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AREA PLAN ON AGING
FISCAL YEARS
2014-2017
TABLE OF CONTENTS
Verification of Intent
Part I
Part II
Part III
Part IV
Part V
Part VI
Part VII
Part VIII
Part IX
Part X
Introduction to the Area Plan on Aging
Description of the Area Agency on Aging
Needs Assessment
Goals, Objectives, and Action Plans
Preference to Older Persons with Greatest Economic or Social Need
Key Changes to Service Delivery
Approved Waivers
Budget
Services by Geographical Area
Appendix
1. Assurances
2. PCOA Organizational Chart
3. Area Agency on Aging Advisory Council Membership List
4. Listing of Services and Providers
6. List of Neighborhood and Volunteer Organizations
7. A Report to the Community

VERIFICATION OF INTENT
This Area Plan on Aging is written for three reasons:
To comply with the Older Americans Act as amended in 2006;
To meet requirements for approval and match the mission of the Arizona Department of
Economic Security, Division of Adult and Aging Services (DAAS); and
To create a quality plan that will assist in accomplishing the goals of the Older
Americans Act and those of DAAS and Pima Council on Aging to benefit older persons
in this planning and service area (Pima County).
This plan is important because it sets forth this agency’s intent to:
Provide comprehensive and coordinated service delivery systems for older persons;
Assure the most effective and efficient use of available resources;
Provide information about older persons, the extent of their needs and services
necessary to improve their quality of life; and
Identify this agency, as part of a larger network, as the point of contact for advocacy,
information, assistance and services to older persons and their families.
This document is important to Pima Council on Aging as the Area Agency on Aging
because:
This Area Agency on Aging was created to develop and implement comprehensive and
coordinated systems to serve older individuals in this planning and service area. As
such, PCOA is responsible for planning and providing supportive services, including
nutrition, social services, caregiver support and support to grandparents raising
grandchildren.
In addition, PCOA will:
Allocate adequate proportions of Title III-B funds for the delivery of access services, inhome
services, and legal services;
Establish and maintain Information and Assistance Services;
Target services to older individuals with greatest economic and social need, with special
attention to minority, frail, disabled and rural individuals, including individuals at risk of
institutional placement, and older individuals with limited English speaking proficiency;
Identify individuals eligible for assistance under the Older Americans Act and serve
them in at least the same proportion as their Census percentage representation in the
community;
Conduct periodic hearings on activities under this Area Plan and provide an annual
update of budgets and services provided;
Provide technical assistance about aging issues to subcontractors and the community;
Solicit views from service recipients and incorporate them where appropriate;
Serve as the advocate and focal point for older individuals within Pima County.
Collaborate and coordinate with other local public and private organizations that provide
long-term care services;
Maintain an Advisory Council to advise the AAA on all matters relating to the
development, administration, and operations conducted under this Area Plan;
Facilitate a comprehensive and coordinated system to provide long-term care in home
and community based settings as directed by the older individual and their family
caregiver;

Implement, along with local service providers, evidence-based programs to assist older
individuals in reducing the risk of injury, disease and disability;
Make use of trained volunteers in providing direct services to older individuals and
individuals with disabilities;
Increase public awareness of mental health disorders, attempt to remove barriers to
diagnosis and treatment and coordinate mental health services, including screenings;
Undertake initiatives to help individuals live independently with dignity in their home
environments.
This document also serves as:
A communication document to DAAS;
A management tool to guide initiatives, budgets and decisions;
An information tool to educate and inform the public, policy makers, local officials,
service providers, seniors and their families; and
A self-evaluation and monitoring tool to assess efforts to address the ever burgeoning
needs of older persons in an environment of diminished resources.

VERIFICATION OF INTENT
This Area Plan on Aging is hereby submitted for Region II, Pima County for the period 2014
through 2017. It includes all assurances and plans to be followed by the Pima Council on
Aging under provisions of the Older Americans Act, as amended during the period identified.
This Area Agency on Aging will assume full authority to develop and administer the Area Plan
on Aging in accordance with all requirements of the Act and related State policy. In accepting
this authority the Area Agency on Aging assumes major responsibility to develop and
administer the Area Plan for a comprehensive and coordinated system of services and to
serve as the advocate and focal point for older people in the planning and service area.
The Area Plan on Aging has been developed in accordance with all rules and regulations
specified under the Older Americans Act and is hereby submitted to the State Agency on
Aging for approval.
Date
(Signed)
(Area Agency Director)
The Area Agency on Aging Advisory Council has had the opportunity to review and comment
on the Area Plan on Aging
Date
(Signed)
(Chairperson of the Area Agency on Aging Advisory Council)
The governing body of the Area Agency on Aging has reviewed and approved the Area Plan
on Aging.
Date
(Signed)
(President Board of Directors)

PART I:
INTRODUCTION TO THE OLDER AMERICANS ACT AND THE AREA PLAN
The Older Americans Act was created by Congress and signed into law by President
Lyndon B. Johnson in 1965. Title I of the Act establishes the seniors’ Bill of Rights. Title II
created the Administration on Aging (AOA) now known as the Administration for Community
Living (ACL) that is located in the Department of Health and Human Services and allowed for
subsequent creation of state and local units on aging. The Act allocates funds under Titles III
and VII to State Units on Aging to plan, develop and coordinate systems of supportive in-home
and community-based services for seniors. Under Title V, the ACL funds the Senior
Community Service Employment Program. Under Title VI, the ACL awards funds to tribes and
native organizations to meet the needs of older American Indians, Aleuts, Eskimos, and
Hawaiians.
The Older Americans Act of 1965 has been reauthorized fifteen times with the most recent
amendment occurring in 2006. The Older Americans Act remains the foundation to improve
the quality of life for all older Americans for now and the near future.
Under the Act, State Agencies on Aging, sometimes called State Units on Aging, are located in
every state and territory in the United States. Most states are divided into planning and service
areas so that programs can be designed to meet the locally identified needs of older persons
residing in those areas. There are approximately 665 Area Agencies on Aging (AAAs) in the
nation, of which Pima Council on Aging is one of eight in Arizona. Federal funding to
states is based on the number of older persons in the states according to the US Census, and
funding to local AAAs also depends on population numbers of elder and minority individuals.
Area Agencies on Aging receive funds from their respective State Units on Aging to plan,
develop, coordinate and arrange for services in each planning and service area to meet locally
identified needs. These funds are used by AAAs to contract with public or private groups for
service provision. Because advocacy to represent older consumers is a mandated function of
Area Agencies on Aging, they are prohibited from providing some services directly. However,
the AAAs must act as the service provider if no local contractor is available. All subcontracted
programs are designed to help seniors live independently in their own homes and communities
for as long as possible.
Additionally, volunteers, families, different levels of local government, (which provide the
matching funds needed in Pima County to attract federal dollars), faith-based organizations,
and groups in the public and private sectors form a network of partners interested in the wellbeing
of seniors. They offer much support toward improving the quality of life for older
individuals.
Under the Older Americans Act, State Units on Aging are charged with dividing the state into
planning and service areas and designating Area Agencies on Aging for each planning and
service area. Pima Council on Aging is responsible for Region 2, Pima County, Arizona. Each
Area Agency on Aging designated under “section 305 (a) (2) (A) of the Older Americans Act
shall, in order to be approved by the State agency, prepare and develop an Area Plan for a
planning and service area for a two, three, or four-year period determined by the State agency,
with such annual adjustments as may be necessary. Each such plan shall be based upon a
uniform format for area plans within the State prepared in accordance with section 307(a) (1)
of the Older Americans Act.”

In summary, Area Plans are legal documents submitted by Area Agencies on Aging to
State Agencies on Aging to receive Federal Older Americans Act dollars. The goals and
objectives identified in local Area Plans are then incorporated into State Plans which must be
submitted and approved by the ACL so states can receive federal OAA dollars. Area Plans
and State Plans contain provisions required by the Act, Federal rules and regulations, State
policies, procedures, and assurances and commitments that Area Agencies and States will
administer activities funded under their Plans in accordance with all Federal and State
requirements. These plans are the blueprints by which Area Agencies and States develop and
administer comprehensive and coordinated systems of services and serve as the advocate
and focal point for older people in their Planning and Service Areas.
Conceptually, the plan must represent a process, which translates locally identified needs into
the establishment of priorities for funding and services.
The Area Plan on Aging, as a planning document, has three major purposes:
1) To serve as the planning document that identifies needs, goals, objectives and the
activities that will be undertaken by the Area Agency on Aging relative to programs for the
older persons in the Planning and Service Area.
2) To represent a formal commitment to the State Agency which describes the manner in
which the Area Agency on Aging plans to utilize the Older Americans Act funds, including
how it will carry out its administrative responsibilities.
3) To be the "the blueprint for action" which represents a commitment by the Area Agency
on Aging that it will fulfill its role as the planner, catalyst, advocate on behalf of older
persons in the Planning and Service Area.

PART II
DESCRIPTION OF THE AREA AGENCY ON AGING (AAA) AND ITS NETWORK
Are you a single-purpose agency to administer programs for older persons?
Pima Council on Aging, Inc. (PCOA) is a single-purpose Arizona nonprofit corporation created
by and for the people of Pima County. Established in 1967, PCOA identifies the needs of older
adults in Pima County and responds to those needs with innovative programs and services.
PCOA is responsible for administering, planning and coordinating services that assist older
persons and their family caregivers - PCOA assists them to make informed decisions that allow
them to live at home or choose a viable option; preserves independence by funding a system of
in-home community based services; and provides accurate information and counsel on a range
of age related concerns. PCOA is the primary resource for advancing the social and economic
interests of our community’s older citizens, their families and caregivers.
How is the agency organized and what is the nature and scope of its work and/or its
capabilities? What methods are used by the agency to carry out AAA responsibilities?
(examples: clear delineation of the roles and responsibilities of project staff, consultants
and partner organizations, how they will contribute to achieving the plan’s objectives)
PCOA is organized under a twenty-five member Board of Directors; a Chief Executive Officer
who oversees a staff of sixteen part-time and fifty-nine full-time positions, (of which
approximately sixty-five percent are involved in Older Americans Act activities); a twenty
member AAA Advisory Council and numerous volunteers. The Board meets monthly in its policy
development role and approves all budgets, contracts and plans prior to implementation by staff.
The AAA Advisory Council meets ten times yearly, during which agency plans, contracts and
service reports are presented, discussed and recommendations presented to the Board of
Directors for approval. The AAA Advisory Council is actively involved in community needs
assessment; prioritization of services; understanding budget challenges; Area Plan
development; and assisting staff in quality assurance and meeting advocacy goals. The CEO
meets weekly with a ten member management team to discuss agency operations; service
delivery methodologies; status of development activities; and budgeting and advocacy issues.
Positive community relationships with affiliated organizations are built by PCOA’s experienced
staff, Board and Council Members. Advocacy activities are directed toward elected officials and
their aides at all levels of government (city, county, state and federal) when funding issues,
policies and planning decisions effecting older individuals are addressed. Further, agency staff
serve on local and state planning and steering committees or coalitions that affect senior issues.
See Appendix 2 for an Agency Organization Chart and Appendix 3 for a list of Advisory
Council Members.
What is the network for which the Area Agency on Aging operates? (examples: service
delivery system, advisory council, partnerships, funders, etc.)
The focus of PCOA’s annual contracting process and its periodic request for proposal process is
to maintain and support a system of non-medical home and community based services that
allow eligible individuals to age in place in their own homes and neighborhoods for as long as
possible; thus meeting the intent of the federal Older Americans Act, the major funder of the
system. The main network for accomplishing this goal is known as the Community Services
System (CSS). CSS is a non-medical coordinated delivery system that provides in-home and
community based services to frail elderly and younger physically disabled residents of Pima
County. Centralized Intake at PCOA assures that area residents have access to information,
assistance, referrals and screening for subsidized CSS services - as funding is available.

Referrals are made to PCOA’s case management division where trained staff authorize, monitor,
track and close clients for in-home supportive services. PCOA also funds a network of nutrition
providers operating senior centers and home delivered meals routes. Not all community
programs and services funded by PCOA are part of the formal CSS, but all services do meet the
goals of keeping elders independent and making the community a better place in which to age.
In addition to the subcontracted services, PCOA provides a number of services directly. These
services focus on elder rights and benefits; engaging older adults in volunteer work; providing
information and assistance and support groups for caregivers; and support of neighbors helping
neighbors. As the designated ADRC (Aging and Disability Resource Center) and a community
focal point for aging services, PCOA operates a help line staffed by four social workers. These
individuals conduct the initial screening for callers to the Community Services System and refer
callers to internal PCOA programs and services or to other community resources as needed.
Maintaining community partnerships requires the participation of the Agency’s CEO and staff,
members of the AAA Advisory Council, sub-contracted agencies, community funders, elected
officials and interested individuals all working together. PCOA participates in County and City
SSBG and CDBG planning processes; the United Way Senior Impact Council; and informs the
public about aging issues through regular presentations at health fairs, TV, radio, and news
releases and through the monthly newsletter “Never Too Late”. PCOA collaborates with
behavioral health providers to address needs of elderly in the region and interacts formally with a
wide array of grass roots community volunteer organizations. Agreements with two organizations
to host PCOA staff at satellite sites, allow expansion of direct services to an enlarged geographic
area. PCOA’s web site www.pcoa.org is available for the public to access information about
issues and services. Funders are discussed in the following question.
See Appendix 4 for a listing of services and providers funded by PCOA.
How does the Area Agency on Aging assure coordination and integration of multiple fund
sources?
The planning, training, coordinating, monitoring, and funding required to administer a complex
system that serves thousands of individuals each year requires the integration of multiple
funding sources. The programs and services funded by PCOA, which are non-entitlement
services, are supported by a variety of different sources ranging from public funds - federal,
state, county, and city, to private funds – grants, bequests, endowments, memberships,
donations, and project income and cost-shares. PCOA has experienced and professional staff
in the areas of financial management, management information system technologies, fund
development, and grants and program administration that work together to meet not only DES
contract requirements but also to be accountable to all funders and the public. The PCOA
Finance Department tracks all PCOA revenues and expenditures by program and funding
source. Financial records are maintained on or Sage MIP Fund Accounting software, with a
chart of accounts set up by general ledger account code, program code and grant/funding
source code.
In addition, Excel spreadsheets are maintained to track and monitor the budgets and billings for
all funding sources. PCOA’s finances are reviewed annually by an independent auditing firm
and reports presented to the Board of Directors and sent to all funding sources.

What is the approach that will be used to monitor and track progress on the Area Plan on
Aging?
Area Plan goals and objectives are reviewed and updated twice yearly by management staff with
progress reports indicating the status of achieving the goals. Depending upon funding or
program changes, utilization patterns, or other variables, amendments to service contracts may
be required. If contract amendments for Area Plan services are required, they are discussed with
applicable funding sources and sub-contractors; changes are made to budgets and scope of
work methodologies and presented to the AAA Advisory Council for comment. They are then
submitted to the Board of Directors for approval and subsequently to AZ DES, Division of Aging
and Adult Services (DAAS). PCOA designated staff prepare monthly financial and social service
reports from all sub-contractors and internal programs for those covered under the Area Plan.
AAA designated staff monitor expenditures and program outcomes and present regular reports
to the AAA Advisory Council and the Board of Directors. At the end of each fiscal year, a formal
“Year-End Report” is completed which lists accomplishments, outputs and outcomes; it is
published in the Annual Report and shared with Advisory Council, Board, staff, and funders.
How is competition used in the Area Agency on Aging in arranging for services for
elderly individuals and their caregivers?
PCOA follows Federal and State procurement codes for obtaining goods and services. Contracts
are awarded for a three-year cycle utilizing a formal Request for Proposal process. Legal notice
is posted in local newspapers and a mailing list of providers is maintained for notification of
Request for Proposals. Sealed bids must be received by the posted deadline and opened
publicly at a specified time. PCOA conducts fiscal and program monitoring of all providers
annually, or more often if needed. Follow-up is provided on any corrective actions to assure
contract compliance.
How have you coordinated activities and long-range emergency preparedness plans
along with local emergency response agencies, local governments, state agencies
responsible for emergency preparedness and other entities involved in disaster relief?
PCOA takes seriously its mandate to plan and advocate for seniors, particularly for those living
in their own homes in the community and communicates the unique needs of the senior
population in emergency preparedness planning by participating in the Pima County
Government’s Functional and Access Needs Task Force (Vulnerable Populations Taskforce).
This taskforce is comprised of numerous county/city/town governmental entities and various
social service agencies whose goal is to plan for disaster recovery by creating and maintaining a
county wide database of individuals deemed as vulnerable or requiring evacuation assistance in
the event of an emergency. PCOA has also received permission from the Pima County’s Office
of Emergency Management to reproduce information from their website in order to provide
information to the population we serve.
PCOA is also a member of the Southern Arizona Volunteer Organizations Active in Disasters
(SoAzVOAD), which is a regional coalition of non-government, government, and for-profit
agencies that may be active in all phases of disaster (preparedness, response, recovery, and
mitigation). SoAzVOAD’s purpose is to establish an organizational protocol should a disaster
occur in southern Arizona requiring the assistance of SoAzVOAD partners. It establishes a
method by which partner organizations can better communicate and collaborate during and after
a disaster to support the needs of the community.

In addition, PCOA, through its Community Services System, works with the Home and
Community Based Services (HCBS) contractors to develop disaster prevention and response
plans that are included in contract documents and service methodologies; providing technical
assistance; and coordinating information and resource distribution. The PCOA Community
Services System has identified and maintains a listing of case managed individuals who would
require evacuation assistance should the need arise. The lists are maintained by case manager
and by zip code in order to quickly identify these individuals by location within the county, in
order to respond with the necessary emergency services.
PCOA departments coordinate the dissemination of advance preparation information appropriate
to the target population throughout Pima County; whether through pamphlets, fliers, posters,
newsletters or email.
How have you partnered with faith-based and community organizations in order to assist
older individuals and their families meet home and community based needs?
PCOA is at the forefront of organizing faith-based and community organizations to assist older
individuals and their families in meeting their needs related to living independently and safely in
their communities. In 2003, PCOA and the United Way of Tucson and Southern Arizona initiated
a partnership with Interfaith Community Services and Old Fort Lowell Live at Home (known as
the Neighbors Care Alliance or NCA) to promote the development of volunteer caregiver
programs throughout Pima County. The NCA has grown to 20 grassroots organizations,
including more than 167 neighborhood and faith based groups. Each program recruits local
volunteers to form, lead, sustain and implement “neighbors helping neighbors” activities in
defined neighborhoods. Agency personnel have developed training manuals, databases,
tracking and reporting formats, and networking forums for these local partners to increase their
capacity to meet the needs of older individuals and their families. Volunteers address a variety
of immediate needs (such as medical transportation, yard and light house work) and make
referrals to supporting agencies for more involved needs.
Since 2000, PCOA personnel have also recruited local volunteers, known as Ambassadors, to
disseminate information and provide referrals to services for seniors, and their families and other
informal caregivers. Nearly 50 Ambassadors serve in City Ward Offices, dozens of faith-based
communities, senior centers, gated-communities, mobile home parks, and some branches of the
Pima County Public Library. Ambassadors provide information and referrals on a wide range of
questions from transportation to in-home support services, volunteer caregiver programs,
insurance questions, recreation and consumer scams. Ambassadors are required to attend
monthly in-service trainings provided by PCOA staff to keep up-to-date with the latest
information and opportunities. Both the NCA and Ambassador Programs have received national
recognition (National Association of Area Agencies on Aging and National Council on Aging) for
their innovation in successfully addressing the needs of older individuals and their families living
in the community.
See Appendix 5 for a list of neighborhood and volunteer organizations affiliated with PCOA

PART III
PUBLIC NEEDS ASSESSMENT PROCESS
The Area Plan on Aging Public Needs Assessment Process began in our community in 1975,
and has been updated in three-year cycles to culminate in this most recent effort. In the 2012-
2013 planning cycle, the community needs assessment and issue identification process was a
collaborative venture of the City of Tucson, Pima County, Town of Marana, Town of Oro
Valley, Town of Sahuarita, City of South Tucson, Greater Green Valley Community
Foundation, United Way of Tucson and Southern Arizona, Community Foundation for
Southern Arizona, Women’s Foundation of Southern Arizona, Direct Center for Independence
and the U of A Center on Aging. These are local funders with major planning responsibilities
for human and social services in Pima County. The “Report to the Community on Aging
Services” (See Appendix 6) identifies the changing nature of our area’s senior population,
anticipates future trends, identifies advocacy issues, best practices, successful programs that
already meet the needs of local seniors and summarizes comments received as part of the
needs assessment process.
Data was collected over a three-month period using a three-pronged approach proven
effective in past years. Input was obtained from:
focus groups of professionals working and providing services in the field of gerontology;
2,330 survey responses tabulated through Survey Monkey from individuals 60 years of
age or older, including homebound, senior club and organization members, service
recipients and readers of “Never Too Late”, and
ten public comment meetings held throughout the county, with Spanish language
interpreters, including Tucson, Green Valley, Sahuarita, Marana, Tucson Estates and
Oro Valley
First, representatives from health and social service providers were invited to participate in
focus groups held at various locations in Pima County during the month of October, 2012. The
questions to be discussed were sent to participants in advance of the focus groups.
Individuals not able to participate in the discussions were invited to complete the questionnaire
in writing and return it for inclusion in the final report. Thirty (30) agencies provided written
and/or verbal responses.
The second method for identifying problem areas for older Americans was the distribution of
surveys, printed in both English and Spanish. The survey was available for completion on
Survey Monkey; included in a publication of PCOA’s “Never Too Late newsletter” and
distributed to congregate and home delivered meal participants, members of numerous senior
clubs and organizations, service recipients of various social service agencies and through faith
communities and neighborhood associations. 2,330 surveys were received and tabulated with
responses coming from all geographical areas of the County.
Third, service needs, concerns and advocacy issues were identified at ten public comment
meetings held in various locations throughout Tucson, Green Valley, Marana, Sahuarita,
Tucson Estates and Oro Valley. At each meeting, a panel of Agency staff, a member of
PCOA’s Board of Directors, Chairperson of the Area Agency on Aging Advisory Council, and
representatives from the collaborative partners were present to listen and respond to advocacy
issues, identification of individual service needs and proposed changes that should be made to
existing services. Notice of these meetings was sent to newspapers and radio stations, an
article was published in “Never Too Late” and the information was distributed to senior clubs,
organizations, centers and service providers in the area. Over one hundred and fifty-six (156)
individuals attended and shared their comments and concerns.

All of the above methods were used in an attempt to be as inclusive and comprehensive as
possible in identifying needs and focusing on areas of greatest priority. It is often difficult to
obtain input through public meetings with transportation, care giving responsibilities, and health
issues being barriers for attendance. Recognizing these barriers, PCOA and its Collaborative
Partners chose to collect information through individual surveys and discussions with
professionals as well as public meetings held in locations where seniors already congregate.
The identified problem areas have not changed significantly from prior needs assessment
processes. Older adults continue to identify lack of affordable dental and health care;
understanding Medicare; maintaining and repairing their home; access to transportation;
assistance with meals, housekeeping, laundry, and personal care; affordable legal assistance
and knowing where to go for information and assistance.
In this current needs assessment, individuals were also concerned with income to meet their
basic needs: utility costs; paying for prescriptions; the cost of assistive devices (hearing aids,
glasses); and the increased costs for grandparents on fixed incomes raising their
grandchildren.
Fear of falling, memory loss, depression and/or anxiety, and loneliness were identified as
significant problems. People were appreciative of the senior centers, recreational programs
and volunteer opportunities, but were concerned how to engage their neighbors and friends
who were alone. Repeatedly, people voiced concern with living alone, falling, and how they
would summon help or whether they would be found.
The professionals working with older adults voiced concerns with the growth of the population
needing assistance and the dramatic reduction in the resources to serve them. The results
have been more people competing for less resources.
The number of individuals with Alzheimer’s has increased significantly, as well as older adults
needing assistance through the Behavioral Health System. Clients are presenting with
numerous chronic conditions and fewer families are able to afford care or placement of their
family members in appropriate settings.
PCOA not only uses information collected from the needs assessment process but a review of
changing demographics in the community to formulate its plan:
• Pima County is home to 209,742 individuals 60 years of age or older (21.4% of total
population). Of this total 151,293 are 65+ and 19,895 are 85+ years of age. Source: U.
S. Census Bureau
• Pima County’s 60+ population increased 36.9% in the last 10 years (2000-2010) while
the total County population increased 16.2% for the same time period.
• The fastest growing segment of the aging population is individuals over 85, the most
vulnerable who tend to need long-term care and whose numbers are expected to
double by 2020. 50% of individuals age 85+ have one or more chronic (on-going)
disability conditions that require assistance with Activities of Daily Living (ADLs).
(N4A & NASUA, 2009 “Project 2020 Talking Points”)

• In Pima County, there are 73,143 individuals 18 to 64 years of age with a disability
(12%). The population 65 and over with a disability is 38.7%. Source: U. S. Census
American Community Survey, 2009..
• By 2020, one in four Arizona residents will be over 60 years of age (compared to one in
six in 2000). Baby boomers were born between 1946 and 1964. Starting in 2011,
10,000 boomers turn 65 each and every day.
• Nearly one out of every four U.S. households contains at least one caregiver for a
relative or friend at least 50 years old. Adult children account for the largest proportion
of caregivers – 42% followed by spouses, 25%.
• In Pima County 14,500 people are diagnosed with Alzheimer’s disease or related
dementias.
• The suicide rate among Arizonans age 65 and older was the highest among all age
groups in nine of the last eleven years. Older adults have a higher suicide completion
rate. (1 out of 4 attempts vs. 1 out of 20 attempts). (American Association of
Suicidology, 2008).
The aging process has always presented individuals, families, communities and society with
challenges. As the Area Agency on Aging, PCOA can operationally and strategically plan to
address these challenges, but can only be successful if public policy makers, community
planners, and funders serve as partners and provide the resources necessary not only to
sustain but also to build systems of service and provide information to help individuals remain
healthy and independent as long as possible.
The following chart identifies the major comments received from all sources. Please see
Appendix 6 for a full listing. Many of these comments will translate into service development,
continuation or expansion. Other comments are beyond PCOA’s ability to address except
through advocacy with elected and appointed officials who make decisions in these areas.

