It has been an exceptional year in many many ways. Without a doubt, 2008 has presented the most difficult economy for nonprofits to operate in, during my career. The downside, of course, is that many nonprofits across the United States, are being forced to reduce services, merge, or (sadly) close permanently. Nonprofits fill all kinds of voids such as complacency, indifference, lack of access, little research, poor or no funding, lack of public knowledge, lack of expertise, infringements on legal oversight, etc. Nonprofits are often a last hope for many. As nonprofit organizations, ours' is an extended hand and it is staggering to think that many of those hands will be removed from our communities. Amid most governments' budget cuts, reduced donating, financial instability, financial scandals, and an uncertain economic outlook - we're all sort of sitting up a little more straight in the chair, and gripping the sides of the seat.
The up side to this kind of adversity is that we're all going through this together. Adversity can unite and unify and has already begun to. In the face of a challenge Americans, historically, have risen to the struggle innovating, pulling together, and sticking in the fight. This economy has forced the very same amongst nonprofits, across the United States. Professional nonprofit affiliations are hosting all kinds of nonprofit forums to provide a public commons for us nonprofit professionals come together for an hour or two to discuss the financial issues we, individually, are facing at each of our organizations, and to then share or brainstorm solutions. Out of adversity comes exceptional leaps forward in theory, method, and best practices. Despite how concerned I am for this country's nonprofit sector, I look forward to learning about your innovation, new methods, and learning about what you 'invented' and shared, in effect, adding to our sector's best practices. Yes, I'm looking at you. Where else does this unification, brainstorming, trial and error, innovation, and discovery come from? I'm standing right next to you, on this front line, doing my work to move us all forward, too.
Despite these difficulties, we must keep the very inspiration, passion, or whatever the flame is, inside you, that brought you to the nonprofit sector alive in ourselves and one another. We've attempted to be there for you and your organization by providing our 'free consultations' series, these past months, on this blog. It isn't a time to horde knowledge or expertise. Our communities' weakest, most under-represented, or disenfranchised are at risk. If your local United Way or just some unofficial but sincere group of nonprofit leaders, in your community, is getting nonprofit representatives together to discuss the challenges of this economy - consider joining that talk. Be there for that brown bag lunch. Make time after work, that evening. Move that meeting, or whatever you need to do to be a part of the solution making. You may think that you have nothing new or innovative to contribute; but who knows, before they discover or innovate something new that they were about to? In a discussion with our professional colleagues, you'll likely learn something new that you and your organization could use in these tough times; and listening to others who also live and work in your community may stimulate ideas or resources that you just haven't thought of (yet), on your own. Despite a common misconception that we are all competing for the exact same single donation dollar; we can come together, as professionals in the same sector, to share. The truth is that donors give to different causes, in different geographic locations, for different reasons. We are not all competing for one donor's single dollar. Also, donors give to what they are passionate about and often that's more than one cause or issue. We are all developing donors interested in our organization's single cause and the work that our organization succeeds at. Be confident in your constituency's dedication and open up to the community, for the sake of each and all of our organizations' missions.
It's a difficult time, but we can be there for one another, even as professionals. Your organization, the organization down the street, and my organization benefits when you and I show up for the 'fight'. In 2009 keep your eyes on the horizon. Watch for the innovation and new professional nonprofit best practices that comes out of this tough economy.
Posted by Arlene M. Spencer at 11:02 AM
Wednesday, December 24, 2008
Sunday, December 21, 2008
The Costs of Senior Housing Vs. Home Care
In recent years, there has been a drastic shift away from institutionalized care for aging seniors. In the last two decades of the twentieth century rest homes began disappearing rapidly. The percentage of people over 75 in nursing homes fell from 9.6% in 1985 to 6.4% in 2004, according to the AARP Public Policy Institute.
Elder care experts say the decline reflects the growth of less-restrictive types of care, ranging from assisted living to supervised adult day care. These alternatives are usually less expensive than nursing homes and often provide a superior quality of life.
Elders, whether they are relatively independent in their care needs or require daily assistance, now have choices that have become increasingly popular since the latter part of the 20th century. Choices include publicly subsidized elder housing for those who are largely independent but are living on a modest fixed income.
For the more affluent senior a new and different housing option has grown rapidly since the 1980s. Known as continuing care retirement communities, or CCRCs, these elder housing options often resemble five-star hotels both inside and out.
With few exceptions continuing care retirement communities are not an option for those living on a modest income. Most require a large "entrance fee" that can be in the range of $250,000 or more, with additional monthly fees in the range of $3000-$5000 per month. Meals are served in an elegant dining room, ordered from a menu of several items prepared by well-trained chefs. Amenities include movie theaters, swimming pools, and many more attractive features.
As the term continuing care implies, as residents of a CCRC get older and require more assistance with daily care, they can move to other sections of the community where assisted-living units and even skilled nursing beds are available.
A related but separate housing option has also grown rapidly throughout the United States in recent years. Usually referred to as assisted-living facilities (ALFs) and sometimes as "intermediate care facilities," these new housing options offer attractive hotel-like surroundings without requiring a steep entrance fee.
For a fixed monthly rental fee, and some optional fees, monthly costs range from $2500 to more than $6000 a month depending on the facility, the level of services provided, and the size of the unit rented. A certain amount of daily assistance with activities, such as bathing and dressing, meal preparation, and transportation, are provided in assisted-living facilities.
Most Elders Still Want to Stay at Home Until They Die
Ask a room full of 80-year-olds where they would like to spend the last years of their lives, and 80% or more will state, "I want to stay in my own home until I die."
Just as the last 20 years has seen the growth of a variety of new senior housing options, so also has there been a rapid growth in "community-based alternatives" to allow frail elders to stay at home.
With a family member or a home health aide to assist with bathing and dressing and light housekeeping, a few hours of assistance each day can allow an elder to remain at home for an indefinite period of time.
Those with severe impairments, such as the advanced stages of Alzheimer’s disease, can’t be left home alone. This is where home care becomes an expensive alternative. At an average cost approaching $25 an hour, keeping someone at home with 24-hour care is more expensive than a nursing home. A typical nursing home on the east and west coast of the U.S. runs about $300 to $350 per day, while round-the-clock care at home can run as high as $600 per day. In an Age of Scarcity, Who Will Care and Who Will Pay?
A USA Today/ABC News Gallup Poll of baby boomers in 2007 found that 41% who have a living parent are providing care for them — financial help, personal care or both — and 8% of boomers say their parents have moved in with them.
It´s estimated that 34 million Americans serve as unpaid caregivers for other adults, and they spend an average 21 hours a week helping out, according to another study released last year by AARP.
Finding a suitable living situation with the level of care an elder may need has become increasingly difficult for the middle class. The USA Today poll report states: “…few (ALFs) are publicly funded... The majority of these units are only available to those who can pay for them out of their own resources.
In the fall of 2007, the U.S. Department of Health and Human Services announced it was dedicating $5.7 million in matching grant funds for “nursing home diversion programs.” While this sounds like an expansion of services, it’s really a shift of funds away from already inadequately funded nursing homes to pay for a modest amount of home care services.
"The upper-income white population has other options than nursing homes,” according to the Brookings Institution. "They´re moving to assisted living or their well-off, baby boomer children are taking care of them in other ways."
For those elders and families of modest means the question of which living situation is best suited for their personal needs is superseded by a much more challenging one: “Where will we get the money to pay for the care that is needed?”
CARE PLAN COST COMPARISON
Assisted Living Home Care Nursing Home Cost
1 Bedroom Unit 2 Bedroom Unit (not available in every facility) Non-Care Costs of Staying at Home Home Care 24 X 7 x $23/hr Home Care Live in Aide Private Room
$4500-$6000 monthly
$54,000-$72,000 annually
$6800-$8000 monthly
$82,000-$96,000 annually
Maintenance Property taxes Utilities Groceries Transportation $550 daily
$15,500 monthly
$186,000 annually
$235-$250 daily
$7000 monthly
$84,600 annually
$325-355 daily
$118,000- $130,000 annually
(Semi Private Room $285-$315 daily)
Bob O’Toole, MSW, LICSW is a clinical social worker with more than 25 years of experience in the field of aging. He is CEO of Informed Eldercare Decisions, Inc., a private eldercare consulting firm in Dedham, Massachusetts. He can be reached at bob@elderlifeplanning.com
You've received this message because you've registered to receive email from ElderCarelink.
If you no longer wish to receive product offer emails from us, please click here.
If you have any questions, email contactus@eldercarelink.com.
