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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.
Page 2 and 3: AREA PLAN ON AGING FISCAL YEARS 201
Page 4 and 5: Implement, along with local service
Page 6 and 7: PART I: INTRODUCTION TO THE OLDER A
Page 8 and 9: PART II DESCRIPTION OF THE AREA AGE
Page 10 and 11: What is the approach that will be u
Page 12 and 13: PART III PUBLIC NEEDS ASSESSMENT PR
Page 14 and 15: • In Pima County, there are 73,14
Page 16 and 17: PART III NEEDS ASSESSMENT COMMENTS
Page 26 and 27: Goal 1: Increase the ability of old
Page 28 and 29: Operational Objective O1-11: Contin
Page 30 and 31: Outcome: 80% of Ambassadors report
Page 32 and 33: Operational Objective O3-6: Provide
Page 34 and 35: Goal 5: need. Increase the ability
Page 36 and 37: PART V PREFERENCE TO OLDER PERSONS
Page 40 and 41: Part VII APPROVED WAIVERS REQUEST F
Page 42 and 43: REQUEST FOR A COST SHARING WAIVER (
Page 44 and 45: PART IX - AREA AGENCY SERVICES TO B
Page 46 and 47: PART IX - AREA AGENCY SERVICES TO B
Page 48 and 49: PART X APPENDIX 1. Assurances 2. PC
Page 50 and 51: (4)(B)(i) Each area agency on aging
Page 52 and 53: Appendix 2: PIMA COUNCIL ON AGING O
Page 54 and 55: APPENDIX 4 HOME CARE SERVICE Attend
Page 56 and 57: Appendix 5: List of Neighborhood an
Page 58 and 59: Aging in Pima County A Report to th
Page 60: Aging in Pima County: A Report to t
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Aging in Pima County: A Report to t
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8467 E. Broadway Blvd. Tucson, AZ 8
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