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HomeMy WebLinkAboutElderly Affairs, FY 2014-15 DEPARTMENTAL BUDGET REVIEWS 4/14/2014 DEPARTMENTAL BUDGET REVIEWS 2014-15 ELDERLY AFFAIRS April 14, 2014 Elderly Affairs (dmc) Page 1 There being no objections, the Committee was called back to order at 3:25 p.m., and proceeded as follows: Elderly Affairs: Honorable Tim Bynum Honorable Mason K. Chock, Sr. Honorable Ross Kagawa Honorable Mel Rapozo Honorable Jay Furfaro, Council Chair (excused at 3.33 p.m.) Excused: Honorable Gary L. Hooser Honorable JoAnn A. Yukimura LUDVINA K. TAKAHASHI, Executive on Aging: Good afternoon, Kealoha Takahashi, Executive with the Agency on Elderly Affairs. With me, I have my Accountant, Teresa Caries. Thank you for this opportunity. I just wanted to reiterate our mission the Agency on Elderly Affairs, we as the designated lead County agency, plans, implements, supports, and advocates for the well-being of Kaua`i's older adults; and serves as a one stop source of information on long-term care support options and services for all residents. With that in mind, I wanted to go over some of the successes and achievements that we have been able to accomplish. Of course on the top is a program known as Better Choice, Better Health. It is a Chronic Disease Self-Management Program and this is developed by the Stanford University. The next achievement is the EnhanceFitness (EF), which is a low impact, strength training program that focuses on balance, strength, endurance, and flexibility. And this has been really popular. On page 2, you have a listing of our sites. We have nine (9) classes at seven (7) different sites. We serve a total of two hundred and twelve (112) participants and this is from a period of July 2012 to June 2013. The next significant program that you are familiar with is the RSVP Recognition Luncheon and this year what RSVP did...and the picture in my budget presentation is the members of the board who have been very supportive. This year... Mr. Rapozo: Kealoha, you had a PowerPoint? Oh, okay, because you mentioned a picture. Ms. Takahashi: Right here in the presentation. This year RSVP coordinated a collection of supplies for homeless veterans and the collection drive was overwhelming. We have fifty (50) kits. Actually, over a hundred (100) kits were made. The next significant program is our Older Americans Month. The theme last year was "Unleash the Power of Age," and the outstanding older Americans were Dr. Lucy Miller and William Neil Rapozo which is by the way, Teresa's grandfather. On page 4 something that we initiated through not County funding but with grants was the Kaua`i Care Transition Program. We completed a Federal demonstration project known as the Hospital Discharge Planning Grant in conjunction with the Kaua`i Veterans Memorial Hospital in which we provided a Care Transition Intervention Program for a high risk patients who are being discharged from the hospital back to the home. These were patients that are sixty (60) years or older and that were admitted with one (1) or more diagnosis of severe cardiac and respiratory/pulmonary problems, sepsis and/or cellulitis. The outcome of the program was we were able to reduce the hospital readmissions. I think the readmission rate was reduced by forty-two point eight percent (42.8%) and I have also submitted a report for your information on the success and evaluation report — very April 14, 2014 Elderly Affairs (dmc) Page 2 successful. Also, we were able to accomplish that Lito Asuncion is in charge of is doing the integrity of our client database to track and record accurate surface utilization and expenditure and produce client demographic data. We now routinely conduct validity and accuracy checks on client and service data elements and identify errors jointly with affected service providers. We are able to submit to the State a report annually. We are able to reduce ninety-eight percent (98%) of missing client data elements which is very significant as far as when we have to compare our data information with the rest of the State. Implementation of improved data collection procedures coupled with working closely with service providers have prompted timely submissions of required reports and I want to thank Lito, who is here in the audience. It was under his coordination that we was able to complete this. Some of the challenges that we face is, as I noted here in my report, the Core Components and Criteria of a Fully Functional Aging and Disability Resource Center (ADRC) which include the following core components. I handed out a handout that describes which core components and what that means. Information, Referral and Awareness is one component. Second component talks about options Counseling and Assistance. Third is Streamlined Eligibility Determination for Public Programs. Fourth, Person-Centered Transition Support. Fifth, Consumer populations, Partnership and Stakeholder Involvement. Sixth, Quality Assurance and Continuous Improvement. These