You asked for an update of OLR Report 2006-R-0042 which describes the functions area agencies on aging (AAAs) perform in regard to home care for seniors.

SUMMARY

The state has five AAAs, which are private, nonprofit elderly planning and service agencies that receive state and federal funds to carry out the federal Older Americans Act (OAA) requirements. Each AAA administers home-care related services to certain seniors over age 60 funded under Titles IIIb and IIIc of the OAA including adult day care, chore services, home-delivered meals, and in-home health care and homemaker services. They employ care managers to arrange service delivery and also award grants to community providers to deliver services.

All five AAAs, in conjunction with the Department of Social Services (DSS), also administer the federally funded National Family Caregiver Support Act program (Title IIIe of the OAA), the state-funded Alzheimer's Respite Care program, and the federally funded Money Follows the Person Demonstration program. Two AAAs (South Central and Southwestern) contract with the Department of Social Services (DSS) to serve as regional access agencies for the Connecticut Home Care Program for Elders (CHCPE). Two AAAs (Western and Senior Resources) coordinate services for the federal Congregate Housing Services program, which provides funding for in-home and related services at certain federally funded elderly housing complexes. The South Central Connecticut AAA also administers “Choices At Home,” a federally funded Nursing Home Diversion Modernization grant program. And the Western Connecticut AAA conducts private case management for people who do not qualify for any subsidized programs.

BACKGROUND

The Older Americans Act (OAA)

The OAA (42 U. S. C. Chapter 35, § 3001 et seq. ) was enacted in 1965 and provides funding to states for services and programs for seniors age 60 and older. Services include information and referral, counseling, congregate dining, home-delivered meals, transportation, homemaking and personal care services, legal services, long-term care ombudsman services, elderly protective services, and senior employment services programs. Services must be targeted to seniors with the greatest economic and social need. The federal Department of Health and Human Services' Administration on Aging distributes federal funding to the states, administers the OAA programs, and advocates for seniors.

The act specifies how states must organize themselves to plan and deliver the OAA-funded services. Each state must designate a state unit on aging, planning regions and regional AAAs. The DSS Aging Services Division is the designated state unit on aging under the OAA. The Aging Services Division administers OAA grant programs and distributes the funding to the AAAs according to a federal formula. According to its 2006-2007 Annual Report, DSS administered approximately $ 24 million from the federal Older Americans Act and other federal and state funds to provide services to 85,265 seniors.

Area Agencies on Aging (AAA)

Connecticut has five AAAs: North Central (NCAAA), South Central (AASCC), Western (WCAAA), Southwestern (SWCAA), and Senior Resources, which covers the eastern region of the state. They are private, nonprofit elderly planning and service agencies that receive state and federal funds to administer programs according to federal requirements. The AAAs must (1) represent elderly people in their geographic areas, (2) develop and administer an area plan, (3) coordinate and assist local public and nonprofit private agencies in developing programs, (4) receive and distribute federal and state funds to regional agencies for these purposes, and (5) perform additional federally required functions.

OAA TITLE IIIB AND TITLE IIIC HOME-CARE RELATED SERVICES

DSS's Aging Services Division distributes the state's OAA funding to the AAAs according to a federal formula. AAAs use these Title IIIb and Title IIIc grants to fund payments for adult day care, chore services, home delivered meals, and in-home health care and homemaker services for people who do not qualify for these services under Medicaid or other programs. According to DSS's 2006-2007 Annual Report, 1,520,853 home-delivered meals were served statewide, 63,516 hours of homemaker services were provided, and 154,005 adult day care hours for personal care were funded.

Examples of Home Care-Related Services

In FY07, WCAAA provided 152,128 hours of direct homecare to 1,724 clients. Homecare services include adult day care, home health aides, chore services, companions, and outreach. The agency also provided 378,792 home delivered meals to 1,766 seniors, according to executive director, Christine Fishbein.

In FY 07, AASCC provided 23,774 units of home care service to 468 clients, including adult day care, companion, home health aide, homemaker, case management, and shopping services. (A “unit of service” is one meal or trip or one hour of chore, home health aide, or other service. ) It also provided 211,329 home-delivered meals to 1,347 clients. In addition, the agency currently serves 51 people through its Bridge Program. This older Title IIIb-funded project provides care management and payment for home care services for those ineligible for the Connecticut Home Care Program for Elders (see below), according to executive director, Neysa Stallman-Guerino.

Senior Resources funded $ 707,966 of homecare services for 3,936 clients and provided 301,056 home-delivered meals to 2,010 seniors in FY 07, stated executive director, Joan Wessel.

NATIONAL FAMILY CAREGIVER SUPPORT ACT PROGRAM

The National Family Caregiver Support Act, Title IIIe, of the federal Older Americans Act (OAA), gives grants to states to provide information and referral, training, counseling, respite care, and other supportive services to (1) people caring at home for chronically ill, frail, elderly relatives or relatives with mental retardation or other developmental disabilities and (2) grandparents and other relatives caring for children at home. Although the program's funding is entirely federal, it is distributed through the states. The states must provide the services through their AAAs.