© 2008 ElderCarelink. All rights reserved. 190 Front Street, Ashland MA 01721
Elder care experts say the decline reflects the growth of less-restrictive types of care, ranging from assisted living to supervised adult day care. These alternatives are usually less expensive than nursing homes and often provide a superior quality of life.
Elders, whether they are relatively independent in their care needs or require daily assistance, now have choices that have become increasingly popular since the latter part of the 20th century. Choices include publicly subsidized elder housing for those who are largely independent but are living on a modest fixed income.
For the more affluent senior a new and different housing option has grown rapidly since the 1980s. Known as continuing care retirement communities, or CCRCs, these elder housing options often resemble five-star hotels both inside and out.
With few exceptions continuing care retirement communities are not an option for those living on a modest income. Most require a large "entrance fee" that can be in the range of $250,000 or more, with additional monthly fees in the range of $3000-$5000 per month. Meals are served in an elegant dining room, ordered from a menu of several items prepared by well-trained chefs. Amenities include movie theaters, swimming pools, and many more attractive features.
As the term continuing care implies, as residents of a CCRC get older and require more assistance with daily care, they can move to other sections of the community where assisted-living units and even skilled nursing beds are available.
A related but separate housing option has also grown rapidly throughout the United States in recent years. Usually referred to as assisted-living facilities (ALFs) and sometimes as "intermediate care facilities," these new housing options offer attractive hotel-like surroundings without requiring a steep entrance fee.
For a fixed monthly rental fee, and some optional fees, monthly costs range from $2500 to more than $6000 a month depending on the facility, the level of services provided, and the size of the unit rented. A certain amount of daily assistance with activities, such as bathing and dressing, meal preparation, and transportation, are provided in assisted-living facilities.
Most Elders Still Want to Stay at Home Until They Die
Ask a room full of 80-year-olds where they would like to spend the last years of their lives, and 80% or more will state, "I want to stay in my own home until I die."
Just as the last 20 years has seen the growth of a variety of new senior housing options, so also has there been a rapid growth in "community-based alternatives" to allow frail elders to stay at home.
With a family member or a home health aide to assist with bathing and dressing and light housekeeping, a few hours of assistance each day can allow an elder to remain at home for an indefinite period of time.
Those with severe impairments, such as the advanced stages of Alzheimer’s disease, can’t be left home alone. This is where home care becomes an expensive alternative. At an average cost approaching $25 an hour, keeping someone at home with 24-hour care is more expensive than a nursing home. A typical nursing home on the east and west coast of the U.S. runs about $300 to $350 per day, while round-the-clock care at home can run as high as $600 per day. In an Age of Scarcity, Who Will Care and Who Will Pay?
A USA Today/ABC News Gallup Poll of baby boomers in 2007 found that 41% who have a living parent are providing care for them — financial help, personal care or both — and 8% of boomers say their parents have moved in with them.
It´s estimated that 34 million Americans serve as unpaid caregivers for other adults, and they spend an average 21 hours a week helping out, according to another study released last year by AARP.
Finding a suitable living situation with the level of care an elder may need has become increasingly difficult for the middle class. The USA Today poll report states: “…few (ALFs) are publicly funded... The majority of these units are only available to those who can pay for them out of their own resources.
In the fall of 2007, the U.S. Department of Health and Human Services announced it was dedicating $5.7 million in matching grant funds for “nursing home diversion programs.” While this sounds like an expansion of services, it’s really a shift of funds away from already inadequately funded nursing homes to pay for a modest amount of home care services.
"The upper-income white population has other options than nursing homes,” according to the Brookings Institution. "They´re moving to assisted living or their well-off, baby boomer children are taking care of them in other ways."
For those elders and families of modest means the question of which living situation is best suited for their personal needs is superseded by a much more challenging one: “Where will we get the money to pay for the care that is needed?”
CARE PLAN COST COMPARISON
Assisted Living Home Care Nursing Home Cost
1 Bedroom Unit 2 Bedroom Unit (not available in every facility) Non-Care Costs of Staying at Home Home Care 24 X 7 x $23/hr Home Care Live in Aide Private Room
$4500-$6000 monthly
$54,000-$72,000 annually
$6800-$8000 monthly
$82,000-$96,000 annually
Maintenance Property taxes Utilities Groceries Transportation $550 daily
$15,500 monthly
$186,000 annually
$235-$250 daily
$7000 monthly
$84,600 annually
$325-355 daily
$118,000- $130,000 annually
(Semi Private Room $285-$315 daily)
Bob O’Toole, MSW, LICSW is a clinical social worker with more than 25 years of experience in the field of aging. He is CEO of Informed Eldercare Decisions, Inc., a private eldercare consulting firm in Dedham, Massachusetts. He can be reached at bob@elderlifeplanning.com
You've received this message because you've registered to receive email from ElderCarelink.
If you no longer wish to receive product offer emails from us, please click here.
If you have any questions, email contactus@eldercarelink.com.
© 2008 ElderCarelink. All rights reserved. 190 Front Street, Ashland MA 01721
Friday, December 19, 2008
Elder Mediation Resolves Family Conflicts
Florida Elder Law Attorney - Blog
A blog by Florida elder law attorneys Ellen S. Morris and Howard Krooks, partners of Elder Law Associates, based in South Florida. The blog covers all issues that encompass elder law, including Medicaid Planning, Estate Planning, Trusts, and Guardianships.
Thursday, December 11, 2008
Elder care includes resolving family conflicts, a situation as Florida elder law attorneys, we're unfortunately very familiar with.
"My daughter is insisting I move in with her," complains Martha. "She just wants to control my life and take away my freedom," she continues.
Jenny, Martha’s daughter worries that her mother keeps falling, and fears one day she will break her hip or hit her head.
"I’ll take my sister to court before I will let her get control of mom and my inheritance," exclaims Jim about Jenny’s desire to move her mother in with her.
It is amazing how quickly formerly cordial relationships between family members will sour when the family has to deal with care of elderly parents or inheritance at their death. Sometimes the consequence of dealing with the final years of elderly parents can break families apart and create long-lasting animosity.
The National Care Planning Council has seen an increase in requests from caregiving children for help in solving disputes with siblings. In one case, the caregiver was being sued by her sister for abusing their parent and stealing the Social Security checks. In another, the caregiving child would not allow siblings to see their mother, claiming they would take advantage of her.
A lot of times it is a “she said,” “he said” situation with neither party really understanding what the elder person needs or wants.
Some families find it hard to communicate with each other when their parent is in need of care. Perhaps when they grew up together they were not accustomed to come together as parents and children to work out problems. And now those children are older and taking care of parents and they don't have this family council strategy to rely on. It may seem unnatural to them. But that is often exactly what is needed, especially in situations where perhaps one child is caring for the parents and the others are left out of the loop.
Children all have a common bond to their parents and as a result a common obligation or responsibility to each other. When disagreements arise, suspicions begin to grow. Suspicions or distrust often lead to anger and the anger often leads to severing the channels of communication between family members. This can occur between parent and child or between siblings or between all of them.
It is often at this point that a neutral third party can come in and repair the damage that has been done and help correct the problems that have come about because of the disagreement.
A practitioner experienced in elder mediation is a perfect choice for solving disagreements due to issues with the elderly.
WHAT IS ELDER MEDIATION?
Mediation is a non-adversarial approach to solving disputes. Mediation is a process of bringing two or more disputing parties together and having them mutually negotiate a solution to their disagreement. The mediator is not a judge and does not render a decision but is there to make sure that communication flows freely between the disputing parties. Elder Mediators are trained in the art of negotiating resolutions between elderly parents and family members.
Mediation can achieve results that the family by itself may not be capable of realizing or have the expertise of achieving. Here are some reasons that make Elder Mediation so valuable.
• A trained expert on communication gives the family a perspective it could not gain by meeting together on its own;
• All family members involved meet and prevent problems from arising by anticipating situations that may cause disputes;
• Allows for the mediator to invite experts such as care managers or other care providers into the meeting to educate the family and give them a new perspective;
• Allows parents to focus on their abilities rather than their limitations;
• Allows children to come up with and consider options not thought of previously;
• Encourages uninvolved family members to become involved;
• Allows parents to express wishes and desires that had previously gone unuttered;
• Allows for a neutral third party to challenge family members and make them take responsibility for their actions;
• Promotes consensus of all involved which in turn creates a much higher rate of compliance with the plan than with any other process; (the success rate for compliance with elder mediation is estimated to be about 80% to 85%)
• Requires a written plan with specific responsibilities which makes compliance feasible.