PART III NEEDS ASSESSMENT COMMENTS 1 – Survey
2 – Focus
Group
3 – Comment
Meetings
COMMENTS/ISSUE SOURCE ACTION
TAKEN
Need assistance with home repairs; need help in advocating with
landlords for home repairs
1, 2, 3 O6-1
O3-2
Grants are needed to help defray the costs of remodeling bathrooms for
safety; grab bars are needed in the bathroom to help reduce fall risks.
1, 2, 3 O6-1
O6-2
Because I live alone I am concerned how I would get someone’s
3 O1-5
attention if I fell or needed medical attention and I could not use the
phone.
Electronic emergency alert systems are needed for safety in the home;
need to educate people about the rewards and value of an electronic
emergency alert system. Lifeline allows clients to feel safe and get
immediate attention for falls/medical emergencies.
1, 2, 3 O1-5
We feel that a great deal more could be done to make homes safer for
elderly people. In particular, fall prevention education and safety
hardware seem to be needed on a community-wide basis. Falls at home
are a common occurrence, create massive costs for the person and the
community, and are largely preventable.
The A Matter of Balance classes in Green Valley are always filled as the risk of
falling is a concern; the Green Valley Fire Department noted they receive 80
calls a month related to falls.
Homecare services are important and the community needs to know that
the waiting list for the services funded through the PCOA Community
Services System has been lifted for now.
Preparing nutritious meals is a problem; Home Delivered meals are
important in Green Valley; need for prepared meals also noted in Tucson
Estates.
People are hesitant to hire people to do work in their home because they
do not know if it is safe and the people are reliable.
Drexel Heights Fire Department provides Lock Boxes for people and the
911 Dispatcher knows that the person has the Lock Box and can alert
emergency personnel to access the box for a key.
1, 3 O1-8
1, 2, 3 O1-1
O1-2
1, 2, 3 O1-3
3 O6-3
Telephone Reassurance programs could help with isolation. 3 O1-11
Memory loss is a problem 1
Counseling is needed to deal with loss of spouse or other life tragedies;
1, 3 O2-4
loss of spouse or loved one serious problem
People need help in cleaning their yards as homeowner associations can
be ruthless in fining people who cannot take care of their yards;
maintaining the yard a problem
1, 3 O1-11
The City of Tucson tries to increase the number of vouchers for
subsidized housing but there is a long waiting list; lack of affordable
housing
Many people have questions and need guidance in how to choose long
term care options.
PCOA needs to provide classes/presentations on how to select Long
Term Care Insurance.
3
2, 3
3 O3-2
O3-7
3 O3-2

PART III NEEDS ASSESSMENT COMMENTS 1 – Survey
2 – Focus
Group
3 – Comment
Meetings
COMMENTS/ISSUE SOURCE ACTION
TAKEN
The Congregate Meal program at the El Pueblo Center is our life;
3 O1-4
concern that the Congregate Meal Programs at the various neighborhood
centers could close if the federal dollars are cut.
It would be nice to have field trips and be able to go somewhere besides
3
the Center on occasion.
The Food Bank can no longer bring food boxes to the City Parks and
3
Recreation neighborhood centers. Older adults with no transportation
find it difficult to go to the food bank location.
The number of Congregate Meal participants at the Green Valley Center
1, 3 O1-4
has declined and marketing is needed to reach isolated individuals in the
community. The socialization that occurs at the sites is as important as
the meals. Loneliness is a problem.
The PCOA Elder Rights and Benefits staff person who visits the Green
3 O3-2
Valley Center is helpful and the service beneficial.
Neighborhood libraries should host adult crafts and promote being a
2
place where people could talk and visit.
The Marana Senior Center needs equipment for people to work out. 3
Need technology classes at the centers for using computers. 3
Need help with purchasing hearing aids and eyeglasses; affordable
1, 3
assistive devices a problem
Many older adults can no longer receive AHCCCS; agencies having
2, 3
difficulty serving this population
The Poison Control Center is concerned about the number of medication
3 O2-3
errors reported for older adults.
There is also a concern with the number of older adults who are sharing
2, 3 O1-6
their medications because they cannot afford their prescriptions; increase
in medication non compliance.
The community needs to provide more opportunities for people to
dispose of their old prescriptions – Could PCOA help sponsor or
3 O2-3
coordinate these events at the Centers?
A percentage of funding received by PCOA needs to be used on health
and wellness programs for older adults.
The cost and structure of fees for dental care needs to be changed;
numerous people voiced concern about the lack of affordable dental care
(noted at many of the public comment locations); maybe dentists could
help one person a year with needed care. (donate services)
3 O1-8
S1-4
1, 3
Better doctors for older people; access to affordable health care 1, 3
Programs need to address diet along with exercise. 3 O1-8
Glad to see PCOA is focusing on suicide prevention and promoting
3 O1-10
discussion in this area.
The Medicare Update Conference book and spread sheets PCOA
prepares are very helpful. Need a class on Medicare and the
benefits/services covered.
3 O1-9
O3-5
O3-6

PART III NEEDS ASSESSMENT COMMENTS 1 – Survey
2 – Focus
Group
3 – Comment
Meetings
COMMENTS/ISSUE SOURCE ACTION
TAKEN
People are very concerned and need information as to how the
Affordable Health Care Act will affect their Medicare and health care
(noted in Quail Creek and Green Valley).
The changes in healthcare are still unknown. The reform and the
interpretation are still unfolding. The need to educate the public about
options, and what to do if they are suffering or have family history of
chronic illness, smoke or are obese is significant. The insurance
exchange will become an issue once the details are mapped.
2, 3 O2-1
O2-3
The (ACO) Affordable Care Organizations will require man power to track
reporting requirements to gain the financial incentives for compliance.
The patients will need to be part of the equation to get results which
begin to tell the statistical story that the quality of care is improving.
Green Valley needs pharmacies who deliver medications; the length of
time it takes for prescriptions to be filled in Green Valley is a problem.
Grandparents raising their grandchildren need some State assistance –
they are saving the State money by caring for the child; increasing
number of Kinship caring for not only their grandchildren but also great
nieces/nephews; need TANF and SNAP benefits; grandparents finding it
difficult to negotiate getting help for children through the schools.
Increase in the number of grandparents-raising-grandchildren, increase in multigenerational
families, increase in the need to have housing unit expand-contract
with changing family size, increase in need to have sufficient affordable housing
near employment centers and/or more readily accessible through affordable
public transportation; increase in need to create sense of neighborhood and
neighborliness (both through supportive services and through neighborhood
leadership engagement).
It is difficult for families to provide care because they are busy with their
jobs.
There needs to be an article in Never Too Late and information provided
to family caregivers on how “to take the keys away”. Respite is needed
for family caregivers (noted numerous times).
Caregivers need groups for grieving and also training ; caregivers need
training in how to assist someone with showering, etc.
Grandparents raising grandchildren need respite from their
responsibilities; the development of a child-sitting co-op was suggested.
Older adults need assistance with legal services. The Elder Justice Act
must go forward to provide funding for the continuation and development
of more services for seniors and disabled adults.
The drivers and staff with Handicar are polite; the Sun Van staff need
additional customer service training.
The van used at the El Rio neighborhood center is difficult to get on and off;
doesn’t have working seat belts and often breaks down; need a van to take
them for shopping.
3
2, 3 O4-3
2 O4-3
2, 3 O4-1
3 O2-1
O4-2
3 S4-1
2, 3 O4-3
1, 2, 3 O3-3
3
3

PART III NEEDS ASSESSMENT COMMENTS 1 – Survey
2 – Focus
Group
3 – Comment
Meetings
COMMENTS/ISSUE SOURCE ACTION
TAKEN
Good sidewalks in the neighborhoods are important and people need to
3
feel safe to walk.
Timing at crosswalks for pedestrians needs to be increased to allow older
adults to cross, especially at St Mary’s and Silverbell and Speedway and
Silverbell.
3
Transportation costs and availability are a problem; need broader
regional approach.
- Oro Valley is assisting with transportation
- The Sun Shuttle service in Green Valley is better – people need
assistance in making their reservations.
- The Northeast part of Tucson is not covered for public
transportation.
- Buses in the community are limited in their times; routes need to
be every half hour instead of every hour.
- Advocacy is needed to provide transportation from Town of
Sahuarita; a nurses group provides some assistance in the Quail
Creek area
- Neighbors Helping Neighbors is a valuable resource for
transportation (noted numerous times). Some people reserve a
ride and then forget so the neighbor needs to remind the person.
- Transportation is difficult for people in the Tucson Estates area as
Handicar is limited.
- Senior Companions provide transportation and also socialization
- Transportation in Marana is difficult when you live that far out.
- The Sun Van cost of $3.00 per ride is too expensive for some
people.
- Provisions of the local bus service (Sun Shuttle) make it possible
for clients without transportation to access services. Casa
Community Center – When Sun Shuttle is not working it is hard to
straighten out.
Question was asked as to how PCOA advertises its’ programs and
services – Could PCOA connect to other health presentations in the
community?
PCOA needs to have articles in newsletters like the one at Tucson
Estates; Desert Times and Northwest Explorer; the Northwest Explorer is
used as a source of information in the Marana area.
PCOA should have seminars describing the types of services that are
available.
There needs to be one place where people can call to see if an
organization is legitimate. Older adults are victims of scams and often
don’t believe the person or organization is not going to provide the
product or service.
1, 2, 3 O5-1
O5-2
O5-3
1, 2, 3 O2-1
O2-2
O2-5
3
3 O2-3
2, 3 O3-1
Make sure PCOA shares the needs gathered through this community
3 S2-1
wide process with our elected officials.
Clients are presenting more financial or economic legal issues. 2 O4-3

PART III NEEDS ASSESSMENT COMMENTS 1 – Survey
2 – Focus
Group
3 – Comment
Meetings
COMMENTS/ISSUE SOURCE ACTION
TAKEN
It is more difficult for our clients to walk, exercise and even have a meal; their 2
health is deteriorated but many of our clientele are living longer and keep active.
Clients are more vulnerable and less able to self-sustain; greater need for basic 2
services by clientele.
Our clients have gotten older and more depressed and need services more than 2
ever.
Clients are better informed but less appreciative. There are more disabled and 2
younger clients that have more needs. Housing is more of an issue; more drug
use (marijuana, meth).
Increased number of baby-boomer elders who have very strange views of old 2
age. They are surprised that they too are affected by age. Many imagined that
they would be able to work, never expecting disability, slowed mental and
physical responses, etc.
Adult Protective Services has seen an increase in reports in general and are
finding higher numbers of vulnerable adults with fewer resources to enable them
to manage in their homes. There is a severe lack of behavioral health treatment
and placement options for elders with dementia. Many more clients are not
plugged in to any kind of community resource.
2
Cost share with APS - cleaning hoarding home, etc. Devote some of the client
services monies (that would already be going toward client services) toward
those who are at greatest risk and those in most jeopardy (i.e. APS clients).
Partner with APS for a Community Services System case manager to go out
and assess APS clients’ needs for CSS services within 48 hours/2 working days
of a referral to Pima Council on Aging.
People are being referred with more severe medical/health needs. Increasing
numbers of severe diabetes, obesity and COPD. More people with
behavioral/mental health issues.
2 O1-1
O1-2
O1-3
2 O1-8
Broader cultural needs- more and different types of refugees. 2
The numbers of people with Alzheimer's disease and related dementias are
growing and will continue to grow as the baby boomers age. Fewer people are able
to afford care and placement of their loved ones suffering from the disease and
more families are burdened with the responsibility of 24/7 caregiving in the home.
And for many of the boomers, the caregiver is still trying to hold down employment
while caregiving.
2 O2-3
Unmet needs include affordable care, balanced meals, in home services, and lack
of research funds to find answers for prevention and cure of Alzheimer’s. Lack of
advocacy for those who no longer have a voice, lack of public education about the
disease which increases denial and prevents elderly from asking for the help they
need.
Marana Health Center patients are typically (56%) Medicaid recipients. Often life
choices have contributed to the illnesses that older individuals are now managing
(diabetes and heart disease). In addition, the nutritional choices and lack of
physical activity contribute to weight problems and back pain problems. Patient
health literacy is low and traditions of treating symptoms vs. prevention prevail with
the 60+yr old demographic.
2 O1-8

PART III NEEDS ASSESSMENT COMMENTS 1 – Survey
2 – Focus
Group
3 – Comment
Meetings
COMMENTS/ISSUE SOURCE ACTION
TAKEN
As expected with aging baby boomers, the number of older/disabled clientele have 2
increased over time.
Our population is younger and their physical and physiological needs are more
prominent. This leads to the dependency of community programs to keep their
needs met. Some examples are Cope, La Frontera and El Rio for low-income
individuals.
2
Adult Day Health Care families are waiting longer to enroll their loved ones
therefore, they are more declined when they enter the program. Behavioral
Health clients are trying to remain independent longer. They are being more
assertive with doctors. Casa Community Center clients are more open to our
programming and les resistant to joining in the activities.
2 O4-1
O2-4
Higher medical needs, increased number of chronic conditions 2 O1-8
Increased number who had second mortgages and are losing their homes 2
Population 85+ years of age increasing and needing assistance in their home 2
Older adults needing to return to work 2
People are outliving their resources 2
The economic downturn has created more older adults living on the edge and
about to fall through the cracks.
Coordination between entities has led to some improvement in identifying
people. Reduction of community services, fewer resources.
Finding financial assistance for utilities, rent, etc. has become harder. Families
are capping out of DES benefits. Many are finding it necessary but difficult to
return to employment.
Fewer services are available as the demand has increased. There are fewer
employment opportunities; increased isolation; cut back in funding for social
services.
People have more choices which helps with self-advocacy and selfdetermination.
It can also be overwhelming and confusing. There are more
caregivers and more training opportunities for the caregivers.
Mental health service cuts have hurt providers and clients of these services.
People (Government officials) seem concerned and interested about senior’s
needs but there is no coordinated effort to address the aging community’s
needs.
Maintaining access to vital services has remained flat and non-essential access
(i.e. pet care) is non-existent. City and state funding has decreased. Lack of
ALTCS/AHCCCS funding and disqualification.
The economic conditions have greatly affected our clientele. We have also
noticed that cutbacks on hours and funding from our funders has affected the
allowed time to perform much needed services for our clientele. As the cutbacks
continue, it makes it more difficult for agencies to hire and retain qualified
personnel to perform the duties needed due to the need to decrease wages.
The passing of the new law (if you are covered by Medicaid or Medicare) you don't
pay for an ambulance ride has affected the 911 calls for Avra Valley Fire Dept. As
MHC we provide transportation and we have made sure we have lifts and adequate
transportation for those clients who need a ride to the clinic.
2
2 O5-4
1, 2, 3 O3-2
2
2 O3-2
2 O2-4
2
2
2

PART III NEEDS ASSESSMENT COMMENTS 1 – Survey
2 – Focus
Group
3 – Comment
Meetings
COMMENTS/ISSUE SOURCE ACTION
TAKEN
Unfortunately with families needing more financial help for daily living due to the 2
economy, families are sticking together for financial and emotional needs.
Sometimes leaving the elderly without their needs met; We see more extended
families living together – that is three and four generations living under the same
(Often leaky) roof.
Many of our clients have other family or friends living with them due to the
2 O3-1
economic hardships. We have to be very diligent on watching for any signs of
abuse either financially, emotional, physical etc ... We also have noticed many
family members contacting us for services for their loved ones while they live
out of state. The economic times have really caused a lot of hardships with the
clientele.
Increase in number of people being exploited by their children 2 O3-1
Domestic violence services tailored to the older populations. 2 O3-1
Lack of affordable housing, especially for our population that require assisted 2
living. We need a shelter for the elderly.
Crisis services – how to get appropriate help when older adult needs help.
2 O2-4
Education about community resources.
It is more difficult to find volunteer opportunities (Volunteer Center). 2
Matching retired professionals and their skills with nonprofits and other areas of 2
need in Tucson and Southern Arizona. Groups don’t always know how to best
use this type of assistance (i.e. their volunteer structure may not match).
The need for incontinence supplies. 2 O4-4
Individualized and population based advocacy. 2 O3-2
Behavioral health services – especially for aging adults with dementia related 2 O2-4
behaviors. Placement options for those with dementia-related behaviors are
lacking – a facility may send them to the ER, refuse to take them back and the
hospital has nowhere to send the client. Health insurance for childless adults;
services for Title XIX and childless adults.
Educational series which are delivered in a way that people want to be engaged. It
is difficult to get folks to show up for a variety of reasons related to resources as
well as time. People need to know there is a health benefit in order to make the
time.
2 O2-3
Stability – the elderly should be able to have their needs met without so much
red tape. A designated person in each agency that can assist with the
bureaucracy of obtaining benefits/services
A shelter for older individuals who need to be removed from a situation; senior
housing that allows grandparents to live with their grandchildren
With more complex and fragmented health care systems, people need someone
to advocate for them and coordinate their care.
Need ad campaigns on a regular basis to help guide people to
resources/services; Agencies need a way to connect, share information; need to
connect to health care settings.
Education of healthcare professionals so they know resources, know how to
have the difficult “end of life” discussions with older adults
2 O5-4
2 O5-4
2
2 S5-1
2

PART III NEEDS ASSESSMENT COMMENTS 1 – Survey
2 – Focus
Group
3 – Comment
Meetings
COMMENTS/ISSUE SOURCE ACTION
TAKEN
Demographics – increase in numbers of people needing services. ACA – parity 2
could affect number of people who have coverage for behavioral health
services.
Will depend on economy and available funds. If program becomes limited,
2
clients may require placement in long term care facilities which will greatly
increase cost of care.
Implementing lessons and ideas gained from the Elder Initiative and other
2 S2-1
efforts (Co-housing” opportunities, IGI, Living Streets Arizona) that aim to make
our communities and neighborhoods more aging/elder “friendly”. Not “just”
delivering service but improving our process. Change in Social Security – folks
need to be banked (ideally) or at least understand how to use new card without
getting lots of charges.
Clients will have more paperwork to complete with the AHCCCS community first 2
choice option – literacy. Resources continue to be limited which will result in
increased costs paid by private pay and fewer dollars available for donation to
non-profits such as Pima Council on Aging. Seems to be greater focus on
licensed/registered professionals on federal level (like RNs).
As older populations grow – naturally recurring retirement communities
2 O1-11
(NORCs) or neighborhoods will face increasing issues related to above
mentioned needs. Services with sliding fee scales should be coordinated to
serve people of all income levels.
Medicare will be even more diagnosis specific in the future but baby boomers
will want more testing, etc. We must find ways to move away from bureaucratic
health care and routine care relying instead on aging in community models.
2
The baby boomers will be contributing enormously to the number of those aging
who need services. Arizona, because of the draw for retirees, will see an influx.
If the recession continues, we will see a continued demand by younger people
and more able bodied people aggressively attempting to get any resources.
Many of these people may not be appropriate for Pima Council on Aging
services and would be better served by the RBHA or other behavioral health
systems. PCOA cannot be everything to everyone and would be better
focusing on the most vulnerable clients who are not eligible to get services
through Medicaid or who refuse Medicaid due to the lien on their home.
Continued and increasing need for broader refugee groups, particularly clients
coming from African and middle eastern/Arabic countries.
As baby boomers begin to develop dementia/Alzheimer's, our health care and
Medicare systems will not be able to handle the huge influx and our systems will
not exist as we know them today. Budget cuts to senior services will cripple our
ability to help seniors remain at home. Services will diminish and we will find
more seniors having to do without basic services.
Home Care is the fastest growing segment in long-term care. Much work is
needed to be done to assure high quality coordinating, delivery, and financing of
those services.
2
2 O2-4
2
2 O1-1
O1-2

PART III NEEDS ASSESSMENT COMMENTS 1 – Survey
2 – Focus
Group
3 – Comment
Meetings
COMMENTS/ISSUE SOURCE ACTION
TAKEN
As funding for in-home assistance decreases, more people are forced into
2
ALTCS, have increased hospitalizations which cost our nation even more
Literacy and health literacy practitioners need to speak simply, number of forms 2
people are requested to complete have become more complicated
Need different marketing techniques; especially for younger seniors 2
People with disabilities under 60 have difficult time accessing needed services. 2
People of moderate income have difficulty paying for all of their needs.
The level of services provided have dropped commiserate with the lack of
2
funding. For a customer that needs bill paying assistance, it means he may
either not qualify or that service may not be provided at all.
I think that the services provided are great and greatly needed. My impression 2
is that there is a great deal more need than Pima Council on Aging and other
agencies can meet, but that the programs are administered as efficiently as
possible.
Elders who don’t qualify for ALTCS and who can’t afford the current cost of
2
home care, need access to services that cost $10 to $12 per hour.
St. Luke’s Home works closely with the Community Services System. What
2
would work better would be more funding and availability.
Services are not adequate. PCOA tries to do too much for too many;
recommend discontinuing discrete housekeeping services and only offer
attendant care and emergency Respite services. The resources spent on
clients that receive discrete housekeeping could be better used to increase the
hours for those most in need. There are people receiving housekeeping
services that scam the system. They will find any free service and take
advantage of the resource while people who have the most critical needs are
too ill to advocate for their needs. Often those who are the most ill, the most
vulnerable do not even know all the available resources. The clients that
receive discrete housekeeping also are the most time consuming for the case
managers. They complain the most; change their schedules the most and
require more communication and feedback. It takes as much time for a case
manager to support someone in 6 hours per month for discrete housekeeping
as it does for someone receiving 20 hours per week of attendant care.
2 O1-1
O1-2
O4-2
Respite services should only be offered for real emergencies. If a family
receives 5 hours per week of attendant care do they really need 2 hours a
month of respite? It is nice to offer but is it the best use of limited resources?
Arizona’s Children Association, Information & Referral – services are good and
good collaboration with Pima Council on Aging
Study the process used at Miracle Square re in-home care and advocacy and
utilize similar techniques.
Convene planning effort for older adults of all income levels. Expand support
and services of Neighbors Care Association. Partner with community agencies
at their intersection points of expertise.
Discrete housekeeping services. Change shopping services so it is only offered
“on-line”. Offer a home delivered meal which is ‘produce’ only – not a meal, just
fresh produce.
2 O4-3
2
2 O1-11
2

PART III NEEDS ASSESSMENT COMMENTS 1 – Survey
2 – Focus
Group
3 – Comment
Meetings
COMMENTS/ISSUE SOURCE ACTION
TAKEN
The home repair program and DME is essential but currently requires a request
from the consumer/client. The most vulnerable and most in need are often too
ill to request or apply. It would be better if this was totally overhauled. It would
be more efficient if providers were required to submit on their quarterly
Supervisor Visit forms identification of a need for home repair or DME. The
PCOA case managers could then prioritize the needs. Money should be spent
on the most vulnerable and in need.
2 O6-2
PCOA case managers appear to be unaware of the potential benefits to their
clients if the most in need were referred to Hospice. Hospice can work
alongside of PCOA and is at no cost to PCOA and to the client. In addition to
receiving many supports through the Hospice doctors, nurses, social worker
and Chaplin, there are also other benefits such as volunteers for
companionship, free DME and free incontinence supplies. PCOA should ask,
whenever a client passes, why that person was not referred to Hospice.
The Community Service System should be referring more and encouraging the
clients to use their hospice benefits
Safety, support, education and delivery of services- We must find a better way 2
of letting seniors know of the available services, encourage them to use what is
available and find a way to deliver those services in a positive manner that is
not demeaning to the recipient.
PCOA has continued to be a very strong advocate and partner for our clientele. 2 O1-9
Especially since the major health insurance companies have moved into this
area of services.
The services offered and the programs of PCOA are a high quality. The awareness 2
of the services like many social work cases need greater visibility.
We really appreciate that PCOA is the agency with the best repository of
2 O5-4
knowledge and services for seniors. It's vital that PCOA continues to provide that
depth and breathe of knowledge.
More collaboration. 2 S5-1
Making or giving more time to work one on one with the elderly. 2 O3-2
Educate community on importance of respite for caregivers, provide more
2 O4-2
support groups, educate adults on how to advocate for themselves within the
O3-6
healthcare system.
The Caregiver Specialists are valuable, especially the information (lists of
2 O4-1
resources)
Change the terminology for case management to care coordination 2
Case managers are important as they build the trusted relationship 2

PART IV
GOALS AND OBJECTIVES
The difference between where we are (operational objectives) and where we
wish to be (vision and goals) is what we do (strategic objectives and action
plans).
This Area Plan on Aging identifies six goals and the operational and strategic objectives Pima
Council on Aging plans to address over the next three years. The Operational objectives
identify what we are already doing to address identified goals. Strategic objectives identify
what we intend to change or initiate to meet goals. Three of these goals mirror the larger
Arizona State Plan on Aging of which this plan will be become a component part.

Goal 1: Increase the ability of older adults to remain active, healthy and living
independently in their communities.
Operational Objective O1-1: Continue provision of housekeeping service for
individuals determined unable to perform tasks such as vacuuming, dishwashing,
laundry, etc. .
Output: 23,000 hours of service
Outcome: 90% of clients report service made it easier for them to remain in their
home.
Operational Objective O1-2: Continue provision of attendant care service for
individuals determined unable to perform personal care tasks such as bathing, dressing,
toileting, transferring, etc.
Output: 120,000 hours of service
Outcome: 90% of clients report service made it easier for them to remain in their
home.
Operational Objective O1-3: Maintain the provision of home delivered meals to meet
the need of homebound individuals determined to be at nutritional risk.
Output: 1,400 individuals; 230,000 meals
Outcome: 75% of surveyed meal recipients will report that the meals
increased their daily intake of food; 80% of surveyed meal recipients will report
that the meals provided a larger variety of fruits, vegetables and meats than they
would be able to prepare for themselves.
Operational Objective O1-4: Maintain 12 congregate meal locations in Pima County
where older individuals, within the OAA target population, can receive meals that meet
at least 1/3 of the Dietary Reference Intakes.
Output: 2,000 individuals; 90,000 meals
Outcome: 80% of surveyed meal recipients will report that the meals
increased their daily intake of food; 80% of surveyed meal recipients will report
that the meals provided a larger variety of fruits, vegetables and meats than they
would be able to prepare for themselves.
Operational Objective O1-5: Maintain provision of an electronic emergency alert
service for individuals at risk for falls.
Output: 3,500 hours of service
Outcome: 95% of Lifeline subscribers know that emergency help can be
accessed quickly, preventing the onset of serious, perhaps life threatening
conditions.

Operational Objective 01-6: Continue nursing clinics at select congregate meal sites to
provide health screening, monitoring and education.
Output: 2,000 client contacts
Outcome: 75% of clients indicate they learn about their health from the nurse.
Operational Objective 01-7: Maintain Budgeting Assistance Program to match lowincome
clients with trained volunteers who assist in balancing check books, paying bills
and creating budgets.
Output: 50 volunteers matched with and assisting 60 clients with at least one
monthly home visit and an additional 40 clients with one-time support.
Outcome: 90% of the clients will be able to meet their financial obligations as
reported by the client on annual client service review, enabling them to remain in
their homes.
Operational Objective O1-8: Continue provision of the evidence-based Chronic
Disease Self Management Program, Enhance Fitness and A Matter of Balance at select
community sites.
Output: 12 A Matter of Balance classes, 6 Enhance Fitness classes and 8
Chronic Disease Self Management classes per year.
Outcome: Survey and or testing results shows improved fitness and/or increased
knowledge for 80% of participants.
Operational Objective O1-9: Provide information and assistance in resolving Medicare
related problems in response to written, telephone or walk-in requests from individuals
or community agencies.
Outputs:
5,000 client contacts; 3,000 individuals
Outcome: 85% of individuals who complete the Client Service Assessment
Survey will indicate “very satisfied/satisfied” with the help they received.
Operational Objective O1-10: Continue to provide suicide prevention trainings
(pending funding) through offering SafeTALK and Applied Suicide Intervention Skills
Training (ASIST).
Output: Offer four 2-day ASIST Trainings and six 3-hour SafeTALK trainings
each year.
Outcome: 90% of the SafeTALK and ASIST participants will report that the
training provided them with increased knowledge to recognize and intervene with
potentially suicidal individuals.