States must give priority to services to older people with the greatest social and economic need (with particular attention to low-income seniors) and to older people who are taking care of relatives with mental retardation or other related developmental disabilities.

The DSS Aging Services Division allocates the federal money to the five AAAs through the OAA's distribution formulas. The AAAs or their contractors provide the services, which include caregiver counseling, information about available services, help in accessing services, respite services, and limited supplemental services not available through other programs. Each AAA must coordinate its activities with community agencies and voluntary organizations providing similar services.

Examples of Home Care-Related Services

In FY 07, WCAAA provided $ 83,000 and 4,253 hours of respite care services for 140 clients. According to Fishbein, this program is used frequently by DSS's Protective Services for the Elderly program to provide and finance homecare services for abused and neglected seniors when their funds are depleted or to supplement existing services. In addition, WCAAA provided $ 52,000 in supplemental services to 174 clients, including payments for hearing aids, tub seats, grab bars, ramps, and minor home repairs to accommodate disabilities that are not funded by other sources.

In FY 07, SWCAA provided 216 hours of care management to 24 respite clients and 19 supplemental services clients. According to executive director, Marie Allen, respite services included primarily adult day care and home health care services. Supplemental services included one-time health related services or items that cannot be obtained through other means.

According to Wessell, Senior Resources provided 7,042 hours of respite care to 200 clients in FY07. AASCC provided $ 200,164 in respite and supplemental services to 179 clients in FY 07, according to Stallman-Guerino.

STATEWIDE ALZHEIMER'S RESPITE PROGRAM

The state-funded Connecticut Statewide Respite Care Program gives families who care for relatives with Alzheimer's or related disorders an occasional break by paying for up to $ 3,500 of respite services per year. Services may include home health aides, skilled nursing care at home, short-term nursing home stays, adult day care, and homemaker services. DSS runs the program in partnership with the AAAs.

Patients are eligible for this program if they have annual incomes of no more than $ 30,000 and assets of no more than $ 80,000. They cannot be enrolled in the Connecticut Home Care Program for Elders (CHCPE). 2007 legislation changed the program requirements to allow Medicaid recipients under age 65 to participate (PA 07-86). Participants can receive the respite care in their home, at an adult day care center, or other out-of-home service (out-of-home services other than adult day care are limited to 30 days annually). There is no age requirement for eligibility, but these diseases affect more seniors than younger people.

Potential clients are referred to the AAAs' care management staff, who send the client the brief application form. After the form is returned to the AAA, the care manager conducts an in-home assessment and if the client is eligible for the program, the AAA orders services consistent with the caregiver's wishes. The AAA then monitors the services, pays the bills, and collects the required 20% copayment. Table 1 lists the number of clients served by each AAA in FY07.

Table 1: Number of Clients Served in the

Statewide Respite Care Program in FY 07

MONEY FOLLOWS THE PERSON

Money Follows the Person (MFP) is a five-year federal demonstration program that permits states to move people out of nursing homes or other institutional settings into less-restrictive community-based settings. To be eligible, individuals must have lived in a nursing home or other institution for at least six months and, if it were not for the community-based services provided under the demonstration, would have to remain in the institution. For the first 12 months the participant lives in the community, the program will pay an enhanced federal match of 75% compared to the usual Medicaid match of 50%.

The program is administered by DSS, which recently received federal approval for its program protocol. According to Allen and Stallman-Guerino, all five AAAs and Centers for Independent Living (CILs) will contract with DSS to help administer the program regionally. Each AAA and CIL will hire and train full-time transition coordinators. DSS will assign each AAA nursing homes in their region. They will be responsible for identifying individuals interested in transitioning out of these nursing homes, providing information and referral services, and developing and implementing participant care plans. The program is expected to begin September 1, 2008 and will initially serve up to 700 individuals (PA-08-180 increases the number of program slots from 700 to 5,000).

CONNECTICUT HOMECARE PROGRAM FOR ELDERS (CHCPE)

The CHCPE is a Medicaid and state funded program that pays for home- and community-based services for infirm seniors age 65 and older who might otherwise require nursing home care. Services include care management, adult day care, adult foster care, homemaker services, transportation, meals-on-wheels, minor home modifications, and certain assisted living services. An “access” agency determines the most appropriate service package for each participant. Qualifying people in the higher income ranges must contribute to the cost of their care.

After the DSS Alternate Care Unit in the Hartford office determines financial eligibility and conducts a brief health screen, it refers the applicant to an access agency. The agencies perform three primary functions: coordination, assessment, and monitoring. Its care manager conducts a comprehensive in-home patient assessment, provides program information, assists the patient with the required paperwork, and develops the patient's care plan. If the patient agrees to the plan, the agency coordinates and monitors service delivery, making adjustments when needed.