There are many organizations and companies throughout the country providing expertise in "Elder Mediation" to help seniors and their families. You will also find that mediators often have many coincident professional accreditations such as, Professional or Geriatric Care Manager, Elder Attorney, Clinical Social Worker or Certified Mediator.
In choosing a mediator, consider your needs. Is there a need for a medical assessment to determine the type of care? Are legal concerns with inheritance or family business or power of attorney, the main need? Perhaps, just bringing the family together to communicate on what needs to be done and who will do it is the agenda for now.
In one case, after months of dispute with her parents over their health and safety issues, Connie enlisted the service of a professional care manager mediator.
“Bringing a neutral person with a professional and compassionate attitude into our disputes was the best thing for all involved,” Connie recalled. “My parents shared their concerns and listened with acceptance to mine. All of a sudden we could communicate and work out a plan that they could live with and I could relax knowing they were safe.”
Seniors Use Mediators to help the family plan for long term care.
In the National Care Planning Council's book, “The 4 Steps of Long Term Care Planning,” the process of creating your own “Care Plan” before you need it is introduced. Quoting from the book:
“If the current or future caregiver wants the other persons attending the meeting to give support with respite care, transportation to doctors, etc., everyone needs to be aware of this and in total agreement to do it. All must also be willing to work with the member of the family, friend or professional who is designated as the Personal Care Coordinator.
If you feel the communication will be strained, consider having a professional mediator present. The mediator will be able to keep things calm and running smoothly
and help work out each person's concerns.”
“The 4 Steps of Long Term Care Planning” book can be found at http://www.longtermcarelink.net/a16four_steps_book.htm
Where to Find an Elder Mediator
• In your local phone book, on the internet or with your community senior services.
• References from friends and neighbors
• Contact the local area agency on aging
• Contact your state bar association
• Contact a local university or college and asked to speak to the department that provides mediation training and ask for a referral.
• On the internet look up mediation in your area
• Yellow pages in local phone books
Labels: Elder Care, Florida Elder Law Attorney
posted by Noah Davis at 7:40 PM
0 Comments:
Post a Comment
<< Home
Previous Posts
Eight Unselfish Ways to Put Yourself First
Being Social - One Key to a Longer Life
Holiday Blues - Depression in the Elderly
Medicare Enrollment Starts November 15, 2008
The State of Florida and Poor Senior Care
Dealing with the Sudden Crisis of Eldercare
Speakers for First Annual Elder Law Forum
Play Golf and Fight Alzheimer's
Ten Tips for Helping Families with Special Needs
Elder Law Article in New York Times
Subscribe to
Posts [Atom]
--------------------------------------------------------------------------------
A blog by Florida elder law attorneys Ellen S. Morris and Howard Krooks, partners of Elder Law Associates, based in South Florida. The blog covers all issues that encompass elder law, including Medicaid Planning, Estate Planning, Trusts, and Guardianships.
Thursday, December 11, 2008
Elder care includes resolving family conflicts, a situation as Florida elder law attorneys, we're unfortunately very familiar with.
"My daughter is insisting I move in with her," complains Martha. "She just wants to control my life and take away my freedom," she continues.
Jenny, Martha’s daughter worries that her mother keeps falling, and fears one day she will break her hip or hit her head.
"I’ll take my sister to court before I will let her get control of mom and my inheritance," exclaims Jim about Jenny’s desire to move her mother in with her.
It is amazing how quickly formerly cordial relationships between family members will sour when the family has to deal with care of elderly parents or inheritance at their death. Sometimes the consequence of dealing with the final years of elderly parents can break families apart and create long-lasting animosity.
The National Care Planning Council has seen an increase in requests from caregiving children for help in solving disputes with siblings. In one case, the caregiver was being sued by her sister for abusing their parent and stealing the Social Security checks. In another, the caregiving child would not allow siblings to see their mother, claiming they would take advantage of her.
A lot of times it is a “she said,” “he said” situation with neither party really understanding what the elder person needs or wants.
Some families find it hard to communicate with each other when their parent is in need of care. Perhaps when they grew up together they were not accustomed to come together as parents and children to work out problems. And now those children are older and taking care of parents and they don't have this family council strategy to rely on. It may seem unnatural to them. But that is often exactly what is needed, especially in situations where perhaps one child is caring for the parents and the others are left out of the loop.
Children all have a common bond to their parents and as a result a common obligation or responsibility to each other. When disagreements arise, suspicions begin to grow. Suspicions or distrust often lead to anger and the anger often leads to severing the channels of communication between family members. This can occur between parent and child or between siblings or between all of them.
It is often at this point that a neutral third party can come in and repair the damage that has been done and help correct the problems that have come about because of the disagreement.
A practitioner experienced in elder mediation is a perfect choice for solving disagreements due to issues with the elderly.
WHAT IS ELDER MEDIATION?
Mediation is a non-adversarial approach to solving disputes. Mediation is a process of bringing two or more disputing parties together and having them mutually negotiate a solution to their disagreement. The mediator is not a judge and does not render a decision but is there to make sure that communication flows freely between the disputing parties. Elder Mediators are trained in the art of negotiating resolutions between elderly parents and family members.
Mediation can achieve results that the family by itself may not be capable of realizing or have the expertise of achieving. Here are some reasons that make Elder Mediation so valuable.
• A trained expert on communication gives the family a perspective it could not gain by meeting together on its own;
• All family members involved meet and prevent problems from arising by anticipating situations that may cause disputes;
• Allows for the mediator to invite experts such as care managers or other care providers into the meeting to educate the family and give them a new perspective;
• Allows parents to focus on their abilities rather than their limitations;
• Allows children to come up with and consider options not thought of previously;
• Encourages uninvolved family members to become involved;
• Allows parents to express wishes and desires that had previously gone unuttered;
• Allows for a neutral third party to challenge family members and make them take responsibility for their actions;
• Promotes consensus of all involved which in turn creates a much higher rate of compliance with the plan than with any other process; (the success rate for compliance with elder mediation is estimated to be about 80% to 85%)
• Requires a written plan with specific responsibilities which makes compliance feasible.
There are many organizations and companies throughout the country providing expertise in "Elder Mediation" to help seniors and their families. You will also find that mediators often have many coincident professional accreditations such as, Professional or Geriatric Care Manager, Elder Attorney, Clinical Social Worker or Certified Mediator.
In choosing a mediator, consider your needs. Is there a need for a medical assessment to determine the type of care? Are legal concerns with inheritance or family business or power of attorney, the main need? Perhaps, just bringing the family together to communicate on what needs to be done and who will do it is the agenda for now.
In one case, after months of dispute with her parents over their health and safety issues, Connie enlisted the service of a professional care manager mediator.
“Bringing a neutral person with a professional and compassionate attitude into our disputes was the best thing for all involved,” Connie recalled. “My parents shared their concerns and listened with acceptance to mine. All of a sudden we could communicate and work out a plan that they could live with and I could relax knowing they were safe.”
Seniors Use Mediators to help the family plan for long term care.
In the National Care Planning Council's book, “The 4 Steps of Long Term Care Planning,” the process of creating your own “Care Plan” before you need it is introduced. Quoting from the book:
“If the current or future caregiver wants the other persons attending the meeting to give support with respite care, transportation to doctors, etc., everyone needs to be aware of this and in total agreement to do it. All must also be willing to work with the member of the family, friend or professional who is designated as the Personal Care Coordinator.
If you feel the communication will be strained, consider having a professional mediator present. The mediator will be able to keep things calm and running smoothly
and help work out each person's concerns.”
“The 4 Steps of Long Term Care Planning” book can be found at http://www.longtermcarelink.net/a16four_steps_book.htm
Where to Find an Elder Mediator
• In your local phone book, on the internet or with your community senior services.
• References from friends and neighbors
• Contact the local area agency on aging
• Contact your state bar association
• Contact a local university or college and asked to speak to the department that provides mediation training and ask for a referral.
