almost 20,000 people received OAA registered services and that AAA’s served over 56,000 individuals. DDAS also provides direct supports through the Office of Public Guardian. DDAS supports older Vermonters and Vermonters with disabilities to live as they choose, pursuing their individual goals and preferences within their chosen communities. DDAS seeks to ensure the basic human and civil rights, health, well-being, and safety of the people it serves.

• Division of Licensing and Protection: The Division of Licensing and Protection enforces federal and state statutes and regulations for providers of health care and investigates cases of alleged abuse, neglect, and exploitation of vulnerable adults.

• Division for the Blind and Visually Impaired: The Division for the Blind and Visually Impaired (DBVI) is the designated state unit to provide vocational rehabilitation and independent living services to eligible Vermonters who are blind and visually impaired.

• Division of Vocational Rehabilitation: The mission of VocRehab Vermont is to help Vermonters with disabilities prepare for, obtain, and maintain meaningful employment and to help employers recruit, train, and retain employees with disabilities.19

Vermont’s five Area Agencies on Aging (AAAs): The primary role of the five AAAs is to serve as the key planning and development agencies within the five service areas. The AAAs are responsible for comprehensively assessing the needs of older Vermonters and family caregivers and to facilitate the development of services to meet the identified needs. In addition to their planning and development function, AAAs provide assistance to many older Vermonters and family caregivers who have short term needs, or require help which is intermittent in nature. In fact, thousands of older Vermonters are able to retain their independence because of ongoing case management, nutrition services and other OAA services that are not crisis driven, but are more preventive in nature. In recent years, emphasis has been placed on promoting the availability of evidence-based disease prevention and health promotion activities. Without such assistance, many people would eventually be at greater risk for deteriorating health and/or economic status, either of which can lead to a loss of independence and diminish the quality of life. In addition, many consumers of AAA services regain their independence after a stay in a hospital or nursing facility, as a result of case management support, nutrition services, transportation, supports for family caregivers and other interventions. AAAs sponsor programs such as Neighbor to Neighbor AmeriCorps, Senior Companion Program, and RSVP, which add a significant contingent of volunteers who enhance AAA services. Volunteers lead a variety of healthy aging programs in communities all over the Vermont, including: performing in-home services, and providing regular friendly visits and assisting with food shopping. AAAs also provide regional outreach and assistance to Medicare beneficiaries about the full range of public and private health benefits through the State Health Assistance Program (SHIP) and help to prevent health care fraud through the SMP (formerly referred to as the Senior Medicare Patrol, administered by the Community of Vermont Elders, see description page 17 under COVE). Adult Day Services: Vermont has 14 adult day service providers operating 16 adult day centers around the state. Adult day services provide an array of services to help older Vermonters and adults with disabilities to remain as independent as possible in their own homes. Adult day services are provided in community-based, non-residential day centers creating a safe, supportive

19 http://www.dail.vermont.gov.

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environment in which people can access both health and social services. Services include: professional nursing services, respite, personal care, therapeutic activities, nutritious meals, social opportunities, activities to foster independence and support and education to families and caregivers.20 Senior Centers: Senior centers serve as focal points within communities for information, referrals and opportunities for volunteering. Senior centers play an important role in helping to prevent social isolation and provide opportunities for people of all ages to connect and contribute to their community. For example, Vermont’s senior centers are places older Vermonters can obtain information about area services and resources, participate in health promotion programs, practice yoga, play Wii bowling, email grandchildren, share meals and learn a new language. While the SUA does not directly fund senior centers, numerous senior centers and other community meal programs receive Older American Act (OAA) funding and other support through Vermont’s network of area agencies on aging. Home Health Agencies: Home health agencies (HHA) provide high-quality, medically-necessary home health and hospice care. Vermont has 12 designated home health agencies, including one statewide for- profit agency. The agencies promote the general welfare of Vermonters with health promotion and long term care services. In addition to their acute care services, HHA programs provide person-centered care for older Vermonters and people with disabilities of any age. HHA provide assistance with the activities of daily living and encourage independence for individuals, enabling them to live safely and comfortably at home. HHA programs and services may include homemaker assistance, assistance with personal care, adult day services, and case management services, in which home and community long term care services are available as an alternative to nursing homes.21 Private Home Care Agencies: Private home care agencies specialize in providing non-medical home care to support independent living and aging in place. Services range from assistance with personal care, companionship services, help with shopping and transportation, homemaking services, meal preparation and much more. In recent years, Vermont has seen growth in the number of home care providers, with providers reporting increasing demand for their services. Residential Care Homes: Vermont’s 111 residential care homes are state licensed group living arrangements designed to meet the needs of people who cannot live independently and usually do not require the type of care provided in a nursing home. When needed, help is provided with daily activities such as eating, walking, toileting, bathing, and dressing. Residential care homes may provide nursing home level of care to residents, known as enhanced residential care (ERC). ERC services include personal care, housekeeping, meals, activities, nursing oversight and medication management. Assisted Living Facilities: There are currently 8 state licensed assisted living residences that combine housing, health and supportive services to promote, resident’s independence and aging in place. Assisted living residences offer, within a homelike setting, a private bedroom, private bath, living space, kitchen capacity, and a lockable door. Assisted living promotes resident self-direction and active participation in decision-making while emphasizing individuality, privacy and dignity.

20 http://www.ddas.Vermont.gov/ddas-programs/programs-adult-day-default-page. 21 http://vna.vt.com/.

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Nursing Homes: Vermont’s 42 nursing homes are licensed facilities providing 24-hour nursing care, supervision, therapies, personal care, meals, nutrition services, activities and social services. Nursing facilities are an important component of Vermont’s Aging Network. They provide long-term care for individuals who require and want 24-hour nursing care and supervision as well as short-term rehabilitation for many Vermonters who need support after an illness or injury. Public Housing Authorities and Nonprofit Housing Providers: Vermont’s non-profit housing organizations and public housing authorities serve the lowest income older Vermonters, providing many of the homes essential to Medicaid participants to remain at home under the Choices for Care program. Public Transit Providers and Private Transportation Agencies: Vermont’s 11 public transit providers, along with numerous private transportation providers, play an important role in helping older Vermonters get to essential medical services, social services, senior centers and community meals programs, grocery stores, drug stores and shopping. Transportation services help older Vermonters stay connected with and participate in community events. Housing and Supportive Services (HASS): HASS providers deliver service coordination and increased access to services at certain congregate housing sites serving older adults and people with disabilities. Resident service coordinators maintain a supportive presence on site and collaborate with a variety of community partners to increase access to homemaker services and provide health, wellness, education and socialization activities for residents.

Homesharing: Vermont’s two homeshare providers help to match people who need some assistance to remain in their home with other Vermonters who seek affordable housing. In some cases, caregiving services are also arranged. Homesharing services are currently available in about half of the state. (Chittenden, Addison, Grand Isle, Washington, Lamoille and Orange counties)

Seniors Aging Safely at Home (SASH): SASH is a pilot project based in congregate housing settings where residents are invited to participate in the SASH as team members along with their primary care practitioner and other providers to develop person-centered Individual Healthy Aging Plans. The plans reflect each individual’s personal preferences and priorities. The SASH staff develops a Community Healthy Aging Plan (CHAP) by aggregating the needs identified in individual plans, such as medication management, falls prevention, nutrition programs, homemaker services, or personal care services. It is hoped that eventually SASH will also be offered to others living in the housing development’s surrounding neighborhood. PACE Vermont: The Program for All-Inclusive Care for the Elderly (PACE) is a program for people age 55 and older that combines an individual’s Medicare and Medicaid benefits to deliver all of their health and long-term care services. There are currently two PACE centers in Vermont, one in Chittenden County, and the other in Rutland County. PACE arranges and pays for doctor visits, physical therapy, medical equipment, medications, transportation, respite, in-home help with household tasks, personal care, as well as other services. The PACE health team works closely to help individuals be as independent as possible in their home.

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Vermont Ombudsman Project: The SUA contracts with Vermont Legal Aid, Inc. to operate the Vermont Ombudsman Project (VOP) – a statewide long-term care ombudsman program that fulfills all of the advocacy requirements of Title VII, Chapter 2 of the Older Americans Act. Currently, there is one full-time State Long Term Care Ombudsman who supervisors 4.6 FTE regional ombudsmen. In addition to paid staff, the project utilizes 15 certified volunteers. In 2005, the Vermont Legislature expanded the LTC ombudsmen’s responsibilities. In addition to advocating for residents of nursing facilities, residential care homes and assisted living residences, the legislature gave ombudsmen the authority to respond to complaints on behalf of individuals receiving home-based services through the 1115 Long Term Care Medicaid Waiver Choices for Care Program. Elder Law Project: (ELP) The Elder Law Project consists of the Senior Law Project (SLP) and Medicare Advocacy Project (MAP), and focuses on the legal needs and problems of seniors. ELP provides a full range of legal services including advice, assistance with documents, and representation. It represents seniors on legal and policy matters with the State government and with the Legislature. ELP attorneys work closely with case managers to provide professional legal advice, consultation and representation to seniors. In addition MAP represents Medicaid beneficiaries in Medicare appeals after referral by the State of Vermont.22 Community of Vermont Elders (COVE): COVE’s mission is to promote and protect a high quality of life for Vermont’s seniors, through advocacy and education. It works with and for older Vermonters and the organizations that serve them to identify, interpret, and respond to critical issues that impact the dignity, security and well-being of seniors. COVE researches and educates the public and policymakers, and advocates for or against the adoption or revision of laws, rules, regulations or policies. COVE also sponsors SMP, funded through the Administration on Aging (AoA) with the goal of empowering older Vermonters “to prevent health care fraud through outreach and education.”23 AARP Vermont: The Association for the Advancement of Retired Persons: promotes the welfare of older Vermonters. AARP is a nonprofit, nonpartisan membership organization that helps people age 50 and over improve the quality of their lives. It is comprised of different legal entities. Further information can be found at http://www.aarp.org/about-aarp/. Volunteer and Community Service Programs: In addition to the programs described above, Vermont has many volunteer and community service programs, such as RSVP, Foster Grandparents, the Senior Companion Program and the Neighbor-to-Neighbor Americorps Program to name a few. These programs provide valuable opportunities for older Vermonters and people of all ages to contribute to their community, and to benefit from the services provided. The range of services and benefits provided through these programs is extensive, from mentoring young children, to delivering health promotion and disease prevention programs, to companionship and assistance with heavy chores. 22 http://www.vtlegalaid.org/elder-law-project/. 23SMP Volunteer Foundations Training Kit, Funded by The U.S. Administration on Aging, Washington, DC, Prepared in cooperation with The National Consumer Protection Technical Resource Center, Waterloo, IA, August 2009.

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University of Vermont Center on Aging: Officially established in 2008, the University of Vermont Center (UVM) Center on Aging aims to forge on-going collaboration among faculty, students, staff and programs within the UVM, Fletcher Allen Health Care, and broader Vermont community to promote a sense of well-being and a high quality of life for older adults. The Center on Aging focuses on coordinating and supporting gerontological and geriatric research at UVM, providing educational opportunities in gerontology and geriatrics and translating research outcomes and educational activities into policy and excellent practice in the fields of medicine and human services. 24

24 The Center on Aging at the University of Vermont, http://www.uvm.edu/~ctraging/index.php?option=com_content&view=frontpage&Itemid=1.

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What Are the Issues and Trends? What Are the Challenges and Opportunities?

The State Unit on Aging (SUA) worked with staff across the Division of Disability and Aging Services (DDAS), as well as with the Department of Disabilities, Aging and Independent Living (DAIL) Advisory Board, Vermont’s five Area Agencies on Aging (AAAs), the State Long Term Care Ombudsman, the Community of Vermont Elders (COVE), and AARP through a statewide telephone survey to identify issues, trends, challenges and opportunities impacting older Vermonters. In Addition, on February 8, 2010 COVE convened a large group meeting of people representing Vermont’s leading agencies, service providers and advocates for a discussion on the long term care needs of older Vermonters. SUA’s efforts coupled with the telephone survey and COVE meeting identified the following issues, trends, challenges and opportunities. Stakeholders shared a common vision: “Vermonters have more choices and control, are receiving what they need in their own communities, and are treated with dignity and respect.”25 Stakeholders also observed:

“Vermont is experiencing a convergence of increasing need presented by a growing population of older Vermonters, greater acuity of need given the shift to aging in community rather than in institutions, and shrinking of capacity due to decreases in funding for vital support programs.” 26

“Future planning must take into account the continuum of health and financial means of all Vermonters; future planning should attend to the broader population with a focus on prevention and function”27

Vermont’s State Unit on Aging (SUA), community partners and consumers indicated common themes regarding trends, challenges and future implications for promoting a comprehensive, flexible and responsive system of service, which will make Vermont the best state in which to grow old and/or live with a disability. In a 2010 Survey of AARP Vermont Members Age 50+ on Health and Livable Community Issues, 65% of AARP Vermonters would prefer to receive long-term care services in their own homes, 18% would like to receive care in an assisted living facility and only 3% would like to receive care in a nursing home setting.28 The two most common concerns expressed in the survey were affordability of health care and access to high quality long-term care.29 While Vermont is the first state in the nation to equalize access to long-term care services among home and community based and nursing home settings, there isstill room to improve access to affordable home and community based options and thereby reduce the reliance on nursing home care. In addition, Vermont’s fiscal crisis is challenging us to find new ways to meet the needs of an increasing older

population

Trends and Challenges The following are highlights of the trends and challenges prominently before the SUA.

