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Description:“Study coordination and delivery of services for seniors, and examine thepossibility of more efficient allocation of services provided by the AreaAgencies on Aging (AAA)”
Goals & Expectations:• Look at modernizing the Older Americans Act service delivery system
to provide essential, high-quality services more efficiently to older Oklahomans.
• Realize possible efficiencies in administrative costs (dollars) as well as practice/structure (contracting, monitoring, etc.)
• Any savings should be diverted back into services• Preserve current service level and quality• Include aging network in the development of a plan
What is the structure of the aging network?– What’s happening demographically and are we prepared to respond?– How many AAAs are aligned with Council of Government (COG) and
why?– What is our service penetration rate (how many are served)?– How many employees work in the AAA system?
How is the aging network in the state funded?– Is the state’s network sufficiently funded?– How does funding flow through the COGs and AAAs?– How much money (and what percentage of overall funding) goes
towards administrative costs?– How much money (and what percentage of admin) goes towards
indirect costs?– Are there guidelines on how much indirect can be charged?– What is the approximate cost per unit for services delivered?
Has the network ever been updated, looked at critically or modernized?– Is there a way to deliver services more efficiently?– Could a plan be put together that saves money but ensures service
delivery remains at present level?– How much money could be saved if redistricting occurred?– What changes would require federal approval?– Are there easier, lower-hanging fruit type changes that could be
made?
How does Oklahoma compare to other states?– What have other states done to modernize their network and has
that worked?– How dependent are we (OK) on state funds versus other states?– If redistricting occurred, how much funding could be diverted to
– Continuation of nutrition, direct care services, caregiver, case-management services, consumer advocacy, transportation
– Development of partnerships to ensure that older Oklahomans stay in touch with “their worlds”
– Optimization of grant opportunities and adoption of best practices
– Ensure current number of OSHL representatives– Ensure adequate support of OSHL activities – Review degrees of success of different AAA’s– Review structure of aging network to ensure
consistency – Ensure proximity of providers to consumers
• High poverty rate (19th in US) – 9.8% of 65+• Larger number of rural dwellers• Very poor health indicators• High disability ratio (8th in US)• High Old-Age Dependency Ratio (14th in US)• Leading state for Grandparents Raising
Grandchildren (6th in US) – 44,000• Reliance on public programs• Income/Lack of savings• Poor LTC planning
Challenges: within service delivery system ~
• Budget Fragility• Competition for resources• Creating a brand• Present capacity of network• Ability to expand network on a dime• Political pressures• General awareness
1965- Older Americans Act (OAA)• Established U.S. Administration on Aging (AoA) & state agencies on aging
(SUA) to address social services needs of older people• Mission: maintain maximum independence and promote continuum of
care• Seven (7) titles
– Title III: Grants for State and Community Programs on Aging– Title IV: Activities for Health, Independence, and Longevity (Program
Innovations)– Title VII: Vulnerable Elder Rights Protection– Note: collaboration with V (Community Service) and VI (Nat Amer)
• Funds are distributed via formula• 66.7% of total funding is Title III• Targeting:
– Greatest economic or social need/means testing prohibited– Voluntary contributions for services– Cost-sharing policies for certain services- sliding scale– No denial of services for failure to contribute
State Unit on Aging =OKDHS Aging Services Division
“…a unifying force at the state level through which the broad policy objectives of the Older Americans Act ultimately come to pass. An agency designated by the Governor as the focal point on all matters relating to the needs of older adults.”
Existing OAA NetworkExisting OAA Network • Established in 1973Established in 1973• State Unit on Aging: OKDHS Aging Services Division (ASD)State Unit on Aging: OKDHS Aging Services Division (ASD)
– Designated by Federal Government and Governor of Oklahoma as the sole agency for administering the Older Americans Act (OAA) programs
– State Plan development every four (4) years• Area Agencies on Aging - planning, advocacy, and
development of OAA services in regional service area• Program Partners – Meals on Wheels, Regional Councils,
Dept of Commerce, Insurance Dept, etc.• Network of Providers (subcontractors) – service delivery at
General Considerations• Reminder of purpose, goals and expectations• Stress efficiency while ensuring service delivery• Recent conversations date back to spring 2011• General legislative inquiries date back to SFY2008• Any plan will be discussed and approved by the federal
government• Appreciate ability to discuss• Many states are looking at changes or have recently made
state network adjustments• All considerations have merit
– Some are larger, structural in nature– All would result in some form of modernization/efficiency– Must fully explore pros/cons
Consideration #1: Is there a way to more efficiently manage the LEGAL AID Services system?