• On the internet look up mediation in your area
• Yellow pages in local phone books
Labels: Elder Care, Florida Elder Law Attorney
posted by Noah Davis at 7:40 PM
0 Comments:
Post a Comment
<< Home
Previous Posts
Eight Unselfish Ways to Put Yourself First
Being Social - One Key to a Longer Life
Holiday Blues - Depression in the Elderly
Medicare Enrollment Starts November 15, 2008
The State of Florida and Poor Senior Care
Dealing with the Sudden Crisis of Eldercare
Speakers for First Annual Elder Law Forum
Play Golf and Fight Alzheimer's
Ten Tips for Helping Families with Special Needs
Elder Law Article in New York Times
Subscribe to
Posts [Atom]
--------------------------------------------------------------------------------
Community Manager
Jobs Home > Community Manager Posted Dec 12
Center for Home Care Policy & Research, Visiting Nurse Servcie of New York, New York, NY
Purpose of Position: The non-profit Center for Home Care Policy and Research (the Center) developed and runs the CHAMP (Curricula for Homecare Advances in Management and Practice) Program; the first national initiative aimed at improving the quality of home care services for older persons. A completely new “Web 2.0” home for CHAMP is under construction (currently, CHAMP is at www.champ-program.org), and we will use this platform to support a Community of Practice for stakeholders in home care quality. We are seeking a Community Manager committed to making the CHAMP Community the premier resource for geriatric home care excellence.
Responsibilities:
• Recruit and organize the efforts of evangelists, advocates and forum moderators.
• Develop strategies to engage and motivate the Community’s most active online participants.
• Work with internal and external stakeholders to identify content, plan, publish, and follow up.
• Monitor online conversations, postings and other user-generated content
• Moderate online forums, message boards, public comment areas, etc. as appropriate
• Stay up to date on new social media tools and best practices.
• Continually evaluate and revise outreach strategies using existing tools and emerging technologies.
• Proactively escalate issues, observations, opportunities, and insights to the CHAMP team.
• Develop and implement guidelines to ensure that CHAMP’s online presence is consistent with its brand and overall marketing strategy.
• Elevate the Community’s online position with search engine optimization, pay-per-click or other techniques as appropriate
• Represent CHAMP in other internet spaces (e.g., influential sites, blogs, etc.)
• Track the performance of, and report on, the Community’s success using metrics from web traffic, events, forum and blog activity, etc.
• Act as a liaison to the CHAMP National Advisory Council
• Work with the CHAMP team to develop and present CHAMP Community events at major home care, geriatrics, and quality improvement conferences and meetings
Reporting Relationships:
• Reports to the Associate Director, CHAMP
• Supervises the part-time Community Coordinato who will assist with the day-to-day operations of the Community of Practice
• Coordinates with the Evaluation Specialist to track progress/success of Community of Practice
Qualifications:
• Experience building and facilitating online communities
• Excellent writing skills
• Passion for creating meaningful interaction and collaboration via the Web
• Self-starter who can run things
• Desire to work with a goal-oriented team
Email resume and salary requirement to the email address below.
The Center for Home Care Policy and Research (http://www.vnsny.org/research/) is based at the Visiting Nurse Service of New York, the largest nonprofit homecare agency in the U.S. The Center moves evidence-based information about home care into real-world application through innovative quality improvement initiatives.
Center for Home Care Policy & Research, Visiting Nurse Servcie of New York, New York, NY
Purpose of Position: The non-profit Center for Home Care Policy and Research (the Center) developed and runs the CHAMP (Curricula for Homecare Advances in Management and Practice) Program; the first national initiative aimed at improving the quality of home care services for older persons. A completely new “Web 2.0” home for CHAMP is under construction (currently, CHAMP is at www.champ-program.org), and we will use this platform to support a Community of Practice for stakeholders in home care quality. We are seeking a Community Manager committed to making the CHAMP Community the premier resource for geriatric home care excellence.
Responsibilities:
• Recruit and organize the efforts of evangelists, advocates and forum moderators.
• Develop strategies to engage and motivate the Community’s most active online participants.
• Work with internal and external stakeholders to identify content, plan, publish, and follow up.
• Monitor online conversations, postings and other user-generated content
• Moderate online forums, message boards, public comment areas, etc. as appropriate
• Stay up to date on new social media tools and best practices.
• Continually evaluate and revise outreach strategies using existing tools and emerging technologies.
• Proactively escalate issues, observations, opportunities, and insights to the CHAMP team.
• Develop and implement guidelines to ensure that CHAMP’s online presence is consistent with its brand and overall marketing strategy.
• Elevate the Community’s online position with search engine optimization, pay-per-click or other techniques as appropriate
• Represent CHAMP in other internet spaces (e.g., influential sites, blogs, etc.)
• Track the performance of, and report on, the Community’s success using metrics from web traffic, events, forum and blog activity, etc.
• Act as a liaison to the CHAMP National Advisory Council
• Work with the CHAMP team to develop and present CHAMP Community events at major home care, geriatrics, and quality improvement conferences and meetings
Reporting Relationships:
• Reports to the Associate Director, CHAMP
• Supervises the part-time Community Coordinato who will assist with the day-to-day operations of the Community of Practice
• Coordinates with the Evaluation Specialist to track progress/success of Community of Practice
Qualifications:
• Experience building and facilitating online communities
• Excellent writing skills
• Passion for creating meaningful interaction and collaboration via the Web
• Self-starter who can run things
• Desire to work with a goal-oriented team
Email resume and salary requirement to the email address below.
The Center for Home Care Policy and Research (http://www.vnsny.org/research/) is based at the Visiting Nurse Service of New York, the largest nonprofit homecare agency in the U.S. The Center moves evidence-based information about home care into real-world application through innovative quality improvement initiatives.
Community Manager
Jobs Home > Community Manager Posted Dec 12
Center for Home Care Policy & Research, Visiting Nurse Servcie of New York, New York, NY
Purpose of Position: The non-profit Center for Home Care Policy and Research (the Center) developed and runs the CHAMP (Curricula for Homecare Advances in Management and Practice) Program; the first national initiative aimed at improving the quality of home care services for older persons. A completely new “Web 2.0” home for CHAMP is under construction (currently, CHAMP is at www.champ-program.org), and we will use this platform to support a Community of Practice for stakeholders in home care quality. We are seeking a Community Manager committed to making the CHAMP Community the premier resource for geriatric home care excellence.
Responsibilities:
• Recruit and organize the efforts of evangelists, advocates and forum moderators.
• Develop strategies to engage and motivate the Community’s most active online participants.
• Work with internal and external stakeholders to identify content, plan, publish, and follow up.
• Monitor online conversations, postings and other user-generated content
• Moderate online forums, message boards, public comment areas, etc. as appropriate
• Stay up to date on new social media tools and best practices.
• Continually evaluate and revise outreach strategies using existing tools and emerging technologies.
• Proactively escalate issues, observations, opportunities, and insights to the CHAMP team.
• Develop and implement guidelines to ensure that CHAMP’s online presence is consistent with its brand and overall marketing strategy.
• Elevate the Community’s online position with search engine optimization, pay-per-click or other techniques as appropriate
• Represent CHAMP in other internet spaces (e.g., influential sites, blogs, etc.)
• Track the performance of, and report on, the Community’s success using metrics from web traffic, events, forum and blog activity, etc.
• Act as a liaison to the CHAMP National Advisory Council
• Work with the CHAMP team to develop and present CHAMP Community events at major home care, geriatrics, and quality improvement conferences and meetings
Reporting Relationships:
• Reports to the Associate Director, CHAMP
• Supervises the part-time Community Coordinato who will assist with the day-to-day operations of the Community of Practice
• Coordinates with the Evaluation Specialist to track progress/success of Community of Practice
Qualifications:
• Experience building and facilitating online communities
• Excellent writing skills
• Passion for creating meaningful interaction and collaboration via the Web
• Self-starter who can run things
• Desire to work with a goal-oriented team
Email resume and salary requirement to the email address below.
The Center for Home Care Policy and Research (http://www.vnsny.org/research/) is based at the Visiting Nurse Service of New York, the largest nonprofit homecare agency in the U.S. The Center moves evidence-based information about home care into real-world application through innovative quality improvement initiatives.
Center for Home Care Policy & Research, Visiting Nurse Servcie of New York, New York, NY
Purpose of Position: The non-profit Center for Home Care Policy and Research (the Center) developed and runs the CHAMP (Curricula for Homecare Advances in Management and Practice) Program; the first national initiative aimed at improving the quality of home care services for older persons. A completely new “Web 2.0” home for CHAMP is under construction (currently, CHAMP is at www.champ-program.org), and we will use this platform to support a Community of Practice for stakeholders in home care quality. We are seeking a Community Manager committed to making the CHAMP Community the premier resource for geriatric home care excellence.
Responsibilities:
• Recruit and organize the efforts of evangelists, advocates and forum moderators.
• Develop strategies to engage and motivate the Community’s most active online participants.
• Work with internal and external stakeholders to identify content, plan, publish, and follow up.
• Monitor online conversations, postings and other user-generated content
• Moderate online forums, message boards, public comment areas, etc. as appropriate
• Stay up to date on new social media tools and best practices.