25 Ibid: Vermont Long Term Care Forum, February 8, 2010. 26 Ibid. 27 Ibid. 28 2010 Survey of AARP Vermont Members Age 50+ on Health and Livable Community Issues. 29 Ibid.

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٠ Challenges for Change: (ACT 068. An act relating to challenges for change, http://www.leg.state.vt/us/.) Recently passed legislation calls upon the State, working with community partners, to find new, creative and more cost-effective ways of providing services. In the months ahead, the SUA will be working with community stakeholders, including people who participate in services, to:

Increase consumer choice and capacity for home-based services through outcome and

performance based contracting; Develop an adult family foster care program; Improve the timeliness of Choices for Care service availability; Create incentives for community-based care; and Better serve Vermonters with co-occurring mental health and other disability/medical

needs. Community partners expressed the need for the Vermont aging network to work collaboratively to maintain effective and responsive management in aging services with mutually clear communication and information sharing. In a time of fiscal challenges the SUA will strive for efficiencies with performance-based contracting and grants, as well as increasing quality outcomes through the use of performance measures and indicators. ٠ Need For a Fully Functioning and Sustainable Aging Disabilities Resource Connections

(ADRC): An ADRC will be key to providing a resource for Vermonters of all ages in planning for their future long term care needs, by providing a full range of information regarding long term care programs as well as information regarding financial planning and creative options such as the purchase of long term care insurance.

٠ Long-term Care Partnership Legislation: Vermont’s State Unit on Aging supports the passage of long term care partnership legislation, but proposed legislation to date has not been passed.

٠ Dual Eligible Initiative: The Vermont Agency of Human Services has received a technical assistance project grant from the Center for Health Care Strategies (CHCS) for individuals dually eligible for both Medicare and Medicaid. AHS, DAIL and the Department of Vermont Health Access (DVHA) are working together on this planning effort with assistance from CHCS staff. The goal of this project is to secure from CMS a Medicare waiver that would allow Vermont to be a Medicare and Medicaid Managed Care plan for the approximately 18,000 dually eligible beneficiaries here. This would be the first Medicare waiver in the nation and would complement the work that Vermont Medicaid is doing under the Global Commitment to Health and the Choices for Care LTC Medicaid waivers. The technical assistance grant lasts through the end of 2010.

٠ Regional Pressures: For the first time Vermont’s five AAAs collaboratively conducted a

statewide needs assessment for their Area Plans FFY 11-14 with regional breakdowns of findings. Key findings identified the following areas of unmet need: assistance with heavy home chores; upkeep and maintenance of homes; shopping; housing expenses; more exercise programs; and respite for caregivers. Individual AAA Area Plans include plans to facilitate the development of services to meet the needs identified through their needs assessment

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Consumers and community partners identified other common challenges: empowering older Vermonters to stay active and healthy through Older Americans Act services; accessing prevention benefits under Medicare; increasing access to quality mental health, dementia and substance abuse services; supporting family caregivers of older Vermonters and older relative caregivers of children; increasing participation of older Vermonters in the workforce; maximizing State and community resources to promote the rights of older Vermonters, including those with disabilities; and preventing abuse, neglect and exploitation. While transportation did not top the list of needs identified through the AAA needs assessment process, this need was mentioned in needs discussions sponsored by the SUA. It was noted that for those who have access to transportation this is not an issue; however, as people grow older, when they no longer have access to transportation, it is a significant issue for those individuals that can have a tremendous impact on one’s ability to obtain needed services and remain living independently in the community. Demographics of Vermont’s aging population indicate Vermont’s older adult population is growing at a rapid pace. Vermont has the lowest birth rate in the nation. The fastest growing segment of the population is now 85 years and older with projections for 2030 showing a 149% increase over 2000 census numbers. Projections for 2030 show the population of Vermonters ages 0-44 will continue to decline, and older Vermonters will offer a valuable resource to employers. According to US Census Bureau, Interim Projections: Ranking of States By Projected Percent of Population Age 65 and Older, in 2000 Vermont ranked 26th in the nation, but is projected to rank 8th in the nation by 2030. The SUA and Vermont AAAs are particularly aware of Vermont’s growing 85 years and older population and the need to plan for and provide services to this growing segment of our population. In FFY 09, over 20% of people served by Vermont AAAs were 85 years and older, this represented over 40% of the state’s age 85 plus population. AAAs employ a number of methods to reach older Vermonters, (including those 85+), which include: use of public media, appearances on public access and other programs geared toward older adults and presentations to community groups that include or have connections with this group. ٠ Vermont State Plan on Dementia: This Plan delineates activities planned to meet the needs

of those with dementia and their family caregivers (please see section on Mental Health, Dementia and Substance Abuse services below). We know that many of the people living with dementia in Vermont are age 85 and older.

٠ Outreach to Minorities and French Canadian Vermonters: Although Vermont’s older

minority population is extremely small (n = 1,738) Vermont’s AAAs reach out to all minority groups and utilize resources to provide culturally sensitive services. For example, where the largest proportion of Vermont’s minority population resides in Chittenden County, CVAA (formerly, the Champlain Valley Agency on Aging) collaborated with the Vermont Refugee Resettlement Program to provide transportation and offer meals for various ethnic groups. In addition, the SUA has shared the AoA Diversity Toolkit with the Vermont Aging Network as

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a resource. Notably one of the most prominent cultural groups served by the Vermont Aging Network are French Canadians, while this group would not necessarily be identified as a minority population in the U.S. Census. AAAs and other service providers utilize bilingual staff, have developed written materials and sponsor special meals and other programs for older Vermonters of French Canadian heritage.

The current economic environment has presented the SUA with continued challenges in meeting the goal of balancing the long term care system in the state. Management of the budget and identifying a course of action within this restrictive fiscal environment has required difficult decisions to be made. Vermont continues to pursue innovative remedies to address the increasing needs of our elders and individuals with disabilities while maintaining fiscal responsibility. Opportunities Trends and challenges in a time of fiscal crisis provide the SUA and community partners with the following opportunities: Aging and Disabilities Resource Connection (ADRC) Vermont has received a second round of funding for its Aging and Disabilities Resource Center (ADRC – known as Aging and Disabilities Resource Connection in Vermont) project. In the first round of funding, October 2006 through September 2009, Vermont developed its vision for the ADRC, agreeing upon a “virtual ADRC” approach with ten partners. Those partners are the five Area Agencies on Aging, Vermont Family Network, Vermont Center for Independent Living, the Brain Injury Association of Vermont, HowardCenter (a Designated Agency in Vermont which provides services to people with developmental disabilities and mental illness) and Vermont 211. ReferWEB, information and referral software, has been implemented by each partner agency through a Memorandum of Understanding. This is a significant step towards integrating the Information/Referral/Assistance functions and providing support for the use of the software among the partners.

Goals for 2009 – 2012 Working under leadership provided by the State Unit on Aging, over the next three years the ADRC’s goals are to: 1. Implement a fully functioning ADRC statewide, including a 5-year sustainability plan. 2. Improve the integration among the ADRC partners including a “warm transfer” capacity

to allow callers to move seamlessly from one partner to the next and improved IT capacity and integration among the partners.

3. Develop and implement a marketing plan, based on consumer input, which increases community understanding and utilization of the ADRC.

4. Enhance the opportunities for older adults and people with disabilities to return to the community after stays in a hospital or nursing home through implementing evidence-based post-discharge support models.

5. Develop and implement collaborative initiatives with the state Medicaid Office. 6. Develop and carry out quality assessment and improvement systems which include

effective consumer input.

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Choices for Care (CfC) The current economic environment has presented the SUA with continued challenges in meeting the intention of balancing the long term care system in the state. Management of the budget and identifying a course of action within this restrictive fiscal environment has required difficult decisions to be made. While we have undertaken numerous initiatives, the most transforming (eligibility changes, estate recovery and system re-design) are either long term goals or subject to American Recovery and Reinvestment Act (ARRA) restrictions. These issues have delayed the implementation of system changes that would create efficiencies and cost savings. Vermont continues to pursue innovative remedies to address the increasing needs of older Vermonters and individuals with disabilities while maintaining fiscal responsibility. The following paragraphs describe the intent and progress of the Choices for Care program. In October 1, 2005 Vermont entered into a Title XIX section 1115 Long Term Care Waiver Demonstration Program known as Choices for Care (CfC) with the Centers for Medicare and Medicaid Services (CMS) to serve older Vermonters and adults with physical disabilities. The intent of this demonstration is to undertake a broad based reform of the long term care service system by offering a continuum of care that includes a series of options, including both home and community based alternatives and traditional nursing facility services. To achieve this overarching goal, CfC’s design brings under its oversight the entire continuum of long term care (home and community based services (HCBS), enhanced residential care (ERCs) and nursing homes) as well as various service types (self-directed care, cash and counseling known as Flexible Choices, surrogate directed care and traditional agency services). In addition to giving participants choices in service setting type, every participant also has a choice between a case manager from a home health agency or from an area agency on aging. While CfC seeks to maximize HCBS options for participants, the waiver was also gives priority to individuals at the highest level of needs. Specifically, those with “highest needs” have a choice of any long term care setting without being subject to any wait list. While “high need” participants also have access to the same level and types of services as highest needs, applicants to the high needs category may be wait-listed if funding is not available. Similarly,” moderate needs” participants, (not nursing home eligible or not financially qualified for Medicaid long term care) may receive limited homemaker, adult day, and case management, subject to a wait list when funding is low. One of the Choices for Care major objectives was to expand service options for community dwelling participants. Beginning in year two (2006) of the five-year demonstration, CfC took a step in this direction by adding four new major HCBS options: Flexible Choices, a cash and counseling program; PACE Vermont; and a 24 hour home care pilot project. Furthermore, policies were finalized in 2007 to enable spouses for CfC participants to receive payments for participant care. Each expansion enriched the range of options for HCBS participants and constitute a major achievement in increasing long term care community options in the Vermont. In addition to increasing the ways participants can receive long term care services, CfC has also increased the number of individuals served. Until a wait list was imposed in 2009 the moderate needs group saw a consistent increase in each year in enrollment, reflecting CfCs ability to reach

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individuals who were excluded from Medicaid long term care supports under previous Medicaid HCBS waivers. CfC is consistently a supportive program for Vermont adults with high degrees of functional impairments living on low incomes. In each of the first three years, the total number of persons served in the highest need groups outpaced that of persons in either the high or moderate need groups. This enrollment trend indicates that CfC is a source of support for a wide-ranging level of need – both functional needs and financial needs. In 2007, CfC evaluators, (UMass Medical School Center for Health Policy Research), in conjunction with CfC’s internal evaluator, identified nine (9) desired outcomes: seven (7) expected to be achieved in the first five years and two (2) to be achieved beyond the initial demonstration period. These outcomes are:

1. Information Dissemination: Participants and their authorized representative receive necessary information and support to choose the long term care setting consistent with the participant’s expressed preference and need.

2. Access: Participants have timely access to long term supports in the settings of their choice.

3. Effectiveness: Participants receive effective HCBS to enable them to live longer in the community.

4. Experiences of Care: Participants have positive experiences with the types, scope and amount of CfC services.

5. Quality of Life: Participants report that their quality of life improves. 6. Applicant List Impact: CfC applicants who meet the high needs criteria will have equal

access to services regardless of the setting of their choice. 7. Budget Neutrality: Medicaid’s cost of serving CfC participants is equal to or less than

under the previous Medicaid and HCBS waiver funding. 8. Public Awareness: Vermont general public is aware of the full range of long term care

settings for persons in need of long term care and have enough information to make decisions regarding long term care.

9. Health Outcomes: CfC participants medical needs are addressed to reduce preventable hospitalizations and their long term care needs are effectively addressed.

Emergency Preparedness Vermont’s SUA collaborates with Vermont Department of Health (VDH), Vermont Emergency Management (VEM) and other stakeholders throughout the state to plan for and respond to public emergencies such as flooding, severe winter storms and pandemic flu outbreaks. The SUA has developed a Continuity of Operations Plan (COOP) that is coordinated with broader Agency of Human Services and State of Vermont Emergency Planning. The COOP identifies the critical functions that would need to be maintained or reinstated shortly after an emergency and identifies the staff and resources needed to perform the functions. The SUA is also involved as appropriate in fulfilling the State’s role related to State Support Function 6 Mass Care, Emergency Assistance, Housing, and Human Services. The SUA participates in bi-weekly Agency of Human Services Emergency Planning Work Group meetings, meetings to plan to meet the needs of those who may need accommodations in the event of an emergency and serve as members of the Patient Care and Coordination Team for the State and are responsible for identifying bed availability for the relocation of residents of long-term care facilities during an event.