Operational Objective O1-11: Continue creating or enlarging the number of Groups
(neighborhoods or faith communities or combinations thereof) to provide volunteer
services such as transportation, friendly visits, yard work, etc. to seniors under the
Neighbors Care Alliance (NCA).
Outputs: Complete 50 presentations each year to interested individuals and
groups within Pima County.
Outcome: 5 new groups are created or added to an existing program to provide
volunteer services to seniors under the NCA.
Strategic Objective S1-1: Partner with Arizona DES/Division of Aging and Adult
Services and Area Agencies on Aging to study best practices in consumer directed care
and explore the feasibility of implementing a pilot and/or model project.
Strategic Objective S1-2: Study best practices and alternative methods for preparing
and delivering congregate and home delivered meals.
Strategic Objective S1-3: In collaboration with DES/DAAS and Area Agencies on
Aging develop, implement and evaluate a strategy for cost sharing and/or sliding fee
scale for services funded through the Older Americans Act and/or state funds.
Strategic Objective S1-4 Develop, implement and evaluate the Diabetes Self
Management Program in Pima County.

Goal 2. Increase awareness and understanding of aging issues and help prepare
Arizona for an aging population.
Operational Objective O2-1: Provide relevant information on aging issues through the
monthly Never Too Late newspaper.
Output: Produce and edit at least ten (10) issues of Never Too Late newspaper
delivered to 16,000 monthly readers across Pima County.
Outcome: 75% of the readership will report the newsletter provided information
on topics of interest, measured by conducting at least one consumer/reader
survey every three years.
Operational Objective O2-2: Collaborate with community organizations to provide
information on benefits and services at scheduled health fairs throughout the metro
Tucson Area.
Output: 8 health fairs per year, on average 100-200 attendees per event
Outcome: Distribution of relevant information
Operational Objective O2-3: Collaborate with community partners to provide special
events and conferences focusing on specific aging issues i.e. annual Salute to
Centenarian event, biannual Behavioral Health and Aging Conference, Caregiver
Conference, Alzheimer’s Disease Conference, and various University of Arizona lecture
series.
Output: 6 events reaching approximately 1,275 attendees
Outcome: 80% of attendees report that they are very satisfied with their
increased knowledge and awareness of specific aging issues.
Operational Objective O2-4: Participate in the monthly meeting of the Behavioral
Health and Aging Council (for profit and not for profit providers of behavioral health and
aging services) to ensure effective service referrals, share information, provide
advocacy for services, provide suicide prevention programs specifically targeting older
adults, develop treatment protocols based on evidence based practices and provide
training opportunities for professionals in the area of behavioral health and aging
services.
Output: 11 Behavioral Health and Aging Council Meetings per year; a Behavioral
Health and Older Adults Conference held biannually in even numbered years.
Outcome: Participating agencies indicate improvement in knowledge and service
efficiency and effectiveness through BHAC participation.
Operational Objective O2-5: Continue to train volunteer Ambassadors who provide
advocacy, service, and educational information to seniors and their families.
Output: 20 Ambassadors disseminate information in their designated
communities.

Outcome: 80% of Ambassadors report that they are very satisfied with their
role to deliver knowledge and awareness of specific aging issues to their target
population.
Strategic Objective S2-1: Raise awareness of county and city/town elected officials
and staff in Pima County to focus on a regional approach to planning for the aging
population.

Goal 3:
Increase the safety and well-being of older Arizonans.
Operational Objective 03-1: Improve coordination of services designed to identify,
investigate and prosecute crimes targeting the elderly (including Neglect, Abuse and
Exploitation) through participation in Statewide Abuse Task Force and the Pima County
Elder Abuse Coalition, Stop Abuse and Financial Exploitation of the Elderly (SAFEE).
Output: Staff attendance at 10 community meetings concerning safety and well
being of elderly.
Outcome: Written report of meeting indicates improvement of participating
agencies’ delivery of service.
Operational Objective 03-2: Maintain Elder Rights and Benefits services to provide
information, advocacy and problem resolution on a one-to-one basis for elderly
individuals and/or their caregivers on topics including Social Security, health care
coverage, consumer issues, social service access, and legal services.
Output: 4,000 client contacts; 2,000 individuals
Outcome: 85% of those randomly surveyed will report that the information and
assistance they received helped them resolve their issue.
Operational Objective O3-3: Ensure access to legal representation and advocacy for
low income and minority individuals through contracts with Southern Arizona Legal Aid,
24 Legal Clinics provided by volunteer attorneys from the National Academy of Elder
Law Attorneys and the PCOA Elder Rights and Benefits Program.
Output: 450 client hours recorded in PCOA reports; 200 individuals.
Outcome: 70% of those randomly surveyed will report positive responses to
legal representation.
Operational Objective O3-4: Advocate for the rights of residents in assisted living
facilities and nursing homes through the Long Term Care Advocacy Program.
Output: 15,000 resident contacts
Outcome: 650 complaints resolved.
Operational Objective O3-5: Provide a monthly class for individuals requiring
information about Medicare and coverage ancillary to Medicare, especially for new
enrollees.
Output:
12 classes, 30 participants per class
Outcome: 75% of participants will report an increase in knowledge based on
class exit evaluation.

Operational Objective O3-6: Provide outreach events and educational presentations to
disseminate current information regarding Medicare, health insurance fraud, waste and
abuse in the system.
Outputs:
12 Outreach events
Outcome: 75% of participants will report an increase in knowledge based on
class exit evaluation.
Operational Objective O3-7: Provide classes to family caregivers and older
individuals requesting information about the Arizona Long Term Care System.
Output:
12 classes, 12 per class
Outcome: 85% of workshop participants will report an increase in knowledge
of ALTCS, based on class exit evaluation

Goal 4: Support, supplement and enhance the role of informal, unpaid family
caregivers as they provide assistance.
Operational Objective O4-1: Provide information, assistance and referrals to help
families in examining options, locating resources and connecting with assistance.
Output:
Outcome:
caregivers.
1,200 individuals, 2,250 client contacts
80% of caregivers report assistance enabled them to be better
Operational Objective O4-2: Continue current provision of short term respite provided
in the caregiver’s home or in an assisted living facility.
Output:
Outcome:
their homes.
135 individuals, 16,000 hours of service
75% of respite recipients report service allowed them to remain in
Operational Objective O4-3: Collaborate with community partners to continue
provision of information, assistance, and support groups to grandparents raising
grandchildren.
Output: 2,500 client contacts for information; 4,500 hours of support groups
Outcome: 90% of clients report assistance helped them deal more effectively
with their problems of raising grandchildren.
Operational Objective 04-4: Continue provision of medically necessary assistive
devices and products, such as disability modifications, DME, incontinence supplies,
nutritional supplements, telephones and dentures, in partnership with community
organizations and businesses.
Output:
Outcome:
15 individuals, 15 jobs
90% of surveyed recipients will report the product or service
increased their independence or comfort.
Strategic Objective S4-1: Identify alternative methods for delivering and increasing
caregiver participation in support groups, training (education) and family facilitation.

Goal 5:
need.
Increase the ability of older adults to access the programs and services they
Operational Objective O5-1: Maintain current levels of transportation subsidies to low
income ADA eligible individuals attending metro area congregate socialization and
nutrition centers.
Output: 115 individuals; 20,000 rides
Outcome: 85% of recipients surveyed will report the transportation subsidy made
it possible for them to receive a nutritious meal.
Operational Objective O5-2: Maintain relationships with rural transportation providers
to continue support for low income seniors in Ajo and Green Valley to attend senior
centers in those communities.
Output: 30 individuals; 3,000 rides
Outcome: 85% of recipients surveyed will report the transportation subsidy made
it possible for them to receive a nutritious meal.
Operational Objective O5-3: Provide supports to Neighbors Care Alliance programs
that provide transportation to seniors.
Output: 20 programs, who are providing transportation or errands to older adults,
receive supports such as training, consultation, mileage reimbursement, and
insurance coverage.
Outcome: 80% of the programs report that PCOA support helps them to provide
needed transportation or errands to older adults.
Operational Objective O5-4: Continue to Identify agency/program/community
partnerships and trainings to improve the efficiency and effectiveness of referrals as
part of the Aging & Disability Resource Consortium.
Output: 1 to 2 trainings per year.
Outcome: 80% of attendees report an increase in knowledge.
Strategic Objective S5-1: Develop and implement a process to bring community
agencies together twice a year to share information on programs and resources and the
impact of funding and community changes on their clients.

Goal 6: Increase the ability of older homeowners to remain living safely and
independently in their own homes for as long as possible through provision of home
maintenance, Durable Medical Equipment and correction of safety hazards.
Operational Objective O6-1: Maintain provision of major and minor home repair and
adaptation services and provide durable medical equipment to correct health and safety
hazards.
Output: 300 individuals; 350 repairs or products
Outcome: 90% of recipients surveyed will report the repair or adaptation service
increased their ability to remain living safely and independently in their own
homes.
Operational Objective O6-2: Maintain allocation of funds to be used by case
managers working within the Community Services System to secure minor home
repairs, adaptations and durable medical equipment (DME) for authorized clients.
Output: 225 individuals; 250 repairs or products
Outcome: 80% of recipients surveyed will report the repair or adaptation service
increased their ability to remain living safely and independently in their own
homes.
Operational Objective O6-3: Promote independence and self-determination of
choices for consumers by continued maintenance and distribution of agency directories
of home repair contractors, durable medical equipment providers and local resources
for subsidized home repairs.
Output: Minimum of 6 updated directories; 300 directories distributed
Outcome: Consumers secure necessary service through safe, reliable vendors
Operational Objective O6-4: Collaborate with corporate partners and private donors
to expand home repair, durable medical equipment and adaptation resources through
in-kind support.
Output: 10 individuals
Outcome: 90% of recipients surveyed will report the repair or adaptation service
increased their ability to remain living safely and independently in their homes.

PART V PREFERENCE TO OLDER PERSONS WITH GREATEST ECONOMIC OR SOCIAL NEED
How will you ensure that the needs of “preference” are being met?
Targeting language as contained below is included in all Request for Proposal Packages so
potential contractors are aware from the outset of the need for “preference” in providing services.
Service methodologies and scopes of work require potential contractors to meet preferences in
service delivery. These methodologies are incorporated into resulting contracts which then hold
providers responsible for meeting the preference objectives. Monthly and quarterly demographic
reports are monitored for targeting compliance. Actual targeting outcomes are discussed with
contractors at yearly assessments if needed.
How will you incorporate published demographic information into your outreach and
service delivery?
Published U.S. Census Data is compiled and analyzed by PCOA staff who prepare a profile of
the area’s senior population. This information is used for community presentations, to educate
media, elected officials and the community at large about the make-up of the area’s population.
Annually, PCOA prepares an income update to share with contractors to assure the most
accurate data is used to prepare service demographic reports. Published demographic data
informs the agency’s activities in scheduling community presentations, participation at health
fairs, preparation and presentation of written materials etc., in those areas of the community with
greater numbers of the target population.
How will you use outreach efforts to identify individuals eligible for assistance under the
Older Americans Act, with special emphasis on older individuals with greatest economic
and social need, with particular attention to low-income minority individuals, individuals
residing in rural areas, individuals who are Native American, individuals at risk of
institutional placement and individuals with a severe disability within your planning and
service area?
Contracted services, community presentations, flyers, participation at health fairs, etc., are
channeled to those areas of the community with greater numbers of the target population.
Information is typically available in both Spanish and English, presented by bi-cultural staff;
usually working with community organizations that have a presence in target areas or a mission
of service delivery to the target population. Regular communication, cooperation and
coordination with target population groups and organizations assist with possible identification of
those eligible for assistance. Contractors are encouraged to send available service information
to agencies, organizations and groups with a high concentration of minority members/clients.
Contractors are also encouraged to hold presentations with groups that have a high
concentration of minority members/clients.

How will you ensure that your service provider(s) will satisfy the service needs of lowincome
minority individuals, individuals residing in rural areas, individuals who are
Native Americans, individuals at risk of institutional placement, and individuals with a
severe disability in the area being served by the service provider?
All service recipients are provided an opportunity to confidentially comment on the services they
have received, including the opportunity to rate the service provider and their staff in meeting
their service needs. This confidential client satisfaction and outcome questionnaire is mailed to
all recipients or provided to the client at time of service delivery; it is printed in Spanish and
English and is sent with a postage paid, pre-printed envelope so that no cost is incurred by the
respondent in returning it. Contractors are then evaluated on their ability to satisfy the service
needs of the target population based on the anonymous comments received from their clientele.
Contractors not meeting the desired outcomes are required to resolve any issues to the
satisfaction of the recipient (if possible). A pattern or practice of not meeting service needs
would require the provider to submit a plan of corrective action.
How will you ensure that your service provider(s) will meet the specific objectives
established by the Area Agency for providing services to low-income minority
individuals, individuals residing in rural areas, individuals who are Native Americans,
individuals at risk of institutional placement and individuals with a severe disability in the
area being served by the service provider?
Most requests for service are first received by the PCOA Help Line/Intake staff. As appropriate
for the service request, the Help Line staff conduct an initial screening, determining the client’s
income, inability to perform Activities of Daily Living, available assistance from family and
friends, and ability to pay for needed services. Individuals meeting the targeted service
preferences are referred to PCOA subcontracted service providers or PCOA internal staff as
appropriate. An Intake or ASCAP is completed for each client receiving service and the data
entered into the State or PCOA data base as required.
Each service provider submits mandatory monthly demographic reports for each OAA funded
service. These reports, which meet NAPIS requirements, are monitored for targeting
compliance.
How will community-based organizations be involved in a meaningful way in the planning
and implementation of the Area Plan on Aging?
The most meaningful way in which community-based organizations are involved in developing
the Area Plan is through their participation in the Community-Wide Needs Assessment Process.
Many participating organizations of the Neighbor’s Care Alliance and many individual
Ambassadors distribute and collect surveys. These representatives are also invited to attend
one of the community-wide needs assessment meetings to comment from their unique,
neighborhood based point of view. Actual implementation of the Area Plan is the responsibility
of PCOA staff working in collaboration with the AAA Advisory Council, which provides guidance
and recommendations, and the PCOA Board of Directors, which approves adoption of the goals,
objectives and budgets contained in the Area Plan. Both the 20 member Advisory Council and
35 member Board of Directors is comprised of members representing various sectors within the
community and other community-based organizations.

Part VI
KEY CHANGES TO SERVICE DELIVERY
The FY 11-13 Area Plan on Aging was developed, the activities undertaken and the services delivered in an
economic climate of reduced state and local funding. This climate has actually worsened as we now
develop our goals and objectives and establish priorities for service provision for the FY 14-17 Area Plan.
The cuts to the FY 12-13 federal funding sources, including the Older Americans Act and Social Service
Block Grant, has only served to exacerbate the difficulties in providing essential services to a growing aging
population.
The System of in-home and community based social and nutrition services, has been built to respond to the
needs of older persons in the greatest social and economic need, and they will continue to be the primary
focus. PCOA has and will continue to evaluate the efficiency and effectiveness of the System and make
changes to maximize the use of limited funding. In FY 11-12, PCOA chose to directly provide the service of
case management instead of subcontracting the service to three community agencies. This change
allowed PCOA to reduce administrative costs and more uniformly apply the eligibility guidelines for receipt
for services through what is known as the Community Services System. PCOA subcontracts on a unit rate
with twelve to fifteen home care agencies for the provision of attendant care, housekeeping, personal care
and respite services. This methodology of service provision allows System clients to have options for their
care and for service provision to be transitioned between home care agencies as needed.
This formal system of care has been supplemented in past years by supportive services for family
caregivers and the development of programs for neighbors helping neighbors. PCOA will continue to
support and expand the neighborhood programs through the Neighbors Care Alliance. This Alliance has
also been key to improving the availability of transportation services to elderly individuals. In FY 06-07 Pima
County voters approved a measure in the Regional Transportation Plan for the reimbursement of mileage to
volunteers who provide rides for elderly and disabled individuals. PCOA developed a methodology to
account for and pay this mileage reimbursement and will continue to work with community organizations for
the expansion of this benefit.
Essential to the success of any system meeting the needs of its target audience, is the plan for outreach,
information dissemination, and coordinated assessment and effective referral. PCOA was designated in FY
08-09 a key partner and lead agency of the Pima County Aging and Disability Resource Consortium. The
Pima County ADRC includes the Arizona Health Care Cost Containment System (AHCCCS), Arizona Long
Term Care System (ALTCS), Direct Center for Independence, and the Arizona Department of Economic
Security’s Division of Developmental Disabilities. In April, 2009, the Pima County ADRC expanded to
include the Arizona Department of Economic Security’s Adult Protective Services for District II, Community
Partnership of Southern Arizona, Pima County Public Fiduciary, Mercy Care, Evercare Select, Sonoran
UCEDD, Az Dept. of Veterans Services and So. AZ VA Health Care System. The Pima County ADRC
members meet on a quarterly basis. The quarterly meetings focus on sharing information, discussing
issues or problems in referring clients to the ADRC agencies for services and sharing information regarding
any programmatic changes the agencies are experiencing. PCOA will continue to take the lead on holding
the quarterly ADRC meetings and working with the agencies on referrals, information sharing, and services
available in the community.
The PCOA Intake Department staff have received training and maintain listings of private pay resources for
elderly and non elderly disabled clients. The PCOA Intake staff serve as a community resource for
information on all types of services, providers and agencies in Southern Arizona. The PCOA Intake staff
meet on a monthly basis and most meetings include a presentation from a community agency or provider.

In March 2010, PCOA implemented a Care Transitions Program that expanded in 2012 with a grant from the
Center for Medicare and Medicaid (CMS). The community-based Care Transition Program funded by CMS
is a partnership between PCOA and Carondelet Health Network with a focus on reducing hospital
readmissions for St. Mary’s and St. Joseph’s Hospitals. PCOA will continue to pursue other partnerships
with ALTCS providers and other health care entities to expand the provision of the Care Transitions program
in Pima County.
PCOA rolled out in FY 06-07 its first evidence based health promotion and disease prevention program, and
quickly expanded these efforts to the provision of three programs: A Matter of Balance, Enhance Fitness
and Chronic Disease Self Management. PCOA will continue to utilize Older Americans Act Title III D funds,
participant contributions, grants and fund raising, to support the three programs. Partnerships have been
built with the City of Tucson and Pima County Parks and Recreation, the Pima County Health Department,
and community organizations to facilitate the offering of these classes. In FY 13-14, PCOA will begin to also
offer the Diabetes Self Management Program.
The PCOA State Health Insurance Assistance Program (SHIP) continues to help older adults understand all
of the available options for Medicare. SHIP is a free health benefits counseling service for Medicare
beneficiaries and their families or caregivers. The mission of the SHIP is to educate, advocate, counsel and
empower people to make informed benefit decisions. SHIP is an independent program and is not affiliated
with the insurance industry. PCOA has one SHIP Coordinator, two additional staff and 21 volunteers who
assist clients by phone or through in person appointments. The PCOA SHIP offers five Medicare Update
conferences in the fall in various locations that are attended by hundreds of older adults. PCOA provides a
New to Medicare class once a month as well as presentations throughout Pima County; the presentations
may be on general Medicare or on Medicare fraud and abuse. Every year, the PCOA SHIP offers volunteer
training for individuals wanting to assist with one-on-one Medicare counseling or for those wanting to
educate the public on Medicare fraud and abuse.
Complimentary to the system of in-home support and nutrition services, are the programs developed to
assist individuals in accessing entitlements, benefits and securing their rights. PCOA plans to continue its
Elder Rights and Benefits Program, Long Term Care Advocates Program, and Personal Budgeting
Assistance. This focus on promoting independence has now been expanded to include Options Counseling
and Partners in Planning, both programs helping individuals identify benefits and resources and plan for the
future.
Strategies for modernizing the nutrition programs were implemented in FY 11-13 and will continue in the
new Plan. PCOA has offered of a “salad bar” twice a week in two locations that has been positively received
by program participants. Menus incorporating the salad bar and meeting all the DRI (Daily Required Intake)
requirements have been developed. Other strategies and best practices will be reviewed and incorporated
as feasible.

Part VII
APPROVED WAIVERS
REQUEST FOR A DIRECT SERVICE WAIVER
(Area Agency on Aging)
hereby requests a waiver of the requirement to
award subgrants or contracts to service providers for the services identified in this request.
1. Identify the service(s) to be delivered by the Area Agency.
2. Identify criteria for which the waiver is warranted.
a. Provision of the service(s) by the Area Agency on Aging is necessary to assure an adequate
supply of such service.
b. The service(s) is directly related to the Area Agency on Aging’s administrative functions.
C.. The service(s) can be provided more economically, and with comparable quality, by the
Area Agency on Aging.
3. Describe the rationale for the identified criteria (this must be completed for each service).
Signature and Title of Authorized Official
Date

REQUEST FOR ADEQUATE PROPORATION WAIVER
(Area Agency on Aging)
hereby requests a waiver of the requirement to
expend an adequate proportion of Title III-B funds as set in the State Plan on Aging for:
1. Identify the Priority Service Category and respective percentage to be budgeted and expended.
a. Access Services (minimum 16%) Percentage
b. In-Home Services (minimum 8%) Percentage
c.. Legal Services (minimum 4%)
Percentage
2. Describe the rationale that services furnished for the priority services category(ies) in the planning
and service area are sufficient to meet the need for the services in the area.
Signature and Title of Authorized Official
Date

REQUEST FOR A COST SHARING WAIVER
(Area Agency on Aging)
hereby requests a waiver of the requirement to
implement cost sharing with the following area:
(identify planning and service area or applicable county/counties) for the following permitted
service:
[ ] Respite Care
[ ] Personal Care/Attendant Care
[ ] Homemaker/Housekeeping
[ ] Adult Day Care
1. Identify the reason for the waiver:
a. A significant proportion of persons receiving services under this Act subject to cost sharing in
the Planning and Service Area have incomes below the threshold established in the Division of Aging
and Adult Services policy.
b. Cost sharing would be an unreasonable administrative or financial burden.
2. Describe the rationale for the identified reason:
Signature and Title of Authorized Official
Date

PART VIII
BUDGET – see attached

PART IX – AREA AGENCY SERVICES TO BE FUNDED BY GEOGRAPHICAL AREA – SFY 2014
This display provides a listing of the anticipated allotments of Area Agency resources for the next fiscal year for the delivery
of services within the various geographical areas of the PSA, i.e. counties, cities, etc. It should also be used where contracts
with profit-income providers are projected.
SERVICE BY TYPE
AREA (by Adminis- Program Advocacy Transpor- House- Personal Reassur- Legal Congregate Home
city/PSA) stration Development tation Keeping Care ance Assistance Meals Delivered
Meals
304,339 27,819 69,176 49,111 113,414 7,904 38,955 45,290 722,660 907,296
(2) (1) (1) (1) (1) (1) (1) (1) (2) (3)
Pima 224,064 1,637 21,116 1,945 21,420 465 77,291 5,032 134,580 120,000
County (9) (6) (9) (13) (7) (6) (6) (16) (13) (12)
134,300 4,070 2,889 245,790 1,622 12,201 2,665 2,100 112,250
(11) (6) (6) (6) (9) (9) (6) (7) (13)
48,886 15,000 71,823 20,076
(11) (17) (10) (8)
141,377 42,510 10,500
(9) (6) (7)
7,500 159,864
(17) (10)
363,952 82,719
(16) (9)
7,500
(17)
53,371
(6)
8,000
(18)
46,142
(16)
TOTAL: 711,589 29,456 94,362 53,945 537,001 9,991 128,447 52,987 1,345,125 1,527,718
*Figures reflect best available projections as of 7/01/2013 and may not reflect future funding realities.
1 = Title III B 9 = SSBG 17 = City
2 = Title III C-1 10 = Other Federal NSIP 18 = Other
3 = Title III C-2 11 = Fundraising/Contributions
4 = Title IIID 12 = ALTCS
5 = Title IIIE 13 = Project Income
6 = State of Arizona 14 = Title VII
7 = United Way 15 = SHIP/Senior Patrol
8 = Pima County 16 = Inkind

PART IX – AREA AGENCY SERVICES TO BE FUNDED BY GEOGRAPHICAL AREA – SFY 2014
This display provides a listing of the anticipated allotments of Area Agency resources for the next fiscal year for the
delivery of services within the various geographical areas of the PSA, i.e. counties, cities, etc. It should also be used
where contracts with profit-income providers are projected.
SERVICE BY TYPE
AREA (by Minor Major Case Respite Long Term Elder Rights & Personal Insurance * Health
city/PSA) Home Home Management Care Benefits Budgeting Counseling/ Promotion
Repair Repair Advocate Assistance
Senior
Patrol
58,045 166,960 387,628 86,849 197,057 70,331 13,119 181,334 62,653
(1) (1) (1) (6) (6) (14) (1) (15) (4)
Pima 28,002 3,150 211,234 12,214 25,330 135,000 7,725 20,965 1,897
County (12) (7) (6) (8) (14) (8) (16) (16) (6)
506 9,823 452,018 236,206 5,000 772 15,972
(13) (6) (9) (5) (13) (6) (13)
3,431 34,950 5,000 75,874
(6) (17) (13) (18)
10,550 960 19,587
(17) (13) (1)
1,600
(13)
TOTAL: 101,628 215,843 1,050,880 340,269 222,387 210,331 21,616 202,299 175,803
*Figures reflect best available projections as of 7/01/2013 and may not reflect future funding realities.
1 = Title III B 9 = SSBG 17 = City
2 = Title III C-1 10 = Other Federal NSIP 18 = Other
3 = Title III C-2 11 = Fundraising/Contributions
4 = Title IIID 12 = ALTCS
5 = Title IIIE 13 = Project Income
6 = State of Arizona 14 = Title VII
7 = United Way 15 = SHIP/Senior Patrol
8 = Pima County 16 = Inkind
*Include Chronic Disease Self Management, Diabetes Self Management, A Matter of Balance, Enhance Fitness

PART IX – AREA AGENCY SERVICES TO BE FUNDED BY GEOGRAPHICAL AREA – SFY 2014
This display provides a listing of the anticipated allotments of Area Agency resources for the next fiscal year for the delivery of
services within the various geographical areas of the PSA, i.e. counties, cities, etc. It should also be used where contracts
with profit-income providers are projected.
SERVICE BY TYPE
AREA (by Nursing Caregiver Caregiver Caregiver Caregiver Caregiver Grandparents Grandparents
city/PSA) Clinics Admin Training Support Group Supplemental I & R I & R Support
Family Facilitation
Groups
17,490 48,059 35,000 36,635 13,000 267,574 48,793 14,852
(1) (5) (5) (5) (3) (5) (5) (5)
Pima 4,200 17,042 7,786
County (7) (6) (8)
1,232 6,755 3,150
(6) (11) (7)
15,000
(17)
TOTAL: 22,922 71,856 35,000 36,635 13,000 293,510 48,793 14,852
*Figures reflect best available projections as of 7/01/2013 and may not reflect future funding realities.
1 = Title III B 9 = SSBG 17 = City
2 = Title III C-1 10 = Other Federal NSIP 18 = Other
3 = Title III C-2 11 = Fundraising/Contributions
4 = Title IIID 12 = ALTCS
5 = Title IIIE 13 = Project Income
6 = State of Arizona 14 = Title VII
7 = United Way 15 = SHIP/Senior Patrol
8 = Pima County 16 = Inkind