• Overview:• Statewide, non-profit organization providing free legal services to
60+• Provides general civil legal services to all 77 counties• Contracts with each of the 11 AAAs• LASO is only entity bidding• Other activities often performed by trained paralegals
• Funding:• Funded through Title III of OAA• Represents about 5% of AAA budget
• Challenges:• Disparate service areas complicates and makes more difficult
bookkeeping and billing• Some communities are excluded from coverage• Repetitive and variable application process, reporting,
• Consideration: Explore the viability of consolidating this statewide service under a single contract
• Potential results:– More efficient, uniform service delivery – Less redundancy in reporting– Reduction in administrative costs for contracting, monitoring,
reporting, etc.– One contract versus eleven– Full statewide coverage– Better coordination– Connectedness to statewide hotline– Uniform oversight by lawyer (Legal Services Developer)
• Next step: At the committee’s pleasure, the aging network looks into the possible implementation of this idea– No statutory mandate required– Will not require federal approval
Consideration #2: Is there a more efficient way to managethe role REGISTERED DIETICIANS play within the network?– Overview:
• Presently, 20 contracts statewide for Registered Dieticians (RD)• RDs provide training for nutrition project staff, develop menus,
provide nutrition counseling • State policy allows either AAA or nutrition project to contract• OAA provides for solicitation of dietitian or other with comparable
expertise in planning of nutritional services• No instances of food poisoning since beginning of nutrition programs
– Funding:$280,108 - cost of services in SFY11
– Challenges:• Some duties don’t require RD licensure• Little time to perform nutrition counseling or other critical duties• Rural areas have little access to RDs and more in travel costs• RD training- minimal due to limitations of high hourly cost ($25-$60/hr)
• Consideration: Explore the viability of consolidating this statewide service under a single contract
• Potential results:– More efficient use of limited available resources– Overall possible reduction of cost– Service Provision consistency– Consistency of training and oversight
• Next step: At the committee’s pleasure, the aging network looks into the possible implementation of this idea– No statutory mandate required– Will not require federal approval
Consideration #3: Should the SENIOR INFO LINE remain in place?
• Overview• Established in 2004 by OKDHS/ASD• 1-800 dedicated phone line to increase access• Serves all 77 counties/connects callers with closest AAA• Trained Information Specialists answer the Senior Info-Lines• 569 completed calls/1435.80 minutes in duration (September 2011)
• Funding• OKDHS pays minimal monthly costs• September 2011 $45.66 (annual costs range between $600-$800)
• Challenges• Recurring problems with proper transfers to the appropriate AAA• Uses AT&T trunk lines (archaic)• Routing problems exist when new area codes are added• Information Specialists not available to answer the phones/use
voice mail/impersonal• Duplicates services provided by 2-1-1
– (Social Services hot-line refers callers to AAA)
• Consideration: Explore the viability of tying line into other existing referral sources
• Potential results:– More efficient use of limited available resources– Overall possible reduction of cost– Service Provision consistency– Consistency of training and oversight
• Next step: At the committee’s pleasure, the aging network looks into the possible implementation of this idea– No statutory mandate required– Will not require federal approval
Consideration #4: Should Oklahoma explore realigning Planning and Service Areas (PSAs) within the state to create a more modern, stronger and efficient service delivery system?– Overview:
• Present structure was put into place in 1973• Most AAA are under the umbrella of COG - 10 of 11• Some AAAs have Direct Service Waivers (DSWs)
– Funding• SFY11 = $26,655,655 (state/federal)• Pass Through vs. Administrative monies• Indirect as part of Administrative monies
– Challenges (cont.):• Indirect costs• How will population shifts impact funding and/or formula?• Funding formula needs to be updated• Is present system efficient (are 11 AAAs needed?)• With budget constraints, will PSA shifting inevitably occur?