• Continually evaluate and revise outreach strategies using existing tools and emerging technologies.
• Proactively escalate issues, observations, opportunities, and insights to the CHAMP team.
• Develop and implement guidelines to ensure that CHAMP’s online presence is consistent with its brand and overall marketing strategy.
• Elevate the Community’s online position with search engine optimization, pay-per-click or other techniques as appropriate
• Represent CHAMP in other internet spaces (e.g., influential sites, blogs, etc.)
• Track the performance of, and report on, the Community’s success using metrics from web traffic, events, forum and blog activity, etc.
• Act as a liaison to the CHAMP National Advisory Council
• Work with the CHAMP team to develop and present CHAMP Community events at major home care, geriatrics, and quality improvement conferences and meetings
Reporting Relationships:
• Reports to the Associate Director, CHAMP
• Supervises the part-time Community Coordinato who will assist with the day-to-day operations of the Community of Practice
• Coordinates with the Evaluation Specialist to track progress/success of Community of Practice
Qualifications:
• Experience building and facilitating online communities
• Excellent writing skills
• Passion for creating meaningful interaction and collaboration via the Web
• Self-starter who can run things
• Desire to work with a goal-oriented team
Email resume and salary requirement to the email address below.
The Center for Home Care Policy and Research (http://www.vnsny.org/research/) is based at the Visiting Nurse Service of New York, the largest nonprofit homecare agency in the U.S. The Center moves evidence-based information about home care into real-world application through innovative quality improvement initiatives.
Thursday, December 4, 2008
Mapping A Senior Care Service Solution
October '07 -
(Mercer County Women, Burlington County Women)
Resources for creating the most beneficial plan from you specific needs ...
As many of us know, statistics about the aging population and care giving are staggering and all numbers seem to grow exponentially. Concurrently, options to help caregivers, adult children caring for elderly parents and even senior care professionals themselves are growing in leaps and bounds. The great growth of services world seem all good news at face value, but very quickly a dichotomy surfaces. Many solutions are aligned with many needs; yet where does one begin?
Today, we are lucky to have service resources for seniors in many forms. To start, there are three basic sources to consider relative to what they can offer your situation: public (federal, state and local), private and not-for-profit organizations. Most often, the best solution consists of some integrated level of the three.
We’ve all been told numerous times – “use the right too (resource) for the Job!” At no time is such an adage more applicable than in the case of mapping a care solution for an aging individual.
Resources come in many forms and are available to seniors and caregivers along the entire continuum of aging life – from the active retiree looking to take on new experiences to the well-aged senior whose growing support needs span numerous areas including housing, nutritional support, help whit home activities, etc.
To make sure you get the right plan in place form the start, a resource to seriously consider invoking is the aid of various professionals focused on providing the type of planning help you need. These professionals can be found in both the public and private domains, will often save you stressful hours of false starts with wrong resources and will almost always save you dollars in the long run.
In the public domain, each state (and then to varying degrees, county or township level municipalities) has some form of Area Aging Offices in place to provide the public guidance on these issues. The Department of Health & Senior Services (or the equivalent) of each state is another great starting point. Individuals in these public departments will be familiar with public resources and programs in the areas of finance, legal, guardianship, etc.
In the private domain, the ranks of Geriatric Care Managers, Eldercare, Attorneys, Certified Senior Advisors, etc. are going in both number as well as in their level of use. These individuals have strong backgrounds and experience relative to their areas of practice (law, registered nursing, social work, financial planning, etc.) and are now leveraging their professional experience in the focused area of senior-related issues. Often these professionals gain certifications which further help to enhance their knowledge of senior issues, the latest regulations, etc.
The value of developing the right plan in a proactive manner cannot be overstated! To the degree that the elder involved is able to actively participate in the process, any necessary subsequent adjustments are transitions are made easier for everyone involved.
Visit: www.SeniorsA2Z.com, to find many more definitions f terms for the senior care environment along with thousands of listing of senior services resources.
www.SeniorsA2Z.com is the newest and most comprehensive website of senior service resources, combining public and private, national and local service providers – all in one place! It contains over 200 categories, organized in a simple-to-use online index. New Jersey based, the site lists basic public resources for all 50 states and is already in the process of expanding local, private listings in additional states.
SeniorsA2Z was founded by Grazina Crisman, entrepreneur and business executive in both large Fortune 500 corporations as well as small businesses, is experienced in the presentation and delivery of critical information to customers.
(Mercer County Women, Burlington County Women)
Resources for creating the most beneficial plan from you specific needs ...
As many of us know, statistics about the aging population and care giving are staggering and all numbers seem to grow exponentially. Concurrently, options to help caregivers, adult children caring for elderly parents and even senior care professionals themselves are growing in leaps and bounds. The great growth of services world seem all good news at face value, but very quickly a dichotomy surfaces. Many solutions are aligned with many needs; yet where does one begin?
Today, we are lucky to have service resources for seniors in many forms. To start, there are three basic sources to consider relative to what they can offer your situation: public (federal, state and local), private and not-for-profit organizations. Most often, the best solution consists of some integrated level of the three.
We’ve all been told numerous times – “use the right too (resource) for the Job!” At no time is such an adage more applicable than in the case of mapping a care solution for an aging individual.
Resources come in many forms and are available to seniors and caregivers along the entire continuum of aging life – from the active retiree looking to take on new experiences to the well-aged senior whose growing support needs span numerous areas including housing, nutritional support, help whit home activities, etc.
To make sure you get the right plan in place form the start, a resource to seriously consider invoking is the aid of various professionals focused on providing the type of planning help you need. These professionals can be found in both the public and private domains, will often save you stressful hours of false starts with wrong resources and will almost always save you dollars in the long run.
In the public domain, each state (and then to varying degrees, county or township level municipalities) has some form of Area Aging Offices in place to provide the public guidance on these issues. The Department of Health & Senior Services (or the equivalent) of each state is another great starting point. Individuals in these public departments will be familiar with public resources and programs in the areas of finance, legal, guardianship, etc.
In the private domain, the ranks of Geriatric Care Managers, Eldercare, Attorneys, Certified Senior Advisors, etc. are going in both number as well as in their level of use. These individuals have strong backgrounds and experience relative to their areas of practice (law, registered nursing, social work, financial planning, etc.) and are now leveraging their professional experience in the focused area of senior-related issues. Often these professionals gain certifications which further help to enhance their knowledge of senior issues, the latest regulations, etc.
The value of developing the right plan in a proactive manner cannot be overstated! To the degree that the elder involved is able to actively participate in the process, any necessary subsequent adjustments are transitions are made easier for everyone involved.
Visit: www.SeniorsA2Z.com, to find many more definitions f terms for the senior care environment along with thousands of listing of senior services resources.
www.SeniorsA2Z.com is the newest and most comprehensive website of senior service resources, combining public and private, national and local service providers – all in one place! It contains over 200 categories, organized in a simple-to-use online index. New Jersey based, the site lists basic public resources for all 50 states and is already in the process of expanding local, private listings in additional states.
SeniorsA2Z was founded by Grazina Crisman, entrepreneur and business executive in both large Fortune 500 corporations as well as small businesses, is experienced in the presentation and delivery of critical information to customers.
Thursday, October 30, 2008
Empower and support people with disabilities and elders to live independly
a vIsIon For THe FuTure
by expanding,
strengthening, and integrating systems of community-based
long-term supports that are person-centered, high in quality and
provide optimal choice.
3
I. suMMary
The Commonwealth of Massachusetts is establishing its community First
olmstead Plan pursuant to a Supreme Court decision compelling states
to create meaningful community living plans for people with disabilities
and elders. In keeping with the framework of Olmstead v. L.C. and the
Patrick Administration’s commitment to a “community fi rst” long-term care
policy, this plan embraces a vision of choice and opportunity that requires
the deliberate development of more accessible and eff ective long-term
supports in local communities. Thus, the Plan supports the Administration’s
commitment to shifting focus of long-term care fi nancing from institutions
to the community. Grounded in the 2002 People’s Plan and the extensive
home and community-based service developments that have occurred
through the eff orts of the Executive Offi ce of Health and Human Services
(EOHHS), the Plan has greatly benefi ted from the signifi cant input of a broad
array of internal and external stakeholders (see Appendix B).
Focusing on six critical goal areas, the Plan provides a roadmap for the
future of community-based support for elders and people with disabilities.
Strategic short-term objectives describe an eighteen-month course of action
for the Administration in crucial regulatory, fi scal and program development
arenas which will, of necessity, be contingent on the availability of re-aligned
as well as new public and private long-term support funding.