PART IX – AREA AGENCY SERVICES TO BE FUNDED BY GEOGRAPHICAL AREA – SFY 2014
This display provides a listing of the anticipated allotments of Area Agency resources for the next fiscal year for the delivery of
services within the various geographical areas of the PSA, i.e. counties, cities, etc. It should also be used where contracts with
profit-income providers are projected.
SERVICE BY TYPE
AREA (by Community Visiting Adult
city/PSA) Attendant Intake Education & Shopper Nurse Day Total
Care Information Care
532,237 124,817 19,964 26,926 2,323 18,669
(1) (1) (6) (1) (1) (1)
Pima 367,365 34,670 1,584 137 5,000
County (6) (12) (6) (6) (5)
1,211,623 28,946 26,497 1,500 1,099
(9) (6) (9) (9) (6)
3,230
(9)
TOTAL: 2,111,225 188,433 19,964 55,007 3,960 27,998 9,974,832
*Figures reflect best available projections as of 7/01/2013 and may not reflect future funding realities.
1 = Title III B 9 = SSBG 17 = City
2 = Title III C-1 10 = Other Federal NSIP 18 = Other
3 = Title III C-2 11 = Fundraising/Contributions
4 = Title IIID 12 = ALTCS
5 = Title IIIE 13 = Project Income
6 = State of Arizona 14 = Title VII
7 = United Way 15 = SHIP/Senior Patrol
8 = Pima County 16 = Inkind

PART X
APPENDIX
1. Assurances
2. PCOA Organizational Chart
3. Area Agency on Aging Advisory Council Membership List
4. Listing of Services and Providers
5. List of Neighborhood and Volunteer Organizations
6. A Report to the Community

Appendix 1:
AREA PLAN ASSURANCES
By signing this document, the authorized official commits the Area Agency on Aging to
performing all listed assurances and required activities.
(2) Each Area Agency on Aging shall provide assurances that an adequate proportion, as
required under section 307(a)(2), of the amount allotted for part B to the planning and service
area will be expended for the delivery of each of the following categories of services—
(A) services associated with access to services (transportation, health services (including
mental health services) outreach, information and assistance (which may include information
and assistance to consumers on availability of services under part B and how to receive
benefits under and participate in publicly supported programs for which the consumer may be
eligible), and case management services);
(B) in-home services, including supportive services for families of older individuals who are
victims of Alzheimer’s disease and related disorders with neurological and organic brain
dysfunction; and
(C) legal assistance;
and assurances that the area agency on aging will report annually to the State agency in detail
the amount of funds expended for each such category during the fiscal year most recently
concluded;
(4)(A)(i)(1) provide assurances that the area agency on aging will--
(aa) set specific objectives, consistent with State policy, for providing services to older
individuals with greatest economic need and older individuals with greatest social need and
older individuals at risk for institutional placement;
(bb) include specific objectives for providing services to low-income minority individuals, older
individuals with limited English proficiency, and older individuals residing in rural areas, and
(ll) include proposed methods to achieve the objectives described in items (aa) and (bb) of
subclause (l);
(ii) provide assurances that the area agency on aging will include in each agreement made
with a provider of any service under this title, a requirement that such provider will—
(I) specify how the provider intends to satisfy the service needs of low-income minority
individuals, older individuals with limited English proficiency, and older individuals residing in
rural areas in the area served by the provider;
(II) to the maximum extent feasible, provide services to low-income minority individuals, older
individuals with limited English proficiency, and older individuals residing in rural areas in
accordance with their need for such services; and
(III) meet specific objectives established by the area agency on aging, for providing services to
low-income minority individuals, older individuals with limited English proficiency, and older
individuals residing in rural areas within the planning and service area; and
(4)(A)(iii) With respect to the fiscal year preceding the fiscal year for which such plan is
prepared, each area agency on aging shall—
(I) identify the number of low-income minority older individuals and older individuals residing in
rural areas and in the planning and service area;
(II) describe the methods used to satisfy the service needs of such minority older individuals;
and
(III) provide information on the extent to which the area agency on aging met the objectives
described in clause (a)(4)(A)(i).

(4)(B)(i) Each area agency on aging shall provide assurances that the area agency on aging
will use outreach efforts that will identify individuals eligible for assistance under this Act, with
special emphasis on—
(I) older individuals residing in rural areas;
(II) older individuals with greatest economic need (with particular attention to low-income
minority individuals and older individuals residing in rural areas);
(III) older individuals with greatest social need (with particular attention to low-income minority
individuals and older individuals residing in rural areas);
(IV) older individuals with severe disabilities;
(V) older individuals with limited English-speaking proficiency;
(VI) older individuals with Alzheimer’s disease and related disorders with neurological and
organic brain dysfunction (and the caretakers of such individuals); and
(VII) older individuals at risk for institutional placement; and
(4)(C) Each area agency on aging shall provide assurance that the area agency on aging will
ensure that each activity undertaken by the agency, including planning, advocacy, and
systems development, will include a focus on the needs of low-income minority older
individuals and older individuals residing in rural areas.
(5) Each area agency on aging shall provide assurances that the area agency on aging will
coordinate planning, identification, assessment of needs, and provision of services for older
individuals with disabilities, with particular attention to individuals with severe disabilities, and
individuals at risk for institutional placement, with agencies that develop or provide services for
individuals with disabilities.
(6) Each area agency will:
(6)(F) in coordination with the State agency and with the State agency responsible for mental
health services, increase public awareness of mental health disorders, remove barriers to
diagnosis and treatment, and coordinate mental health services (including mental health
screenings) provided with funds expended by the area agency on aging with mental health
services provided by community health centers and by other public agencies and nonprofit
private organizations;
(9) Each area agency on aging shall provide assurances that the area agency on aging, in
carrying out the State Long-Term Care Ombudsman program under section 307(a)(9), will
expend not less than the total amount of funds appropriated under this Act and expended by
the agency in fiscal year 2000 in carrying out such a program under this title;
(11) Each area agency on aging shall provide information and assurances concerning services
to older individuals who are Native Americans (referred to in this paragraph as ‘‘older Native
Americans’’), including—
(A) information concerning whether there is a significant population of older Native Americans
in the planning and service area and if so, an assurance that the area agency on aging will
pursue activities, including outreach, to increase access of those older Native Americans to
programs and benefits provided under this title;
(B) an assurance that the area agency on aging will, to the maximum extent practicable,
coordinate the services the agency provides under this title with services provided under title
VI; and
(C) an assurance that the area agency on aging will make services under the area plan
available, to the same extent as such services are available to older individuals within the
planning and service area, to older Native Americans.

(13)(A) Each area agency on aging shall provide assurances that the area agency on aging will
maintain the integrity and public purpose of services provided, and service providers, under this title in
all contractual and commercial relationships.
(13)(B) Each area agency on aging shall provide assurances that the area agency on aging will
disclose to the Assistant Secretary and the State agency—
(i) the identity of each nongovernmental entity with which such agency has a contract or
commercial relationship relating to providing any service to older individuals; and
(ii) the nature of such contract or such relation-ship;
(13)(C) Each area agency on aging shall provide assurances that the area agency will demonstrate that
a loss or diminution in the quantity or quality of the services provided, or to be provided, under this title
by such agency has not resulted and will not result from such non-governmental contracts or such or
such commercial relationships.
(13)(D) Each area agency on aging shall provide assurances that the area agency will demonstrate that
the quantity or quality of the services to be provided under this title by such agency will be enhanced as
a result of such non-governmental contracts or commercial relationships.
(13)(E) Each area agency on aging shall provide assurances that the area agency will, on the request
of the Assistant Secretary or the State, for the purpose of monitoring compliance with this Act (including
conducting an audit), disclose all sources and expenditures of funds such agency receives or expends
to provide services to older individuals;
(14) Each area agency on aging shall provide assurances that funds received under this title will not be
used to pay any part of a cost (including an administrative cost) incurred by the Area Agency on Aging
to carry out a contract or commercial relationship that is not carried out to implement this title.
(15) provide assurances that funds received under this title will be used –
(A) to provide benefits and services to older individuals, giving priority to older individuals identified in
paragraph (4)(A)(i); and
(B) in compliance with the assurances specified in paragraph (13) and the limitations specified in
section 212.
Signature and Title of Authorized Official
Date

Appendix 2: PIMA COUNCIL ON AGING ORGANIZATIONAL CHART FY 2012-2013
AREA AGENCY ON AGING (Funded totally/partially by OAA TITLE III, V & VII)
OTHER FUNDING SOURCES
AAA
ADVISORY
COUNCIL
PCOA
BOARD OF
DIRECTORS
RSVP ADVISORY
COUNCIL
PRESIDENT & CHIEF EXECUTIVE OFFICER
ADMINISTRATIVE ASSISTANT
CHIEF FINANCIAL
OFFICER
CHIEF OPERATING
OFFICER
COMMUNITY SERVICES
SYSTEM DIRECTOR
SERVICES
DIRECTOR
COMMUNITY RELATIONS
DIRECTOR
PUBLIC
RELATIONS
DIRECTOR
OMBUDSMAN
.66%
PAYROLL
SPECIALIST
ACCOUNTS
PAYABLE
SPECIALIST
ACCOUNTS
RECEIVABLE
SPECIALIRST
HR
MANAGER
0.67
DATA
ENTRY
ADMINISTRATIVE
AIDE
OAA PROGRAM
MANAGER
OAA PROGRAM
MONITOR
SECRETARY
50%
SECRETARY
CASE MANAGERS
LEAD
CASEMANAGER
CAREGIVER
SPECIALISTS
CAREGIVER
SPECIALIST
SENIOR ADVOCATE
ADVOCATE
0.87
ADVOCATE
0.67
SECRETARY
.32
NEIGHBORS CARE
VOLUNTEER
SERVICES
MANAGER
.
ADMINISTRATIVE
ASSISTANT
50%
DEVELOPMENT
DIRECTOR
DEVELOPMENT
COORDINATOR
ADMINISTRATIVE
ASSISTANT
IT SPECIALIST
LONG TERM CARE
CERTIFIED ADVOCATE
COORDINATOR
LTC CERTIFIED
ADVOCATE
ACCOUNTING
ASSISTANT
SECRETARY
RECEPTIONIST/
SWITCHBOARD
HEALTH
PROMOTION
COORDINAT
0.67
SECRETARY
ADMINISTRATIVE
AIDE
50%
CARE TRANSITIONS
COACH
NAVIGATOR
INTAKE
SPECIALISTS
SHIP
COORDINATOR
SECRETARY
50%
ADMINISTRATIVE
AIDE
50%
DATA ENTRY CLERK
ADMINISTRATIVE
AIDE
PERSONAL
BUDGETING COORD
0.27
SECRETARY
0.34
50%
LTC CERTIFIED
ADVOCATE
SECRETARY
0.34
ADVOCATE AIDES
.32
HEALTH
PROMOTION
COORDINATOR
Courier
NAVIGATOR
ADMINISTRATIVE AIDE
SCSEP
0.67

APPDENDIX 3: AREA AGENCY ON AGING ADVISORY COUNCIL MEMBERSHIP LIST
The AAA has an established Advisory Council representative of the planning and service area organized for the
express purpose of fulfilling responsibilities of the Area Agency. Our council was organized in 1978 and has
remained active since that time. Council officers include a Chairman and Vice-Chairman, voting members who
serve three year terms with the option of re-election for a second three year term. Terms cannot exceed six
consecutive years. The Council also contains “alternate members” who do not have voting rights but are
probationary members in training, available when and if vacancies arise. Providers from subcontracting agencies
are invited to participate at Council meetings for input and information but do not have voting rights. Meetings are
on the third Wednesday morning of each month excepting July and August with business meetings alternating
with site visits as time and circumstances permit. Members offer advice on area plan development, OAA
administration and operation. A list of council membership follows:
PIMA COUNCIL ON AGING
AREA AGENCY ON AGING - ADVISORY COUNCIL MEMBERSHIP ROSTER - 2013-2014 Program Year
CHAIRPERSON:
Amy W. Levin
VICE CHAIRPERSON:
Lucy Read
MEMBERS:
Paula Bressler
Elizabeth Davidson
Patricia Finger
Roger Fulton
Maxine Goldstein
Lea Goodwine-Cesarec
Allan Gordon
Donald Kret
George Mairs
Lisa Marshall
Ron Meck
Elsie Morales
Paul Morris
Lucy Read
Fay Roos

APPENDIX 4
HOME CARE
SERVICE
Attendant Care, Personal Care, Housekeeping, Respite
VISITING NURSE
ADULT DAY CARE
SHOPPER SERVICE
EMERGENCY ALERT (Reassurance)
FAMILY CAREGIVER SERVICES-
Grandparents Raising Grandchildren
Information & Assistance
Support Groups
FAMILY CAREGIVER SERVICES
Unpaid Family Caregiver Training
NUTRITION
Home Delivered Meals
NUTRITION
Congregate Meals
GENERAL TRANSPORTATION
LEGAL SERVICES
HOME REPAIR/ADAPTATION/RENOVATION
HEALTH MAINTENANCE, PROMOTION & SCREENING
Nursing Clinics at Congregate Meal Centers
PCOA SUBCONTRACTED SERVICE PROVIDERS
FY 2013-2014
PROVIDER
Accent Care
Aires, Inc.
Arcadia Health Care
Arizona Consumer Direct Personal Care
Aventas
Dependable Nurses, Inc.
Lutheran Social Services of the Southwest
My House Senior Living
Nursecore
Rescare Home Care
Soreo In-Home Support Services
Southern Arizona Family Services
United Cerebral Palsy of Southern Arizona
Dependable Nurses, Inc.
Handmaker Jewish Services for the Aging
La Posada at Park Center dba Casa de Esperanza
Lutheran Social Services of the Southwest
Philips Lifeline
Arizona’s Children Association
Lutheran Social Services of the Southwest
Catholic Community Services of Southern Arizona, Inc.
Lutheran Social Services of the Southwest
Catholic Community Services of Southern Arizona, Inc.
City of Tucson Parks & Recreation
Tucson Urban League
City of Tucson Parks & Recreation
La Posada at Park Centre dba Casa de Esperanza
Also PCOA purchases rides from City/County Special Needs
Southern Arizona Legal Aid
Community Home Repair Projects of Southern Arizona
City of Tucson, Community and Housing Services
Pima County Health Department

APPENDIX 4
SERVICE
CASE MANAGEMENT
PCOA HELPLINE/INTAKE
MINOR HOME REPAIR
FAMILY CAREGIVER
Information & Referral
Support Groups for the Elderly
Supplemental Services
HEALTHY LIVING (Health Promotion/Disease Prevention)
Enhance Fitness
A Matter of Balance
Chronic Disease Self Management Program
ELDER RIGHTS & BENEFITS
PERSONAL BUDGETING ASSISTANCE
LONG TERM CARE ADVOCACY - OMBUDSMAN
MEDICARE/INSURANCE COUNSELING (SHIP)
PCOA SUBCONTRACTED SERVICE PROVIDERS
FY 2013-2014
PROVIDER
Pima Council on Aging
Pima Council on Aging
Pima Council on Aging purchases from vendors in community
Pima Council on Aging
Pima Council on Aging
Pima Council on Aging
Pima Council on Aging
Pima Council on Aging
Pima Council on Aging
OTHER NON OLDER AMERICANS ACT SERVICES
RETIRED AND SENIOR VOLUNTEER PROGRAM
AMBASSADOR
NEIGHBOR’S CARE ALLIANCE
SUICIDE PREVENTION TRAININGS
Pima Council on Aging
Pima Council on Aging
Pima Council on Aging
Pima Council on Aging

Appendix 5: List of Neighborhood and Volunteer Organizations
Neighbors Care Alliance
Programs, Partners & Supporters
29 th Street CAN (Community Assistance Network)
Alvernon Heights N.A.
Arizona Canning Company
Church of Jesus Christ of Latter-Day Saints
Pantano Ward
Compass Bank
Connecting Communities
Dale’s Doors ‘N’ Windows
Dunn Edwards
Elastek
Freedom Park
Fry’s (22 nd Street)
Habitat for Humanity
Horizon Church
Junior League of Tucson
Julia Keen N.A.
Lend-A-Hand
Myers N.A.
Naylor N.A.
PRO Neighborhoods
Raytheon
Roberts N.A.
Senior Companion
Tucson Intl Alliance of Refugee Communities
UA Athletic Department
Wal-Mart
Ward 5
YES Network
Arivaca Coordinating Council HRG
Armory Park Neighbors Helping Neighbors
Armory Park N.A.
Armory Park Senior Center
Saint Andrews Church
Santa Cruz Church
Blenman-Elm Neighbors Care Alliance
Blenman-Elm N.A.
Catalina Vista
City of Tucson Ward 6
Environmental Strategies/Ken Goodman
Catalina Community Services
Saddlebrooke
Grater Vail Community Services
Civano Aging in Community
Caring Transitions of Southern Arizona
Civano Morning Coffee Group
Civano N.A.
Civano Pioneers
Civano AIC (cont)
RS Associates
SL Designs of Arizona
Splinters Handyman Service
The Inn at Civano
Corona Cares
American Legion Post #109
Corona Baptist Church
Corona de Tucson Fire Department
Vail Community Food Bank
Ladies Club
Newtowners
Santa Rita Foothills Community Assn.
Sahuarita Foothills Community Assn.
Eastside Neighbors Volunteer Program
22nd St Baptist Church
Armory Park Foundations
Broadway NE N.A.
Christ Community Church
City of Tucson Ward 2
Dairy Queen (Sarnoff & Broadway)
Desert View Christian School
East Tucson Baptist Church
Fountain of Life Lutheran Church
Health and Wellness Marketing Group, Inc
Immanuel Presbyterian Church
Kenyon/Millet N.A.
Kiwanis Club of Rincon
Long Realty
Men’s Mercy Ministry
New Spirit Lutheran Church
Nichols Genematas II Foundation
Our Mother of Sorrows Church
Pantano Christian Church
Rincon Rotary
Rita Ranch
Rosemont West N.A.
Saguaro Christian Church
South Harrison N.A.
St. Mathews Episcopal Church
Terra del Sol N.A.
Wal-Mart (Speedway & Kolb)
Friendly Neighbors of El Encanto
El Encanto N.A.
Interfaith Community Services
Aldea: A Spiritual Community
Alive Church
Interfaith Community Services (cont)
Amber Lights Assisted Living
American Red Cross
Ascension Lutheran Church
Atria Campana Del Rio
Avra Valley Community Church
Beautiful Savior Lutheran Church
Canyon del Oro Baptist Church
Capilla Del Sol Christian Church
Casas Adobes Congregational Church
Carondelet Health Network
Catalina United Methodist
City of Tucson, Comm. Services Dept.
Chapel of Country Club of La Cholla
Christ Church United Methodist
Christ Presbyterian Church
Christ the King Episcopal Church
Church of the Apostles
Church of the Painted Hills
Commerce Bank
Community Christian Church Marana
Congregation Anshei Israel
Congregation Chaverim
Congregation Or Chadash
Congregation M’Kor Hayim
Cortaro Vista Community Church
Desert Skies United Methodist Church
Dove of Peace Lutheran Church
Ebenezer All Nations Seventh Day Adventist
Church
Faith Christian Fellowship of Tucson
First Christian Church
Fountain of Life Lutheran Church
Grace St. Paul Episcopal Church
Health South Rehabilitation Hospital
Immanuel Presbyterian Church
Local Spiritual Assembly of Baha’is of OV
Lutheran Social Services of the S.W.
Mac Court Fund
Mtn Shadows Presbyterian Church
Mountain View Care Center
Mtn View Baptist Church
New Life Church of God
New Spirit Lutheran Church
Northminster Presbyterian Church
Northwest Baptist Church
Northwest Community Friends Church
Interfaith Community Services (cont)
Northwest Heights Seventh Day Adv. Church
Northwest Medical Center
See reverse side for more! (Updated 2/27/2013)
The Neighbors Care Alliance is administered through Pima Council on Aging
Funded by PCOA, Pima Association of Governments, Pima County, and United Way of Tucson and Southern Arizona
8467 East Broadway * Tucson, Arizona * 85710 * Tel. 520-790-0504 * Fax 520-790-7577

Appendix 5: List of Neighborhood and Volunteer Organizations
Neighbors Care Alliance
Programs, Partners & Supporters
Tucson Omni National
Oro Valley Church of the Nazarene
Oro Valley Hospital
Oro Valley United Church of Christ
Our Savior’s Lutheran Church
Presbytery de Cristo
Pusch Ridge Christian Church
Resurrection Lutheran Church
Rincon Congregational UCC
Sanctuary United Methodist
Santa Catalina Villas
Southside Presbyterian Church
St. Andrew’s Episcopal Church
St. Andrew's Presbyterian Church
St. Elizabeth Ann Seton Catholic Church
St. Francis in the Foothills UMC
St. John on the Desert Presbyterian Church
St. Mark the Evangelist Catholic Church St.
Mark’s Presbyterian Church
St. Mark's United Methodist Church
St. Matthews Episcopal Church
St. Michael & All Angels Episcopal Church
St. Odilia Catholic Church
St. Phillip's In the Hills Episcopal Church
Streams in the Desert Lutheran Church
Tanque Verde Lutheran Church
Temple Emanu-El
Templo La Uncion
Third Church of Christ, Scientist
Thrivent Financial for Lutherans
Tortolita Presbyterian Church
Tucson Community Church of Christ Tucson
Unitarian Universalist Church of Tucson
Unitarian Universalist of NW Tucson
United Way of Tucson & So. AZ
Unity of Tucson
Vida Nueva Church of God
Northwest Community Friends Church
Junction Connection (Robles Junction)
Friends of Robles Junction
Robles Ranch Community Center
Serenity Baptist Church
Three Points Clinic
Three Points Communications Group
Lend A Hand
29th St CAN
Adult Loss of Hearing Association (ALOHA)
Campbell Avenue Business Partnership
Campus Farm N.A.
Carlos & Company
City of Tucson Ward 3 Office
Hedrick Acres N.A.
Jefferson Park N.A.
Jewish Federation of Southern Arizona
Junior League of Tucson
La Madera N.A.
Limberlost N.A.
M’kor Hayim Congregation
Mountain & 1st N.A.
Mountain Ave Church of Christ
Mountain View N.A.
Northminster Presbyterian Church
Pima County Supervisor District 3
Prince Tucson N.A.
Richland Heights East N.A.
Richland Heights West N.A.
Samos N.A.
Shred-it
St Francis in the Foothills Church
Tucson International Alliance of Refugee
Communities
Walmart
Winterhaven Neighborhood
UA Athletic Department
UA Eller School of Management
UA English Dept – So. AZ Writing Project
UA LDS Students
UPS
Mobile Meals of Tucson, Inc.
Davis Monthan AFB
Fellowship Square
Golden Eagle Distributors
Health South Rehabilitation
La Posada
Pima County Medical Society Alliance
St. Joseph’s Hospital
St. Mary’s Hospital
Tucson Medical Center
UAMC-South Campus
University Medical Center
Notch Assist
The Notch N.A.
Old Fort Lowell Live-at-Home
Basha’s (Swan and Camp Lowell)
Encore
Health and Wellness Marketing Group, Inc
Long’s Realty Foundation
Old Fort Lowell N.A.
Tucson Medical Center Senior Services
Park West Neighbors Helping Neighbors
Park West Mobile Home Park
So. AZ Aids Foundation- Food for Life
St. Andrews Episcopal Church
Sunrise Neighborhood Assistance Program
Health and Wellness Marketing Group, Inc
Sunrise Canyon
Sunrise Mountain Ridge
Sunrise Mountain View Estates
Sunrise Presidio East
Sunrise Presidio
Sunrise Ridge
Sunrise Presidio Townhomes
Tucson Estates Neighbors Helping
Neighbors
Mt. Zion Lutheran Church
Tucson Estates
Tucson Estates II
Valley Assistance Services Volunteer Corps
Bodyworks by Mark
Beth Shalom Temple Center
Casa de Esperanza
Desert Hills Lutheran Church
First Church of Christ, Scientist
Friends in Deed
Green Valley Community Church
Green Valley Fire District
Good Shepherd United Church of Christ
Interfaith Council of Santa Cruz Valley
Jim Click Ford
La Posada
Lutheran Church of the Risen Savior
Our Lady of the Valley Catholic Church
St. Francis in the Valley Episcopal Church
Unitarian Universalist Congregation
United Community Health Center
Unity in the Valley
Valley Presbyterian Church
Valley Verde Rotarians
See reverse side for more! (Updated 2/27/2013)
The Neighbors Care Alliance is administered through Pima Council on Aging
Funded by PCOA, Pima Association of Governments, Pima County, and United Way of Tucson and Southern Arizona
8467 East Broadway * Tucson, Arizona * 85710 * Tel. 520-790-0504 * Fax 520-790-7577

Aging in
Pima County
A Report
to the
Community
April 2013

Acknowledgements
Contributed Material for the Report
Karen D’Huyvetter
Faculty, University of Arizona, Arizona Geriatric Education Center
Chris Erickson
SHiM Program Coordinator, Valley Assistance Services
Anna Sanchez
Community Services Administrator, City of Tucson
Julie Treinen
Program Director, Arizona’s Children Association, KARE Family Center
Anthony Young
Executive Director, Southern Arizona Legal Aid
PCOA Staff
Debra Adams, Jan Baker, Carolyn Cortesi, Jennie Cunningham,
Tony Estrada, Stew Grabel, Lynn Heskett, Jim Murphy, Karen Ring,
Cecilia Salaz, Pam Wessel, Adina Wingate, Ann Zaha

Aging in Pima County: A Report to the Community
Executive Summary 1
I Introduction 5
II Identified Issues/Problem Areas
A. Affordable Dental Care 7
B. Fear of Falling 8
C. Affordable Assistive Devices 10
D. Home Maintenance and Repair 11
E. Transportation 12
F. Understanding Changes in Medicare 14
G. Economic Concerns 15
H. Affordable Legal Assistance 16
I. Preparing Nutritious Meals 18
J. Behavioral Health 19
K. In-Home Assistance 21
L. Assistance for Family Caregivers 22
III Demographics 25
IV 2012 Community Survey Results 31
Addenda
2012 Focus Group Results 47
2012 Public Comment Meeting Results 63