are the components that needed to become a successful or fully functional ADRC and so we work really hard into being able to accomplish that. Some of the problem areas that staff have been facing is core number 3 into the Streamline Eligibility Determination for Public Programs, they are using the interRAl-Home Care assessment tool which has been really...challenging for them because it takes anywhere from two (2) to three (3) hours to complete. Many of the comments that I have indicated here, some staff have encountered negative comments, "how can you subject a ninety-three (93) year old to an hour long interview?" And so staff is working really hard into narrowing that three (3) hour to a half and so it is a work in progress but they are doing magnificently. We have had support from our State executive office as far as training staff as to how to complete that in an efficient way. Next is implementing our Management Information System (MIS) that will support the core operational functions of the Aging and Disability Resource Center has also been challenging. Staff need to also...is in charge of trying to mediate some of those issues with the rest of the State. He meets on a quarterly basis with the other County's into working to integrate of all Counties' database into one Statewide database. So, that is a work in progress. Of course I need to mention because of the dwindling Federal, State and County funding for services is a challenge and plan to seek other revenue streams and incorporate into a business plan. And so some of the plan improvements is to look at our Strategic Plan which we have been currently completed but need our advisory council approval before we present it to you and to the Mayor. We are also looking into doing a business plan and how to look at some of the services that staff provide and trying to see if we can receive reimbursements from insurance companies for the work that we do. Goals and objectives, I have listed six (6) goals that I have highlighted. The first one is to develop Hawaii' Aging and Disability Resource Center to its fully functioning capacity and I have listed you the criteria of what that looks like. I have also listed some of the objectives. I want to turn to page 6 to highlight some of the outcomes that we were able to achieve. We are looking at...on our website we are able to have...during the period July 2012 to June 2013, two thousand four hundred and sixty-three (2,463) visits were made on our ADRC website. If you look at the short time that...in this current year from July 2013 to February 2014, we already have one thousand two hundred fifty-four (1,254) visits. Our April 14, 2014 Elderly Affairs (dmc) Page 3 goal was to have at least a thousand and two hundred (1,200) visits to our website. From that website it normally generates referral process where the staff would then follow-up on their assessed needs of our clients. Our staff made six thousand eight hundred fifty-four (6,854) contacts. We served over a thousand three hundred eighty-five (1,385) older adults. I want to highlight in the middle where you have presently our Agency was awarded a hundred and twenty-five thousand dollars ($125,000) contract to serve as the local kokua, of the marketplace assisters. This is to conduct community outreach to the uninsured individuals for a health plan through the Hawai`i Health Connector's or what they call the Hii Ola Program. To date we are able to serve, up to February, we are able to serve a hundred and six (160) people. In March, there have been an increase because of the late delay and tomorrow will be the last final that they can apply for health insurance. Another note, AEA has engaged in a local public relations agency and a videographer to enhance its marketing and community outreach efforts to the Kaua`i community. We just received today a video of that completion, that project, and so we will be forwarding off to the Mayor for his approval and hopefully to post on our website and view through youtube as well. Goal number 2, enable older adults to remain in their own homes with a high quality of life for as long as possible through the provision of home and community-base services. Some of the outcomes as recorded here, if you look at the bottom of the page 7 regarding home and community-based services, AEA served a thousand one hundred fifty-three (1,153) older adults for the period of July 1, 2012 to June 30, 2013. This translates to a hundred and three thousand four hundred fifty-three (103,453) hours of home and community services including personal care, homemaker, adult day care, friendly visiting, telephone reassurance, legal assistance, case management, and elder abuse prevention. Seventeen thousand and twenty-nine (17,029) one-way trips, seventy-five thousand five hundred and ninety (75,590) meals, this is for home delivery meals and for congregate meals ten thousand five hundred and thirteen (10,513) meals. We are able to serve a total of a hundred and eighty-four (184) caregivers Goal number 3 is to empower older adults to stay healthy using prevention and disease self-management strategies and stay active and socially engaged through volunteer opportunities. Again, I just want to reiterate for this past year, we served a hundred and seventy-five (175) elders who participated in that EnhanceFitness. We have three hundred fifty (350) older adults who are engaged in volunteer opportunities through RSVP. Some of the outcomes that are really significant and I wanted to thank publicly are our Certified EnhanceFitness instructors, they are doing a really wonderful job. We are so fortunate here on Kaua`i that we do have that resource. That is why our training classes are so popular with the seniors. Also, we conducted surveys which was sent to three hundred fifty-two (352) volunteers, thirty-two (32) volunteer stations, with a sixty-one percent to sixty-five percent (61% - 65%) return rate. Out of the hundred seventy-six (176) who responded, ninety-seven percent (97%) are satisfied with their volunteer assignment and would recommend RSVP to others. Eighty-five percent (85%) drive to their volunteer stations, and the primary reasons they stated were: 1) it made them feel good about themselves; 2) they see a need to help other people; 3) it opened them up to new experiences. So, out of the fifty (50) volunteer respondents, ninety-two percent (92%) indicated that they were significantly satisfied with RSVP volunteers. Eighty-three percent (83%) indicated that RSVP volunteers significantly helped their organization and they were able to serve more people. Seventy-five percent (75%) indicated that the volunteers significantly help their organization develop partnership in the community. So, I am really happy that both the volunteers and the stations are happy with the great work that the volunteers have been doing. Goal number 4, manage funds and other resources efficiently and effectively, using person-centered planning, to target public funds to assist persons at risk of April 14, 2014 Elderly Affairs (dmc) Page 4 institutionalization and impoverishment. It speaks specifically to the Kaua`i Care Transition Program that I mentioned earlier and you have the Kaua`i Care Transition Program Evaluation Report attached. Dr. Fenfang who did an evaluation will also be publishing in medical journals the evaluation reports, so we look forward to seeing that publication. The community living program was a three (3) year pilot program that began in September 2009 and this was support from the Administration on Aging grant rewarded to the State Executive Office on Aging. The first two (2) years, the pilot program was actually conducted, we had the coach that flew over from Kaua`i we had ten (10) families that were involved. This program, what happened was, the families would be given a voucher of x amount of dollars to help them with the care of their loved ones. That program also came to an end and I submitted the Community Living Evaluation Report that is attached. On page 10, the fifth goal is to ensure the rights of older people and prevent their abuse and neglect and exploitation. Our outcomes, we had two hundred and seventy-one (271) older adults who received one thousand five hundred eighty (1,580) hours of legal assistance services which included will/trust advice and counseling, power of attorney, settling landlord/tenant issues, and advanced health care directives. We also had a one-day workshop that was attended by three hundred (300) seniors and six (6) elder abuse prevention educational workshop throughout Kauai. We also had train-the-trainer workshop on elder abuse prevention for the eldercare network providers. If you move on to page 12, it just shows the graph on some slight increases of course with the salaries and wages and operations we have asked for moneys. The sixty-seven thousand five hundred fifty-four (67,554) home delivered meals. We are fully staffed. We are able to hire the Community Service Worker and our Case Manager, which was the last. Everybody is on board and we are really excited. Thank you. Mr. Rapozo: Thank you very much. Any questions? Mr. Bynum. Mr. Bynum: Thank you very much for the presentation. The EnhanceFitness, it is still going and we are County funding it now? Ms. Takahashi: Yes. Mr. Bynum: And it has been successful. Ms. Takahashi: It does have State funds as well, yes. Mr. Bynum: And initially, I just remembered, we kept it going. It is still working out really good. Ms. Takahashi: Yes. Mr. Bynum: Three (3) years ago I was going to visit and attend the workshop... Ms. Takahashi: The invitation is still open. Mr. Bynum: ...and you are still waiting for me, right? Ms. Takahashi: Yes. April 14, 2014 Elderly Affairs (dmc) Page 5 Mr. Bynum: But I heard from the seniors who are involved and they are very happy with it. This Kauai Care Transition Program is wonderful and thanks for including the study, I read some of the Executive Study...will these serves continue now? Or was this a