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Administration for Community Living

Administration for Community Living. U.S. Department of Health and Human Services.

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Administration for Community Living

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  1. Administration for Community Living U.S. Department of Health and Human Services

  2. "For too long, too many Americans have faced the impossible choice between moving to an institution or living at home without the long-term services and supports they need. The goal of the new Administration for Community Living will be to help people with disabilities and older Americans live productive, satisfying lives." - Secretary Kathleen Sebelius

  3. Overview • This new HHS Operating Division brings together the Administration on Aging (AoA), the Office on Disability (OD) and the Administration on Developmental Disabilities (ADD) • This single agency is charged with developing policies and improving supports for seniors and people with disabilities.

  4. Why Is This Important? • The common interests of the aging and disability populations have been recognized at the local and state levels. • The mechanisms for providing supports that facilitate community living have been brought together into agencies that serve both populations. • Yet at the federal level, policy development, community outreach and program implementation related to aging and disability across the lifespan was fragmented across HHS.

  5. Background • In 2009, on the 10th anniversary of the Supreme Court’s landmark Olmstead decision, President Obama announced the Year of Community Living. • He directed the HHS and HUD Secretaries to work together to identify ways to improve access to housing, community supports, and independent living for people with disabilities.

  6. Background • In 2009 HHS Secretary Sebelius established an interagency Coordinating Council co-led by the Director of the Office on Disability and the Assistant Secretary on Aging. • Through the Community Living initiative, stakeholders and states have been engaged, investments made to improve access to housing and critical long-term services and supports; increase in communities that have Aging and Disability Resource Centers and enhanced state participation in the Money Follows the Person program.

  7. Organizational Structure

  8. Enhanced ADRC Options Counseling Program

  9. ADRC Funding Opportunity Vision • Reflects a joint vision of ACL/OD/CMS/VHA • Includes a robust Options Counseling Program that serves as the front door to LTSS for all populations and all payors • Supports the LTSS rebalancing efforts of both Medicaid and the VHA as well as the ACA/CMMI initiatives that are promoting the integration of health and LTSS

  10. ADRC Funding Opportunity Vision, (continued) • Provides a financially sustainable path for high-performing ADRC programs • Supports the three primary populations served by ACL: older adults, persons with physical disabilities and person with intellectual and developmental disabilities. • Establish a single set of program specs for the CMS NWD/SEP and ACL ADRCs

  11. ADRC Funding Opportunity Goals • Strengthening the capacity of the ADRC Options Counseling Program to serve people of all ages, income levels and disabilities by adopting a “No Wrong Door” approach that operationally involves a wide array of community agencies and organizations. • Rapidly diffusing trained and certified ADRC Options Counselors throughout the funded states, and building stronger partnerships between health and LTSS systems to reduce unnecessary readmissions and promote improved health, better care and lower costs.

  12. ADRC Funding Opportunity Goals(continued) 3. Developing financially sustainable ADRC models that includes revenue from multiple public programs (including Medicaid, Medicare, the Older Americans Act, the VHA and other programs) to cover expenses plus margin. 4. Adopting national performance and outcome standards and aligning data collection and reporting methods across LTSS payers within a state to minimize administrative burden and support continuous quality improvement. The funded states will participate in a 6 month collaborative process with ACL, CMS, and VHA to develop a nationally directed evaluation.

  13. ACL/AoA Overview • AoA Mission: To help older adults maintain health and independence in their homes and communities • Aging Network provides variety of programs consistent with a 3-part aim: Better Health/ Quality of Life, Better Care, Lower Costs • Funding authorities: • Older Americans Act of 1965 • Public Health Service Act section 398 – Alzheimer’s Disease Supportive Services • Public Health Service title XVII – Lifespan Respite Care • Medicare Improvements for Patients and Providers Act of 2008 • ARRA – Chronic Disease Self-Management, Nutrition Services

  14. Who We Serve • 10.5 Million Elderly 60 & Over, of whom3 Millionreceive Intensive Services • Nearly 700,000 Caregivers • Veterans of all ages • 73-85% are poor or near-poor • 55-69% live alone • Over 90% have multiple chronic conditions • 25% minority • 37% rural • High risk for ER visits, hospitalization and nursing home admission with multiple medications and ADL impairment.