– Consideration: Explore the viability of modernizing, streamlining and strengthening Oklahoma’s aging network
– Potential results:• More efficient use of limited available resources• Overall possible reduction of cost• Service provision consistency• Consistency of training and oversight
– Next step: At the committee’s pleasure, the aging network looks into the possible implementation of this idea
• No statutory mandate required• Could require federal approval if structure is changed
National Data on AAA organizational infrastructure• Independent/NP = 42%• Part of County Gov = 29%• Part of COG = 23%• Part of City Gov = 2%• Other = 4%• Reminder: in Oklahoma, all
but one of the 11 are in COGs
• Some COGs provide additional support that is difficult to track
An Area Agency on Aging (AAA) develops an Area Plan to receive Older Americans Act funding from the State Agency
•Establish advisory councils•Develop and administer area plans•Develop and coordinate resources•Advocate for older Oklahomans•Fund and monitor local projects•Provide technical assistance and training•Designate community focal points
While no 2 are necessarily the same, have common responsibilities
Supportive Services (service provider contractors) Homemaker Personal care Chore Transportation Assisted Transportation Outreach Home repair Legal assistance Health promotion Case management
– During economic downturns, state leaders and policy makers strategize about ways to become more administratively efficient
• Focus on Function– Able to carry out three basic functions effectively: Grant
management, Information and assistance (ADRC), Resource development
• Vision– Changes based on how best to meet needs of the people served– Fewer AAAs but stronger– Better communication and stronger relationship between SUA and
AAA• Resources
– Consolidation will give regions more resources in total– Streamlining AAAs will make them capable of taking on new grants
and provide additional services• Local network changes have a profound impact on oversight, pricing, and
contact with consumers in states with large rural regions
– Impetus• Fourteen (14) AAAs, some so small (1.5 staff), they were
unable to carry out all three basic functions effectively- grant management, I&A, and resource development
– Outcomes• Began process in 2001; completed in 2005• Reduced the number of PSAs and AAAs from 14 to 7• Increased capacity of each AAA and more resources in total• Stronger relationship between the SUA and AAAs
• No “loss of local presence” if the structure is changed– Any accepted plan would preserve current presence– Recognize fresh programs/initiatives like 2-1-1 and the Aging &
Disability Resource Consortium (ADRC), information access is growing more efficient and seamless
– Existing, local providers would still likely be in place– End result could be more served for less administrative cost
• No “slippage in quality assurance” of programs– Accepted plan would ensure quality of services
• Costs would not climb much higher (ex: travel) if the structure is changed– Any accepted plan would address travel expenses – Understandably, some costing may shift (some up, some
down) but at the very least the plan should be cost neutral with greater programmatic efficiencies being realized
Possible efficiencies in contemplated streamlining
• Efficiencies realized– Increase in competition amongst service providers– Increase in quality of services– Use of limited available resources more efficiently – Potential reduction of costs– Consistency of provision of services – Consistency of training and oversight
• Example - ASCOG nutrition consolidated three nutrition programs into one successfully
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CURRENT SYSTEMCURRENT SYSTEM
OKDHS ASDOKDHS ASD State Unit on AgingState Unit on Aging
AAA
COG COG COG COG COG COGCOG COG
AAA
COG
AAA AAA
Ombudsman(24)
AAA
OAA CM(1)
AAA AAAAAAAAA AAAAAA
Information & Assistance(14)
In-Home Services
Outreach Legal Services
Congregate/HDMNutrition ED
Nutrition CounselingHP/MM
TransportationFamily Caregiver Support Services
PERMANENT WAIVERS
LOCAL SERVICE PROVIDERS LOCAL SERVICE PROVIDERS
TEMPORARY WAIVERS
COG(COG)
STREAMLINED SYSTEMSTREAMLINED SYSTEM
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OK SUA
COG COG COG COGCOG COG
DHHS / AOA
OMB(24)
AAA
OAA CM(1)
AAA AAAAAAAAAAAA
I&A(14)
Transportation
PERMANENT WAIVERS
LOCAL SERVICE PROVIDERS LOCAL SERVICE PROVIDERS
Outreach
Congregate/HDMNutrition ED
Nutrition CounselingHP/MM
In-Home Services
Family Caregiver Services Legal Services
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AAA AAAAAA AAAAAA AAA AAAAAAAAA AAAAAA
Transportation(1)
SFY 2011 TEMPORARY WAIVERS
Health Promotion/Medication Management
(5)
Family CaregiverSupport Program
(5)
LegendState Fiscal Year (SFY)Area Agency on Aging (AAA)
OKDHS ASD wishes to thank Oklahoma legislators for their time and for the opportunity to share the Modernizing & Strengthening Modernizing & Strengthening
Oklahoma’s Aging Network Oklahoma’s Aging Network presentation and to thank the partners, presentation and to thank the partners, advocates and constituents for their valuable contributions and advocates and constituents for their valuable contributions and