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Moreover, the SUA has also placed particular emphasis on encouraging and supporting individuals to plan in advance for emergencies. Events occur in Vermont each year that put older Vermonters and people with disabilities at risk of harm. While state agencies, community providers and local emergency response teams are working together to build a united response to large scale emergencies, individuals and families are encouraged to develop their own emergency plans. SUA and community partners created an emergency preparedness guide for vulnerable populations that is available in print and on the Department’s website.30 It directs consumers and their support persons to prepare for sheltering in place and for evacuation. SUA has also produced a manual to assist long-term care facilities in developing and/or improving their emergency preparedness plans. Training and technical assistance will be provided to facilities to assist them in their planning efforts. Please refer to Objectives 1.3 and 1.4 in the Goals, Objectives, Outcomes and Strategies section of the State Plan for additional information regarding SUA involvement in Emergency Preparedness and Planning. Empowering Older Vermonters to Stay Active and Healthy In report after report, Vermont is often cited as one of the healthiest places to live. In the 2009 edition of America’s Health Rankings, Vermont was named the healthiest state in the country. This does not mean there is no work left to do or that we can turn our attention elsewhere. Focusing on prevention and modifying behaviors are a key strategy to improving the health status of all Vermonters, especially older adults.31 According to The National Report Card on Healthy Aging, Vermont is no different than any other state in that the Healthy People 2010 targets for physical activity, flu or pneumonia vaccines have yet to be met.32 Physical activity assists in achieving and maintaining a healthy weight, but for many it is hard to do. Couple this with the knowledge that adults tend to become less active as they age and it is clear that promoting changes to the built environment, especially reducing barriers to walking, will increase the supports needed by seniors to spend time being physically active. Community volunteers who are trained in evidence-based exercise programs will also encourage older Vermonters to engage in appropriate physical activity and maintain a healthy weight and lifestyle. Each flu season brings the reminder that influenza and pneumonia are the leading causes of hospitalization among people age 65 and older. Even though vaccination for both influenza and pneumonia is covered by Medicare, about one third of older Vermonters go without these vaccinations. The use of evidence based interventions such as SPARC (Sickness Prevention Achieved through Regional Collaboration) will assist with promoting the use of preventive services by older adults. 30 For additional information on emergency planning for consumers please see Just In Case: An Emergency Preparedness Planning Guide for People Who May Need Additional Assistance available at www.dail.vermont.gov <http://www.dail.vermont.gov/> under Helpful Resources. 31 United Health Foundation, America’s Health Rankings 2009. 32 Centers for Disease Control and Prevention and The Merck Company Foundation, The State of Aging and Health in America 2007.

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Mental Health, Dementia and Substance Abuse Services An estimated 20% of Vermonters aged 60 or older experience mental disorders that are not a part of normal aging. Nationally, only 50% of older adults who acknowledge mental health problems receive treatment from any health care provider and only 3% receive specialized mental health services. This rate of utilization is lower than for any other adult age group.33 Vermont SUA collaborates with aging network providers and the Department of Mental Health to provide home-based mental health, dementia and substance abuse services to approximately 450 older adults annually. An additional 400-500 individuals obtain specialized mental health services at community mental health centers. The SUA and other stakeholders are working to expand the elder mental health provider network to include private licensed clinicians to ensure the State has the capacity to meet the mental needs of a growing older population. A current lack of capacity in the provision of mental health services for older Vermonters with untreated mental health needs, and increasing functional decline, provides a significant challenge to the service system. Older Vermonters are sometimes placed into inappropriate settings or go without services because our mental health system is not set up to meet their physical care needs and our physical care needs system is unable to meet their mental health needs. Accordingly Vermont would like to reverse this trend so older Vermonters with mental health needs are able to access long term services in settings of their choice. Vermont’s State Unit on Aging and the Governor’s Commission on Alzheimer’s Disease and Related Disorders completed the Vermont State Plan on Dementia in 2008. Now we are working toward the development of a dementia-informed infrastructure to increase public awareness about dementia, improve dementia care across health care settings, increase the dementia care workforce, expand supports for family caregivers of people with dementia and establish policies that improve access, quality and efficiency in dementia care.34 Supporting Family Caregivers and Older Relative Caregivers of Children In Vermont, as in the rest of the nation, family and friends provide the bulk of long term care services to individuals age 18 and older who receive long term care at home. While the majority of Vermont’s family caregivers of older adults are aged 60 and older, a substantial number of older Vermonters receive care from family and friends under 60. In addition, approximately 2,800 older relative caregivers are primary caregivers of 4,000 children under age 18. The economic value of care provided by Vermont’s 55,000 family caregivers was estimated at $680 million in 2007.35 Although caregiving has many rewards, it can also be physically and emotionally challenging for the caregiver. Programs to assist family caregivers include the statewide Dementia Respite Program and the National Family Caregiver Support Program. Vermont’s AAAs and the Vermont Kin as Parents program provide additional supportive services for family caregivers. 33 http://www.aagponline.org/prof/facts_mh.asp 34 The Vermont State Plan on Dementia can be referenced on the Department’s website: http://www.ddas.vermont.gov/ddas-publications/publications-dementia/publications-dementia- documents/state-plan-demenita-exec-summary. If you cannot locate the State Plan on Dementia at http://www.dail.vermont.gov please contact Maria Mireault at Marie.Mireault@ahs.state.vt. 35 Family Caregiver Alliance, 2007. http://www.caregiver.org/caregiver/jsp/content/pdfs/state_profile_vt.pdf.

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Increased Participation of Older Vermonters in the Workforce Labor supply is a fundamental indicator of a state’s ability to prosper and compete in domestic and international markets. Vermont is experiencing significant shifts in the labor supply which will require a strategic approach to workforce recruitment, retention and development. While Vermont expects a 6.8% increase in the labor force by the year 2020, there will be a relative decrease in younger workers, (5.0% decrease in the labor force aged 54 and under) and a potential increase in the older labor force of 54.6% aged 55 if older Vermonters are effectively employed.36 For many Vermont companies, a major consequence of the retirement of the “baby boom” generation will be the loss of institutional knowledge/experience and the challenge of succession planning. Barriers to older worker employment must be addressed. While some barriers are associated with federal and state legislation, rules and practices, others are caused by a lack of employer familiarity with programs and opportunities and some simply by myths and stereotypes associated with hiring the older workers.37 During FFY 2011 – 2014 SUA will strive (with community partners) to increase the participation of older Vermonters in the workforce through creating opportunities for public education and key partnerships with employment agencies and the business community to increase awareness of the benefits of hiring older Vermonters.

36 Optimizing the Potential of Vermont’s Older Workers, Report of the Thirty-Fourth Grafton Conference, The Windham Foundation, Grafton, Vermont. 37 Optimizing the Potential of Vermont’s Older Workers.

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Strengthening Older Americans Act Title III and Title VII Services Strengthening and expanding Title III and Title VII services has proven challenging in the face of level funding, rising costs and an increased demand for services. To date, Title III case management has been supported by additional revenues from Choices for Care (CfC). Case management provided through the OAA serves an important role in providing essential preventive and long-term care support to older Vermonters with few other resources. Responding to new trends in promising and/or best practices in cost-effective service provision for older adults, at least two of the five AAAs plan to continue work begun through an AoA Nursing Home Diversion grant (now referred to as the Community Living Program, see below) and to move forward with implementing options counseling. Through the development of ADRC Vermont has been able to strengthen Information/Referral/Assistance (I/R/A) by implementing ReferWEB software; allowing for better, more efficient tracking of resources, calls and management of problem areas. Vermont’s five Area Agencies on Aging now share a centralized staff person with expertise in Refer who can provide consistent and efficient technical assistance. Adult Protective Services within DAIL’s Division of Licensing and Protection is maximizing all possible resources and updating policies and procedures. Further information regarding planned strengthening Title III and Title VII services is noted below, as well as in the section on Promoting the Rights of Older Vermonters, Including Those With Disabilities and Preventing Their Abuse, Neglect and Exploitation. The American Recovery and Reinvestment Act (ARRA), Communities Putting Prevention to Work, Chronic Disease Self Management Program (CDSMP) The SUA is partnering with the Vermont Department of Health to: embed the Chronic Disease Self-Management Program infrastructure at the community level; enhance the engagement of older adults and the aging network of providers in this programming; and improve the quality of life for older Vermonters with chronic disease. This funding opportunity directly links with Vermont’s Blueprint for Health. “The Vermont Blueprint for Health is a vision, a plan and a statewide partnership to improve health and the health care system for Vermonters. The Blueprint provides the information, tools and support that Vermonters with chronic conditions need to manage their own health – and that doctors need to keep their patients healthy. The Blueprint is working to change health care to a system focused on preventing illness and complications, rather than reacting to health emergencies.”38 Community Living Program (CLP) Vermont had a CLP grant (known as Nursing Home Diversion) from 2007 until 2009. During that period creative and person-centered approaches were developed to meet the needs of older Vermonters at risk of nursing home placement and to implement an Options Counseling approach to case management in our partner agencies. Our application to continue the project into a second round was approved by the AoA, but not funded due to the competitive nature of the grant application process and AoA’s limited funds. Despite the lack of federal funding our agency partners are moving forward to implement Options Counseling into parts of their agencies. We will continue to search for funding needed to move the goals of Community Living across the entire state.

38 http://healthvermont.gov/blueprint.aspx

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Veterans Directed Home and Community Based Services (VDHCBS) Vermont wrote a VDHCBS section into our 2009 Community Living Program (CLP) proposal which was not funded. Nonetheless, much of the expertise and infrastructure needed to implement a VDHCBS initiative currently exists within our state Agencies on Aging and across the state. The AAAs have also expressed some interest in pursuing this even in the absence of start-up funding. As a result, we will work with our AAAs, our local Veterans’ Administration, and our local fiscal agent, ARIS Solutions to develop and implement a VDHCBS program in the state. The scope and size of the program will need to be determined as the planning process moves along. OAA Nutrition Program Issues and Trends/Challenges and Opportunities The interest in locally grown foods and connecting consumers with the farmers who grow and harvest food has led to new partnerships and energy in the nutrition program. Participants literally may be at the table because of food quality, support of the local economy, concern for the environment, love of the land, or memories of harvests in years past. These are key points in marketing and promoting the nutrition program as they touch many in the target population for this service. Incorporating local foods into menus requires meal providers to procure, store and prepare meals in different ways. Training and incentives may be necessary to extend the use of local foods and achieve economies of scale throughout the program. We will endeavor to align and collaborate with the work being done in schools, prisons and worksites. The demand for home delivered meals continues to grow beyond that for congregate meals. The home delivered meal system has been strained by transportation costs and will continue to be vulnerable to this and the demand for a network of volunteer or paid drivers. Improving the health status of all meal participants, particularly those who receive home delivered meals, may assist in developing new congregate service delivery models as well as increasing the number of congregate meals served. In addition to strengthening OAA nutrition services through the promotion of the use of local foods, State Plan Goals 1, 2 and 4 are relevant and will involve the OAA Nutrition Program. Case Management Services Case managers play a vital role in helping older Vermonters and their families build upon their strengths, garner new resources, and develop a solid plan for achieving the goal of maximum independence. Over the years, the SUA has worked closely with the AAAs and the HHA network, to provide comprehensive case management services. Work between SUA and agency partners continues to strengthen case management services. During 2009 the SUA received the final recommendations from the UMass Center for Health Policy Research on Quality Management and Oversight in Choices for Care. Choices for Care provider agencies, which include the five Area Agencies on Aging in Vermont, are responsible for the coordination of services and long term care supports CfC participants receive while living in the community. Among the recommendations the UMass group made was to assess the quality of the CfC program by reviewing the case management function. The SUA decided to

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implement the UMass recommendation and include OAA case management services in that quality focus. We identified and completed several quality-focused projects needed to implement the UMass recommendations. In 2009 the SUA, in collaboration with agency partners, revised the Case Management Standards and Procedures for Older American Act Programs and Choices for Care, and in consultation with case managers from throughout the state, updated the training curriculum and developed a new case manager training process. Currently, the SUA is working with representatives from case management agencies to create a certification process for agencies providing case management services. Agency Certification will standardize the criteria and processes for all case management agencies providing services for OAA programs or Choices for Care.

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Promoting the Rights of Older Vermonters, Including those with Disabilities and Preventing Abuse, Neglect and Exploitation

Adult Protective Services (APS) Adult Protective Service (APS) is a cornerstone of Vermont’s system for protecting vulnerable adults from abuse, neglect and exploitation. The goals of APS are to promptly and thoroughly investigate allegations of abuse, neglect and exploitation, to increase awareness of adult abuse in all of its forms, to provide information about alternatives and services for vulnerable adults who are the victim of abuse, and to increase the reporting of suspected abuse.39 During SFY 2009 the APS unit received 2,452 unduplicated reports from 2,957 reporters. Embedded in those reports were 3,518 separate allegations of abuse, neglect or exploitation, with 1,456 reports closed during the screening process. Investigators were assigned to, and conducted, 996 investigations, which included 108 self neglect cases of vulnerable Vermonters less than 60 years of age. APS referred 175 cases of self neglect involving persons age 60 and over to the AAAs. APS recommended substantiations of 165 allegations against 82 perpetrators. As a result 80 new names were added to the APS abuse registry.40 According to Vermont’s APS Chief reports to APS continue to increase. An ideal caseload is 25 – 30 active investigations. APS investigators currently have 70 – 100 active investigations at once, which is an increase from a previous average when it had 35 to 60 active investigations. APS has noted a rise in reports attributed to financial exploitation of older adults in their homes, as well as in residential facilities by caregivers. Older Vermonters are frequently abused, neglected or exploited by their adult children or caregivers due to an increasing rate of drug abuse by the adult child, grandchild or caregiver. APS is managing its increased caseloads by performing more pre-investigative work in the office and increased use of police reports, before going to visit an older Vermonter at home. APS responds to reports of abuse, neglect and exploitation by prioritizing reports. Reports are then investigated according to this prioritization. The advocacy community has proposed to the Vermont Legislature a study of the APS system to determine trends, functioning and recommendations for ways to improve the system. The SUA supports a study of the APS system if funds are found to conduct the study independently of the SUA. During FFY 2011 – 2014, the SUA will strive to maximize APS and community resources to prevent abuse, neglect and exploitation. Community education will attempt to increase reporting from mandated reporters by targeting specific groups with information pertaining to: the abuse, neglect and exploitation of older Vermonters; risk factors; and the role of the mandated reporter. The SUA will strive to increase collaboration between APS, community partners and the Agency of Human Services (AHS) to maximize all possible resources. 39 Adult Protective Services Annual Report, January 2010, Department of Disabilities, Aging and Independent Living. 40 Ibid: Adult Protective Services Annual Report.

