Affordable Assisted Living Long Term Care Demonstration Program Program Development Update 11/6/08 MALA/MAHSA Assisted

1. Affordable Assisted Living Long Term Care Demonstration ProgramProgram Development Update11/6/08 MALA/MAHSA Assisted Living Tim McIntyre – DYNS Services, Inc.

2. AAL Initiative • The project was initiated by MSHDA via a work group exploring Aging in Place issues. Partnering agencies include MDCH, DHS & OSA • The project’s intent is to successfully combine housing & services as a new LTC component in MI that is cost effective & meets consumer satisfaction requirements • Consistent with the principles & approaches of national AL efforts (ALFA), other state AAL pilot programs and national AAL experts, the MI model is purpose driven and promotes tenant dignity, privacy & prolonged independence

3. AAL Initiative continued • The partners established baseline components of an AAL demonstration & requested concept papers from housing developers and local human service partners • The state partners established agreements defining agency commitments including; • MSHDA to facilitate inter agency cooperation & dedicated funding for TA to develop and support the demonstration • MDCH seeking approval of a special Medicaid waiver and • MDHS utilization of existing food assistance services to support AAL consumers

4. AAL Model Components • Promotes Continuing Care Retirement Community model – a range of housing & health options on site. • Combines affordable housing with access to community-based AL Medicaid services. • Affordability – a minimum of 20% of total units must shelter persons aged 55 years and older with incomes at or below 50% of the Area Median Income. • Addresses multiple consumer directed initiatives • Targets LTC consumers unable to remain at home, NFT consumers & those who meet LOC & prefer housing with services setting

5. AAL Project Initiation • Housing developers & local community service partners selected will serve the Detroit, Battle Creek, Grand Rapids, Grand Haven & St Ignace areas.The first site is located in Grand Rapids and will be accepting tenants in Spring 2009 • DYNS serves as the TA contractor to develop the demonstration initiative and support all phases of implementation. • DYNS is facilitating a collaborative process to define the AAL model & produce the tools & resources to be utilized in the program.

6. AAL Steering Committee • A state level AAL team was assembled to envision, plan & implement the demonstration project. • The team has been defining AAL services & promote housing features that support aging in place. • The group will increase the collective understanding among stakeholders regarding housing, Aging & Medicaid service opportunities. • The committee organized a stakeholder event that brought experts in aging in place housing design & AAL programming

7. Working - AAL Philosophy To provide a community-based LTC program in a home-like apartment style residence that facilitates person centered planning self direction, and managed risk to maximize tenant independence, dignity, privacy and aging in place in an accessible environment. • Person centered planning – a process to build on consumer capabilities & honors preferences & choices • Self direction - a program option that supports consumers in planning & directing their own care through an individual budget. • Risk management – promoting autonomy means allowing tenants to take some risk which may be managed through care planning

8. Full bathroom Kitchen area Lockable doors Private sleeping and living space Individual temperature controls Personal furnishings Community space for dining, laundry, living room, library, TV lounge Access/walkability to surrounding community activities for: Health (pharmacy, physicians, etc) Dining; groceries, restaurants Social & Cultural opportunities Consumer Centered Design Elements

9. Aging in Place Considerations - Housing • The steering committee encourages designers of AAL physical environments to go beyond local code and federal laws: • Openings wider than 32” with zero height thresholds • Power assisted & weather shielded entries & exits • Lever hardware for doors • Rooms large enough to provide accessibility routes & turnaround space with furnishings in place. • Flooring with nonskid surface, direct glue carpeting and transitions between floor types • Zero clearance roll in showers & vanity, combination tub shower units, & reinforced shower & tub walls

10. Aging in Place Considerations - Services • The committee supports a comprehensive Medicaid service package to minimize tenant moves due to an unavailability of needed services • Arrangements have also been made to access AAA & local service resources to support AAL consumers • Some sites may employ staff to broker services & supports from area community based providers. Others will contract with home health or other providers to be on-site. Regardless, choice is required • To promote the specialized nature of this LTC option, the Steering Committee has recommending that MI pursue an AAL specific Medicaid waiver for FY ‘09

11. Project status & challenges • AAL MA funding was not available in FY 2007 or 2008 prompting delays in the development of the demonstration • The AAL project was removed from the 2009 budget and reinstated in late 2008 • The 1st site is opening without an AAL waiver or MA dedicated funding • Other developers are waiting for guaranteed service funding • MDCH is exploring amendments to MI Choice • And if MSA project trade off decisions are needed

12. Contact Information • Tim McIntyre, Project Director • tim@dynsinc.com • 269/317-3654 • J.T. Johnston, MSHDA-AAL Project Director • johnstonjt@michigan.gov • 517/335-0973