Aging in Pima County: A Report to the Community
Executive Summary
Undertaking the Area Plan on Aging Community Needs Assessment affords the community a
look at the current state of older adult residents, highlights what the community is doing well,
and where it needs to improve. Established in 1975, the Area Plan on Aging Community Needs
Assessment has been updated every three years and is the only assessment of its kind for and
about the needs and concerns of older adults and their caregivers.
In the fall of 2012, Pima Council on Aging ( PCOA) initiated the most recent Area Plan on Aging
Community Needs Assessment process as a collaborative venture of the City of Tucson, Pima
County, Town of Marana, Town of Oro Valley, Town of Sahuarita, City of South Tucson, Greater
Green Valley Community Foundation, United Way of Tucson and Southern Arizona, Community
Foundation for Southern Arizona, Women’s Foundation of Southern Arizona, Direct Center for
Independence and the Arizona Center on Aging at the University of Arizona. These are leading
local agencies and groups with major planning responsibilities for human and social services in
Pima County.
This unique collaborative partnership guided the process, distributed and tabulated community
surveys, attended 10 public comment meetings, participated in four focus groups, and also
consulted with PCOA in the preparation of the Report to the Community.
The Report to the Community identifies the changing nature of our area’s older adult population,
anticipates future trends, identifies advocacy issues, best practices, successful programs
that already meet the needs of older adults, and summarizes comments received from aging
network professionals and the public-at-large as part of the needs assessment process.
Data was collected over a three-month period using a three-pronged approach. Input was
obtained from:
——
Four Focus Groups of professionals working and providing services in the field of
gerontology;
——
A Community Survey of 42 questions from 2,330 individuals age 60 or older, including
homebound, senior center club and program members, service recipients, and readers of
PCOA’s monthly newspaper, Never Too Late;
——
Ten Public Comment Meetings held throughout the county, with Spanish language
interpreters, including Tucson, Green Valley, Sahuarita, Marana, Tucson Estates and
Oro Valley.
Key Finding
Established in 1975, the Area Plan on Aging Community Needs Assessment Community
Survey of key issues and problem areas has not changed significantly from prior needs
assessments. Indeed, older adults continue to identify the lack of affordable dental and health
care; maintaining and repairing their home; access to transportation; assistance with meals,
housekeeping, laundry, and personal care; affordable legal assistance, understanding Medicare
plans, and knowing where to go for information and assistance.
1

Aging in Pima County: A Report to the Community
Executive Summary
By 2020, one in four Arizona residents will be
over 60 years of age.
Source: U.S. Census Bureau
The 2012 Community Survey data found that many older individuals were also concerned with
economic insecurity and the rising costs of daily living to meet their basic needs: utility costs;
paying for prescriptions; the cost of assistive devices (hearing aids, glasses); and the increased
costs for grandparents on fixed incomes raising their grandchildren.
Pima County is home to 209,742 individuals who are
age 60+ (21.4% of total population); 151,293 are 65+;
and 19,895 are 85+ years of age.
Source: U. S. Census Bureau
Special Notable Findings
Twenty issues about health, safety and social, and economic well-being were identified by more
than 2,300 older adults who completed the community survey. Among them: Fear of falling,
memory loss, depression and/or anxiety, and loneliness were identified as significant problems.
People said they appreciate the community network of local senior centers, recreational
programs, and volunteer opportunities, but they also want to know how to engage their
neighbors and friends who are living alone. Repeatedly, people voiced concern about living
alone, fear of falling, and anxiety about how to summon help and whether they would be found.
The number of individuals needing assistance through the Behavioral Health System and
growing numbers of older adults presenting with one or more chronic health conditions
also complicate personal care plans, and many families say they are unable to afford care or
placement of their family members in appropriate settings.
Professionals working with older adults speak about the exponential growth of the aging
population needing assistance, and the dramatic reduction in financial resources to provide
services.
As the Area Agency on Aging, PCOA takes the lead to plan for services, but PCOA can only be
successful as a planner and funder and provider of services when public policy and community
planners, funders and stakeholders come together in a collaborative partnership and invest the
human and financial resources necessary to ensure sustainable aging in our community.
Community characteristics that promote aging in place have the potential to lead to positive
outcomes for the entire population. Among them: improving the health and well-being of older
adults, and benefiting other residents, businesses, organizations and local governments by
fostering the economic and environmental health of the community.
2

Aging in Pima County: A Report to the Community
Executive Summary
A livable community offers a variety of accessible,
affordable and visitable housing options so that older
adults have a safe place to live.
Livable Community Indicators for Sustainable Aging in Place, March 2013;
Metlife Mature Market Institute and Stanford Center on Longevity
The rapid transformation of our community that’s underway as we are aging requires bold
thinking, setting ambitious goals and measuring results, and a clear blueprint of the road ahead
to ensure that urban, suburban and rural places across the county are great places to grow up
and grow old.
A livable community has features that promote access
to the community, including:
— Safe and walkable neighborhoods
— Transportation options
— Safe driving conditions
— Emergency preparedness
Livable Community Indicators for Sustainable Aging in Place, March 2013;
Metlife Mature Market Institute and Stanford Center on Longevity
Pima Council on Aging will continue to lead by providing the Area Plan on Aging for the county’s
diverse population of older adults and their family caregivers, convene community partnerships,
and collaborate across all sectors of the community to promote sustainable aging in place, now
and for generations to come.
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Aging in Pima County: A Report to the Community
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Aging in Pima County: A Report to the Community
Part I: Introduction
Pima Council on Aging (PCOA) is a private non-profit corporation that serves as the designated
Area Agency on Aging for Pima County, Arizona. In this role, PCOA conducts a community
needs assessment every three to four years to identify problems, concerns and critical issues
affecting older adults, their family caregivers and the agencies striving to meet their needs.
For the 2012 needs assessment, a collaborative partnership was formed in an attempt to
secure broader participation in the process. Partners included the City of Tucson, Pima County,
Town of Marana, Town of Oro Valley, Town of Sahuarita, City of South Tucson, Greater Green
Valley Community Foundation, United Way of Tucson and Southern Arizona, Community
Foundation for Southern Arizona, Women’s Foundation of Southern Arizona, Direct Center
for Independence and the U of A Center on Aging. The Collaboration guided the process,
distributed and entered surveys, participated in public comment meetings and consulted in the
preparation of the report.
Data was collected over a three-month period using a three-pronged approach proven effective
in past years. Input was obtained from:
——
focus groups of professionals working and providing services in the field of gerontology;
——
2,330 survey responses tabulated through Survey Monkey from individuals 60 years of age
or older, including homebound, senior club and organization members, service recipients and
readers of “Never Too Late”, and
——
ten public comment meetings held throughout the county, with Spanish language
interpreters, including Tucson, Green Valley, Sahuarita, and Marana, Tucson Estates and
Oro Valley.
First, representatives from health and social service providers were invited to participate in
focus groups held at various locations in Pima County during the month of October, 2012. The
questions to be discussed were sent to participants in advance of the focus groups. Individuals
not able to participate in the discussions were invited to complete the questionnaire in writing
and return it for inclusion in the final report. Thirty (30) agencies provided written and/or
verbal responses.
Second, the method for identifying problem areas for older Americans was the distribution
of surveys, printed in both English and Spanish. The survey was available for completion on
Survey Monkey; included in a publication of PCOA’s Never Too Late newspaper and distributed
to congregate and home delivered meal participants, members of numerous senior clubs
and organizations, service recipients of various social service agencies and through faith
communities and neighborhood associations. 2,330 surveys were received and tabulated with
responses coming from all geographical areas of the County.
Third, service needs, concerns and advocacy issues were identified at ten public comment
meetings held in various locations throughout Tucson, Green Valley, Marana, Sahuarita, Tucson
Estates and Oro Valley. At each meeting, a panel of Agency staff, a member of PCOA’s Board of
Directors, Chairperson of the Area Agency on Aging Advisory Council, and representatives from
the collaborative partners were present to listen and respond to advocacy issues, identification
of individual service needs and proposed changes that should be made to existing services.
Notice of these meetings was sent to newspapers and radio stations, an article was published
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Aging in Pima County: A Report to the Community
Part I: Introduction
in “Never Too Late” and the information was distributed to senior clubs, organizations, centers
and service providers in the area. Over one hundred and fifty-six (156) individuals attended and
shared their comments and concerns.
All of the above methods were used in an attempt to be as inclusive and comprehensive as
possible in identifying needs and focusing on areas of greatest priority. It is often difficult
to obtain input through public meetings with transportation, care giving responsibilities,
and health issues being barriers for attendance. Recognizing these barriers, PCOA and its
Collaborative Partners chose to collect information through surveys and discussions with
professionals, as well as public meetings held in locations where seniors already congregate.
This “Report to the Community” details some of the major
results of this needs assessment process; identifies the
changing demographics of our region’s older population;
describes the critical problem areas affecting older adults
and their family caregivers; anticipates future trends and
identifies best practices and successful programs. While
there is significant data available now, there is much
more analysis of data that could be conducted. We will
therefore, make available to partner organizations or
other entities the opportunity to have access to further
“mine” the data that would be useful to them in their
respective planning and resource allocations processes.
The aging process has always presented individuals, families, and communities with challenges.
The elderly population of this region continues to grow at a rate greater than the national
average, both with those relocating here and the longevity of our current residents. The needs
of the oldest old for supportive services are greater than ever and we cannot forget how the
baby boomers and their numbers are affecting service demands.
To address the problems and needs identified in this Report, and meet the challenges that are
ahead of us, we will need to work collaboratively to expand our systems of service, develop new
approaches to service delivery and find the necessary resources to provide quality care.
Please read the Report and use the information. As your
Area Agency on Aging, Pima Council on Aging invites
discussion and partnership in addressing the problems
and concerns brought forward in this Report. The
information and data derived from this process forms
the major input into the development of the 2014-2017
Area Plan on Aging which is part of PCOA’s Strategic Plan.
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Aging in Pima County: A Report to the Community
Part II: Identified Issues/Problem Areas
A. AFFORDABLE DENTAL CARE
For the last three Community Surveys and again in 2012, affordable dental care has
been identified as the number one serious problem for individuals aged 60 and older living in
Pima County.
It has long been recognized that oral health has far ranging effects on the overall health of
individuals. Disparities in oral health care were highlighted in a 2000 report by then Surgeon
General David Satcher. Oral Health in America reported that no less than a “silent epidemic
of oral diseases is affecting our most vulnerable citizens—poor children, the elderly, and many
members of racial and ethnic minority groups.” In April 2003 then Surgeon General Richard
Carmona released a National Call to Action to Promote Oral Health which was followed in
September 2003 by his remarks before the US Senate Special Committee on Aging entitled
“Ageism in Healthcare: Are Our Nation’s Seniors Receiving Proper Oral Health Care?” providing
the following facts:
——
Periodontal infections are more common in the elderly; about 23% of 65-74 year olds have
several periodontal diseases;
——
About 30% of individuals 65 and older have lost all their teeth, statistics vary by state.
——
Studies have shown possible association between oral infections and systemic diseases such
as diabetes, heart disease, and respiratory infections.
——
The incidence rate of oral and pharyngeal cancers is higher among seniors than for other age
groups. Seniors who are 65 years and older are seven times more likely to be diagnosed with
oral cancer than younger individuals.
——
Many seniors take medications that have the complicating side effect of reducing salivary
flow (the amount and flow of saliva) resulting in “dry mouth”. Reduction in salivary flow
contributes to increased dental decay.
Payment for dental services is generally out-of-pocket
for older people. Medicare does not cover routine
dental services like cleaning, oral exam or x-rays. There
is Medicare coverage for very limited situations, for
example, extraction of teeth for the purpose of radiation
treatment involving the jaw or if an inpatient hospital
stay is required for a dental procedure. Many Medicare
Advantage (MA) plans offer supplemental dental
coverage as an option, usually for an extra cost. The
levels of coverage vary from routine care, like cleaning,
x-ray and oral exam to a more comprehensive dental
package. For most people who have dental insurance
coverage as a benefit of their employment, that
coverage ends upon their retirement. In addition, most
seniors have limited income. This results in compromised access to dental care. While 61% of
the population report having a dental visit in the past year, only 45% of seniors 75 years and
older report having a dental visit.
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Aging in Pima County: A Report to the Community
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In the past, the Surgeons General have called upon
policymakers, community leaders, private industry, health
professionals, the media, and the public to affirm that oral
health is essential to general health and well-being and
to take action. The Call to Action urges that oral health
promotion, disease prevention, and oral health care have
a presence in all health policy agendas set at local, state,
and national levels.
Subsidized assistance for dental care is very limited in Pima County. PCOA calls upon our
legislators at the local, state, and national levels to work as partners in bringing together ideas,
resources and expertise to provide necessary dental care to the older adults in our community.
Source: U.S. Department of Health and Human Services. Oral Health in America: A Report of the Surgeon
General. Rockville, MD: U.S. Department of Health and Human Services, National Institute of Dental and
Craniofacial Research, National Institutes of Health, 2000:2-3.
U.S. Department of Health and Human Services. National Call to Action to Promote Oral Health. Rockville, MD:
U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National
Institute of Dental and Craniofacial Research. NIH Publication No. 03-5303, Spring 2003.
B. FEAR OF FALLING
Survey respondents identified the Fear of Falling as the second most serious problem in 2012
and 2009. When combined with responses for “some” problem, the Fear of Falling moves to
number one. 49.6% of Survey respondents noted they had fallen one or more times in the past
year with 14% having fallen 3 or more times in the last year. Individuals at numerous Public
Comment Meetings also noted a concern with living alone, falling and whether or not they
would be found or be able to summon assistance.
The risk of falling and fear of falling tend to get worse as we age and have numerous chronic
health conditions. This is especially true for individuals who have problems with balance and
those with osteoarthritis. Many people who fall, even if they are not injured, develop a fear of
falling. This fear may cause them to
In the past year, how many times have you fallen?
limit their activities, which lead to
reduced mobility and loss of physical 35%
fitness, and in turn increases their
1 or 2 times
30%
actual risk of falling. 1
According to the Center for Disease
Control and Prevention (CDC), one in
three community-dwelling persons
over the age of 65 falls each year,
and this number increases to one in
1
Scott JC. Osteoporosis and hip fractures.
Rheumatic Diseases Clinics of North America;
6(3):707-40
8
25%
20%
15%
10%
5%
0
3 to 5 times
More than
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Aging in Pima County: A Report to the Community
Part II: Identified Issues/Problem Areas
two by the age of 80. Fall-related injuries are often serious enough to result in hospitalization
and even premature death; moreover, persons who fall often face significant declines in
mobility and independence. Half of all older adults hospitalized for hip fractures cannot return
home to live independently.
Falling is not an inevitable result of aging and fortunately,
falls are a public health concern that is largely
preventable. Through evidence-based interventions,
practical lifestyle adjustments, and community
partnerships we can substantially reduce the number of
falls occurring in our community.
Since 2005, PCOA has sponsored three evidenced-based programs, in collaboration with
community partners. These valuable programs help individuals gain self-confidence in
managing health concerns, address symptoms of ongoing chronic conditions, promote regular
exercise, promote environmental changes to reduce fall risks and viewing falls and the fear of
falling as controllable.
Specifically, A Matter of Balance, emphasizes the importance of maintaining an active lifestyle
in order to reduce the risk of falling. Participants learn to view falls as controllable and the
role of assertiveness in fall prevention. Simple exercises are learned and practiced to increase
strength and balance. Fall hazards in
the home and techniques for getting
up and down safely are discussed
by a guest therapist. EnhanceFitness
is an ongoing low to moderate level
exercise class taught by certified
fitness instructors. The classes
provide interactive instruction and
exercises, including no/low impact
aerobic, stretches and structured
strength training using weights.
Participants are able to stand and
sit during the class. The Enhance Fitness Program is now being offered in five City of Tucson
Parks & Recreation sites and four Pima County Natural Resources, Parks and Recreation sites.
The Healthy Living (CDSMP) Program focuses on assisting those with chronic or ongoing health
conditions and their caregivers. Participants learn tips and techniques to help them be the best
self-manager of their conditions, rather than having their conditions be the manager of their life.
This program also identifies proven ways to reduce the risk of falling and offers flexibility and
strengthening exercises that are particularly beneficial.
In Green Valley, the Fire Department records an average of 120 falls each month with over
70% of the falls occurring in the home; of which 75% are preventable. In the summer of 2010,
the Green Valley Fire District, Valley Assistance Services, (a local non-profit) and the Green
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Aging in Pima County: A Report to the Community
Part II: Identified Issues/Problem Areas
Valley’s Volunteer Clearinghouse, began to discuss how best to address fall prevention. What
emerged is a Fall Prevention Program, called SHiM (Safety and Health in Motion). The first of its
kind, this program brings all the pieces of fall prevention into one program. SHiM is a grass-roots
program, developed and implemented by RNs with a holistic approach to education and the
prevention of falls.
Empowered by prevention and knowledge, seniors and persons with disabilities have welcomed
an in-home safety assessment through SHiM. A team, which includes a volunteer Fire Corps
member and a registered nurse volunteer, helps identify fall risks, health conditions and
medications that affect balance. A volunteer handyman, a part of SHiM, completes small home
modifications that improve safety. Since SHiM started in April 2011, participants have reported a
93% decrease in falls. Local seniors are becoming “SHiM Champions.” They now boast an updated
medication and an emergency contact list; use of safety items (reach sticks, and night lights);
the start of an exercise program and attendance at bi-annual fall prevention educational days
and screenings. This synergy of positive change has prevented 150 potential falls with a potential
savings of over $700,000 in medical costs. The initial grant investment by Freeport, McMoRan,
Copper and Gold represents a tenfold return on investment; and more importantly, social change
to improve the quality of life for seniors so they can age safely in place in their homes.
This community-centered fall prevention program has also raised other concerns with seniors.
Valley Assistance Services has extended the scope of SHiM to include SHiM TLC (teaching and
learning in our communities), funded by Freeport, McMoRan, Copper and Gold, with added RN
advocacy, outreach to the healthcare network and the provision of grab bars and other safety
equipment.
The provision of grab bars and other in home safety equipment is a key component to any effort
to reduce the incidence of falls. Pima Council on Aging uses a portion of its funding to purchase
and install adaptive equipment for low income older adults who cannot purchase the equipment
for themselves. PCOA also provides funding for an electronic emergency alert system to assist
individuals who are at fall risk and have no family or friends to check on them.
Efforts are underway in Pima County to address this public health concern, but resources
devoted to these fall prevention efforts must be increased and new partnerships formed. Green
Valley has set an example for how community groups can come together to work with the local
fire department to prevent falls. This program now needs to be replicated in every community in
Pima County.
PCOA has brought successful evidence-based programs to the community but resources
are needed to secure their continuation and expansion so all older adults have access to the
programs. We need to find ways to involve our health care networks in supporting the programs
and informing their patients of the availability of assistance.
In 2010, the direct medical cost of falls, adjusted for inflation, was $30.4 billion in the United
States. 2 This costly, life changing event is largely preventable. Working together we can provide
the education and intervention necessary to address this concern for Pima County older adults.
2
Steven JA. Fatalities and injuries from falls among older adults—United States, 1993-2003 and 2001-2005.
MMWR 2006;55(45).
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Aging in Pima County: A Report to the Community
Part II: Identified Issues/Problem Areas
C. AFFORDABLE ASSISTIVE DEVICES
Affordable Assistive Devices (hearing aids, eyeglasses) has ranked in the top five serious
problems in the last four Community Surveys (2002, 2005, 2009, 2012).
Payment for these assistive devices is generally out of pocket for older individuals as original
Medicare does not cover routine hearing exams or hearing aids, eye exams or glasses, except
after cataract surgery, when Medicare will help cover the first pair of glasses. Exams due to
disease of the eye are covered at 80% after the Medicare Part B deductible is met. If individuals
are enrolled with a Medicare Advantage Plan, they may have coverage for a hearing or eye
exam and some coverage for hearing aids. These Plans also cover or help to pay for one pair of
glasses after cataract surgery.
Other resources to help defray the cost of these devices for low income older adults are very
limited so often people go without, especially hearing aids.
Hearing loss is a common condition affecting older adults. The National Institute on Health
notes that approximately 17% of American adults report some degree of hearing loss, with 47%
of adults 75 years of age or older having a hearing impairment.
People with hearing loss may find it difficult to have a conversation with friends and family so
they may withdraw and become socially isolated. They may also have trouble understanding a
doctor’s advice, responding to warnings, and hearing doorbells and alarms.
Similar to dental care, our policymakers, health professionals and community leaders need
to work together to discuss this need as part of health policy. We need to develop low cost
or subsidized resources to assist older adults with these life changing conditions that can
be rectified.
D. HOME MAINTENANCE/REPAIR AND YARD MAINTENANCE/CLEANING
Since 1996, difficulties with home maintenance and repair and yard maintenance and clean-up
has consistently been identified as a top serious problem by Survey respondents. During the
2012 Public Comment Meetings, individuals expressed concern with their ability to pay for home
repairs and, if able to pay, their hesitancy in hiring people to come into their home. Many older
adults are targeted in home repair scams and they feel vulnerable in determining if workers are
safe and reliable. Other participants voiced their frustration with homeowner associations and
the fines that are assessed when someone can no longer take care of their yard.
The City of Tucson and Pima County 5-Year HUD
Consolidated Plan indicates that 42% of Pima County’s
elderly households have low and moderate incomes.
With limited and/or fixed incomes, many older adults
find they can no longer afford necessary home repairs
or needed modifications to improve safety and
accessibility in the home.
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Aging in Pima County: A Report to the Community
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Pima Council on Aging has for over 30 years allocated
a portion of its funding to support a home repair and
adaptation program. Each year PCOA assists 450 to
500 older adults with minor to major home repairs and
adaptations, but many also go unserved. Repairs include
cooler and heater repair, maintenance and replacement;
hot water heater replacement; electrical and plumbing
repair; disability modifications and limited structural
repairs. Seventy-seven percent (77%) of the 475 people
assisted in FY 11-12 were older women, 37% age 75 or
older, 63% lived alone and 66% were frail and disabled.
Seventy-one per cent (71%) of the homes were located
in zip codes 85705, 85706 and 85713, all neighborhoods
that have been identified by the City of Tucson as High
Stress areas based on the number of residents who are
low income.
The City of Tucson and Pima County devote resources to provide for and preserve safe, decent
and affordable housing, especially for the most vulnerable residents, but the need often
outweighs the resources. Many non profit organizations are also working to meet this need, but
their resources are not sufficient. The City/County Consolidated Plan notes that almost half of
the housing stock in Pima County is 30 years old or older. The majority of the older units are
located in Tucson, where 49% of the homes are more than 30 years old. These older units are
the most likely to require rehabilitation.
A 2006 study in the journal Community Development reported that 1 million elderly people
live in homes with serious rehab or modification needs that, if unmet, could force them to
move. (Blueprint for Boomers, Va. Explores Housing Options for Retirees who want to Stay
Put). The benefits of aging in place for older adults are many, including a sense of attachment,
familiarity and identity with the home and neighborhood environment. As a community we
need to work together to develop new approaches and increase the available resources for
helping older homeowners maintain and adapt their homes. Neighborhoods are organizing in
the development of new programs to formalize efforts for “neighbors helping neighbors”. Their
efforts need to be encouraged and supported.
E. TRANSPORTATION
Transportation appeared as the seventh most serious problem in 1996 and has now moved to
number four in the 2012 Community Survey.
Time after time, transportation is identified as a major problem among older adults. While
many older adults drive, the majority will likely lose, at some point, the physical and/or
financial means to do so as they age. Certain physical and cognitive changes can occur with
age that can make it more challenging to continue driving safely. These include worsening
eyesight, which can make it difficult to read road signs or estimate the speed of oncoming
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Aging in Pima County: A Report to the Community
Part II: Identified Issues/Problem Areas
traffic, as well as slower reaction
time and physical movements in
response to the movements of other
vehicles, pedestrians, and roadway
impediments.
Many older adults also find it difficult
to access essential transportation
services in their communities. This
is particularly true for older adults
who live in suburban or rural
communities where destinations
are too far to walk, public transit is
non-existent or inadequate, and
private transportation is limited and
prohibitively expensive.
Some older adults depend on family and friends to take them to their destinations. However,
employed family caregivers must leave work to transport their loved ones. For others there may
be a reluctance to “burden” family and friends to take them to destinations they may consider
non-essential, but are important for socialization and a sense of well-being.
Although the region’s fixed route transit system, Sun Tran, serves 296 square miles and
provides over 20 million passenger trips a year, Pima Association of Governments’ 2010 and
2011 surveys indicate that “73 percent of agencies cite ‘clients or destinations located outside
of the public transit service area’ as a barrier to using the public transit system. The other major
barriers are infrequent schedule, safety concerns, inconvenient transit routes and transfers and
unaffordable fare.” Public transportation can be daunting for older adults who cannot walk the
distance to and from the bus stop, especially in the summer heat or when carrying groceries.
The same declines in their physical and mental capabilities that necessitated giving up their car
keys may make it impossible for some older adults to “catch the bus”.
Paratransit (a transportation service that supplements larger public transit systems by
providing individualized rides without fixed routes or timetables) is available through Sun Van,
Handicar, and Coyote Run to individuals who are ADA (Americans with Disabilities Act) eligible.
However, not all areas are covered and barriers still exist for passengers who require additional
assistance such as opening doors and verbal guidance, hands-on physical support to help keep
their balance and climb steps, help with activities at the destination, putting away purchases
in the home, and help for passengers who are faced with challenges related to communication
or confusion. Personal care companions can provide this assistance but the wait times before
pickup and stops along the way mean a long day for them and for passengers with regimented
prescription schedules or incontinence.
Various non-profit groups provide volunteer door-to-door services at little or no cost, but
participants must live within defined service areas and rides are dependent on volunteer
availability.
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Aging in Pima County: A Report to the Community
Part II: Identified Issues/Problem Areas
Rural seniors lack transportation options in every category when compared to other geographic
areas 3 and in addition to needing transportation within their communities, rural seniors often
face the challenge of accessing needed services at a long distance.
More than 50% of non-drivers 65 or older stay home on
any given day partially because they lack transportation
options 4 , causing them to miss doctor and health-related
appointments, become unable or unwilling to grocery
shop, and become isolated in their homes. Businesses
lose valuable customers because their patrons can no
longer find rides and suffer from lost productivity when
caregivers must leave work to take a family member to
an appointment.
While a wide range of both paid and volunteer transportation services are available to seniors
in some parts of the county, a variety of affordable, accessible transportation services are
needed for seniors in all parts of Pima County, especially for medical and grocery needs. PCOA
continues to work in this area by subsidizing the cost of Sun Van passes to attend meals at nine
of PCOA’s nutrition centers and administering and expanding the Neighbors Care Alliance, a
network of 20 neighbors care programs, many of which provide transportation. PCOA supports
new transportation options and ideas, including ITNGreaterTucson, a membership based model
that will provide service to adults 60 years and older for a reasonable fare.
F. UNDERSTANDING CHANGES IN MEDICARE
Understanding changes in Medicare appeared as the second most serious problem in 2005,
third in 2009 and number four in 2012. Questions were repeatedly asked at the 2012 Public
Comment Meetings as to how the Affordable Care Act would be affecting Medicare and how
these changes would be communicated to beneficiaries.
When Medicare started in 1965, it was quite easy to comprehend. Part A was the hospital
coverage and Part B was the medical coverage. The only other decision for a beneficiary to
make was whether or not to purchase a Medicare Supplement plan.
A big change came in 1998 when Medicare Advantage plans (previously called Medicare+Choice
plans or Part C) were introduced. Beneficiaries were now able to choose to enroll in an
alternative health plan. These plans have greatly expanded through the years and Pima County
currently has 20 Medicare Advantage plans to choose from.
In 2006, Medicare’s Part D (prescription drug coverage) was added that allowed beneficiaries to
enroll in an insurance plan to help with medication costs. There are 26 Part D options in Pima
County in 2013. Choosing between twenty Medicare Advantage Plans and twenty-six Part D
plans can be overwhelming for many older adults and their family caregivers.
3
National Center on Senior Transportation, 2009 survey
4
Aging Americans: Stranded without Options, April 2004
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Aging in Pima County: A Report to the Community
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To assist Medicare beneficiaries and their families in understanding the various options
available, PCOA offers presentations and counseling services through our SHIP (State Health
Insurance Assistance Program). PCOA staff and trained volunteers present the latest Medicare
information throughout the year, including at our Medicare Update conferences during October
and November. PCOA also offers New to Medicare classes on the first Wednesday of each
month and ongoing personal counseling by telephone or in person.
The increasing numbers of client contacts in the PCOA Medicare Program are a reflection of
both the complexity of decisions and the increasing numbers of Medicare beneficiaries. In the
last five years, the number of client contacts increased from 4,482 in FY 2007-2008 to 12,180
in FY 2011-2012. Each year over 800 individuals attend the Medicare Update Conferences and
500+ people come for the New to Medicare classes.
With the sheer volume of boomers turning 65 years of age each year, Pima Council on Aging
is going to need a larger volunteer base and additional community partners to address this
identified problem area.
G. ECONOMIC CONCERNS
Economic concerns including having sufficient income to meet basic needs; paying for
prescription drugs; the cost of utilities; and paying the rent, mortgage or property taxes have
all consistently appeared in the top nine identified serious problems since 1996. Agencies
participating in the 2012 focus groups reported an increase in the older adults living on the
edge; many caught between not being able to qualify for services and assistance and not being
able to make ends meet.
From July 1, 2011 through June 30, 2012, Pima Council
on Aging’s Help Line fielded 11,792 calls with 13,885
requests for assistance in one or more areas. Seventeen
percent (17%) or over 2,400 calls were in relation to
benefits counseling/financial assistance.
35% of Pima County’s 65+ population (52,953) have
income below 200% of federal poverty level. National
measures such as the Elder Economic Security Index
indicate this is the minimum income for older adults to
make ends meet. Below that, people are making choices
between eating and buying medicine.
Many older adults are unable to cope with the complex
maze of organizations and the bureaucratic systems
that serve as their lifeline. Often the older person does
not have the physical and mental energy or capacity
to make the numerous phone calls, complete the required forms and write the detailed letters
necessary to receive the services they require. Information that they need to receive benefits
or services may not be readily available, especially to those of limited means or those facing
cultural barriers.
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Aging in Pima County: A Report to the Community
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The Pima Council on Aging Elder Rights and Benefits Program (ERAB) assists individuals sixty
years of age or older by providing information, advocacy, guidance, and representation in
accessing benefits/services that can help them use their limited income more efficiently or help
in paying for needed services. Often people do not know they are eligible and entitled to certain
state and/or federal benefits. ERAB staff also help in resolving problems or consumer issues
that individuals have not been successful in resolving themselves.
H. AFFORDABLE LEGAL ASSISTANCE
Affordable legal assistance first appeared in the top nine serious problems in the 2005 Community
Survey, moving to number six in the 2012 Survey. Also rated as a serious problem in 2012
was accessing health care legal options such as Medical Power of Attorney and Living Wills.
Access to free or low cost civil legal services has gained the ranking of sixth in the PCOA Survey
because many Arizonans are in need of civil legal assistance and they cannot get it. Seniors
are caught in the crunch of having to compete with non-seniors for scarce legal aid services.
According to the Unites States Census Bureau, 16.5% of Arizona’s population lives below the
poverty guidelines. 5 Over 860,000 Arizona residents have household incomes within the federal
poverty levels. The Arizona Foundation for Legal Services & Education (Foundation) 2007
access to justice study, “Voicing a Need for Justice,” indicated that approximately 32% of the
population had a crisis civil legal issue in the last twelve-month period where they believed
an attorney’s expertise was required. 6 This estimate does not include the civil legal needs of
the “modest means” population, who also struggle to afford legal services. Nor does it take
into consideration the vast geographic area of Arizona, Pima County, and the lack of legal
representation available in specific regions.
Seniors like other Arizona residents seek legal aid
services for help with: consumer protection, to protect
income and avoid financial exploitation, housing matters,
family law matters such as divorce and guardianship,
access to public benefits like Social Security and SNAP
and healthcare issues as well as wills.
Southern Arizona Legal Aid (SALA) participated in a 2013 statewide civil legal needs assessment
conducted by the Foundation. Twelve percent of the participants reported being between the
age of 60-70, and 8% reported being 71 or older. 7 Public feedback placed consumer issues as
the highest need (77%), followed by family law (38%) and domestic violence (31%). Housing,
both rental and ownership (27%) rounded out the top five needs. 8
The survey responses indicated that over 60% attempted to deal with their legal problem
on their own or just ignored it. 9 The responses also showed that attempting to address the
5
http://quickfacts.census.gov/qfd/states/04000.html
6
2007 Voices Report - Foundation Survey Results on Legal Aid Access in Arizona
7
2013 The Legal Need In Arizona – Foundation Survey Results on Legal Aid Access in Arizona
8
Id.
9
Id.
16