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State Long Term Care Ombudsman Program The SUA contracts with Vermont Legal Aid, Inc. to operate the Vermont Ombudsman Project (VOP) – a statewide long-term care ombudsman program that fulfills all of the advocacy requirements of Title VII, Chapter 2 of the Older Americans Act. Currently, there is one full-time State Ombudsman who supervisors 4.6 FTE regional ombudsmen. In addition to paid staff, the project utilizes 15 certified volunteers. In 2005, the Vermont legislature expanded the ombudsmen’s responsibilities. In addition to advocating for residents of nursing facilities, residential care homes and assisted living residences, the legislature gave ombudsmen the authority to respond to complaints on behalf of individuals receiving home-based services. The legislature directed the state to fund the equivalent of two full time regional ombudsmen to advocate for individuals receiving home based services under Choices for Care leaving the equivalent of 2.6 ombudsmen to serve individuals in facilities. All paid ombudsmen are crossed trained to handle both facility and community based complaints. During FFY 2011 – 2014 the Office of Long Term Care Ombudsman will: provide annual training on abuse, neglect and exploitation to nursing home residents and their families in five targeted facilities; develop a residents rights fact sheet and distribute it quarterly to residential care homes and assisted living residences. As a result of these efforts, the Ombudsman Project anticipates that Vermonters living in nursing homes will better understand their right to be free from abuse neglect. It also anticipates increasing by 10% the number of responses to requests for assistance from residents, family members and staff in residential care homes and assisted living residents. Legal Services The Senior Citizen’s Law Project through Vermont Legal Aid has received a three year grant from the Administration on Aging, with which the SUA will partner to improve the lives of older Vermonters by providing greater access to comprehensive and coordinated legal services in all areas of the state. Through this grant, a legal needs study will be conducted for the State of Vermont, a comprehensive and integrated legal intake and referral system will be developed for older Vermonters, and a statewide legal helpline focused on consumer law issues for older Vermonters, which can serve as a template for integrating legal helpline services into a full service organization will be piloted.

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How will Vermont’s Aging Network meet the needs of older adults? Goal 1 –Maintain effective and responsive management in Aging Services.

• Objective 1.1: Make State Unit on Aging (SUA) policies, procedures, guidelines and publications readily available and understandable for community partners.

Outcome 1.1: AAAs indicate during annual site visits they have the information they need from the SUA; it is readily available, accurate, concise and easy to understand.

Strategies: 1. SUA information will be made available through the Department’s website and other

forms of technology. 2. Information posted on the Department’s website will be timely, concise and clear. 3. Aging Disabilities Resource Connections (ADRC) partners will have complete

information on programs and services.

• Objective 1.2: Implement performance-based contracting and grants.

Outcome 1.2: Have fully implemented performance-based contracting and grants by FFY 2012. Strategies: 1. The SUA staff will review all SUA grants and contracts to ensure that they are

performance based with measurable outcomes.

• Objective 1.3: Develop plans for the continuity of operations that address the needs of older Vermonters in the case of a disaster or other emergency.

Outcome 1.3: Older Vermonters in need of assistance are identified and assisted in a disaster.

Strategies: 1. Update SUA continuity of operations plan (COOP) annually. 2. Inform and educate other AHS departments, Vermont Emergency Management and

SUA community providers about emergency preparedness for older adults. 3. Describe requirements for emergency preparedness in providers’ grants and contracts. 4. Monitor and evaluate continuity of operations planning of community providers

through the SUA quality review process.

• Objective 1.4: Promote the development of personal emergency preparedness plans by older Vermonters .

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Outcome 1.4: Older Vermonters receiving Choices for Care, (CfC) services in home and community based settings report they have an emergency plan. Strategies: 1. Provide SUA community providers with emergency preparedness information for

distribution to consumers. 2. Community providers will assist consumers with emergency preparedness planning

when no family supports are available. 3. Emergency preparedness activities of community providers will be monitored and

evaluated through the SUA quality review process.

• Objective 1.5: Improve the completeness and accuracy of required Older Americans Act State Program Reporting.

Outcome 1.5: The Vermont State Unit on Aging Older Americans Act State Program Report will include 10 percent or less missing data. Strategies: 1. AAAs will review required Older Americans Act (OAA) reporting and provide

explanations for any place in which 10% or more of the report data is missing; along with plans for improved data reporting.

2. SUA staff will provide technical assistance and information to AAAs based on suggestions obtained from states with lower percentages of missing data.

3. SUA will apply performance related measures to all programmatic and financial reporting.

Goal 2 – Promote a comprehensive, flexible and responsive system of service.

• Objective 2.1: Increase understanding of the strengths and mental health needs of older Vermonters between the Departments within the Agency of Human Services (AHS).

Outcome 2.1: Departments within AHS and community partners will have increased understanding of the mental health needs and strengths of Older Vermonters. Strategies: 1. Provide opportunities for collaboration within AHS and with community partners

related to the mental health needs of older Vermonters. 2. Contract with a geriatric psychiatrist to provide training, technical assistance and

consultation regarding the mental health needs and effective mental health services delivery to older Vermonters

• Objective 2.2: Improve the quality, flexibility and responsiveness of Older Americans

Act services, through the use of technology, performance measures and indicators.

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Outcome 2.2a: Each core Older Americans Act service and/or program will have performance measures. Strategies: 1. In consultation with AAAs, SUA staff will identify key outcomes and performance

measures for core Older Americans Act services and establish standards for AAA tracking and reporting on the measures.

2. SUA program staff will identify, track and report on statewide performance measures for each core Older Americans Act service and/or program, as well as target OAA services in accordance with AoA expectations.

Outcome 2.2b: Choices for Care participants will receive effective home and community based services to enable them to live longer in the community. Strategies: 1. SUA will support self-directed home and community based options, including

twenty-four hour, seven days a week residential alternatives. 2. Community providers will develop partnerships with local organizations to help CFC

participants connect to existing social activities or access more transportation without additional cost.

Goal 3 – Empower older Vermonters, their families, and other consumers to make informed decisions about, and to be able to easily access, existing health and long-term care options.

• Objective 3.1: A fully functioning and sustainable Aging Disabilities Resource Connection (ADRC) will exist in Vermont by 10/1/2012.

Outcome 3.1: Vermont’s ADRC will meet all Administration on Aging (AoA) specifications and will have a predictable funding stream. Strategies: 1. SUA will increase integration of ADRC partners through the use of “warm transfer”

technology and through the increased ease of moving from one partner’s website to the other.

2. SUA will expand options counseling/decision support capability among the partners, especially within the aging network.

3. SUA will increase the ability of the ADRC partners to support elders and individuals with disabilities who are at risk of institutionalization because of their recent discharge from an acute care or rehabilitation facility.

4. SUA will develop a five year plan for ADRC with ADRC partners, which addresses sustainable funding.

Objective 3.2: Older Vermonters, their families and other consumers will have ready

access to information from a variety of sources, including the ADRC,

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about financial planning for long-term care, including long-term care insurance.

Outcome 3.2: Vermonters, their families, and other consumers report that they

have the information they need for financial planning and for the purchase of long term care insurance, if wanted, on follow up surveys conducted by the ADRC.

Strategies: 1. ADRC will be a resource for Vermonters of all ages in planning for their future long

term care needs by providing a full range of information regarding long term care planning.

2. SUA will support the passage of long term care partnership legislation.

• Objective 3.3: Ensure Choices for Care (CfC) participants in nursing facilities receive ongoing options education on the efficacy of home and community based Services.

Outcome 3.3.1: All seniors transitioning from an acute to a sub-acute or long- term care setting will receive information about community based long- term care. Outcome 3.3.2: All seniors or their designated decision makers who express an interest in moving from a nursing home to a community based setting will be referred to an agency that can offer them comprehensive an unbiased information on community options and assist with a transition to the community if appropriate.

Strategies: 1. SUA will increase the ability of discharge planners in hospitals and nursing homes to provide comprehensive options counseling to elders and their family members through the provision of training and written materials. 2. SUA will modify current LTCCC options counseling practice to provide an option for detailed follow up with a home based provider of the consumer’s choice of available options. 3. The ADRC will work with hospital and nursing discharge staff to assure that appropriate transition information and supports are in place for all institutionalized seniors. 4. Working within the framework of the MDS, and the ADRC, the SUA will identify a local contact agency for nursing home staff to refer residents to who are interested in returning to the community.

• Objective 3.4: Develop mechanisms within CfC to improve timeliness of access.

Outcome 3.4: CfC participants have timely access to long term care supports in the setting of their choice.

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Strategies: 1. AHS will streamline financial eligibility process by implementing an expedited

decision process for clinically eligible individuals who meet initial financial eligibility criteria while their full eligibility for CfC is being determined.

2. DDAS will examine feasibility of Long Term Care Clinical Coordinator’s conducting initial clinical eligibility and certification through improved technology.

• Objective 3.5: Promote awareness of CfC and information for the general public..

Outcome 3.5: General public will show an awareness of long-term care options and settings as demonstrated by DAIL surveys and ADRC needs assessment and follow up calls. Strategies: 1. SUA will develop a more effective mechanism to disseminate information to the

general public regarding the extensive “menu” of service options for long term care services.

2. SUA will educate community partners including hospital and nursing home discharge planners on the range of LTC options so they are more effective in their option counseling to their clients.

Goal 4 – Empower older Vermonters to stay active and healthy through Older American Act services and prevention benefits under Medicare.41

• Objective 4.1: Create opportunities for older Vermonters to stay healthy and active.

Outcome 4.1: Increase the percentage of people 65 and older who are physically active; specifically the Behavioral Risk Factor Surveillance System will show a decrease in the percentage of people 65 and older who report no leisure time physical activity from 32.2% to 20%. Strategies: 1. SUA will collaborate with state and community partners to embed evidence based

prevention programs in communities. 2. SUA will collaborate with state and community partners to promote environmental

changes to support walking. 3. SUA will support AmeriCorps and RSVP programs that provide and train leaders for

health promotion programs.

• Objective 4.2: Promote broader use of preventive services by older Vermonters.

41 While OAA services are for people age 60+ the Vermont SUA is focusing on 65+ in this section due to the way the BRFSS data is collected and analyzed.

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Outcome 4.2a: The Behavioral Risk Factor Surveillance System will show an increase in the percentage of people 65 and over who have had a flu vaccine in the past year from 66.6% to 90%. Outcome 4.2b: The Behavioral Risk Factor Surveillance System will show an increase In the percentage of people 65 and over who have had pneumonia Vaccine from 65.6% to 90%. Strategies: 1. SUA will collaborate with state and community partners to establish convenient and

community based sites for delivery of services. 2. SUA will collaborate with state and community partners to bundle preventive

services. 3. SUA will collaborate and coordinate services with health care providers, Department

of Health, Department of Vermont Health Access and community organizations.

• Objective 4.3: Expand the use of locally procured foods in the Older Americans Act Nutrition Program.

Outcome 4.3a: Establish baseline measure of use of locally procured foods in the nutrition program. Outcome 4.3b: Increase the use of locally procured foods in the nutrition program by 15%. Strategies: 1. SUA will assess meal site provider needs regarding the use of fresh foods in the

nutrition program; 2. SUA will collaborate with community and state partners to enhance local foods

distribution. 3. SUA will explore the use of preferential purchasing policies. 4. SUA will spearhead the development of education and training programs and

materials for meal site providers. 5. SUA will explore providing incentives for meal site providers to procure and serve

local foods. 6. SUA will create “Healthy Food in OAA Nutrition Program Pledge” for meal site

providers. Goal 5 – Older Vermonters have access to quality mental health, dementia and substance abuse services.

• Objective 5.1: Increase access to quality mental health, dementia and substance services for older Vermonters.

Outcome 5.1:.Increased number of clinicians to serve older Vermonters as well as increased numbers of older Vermonters receiving mental health dementia and substance abuse services.

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Strategies: 1. SUA in collaboration with the VT Association of Social Workers (VASW) will

develop a consortium of private, licensed mental health clinicians to provide elder mental health, dementia and substance abuse services.

2. SUA will support the provision of best practice interventions for clinicians to improve quality of care.

3. SUA will collaborate with the Department of Mental Health (DMH) to ensure provider grants and contracts are performed-based for service delivery, program evaluation and reporting.

4. SUA will collaborate with DMH in the development of standards to evaluate quality of elder mental health, dementia and substance abuse services.