pilot and it is all done? Ms. Takahashi: We are hoping to and that would be part of our business plan offering... Mr. Bynum: Because it was highly successful and forty-two percent (42%) reduction and readmission, you know, the health company should fund this plan for you. It is going to save them money—the health insurance companies. Ms. Takahashi: Exactly. Mr. Bynum: I mean forty-two percent (42%) and just monitoring it. Our population is aging, right? Ms. Takahashi: Yes. Mr. Bynum: Have you done outlook to... I mean have you done that...about what our aging population is going to be over the next ten (10) years and how much the Agency needs to grow to meet those needs? Ms. Takahashi: It is going to grow because you are looking at my age group, the baby boomers, are turning sixty (60), yes. Mr. Bynum: I make sixty (60) this year. Ms. Takahashi: So the next twenty (20) years or so you will be bombarded with a lot of seniors needing help in programs. Mr. Bynum: I noticed that one of your goals was a strategic plan. Ms. Takahashi: Yes. Mr. Bynum: And so how do you move forward on that goal? Is there funding in here for that? Ms. Takahashi: No. It is based on looking at operations as well as looking what we have the funding that we currently have to use to target our plans that we have going forward. Mr. Bynum: And so we are the aging and disability resource center on Kauai. Ms. Takahashi: Yes. Mr. Bynum: The webpage, who manages it? + Ms. Takahashi: We do. We do the updates on the event calendar. Right now, it is under the State and they have a company that they source out. April 14, 2014 Elderly Affairs (dmc) Page 6 Mr. Bynum: So, you do the Kaua`i based updates but the whole database where you search for needs and stuff is managed by the State? Ms. Takahashi: It is managed by the State and they contract it out. Mr. Bynum: I cannot thank you enough for the work you do. I absolutely love your agency and I think it needs to grow. We need to do a strategic plan to meet the needs of the community and I really encourage us collectively to look at resources on how we can hire a consultant to do a long range strategic plan for the agency because I think the needs will grow. Am I correct that Federal money have been difficult and tight but there is an intention to move more services as the population ages from the Federal government, correct? Ms. Takahashi: Our funding has been status quo for the longest time. So, you are looking at other revenues with the Centers for Medicare Services, they have the money. So, it is looking at how we can strategically set ourselves up so we can see those reimbursements for that program. Mr. Bynum: I have been in conferences lately where there were strong presences from the health industry wanting to work with communities on these kinds of preventive things. Ms. Takahashi: Exactly. Mr. Bynum: Has your agency explored Kaiser Foundation and these folks...I was at Windward Shopping Center and a Kaiser person says that we have all this money and we want to... Ms. Takahashi: Exactly and that is where the nitch is that we need to get ourselves into... Mr. Bynum: It is in the health industry and then preparing for this aging population. Ms. Takahashi: Yes. Mr. Bynum: You are on it, thank you very much. Mr. Rapozo: Mr. Chock. Mr. Chock: Mahalo for the wonderful work that you folks do. I can see all the community partnerships that you have created, the services are islandwide and disperse within the community. I had a similar question as Councilmember Bynum in terms of the strategic plan. Is there some sort of evaluation process that we might be able to look at that would help to clue in this body as to what the financial needs will be in order to serve the growing population within these programs because I do see it as a real big need. I am also happy that that last time you folks were here you talked about the meal on wheels program and the need that was lacking. You called us on it and it is in there, I see, would that be a part of the consultant services as well that is in your operating budget? I am looking at seventy-two thousand and this is the first page of the budget. It says consultant services at seventy-two thousand and I just wanted to confirm what that is? April 14, 2014 Elderly Affairs (dmc) Page 7 Ms. Takahashi: Yes, that would be consultant services. Mr. Chock: Okay. So, you contract out for the meals to be provided, is that correct? Ms. Takahashi: Yes. Mr. Chock: The only thing I recall being bought up was that there was some discussion about other partnerships that are in the community, farmers and so forth, that might be able to contribute to the types of food or...not, so much a request but just sharing of that comment because I think it is important that we collaborate with other farmers on the island that might be able to contribute. Ms. Takahashi: My communications will address that when we do contract negotiation. Mr. Chock: Mahalo. I also wanted to recognize that Councilmember Rapozo introduced a NACo