  15. Aging Network – An Infrastructure that Supports 11 Million Older Adults and Caregivers • AoA • 56 State Units on Aging • 629 Area Agencies/365 Aging and Disability Resource Centers (ADRCs) • 246 Tribal organizations • 20,000 Service Providers & 500,000 Volunteers • Provides Services & Supports to 1 in 5 Seniors • 242 million meals • 28 million rides • 29 million hours of personal care • 69,000 caregivers trained 855,000 assisted • 4 million hours of case management • 9,115 individuals transitioned • 67,757 CDSMP completers

  16. A NETWORK OF PARTNERS & SERVICES • Federal: CDC, CMS, HRSA, Veterans Affairs, AHRQ , NIA etc. • Hospitals for discharge planning • Home Care Agencies • Community Health Centers/ FQHCs • Public Health Departments • Assisted Living/Nursing Facilities • Social Security • Medicaid • HUD Public Housing • Alzheimer’s Associations • Senior Centers • Volunteer Groups • Care Transitions and MFP • Chronic Disease Self-Management / Falls prevention, physical activity and other evidence-based health programs • Information & Referral • Adult Day Care/Respite Care • Home /Congregate Meals • Personal Care • Socialization/Senior Centers • Medication Management • Benefits Counseling • Partnerships • Services

  17. ACL/AoA Overview • Better Health/ Quality of Life: • Older Americans Act Title III/ medication management • 2003-2011 Evidence-based Prevention Program (CDSMP, falls, mental health, physical activity) to 24 states • Recovery Act CDSMP grants to 47 grantees • Senior Community Services Employment Program • Care Transitions grants • Better Care: • Single point of entry ADRCs/AAAs • Participant-directed programs that support community living: Money Follows the Person (MFP) and Veterans-Directed Home and Community-Based Services (VDHCBS) • Lower Costs: • The Senior Medicare Patrol (SMP) • State Health Insurance Program (SHIP) and Benefit Enrollment Centers

  18. Holistic Approach: Key Elements in a Fully Functional ADRC • Highly visible and trusted single point of entry where people of all incomes and ages can get information on the full range of long term support programs and benefits • Bridges access to aging and disability services, community supports and health care services

  19. ADRCs and No Wrong Door, Person-Centered, Integrated Services Person and Caregiver

  20. AoA is Focusing on Translating Research into Practice Science Agency (eg. NIA) Science Agency/AoA ACL/AoA Bench Science Translation Dissemination

  21. Aligning on Population Health: Examples of Evidence-Based Programs Being Translated/Disseminated within AoA’s network

  22. Example: Chronic Disease Self-Management • 48 States and Territories • 67,757 participants completed the workshop • 8,223 workshops at 5300+ sites • Average age 67 years; 22% males; 67% Whites, 21% African Americans; 18% Hispanics • 60.3% more than one chronic condition • Hypertension 43% • Arthritis 41% • Diabetes 30% *As of March 27, 2012

  23. Evidence-Based Healthy Aging Programs as the Gold Standard for Evidence-Based Programs 27 Evidence-Based Programs endorsed by AoA, including: • A Matter of Balance • Chronic Disease Self-Management Program • Healthy IDEAS (Identifying Depression, Empowering Activities for Seniors • Diabetes Self-Management Program • Positive Self-Management Program for HIV • Chronic Pain Self-Management Program • Online Chronic Disease Self-Management Program (Better Choices Better Health and Better Choices Better Health – Diabetes) • Tomando Control su de Salud (Spanish Chronic Disease Self-Management Program

  24. Change to Title III-D in 2012 When States received their Notice of Award for Older Americans Act funding in February 2012, it included this change: Effective with this action, funding in the amount of __ for Title III Part D section 361 of the Older Americans Act for Disease Prevention and Health Promotion, may only be used for programs and activities which have been demonstrated through rigorous evaluation to be evidence-based and effective.

  25. Aligning with Partnership for Patients and Care Transitions • Implementing Evidence-Based Care Transition Models including Care Transitions Intervention (CTI), Transitional Care Model (TCM) , Guided Care, GRACE, Bridge. • Currently active in 100 sites and partnering with 169 hospitals - an additional 90 sites are gearing up • 15 AoA Webinars ; Aging Network Toolkit; Materials downloaded over 200,000 time from the AoA Website. • AoA is supporting 16 care transition grantees in 22 sites targeting the MCC population including those with disabilities; all payers • First 27 of 30 P4P /CCTP site selections are within the AoA Aging Network in partnership with the health community.

  26. Aligning with Million Hearts • Nutrition/Counseling • CDSMP • Care transitions • Direct Services • Health & Aging Resource Center • Conferences • Training Communications • Online newsletters • National affiliates and partners meetings and conferences

  27. Intersection of Public Health, Aging Services and Health Care Sectors for the Dissemination and Implementation of Effective Evidence-Based Prevention Programs Current CDSMP, Falls and other Evidence-based Activities ADRC Care Transitions Activities Aging Services Public Health Health Care Delivery SWEET SPOT Link ALL 3

  28. Constantinos I. Miskis Regional Administrator Region IV – Atlanta (AL, FL, GA, KY, MS, NC, SC, TN) Administration for Community Living U.S. Department of Health & Human Services

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