COA Program Updates

Contracts awarded for Title III services

Congregate meals are one of the services provided by Title III funding.

A bidding process for Title III services such as transportation and congregate meals is complete and providers have been awarded new agreements.

Thirty organizations responded to COA's Request for Proposals and 25 received funding to deliver all or some of the services for which they applied. However, nearly all received a reduced number of units and/or unit rate compared to their bid.

Three applicants, who provide high priority services to seniors with the greatest needs, did not receive contracts. COA reserved funds to assure that services to these seniors continue and will decide the best way to accomplish this.

COA decided to terminate its Title III contracts and seek new bids following a decision by the state to cut 39 percent of funds for services such as transportation, congregate meals, caregiver support and wellness programs.

Title III is a section of the Older Americans Act which authorizes funds to states and Area Agencies on Aging. Council on Aging uses the funds to advocate for older adults and help them remain within their own homes and communities. Money goes to senior centers and service organizations such as Pro Seniors and Catholic Social Services. Title III funds are leveraged with the State Community Services Block Grant, which Ohio legislators cut by 39 percent for State Fiscal Year 2010-2011.

"It is very difficult to have to cut this much out of important services," said David Wolfzorn, COA chief financial officer. "But several good things came out of the bidding process. We preserved funding for the highest priority services and we contracted with the highest performing providers -- those who are financially stable and can balance quality with cost. We also gained experience in the complexities of competitive bidding. That's important because we expect to be doing more of it."

Current Title III contracts will end Dec. 31 and the new agreements will begin Jan. 1.

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Simple actions net big results for seniors with depression

Simple things can have a big impact in the lives of older adults with mild to moderate depression.

For one woman, it was simply getting outdoors and tossing a ball with her home health aide. For another, it was saying hello to a stranger on her daily walk. Through a program called Healthy IDEAS, simple acts like these have helped older adults with mild to moderate depression boost their energy and just feel better about life.

Healthy IDEAS is an evidence-based program that helps detect and reduce depressive symptoms in older adults. Council on Aging received a grant earlier this year to train PASSPORT and Elderly Services Program (ESP) care managers on how to use the program with their clients.

Since July, nearly 400 PASSPORT and ESP clients have been screened using the Healthy IDEAS model. Of those, more than 60 have gone through a more in depth assessment.

Healthy IDEAS helps older adults and families identify depressive symptoms by asking simple, non-threatening questions, such as: "Do you prefer to stay at home, rather than going out and doing new things?" "Are you in good spirits most of the time?" and "Are you afraid that something bad is going to happen to you?"  

Care managers review these and other questions with their clients and then come up with a score based on their responses. Clients identified through the assessment process work with their care manager over a three month period to help improve their mood. They develop a Behavioral Action Plan, including a goal and action steps to try and meet that goal. The client's plan may include help from an aide, friend, family member or other community resource. The client's progress is monitored for three months and then reevaluated. Some clients then set new goals for themselves and others are referred to community-based resources for additional help.

According to Theresa Bracher, COA's Resources, Intake and Assessment manager, clients who participate in the program see results in a short period of time. They report lower pain levels, sleep better at night, have more energy and are ready to take on the next challenge.

The program is still in the early stages in most counties served by COA, except in Warren County, where all ESP care managers have begun using the Healthy IDEAS screening model. By the end of 2010, all ESP and PASSPORT care managers will be trained and using the screening tools with their clients.

In Butler County, two additional programs are underway to help meet the more complex mental health needs of the county's elderly residents.  (Click here to read related story.)

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Plan is underway to reduce number of Elderly Services Program providers

• Adding requirements to the contracting process
• Eliminating providers who had not billed for services in two years
• Reducing the number of providers serving two senior housing complexes, one in Hamilton County and one in Warren County (This plan will expand to additional housing complexes)

• Use competitive bidding to reduce the number of providers
• Split counties into regions and bid each region separately (two regions in Warren County; six in Hamilton County)
• Group similar services and offer bid alternatives (example: a provider could bid on home care services, home-delivered meals, or both
• Include quality measures in the referral process

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Rising demand prompts eligibility limits for Hamilton County ESP

Beginning in February, COA expects to tighten eligibility for new clients applying for the Hamilton County Elderly Services Program. The change is designed to control demand, which threatens to outpace the program's tax levy funding.

The program is already serving more people than was projected for 2012, the year the current levy expires. Last spring, COA started a waiting list in order to manage enrollment. The wait is relatively brief at this point -- only two to three weeks.

Hamilton County ESP is already serving more people than was projected for 2012, the year the current levy expires.

The Hamilton County Elderly Services Program Advisory Council approved the recommended changes last fall. Hamilton County Commissioners are expected to adopt a resolution soon that would allow the new standards to take effect. Current clients will not be affected.

The changes would take place in three phases. Phase 1 would remove "mechanical assistance," as a criterion for enrollment. For example, the fact that an applicant uses a walker would not alone qualify her for the program. This change is expected to reduce new demand for ESP by 30 percent.

Phase 2 will coincide with a new care management software system for ESP that will allow COA to adopt a more sophisticated and widely used scale for assessing Activities of Daily Living and Instrumental Activities of Daily Living (ADL and IADL -- disability and level of care assessment tools). We will also start using a scale to measure cognitive impairment. This phase is expected to reduce demand by an additional 5 percent.

In Phase 3, we would lower the age of eligibility from 65 to 60. This can't be done now because of the waiting list. But the change would bring the program in line with age eligibility for Title III services and PASSPORT. It would also help serve a large unmet need of disabled older adults who could avoid unnecessary institutionalization with the help of in-home services.

The proposed changes are based on a study completed for COA by Miami University's Scripps Gerontology Center. The study found that if the program continues growing at its current pace, it will have a 50 percent cost increase over 10 years.

COA asked Scripps to conduct the study after passage of the Hamilton County senior services levy in 2007. At that time, the county's Tax Levy Review Committee suggested that demand be reduced by raising the eligibility age to 67 and gradually increasing it, in line with eligibility for Social Security.

COA disagreed with that idea because ESP is tied to disability; it's for long-term care, not retirement.

"Given the limits of tax levy funding, the program is unsustainable with its current eligibility criteria," said Ken Wilson, COA director of Program Operations. "With these changes, we would focus on serving clients who are more frail -- those who are at high risk of nursing home placement -- offering more services to them and avoiding a waiting list for the long term."

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Non-medical transportation to begin for Butler County clients

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