Aging in Pima County: A Report to the Community
Part II: Identified Issues/Problem Areas
problem without a lawyer or ignoring it was not working. Only 5% reported that their legal
needs were resolved with 95% reporting that the legal issues are still hovering over them. 10 .
SALA’s closed case data provides the best example of where seniors have the greatest unmet
civil legal needs. SALA’s 2012 closed case data shows that 542 seniors received assistance. The
areas noted below are where seniors most often sought legal assistance and these areas are in
line with the 2013 statewide legal assessment.
Requested legal assistance was high for bankruptcy, debt collection and garnishment issues,
consumer contracts, divorce, family support issues, domestic abuse issues, adult guardianship,
AHCCCS benefits and Medicare issues. In the area of housing, seniors received assistance
with homeownership including foreclosures and private landlord/tenant matters. In the
area of income maintenance, seniors received assistance accessing SNAP, SSDI, SSI and
unemployment benefits, and other income maintenance issues.
While SALA provided civil legal assistance to 542 seniors in 2012, SALA has been unable to
serve every senior who requested assistance. This was due in part to the increased demand for
services resulting from the economic downturn in Arizona, while SALA’s funding was in decline.
Decreases in funding have stymied SALA’s efforts to expand services and it is expected that
services will decrease further in 2013 and beyond.
Because SALA is the only provider of a full-range of free civil legal services to seniors in Pima
County, Pima Council on Aging (PCOA) has tried to supplement access to service through the
development of partnerships with the National Academy of Elder Law Attorneys, the State Bar
of Arizona and the Arizona Foundation for Legal Services and Education.
Twice a month, members of the National Academy of Elder Law Attorneys in Tucson volunteer
to meet with six low income older adults at PCOA’s office. The attorney meets for a half hour
with each person and provides information on how to proceed. If it is determined there is a
legal issue requiring representation, they are referred to the appropriate resource.
PCOA has also partnered with the State Bar of Arizona
and the Arizona Foundation for Legal Services and
Education to provide Wills for the Greatest Generation two
to three times a year. Tucson elder law attorneys volunteer
their time to meet at PCOA with qualified older adults who
need to have a valid simple will, living will, and/or health
care and financial power of attorney prepared, but can’t
afford a private attorney. Twenty-eight people leave each
workshop with professionally prepared documents.
Legal services need to be available to everyone. As a concerned community, we must find the
resources to adequately fund Southern Arizona Legal Aid and find new approaches to meeting
the legal needs of older adults.
10
Id.
17

Aging in Pima County: A Report to the Community
Part II: Identified Issues/Problem Areas
I. PREPARING NUTRITIOUS MEALS
Preparing nutritious meals moved into the top eight serious problems for the first time in the
2012 Community Survey. In prior years, this problem was noted as a serious concern for survey
respondents 85+ years of age, but has now been identified as a serious problem for all age
groups combined. The need for prepared, nutritious meals delivered to individuals’ homes and
served at community sites was also affirmed by Public Comment Meeting participants. Many
of the participants wanted us to know how important the Congregate Meal Centers were to
them, not only for the meals but for the socialization. They described the people at the Center
as “their family”. Agencies at the Focus Groups identified concern with the increased number of
clients living on the edge and needing assistance in meeting their basic needs.
In a report prepared for Meals on
Wheels Association of America, Inc.,
Arizona ranked eleventh in the rate
of food insecurity among Senior
Americans in 2001-2007. Many
physiological and socio-economic
factors affect the nutritional status
of our communities’ elders and lead
to this food insecurity. For some,
limitations on physical mobility
interfere with the independent
performance of Activities of
Daily Living like shopping for and
preparing healthy well balanced meals. For others, depression and social isolation lead to the
inadequate consumption of enough calories as many seniors do not eat regularly when having
to dine alone. Still others cannot afford to buy nutritious food as demands for health care costs
consume a large portion of their limited fixed incomes. If not addressed, these factors can lead
to poor health, delay in recovering from illness, advance of age-related degenerative diseases
and eventual loss of independence.
Each year PCOA provides close to 350,000 prepared meals, through its twelve Congregate
Meal sites and on its sixteen Home Delivered Meal routes. The main source of funding for
over thirty-three years for these two programs has been the federal Older Americans Act.
Funding appropriated through this Act, has not kept pace with inflation or the growth of the
population, but has always been a steady source of support. For the first time these programs
are in jeopardy as the funding is being reduced in the federal sequester budget cuts. The State,
County, City and United Way provide limited support to these programs, but is not sufficient
to compensate for the loss of federal dollars. Periodically PCOA has had to implement waiting
lists for home delivered meals, but has never faced having to ration the meals served at the
Congregate Meal sites.
To provide these services in an effective, efficient and low cost method, PCOA works with
community agencies and public entities. The City of Tucson Parks and Recreation, Pima County
Parks and Recreation, La Posada at Park Centre and Tucson Medical Center provide space for
18

Aging in Pima County: A Report to the Community
Part II: Identified Issues/Problem Areas
the Congregate Meal Program sites. PCOA contracts with Tucson Urban League, City of Tucson
Parks and Recreation, Catholic Social Services and Lutheran Social Services of the Southwest
to provide the programs in specific geographic areas. Between the two programs, 3,600 –
3,900 individuals are served each year, with 60+% of the participants being women and 50+%
being 75 years of age or older.
Other community nutrition programs are supported through County funding, special grants
and or fees. These include Mobile Meals, Northwest Mobile Meals, Catalina Community Services
Home Delivered and Congregate Meals, Arivaca and Picture Rocks Congregate Meals and
the House of Neighborly Services. Each of these programs has specific geographic service
areas. Some serve low income younger adults in addition to seniors, and all of the community
programs work cooperatively so there is no duplication of service.
Even with this wide geographic based response, there are isolated older adults who are not
meeting their nutritional needs. The programs are facing an increased demand for service,
but with very limited resources. Volunteers are an integral part of many of these community
programs, but a source of steady revenue will always be needed to keep these programs viable
and the number of meals sufficient to meet the need throughout the County.
J. BEHAVIORAL HEALTH
The loss of a spouse or loved one and depression and/or anxiety were identified as two of
the top nine serious problems in the community survey. In the focus groups conducted with
agencies that work with older adults, every agency indicated that they are seeing more clients
who have behavioral health issues and that the issues are becoming increasingly complex and
challenging. Pima County has established behavioral health as a public health priority.
One of the avenues for addressing
behavioral health issues in Pima
County at the systems level is the
Behavioral Health and Aging Council
of Southern Arizona (BHAC). BHAC
was established in 2002 to bring
together service providers from
both the behavioral health and the
aging networks. The vision of BHAC
is that older adults have the right to
embrace good physical, emotional,
social and spiritual well-being. The
mission of BHAC is to promote awareness, education and advocacy of wellness services for
older adults in Southern Arizona through community collaborations. Not only does BHAC allow
for relationship building between service providers and improved collaborations, but BHAC also
sponsors quarterly trainings for the community as well as a conference on Behavioral Health
and Older Adults every two years on even numbered years.
Depression is commonly associated with suicide in older adults and is widely under-recognized
and undertreated. The risk of depression in the elderly increases with other illnesses and when
19

Aging in Pima County: A Report to the Community
Part II: Identified Issues/Problem Areas
ability to function becomes limited. Estimates of major depression in older people living in
the community range from less than 1 percent to about 5 percent, but rises to 13.5 percent in
those who require home healthcare and to 11.5 percent in elderly hospital patients. 11 Overall,
suicide rates in Arizona are higher than the national rates with the highest suicide rates in
Arizona in the 75-84 year old population and the age 85+ population. 12 Through a partnership
with Community Partnership of Southern Arizona (CPSA), PCOA offers two suicide prevention
programs using the Living Works model. These evidence-based suicide awareness, alertness
and intervention skills trainings have been recognized as best practice in the field of suicide
prevention.
Mental illness is associated with increased occurrence of chronic diseases such as
cardiovascular disease, diabetes, obesity, asthma, epilepsy and cancer. 13 Arizona Living Well is
a series of health promotion programs sponsored by PCOA in collaboration with community
partners. Living Well is about managing one’s personal health, staying fit and maintaining or
improving quality of life. PCOA offers three evidence-based health promotion programs for
adults 60 years and older.
Another avenue for addressing depression and the isolation experienced by many older adults
is volunteering and finding ways to stay connected to other people and to their community.
Over the past 20 years, research has found a significant connection between volunteering and
good health in addition to social benefits. A research conducted by the Office of Research and
Policy Development, Corporation for National and Community Service, The Health Benefits of
Volunteering: A Review of Recent Research shows that volunteers have:
——
Lower rates of depression (later in life than those who do not volunteer)
——
Greater longevity
——
Higher functional ability
——
A sense of purpose at a time when their social roles are changing
——
Volunteers who devote a “considerable” amount of time to volunteer activities (about 100
hours per year) are most likely to exhibit positive health outcomes.
——
Volunteering also provides individuals with a sense of purpose and life satisfaction
Individuals can reach out to faith communities, schools,
social or community service organizations, hospitals and
other health organizations to volunteer. For those who
need encouragement and guidance in locating a volunteer
opportunity, the Retired and Senior Volunteer Program
through PCOA and/or the Volunteer Center at United Way
can provide assistance.
11
“Older Adults: Depression and Suicide Facts,” National Institute of Mental Health, 2007, www.nimh.nih.gov.
12
“Arizona Older Adult Profile 2012,” Arizona Department of Health Services, January 15, 2003.
13
U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, 2013,
www.samsha.gov.
20

Aging in Pima County: A Report to the Community
Part II: Identified Issues/Problem Areas
K. IN-HOME ASSISTANCE
A review of the responses received from community agencies participating in the 2012 Focus
Groups has highlighted the increased number of people: with Alzheimer’s disease; with
behavioral, mental health needs; and with multiple chronic conditions along with an increase
in the number of younger physically disabled individuals who are requesting some form of
assistance to remain in their home.
The ability to carry out one’s daily activities is a measure
of both quality of life and independence for most
adults. Frailty, injury, illness, disability and many chronic
conditions can leave older individuals experiencing
difficulties with the independent performance of basic
Activities of Daily Living (ADLs) like dressing, bathing,
eating, doing housework, laundry, shopping, and meal
preparation. When no family supports or caregivers are
available to assist with these functions, older individuals
can be at significant risk of falling, further health decline
and loss of their ability to remain safe and independent
in their own homes.
One of the fastest growing segments of Pima County’s
population is individuals over age 85. This age group
grew by 52% in the last ten years while the total population of Pima County grew by 16.2%.
With life expectancy rising, older adults will, collectively, live longer than their predecessors.
With a high percentage of baby boomers expected to live beyond 85, forecasters expect a 60%
surge in the age 85 and older population between 2030 and 2040. 14 Fifty percent of those age
85+ have one or more chronic (on-going) or disabling conditions that require assistance with
Activities of Daily Living.
The vast majority of people in need of long-term services want to live in their own homes and
communities. While long-term care is often associated with nursing homes, most of the care is
actually provided at home. To remain living in their home, older adults often require assistance
from both formal and informal sources. PCOA has funded and administered a home and
community-based system of in-home care since the early 1970s. This system provides nonmedical
in-home services including case management, personal care, housekeeping, electronic
emergency alert, shopping, home delivered meals, adult day health care and respite services.
The system targets individuals 60 years of age or older, of greatest social and economic need,
who require assistance in 3 or more activities of daily living or instrumental activities of daily
living. In FY 11-12, 80% of the clients were women, 34% were 75 to 84 years of age and 22%
were 85+ years of age.
In Pima County this System, which is mainly supported with federal funds, serves as the only
bridge between paying for services privately and if eligible, receiving services through the
14
U.S. Census Bureau, National Population Projections, 2008, www.census.gov/population/www/projections/
summarytables.html
21

Aging in Pima County: A Report to the Community
Part II: Identified Issues/Problem Areas
Arizona Long Term Care System
(ALTCS). The average cost to support
someone in the PCOA system is
$2,174 a year while the average cost
through ALTCS community based
services is $19,428 a year. For many
low to moderate income older adults
the system administered by PCOA
is their only resource for staying in
their own home.
This System at one time assisted
2,700 older adults each year. Due to
funding reductions at the State level,
this System now supports around
1,200 people. Unfortunately the federal funds that have always been the foundation of support
for this System are due to be reduced in the federal sequester cut.
PCOA has tried to supplement these formal services with informal supports through the
Neighbors Care Alliance. Neighbors can assist with some in-home services like occasional
housecleaning or meal preparation, but many older adults require hands on care that must be
provided by trained staff from a reputable homecare agency.
Livable communities for all ages are defined as places where citizens can grow up and grow old
with maximum independence, safety and well being. As policy makers, community leaders and
citizens we must make sure these safety nets for in-home support stay viable and funded at a
level to support all who may find themselves in need of a helping hand.
L. ASSISTANCE FOR FAMILY CAREGIVERS
Family caregivers are key in helping older adults age in place in their homes but it comes at a
substantial cost to the caregivers, themselves, and to their families and the community. They
may experience stress, physical strain, competing demands, and financial hardship. Because
of the risks associated with family caregiving, it is now viewed as an important public health
concern. In 2009, about 42.1 million unpaid family caregivers in the U.S. and 855,000 in Arizona
provided care to an adult with limitations in daily activities at any given point in time. About
61.6 million in the U.S. and 1,250,000 in Arizona provided care at some time during the year. The
estimated economic value of their unpaid contributions in 2009 was approximately $450 billion
in the U.S. and $9,400 million in Arizona. 15
15
Lynn Feinberg, Susan C. Reinhard, Ari Houser and Rita Choula, “Valuing the Invaluable: 2011 Update,
The Economic Value of Family Caregiving in 2009”. AARP Public Policy Institute.
22

Aging in Pima County: A Report to the Community
Part II: Identified Issues/Problem Areas
Family caregiving accounts for approximately 21% of all
calls to PCOA’s Helpline. PCOA’s Caregiving department
offers a variety of services to meet the needs of unpaid
family caregivers:
——
Consultation to individuals or families to listen to their experiences and frustrations
and to help them explore options, both for the caregiver and the care recipient.
——
Information about caregiving issues and other community resources.
——
Linking caregivers to appropriate resources such as in-home care, placement in a facility,
or for support for themselves as caregivers.
——
Support groups that meet in a variety of locations and times throughout Pima County
so that caregivers can share with each other in a caring environment
PCOA is currently partnering with Lutheran Social
Services to provide unpaid family caregiver training.
The training is divided into two four-hour sessions with
the first session comprised of classroom education on
topics such as infection control, stress management,
dementia, grief and end of life issues, communication
skills, nutrition, and others. The second session is a
hands-on workshop designed to enhance the skills
necessary in caregiving such as proper body mechanics,
transferring from a bed or wheelchair, and proper bed
bath techniques. Learning the appropriate techniques to
care for a loved one can increase caregiver confidence.
Grandparents raising grandchildren has been on the rise across the country. This growth
is most dramatic among families with the least financial resources and the highest social
service needs. Approximately 2.7 million children are being cared for by kin, representing an
18% increase over the past decade. The vast majority of these kinship care arrangements
are informally established within the family. Approximately 5% of these children have been
placed with kin formally through the child welfare system (Gleeson, et al 2008; AECF, 2012). In
Arizona, both formal and informal kinship care have been on the rise. Recent reports indicate
that 198,814 children under age 18 live in kinship homes (12.2% of all children under 18 in the
state) and 21% live in poverty. Compared to the general population of children, those in informal
kinship care tend to have higher poverty rates and are less likely to be covered by health
insurance and are more likely to have physical and mental disabilities (AECF 2012).
It is estimated that the cost to the state of Arizona to care for children in foster care, if they
were not being cared for by kin, would exceed $40 million. The Kinship, Adoption, Resources
and Education Family Center (KARE) in Tucson calculates if their services helped prevent formal
foster care placements in just 1 in 5 of the 1,470 informal kinship children they served in 2007
the savings in Pima County is more than 4.2 million each year (AzCA/CASEY 2009).
23

Aging in Pima County: A Report to the Community
24

Aging in Pima County: A Report to the Community
Part III: Demographics
According to a 2010 Census brief from the U.S. Census
Bureau on the nation’s older population, the U.S. population
65 and older is now the largest in terms of size and percent
of the population, compared with any previous census.
Between 2000 and 2010, the U.S. population 65 and older
grew 15.1 percent, while the total U.S. population grew
9.7 percent.
This same trend occurred in Pima County. Pima County’s
65+ population increased 26.2% between 2000 and 2010
while the total County population increased 16.2%.
Tucson is home to 86,750 individuals 60 years
of age or older (16.8% of Tucson’s total population).
209,742 individuals 60+ reside in Pima County.
21.4% of total population)
The fastest growing segment of the aging population
is individuals over 85, the most vulnerable older adults
who tend to need long-term care and whose numbers
are expected to double by 2020. In Pima County, the 85+
population increased 52% since 2000 and in Tucson 26.5%.
By 2020 one in four Arizona residents will be
over 60 years of age.
Starting in 2011, 10,000 boomers turn 65 each and every day.
Americans are also living longer. Persons reaching age 65
have an average life expectancy of an additional 18.8 years
(20.0 years for females and 17.3 years for males.) 1 Longer
life span poses challenges. Nearly all older Americans now
encounter chronic illness and disability in last phase of life.
Administration on Aging, A Profile of Older Americans: 2011 Principle sources of data for the Profile are the U.S. Census
Bureau, the National Center for Health Statistics, and the Bureau of Labor Statistics. The Profile incorporates the latest
data available but not all items are updated on an annual basis.
25

Aging in Pima County: A Report to the Community
Part III: Demographics
Chronic diseases now account for seven out of ten
leading causes of death in Arizona.
The five leading causes among adults 65 or older in Arizona
for 2008 were diseases of the heart, malignant neoplasms,
cerebrovascular diseases, chronic lower respiratory diseases
and Alzheimer’s disease. In the past decade, Alzheimer’s
disease replaced influenza and pneumonia as one of the five
leading causes of deaths. Also, during this period there was a
substantial increase in the rate of fall related deaths for both
men and women.
Although functional loss and disability are not necessary
consequences of the aging process, both tend to increase
with age as a result of underlying chronic disease. 50% of
those age 85+ have one or more chronic disability conditions
that require assistance with Activities of Daily Living (ADL),
bathing, toileting, grooming.
In Pima County, there are 73,143 individuals 18 to 64
years of age with a disability (12%).
The population 65 and over with a disability is 38.7%.
Source: U. S. Census Bureau, American Community Survey, 2009
Older men were much more likely to be married than older
women – 72% of men vs. 42% of women. 40% of older
women in 2010 were widows. Almost half of older women
(47%) age 75+ live alone.
Administration on Aging, A Profile of Older Americans: 2011 Principle sources of data for the Profile are the U.S. Census
Bureau, the National Center for Health Statistics, and the Bureau of Labor Statistics. The Profile incorporates the latest
data available but not all items are updated on an annual basis.
26

Aging in Pima County: A Report to the Community
Part III: Demographics
In Pima County among households age 65+, 9.9% lived
alone, in Tucson 9.3% and in Green Valley 32.2%.
Source: 2005-2007 American Community Survey 3-Year Estimates.
Social Security constituted 90% or more of the income
received by 35% of beneficiaries in 2009 (22% of married
couples and 43% of non-married beneficiaries).
Administration on Aging, A Profile of Older Americans: 2011 Principle sources of data for the Profile are the U.S. Census
Bureau, the National Center for Health Statistics, and the Bureau of Labor Statistics. The Profile incorporates the latest
data available but not all items are updated on an annual basis.
35% of Pima County’s 65+ population (52,953) have
income below 200% of federal poverty level.
National measures such as the Elder Economic Security Index
indicate this is the minimum income for older adults to make
ends meet. Below that, people are making choices between
eating and buying medicine.
In Pima County 14,500 people are diagnosed with Alzheimer’s
disease or related dementias. It is likely there are at least an
additional 4,000 undiagnosed persons with dementia, for a
total of 18,500 persons with dementias.
The facts are clear. Tucson and Pima County face not only
an increase in the absolute numbers of persons 60+, but an
increase in the relative share of older adults. The question
is whether we are ready to respond.
27

Aging in Pima County: A Report to the Community
Part III: Demographics
This demographic shift will be accompanied by a
corresponding rise in the need and demand for fiscal, health
and social supports that are necessary to ensure a sound
quality of life for older Americans. The aging of our nation’s
population will challenge not only federal entitlement
programs, such as Social Security, Medicare and Medicaid,
but will substantially increase the demand for home and
community-based services and supports, housing options,
transportation and emergency response systems.
“Livable communities for all ages” refers to places where
all citizens can grow up and grow old with maximum
independence, safety and well-being. Policy makers and
community planners must take these demographic changes
into account as the aging of our populace will affect the
social, physical and economic fabric of the communities we
live in.
28

Aging in Pima County: A Report to the Community
Part III: Demographics
Pima County Older Adult Population Growth
2000 Census 2010 Census % Growth
% of Total Population % of Total Population from 2000
Pima County Total Population 843,746 980,262 16.2%
60+ 153,232 18.2% 209,742 21.4% 36.9%
65+ 119,487 14.0% 151,293 15.4% 26.2%
85+ 13,072 1.5% 19,895 2.0% 52.0%
Older Adult Population Growth by Jurisdiction
2000 Census 2010 Census % Growth
% of Total Population % of Total Population from 2000
City of Tucson Total Population 486,699 520,116 6.9%
60+ 72,874 15% 86,750 16.8% 19%
85+ 7,317 1.5% 9,256 1.78% 26.5%
South Tucson Total Population 5,490 5,652 3%
60+ 812 14.8% 874 15.4% 7.6%
85+ 48 .87% 55 .97% 14.6%
Oro Valley Total Population 29,700 41,011 38.1%
60+ 8,608 29% 13,968 34.1% 62.3%
85+ 355 1.2% 1,196 2.92% 236.9%
Marana Total Population 13,556 34,961 157.9%
60+ 1,876 13.8% 7,584 21.7% 304.3%
85+ 62 46% 267 .76% 330.6%
Sahuarita Total Population 3,242 25,259 679.1%
60+ 690 21.3% 5,289 21% 665.5%
85+ 52 1.6% 233 .92% 348.1%
Green Valley Total Population 17,283 21,391 23.8%
60+ 14,506 83.9% 18,124 84.7% 24.9%
85+ 1,385 8.01% 2,179 10.19% 57.3%
29