The public-private collaborations that have brought the Plan thus far will
be the cornerstone of future eff orts and hold the promise of new and
meaningful opportunities for the nearly 20% of Massachusetts residents who
are elder or disabled and want the opportunity to choose community fi rst.
4 The Community First Olmstead Plan
II. Background
What is an Olmstead Plan?
In 1999, the U.S. Supreme Court rendered a favorable decision in Olmstead
v. L.C, a case that challenged the state of Georgia’s efforts to institutionalize
people with mental disabilities. The Court ruled that the Americans with
Disabilities Act (ADA) required states to provide services in the most
integrated settings appropriate to the needs of individuals with disabilities;
additionally, the Court indicated that each state should develop an Olmstead
plan consistent with the decision. The 2001 federal New Freedom Initiative,
multiple subsequent directives and grant funding from the Centers for
Medicare and Medicaid Services, and extensive monitoring by the Office
of Civil Rights, the National Council on State Legislatures, the American
Association for Retired Persons, and others have supported and tracked the
development of Olmstead plans now underway in most states.
Why is an Olmstead Plan important to Massachusetts?
The elder and disabled populations in Massachusetts are growing. They are a
diverse group of individuals and many depend on state-supported programs.
With a broad array of home and community-based services, including case
management and housing supports, they may live in less restrictive, and
sometimes less expensive, community-based settings where many wish to
remain.
Approximately 1.64M (20%) of Massachusetts’ residents are elders or
people with disabilities; over 300,000 are enrolled in MassHealth, and
32,000 are in nursing facilities on an average day.
Of the 856,000 elders in Massachusetts, approximately 104,000
(12.1%) are enrolled in MassHealth.
Of the 785,000 persons with disabilities in Massachusetts,
approximately 210,000 (26.8%) are under age 65 and enrolled in
MassHealth.
The current federal long-term care financing system tends to favor
institutional over community care.
5
Among the approximately 250,000 elder or disabled MassHealth
members living in the community, there is a desire for increased
access to community support services. Many more elders and
people with disabilities who are not enrolled in MassHealth also
desire increased access to home and community-based support.
MA is in the highest quartile of states for the number of nursing
home beds per population.
Employment opportunities, critical for supporting people with
disabilities in leading self-sufficient and independent lives, are limited
in MA as elsewhere.
People with disabilities in MA are almost three times as likely to be
unemployed as their non-disabled peers (American Community
Survey, 2006).
Access to affordable and accessible housing often functions as one of the
greatest challenges to individuals successfully leaving institutional care.
Lack of many community service options limits the ability of elders and
people with disabilities to choose community over institutional care.
How was the Plan developed?
At Governor Patrick’s request, an Olmstead Planning Committee was
convened in late Fall 2007. A large group of representatives including
provider, consumer, and advocacy organizations, as well as elders and
people with disabilities (see Appendix B), worked collaboratively with state
agency staff to develop the framework and implementation strategies for
the Administration’s Plan. The People’s Olmstead Plan, which was produced
by a group of consumer advocates in 2002, provided the starting point for
the discussions. Using the People’s Plan goals as a foundation, the Olmstead
Planning Committee reviewed prior and current EOHHS initiatives focused on
achieving Olmstead-related objectives and identified gaps in needed service
and policy development. The Committee articulated six over-arching goals
and focused on identifying short-term action steps that now form the basis of
an eighteen-month implementation plan (Appendix A).
6 The Community First Olmstead Plan
What are the Principles that underlie this Plan?
The primary principles that inform the Plan are the following:
People with disabilities and elders should have access to community
living opportunities and supports;
The principle of “community first” should shape state elder and
disability policy development and funding decisions;
A full range of long-term supports, including home and communitybased
care, housing, employment opportunities, as well as nursing
facility services are needed;
Choice, accessibility, quality, and person-centered planning should be
the goals in developing long-term supports;
Systems of community-based care and support must be strengthened,
expanded and integrated to ensure access and efficiency;
Public and private mechanisms of financing long-term care and support
must be expanded;
Long-term supports developed under this plan must address the
diversity of individuals with disabilities and elders in terms of race,
ethnicity, language, ability to communicate, sexual orientation, and
geography.
The Community First Olmstead Plan is a work in progress. Ongoing
community engagement will be critical to implementation, evaluation, and
revision as the Plan evolves to meet changing needs and resources.
7
III. The Community First Olmstead Plan
The overarching purpose of the Massachusetts Olmstead Plan is to maximize
the extent to which elders and people with disabilities are able to live
successfully in their homes and communities. Six goals provide the framework
for achieving that vision:
1. Help individuals transition from institutional care.
2. Expand access to community-based long-term supports.
3. Improve the capacity and quality of community-based
long-term supports.
4. Expand access to affordable and accessible housing
and supports.
5. Promote employment of persons with disabilities and elders.
6. Promote awareness of long-term supports.
Detailed objectives and timeframes for each of the goal areas are included
in Appendix A. The rest of this section highlights the major objectives and
provides additional background for each goal area.
1. Help individuals transition from institutional care.
Objectives:
Expand existing and implement new mechanisms for identifying
individuals in institutions who wish to live in the community
Implement additional mechanisms for facilitating transition from
institutional settings
This goal reaches to the heart of the Olmstead decision and, thus, is a core
obligation of this Plan. Successfully identifying institutionalized individuals who
want to move back home or to other community settings can be challenging.
Aging Service Access Points, Independent Living Centers, EOHHS agency staff,
and other disability and elder related organizations currently work to engage
individuals in transition processes, but a more systematic approach is needed
to ensure greater success. Implementation of the Long-term Care Options
Counseling process, mandated under Chapter 211 of the Acts of 2006, and
initiation of the transition services components of the planned Community
First (CF) 1115 waiver, the Hutchinson settlement, and the alternative Rolland
8 The Community First Olmstead Plan
settlement will put in place capacity needed to facilitate successful movement
of institutionalized individuals to community settings. Ongoing assessment of
the effectiveness of transition interventions will provide a basis for continuous
quality improvement.
2. E xpand access to community-based long-term supports.
Ob jecti ves:
Improve access to necessary home and community-based services
including, but not limited to, case management, medication
management, behavioral health, caregiver supports, and assistive
technology for elders and persons with disabilities
Improve access to accessible transportation for elders and persons
with disabilities
Improve transition services for adolescents with disabilities who are
leaving the education system
Massachusetts’ public and private systems of long-term supports are unevenly
available to elders and people with disabilities. In the public arena, one of
the challenges to access is differing financial and clinical eligibility standards
that exist across programs and funding streams that particularly affect
persons as they age and/or their conditions change. In this goal area, the
focus will be on reviewing eligibility standards to implement ways to broaden
coverage as resources permit. Successfully launching the Community First
1115 Waiver is the major focal point of this goal during the initial Olmstead
Plan implementation period; 15,600 people will be enrolled by the end of
the eighteen-month timeframe. During this same period, EOHHS will also
begin to meet the obligations of the resolution of both Hutchinson v. Patrick
and Rolland. Over time, services developed in response to these cases will
reach hundreds of individuals currently residing in nursing homes. The state
will also explore the feasibility of expanded Medicaid community support
coverage options for other disabled and elder MassHealth members, such
as those permitted under the federal Deficit Reduction Act. Additionally, the
development of expanded private and public-private financing mechanisms
for long-term supports will be initiated.
9
The implementation plan references several current program review processes
underway that will, when completed, yield solutions to other access challenges.
The Personal Care Attendant Improvement Workgroup, for example, will
identify and implement effective ways to improve the MassHealth program’s
operations. The EOHHS Turning 22 Initiative is working to guide changes in
planning and supports for young adults with disabilities who are turning 22 and
aging out of educational services. The absence of a clear “agency of tie” for many
of these young people makes adult service planning challenging.
Even when community services exist, access is often complicated for both
elders and people with disabilities by the often limited availability of accessible
transportation options. Several EOHHS initiatives currently focused on
increasing transportation access will expand cross-secretariat coordination and
collaborative purchase mechanisms.
A core principle of the Olmstead Plan is choice, choice that is informed,
supported, and secure. Work within this goal arena will assure that expanded
consumer empowerment and decision-making is accompanied by
improvements in current guardianship regulatory and administrative practices.