Two AAAs, SWCAA and AASCC, contract with DSS to serve as access agencies for the program. According to Allen, in FY 07, SWCAA served 1,836 clients in 24 towns in southwestern Connecticut. In FY 07, AASCC served 4,143 clients in 37 towns in the south central region, according to Stallman-Guerino. Each agency employs both clinical and administrative staff in support of the CHCPE contract. Connecticut Community Care, Inc. , a nonprofit agency, is the access agency for the rest of the state, serving approximately 7,400 clients. OLR Report 2005-R-0931 explores this program in greater detail.

CONGREGATE HOUSING SERVICES PROGRAM

This federal program, funded by the U. S. Department of Housing and Urban Development (HUD) keeps seniors living in specific HUD-funded housing out of long-term care institutions by providing meals and supportive services. Clients pay up to 10% of their adjusted gross income to access services. Care plans are reviewed by a professional assessment committee, which includes medical personnel. The program requires assessments and monthly monitoring visits. Services are financed with a split of 40% HUD funds, 50% local sources, and 10% client fees.

HUD administers the program in conjunction with DSS's Aging Services Division. WCAAA and Senior Resources are the only two AAAs involved in the program. According to Fishbein, in FY 07, WCAAA served 128 elderly and younger disabled residents at four housing sites seven days per week: Nunnawauk Meadows in Newtown, Grace Meadows in Southbury, Spruce Bank Farm in Woodbury, and George B. Lewis I and II in Naugatuck. Services provided include homemaker, personal emergency response systems, skilled nursing visits, medication monitoring, adult day care, and home health aides.

Senior Resources served 89 individuals in the program in FY07. Its resident services coordinator coordinates services for individuals living in seven housing sites: Little River Acres in Putnam, Moosup Manor in Moosup, Cedar View Village and Eastwind Village in Plainfield, Westfield Village in Danielson, and GA-NA-DEN 1 and 2 in Willimantic. Services include in-home services, transportation, and congregate meals for eligible residents.

NURSING HOME DIVERSION MODERNIZATION GRANT

In 2007, Connecticut received a $ 500,000 grant from the federal Administration on Aging's Nursing Home Diversion Modernization Grant program. It authorized DSS's Aging Services Division, in partnership with the AASCC and community providers to operate a “Choices at Home” project in South Central Connecticut. The goal of the project is to help individuals who are at high risk of nursing home placement but not yet eligible for Medicaid to remain in their own homes. The 18-month project has several initiatives including the development and implementation of a pilot single point of entry system in the South Central region of Connecticut which is expected to become operational by October 1, 2008.

As part of the project, AASCC also operates a “cash and counseling” initiative, which uses existing funds from the National Family Caregiver Support Program and the Statewide Respite Care Program to offer seniors the option to manage a flexible budget for certain homecare services. It allows individuals to hire their own personal care aides without going through a provider agency and purchase items or services, including home modifications, that help them live independently. According to Stallman-Guerino, the cash and counseling model started in July of 2008 and currently serves eight families.

PRIVATE CARE MANAGEMENT

Western area seniors and younger disabled people who are not eligible for the CHCPE, OAA, or other programs can receive private care management from the WCAAA by paying privately for the services, according to Fishbein. The agency's staff registered nurse conducts a home assessment, negotiates services with the client and caregiver if applicable, and orders the services through the agency's regular contracting process. The client pays for the services directly. WCAAA provides private care management services to 8-14 clients at any given time.

ADDITIONAL RESOURCES

Connecticut Department of Social Services 2006-2007 Annual Report, http: //www. ct. gov/dss/lib/dss/pdfs/annual_report/2006-2007_sfy_dss_annual_report. pdf.

OLR Report, R-2005-0931, Connecticut Homecare Program for Elders and Procedures at DSS Alternate Care Unit and Regional Access Agencies, http: //www. cga. ct. gov/2005/rpt/2005-R-0931. htm.

OLR Report, R-2006-0042, Area Agency on Aging Homecare Functions, http: //www. cga. ct. gov/2006/rpt/2006-R-0042. htm.

North Central Area Agency on Aging, http: //www. ncaaact. org/, last visited on August 11, 2008.

Senior Resources, http: //www. seniorresourcesec. org/ http: //www. wcaaa. org/, last visited on August 11, 2008.

South Central Connecticut Area Agency on Aging (also referred to as Agency on Aging of South Central Connecticut) http: //www. agencyonaging-scc. org/ http: //www. wcaaa. org/, last visited on August 11, 2008.

Southwestern Connecticut Area Agency on Aging, http: //www. swcaa. org/ http: //www. wcaaa. org/, last visited on August 11, 2008.

Western Connecticut Area Agency on Aging, http: //www. wcaaa. org/, last visited on August 11, 2008.

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