Aging in Pima County: A Report to the Community
30

Aging in Pima County: A Report to the Community
Part IV: 2012 Community Survey Results
AGING IN PIMA COUNTY
The Community Survey for older adults who are 60 years of age and older.
Please return to PCOA before November 16, 2012.
A. If you are age 60 or over, we want to hear from you! Here’s a list of things that are problems
for some older residents. To what degree is each of these things a problem for you personally?
Please circle one number for the most appropriate response to each listed item.
NO SOME SERIOUS
PROBLEM PROBLEM PROBLEM
1. Fear of falling 1 2 3
2. Memory loss 1 2 3
3. Having someone check on me daily 1 2 3
4. Transportation costs (gas, insurance, repairs, public transit) 1 2 3
5. Getting information about senior services 1 2 3
6. Obtaining benefits (Social Security, AHCCCS, ALTCS, Medicare, etc.) 1 2 3
7. Understanding changes in Medicare coverage 1 2 3
8. Processing monthly bills and/or medical claims 1 2 3
9. Access to affordable health care (doctor, hospital, ER) 1 2 3
10. Affordable dental care 1 2 3
11. Paying for prescription drugs 1 2 3
12. Affordable assistive devices (hearing aids, glasses) 1 2 3
13. Safe and decent housing 1 2 3
14. Cost of energy or utilities 1 2 3
15. Having enough income to meet my basic needs 1 2 3
16. Paying for my rent, mortgage or property taxes 1 2 3
17. Maintaining and repairing my home 1 2 3
18. Maintaining and cleaning my yard (weeds, trash, etc.) 1 2 3
19. Accessibility modifications in my home (grab bars, ramp, widening doorway, raised toilet seat) 1 2 3
20. Affordable legal assistance 1 2 3
21. Accessing health care legal options (medical power of Attorney, Living Wills, DNR orders, etc.) 1 2 3
22. Age discrimination (loans, insurance, employment) 1 2 3
23. Elder abuse (physical or emotional) 1 2 3
24. Elder exploitation, fraud and scams 1 2 3
25. Feeling like your voice is heard in the community 1 2 3
26. Preparing nutritious meals 1 2 3
27. Personal Care (bathing, washing hair) 1 2 3
28. Housekeeping, laundry 1 2 3
29. Shopping for groceries 1 2 3
30. Medication set-up 1 2 3
31. Caring for an older family member, neighbor or friend 1 2 3
32. Raising grandchildren 1 2 3
33. Providing care for an older person while still employed 1 2 3
34. Selecting a Nursing Home or Assisted Living Facility 1 2 3
35. Obtaining mental health counseling 1 2 3
36. Depression and/or anxiety 1 2 3
37. Loneliness and/or isolation 1 2 3
38. Loss of spouse or loved one 1 2 3
39. Employment opportunities 1 2 3
40. Personal safety (crime) 1 2 3
41. Recreational or social opportunities 1 2 3
42. Access to volunteer opportunities 1 2 3
B. In the past year, how many times have you fallen?
1. Never 2. One or two times 3. 3 to 5 times 4. More than 5 times 5. Don’t know
C. In the past year, how many days did you spend…
As a patient in a hospital?
In a Nursing Home or Rehab facility?
(number of days)
(number of days)
31

Aging in Pima County: A Report to the Community
Part IV: 2012 Community Survey Results
D. Where do you usually call to get information about services? Circle as many as apply.
1. Pima Council on Aging 6. Faith Communities (churches, synagogues etc.)
2. Political Representative’s Office 7. Local Senior Centers (Please specify):
3. City Office (Please specify): 8. Use computer to get information
4. County Office 9. Other (Please specify):
5. Information & Referral Services 10. Have never called any place for information or referrals
E. Which group contains your age?
1. Under 60 3. 65 - 69 5. 75 - 79 7. 85 - 89
2. 60 - 64 4. 70 - 74 6. 80 - 84 8. 90 +
F. Are you: 1. Male 2. Female
G. What is your background or origin?
1. White (Caucasian) 3. Black (African-American) 5. Native American
2. Hispanic (Latino) 4. Asian/Pacific Islander 6. Other
H. Primary language spoken:
I. Living arrangements:
1. Live alone 3. Live with relatives 5. Live with friends
2. Live with spouse 4. Live with partner 6. Other
J. Reside at:
1. House 3. Apartment 5. Nursing Home
2. Mobile Home 4. Assisted Living Home 6. Condo
K. Do you 1. Rent or 2. Own your residence? or 3. Not applicable
L. What is your residential zip code? Closest Major Intersection
M. How long have you lived at your current residence?
1. 1 - 10 years 2. 11 - 20 years 3. 21 or more years
N. How long have you lived in Pima County?
1. 1 - 10 years 2. 11 - 20 years 3. 21 or more years
O. Can you pay for needed maintenance and repairs on your house ?
1. Yes 2. No 3. Does Not Apply
P. Do you fear losing your home to foreclosure?
1. Yes 2. No 3. Does Not Apply
Q. Are you providing care for an elderly friend or family member who is not in an assisted
living facility or a nursing home?
1. Yes (in my home) 2. Yes (in their home) 3. No
R. When you take a break (respite) from caring for an elderly friend or family member,
who do you call for assistance? Circle as many as apply.
1. Family member 5. Pay for assistance 9. No one
2. Friend 6. Receive help from an agency
3. Neighbor 7. Ask my physician for a referral
4. Member of my faith community 8. Employee Assistance program
S. What is your source(s) of transportation at this time? Circle as many as apply.
1. Drive my vehicle 3. Taxicab/Other service 5. Volunteer driver program
2. Public bus (Sun Tran / 4. Family/friends 6. Member of my faith community
Sun Van / Sun Shuttle)
T. I need transportation support for the following reasons: Circle as many as apply.
1. Medical appointments 3. For group activities 5. To transact business
2. To shop for groceries 4. Attend faith community 6. To pick up prescriptions 7. Other
U. Are you aware of transportation assistance in your neighborhood? 1. Yes 2. No
V. How do you rate your community as a place to live?
1. Excellent 2. Good 3. Fair 4. Poor 5. Don’t know
W. How do you rate your community as a place to retire?
1. Excellent 2. Good 3. Fair 4. Poor 5. Don’t know
X. How do you rate the overall services available to older adults in your community?
1. Excellent 2. Good 3. Fair 4. Poor 5. Don’t know
Y. What new or improved aging services would you like to see in the community?
32

Aging in Pima County: A Report to the Community
Part IV: 2012 Community Survey Results
2012 Pima County Survey Responses
2010 Census PCOA Survey
Population % of Population % of Responses No. of Responses
Pima County All ages 974,181 100% 100%
60+ 204,578 21% 100% 2330
% of 60+ Population
Sex Female 110,881 54.2% 69.7% 578
Male 93,697 45.8% 30.3% 1,327
Ethnicity/Race White, not Hispanic 160,185 78.3% 80.2% 1,757
White, may include Hispanic 184,120 90.0%
Hispanic, may include White 33,551 16.4% 15.2% 333
Black 3,887 1.9% 3.1% 68
Asian/Pacific Islander 3,682 1.8% 0.8% 18
Native American 2,864 1.4% 2.1% 46
Other, including multiracial 10,024 4.9% 0.9% 21
Age 60-64 56,502 28% 14.5% 325
65-69 44,812 22% 22.2% 495
70-74 34,096 17% 18.8% 420
75-79 28,251 14% 15.2% 340
80-84 21,432 10% 14.1% 316
85+ 19,484 10% 13.2% 297
Source: American Community Survey 5-Year Estimate 2007-2011
33

Aging in Pima County: A Report to the Community
Part IV: 2012 Community Survey Results
34

Aging in Pima County: A Report to the Community
Part IV: 2012 Community Survey Results
Number of Responses by Zip Code
Total Responses=2,138
Total outside of Pima County=29
No Answer=163
8532
1
P I M A
C O U N T Y
8563
1
8560
4
2,113
See Tucson
area map.
8564
1
MARANA
85653
13
85652
1
85742
22
85755
38
85737
35
85739
13
SANTA CATALINA
MOUNTAINS
SAGUARO
NATIONAL
PARK
85735
19
85743
71
85757
12
85741
31
85745
115
TUCSON
85713
114
85704
93 85718
48
85705
188
44
85719 117
85716 87
85714 33
85756 61
85712
104
85711
110
85750
91 85749
32
85716
58
85710
161
85730
59
85748
34
85747
26
SAGUARO
NATIONAL
PARK
85746
45
TOHONO O’ODHAM
NATION
85706
21
85736
14
SAHUARITA
85629
11
85614 109
85641
19
CORONA DE TUCSON
85622 28
35

Aging in Pima County: A Report to the Community
Part IV: 2012 Community Survey Results
Top 20 Problems Rated Serious or Some Problem
Fear of falling 56%
1
Memory loss 48%
2
Affordable dental care 46%
3
Understanding changes in Medicare 46%
4
Maintaining and repairing my home 40%
5
Transportation costs 37%
6
Affordable assistive devices 37%
7
Depression and/or anxiety 36%
8
Maintaining and cleaning my yard 36%
9
Enough income to meet basic needs 35%
10
Cost of energy or utilities 34%
11
Affordable legal assistance 34%
12
Getting information about senior services 31%
13
Feeling voice is heard in the community 30%
14
Paying for prescription drugs 30%
15
Loneliness and/or isolation 28%
16
Paying rent, mortgage or taxes 27%
17
Access to affordable health care 26%
18
Accessing health care legal options 26%
19
Preparing nutritious meals 25%
20
36

Aging in Pima County: A Report to the Community
Part IV: 2012 Community Survey Results
Top 20 Problems Rated Serious Problem
Affordable dental care 21%
1
Fear of falling 13%
2
Affordable assistive devices 12%
3
Maintaining and repairing my home 11%
4
Transportation costs 11%
5
Understanding changes in Medicare 11%
6
Maintaining and cleaning my yard 11%
7
Enough income to meet basic needs 10%
8
Affordable legal assistance 9%
9
Paying for prescription drugs 8%
10
Paying rent, mortgage or taxes 8%
11
Cost of energy or utilities 8%
12
Access to affordable health care 8%
13
Loss of spouse or loved one 7%
14
Preparing nutritious meals 7%
15
Accessing health care legal options 7%
16
Depression and/or anxiety 6%
17
Housekeeping, laundry 6%
18
Getting information about senior services 6%
19
Accessing modifications in my home 6%
20
37

Aging in Pima County: A Report to the Community
Part IV: 2012 Community Survey Results
Top 10 Problems for 60-64 Year Old Respondents
323 Responses
Understanding changes in Medicare 47+131
1
Affordable dental care 91+84
2
Fear of falling 30+128
3
Enough income to meet basic needs 55+97
4
Cost of energy or utilities 49+99
5
Memory loss 25+122
6
Maintaining and repairing my home 56+88
7
Affordable assistive devices 62+82
8
Transportation costs 47+96
9
Affordable legal assistance 41+94
10
Serious problem
Some problem
Top 10 Problems for 65-69 Year Old Respondents
494 Responses
Affordable dental care 116+139
1
Understanding changes in Medicare 56+194
2
Fear of falling 39+181
3
Memory loss 21+188
4
Maintaining and repairing my home 57+151
5
Transportation costs 65+133
6
Enough income to meet basic needs 59+134
7
Cost of energy or utilities 50+139
8
Affordable assistive devices 61+119
9
Affordable legal assistance 52+126
10
38

Aging in Pima County: A Report to the Community
Part IV: 2012 Community Survey Results
Top 10 Problems for 70-74 Year Old Respondents
417 Responses
Fear of falling 42+178
1
Affordable dental care 80+100
2
Memory loss 13+165
3
Understanding changes in Medicare 31+132
4
Maintaining and repairing my home 38+114
5
Maintaining and cleaning my yard 37+109
6
Transportation costs 45+101
7
Affordable assistive devices 48-93
8
Depression and/or anxiety 18+117
9
Affordable legal assistance 24+106
10
Serious problem
Some problem
Top 10 Problems for 75-79 Year Old Respondents
312 Responses
Fear of falling 39+141
1
Affordable dental care 68+83
2
Memory loss 21+127
3
Understanding changes in Medicare 38+103
4
Maintaining and repairing my home 38+88
5
Maintaining and cleaning my yard 42+76
6
Affordable assistive devices 29+85
7
Transportation costs 37+76
8
Enough income to meet basic needs 32+78
9
Depression and/or anxiety 15+93
10
39

Aging in Pima County: A Report to the Community
Part IV: 2012 Community Survey Results
Top 10 Problems for 80-84 Year Old Respondents
312 Responses
Fear of falling 55+149
1
Memory loss 20+139
2
Affordable dental care 39+78
3
Understanding changes in Medicare 26+86
4
Affordable assistive devices 23+81
5
Maintaining and repairing my home 16+83
6
Maintaining and cleaning my yard 17+80
7
Depression and/or anxiety 10+73
8
Transportation costs 20+63
9
Enough income to meet basic needs 12+70
10
Serious problem
Some problem
Top 10 Problems for 85-89 Year Old Respondents
190 Responses
Fear of falling 43+87
1
Memory loss 15+84
2
Maintaining and repairing my home 25+58
3
Understanding changes in Medicare 23+59
4
Depression and/or anxiety 17+61
5
Preparing nutritious meals 30+45
6
Maintaining and cleaning my yard 32+43
7
Transportation costs 21+47
8
Housekeeping, laundry 14+53
9
Shopping for groceries 18+47
10
40

Aging in Pima County: A Report to the Community
Part IV: 2012 Community Survey Results
Top 10 Problems for 90+ Year Old Respondents
98 Responses
Fear of falling 23+52
1
Memory loss 14+41
2
Loneliness and/or isolation 7+28
3
Preparing nutritious meals 13+22
4
Maintaining and repairing my home 11+24
5
Maintaining and cleaning my yard 11+23
6
Understanding changes in Medicare 11+23
7
Depression and/or anxiety 6+26
8
Loss of spouse or loved one 16+15
9
Getting information about senior services 1+29
10
Serious problem
Some problem
41

Aging in Pima County: A Report to the Community
Part IV: 2012 Community Survey Results
Rate Your Community As a Place to Live
Excellent 36%
Good 46%
Fair 14%
Poor 3%
Don’t know 1%
Rate Your Community As a Place to Retire
Excellent 33%
Good 42%
Fair 16%
Poor 5%
Don’t know 4%
Rate the Overall Services Available to Older Adults
in Your Community
Excellent 20%
Good 41%
Fair 18%
Poor 6%
Don’t know 15%
42

Aging in Pima County: A Report to the Community
Part IV: 2012 Community Survey Results
Transportation Sources
Drives own vehicle 71.8%
Family and/or friends 21.4%
Public bus (Sun Tran, Sun Van, Sun Shuttle) 17.4%
Taxicab or paid service 5.9%
Volunteer driven program 3.6%
Member of faith community 1.5%
Reasons Transportation Support Is Needed
For medical appointments 88%
To shop for groceries 72%
To pick up prescriptions 53%
For group activities 30%
To attend my faith community 29%
To transact business 28%
Are You Aware of Transportation Assistance
in Your Neighborhood?
Yes 47.1%
No 52.9%
43

Aging in Pima County: A Report to the Community
Part IV: 2012 Community Survey Results
Ability to Maintain and Repair Home
Yes 68.5%
No 31.5%
Type of Housing
House 63.0%
Mobile home 14.4%
Apartment 17.7%
Nursing home 0.3%
Assisted living home/facility 1.0%
Condo 3.7%
Type of Living Arrangements
Live alone 52.8%
Live with spouse 33.0%
Live with relatives 8.5%
Live with partner 4.9%
Live with friends 1.2%
44

Aging in Pima County: A Report to the Community
Part IV: 2012 Community Survey Results
Where Individuals Go for Information About Services
Pima Council on Aging 873
Use computer to get information 810
Other 408
Faith communities 282
Local senior center 270
Information and referral service 244
Political representative’s office 78
City hall office 70
County office 60
Have never called any place for information or referral 525
45

Aging in Pima County: A Report to the Community
46

Aging in Pima County: A Report to the Community
Addendum 1: Focus Group Comments
Introduction
Representatives of seventy-one (71) health and social service providers were invited to
participate in four focus groups that were held at various locations in Pima County during
October, 2012. The questions that were to be discussed were sent to participants in advance
of the focus groups. Individuals were invited to bring the completed questionnaire to the focus
groups and those who were unable to attend were asked to complete the questionnaire in
writing and return it for inclusion in the final report.
Written responses were received from twenty-three (23) agencies representing a diverse cross
section of agencies serving older adults. Fifteen (15) of these agencies also attended a focus
group and provided comment as part of the group discussion. Seven (7) agencies provided their
comments through participation in a focus group meeting only.
The following remarks were made in response to the five questions asked about health and
social services provided for older adults in Pima County.
1. How have your older/disabled clientele changed over the past three to five years?
TUCSON URBAN LEAGUE
It is more difficult for them to be able to walk, exercise and even have a meal; their health is
deteriorated but many of our clientele are living longer and keep active.
SOUTHERN ARIZONA LEGAL AID
No change, except that clients are presenting more financial or economic legal issues.
ADMINISTRATION OF RESOURCES AND CHOICES
They are more vulnerable and less able to self-sustain.
COMMUNITY PARTNERSHIP OF SOUTHERN ARIZONA
Greater need for basic services by clientele. Small increase in younger-older adult population,
Ability to provide services to elders who do not have AHCCCS due to budget cuts.
ARIZONA’S CHILDREN ASSOCIATION – KARE CENTER
Increasing number of kinship caring for not only their grandchildren but also great
nieces/nephews.
UNITED WAY, SENIOR IMPACT COALITION
Many are struggling economically. They have gotten older and more depressed and need
services more than ever.
ST. ELIZABETH’S HEALTH CENTER
Increased number of unemployed older persons; more people dependent on Social Security as
only income.
UNITED WAY
United Way doesn’t really have clientele but we have volunteer partners. As our volunteers and
partners age, participation fluctuates.
ARCADIA HOME CARE
Behavioral needs; demand from younger clients.
47

Aging in Pima County: A Report to the Community
Addendum 1: Focus Group Comments 2012
MERCY CARE PLAN
They are better informed but less appreciative. There are more disabled and younger clients
that have more needs. Housing is more of an issue; more drug use (marijuana, meth).
JEWISH FAMILY & CHILDREN’S SERVICES
As the demographic shift takes place—more people are in need of critical services and need
more services—making case management for people of all income levels very important.
MIRACLE SQUARE, INC.
Increased number of baby-boomer elders who have very strange views of old age. They are
surprised that they too are affected by age. Many imagined that they would be able to work,
never expecting disability, slowed mental and physical responses, etc.
ADULT PROTECTIVE SERVICES
Adult Protective Services has seen an increase in reports in general and we are finding higher
number of vulnerable adults with fewer resources to enable them to manage in their homes.
There is a severe lack of behavioral health treatment and placement options for elders with
dementia. Many more clients are not plugged in to any kind of community resource.
SOREO (Home Care Agency)
Increased number of younger clients. Also people are being referred with more severe medical/
health needs. Increasing numbers of severe diabetes, obesity and COPD. More people with
behavioral/mental health issues. Broader cultural needs—more and different types of refugees.
ALZHEIMER’S ASSOCIATION DESERT SOUTHWEST CHAPTER
The numbers of people with Alzheimer’s disease and related dementias are growing and will
continue to grow as the baby boomers age. Fewer people are able to afford care and placement
of their loved ones suffering from the disease and more families are burdened with the
responsibility of 24/7 caregiving in the home. And for many of the boomers, the caregiver is still
trying to hold down employment while caregiving.
LUTHERAN SOCIAL SERVICES OF THE SOUTHWEST
Many of our clients have other family or friends living with them due to the economic hardships.
We have to be very diligent on watching for any signs of abuse either financially, emotional,
physical etc. ... We also have noticed many family members contacting us for services for
their loved ones while they live out of state. The economic times have really caused a lot of
hardships with the clientele.
MARANA HEALTH CARE
MHC patients are typically (56%) Medicaid recipients. Often life choices have contributed to
the illnesses that older individuals are now managing (diabetes and heart disease). In addition,
the nutritional choices and lack of physical activity contribute to weight problems and back
pain problems. Patient health literacy is low and traditions of treating symptoms vs. prevention
prevail with the 60+year old demographic.
SOUTHWEST GAS CORPORATION
As expected with aging baby boomers, the number of older/disabled clientele have increased
over that time.
48

Aging in Pima County: A Report to the Community
Addendum 1: Focus Group Comments 2012
COMMUNITY HOME REPAIR PROJECTS OF ARIZONA
I think that we are seeing a higher number of households comprised of an older person with
Alzheimer’s/dementia and his or her caregiver—usually other family members.
CATALINA IN-HOME SERVICES, INC.
Our clients are frail, at-risk elders. They receive nursing coordinated services that include
personal care and support services in their homes.
ST. LUKE’S HOME
Our population is younger and their physical and physiological needs are more prominent. This
leads to the dependency of community programs to keep their needs met. Some examples are
Cope, La Frontera and El Rio for low-income individuals.
HABITAT FOR HUMANITY TUCSON
No significant change noted, as we’ve been serving grandparents-raising-grandchildren for
awhile, and as we continue to service families with disabilities.
CASA COMMUNITY SERVICES
Adult Day Health Care families are waiting longer to enroll their loved ones therefore, they are
more declined when they enter the program. Behavioral Health clients are trying to remain
independent longer. They are being more assertive with doctors. Casa Community Center
clients are more open to our programming and less resistant to joining in the activities.
Additional comments provided at the focus group meetings:
——
Increased behavioral health needs
——
Increase in number of people being exploited by their children
——
Increase in noncompliance with medication
——
Increased number who had second mortgages and are losing their homes
——
Number of baby boomers requesting service has increased, they lack resources shocked at
how aging has affected them
——
Older adults needing to return to work
——
Higher medical needs, increased number of chronic conditions
——
Population 85+ years of age increasing and needing assistance in their home
——
People are outliving their resources
2. How have changes in the community (county) affected your older/disabled clientele?
TUCSON URBAN LEAGUE
Active registered clients went down in last 2 years.
SOUTHERN ARIZONA LEGAL AID
Increased stress.
ADMINISTRATION OF RESOURCES AND CHOICES
The economic downturn has created more older adults living on the edge and about to fall
through the cracks.
COMMUNITY PARTNERSHIP OF SOUTHERN ARIZONA
Coordination between entities has led to some improvement in identifying people. Reduction of
community services, fewer resources.
49

Aging in Pima County: A Report to the Community
Addendum 1: Focus Group Comments 2012
ARIZONA’S CHILDREN ASSOCIATION – KARE CENTER
Finding financial assistance for utilities, rent, etc. has become harder. Families are capping out
of DES benefits. Many are finding it necessary but difficult to return to employment.
UNITED WAY, SENIOR IMPACT COALITION
Fewer services are available as the demand has increased. There are fewer employment
opportunities; increased isolation; cut back in funding for social services.
ST. ELIZABETH’S HEALTH CENTER
Increased number of uninsured older persons due to AHCCCS cuts.
UNITED WAY
Mostly economic issues. Overwhelming amount of information. No good process for
communication in network among providers.
ARCADIA HOME CARE
With assistance, clients have been able to reside in own residence longer (in-home services/
support). Lifeline allows clients to feel safe and immediate attention for falls/medical
emergencies and lengthy hospital/rehab stays, complications and cost.
MERCY CARE PLAN
They have more choices which helps with self-advocacy and self-determination. It can also be
overwhelming and confusing. There are more caregivers and more training opportunities for the
caregivers.
JEWISH FAMILY & CHILDRENS SERVICES
Mental health service cuts have hurt providers and clients of these services. People
(Government officials) seem concerned and interested about senior’s needs but there is no
coordinated effort to address the aging community’s needs.
MIRACLE SQUARE, INC.
Transportation has become a more serious issue. Maintaining access to vital services has
remained flat and non-essential access (i.e. pet care) is non-existent. City and state funding has
decreased. Lack of ALTCS/AHCCCS funding and disqualification.
ADULT PROTECTIVE SERVICES
Reduction in funding for community resources has significantly, negatively impacted our clients.
It is more difficult to successfully connect clients to service system that can help them long
term or even in a crisis situation. Transportation resources are not sufficient to meet the needs.
SOREO (Home Care Agency)
The recession has resulted in less community resources; decreases in hours and more people
scamming the system. People are more aware of the limited resources that are available
and people who are more assertive (younger and many with behavioral health issues) are
aggressively advocating to gain as many services as they can.
ALZHEIMER’S ASSOCIATION DESERT SOUTHWEST CHAPTER
There are fewer resources available. Many are caught in the between area of not being able
to qualify for services but still unable to make ends meet. Seniors who are caregiving become
isolated with their person with dementia which can cause depression and often leads to neglect
and/or abuse for both the caregiver and the person with the disease.
50

Aging in Pima County: A Report to the Community
Addendum 1: Focus Group Comments 2012
LUTHERAN SOCIAL SERVICES OF THE SOUTHWEST
The economic conditions have greatly affected our clientele. We have also noticed that
cutbacks on hours and funding from our funders has affected the allowed time to perform
much needed services for our clientele. As the cutbacks continue, it makes it more difficult for
agencies to hire and retain qualified personnel to perform the duties needed due to the need to
decrease wages.
MARANA HEALTH CENTER
The passing of the new law (if you are covered by Medicaid or Medicare) you don’t pay for
an ambulance ride has affected the 911 calls for Avra Valley Fire Dept. As MHC we provide
transportation and we have made sure we have lifts and adequate transportation for those
clients who need a ride to the clinic.
SOUTHWEST GAS CORPORATION
With a major drop in funding for services in support of older/disabled clientele, we see more
elderly customers competing for fewer resources as well as more elderly relying on the Food
Bank and other organizations. As a consequence, there are more elderly customers coming into
the public office talking about how they don’t qualify for assistance because of their income
being over the limit sometimes by only a few dollars.
COMMUNITY HOME REPAIR PROJECTS OF ARIZONA
We see more extended families living together—that is three and four generations living under
the same (often leaky) roof.
CATALINA IN-HOME SERVICES
These changes do not affect our clients.
ST. LUKE’S HOME
Unfortunately with families needing more financial help for daily living due to the economy,
families are sticking together for financial and emotional needs. Sometimes leaving the elderly
without their needs met.
HABITAT FOR HUMANITY TUCSON
Loss of income challenges, as well as transportation cost challenges.
CASA COMMUNITY SERVICES
Adult Day Health—NA; Behavioral Health—Provisions of the local bus service (Sun Shuttle) make
it possible for clients without transportation to access services. Casa Community Center—When
Sun Shuttle is not working it is hard to straighten out.
Additional comments provided at the focus group meetings:
——
Limited transportation, need a broader regional approach
——
Downturn in economy
——
Longer waiting lists for services, programs tightening eligibility
——
Families having less time to assist with caregiving
51

