Department of Health and Social Services

Division of Services for Agingand Adults with Physical Disabilities

Joint Finance Committee HearingFiscal Year 2012

Bill LoveDivision Director

Thursday, March 3, 2011

Division of Service for Agingand Adults with Physical Disabilities

The mission of the Division of Services for Aging andAdults with Physical Disabilities is to maintain and improvethe quality of life for Delawareans who are seniors or whoare at least 18 years of age and have a physical disability.

The Division is committed to providing services thatmaximize independence through individual choice, enabling persons to continue living active and productive lives, and to

protecting constituents who may be vulnerable or at risk.

Delaware Health and Social Services

Overview & AccomplishmentsAgency Snapshot• Staff: 883 includes Nurses, CNA’s, Planners, Contract & Program

Managers, Case Managers, Fiscal & Administrative staff (includes long-term care facilities)

• Total Budget: $79.9 M (approximately 50% of funding for community programs is federal)

• Service delivery is a partnership between DSAAPD and contracted providers

• Over 30 providers are used for direct service delivery• Client assessment, case management and program oversight,

provided by DSAAPD, are vital to service delivery • Funding: State, Social Services Block Grant, Medicaid, Older

Americans Act, Health Fund (Tobacco)

Delaware Health and Social Services

Overview & Accomplishments

Adult Protective Services Delaware Senior Medicare Patrol Nursing Home Transition

Case Management Information & Assistance

Delaware Money Management Nursing Home Care

Adult Day Services Congregate Meals Medical Transportation

Adult Foster Care Day Habilitation Personal Care

Alzheimer’s Day Treatment Delaware Kinship Navigator Personal Emergency Response

Assisted Living Home-Delivered Meals Respite Care

Assistive Devices Home Modification Senior Comm. Service Employment

Attendant Services Housekeeping Specialized Medical Equipment

Cognitive Services Legal Services Support for Participant Direction

CARE Delaware Joining Generations

Delaware Aging and Disability Resource Center (ADRC) Medicaid Waiver for the Elderly & Disabled

Services Provided by DSAAPD Staff

Services Provided by Contractors

Programs Provided by DSAAPD Staff in Coordination with Contractors

Delaware Health and Social Services

Population Growth

0

50000

100000

150000

200000

250000

300000

350000

400000

2000 2005 2010 2015 2020 2025 2030 2035 2040

Age 60+

Age 75+

Age 85+

The size of the age 60+ population began to spike dramatically around 2005 and will continue to expand steadily for the next 20 years. The age 75+ population will climb noticeably by the year 2015. The “oldest old” population, age 85+, most in need of critical care services, will nearly double between 2005 and 2020, then double again by 2040. By 2030, Delaware is projected to have the 9th highest proportion of persons aged 65+ among all states.

The size of the age 60+ population began to spike dramatically around 2005 and will continue to expand steadily for the next 20 years. The age 75+ population will climb noticeably by the year 2015. The “oldest old” population, age 85+, most in need of critical care services, will nearly double between 2005 and 2020, then double again by 2040. By 2030, Delaware is projected to have the 9th highest proportion of persons aged 65+ among all states.

Overview & Accomplishments

Delaware Health and Social Services

Long Term Care Expenditure Patterns

Institutional Bias in Delaware…

Costs for institutional care

Community care costs

Institutional Bias in the US…

Delaware ranks 38th among all states in the percentage of long-term care dollars spent on home and community based services.

Delaware ranks 38th among all states in the percentage of long-term care dollars spent on home and community based services.

Costs for institutional care

Overview & Accomplishments

About 66% of long-term care dollars are spent in facilities.

About 87.5% of long-term care dollars for aging and physical disabilities are spent in facilities.

Community care costs

Delaware Health and Social Services

Overview & AccomplishmentsPriority Initiatives

Delaware Health and Social Services

Overview & Accomplishments

• Facilitates access to information and services

• Delaware Model– Call Center (information, referrals, case assignments)

– ADRC website

– Core Services: information and awareness; options counseling; service access; care transition assistance

– Designated Local Contact Agency (LCA) for nursing home transition

– Discharge planning (partnering with Christiana Care)

• Federal priority and a magnet for grants and funding

• Working toward “fully functioning ADRC” model to include all disabilities

Aging and Disability Resource Center (ADRC)

Delaware Health and Social Services

Overview & Accomplishments

1. Focus on system reform opportunities

• Money Follows the Person and Nursing Home Transition programs

• Transition/discharge planning best practices

• Pre-admission screening–deflecting nursing home admissions (facilitating access to community-based services)

• Independent assessment of current residents of five DHSS facilities

• Long-term care reform options under Affordable Care Act

• Rapid response team

Rebalancing Long-Term Care

Delaware Health and Social Services

Overview & Accomplishments

2. Expand access to home and community-based services

• Aging and Disability Resource Center (ADRC)

• Consolidation of three Medicaid Waivers– Increased opportunities for self-direction and person-centered care– More service options– Streamlined service access– Administrative simplification– Increased efficiencies

Rebalancing Long-Term Care (continued)

Delaware Health and Social Services

Overview & AccomplishmentsOrganizational Restructuring

Delaware Health and Social Services

Overview & Accomplishments

• Integration of three Long Term Care facilities (State-operated)– Smooth transition for staff and residents

– Integration of facility service functions with DSAAPD operations

– Deflecting admissions and transitioning individuals to the community

– Comprehensive assessment of each resident

– Ensures access to community-based supports for all long-term care residents

• Transfer of Long Term Care Ombudsman Program (LTCOP) and Adult Protective Services (APS)

– Phased-in transition to Office of the Secretary

– Enhance service model for constituent services in Delaware

– Increase visibility of these services

Organizational Restructuring (continued)

Delaware Health and Social Services

FY 12 Governor’s Recommended BudgetBase Adjustments

• 35-14-01– The addition of $750K in General Funds to replace Social Services Block Grant funds lost in

past years

Structural Changes

• 35-14-01– Transfer Long Term Care Ombudsman Program and Adult Protective Services salaries and

positions to the Office of the Secretary

• 35-14-20– Transfer, salaries, positions, and related operating costs for the Delaware Hospital for the

Chronically Ill (DHCI) from the Division of Public Health

• 35-14-30– Transfer, salaries, positions, and related operating costs for the Emily P. Bissell Hospital

from the Division of Public Health

• 35-14-40– Transfer, salaries, positions, and related operating costs for the Governor Bacon Health

Center from the Division of Public Health

Delaware Health and Social Services

Thank You.