3. Improve the capacity and quality of community-based long-term supports.
Ob jecti ves:
Expand and sustain a high-quality workforce in the community
Increase availability and diversity of residential support options
Improve financing for community-based long-term supports
Incorporate self-direction in the long-term supports system
Implement system-wide quality improvement processes in the existing
and future long-term support delivery systems
The success of the state’s efforts to effectively assist individuals in returning
to live safely in the community relies on enhancing access to high quality
community-based services. This requires an adequate workforce, funding
for a broad mix of services, flexible choices that respond to diverse needs
and preferences, including culture and communication, and a system that is
responsive to changing individual needs
by expanding,
strengthening, and integrating systems of community-based
long-term supports that are person-centered, high in quality and
provide optimal choice.
3
I. suMMary
The Commonwealth of Massachusetts is establishing its community First
olmstead Plan pursuant to a Supreme Court decision compelling states
to create meaningful community living plans for people with disabilities
and elders. In keeping with the framework of Olmstead v. L.C. and the
Patrick Administration’s commitment to a “community fi rst” long-term care
policy, this plan embraces a vision of choice and opportunity that requires
the deliberate development of more accessible and eff ective long-term
supports in local communities. Thus, the Plan supports the Administration’s
commitment to shifting focus of long-term care fi nancing from institutions
to the community. Grounded in the 2002 People’s Plan and the extensive
home and community-based service developments that have occurred
through the eff orts of the Executive Offi ce of Health and Human Services
(EOHHS), the Plan has greatly benefi ted from the signifi cant input of a broad
array of internal and external stakeholders (see Appendix B).
Focusing on six critical goal areas, the Plan provides a roadmap for the
future of community-based support for elders and people with disabilities.
Strategic short-term objectives describe an eighteen-month course of action
for the Administration in crucial regulatory, fi scal and program development
arenas which will, of necessity, be contingent on the availability of re-aligned
as well as new public and private long-term support funding.
The public-private collaborations that have brought the Plan thus far will
be the cornerstone of future eff orts and hold the promise of new and
meaningful opportunities for the nearly 20% of Massachusetts residents who
are elder or disabled and want the opportunity to choose community fi rst.
4 The Community First Olmstead Plan
II. Background
What is an Olmstead Plan?
In 1999, the U.S. Supreme Court rendered a favorable decision in Olmstead
v. L.C, a case that challenged the state of Georgia’s efforts to institutionalize
people with mental disabilities. The Court ruled that the Americans with
Disabilities Act (ADA) required states to provide services in the most
integrated settings appropriate to the needs of individuals with disabilities;
additionally, the Court indicated that each state should develop an Olmstead
plan consistent with the decision. The 2001 federal New Freedom Initiative,
multiple subsequent directives and grant funding from the Centers for
Medicare and Medicaid Services, and extensive monitoring by the Office
of Civil Rights, the National Council on State Legislatures, the American
Association for Retired Persons, and others have supported and tracked the
development of Olmstead plans now underway in most states.
Why is an Olmstead Plan important to Massachusetts?
The elder and disabled populations in Massachusetts are growing. They are a
diverse group of individuals and many depend on state-supported programs.
With a broad array of home and community-based services, including case
management and housing supports, they may live in less restrictive, and
sometimes less expensive, community-based settings where many wish to
remain.
Approximately 1.64M (20%) of Massachusetts’ residents are elders or
people with disabilities; over 300,000 are enrolled in MassHealth, and
32,000 are in nursing facilities on an average day.
Of the 856,000 elders in Massachusetts, approximately 104,000
(12.1%) are enrolled in MassHealth.
Of the 785,000 persons with disabilities in Massachusetts,
approximately 210,000 (26.8%) are under age 65 and enrolled in
MassHealth.
The current federal long-term care financing system tends to favor
institutional over community care.
5
Among the approximately 250,000 elder or disabled MassHealth
members living in the community, there is a desire for increased
access to community support services. Many more elders and
people with disabilities who are not enrolled in MassHealth also
desire increased access to home and community-based support.
MA is in the highest quartile of states for the number of nursing
home beds per population.
Employment opportunities, critical for supporting people with
disabilities in leading self-sufficient and independent lives, are limited
in MA as elsewhere.
People with disabilities in MA are almost three times as likely to be
unemployed as their non-disabled peers (American Community
Survey, 2006).
Access to affordable and accessible housing often functions as one of the
greatest challenges to individuals successfully leaving institutional care.
Lack of many community service options limits the ability of elders and
people with disabilities to choose community over institutional care.
How was the Plan developed?
At Governor Patrick’s request, an Olmstead Planning Committee was
convened in late Fall 2007. A large group of representatives including
provider, consumer, and advocacy organizations, as well as elders and
people with disabilities (see Appendix B), worked collaboratively with state
agency staff to develop the framework and implementation strategies for
the Administration’s Plan. The People’s Olmstead Plan, which was produced
by a group of consumer advocates in 2002, provided the starting point for
the discussions. Using the People’s Plan goals as a foundation, the Olmstead
Planning Committee reviewed prior and current EOHHS initiatives focused on
achieving Olmstead-related objectives and identified gaps in needed service
and policy development. The Committee articulated six over-arching goals
and focused on identifying short-term action steps that now form the basis of
an eighteen-month implementation plan (Appendix A).
6 The Community First Olmstead Plan
What are the Principles that underlie this Plan?
The primary principles that inform the Plan are the following:
People with disabilities and elders should have access to community
living opportunities and supports;
The principle of “community first” should shape state elder and
disability policy development and funding decisions;
A full range of long-term supports, including home and communitybased
care, housing, employment opportunities, as well as nursing
facility services are needed;
Choice, accessibility, quality, and person-centered planning should be
the goals in developing long-term supports;
Systems of community-based care and support must be strengthened,
expanded and integrated to ensure access and efficiency;
Public and private mechanisms of financing long-term care and support
must be expanded;
Long-term supports developed under this plan must address the
diversity of individuals with disabilities and elders in terms of race,
ethnicity, language, ability to communicate, sexual orientation, and
geography.
The Community First Olmstead Plan is a work in progress. Ongoing
community engagement will be critical to implementation, evaluation, and
revision as the Plan evolves to meet changing needs and resources.
7
III. The Community First Olmstead Plan
The overarching purpose of the Massachusetts Olmstead Plan is to maximize
the extent to which elders and people with disabilities are able to live
successfully in their homes and communities. Six goals provide the framework
for achieving that vision:
1. Help individuals transition from institutional care.
2. Expand access to community-based long-term supports.
3. Improve the capacity and quality of community-based
long-term supports.
4. Expand access to affordable and accessible housing
and supports.
5. Promote employment of persons with disabilities and elders.
6. Promote awareness of long-term supports.
Detailed objectives and timeframes for each of the goal areas are included
in Appendix A. The rest of this section highlights the major objectives and
provides additional background for each goal area.
1. Help individuals transition from institutional care.
Objectives:
Expand existing and implement new mechanisms for identifying
individuals in institutions who wish to live in the community
Implement additional mechanisms for facilitating transition from
institutional settings
This goal reaches to the heart of the Olmstead decision and, thus, is a core
obligation of this Plan. Successfully identifying institutionalized individuals who
want to move back home or to other community settings can be challenging.
Aging Service Access Points, Independent Living Centers, EOHHS agency staff,
and other disability and elder related organizations currently work to engage
individuals in transition processes, but a more systematic approach is needed
to ensure greater success. Implementation of the Long-term Care Options
Counseling process, mandated under Chapter 211 of the Acts of 2006, and
initiation of the transition services components of the planned Community
First (CF) 1115 waiver, the Hutchinson settlement, and the alternative Rolland
8 The Community First Olmstead Plan
settlement will put in place capacity needed to facilitate successful movement
of institutionalized individuals to community settings. Ongoing assessment of
the effectiveness of transition interventions will provide a basis for continuous
quality improvement.
2. E xpand access to community-based long-term supports.
Ob jecti ves:
Improve access to necessary home and community-based services
including, but not limited to, case management, medication
management, behavioral health, caregiver supports, and assistive
technology for elders and persons with disabilities
Improve access to accessible transportation for elders and persons
with disabilities
Improve transition services for adolescents with disabilities who are
leaving the education system
Massachusetts’ public and private systems of long-term supports are unevenly
available to elders and people with disabilities. In the public arena, one of
the challenges to access is differing financial and clinical eligibility standards
that exist across programs and funding streams that particularly affect
persons as they age and/or their conditions change. In this goal area, the
focus will be on reviewing eligibility standards to implement ways to broaden
coverage as resources permit. Successfully launching the Community First
1115 Waiver is the major focal point of this goal during the initial Olmstead
Plan implementation period; 15,600 people will be enrolled by the end of
the eighteen-month timeframe. During this same period, EOHHS will also
begin to meet the obligations of the resolution of both Hutchinson v. Patrick
and Rolland. Over time, services developed in response to these cases will
reach hundreds of individuals currently residing in nursing homes. The state
will also explore the feasibility of expanded Medicaid community support
coverage options for other disabled and elder MassHealth members, such
as those permitted under the federal Deficit Reduction Act. Additionally, the
development of expanded private and public-private financing mechanisms
for long-term supports will be initiated.