Aging in Pima County: A Report to the Community
Addendum 1: Focus Group Comments 2012
3. What unmet needs have you seen emerging in the past few years?
TUCSON URBAN LEAGUE
Transportation, food assistance, assisted living and caregiving.
SOUTHERN ARIZONA LEGAL AID
Needs associated with economic insecurity.
ADMINISTRATION OF RESOURCES AND CHOICES
Affordable housing; domestic violence services tailored to the older populations.
OFFICE OF THE ARIZONA ATTORNEY GENERAL
Lack of affordable housing, especially for our population that require assisted living. We need a
shelter for the elderly.
COMMUNITY PARTNERSHIP OF SOUTHERN ARIZONA
Transportation in itself and education about what is out there. Crisis services—how to get
appropriate help when older adult needs help. Education about community resources.
ARIZONA’S CHILDREN ASSOCIATION – KARE CENTER
Some seniors are losing their housing; not qualifying for assistance. Grandparents finding it
difficult to negotiate getting help for children through the schools. Increase in cost of living;
clients are not keeping up with fixed incomes.
UNITED WAY, SENIOR IMPACT COALITION
Need for more help for family caregivers. It is more difficult to find volunteer opportunities
(Volunteer Center). More transportation needs.
ST. ELIZABETH’S HEALTH CENTER
Increased numbers of seniors caring for other family members in their homes.
UNITED WAY
Matching retired professionals and their skills with nonprofits and other areas of need in
Tucson and Southern Arizona. Groups don’t always know how to best use this type of
assistance (i.e. their volunteer structure may not match).
ARCADIA HOME CARE
The need for incontinence supplies, home repairs and behavioral health needs. Unmet needs for
podiatry and dental assistance.
MERCY CARE PLAN
Home repairs; medication assistance with donut hole coverage in Medicare Part D for
non-ALTCS folks; incontinence supplies; podiatry and dental; housing.
JEWISH FAMILY & CHILDRENS SERVICES
Transportation; help with housekeeping, home repair and yard work. These are not new but are
growing. Prevalence of dementia—need respite and other caregiving services.
MIRACLE SQUARE, INC.
Transportation (accessible and non-accessible). Affordable community oriented housing.
Maintaining hi-tech access to medical care. Individualized and population based advocacy.
52

Aging in Pima County: A Report to the Community
Addendum 1: Focus Group Comments 2012
ADULT PROTECTIVE SERVICES
Behavioral health services—especially for aging adults with dementia related behaviors.
Placement options for those with dementia-related behaviors are lacking—a facility may send
them to the ER, refuse to take them back and the hospital has nowhere to send the client.
Health insurance for childless adults; services for Title XIX and childless adults.
SOREO (Home Care Agency)
Less home modifications, increased need for greater physical accessibility; less DME in homes.
ALZHEIMER’S ASSOCIATION DESERT SOUTHWEST CHAPTER
Unmet needs include affordable care, balanced meals, in home services, and lack of research
funds to find answers for prevention and cure of Alzheimer’s. Lack of advocacy for those who
no longer have a voice, lack of public education about the disease which increases denial and
prevents elderly from asking for the help they need.
LUTHERAN SOCIAL SERVICES OF THE SOUTHWEST
There is still a need for transportation for many of our clientele. There is also a need for more
services that may be conducted in the home for those who cannot leave their home very easily.
It would be beneficial to see more services offered to these individuals. We have also received a
lot of feedback on the lack of social activities for our clientele. Many of them miss our Day Care
Program we used to offer but had to close due to lack of funding.
MARANA HEALTH CENTER
Educational series which are delivered in a way that people want to be engaged. It is difficult to
get folks to show up for a variety of reasons related to resources as well as time. People need
to know there is a health benefit in order to make the time.
SOUTHWEST GAS CORPORATION
There are more elderly needing services and not qualified to receive them; an overall lack of
support system for the elderly.
COMMUNITY HOME REPAIR PROJECTS OF ARIZONA
We feel that a great deal more could be done to make homes safer for elderly people. In
particular, fall prevention education and safety hardware seem to be needed on a communitywide
basis. Falls at home are a common occurrence, create massive costs for the person and
the community, and are largely preventable.
CATALINA IN-HOME SERVICES, INC.
Home care services for middle income; health literacy, advocacy and self-responsibility;
volunteer activation.
ST. LUKE’S HOME
Stability—the elderly should be able to have their needs met without so much red tape.
HABITAT FOR HUMANITY TUCSON
The need to have additional affordable housing located near employment centers
(e.g. downtown).
CASA COMMUNITY SERVICES
Adult Day Health, Behavioral Health, Casa Community Center—need central location for
resource information staffed by individuals who can assess needs of clientele and direct them.
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Aging in Pima County: A Report to the Community
Addendum 1: Focus Group Comments 2012
Additional comments provided at the focus group meetings:
——
Lack of resources to purchase incontinent supplies
——
Need increased assistance to help pay for home modifications
——
A designated person in each agency that can assist with the bureaucracy of obtaining
benefits/services
——
Podiatry services
——
Affordable dental care
——
Affordable housing
——
A shelter for older individuals who need to be removed from a situation
——
With more complex and fragmented health care systems, people need someone to advocate
for them and coordinate their care
——
Need ad campaigns on a regular basis to help guide people to resources/services
——
Agencies need a way to connect, share information; need to connect to health care settings
——
Education of healthcare professionals so they know resources, know how to have the difficult
“end of life” discussions with older adults
——
Senior housing that allows grandparents to live with their grandchildren
——
Respite for grandparents raising grandchildren
4. What future changes (demographics, national, state or local policies, etc.)
do you see affecting the delivery of services to older/disabled persons?
TUCSON URBAN LEAGUE
Social Security and health care.
SOUTHERN ARIZONA LEGAL AID
Less financial resources to support the required work to meet the unmet legal needs and an
increasing demand for assistance.
ADMINISTRATION OF RESOURCES AND CHOICES
It depends on who wins the election. Statewide I see more cuts coming down the pike.
OFFICE OF THE ARIZONA ATTORNEY GENERAL
Change in the sheer number of people that will become part of this group vs. the limitations on
funding to assist them.
COMMUNITY PARTNERSHIP OF SOUTHERN ARIZONA
Demographics—increase in numbers of people needing services. ACA—parity could affect
number of people who have coverage for behavioral health services.
ARIZONA’S CHILDREN ASSOCIATION – KARE CENTER
There are more grandparents raising grandchildren. TANF benefits like cash or SNAP are
less available.
UNITED WAY, SENIOR IMPACT COALITION
Decreased funding for senior support services. Increase in number of seniors and low income
seniors. More homeless seniors. More cases of dementia.
ST. ELIZABETH’S HEALTH CENTER
Possible future expansion of Medicaid would be beneficial.
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Aging in Pima County: A Report to the Community
Addendum 1: Focus Group Comments 2012
UNITED WAY
Implementing lessons and ideas gained from the Elder Imitative and other efforts (Co-housing”
opportunities, IGI, Living Streets Arizona) that aim to make our communities and neighborhoods
more aging/elder “friendly”. Not “just” delivering service but improving our process. Change in
Social Security—folks need to be banked (ideally) or at least understand how to use new card
without getting lots of charges.
ARCADIA HOME CARE
Will depend on economy and available funds. If program becomes limited, clients may require
placement in long term care facilities which will greatly increase cost of care.
MERCY CARE PLAN
They will have more paperwork to complete with the AHCCCS community first choice option—
literacy. Resources continue to be limited which will result in increased costs paid by private
pay and fewer dollars available for donation to non-profits such as Pima Council on Aging.
Seems to be greater focus on licensed/registered professionals on federal level (like RNs).
JEWISH FAMILY & CHILDRENS SERVICES
As older populations grow – naturally recurring retirement communities (NORCs) or
neighborhoods will face increasing issues related to above mentioned needs. Services with
sliding fee scales should be coordinated to serve people of all income levels.
MIRACLE SQUARE, INC.
Medicare will be even more diagnosis specific in the future but baby boomers will want more
testing, etc. We must find ways to move away from bureaucratic health care and routine care
relying instead on aging in community models.
ADULT PROTECTIVE SERVICES
The baby boomers will be contributing enormously to the number of those aging who need
services. Arizona, because of the draw for retirees, will see an influx. The Elder Justice Act
must go forward to provide funding for the continuation and development of more services for
seniors and disabled adults. Our legislators must act!
SOREO (Home Care Agency)
If the recession continues, we will see a continued demand by younger people and more able
bodied people aggressively attempting to get any resources. Many of these people may not
be appropriate for Pima Council on Aging services and would be better served by the RBHA or
other behavioral health systems.
PCOA cannot be everything to everyone and would be better focusing on the most vulnerable
clients who are not eligible to get services through Medicaid or who refuse Medicaid due to
the lien on their home. Continued and increasing need for broader refugee groups, particularly
clients coming from African and middle eastern/Arabic countries.
ALZHEIMER’S ASSOCIATION DESERT SOUTHWEST CHAPTER
As baby boomers begin to develop dementia/Alzheimer’s, our health care and Medicare
systems will not be able to handle the huge influx and our systems will not exist as we know
them today. Budget cuts to senior services will cripple our ability to help seniors remain at
home. Services will diminish and we will find more seniors having to do without basic services.
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Aging in Pima County: A Report to the Community
Addendum 1: Focus Group Comments 2012
LUTHERAN SOCIAL SERVICES OF THE SOUTHWEST
Decreased funding will of course have a huge impact on the services that we as agencies
and the community can provide. There is only going to be an increase in the demand of these
services as the population continues to grow.
MARANA HEALTH CENTER
The changes in healthcare are still unknown. The reform and the interpretation are still
unfolding. The need to educate the public about options, and what to do if they are suffering or
have family history of chronic illness, smoke or are obese is significant. The insurance exchange
will become an issue once the details are mapped.
The (ACO) Affordable Care Organizations will require man power to track reporting requirements
to gain the financial incentives for compliance. The patients will need to be part of the equation
to get results which begin to tell the statistical story that the quality of care is improving.
SOUTHWEST GAS CORPORATION
The number of elderly will continue to increase and, based on economic issues, our community
will have increased unmet needs of people that are dropped from the system because they
don’t qualify.
COMMUNITY HOME REPAIR PROJECTS OF ARIZONA
I think that as fiscal and political conservatives take the reins of government, programs that
serve the poor become less of a priority than balancing budgets, cuttings taxes and feeding the
military, industrial complex .
CATALINA IN-HOME SERVICES, INC.
Home Care is the fastest growing segment in long-term care. Much work is needed to be done
to assure high quality coordinating, delivery, and financing of those services.
ST. LUKE’S HOME
As we have a younger population, we need to secure social security and insurance for the
low-income seniors we serve. We cannot help if they don’t have stability of what they have
worked for.
HABITAT FOR HUMANITY TUCSON
Increase in the number of grandparents-raising-grandchildren, increase in multi-generational
families, increase in the need to have housing unit expand-contract with changing family size,
increase in need to have sufficient affordable housing near employment centers and/or more
readily accessible through affordable public transportation; increase in need to create sense of
neighborhood and neighborliness (both through supportive services and through neighborhood
leadership engagement).
CASA COMMUNITY SERVICES
Adult Day Health—If Medicare and other healthcare support services stop, the clients will
be unable to pay for services. Behavioral Health—Any Medicaid cutbacks would likely also
impact low income Medicare recipients. Casa Community Center—Fortunately Green Valley has
outstanding grant/funding sources who step in when the need is greatest. Pima Council on
Aging is an ‘elder angel” to our clients.
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Aging in Pima County: A Report to the Community
Addendum 1: Focus Group Comments 2012
Additional comments provided at the focus group meetings:
——
As funding for in-home assistance decreases, more people are forced into ALTCS, have
increased hospitalizations which cost our nation even more
——
Number of people living with a chronic condition
——
Sheer number of people who will need assistance
——
Literacy and health literacy practitioners need to speak simply, number of forms people are
requested to complete have become more complicated
——
People will be living longer and need affordable home health insurance
——
Need different marketing techniques; especially for younger seniors
——
The COLAs are not keeping up with the increase costs
5. If you are familiar with the Community Services System administered by Pima Council
on Aging, please answer the questions listed below. This System provides housekeeping,
shopping, attendant care, home delivered meals, respite care, adult day care and
emergency alert, monitored by a case manager.
a. From your agency’s perspective, are the type and level of home care services provided
by the Community Services System adequate to meet the needs of your older and/or
disabled clients? If not, please explain what is inadequate about the system and what
changes you would recommend.
TUCSON URBAN LEAGUE
Yes
SOUTHERN ARIZONA LEGAL AID
Yes
OFFICE OF THE ARIZONA ATTORNEY GENERAL
Yes
ARIZONA’S CHILDREN ASSOCIATION – KARE CENTER
None of our clients are able to utilize these services. They are in need of this assistance to meet
the children’s needs but are not fragile enough to qualify.
ST. ELIZABETH’S HEALTH CENTER
Adequate, to my knowledge.
ARCADIA HOME CARE
Include 5th week of services for housekeeping service.
MERCY CARE PLAN
Your service system is pre-ALTCS.
JEWISH FAMILY & CHILDRENS SERVICES
People with disabilities under 60 have difficult time accessing needed services. People of
moderate income have difficulty paying for all of their needs.
MIRACLE SQUARE, INC.
Yes and no. This is bureaucratic case management not the incorporation of community reflex in
older adults.
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Aging in Pima County: A Report to the Community
Addendum 1: Focus Group Comments 2012
ADULT PROTECTIVE SERVICES
I believe it’s a terrific and very necessary system. I would like to see a cooperative arrangement
between APS and Pima Council on Aging that APS clients who are at greater risk could bypass
a wait list and receive services as quickly as possible.
SOREO (Home Care Agency)
Services are not adequate. PCOA tries to do too much for too many. I would recommend
discontinuing discrete housekeeping services and only offer attendant care and emergency
Respite services. The resources spent on clients that receive discrete housekeeping could
be better used to increase the hours for those most in need. There are people receiving
housekeeping services that scam the system. They will find any free service and take
advantage of the resource while people who have the most critical needs are too ill to advocate
for their needs. Often those who are the most ill, the most vulnerable do not even know all
the available resources. The clients that receive discrete housekeeping also are the most time
consuming for the case managers. They complain the most; change their schedules the most
and require more communication and feedback. It takes as much time for a case manager
to support someone in 6 hours per month for discrete housekeeping as it does for someone
receiving 20 hours per week of attendant care.
Respite services should only be offered for real emergencies. If a family receives 5 hours per
week of attendant care do they really need 2 hours a month of respite? It is nice to offer but is it
the best use of limited resources?
MARANA HEALTH CENTER
Was unaware this was a service.
SOUTHWEST GAS CORPORATION
The level of services provided have dropped commiserate with the lack of funding. For a
customer that needs bill paying assistance, it means he may either not qualify or that service
may not be provided at all.
COMMUNITY HOME REPAIR PROJECTS OF ARIZONA
I think that the services provided are great and greatly needed. My impression is that there is
a great deal more need than Pima Council on Aging and other agencies can meet, but that the
programs are administered as efficiently as possible.
CATALINA IN-HOME SERVICES, INC.
Elders who don’t qualify for ALTCS and who can’t afford the current cost of home care, need
access to services that cost $10 to $12 per hour.
ST. LUKE’S HOME
Yes, our facility works closely with this program. What would work better would be more funding
and availability.
CASA COMMUNITY SERVICES
Unaware of how the services are provided, and what the eligibility requirements are.
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Aging in Pima County: A Report to the Community
Addendum 1: Focus Group Comments 2012
b. From your agency’s perspective, what should PCOA do more or less of as a system of
service providers to have the greatest impact on older or disabled individuals’ quality of
life? What changes would you recommend?
SOUTHERN ARIZONA LEGAL AID
None
OFFICE OF THE ARIZONA ATTORNEY GENERAL
Increased transportation services; recruitment of volunteers. Perhaps work with local colleges
to give intern credit to people in nursing programs, etc.
ARIZONA’S CHILDREN ASSOCIATION – KARE CENTER
Information & Referral—services are good and good collaboration with Pima Council on Aging.
ST. ELIZABETH’S HEALTH CENTER
No specific recommendations currently.
UNITED WAY
More energy around larger senior community. More client/customer centered (relationship
based follow-up).
ARCADIA HOME CARE
Lifeline; psycho/social needs; home repairs.
JEWISH FAMILY & CHILDRENS SERVICES
Convene planning effort for older adults of all income levels. Expand support and services of
Neighbors Care Association. Partner with community agencies at their intersection points of
expertise.
MIRACLE SQUARE, INC.
Study the process used at Miracle Square re in-home care and advocacy and utilize similar
techniques.
ADULT PROTECTIVE SERVICES
Cost share with APS—cleaning hoarding home, etc. Devote some of the client services monies
(that would already be going toward client services) toward those who are at greatest risk and
those in most jeopardy (i.e. APS clients). Partner with APS for a Community Services System
case manager to go out and assess APS clients’ needs for CSS services within 48 hours/2
working days of a referral to Pima Council on Aging.
SOREO (Home Care Agency)
Discrete housekeeping services. Change shopping services so it is only offered “on-line”. Offer a
home delivered meal which is ‘produce’ only—not a meal, just fresh produce.
The home repair program and DME is essential but currently requires a request from the
consumer/client. The most vulnerable and most in need are often too ill to request or apply.
It would be better if this was totally overhauled. It would be more efficient if providers were
required to submit on their quarterly Supervisor Visit forms identification of a need for home
repair or DME. The PCOA case managers could then prioritize the needs. Money should be spent
on the most vulnerable and in need.
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Aging in Pima County: A Report to the Community
Addendum 1: Focus Group Comments 2012
PCOA case managers appear to be unaware of the potential benefits to their clients if the
most in need were referred to Hospice. Hospice can work alongside of PCOA and is at no
cost to PCOA and to the client. In addition to receiving many supports through the Hospice
doctors, nurses, social worker and chaplain, there are also other benefits such as volunteers for
companionship, free DME and free incontinence supplies. PCOA should ask, whenever a client
passes, why that person was not referred to Hospice.
The PCOA Enhanced Fitness and Matter of Balance programs are great but how many people
does it really touch? Wouldn’t the resources be better spent developing self help information
sheets in multiple languages that could be sent and given out to 100s of people. PCOA case
managers could request assistance for the most vulnerable people who are ‘shut in’ but would
benefit from a therapist or activity specialist going to the home to educate the client and family
members and caregiver on exercises to help with their medical condition.
ALZHEIMER’S ASSOCIATION DESERT SOUTHWEST CHAPTER
Safety, support, education and delivery of services—we must find a better way of letting seniors
know of the available services, encourage them to use what is available and find a way to
deliver those services in a positive manner that is not demeaning to the recipient.
LUTHERAN SOCIAL SERVICES OF THE SOUTHWEST
PCOA has continued to be a very strong advocate and partner for our clientele. Especially since
the major health insurance companies have moved into this area of services. It would be very
helpful to have more transportation and respite services for caregivers.
MARANA HEALTH CENTER
The services offered and the programs of PCOA are a high quality. The awareness of the
services like many social work cases need greater visibility.
SOUTHWEST GAS CORPORATION
We really appreciate that PCOA is the agency with the best repository of knowledge and
services for seniors. It’s vital that PCOA continues to provide that depth and breathe of
knowledge.
COMMUNITY HOME REPAIR PROJECTS OF ARIZONA
I would like to see more programs that provide home visits to elderly and disabled persons in
their home. A friendly chat with a caring person (who is also trained on accessing available
services) would “make the day” for many isolated people, and increase their sense of the quality
of their lives.
CATALINA IN-HOME SERVICES.
More collaboration.
ST. LUKE’S HOME
Making or giving more time to work one on one with the elderly.
CASA COMMUNITY SERVICES
Educate community on importance of respite for caregivers, provide more support groups,
educate adults on how to advocate for themselves within the healthcare system.
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Aging in Pima County: A Report to the Community
Addendum 1: Focus Group Comments 2012
Additional comments provided at the focus group meetings:
——
The Caregiver Specialists are valuable, especially the information (lists of resources)
——
Home Delivered Meal clients like the fresh produce; is there a way people could just receive
the fresh produce
——
Develop a process for the supervisors from the home care agencies to inform the case
managers when adaptive equipment is needed
——
Change the terminology for case management to care coordination
——
Case managers are important as they build the trusted relationship
——
The Community Service System should be referring more and encouraging the clients to use
their hospice benefits
——
Need to continue home repairs
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Aging in Pima County: A Report to the Community
62

Aging in Pima County: A Report to the Community
Addendum 2: Public Comment Meeting Results
Introduction
Ten Public Comment meetings were held at various locations in Pima County from November 5
to December 13, 2012. An announcement of the meetings was published in PCOA’s newsletter,
“Never Too Late”, the Arizona Daily Star and sent to community clubs, organizations and social
service agencies. The meetings began with an explanation of the current service delivery
system and posited questions to the audience about government advocacy, unmet needs of
older adults and their caregivers and changes that should be made in existing services. The
remarks made by the audience in attendance are presented below.
In-Home Assistance
Need assistance with home repairs.
Grants are needed to help defray the costs of remodeling bathrooms for safety.
Grab bars are needed in the bathroom to help reduce fall risks.
Because I live alone I am concerned how I would get someone’s attention if I fell or needed
medical attention and I could not use the phone.
Electronic emergency alert systems are needed for safety in the home.
Need to educate people about the rewards and value of an electronic emergency alert system.
Homecare services are important and the community needs to know that the waiting list for the
services funded through the PCOA Community Services System has been lifted for now.
Home Delivered meals are important in Green Valley; need for prepared meals also noted in
Tucson Estates.
People are hesitant to hire people to do work in their home because they do not know if it is
safe and the people are reliable.
Drexel Heights Fire Department provides lock boxes for people and the 911 dispatcher
knows that the person has the lock box and can alert emergency personnel to access the box
for a key.
Telephone reassurance programs could help with isolation.
People need help in cleaning their yards as homeowner associations can be ruthless in fining
people who cannot take care of their yards.
Housing
The City of Tucson tries to increase the number of vouchers for subsidized housing but there is
a long waiting list.
Many people have questions and need guidance in how to choose long term care options.
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Aging in Pima County: A Report to the Community
Addendum 2: Public Comment Meeting Results
Senior Center/Congregate Meal Program
The Congregate Meal Program at the El Pueblo Center is our life.
Concern that the Congregate Meal Programs at the various neighborhood centers could close if
the federal dollars are cut.
The Food Bank can no longer bring food boxes to the City Parks and Recreation neighborhood
centers. Older adults with no transportation find it difficult to go to the food bank location.
It would be nice to have field trips and be able to go somewhere besides the Center on
occasion.
The number of Congregate Meal participants at the Green Valley Center has declined and
marketing is needed to reach isolated individuals in the community. The socialization that
occurs at the sites is as important as the meals.
The PCOA Elder Rights and Benefits staff person who visits the Green Valley Center is helpful
and the service beneficial.
Neighborhood libraries should host adult crafts and promote being a place where people could
talk and visit.
The Marana Senior Center needs equipment for people to work out.
Need technology classes at the centers for using computers.
Health
Need help with purchasing a hearing aid.
Many older adults can no longer receive AHCCCS.
The Poison Control Center is concerned about the number of medication errors reported for
older adults.
There is also a concern with the number of older adults who are sharing their medications
because they cannot afford their prescriptions.
The community needs to provide more opportunities for people to dispose of their old
prescriptions— could PCOA help sponsor or coordinate these events at the Centers?
A percentage of funding received by PCOA needs to be used on health and wellness programs
for older adults.
The cost and structure of fees for dental care needs to be changed.
Numerous people voiced concern about the lack of affordable dental care (noted at many of the
public comment locations).
Maybe dentists could help one person a year with needed care. (donate services)
Better doctors for older people.
Programs need to address diet along with exercise.
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Aging in Pima County: A Report to the Community
Addendum 2: Public Comment Meeting Results
Glad to see PCOA is focusing on suicide prevention and promoting discussion in this area.
The Medicare Update Conference book and spreadsheets PCOA prepares are very helpful.
People are very concerned and need information as to how the Affordable Health Care Act will
affect their Medicare and health care (noted in Quail Creek and Green Valley).
Need a class on Medicare and the benefits/services covered.
Green Valley needs pharmacies who deliver medications.
The length of time it takes for prescriptions to be filled in Green Valley is a problem.
The A Matter of Balance classes in Green Valley are always filled as the risk of falling
is a concern.
The Green Valley Fire Department noted they receive 80 calls a month related to falls.
PCOA needs to provide classes/presentations on how to select Long Term Care Insurance.
Counseling is needed to deal with loss of spouse or other life tragedies.
People need assistance in purchasing eyeglasses and hearing aids. (It was noted that the
Lions Club can help with eyeglasses.)
Family Caregiving
It is difficult for families to provide care because they are busy with their jobs.
Grandparents raising their grandchildren need some State assistance—they are saving the
State money by caring for the child.
There needs to be an article in Never Too Late and information provided to family caregivers on
how “to take the keys away”.
Respite is needed for family caregivers (noted numerous times).
Caregivers need groups for grieving and also training.
Caregivers need training in how to assist someone with showering, etc.
Grandparents raising grandchildren need respite from their responsibilities; the development of
a child-sitting co-op was suggested.
Legal
Older adults need assistance with legal services (noted two times).
Transportation
The Sun Van cost of $3.00 per ride is too expensive for some people.
The van used at the El Rio neighborhood center is difficult to get on and off; doesn’t have
working seat belts and often breaks down; need a van to take them for shopping.
The drivers and staff with Handicar are polite; the Sun Van staff need additional customer
service training.
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Aging in Pima County: A Report to the Community
Addendum 2: Public Comment Meeting Results
Good sidewalks in the neighborhoods are important and people need to feel safe to walk.
Timing at crosswalks for pedestrians needs to be increased to allow older adults to cross,
especially at St. Mary’s and Silverbell and Speedway and Silverbell.
Oro Valley is assisting with transportation.
The Sun Shuttle service in Green Valley is better—people need assistance in making their
reservations.
The Northeast part of Tucson is not covered for public transportation.
Buses in the community are limited in their times; routes need to be every half hour instead of
every hour.
Advocacy is needed to provide transportation from Town of Sahuarita; a nurses group provides
some assistance in the Quail Creek area.
Neighbors Helping Neighbors is a valuable resource for transportation (noted numerous times).
Some people reserve a ride and then forget so the neighbor needs to remind the person.
Transportation is difficult for people in the Tucson Estates area as Handicar is limited.
Senior Companions provide transportation and also socialization.
Transportation in Marana is difficult when you live that far out.
Outreach/Marketing Services
Question was asked as to how PCOA advertises its programs and services—could PCOA connect
to other health presentations in the community?
PCOA needs to have articles in newsletters like the one at Tucson Estates.
Need to market services by having articles in outlying newspapers like the Desert Times and
Northwest Explorer.
PCOA should have seminars describing the types of services that are available.
The Northwest Explorer is used as a source of information in the Marana area.
Elder Rights
There needs to be one place where people can call to see if an organization is legitimate. Older
adults are victims of scams and often don’t believe the person or organization is not going to
provide the product or service.
Older adults need help in advocating with their landlords for home repairs.
Make sure PCOA shares the needs gathered through this community-wide process with our
elected officials.
66

Godat Design

8467 E. Broadway Blvd.
Tucson, AZ 85710-4009
PCOA Helpline: 520-790-7262
Medicare Information: 520-546-2011
Admin/Business: 520-790-0504
Fax: 520-790-7577
www.pcoa.org