Goal 6 – Resources to support family caregivers of older adults and older relative caregivers of children are available and accessible.

• Objective 6.1: Increase support and knowledge of resources for caregivers of older Vermonters and older relative caregivers of children.

Outcome 6.1: Family caregivers who obtain services through the National Family Caregiver Support Program and/or the State Dementia Respite Program are able to maintain their health and quality of life while continuing in their caregiving roles as demonstrated by responses to annual surveys.

Strategies: 1. ADRC and community partners will provide opportunities for caregivers to increase

their awareness of existing caregiver resources. 2. Aging providers will conduct caregiver needs assessments to identify gaps in

services. 3. Aging providers will establish programs and services to meet identified needs of older

relative caregivers of children. 4. Aging providers and SUA will evaluate the effectiveness of caregiver programs

services. 5. SUA will explore feasibility of conducting a needs assessment process for caregivers

utilizing the Behavioral Risk Factor Surveillance System. Goal 7 – Increase the participation of older Vermonters in the workforce.

• Objective 7.1: Create opportunities for public education and key partnerships with employment agencies, the Division of Vocational Rehabilitation, (DVR) and the business community to increase awareness of the benefits of hiring older Vermonters.

Outcome 7.1a: Build capacity to respond to the inquiries and educational needs of mature workers and employers.

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Strategies: 1. The SUA will collaborate with employment and human service agencies, including

the Division of Vocational Rehabilitation (DVR) to develop information and referral portals for older Vermonter’s and employers.

2. The SUA will collaborate with The Governor’s Committee on the Employment of People with Disabilities and DVR as a venue for employer education, technical assistance and networking.

Outcome 7.1b: Increase employment and community service options for older Vermonters. Strategies: 1. The SUA will explore initiatives for older workers to access temporary employment

service organizations. 2. The SUA will partner with Vermont Associates for Training and Development’s

Aging Workforce Demonstration Grant to support the goal of connecting the mature workforce to Vermont employers.

3. Community partners will build opportunities for meaningful volunteer and community service work for older Vermonters that enables them to contribute their knowledge and experience while also enjoying greater flexibility in work schedules.

Goal 8 – Promote the rights of older Vermonters including those with disabilities and prevent abuse, neglect and exploitation.

• Objective 8.1: Maximize SUA and community resources to prevent abuse, neglect and exploitation.

Outcome 8.1a: Increase collaboration between Adult Protective Services (APS), community partners and the Agency of Human Services (AHS). Strategies: 1. APS will provide community education targeting specific groups of mandated

reporters with information pertaining to the abuse, neglect and exploitation of older Vermonters, risk factors and the role of the mandated reporter.

2. APS will conduct follow-up on a small percentage of referrals to community partners to determine outcomes of individual referrals and enhance collaboration.

3. The APS Chief will attend quarterly meetings with Area Agencies on Aging (AAAs) Executive Directors and SUA to enhance communication and resolve issues of concern to both APS and AAAs.

4. APS staff will work with the DAIL Advisory Board as directed and invited by the Board and the Commissioner to enhance collaboration and to explore ways to resolve issues of concern to both APS and the DAIL Advisory Board.

• Objective 8.2: Long Term Care Facility Residents and their families, and Choices for Care (CfC) participants receiving services in home- and community-

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based settings will know they have the right to be free from abuse, exploitation and neglect, including caregiver neglect.

Outcome 8.2: Long Term Care Facility Residents and their families, and Choices for Care (CfC) participants in home- and community-based settings will understand what constitutes abuse, exploitation and neglect, including caregiver neglect.

Strategies: 1. Vermont Ombudsman Project (VOP) staff will provide five trainings on abuse,

neglect and exploitation to nursing home residents and their families each year. 2. VOP will survey nursing home residents and family members after training to see

what knowledge they have retained about this subject. 3. AAAs and HHAs will provide annual training for case managers working with CfC

participants in home- and community-based settings and other staff on abuse, neglect and exploitation, and ensure staff know how to make a report.

• Objective 8.3: Vermonters living in residential care homes and assisted living residences will know they have the right to be free from abuse, exploitation and neglect, including caregiver neglect.

Outcome 8.3: VOP will see a 10% increase in the number of requests for assistance from residents, family members and staff in residential care homes and assisted living residences.

Strategies: 1. VOP will develop a resident rights fact sheet targeted to residential care homes and

assisted living residences. 2. VOP will distribute the fact sheet during quarterly visits to each facility. 3. VOP will track data.

• Objective 8.4: Improve the lives of older Vermonters by providing greater access to comprehensive and coordinated legal services in all areas of the state.

Outcomes: 8.4: Coordinated system for the intake, referral, and delivery of legal services that increases access to legal services for older Vermonters statewide. Strategies: 1. The Senior Law Project (SLP) will complete a legal needs study for the State of

Vermont. 2. SLP will develop a comprehensive and integrated legal intake and referral system for

older Vermonters. 3. SLP will pilot a statewide legal helpline focused on consumer law issues for older

Vermonters, which can serve as a template for integrating legal helpline services into a full service organization.

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Goal 9: The SUA will encourage the development of affordable housing options and supportive services for older Vermonters with lower incomes.

• Objective 9.1: SUA will support efforts to preserve and expand community based affordable housing for older Vermonters.

Strategies: 1. SUA will respond to requests for letters of support from housing providers. 2. SUA will provide data and information relevant to Vermont’s aging population

as requested by housing providers. 3. SUA will participate on the Agency of Human Services (AHS) Housing Task Force in

identifying AHS priorities, including addressing homelessness, and developing affordable housing options.

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Summary of Public Hearing And Comment Process

A public hearing on the Vermont Draft State Plan on Aging was held on May 13, 2010 in the Waterbury, Vermont State Office Complex following the Department of Disabilities, Aging and Independent Living (DAIL) Advisory Board Meeting. Many members of the DAIL Advisory Board attended the public hearing, as did four of the five Area Agency on Aging Directors. The hearing was structured around the DAIL Advisory Board to encourage broad input, feedback and suggestions on the Draft. We are pleased this effort was successful; SUA received significantly more feedback than in prior years. In addition to the public hearing written comments were received from representatives of five housing providers, one representative of nursing facilities, residential care homes, assisted living facilities, one member of the DAIL Advisory Board, the Statewide Program Director for the Neighbor to Neighbor AmeriCorps Program, and three staff within the SUA. We are appreciative of the interest and time taken by members of the DAIL Advisory Board and those representatives who provided written feedback on behalf of older Vermonters and family caregivers. Representatives of housing providers commented that while the Draft indicated the majority of older Vermonters prefer to receive long-term care services in their homes there was no clear identification of DAIL resources directed toward housing issues to respond to the growing demand for affordable senior housing. Representatives indicated several barriers to older Vermonters living independently in the community including the rising cost of housing and the rising cost of serving frail, older Vermonters. Several recommendations were offered such as adding a goal to promote affordable housing options with supportive services for older Vermonters with low incomes, fostering networks between social service agencies and housing providers, supporting efforts to preserve community-based affordable senior housing and providing needed services to existing community-based affordable housing developments for older Vermonters. It was also recommended DAIL support the inclusion and expansion of the Seniors Aging Safely at Home (SASH) pilot to all residents of affordable senior housing owned or managed by public housing authorities or nonprofits. In response to these comments, and mindful of the limited resources at the SUA for these activities, a goal has been added to encourage the development of affordable housing options and supportive services for older Vermonters with lower incomes. A representative of the Vermont Health Care Association (VHCA), representing nursing facilities, residential care homes and assisted living residences, suggested further inclusion of objective and factual information describing the services offered and provided by nursing homes, residential care homes and assisted living residences. The SUA agrees that nursing homes, residential care homes and assisted living residences are an important component of Vermont’s Aging Network. In response to this comment, the SUA added descriptions of these providers to the State Plan. The VHCA also requested a modification of Objectives under Goal 8 for the Long Term Ombudsman Program to target older Vermonters and family members of those receiving Choices for Care services in home based settings in program efforts to inform older Vermonters and family members of what constitutes abuse, neglect and exploitation, and knowing how to make a report, as well as residential, nursing and assisted living facilities. The final draft incorporates this recommendation.

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The Statewide Director of the Neighbor to Neighbor AmeriCorps program requested inclusion in the State Plan of the Corporation for National and Community Service programs: Neighbor to Neighbor AmeriCorps, Senior Companions and RSVP . This was also a recommendation of a member of the DAIL Advisory Board. In response to these comments, these programs are now included in the description of Vermont’s Aging Network and Goal 7 has been expanded to reference volunteer and community service programs. A member of the Advisory Board suggested the development of a certification process for clinicians who provide elder mental health, dementia and substance abuse services. This suggestion was not incorporated as a State Plan goal due to already existing extensive professional licensure requirements in Vermont. More detailed work related to the identification of the consortium of private, licensed mental health clinicians will be incorporated into SUA staff workplans at the Department. DAIL Advisory Board members requested further clarification of Goal 8 concerning Adult Protective Services (APS) work to maximize SUA and community resources to prevent, abuse, neglect and exploitation. Key staff from APS within the Division of Licensing and Protection will continue to work with the DAIL Advisory Board on issues of concern as directed and invited by the Board and the Commissioner of DAIL. One representative of Area Agencies on Aging requested another objective be added for nutrition services under Goal 4. While the OAA Nutrition Program is not specifically mentioned, these activities are reflected in Goals 1 and 2. Therefore, no change to Goal 4 was made. A suggestion was offered under Goal 4 to promote broader use of preventive services by older Vermonters beyond immunizations and for influenza and pneumonia to other immunizations such as for shingles. This is included in the strategy under this objective to bundle preventive services. While shingles is not included in Medicare adult immunization prevention benefits the SUA will encourage the administration of shingles vaccine at visits for influenza immunization as part of this strategy. A recommendation was given by a DAIL Advisory Board member to provide information in the State Plan on Aging evaluating the progress of goals and objectives in the current State Plan on Aging. This information has been incorporated into an appendix in the final draft. DAIL staff working in Deaf/Hard of Hearing Services noted the prevalence of hearing loss issues among older Vermonters, the increase of Vermont’s aging population and the cost of hearing aids, with presently no insurance plans providing coverage. While this is an important issue, the need is beyond the scope of the State Plan on Aging. It should be noted; however, that the AAAs provide Information, Referral and Assistance to older Vermonters around the issue of obtaining necessary diagnosis and treatment of hearing loss. One staff person within DAIL commented on the absence of a plan for substantive change to Adult Day Services. It was suggested the State Plan be a place to support a new and innovative approach to Adult Days that reflects the needs of the next generation of older Vermonters. While DAIL and service providers should always be thinking about how to develop better response to the needs and preferences of people we serve, given DAIL’s resources at this time we need to be somewhat conservative in how many goals/objectives we take on, or ask providers to take on. DAIL recognizes the importance of encouraging adult day providers to provide more

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1:1 experiences in the community for participants. While this is particularly challenging given the state of transportation and limited resources innovative approaches to adult day services is an important area that is likely to be a goal/objective in a future State Plan on Aging, particularly related to Goal 2, as the SUA will be working with adult day providers to establish and measure outcomes.

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Guide To State Plan On Aging Acronyms

Acronym Description AAA Area Agency on Aging ADDGS Alzheimer’s Disease Demonstration Grants to States Program ADP Adult Day Program ADRC Aging And Disability Resource Connections ADRD Alzheimer’s Disease and Related Disorders AHS Vermont Agency of Human Services AoA Administration on Aging APS Adult Protective Services ARRA American Recovery and Reinvestment Act BISHCA Vermont Department Of Banking, Securities and Health Care Administration BRFSS Behavioral Risk Factor Surveillance System CFC Choices for Care CMS Centers For Medicare and Medicaid Services COASEV Council on Aging for Southeastern Vermont COVE Community of Vermont Elders CVAA Champlain Valley Agency on Aging CVCOA Central Vermont Council on Aging DAIL Department of Disabilities, Aging and Independent Living DDAS Division of Disability and Aging Services DVHA Department of Vermont Health Access DMH Department of Mental Health ERC Enhanced Residential Care HASS Housing and Supportive Services Grant Program HCB Home- and Community-Based HHA Home Health Agency I/R/A Information/Referral/Assistance LTC Long Term Care NEVAAA Northeastern Vermont Area Agency On Aging NFCSP National Family Caregiver Support Program NSIP Nutrition Services Incentive Program OAA Older Americans Act OAP Old, Alone and Poor PACE Program for All-Inclusive Care for The Elderly SASH Seniors Aging Safely at Home Pilot SLP Senior Law Project SCSEP Senior Community Service Employment Program SMPP Senior Medicare Patrol Project SHIP State Health Insurance Assistance Program SVCOA Southwestern Vermont Council On Aging TBI Traumatic Brain Injury VAHHA Vermont Assembly of Home Health Agencies VCIL Vermont Center for Independent Living VDH Vermont Department of Health VOP Vermont Ombudsman Project

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Vermont State Unit on Aging Monitoring Guide September 29, 2009

This is a section from the September 29, 2009 Vermont State Unit on Aging Monitoring Guide to provide a brief summary on the progress on Goals from the State Plan on Aging FFY 2007 – 2010.