9
The implementation plan references several current program review processes
underway that will, when completed, yield solutions to other access challenges.
The Personal Care Attendant Improvement Workgroup, for example, will
identify and implement effective ways to improve the MassHealth program’s
operations. The EOHHS Turning 22 Initiative is working to guide changes in
planning and supports for young adults with disabilities who are turning 22 and
aging out of educational services. The absence of a clear “agency of tie” for many
of these young people makes adult service planning challenging.
Even when community services exist, access is often complicated for both
elders and people with disabilities by the often limited availability of accessible
transportation options. Several EOHHS initiatives currently focused on
increasing transportation access will expand cross-secretariat coordination and
collaborative purchase mechanisms.
A core principle of the Olmstead Plan is choice, choice that is informed,
supported, and secure. Work within this goal arena will assure that expanded
consumer empowerment and decision-making is accompanied by
improvements in current guardianship regulatory and administrative practices.
3. Improve the capacity and quality of community-based long-term supports.
Ob jecti ves:
Expand and sustain a high-quality workforce in the community
Increase availability and diversity of residential support options
Improve financing for community-based long-term supports
Incorporate self-direction in the long-term supports system
Implement system-wide quality improvement processes in the existing
and future long-term support delivery systems
The success of the state’s efforts to effectively assist individuals in returning
to live safely in the community relies on enhancing access to high quality
community-based services. This requires an adequate workforce, funding
for a broad mix of services, flexible choices that respond to diverse needs
and preferences, including culture and communication, and a system that is
responsive to changing individual needs
Olmstead Community First Program
Mass Home Care presented the
following list of specifi c program goals as ‘next
steps’ in the Olmstead/Community First movement:
1. Implement Long-term Care
Options Counseling statewide.
2. Implement the Community First (CF)
1115 waiver program, enhanced services,
with enhanced income and asset rules.
3. Support expansion of respite care capacity for caregivers.
4. Improve funding for case management, medication
management, behavioral health, and caregiver supports
5. Submit a Home and Community Based
Services (HCBS) State Plan Amendment (SPA)
to uncouple HCBS from nursing home eligibility.
6. Increase funding and community-based
services for people who are not low-income
or otherwise not eligible for MassHealth.
7. Remove barriers to community-based care,
make eligibility rules uniform regardless of age.
8. Implement PCA Improvement workgroup
recommendations, including allowing
cueing and supervision to be a need for
care, and creation of the PCA directory, etc.
9. Allow spouses to become paid caregivers
in programs like PCA and Adult Family Care.
10. Increase supply of supportive housing sites,
and 24/7 “housing with services” packages,
including small group homes, using funding from
Community Housing bond and other sources.
11. Implement and fund the ADRC model statewide.
12. Implement mandatory training in cultural competency
on LGBT issues, and a statewide needs assessment of
LGBT individuals with disabilities and the elderly.
13. Increase funding for the protective
services programs, and education on reporting
responsibilities under the abuse and neglect law.
14. Create a medication assistance program for
elders and individuals with disabilities in their homes
by amending the nurse practices act requirements.
“The key to any plan is its implementation,” said
Paul J. Lanzikos, President of Mass Home Care. “We
Friday, October 24, 2008
The Program of All-Inclusive Care for the Elderly
(PACE) is a capitated benefit authorized by the Balanced Budget Act of 1997 (BBA) that features a comprehensive service delivery system and integrated Medicare and Medicaid financing. The program is modeled on the system of acute and long term care services developed by On Lok Senior Health Services in San Francisco, California. The model was tested through CMS (then HCFA) demonstration projects that began in the mid-1980s. The PACE model was developed to address the needs of long-term care clients, providers, and payers. For most participants, the comprehensive service package permits them to continue living at home while receiving services rather than be institutionalized. Capitated financing allows providers to deliver all services participants need rather than be limited to those reimbursable under the Medicare and Medicaid fee-for-service systems.
The BBA established the PACE model of care as a permanent entity within the Medicare program and enables States to provide PACE services to Medicaid beneficiaries as a State option. The State plan must include PACE as an optional Medicaid benefit before the State and the Secretary of the Department of Health and Human Services (DHHS) can enter into program agreements with PACE providers.
Participants must be at least 55 years old, live in the PACE service area, and be certified as eligible for nursing home care by the appropriate State agency. The PACE program becomes the sole source of services for Medicare and Medicaid eligible enrollees.
An interdisciplinary team, consisting of professional and paraprofessional staff, assesses participants' needs, develops care plans, and delivers all services (including acute care services and when necessary, nursing facility services) which are integrated for a seamless provision of total care. PACE programs provide social and medical services primarily in an adult day health center, supplemented by in-home and referral services in accordance with the participant's needs. The PACE service package must include all Medicare and Medicaid covered services, and other services determined necessary by the interdisciplinary team for the care of the PACE participant.
PACE providers receive monthly Medicare and Medicaid capitation payments for each eligible enrollee. Medicare eligible participants who are not eligible for Medicaid pay monthly premiums equal to the Medicaid capitation amount, but no deductibles, coinsurance, or other type of Medicare or Medicaid cost-sharing applies. PACE providers assume full financial risk for participants' care without limits on amount, duration, or scope of services.
The BBA established the PACE model of care as a permanent entity within the Medicare program and enables States to provide PACE services to Medicaid beneficiaries as a State option. The State plan must include PACE as an optional Medicaid benefit before the State and the Secretary of the Department of Health and Human Services (DHHS) can enter into program agreements with PACE providers.
Participants must be at least 55 years old, live in the PACE service area, and be certified as eligible for nursing home care by the appropriate State agency. The PACE program becomes the sole source of services for Medicare and Medicaid eligible enrollees.
An interdisciplinary team, consisting of professional and paraprofessional staff, assesses participants' needs, develops care plans, and delivers all services (including acute care services and when necessary, nursing facility services) which are integrated for a seamless provision of total care. PACE programs provide social and medical services primarily in an adult day health center, supplemented by in-home and referral services in accordance with the participant's needs. The PACE service package must include all Medicare and Medicaid covered services, and other services determined necessary by the interdisciplinary team for the care of the PACE participant.
PACE providers receive monthly Medicare and Medicaid capitation payments for each eligible enrollee. Medicare eligible participants who are not eligible for Medicaid pay monthly premiums equal to the Medicaid capitation amount, but no deductibles, coinsurance, or other type of Medicare or Medicaid cost-sharing applies. PACE providers assume full financial risk for participants' care without limits on amount, duration, or scope of services.
Wednesday, October 1, 2008
Home and Community-Based Care Surveys
Going from Good to Great: Livable Communities Surveys in OH
Research Report
Brittne M. Nelson, M.S., AARP Knowledge Management
Terri Guengerich, AARP Knowledge Management
September 2008
AARP defines a livable community as one that allows people to maintain their independence and quality of life as they age and retire. Specific aspects of a livable community include adequate mobility options, supportive community features and services that allow residents to maintain their independence and enjoy an engaging civic and social life, and affordable and appropriate housing. AARP Ohio commissioned a telephone survey of the general populations age 45 years and older of Clermont County and Marietta, Ohio, to ask them about what they would need and want as they got older to make their community a great place to grow old. The survey findings include:
Survey respondents have been long-time residents of their communities — over two decades in Clermont County and three decades in Marietta.
Most of these residents are rooted in their community, satisfied with it, and think it is a good place for people approaching retirement.
Most of them would like to stay in their community for as long as possible.
They are in frequent contact with their friends, family, and neighborhoods regardless of their age.
However, most also said that street repair and limited or unavailable public transportation are problems in their community.
Many of these residents were unaware that legal support, respite care, and health monitoring services exist in their communities.
This study is based on telephone surveys of 801 residents age 45 and older living in the 45750 ZIP Code area of Marietta Ohio, and 1,002 residents aged 45 and older living in Clermont County, Ohio. The first-stage interviews were conducted by Woelfel Research, Inc., from November 8 to November 19, 2007, with a second stage conducted from March 30 to April 3, 2008. For more information, contact Terri Guengerich at 202-434-6306.
Subscribe to:
Comments (Atom)