health care plan, dental plan, that I thought were really key, you might want to continue to look at that in terms of needs and services. Ms. Takahashi: Okay. Mr. Chock: Other than that thank you for the presentation. Mr. Rapozo: Mr. Kagawa: Mr. Kagawa: Following up on the consultant services, so in 2012 you had two hundred and one thousand in there; 2013 we had a hundred and seventy- six, five; and in this year budget got cut by more than half to eighty-one thousand five, fifty- two. And in this new proposed budget for next year, we are asking for one, fifty-four, two, six, six. Are we returning closer to the amount of services that were given in 2013 or 2012 or is that just the price of the services that have gone up? Ms. Takahashi: No. Going back to the original level of services that we were providing. Mr. Kagawa: Excluding the weekend? Ms. Takahashi: Yes. Mr. Kagawa: So there is not enough for the weekends? Ms. Takahashi: No. Mr. Kagawa: And how much will the full return...how much additional we will need to return at least one (1) day of that weekend service? Ms. Takahashi: I did not calculate that. I just in my correspondence, I just added the sixty-seven thousand would provide seven thousand six hundred sixty-two additional meals and this is six hundred thirty-eight meals per month. It does not include the weekend meals. April 14, 2014 Elderly Affairs (dmc) Page 8 Mr. Kagawa: Okay. I guess we can do that in a follow-up because typically during the budget at the end of our decision making, we may have some moneys that Councilmembers get to add and that would be one that I may consider adding. As Councilmember Hooser said, there are people out there that is difficult for them to get to the store and what have you and they still do not want to go to the care home and I think expanding at least having maybe one (1) day of food on the weekend would be something that I could support. I will send a follow-up and see what that total is and if I get a chance to add something that would be something I would add. Thank you. Mr. Rapozo: Thank you. Any other questions for Elderly? Mr. Chair. Chair Furfaro: Thank you for filling in for me, Mr. Rapozo. First of all, congratulations on another great year. Your work is very much appreciated. Ms. Takahashi: Thank you. Chair Furfaro: You folks do a great job over there. Ms. Takahashi: We have a great team. Thank you. Chair Furfaro: Thank you for reflecting on them because you are as good as the people you surround yourself with—good point. Ms. Takahashi: Exactly. Chair Furfaro: Tomorrow we have Housing in front of us, do you get much feedback from our seniors about challenges in the housing market? Ms. Takahashi: Not too much come to my level. Chair Furfaro: I see. Ms. Takahashi: If anything, it would be with the workers but they have not...in our meetings as the staff bought up any issues that they face so far. Chair Furfaro: You are serving the seniors that are in the Lihu`e Theatre Housing Project. Ms. Takahashi: We do. Chair Furfaro: And how about some of the State Housing Project? Ms. Takahashi: We do. Chair Furfaro: Do you know through a sign-in, if you can identify those mixes for us? Ms. Takahashi: Okay. Chair Furfaro: Would you? April 14, 2014 Elderly Affairs (dmc) Page 9 Ms. Takahashi: Of people that we are presently serving? Chair Furfaro: Yes, presently serving. I just find that interesting as we come up with the Rice Camp Project, I would like to have that information. Ms. Takahashi: Okay. Chair Furfaro: I know Mr. Rapozo has been a champion on this but the meals on wheels for the last say three (3) years has been flat, has grown, has depleted, what is the reality on that grant money? Ms. Takahashi: Grant? Chair Furfaro: Has it stayed flat? Ms. Takahashi: Pretty much. Yes, it has stayed flat. Chair Furfaro: Do we get any narrative on the State or Feds on that? Ms. Takahashi: What State has done is gone in for a supplemental funding from the State legislature every year and they were successful in getting additional funds. So, whatever they can throw away, we will be able to use some funds. We usually, in our... when we look at the services provided, we look at the high demand for services and it fluctuates throughout the year and so when we have those extras funding from the State, we do apply it as much as we can to fill in... Chair Furfaro: I guess my question is, I guess I can ask our group to track any of those House bills that are going on about meals on wheels because it is not really final until the budget is finally approved. Ms. Takahashi: Currently there is one that they are reviewing. I cannot remember the Bill number. Chair Furfaro: We will look it up. But you do keep an eye on that? Ms. Takahashi: Yes. Chair Furfaro: Other than that, I just want to encourage you to do the great job you are doing and continue to do your best. Thank you very much. Mr. Rapozo: Anymore questions for Elderly? If not, thank you very much. There being no objections, the Committee recessed at 3:58 p.m.