AAA Key:

COASEV: Council on Aging for Southeastern VT CVCOA: Central VT Council on Aging CVAA: Champlain Valley Agency on Aging NEVAAA: Northeastern Vermont Area Agency on Aging SVCOA: Southwestern VT Council on Aging I. VT State Plan on Aging Goals: How is the SUA progressing in meeting the Goals stated in the 2007 plan submission?

1. Developing Aging and Disability Resource Centers (ADRC) as highly visible and trusted places in the community where older Vermonters and family caregivers can go to receive comprehensive, Information, Referral and Assistance, streamlined access to services and help in planning to meet their future long-term care needs. • Core partners in the ADRC project include the 5 AAA’s statewide, Brain Injury

Association, VT 2-1-1, VT Center for Independent Living, VT Family Network, and HowardCenter (developmental services).

• Over the course of the grant, we merged from two regional ADRCs to one Statewide ADRC initiative-evolving into the VT Aging and Disability Resource Connection, including expansion to three new AAA regions.

• Vermont has recently purchased a statewide Refer license (I&A software) and ADRC partners jointly fund Centralized Refer Database Coordinator. This will support all ADRC partners to benefit from using the same software and having access to skilled technical assistance and support around the use of the software, organization of resource information and exchange of information.

• Please see the ADRC Final Report included with the monitoring packet for a more detailed summary of accomplishments.

• Vermont is pleased to learn that it has been awarded another ADRC grant for FFY 10 – 12 and looks forward to expanding and enhancing ADRC services across the state.

2. Enhance the ability of older Vermonters to live as independently as possible, actively

participating in and contributing to their communities, by expanding the options available, increasing consumer choice and control, and maximizing the value of public resources. • Improved access to and flexibility of services through the development and

implementation of ADRC. • Flexible Choices is currently serving 87 individuals. Flexible Choices is a “cash and

counseling” model of service whereby individuals are provided with an allocation based on an assessment of their long term care needs. They work with an options counselor to develop an individualized plan about how they will use their allocation

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to meet their long term care goals. This program has been somewhat slow to grow in Vermont. We believe that this is likely due to the fact that individuals are generally pleased with the services that they receive; and Vermont already has a large number of persons who receive personal care through a consumer- or surrogate-directed model.

• Individuals served in adult day services have expanded from roughly 716 in FY 2006 to 1,110 in FY 2008. Adult day participation in FY 2009 through the third quarter is roughly 918; suggesting that adult day centers will serve a slightly higher number of individuals in FY 2009.

• Choices for Care (CFC): Enhanced Residential Care has increased from 173 individuals served in 2006 to 314 as of April 2009. Home and Community-Based Services participation has increased from 968 individuals served in 2006 to 1,439 in April 2009. Nursing facility utilization has decreased from 2, 286 to 2,046 in April 2009.

• Consumer Perceptions surveys indicate a high degree of satisfaction with services they receive. The 2008 Consumer Satisfaction Survey of individuals receiving Choices for Care personal care, adult day services and/or homemaker services, and Attendant Services indicated “overwhelming satisfaction with, and approval of, the programs in which they participated,” indicating at least 84% satisfaction with all services.i

3. Enhance the ability of Vermonters of all ages to make healthy lifestyle choices by

developing a Healthy Aging Plan for Vermont. The Plan will address specific chronic conditions and supportive services that promote healthy aging and increase the awareness of the benefits of engaging in programs and activities that will lead to improved physical and emotional well-being. As part of this effort, Vermont will continue to shift the balance of long-term care funding toward services that expand our capacity to promote and provide prevention-based systems of service. Vermont will also support efforts to increase the number of health care and human service professionals with training in geriatrics and gerontology: specifically as they related to health, well-being and chronic disease management.

• The Governor’s Commission on Healthy Aging meets bimonthly to address specific chronic conditions through partnering with the Department of Health and the Vermont Blueprint for Health. The Commission completed a Plan for Healthy Aging which has been in place for a few years and is in the process of updating it.

• Evidence-based practice and promising practice programs that promote healthy aging and independent living have increased in primary care settings and community programs. Examples include: Matter of Balance, PEARLS and Healthier Living Workshops.

• The Blueprint for Heath has now established guidelines for primary care practices in the treatment of diabetes and in two regions of the state community care teams have been created to promote improved health status for Vermonters with chronic conditions.

• The University of Vermont is creating a new Center on Aging. This year, for the first time, the Center sponsored its first Symposium on Aging, in Burlington and Rutland.

• Lyndon State College and the Simmons School of Social Work are exploring the feasibility of a satellite MSW program with a focused track on gerontology and aging. This will be a long-term project.

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4. Continue to support family caregivers by developing and strengthening of multifaceted systems of services that provide needed support and resources to maintain their caregiving role. Goal: Expand availability of all five categories of National Family Caregiver Support Program (NFCSP) services in each AAA planning and service area.

• All five AAAs receive State General Funds to support a Dementia Respite Grant program for caregivers of individuals with Alzheimer’s Disease and Related Disorders. Funding in this program has significantly decreased this year (nearly 50%), as previously some funds from the AoA Alzheimer’s Disease Demonstration Grants to State (ADDGS) program helped to support this program.

• Two AAAs (NEVAAA and COASEV) provide respite grants to family caregivers who are ineligible for respite through other programs. The number of NFCSP grants for dementia caregivers have increased since the AoA ADDGS funding ended.

• Four AAAs (all but CVAA) provide regular training workshops on topics of importance to family caregivers. For example, this fall, SVCOA along with its partners in the Southwestern Vermont Caregiving Coalition is offering workshops on "Being an Effective Caregiver"; and "Seniors with Seizures" (in partnership with the Epilepsy Foundation of VT). COASEV has offered training on topics such as home safety and NEVAAA offers Powerful Tools for Caregivers at two locations in the Northeast Kingdom several times per year. This 6-week program has been well-received by the community and there are waiting lists for the training program at times.

• COASEV & SVCOA had start-up kinship caregiver support groups for a short time; however, the groups were small and unsustainable.

• CVAA has provided $5.000 in funding for the annual Vermont Kin as Parents conference for several years.

• Identifying kinship caregivers who are eligible for NFCSP services continues to be a challenge for the AAAs, even with the change in the OAA definition of eligible caregiver in this category. The AAAs are trying to increase support for kinship caregivers by increasing their collaboration with VT Kin as Parents who have a statewide presence for kinship caregivers. NEVAAA has worked with VKAP to offer respite grants for grandparent caregivers to send the grandchildren in their care to summer camps. DAIL, AAAs and VKAP are currently trying to develop a statewide program of this type. VKAP will be attending the October AAA Executive Directors meeting to discuss further.

Major recent accomplishment: DAIL, working in cooperation with the AAAs, has modified the reporting process for the dementia respite program. This will increase the accuracy of dementia respite services and expenditures included on the SPR.

5. Develop a system of continuous quality improvement that includes effective evaluations of those services and organizations funded under the OAA, as well as those linked to these services and organizations through the community network of providers.

• Tracking of outcome-based performance indicators of services administered by the Department: The former Quality Management Unit reviewed AAAs in terms

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of CFC Case Management Services, Home Health Agencies for Choices for Care services (case management, personal care), adult day services, developmental services and traumatic brain injury services. Quality management reviews also included consumer-directed and surrogate-directed services for both AAAs and HHAs.

• Current quality management development work is underway, looking at the process for Quality Assurance/Continuous Quality Improvement (QA/CQI) for OAA Nutrition Services, OAA & CFC case management services, adult day services and other service areas. Quality management reviews began this summer of developmental services, traumatic brain injury services and adult day services using revised methodologies that were developed in consultation with providers and consumers.

As part of the CFC evaluation process, focused attention is being placed on developing an effective QA/CQI process for CFC services, which will extend to OAA case management. A key recommendation by evaluators is to look at quality through the lens of the case manager. There is a Case Management Work Group currently focusing on the components of case management agency certification, (strong focus on agencies having internal QA/CQI plan and process, which DAIL will review, as well as peer review) Case Management Training and possible restructuring of individual case management certification. A full copy of the CFC Quality Brief may be found on the DAIL website at: http://www.ddas.vermont.gov/ddas-publications/publications-idu/publications-idu-documents/umass-quality-policy-brief

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Method of Distribution For Title III and State Funding The Area Agencies on Aging were consulted regarding the current method of distribution for Title III and state funding for FFY 2011 – 2014 and invited to offer input regarding possible changes. No comments were offered. Therefore, the SUA is electing to retain the current methodology. There are four steps in the distribution process of Older Americans Act and state funding to the Area Agencies on Aging. These include:

1. Base distribution of $425,220 is divided equally among the AAA ($85,044 per AAA). 2. Calculation of remaining funds includes weighting of factors related to social need

(OAP), numbers of aged 60 and over and economic need. • One-third of the funds are distributed according to age; • 80% of the remaining two-thirds is distributed using the OAP formula; • 20% of the remaining two-thirds is distributed according to the number of

individuals below 125% of poverty. 3. Social need calculation based on population cohort age 75+ living alone and below the

poverty line (OAP) in each AAA region. 4. Economic need based on population cohort 60+ below 125% of poverty and not OAP

(Pov 125) in each AAA region. Funding Formula Factors (UPDATE) Population cohorts for cohorts for the 60 and Over Age category are based on the Municipal Population Estimates for July 1, 2000 through July 1, 2008 as published by the US Census in conjunction with the Federal/State Cooperative Program for Population Estimates (FSCPE) and use 2000 Census baseline data. Population cohorts for the Old, Alone and Poor category (OAP) are estimated based on detailed economic and demographic data from the 2000 Census. Specifically, the 2000 Census data for Old, Alone and Poor are projected forward based on the percentage growth rate by age segments in the Age 75 and Over cohort between the July 1, 2000 Census and the July 1, 2008 Census estimates. Population cohorts for the Pov125 category are estimated based on detailed economic and demographic data from the 2000 Census. Specifically, the 2000 Census data for Pov125 are projected forward based on the percentage growth in the Age 60 and Over cohort between the 2000 Census and the 2004 Census estimates by County and Region.

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Population Data and ‘Old, Alone and Poor’ Data For Selected AAA Service Area By Elderly Age Groups

These are the age 60 and over factors (Age): Area Population Factor (% of State) Central 19,181 18.82% Champlain 31,658 31.06% Northeast 12,814 12.57% Southeast 18,753 18.40% Southwest 19,533 19.16% Total 101,940 100% These are the Old, Alone and Poor Factors (OAP): Area Population Factor (% of State) Central 477 20.24% Champlain 671 28.47% Northeast 367 15.57% Southeast 384 16.29% Southwest 458 19.43% Total 2,357 100% These are the age 60 and over, below 125% of Poverty, not the OAP Factors (Pov 125%) Area Population Factor (% of State) Central 1,905 18.51% Champlain 2,895 28.13% Northeast 1,757 17.07% Southeast 1,758 17.08% Southwest 1,976 19.20% Total 10,291 100% Note: Population cohorts for the 60 and Over Age category are based on the Municipal Population Estimates for July 1, 2000 through July 1, 2008 as published by the US Census in conjunction with the Federal/State Cooperative Program for Population Estimates (FSCPE) and use 2000 Census baseline data. Population cohorts for the Old, Alone and Poor category (OAP) are estimated based on detailed economic and demographic data from the 2000 Census. Specifically, the 2000 Census data for Old, Alone and Poor are projected forward based on the percentage growth rate by age segments in the Age 75 and Over cohort between the July 1, 2000 Census and the July 1, 2008 Census estimates.

Older Americans Act Allocations to Area Agencies On Aging

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OLDER AMERICANS ACT ALLOCATIONS TO AREA AGENCIES ON AGING

RESOURCE PROJECTIONS FOR 2011 BASED ON AWARD DATED 01129110

CENTRAL CHAMPLAIN NORTHEAST SOUTHEAST SOUTHWEST TOTAL

TITLE III and VII SERVICE BASE 85,044 85,044 85,044 65,044 85,044 425.22D SUPPORTIVE SERVICES 850,655 1,275,352 643,247 744,624 84DP949 4,354,827

SUB-TOTAL SERVICES 935,699 1.360,396 728,291 629,668 925,993 4,780,047 AREA PLAN ADMINISTRATION 110,636 110,636 110,637 110,637 110,636 553,182 NET TITLE III and VII 1,046,335 1,471,032 836,928 940,305 1,036,629 5.333,229 STATE GENERAL FUND 860,22D 1,289,691 650,477 752,998 850,408 4,403,794 LONG TERM CARE FLEX FUMDS 18,064 29,814 12,067 17,660 18,395 96.00D SPECIAL SERVICES FUND 4,785 6,732 3.6B2 3.852 4,595 23,646 ALZHEIMER FUND 47,040 77,639 31,426 45,991 47,904 250.OOD ST GEN FUND MATCH FOR 3SVT OR TRANS TO DCF" 41,509 62,233 31,366 36,335 41,035 212,SOD ST GEN FUND TRANS TO DMH 48,833 73,215 36,926 42,747 48,277 250.00D NUTRITION SERVICES INCENTIVE PROGRAM 120,811 211,641 103,401 149,331 142,963 728,147

TOTAL 2,187,597 3.221,997 1,708,297 1,969,219 2,190,206 11,297,316

Title III and VII funds are based upon the January 28, 2010 Title III and VII FV10 awards to the State.

Title III and related resources are based on 2DD0 Census data and July 1, 2008 Census estimates far Vermont by county and age. Old Alone and Poor, Pov 1 25 and 6D+ population figures are based on Data Set Census 2D00 Summary File 3 (SF 3) - Sample Data.

Nutrition Services Incentive Program (NSIP) uses FY1D award dated April 12, 2D 10 and is allocated using NSIP meals served tor FY09.

* The General Fund match for the 3 Squares VT (3SVT) outreach is to be transferred by the Department of Disabilities, Aging and Independent Living (DAIL] to the Department for Children and Families {DCF) based on agreement between DAIL and DCF and distributed to the AAAs in accordance with 1he DCF-AAA 3SVT outreach grants.

** Area Agencies on Aging are required to expand at least 65% of Part B funds for Access to Services, 1% of Part B funds for In-home Services and 5% of Part B funds for Legal Assistance.

*** Section 307 (a) (3) (B) with respect to supportive services: all funds for FFY 11-14 will be spent on elder services provided in rural areas.

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State Agency and Area Agency Information

VERMONT State Agency on Aging

Department of Disabilities, Aging and Independent Living 103 South Main Street

Waterbury, Vermont 05671-1601 Commissioner: Joan Senecal

Phone: (802) 241-2401 Fax: (802)

TTY: (802) 241-3557 State Unit on Aging Contact: Marie Bean

Phone: (802) 241-4425 Fax: (802) 241 - 4224

Website: www.dail.state.vt.us

Area Agencies on Aging

Statewide Information and Assistance: Senior HelpLine: 1-800-642-5119 Central Vermont Council on Aging 30 Washington Street Barre, VT 05641 Director: Elizabeth Stern Phone: (802) 479-0531 Fax: (802) 479-4235 Web site: http://www.cvcoa.org/

Champlain Valley Agency on Aging 76 Pearl Street, Suite 201 Essex Junction, VT 05452 Director: John Barbour Phone: (802) 865-0360 Fax: (802) 865-0363 Web site: www.cvaa.org E-mail: info@cvaa.org

Council on Aging for Southeastern Vermont 56 Main Street, Suite 304 Springfield, VT 05156 Director: Joyce Lemire Phone: (802) 885-2655 Fax: (802) 885-2665 Web site: www.coasevt.org

Northeastern VT Area Agency on Aging 481 Summer Street, Suite 101 St. Johnsbury, VT 05819 Director: Ken Gordon Phone: (802) 748-5182 Fax: (802) 748-6622 Web site: www.nevaaa.org

Southwestern Vermont Council on Aging East Ridge Professional Building 1085 U.S. Route 4 East, Unit 2B

Rutland, VT 05701 Director: Diane Novak Phone: (802) 786-5990 Fax: (802) 786-5994

Web site: www.svcoa.org

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FY 2011 State Plan Guidance

Attachment A

STATE PLAN ASSURANCES, REQUIRED ACTIVITIES AND INFORMATION REQUIREMENTS

Older Americans Act, As Amended in 2006

By signing this document, the authorized official commits the State Agency on Aging to performing all listed assurances, required activities and information requirements as stipulated in the Older Americans Act, as amended in 2006. ASSURANCES Sec. 305(a) - (c), ORGANIZATION (a)(2)(A) The State agency shall, except as provided in subsection (b)(5), designate for each such area (planning and service area) after consideration of the views offered by the unit or units of general purpose local government in such area, a public or private nonprofit agency or organization as the area agency on aging for such area. (a)(2)(B) The State agency shall provide assurances, satisfactory to the Assistant Secretary, 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. (a)(2)(E) The State agency shall provide assurance that preference will be given to providing services to older individuals with greatest economic need and older individuals with greatest social need, (with particular attention to low-income older individuals, including low-income minority older individuals, older individuals with limited English proficiency, and older individuals residing in rural areas) and include proposed methods of carrying out the preference in the State plan; (a)(2)(F) The State agency shall provide assurances that the State agency will require use of outreach efforts described in section 307(a)(16). (a)(2)(G)(ii) The State agency shall provide an assurance that the State agency will undertake specific program development, advocacy, and outreach efforts focused on the needs of low-income minority older individuals and older individuals residing in rural areas. (c)(5) In the case of a State specified in subsection (b)(5), the State agency and area agencies shall provide assurance, determined adequate by the State agency, that the area agency on aging will have the ability to develop an area plan and to carry out, directly or through contractual or other arrangements, a program in accordance with the plan within the planning and service area. States must assure that the following assurances (Section 306) will be met by its designated area agencies on agencies, or by the State in the case of single planning and service area states. Sec. 306(a), AREA PLANS (2) Each area agency on aging shall provide assurances that an adequate proportion, as required under section 307(a)(2), of 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- (A) services associated with access to services (transportation, health services (including mental health services), outreach, information and assistance (which may include information and

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assistance to consumers on availability of services under part B and how to receive benefits under and participate in publicly supported programs for which the consumer may be eligible), and case management services); (B) in-home services, including supportive services for families of older individuals who are victims of Alzheimer's disease and related disorders with neurological and organic brain dysfunction; and (C) legal assistance; and assurances that the area agency on aging will report annually to the State agency in detail the amount of funds expended for each such category during the fiscal year most recently concluded. (4)(A)(i)(I) provide assurances that the area agency on aging will— (aa) set specific objectives, consistent with State policy, for providing services to older individuals with greatest economic need, older individuals with greatest social need, and older individuals at risk for institutional placement; (bb) include specific objectives for providing services to low-income minority older individuals, older individuals with limited English proficiency, and older individuals residing in rural areas; and (II) include proposed methods to achieve the objectives described in items (aa) and (bb) of subclause (I); (ii) provide assurances 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) specify how the provider intends to satisfy the service needs of low-income minority individuals, older individuals with limited English proficiency, and older individuals residing in rural areas in the area served by the provider; (II) to the maximum extent feasible, provide services to low-income minority individuals, older individuals with limited English proficiency, and older individuals residing in rural areas in accordance with their need for such services; and (III) meet specific objectives established by the area agency on aging, for providing services to low-income minority individuals, older individuals with limited English proficiency, and older individuals residing in rural areas within the planning and service area; and (4)(A)(iii) With respect to the fiscal year preceding the fiscal year for which such plan is prepared, each area agency on aging shall-- (I) identify the number of low-income minority older individuals and older individuals residing in rural areas in the planning and service area; (II) describe the methods used to satisfy the service needs of such minority older individuals; and (III) provide information on the extent to which the area agency on aging met the objectives described in clause (a)(4)(A)(i). (4)(B)(i) Each area agency on aging shall provide assurances that the area agency on aging will use outreach efforts that will identify individuals eligible for assistance under this Act, with special emphasis on-- (I) older individuals residing in rural areas; (II) older individuals with greatest economic need (with particular attention to low-income minority individuals and older individuals residing in rural areas); (III) older individuals with greatest social need (with particular attention to low-income minority individuals and older individuals residing in rural areas); (IV) older individuals with severe disabilities; (V) older individuals with limited English proficiency; (VI) older individuals with Alzheimer’s disease and related disorders with neurological and organic brain dysfunction (and the caretakers of such individuals); and

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(VII) older individuals at risk for institutional placement; and (4)(C) Each area agency on agency shall provide assurance that the area agency on aging will ensure that each activity undertaken by the agency, including planning, advocacy, and systems development, will include a focus on the needs of low-income minority older individuals and older individuals residing in rural areas. (5) Each area agency on aging shall provide assurances that the area agency on aging will coordinate planning, identification, assessment of needs, and provision of services for older individuals with disabilities, with particular attention to individuals with severe disabilities, and individuals at risk for institutional placement, with agencies that develop or provide services for individuals with disabilities. (6)(F) Each area agency will: in coordination with the State agency and with the State agency responsible for mental health services, increase public awareness of mental health disorders, remove barriers to diagnosis and treatment, and coordinate mental health services (including mental health screenings) provided with funds expended by the area agency on aging with mental health services provided by community health centers and by other public agencies and nonprofit private organizations; (9) Each area agency on aging shall provide assurances that the area agency on aging, in carrying out the State Long-Term Care Ombudsman program under section 307(a)(9), will expend not less than the total amount of funds appropriated under this Act and expended by the agency in fiscal year 2000 in carrying out such a program under this title. (11) Each area agency on aging shall provide information and assurances concerning services to older individuals who are Native Americans (referred to in this paragraph as "older Native Americans"), including- (A) information concerning whether there is a significant population of older Native Americans in the planning and service area and if so, an assurance that the area agency on aging will pursue activities, including outreach, to increase access of those older Native Americans to programs and benefits provided under this title; (B) an assurance that the area agency on aging will, to the maximum extent practicable, coordinate the services the agency provides under this title with services provided under title VI; and (C) an assurance that the area agency on aging will make services under the area plan available, to the same extent as such services are available to older individuals within the planning and service area, to older Native Americans. (13)(A) Each area agency on aging shall provide assurances that the area agency on aging will maintain the integrity and public purpose of services provided, and service providers, under this title in all contractual and commercial relationships. (13)(B) Each area agency on aging shall provide assurances that the area agency on aging will disclose to the Assistant Secretary 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. (13)(C) Each area agency on aging shall provide assurances that the area agency will demonstrate that a loss or diminution in the quantity or quality of the services provided, or to be provided, under this title by such agency has not resulted and will not result from such non-governmental contracts or such commercial relationships. (13)(D) Each area agency on aging shall provide assurances that the area agency will 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 non-governmental contracts or commercial relationships.

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(13)(E) Each area agency on aging shall provide assurances that the area agency will, on the request of the Assistant Secretary 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. (14) Each area agency on aging shall provide assurances 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 carry out a contract or commercial relationship that is not carried out to implement this title. (15) provide assurances that funds received under this title will be used- (A) to provide benefits and services to older individuals, giving priority to older individuals identified in paragraph (4)(A)(i); and (B) in compliance with the assurances specified in paragraph (13) and the limitations specified in section 212; Sec. 307, STATE PLANS (7)(A) The plan shall provide satisfactory assurance that such fiscal control and fund accounting procedures will be adopted as may be necessary to 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. (7)(B) The plan shall provide assurances that-- (i) no individual (appointed or otherwise) involved in the designation of the State 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; (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. (9) The plan shall provide assurances that the State agency will carry out, through the Office of the State Long-Term Care Ombudsman, a State Long-Term Care Ombudsman program in accordance with section 712 and this title, and will expend for such purpose an amount that is not less than an amount expended by the State agency with funds received under this title for fiscal year 2000, and an amount that is not less than the amount expended by the State agency with funds received under title VII for fiscal year 2000. (10) The plan shall provide assurance that the special needs of older individuals residing in rural areas will be taken into consideration and shall describe how those needs have been met and describe how funds have been allocated to meet those needs. (11)(A) The plan shall provide assurances that area agencies on aging will-- (i) enter into contracts with providers of legal assistance which can demonstrate the experience or capacity to deliver legal assistance; (ii) include in any such contract provisions to assure that any recipient of funds under division (A) 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 membership of local governing boards) as determined appropriate by the Assistant Secretary; and (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. (11)(B) The plan contains assurances that no legal assistance will be furnished unless the grantee administers a program designed to provide legal assistance to older individuals with social or

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economic need 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 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, that any grantee selected is the entity best able to provide the particular services. (11)(D) The plan contains assurances, to the extent practicable, that legal assistance furnished under the plan will be in addition to any legal assistance for older individuals being furnished with funds from sources other than this Act and that reasonable efforts will be made to maintain existing levels of legal assistance for older individuals; (11)(E) The plan contains assurances 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. (12) The plan shall provide, whenever the State desires to provide for a fiscal year for services for the prevention of abuse of older individuals, the plan contains assurances that any area agency on aging carrying out such services will conduct a program consistent with relevant State law and coordinated with existing State adult protective service activities for-- (A) public education to identify and prevent abuse of older individuals; (B) receipt of reports of abuse of older individuals; (C) 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 (D) referral of complaints to law enforcement or public protective service agencies where appropriate. (13) The plan shall provide assurances that each State will assign personnel (one of whom shall be known as a legal assistance developer) to provide State leadership in developing legal assistance programs for older individuals throughout the State. (14) The plan shall, with respect to the fiscal year preceding the fiscal year for which such plan is prepared— (A) identify the number of low-income minority older individuals in the State, including the number of low income minority older individuals with limited English proficiency; and (B) describe the methods used to satisfy the service needs of the low-income minority older individuals described in subparagraph (A), including the plan to meet the needs of low-income minority older individuals with limited English proficiency. (15) The plan shall provide assurances that, if a substantial number of the older individuals residing in any planning and service area in the State are of limited English-speaking ability, then the State will require the area agency on aging for each such planning and service area— (A) to utilize in the delivery of outreach services under section 306(a)(2)(A), the services of workers who are fluent in the language spoken by a predominant number of such older individuals who are of limited English-speaking ability; and (B) to designate an individual employed by the area agency on aging, or available to such area agency on aging on a full-time basis, whose responsibilities will include-- (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 in order to assist such older individuals in participating in programs and receiving 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.

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(16) The plan shall provide assurances 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 areas; (ii) older individuals with greatest economic need (with particular attention to low-income older individuals, including low-income minority older individuals, older individuals with limited English proficiency, and older individuals residing in rural areas; (iii) older individuals with greatest social need (with particular attention to low-income older individuals, including low-income minority older individuals, older individuals with limited English proficiency, and older individuals residing in rural areas; (iv) older individuals with severe disabilities; (v) older individuals with limited English-speaking ability; and (vi) older individuals with Alzheimer’s disease and related disorders with neurological and organic brain dysfunction (and the caretakers of such individuals); and (B) inform the older individuals referred to in clauses (i) through (vi) of subparagraph (A), and the caretakers of such individuals, of the availability of such assistance. (17) The plan shall provide, with respect to the needs of older individuals with severe disabilities, assurances that the State will coordinate planning, identification, assessment of needs, and service for older individuals with disabilities with particular attention to individuals with severe disabilities with the State agencies with primary responsibility for individuals with disabilities, including severe disabilities, to enhance services and develop collaborative programs, where appropriate, to meet the needs of older individuals with disabilities. (18) The plan shall provide assurances that area agencies on aging will conduct efforts to facilitate the coordination of community-based, long-term care services, pursuant to section 306(a)(7), for older individuals who-- (A) reside at home and are at risk of institutionalization because of limitations on their ability to function independently; (B) are patients in hospitals and are at risk of prolonged institutionalization; or (C) are patients in long-term care facilities, but who can return to their homes if community-based services are provided to them. (19) The plan shall include the assurances and description required by section 705(a). (20) The plan shall provide assurances that special efforts will be made to provide technical assistance to minority providers of services. (21) The plan shall (A) provide an assurance that the State agency will coordinate programs under this title and programs under title VI, if applicable; and (B) provide an assurance that the State agency 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 provided under this title, if applicable, and specify the ways in which the State agency intends to implement the activities. (22) 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)(8). (23) The plan shall provide assurances that demonstrable efforts will be made-- (A) to coordinate services provided under this Act with other State services that benefit older individuals; and (B) to provide multigenerational activities, such as opportunities for older individuals to serve as mentors or advisers in child care, youth day care, educational assistance, at-risk youth intervention, juvenile delinquency treatment, and family support programs.

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(24) The plan shall provide assurances that the State will coordinate public services within the State to assist older individuals to obtain transportation services associated with access to services provided under this title, to services under title VI, to comprehensive counseling services, and to legal assistance. (25) The plan shall include assurances that the State has in effect a mechanism to provide for quality in the provision of in-home services under this title. (26) The plan shall provide assurances 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 agency or an area agency on aging to carry out a contract or commercial relationship that is not carried out to implement this title. (27) The plan shall provide assurances that area agencies on aging will provide, to the extent feasible, for the furnishing of services under this Act, consistent with self-directed care. Sec. 308, PLANNING, COORDINATION, EVALUATION, AND ADMINISTRATION OF STATE PLANS (b)(3)(E) No application by a State under subparagraph (b)(3)(A) shall be approved unless it contains assurances that no amounts received by the State under this paragraph will be used to hire any individual to fill a job opening created by the action of the State in laying off or terminating the employment of any regular employee not supported under 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. Sec. 705, ADDITIONAL STATE PLAN REQUIREMENTS (as numbered in statute) (1) The State plan shall provide an assurance that the State, in carrying out any chapter of this subtitle for which the State receives funding under this subtitle, will establish programs in accordance with the requirements of the chapter and this chapter. (2) The State plan shall provide an assurance that the State will hold public hearings, and use other means, to obtain the views of older individuals, area agencies on aging, recipients of grants under title VI, and other interested persons and entities regarding programs carried out under this subtitle. (3) The State plan shall provide an assurance that the State, in consultation with area agencies on aging, will identify and prioritize statewide activities aimed at ensuring that older individuals have access to, and assistance in securing and maintaining, benefits and rights. (4) The State plan shall provide an assurance that the State will use funds made available under this subtitle for a chapter in addition to, and will not supplant, any funds that are expended under any Federal or State law in existence on the day before the date of the enactment of this subtitle, to carry out each of the vulnerable elder rights protection activities described in the chapter. (5) The State plan shall provide an assurance that the State will place no restrictions, other than the requirements referred to in clauses (i) through (iv) of section 712(a)(5)(C), on the eligibility of entities for designation as local Ombudsman entities under section 712(a)(5). (6) The State plan shall provide an assurance that, with respect to programs for the prevention of elder abuse, neglect, and exploitation under chapter 3— (A) in carrying out such programs the State agency will conduct a program of services consistent with relevant State law and coordinated with existing State adult protective service activities for--(i) public education to identify and prevent elder abuse; (ii) receipt of reports of elder abuse; (iii) active participation of older individuals participating in programs under this Act through outreach, conferences, and referral of such individuals to other social service agencies or sources of assistance if appropriate and if the individuals to be referred consent; and

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(iv) referral of complaints to law enforcement or public protective service agencies if appropriate; (B) the State will not permit involuntary or coerced participation in the program of services described in subparagraph (A) by alleged victims, abusers, or their households; and (C) all information gathered in the course of receiving reports and making referrals shall remain confidential except-- (i) if all parties to such complaint consent in writing to the release of such information; (ii) if the release of such information is to a law enforcement agency, public protective service agency, licensing or certification agency, ombudsman program, or protection or advocacy system; or (iii) upon court order REQUIRED ACTIVITIES Sec. 307(a) STATE PLANS (1)(A)The State Agency requires each area agency on aging designated under section 305(a)(2)(A) to develop and submit to the State agency for approval, in accordance with a uniform format developed by the State agency, an area plan meeting the requirements of section 306; and (B) The State plan is based on such area plans. Note: THIS SUBSECTION OF STATUTE DOES NOT REQUIRE THAT AREA PLANS BE DEVELOPED PRIOR TO STATE PLANS AND/OR THAT STATE PLANS DEVELOP AS A COMPILATION OF AREA PLANS. (2) The State agency: (A) evaluates, using uniform procedures described in section 202(a)(26), the need for supportive services (including legal assistance pursuant to 307(a)(11), information and assistance, and transportation services), nutrition services, and multipurpose senior centers within the State; (B) has developed a standardized process to determine the extent to which public or private programs and resources (including Department of Labor Senior Community Service Employment Program participants, and programs and services of voluntary organizations) have the capacity and actually meet such need; (4) The plan shall provide that the State agency will conduct periodic evaluations of, and public hearings on, activities and projects carried out in the State under this title and title VII, including evaluations of the effectiveness of services provided to individuals with greatest economic need, greatest social need, or disabilities (with particular attention to low-income minority older individuals, older individuals with limited English proficiency, and older individuals residing in rural areas). Note: “Periodic” (defined in 45CFR Part 1321.3) means, at a minimum, once each fiscal year. (5) The State agency: (A) affords an opportunity for a public hearing upon request, in accordance with published procedures, to any area agency on aging submitting a plan under this title, to any provider of (or applicant to provide) services; (B) issues guidelines applicable to grievance procedures required by section 306(a)(10); and (C) affords an opportunity for a public hearing, upon request, by an area agency on aging, by a provider of (or applicant to provide) services, or by any recipient of services under this title regarding any waiver request, including those under Section 316. (6) The State agency will make such reports, in such form, and containing such information, as the Assistant Secretary may require, and comply with such requirements as the Assistant Secretary may impose to insure the correctness of such reports.

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(8)(A) No supportive services, nutrition services, or in-home services are directly provided by the State agency or an area agency on aging in the State, unless, in the judgment of the State agency-- (i) provision of such services by the State agency or the area agency on aging is necessary to assure an adequate supply of such services; (ii) such services are directly related to such State agency's or area agency on aging's administrative functions; or (iii) such services can be provided more economically, and with comparable quality, by such State agency or area agency on aging. INFORMATION REQUIREMENTS Section 102(19)(G) – (required only if the State funds in-home services not already defined in Sec. 102(19)) The term “in-home services” includes other in-home services as defined by the State agency in the State plan submitted in accordance with Sec. 307. Section 305(a)(2)(E) provide assurance that preference will be given to providing services to older individuals with greatest economic need and older individuals with greatest social need, (with particular attention to low-income older individuals, including low-income minority older individuals, older individuals with limited English proficiency, and older individuals residing in rural areas) and include proposed methods of carrying out the preference in the State plan; Section 306(a)(17) Each Area Plan will include information detailing how the Area Agency will coordinate activities and develop long-range emergency preparedness plans with local and State emergency response agencies, relief organizations, local and State governments and other institutions that have responsibility for disaster relief service delivery. Section 307(a) (2) The plan shall provide that the State agency will: (C) Specify a minimum proportion of the funds received by each area agency on aging in the State to carry out part B that will be expended (in the absence of a waiver under sections 306 (c) or 316) by such area agency on aging to provide each of the categories of services specified in section 306(a)(2) (Note: those categories are access, in-home, and legal assistance). Section (307(a)(3) The plan shall: (A) include (and may not be approved unless the Assistant Secretary approves) the statement and demonstration required by paragraphs (2) and (4) of section 305(d) (concerning distribution of funds); (Note: the “statement and demonstration” are the numerical statement of the intrastate funding formula, and a demonstration of the allocation of funds to each planning and service area) (B) with respect to services for older individuals residing in rural areas: (i) provide assurances the State agency will spend for each fiscal year of the plan, not less than the amount expended for such services for fiscal year 2000. (ii) identify, for each fiscal year to which the plan applies, the projected costs of providing such services (including the cost of providing access to such services).

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(iii) describe the methods used to meet the needs for such services in the fiscal year preceding the first year to which such plan applies. Section 307(a)(8)) (Include in plan if applicable) (B) Regarding case management services, if the State agency or area agency on aging is already providing case management services (as of the date of submission of the plan) under a State program, the plan may specify that such agency is allowed to continue to provide case management services. (C) The plan may specify that an area agency on aging is allowed to directly provide information and assistance services and outreach. Section 307(a)(10) The plan shall provide assurance that the special needs of older individuals residing in rural areas are taken into consideration and shall describe how those needs have been met and describe how funds have been allocated to meet those needs. Section 307(a)(21) The plan shall: (B) provide an assurance that the State agency 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 provided under this title (title III), if applicable, and specify the ways in which the State agency intends to implement the activities . Section 307(a)(28) (A) The plan shall include, at the election of the State, an assessment of how prepared the State is, under the State’s statewide service delivery model, for any anticipated change in the number of older individuals during the 10-year period following the fiscal year for which the plan is submitted. (B) Such assessment may include— (i) the projected change in the number of older individuals in the State; (ii) an analysis of how such change may affect such individuals, including individuals with low incomes, individuals with greatest economic need, minority older individuals, older individuals residing in rural areas, and older individuals with limited English proficiency; (iii) an analysis of how the programs, policies, and services provided by the State can be improved, including coordinating with area agencies on aging, and how resource levels can be adjusted to meet the needs of the changing population of older individuals in the State; and (iv) an analysis of how the change in the number of individuals age 85 and older in the State is expected to affect the need for supportive services. Section 307(a)(29) The plan shall include information detailing how the State will coordinate activities, and develop long-range emergency preparedness plans, with area agencies on aging, local emergency response agencies, relief organizations, local governments, State agencies responsible for emergency preparedness, and any other institutions that have responsibility for disaster relief service delivery.

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Section 307(a)(30) The plan shall include information describing the involvement of the head of the State agency in the development, revision, and implementation of emergency preparedness plans, including the State Public Health Emergency Preparedness and Response Plan. Section 705(a)(7) In order to be eligible to receive an allotment under this subtitle, a State shall include in the State plan submitted under section 307: (7) a description of the manner in which the State agency will carry out this title in accordance with the assurances described in paragraphs (1) through (6). (Note: Paragraphs (1) of through (6) of this section are listed below) In order to be eligible to receive an allotment under this subtitle, a State shall include in the State plan submitted under section 307: (1) an assurance that the State, in carrying out any chapter of this subtitle for which the State receives funding under this subtitle, will establish programs in accordance with the requirements of the chapter and this chapter; (2) an assurance that the State will hold public hearings, and use other means, to obtain the views of older individuals, area agencies on aging, recipients of grants under title VI, and other interested persons and entities regarding programs carried out under this subtitle; (3) an assurance that the State, in consultation with area agencies on aging, will identify and prioritize statewide activities aimed at ensuring that older individuals have access to, and assistance in securing and maintaining, benefits and rights; (4) an assurance that the State will use funds made available under this subtitle for a chapter in addition to, and will not supplant, any funds that are expended under any Federal or State law in existence on the day before the date of the enactment of this subtitle, to carry out each of the vulnerable elder rights protection activities described in the chapter; (5) an assurance that the State will place no restrictions, other than the requirements referred to in clauses (i) through (iv) of section 712(a)(5)(C), on the eligibility of entities for designation as local Ombudsman entities under section 712(a)(5); (6) an assurance that, with respect to programs for the prevention of elder abuse, neglect, and exploitation under chapter 3-- (A) in carrying out such programs the State agency will conduct a program of services consistent with relevant State law and coordinated with existing State adult protective service activities for: (i) public education to identify and prevent elder abuse; (ii) receipt of reports of elder abuse; (iii) active participation of older individuals participating in programs under this Act through outreach, conferences, and referral of such individuals to other social service agencies or sources of assistance if appropriate and if the individuals to be referred consent; and (iv) referral of complaints to law enforcement or public protective service agencies if appropriate; (B) the State will not permit involuntary or coerced participation in the program of services described in subparagraph (A) by alleged victims, abusers, or their households; and (C) all information gathered in the course of receiving reports and making referrals shall remain confidential except--