Cuyahoga CountyStat Preparation. Evaluation. Innovation.

1. Cuyahoga CountyStatPreparation. Evaluation. Innovation. Division of Senior and Adult Services (DSAS) Date: 01/16/14, Presentation #12

2. Action Items 2 Break out medical/nursing home referral data. Are some institutions better or worse than others? Which ones are good at identifying problems? (See slide 12) Begin to add more info to website that directs seniors and their caregivers to more resources, including for veterans, Affordable Care Act, etc. Do other counties do this? Check their sites. (See slide 7) Provide more information on $700,000 variance in revenue. (See slide 24) Other Discussion Items: Continue to benchmark all measures Continue to track productivity Continue to identify best practices as appropriate Catalogue your internal promising practices Executive Debriefing: October 21, 2013

3. Action Item-Records Retention Initiative Objective: To effectively adhere to the state’s Public Records Law and manage and facilitate access to agency information in order to support and accelerate decision making and ensure accountability. • Public Records Policy and RC-2 were completed in 2012; will be reviewed in 2014 • DSAS staff completed training on County Public Records Portal in July • Reviews of agency records were processed in December by Records Managers and the Records Coordinator on the inventory of records submitted by all program areas • DSAS staff conducting ongoing meetings to standardize process improvements for client record retention • All DSAS Public Records Managers and relevant staff attended mandatory Sunshine Law training in September • Need for records scanning system to address storage challenges and improve casework efficiency; New Case Management system will assist with this challenge

4. 4 2014-2016 DSAS Strategic Plan Goals and Objectives Create Programmatic Centers of Excellence to Foster Collaboration and Best Practices Explore and implement models of care that empower clients to make individual choices that support their independence Ensure customers have “no wrong door” access to services needed Ensure that all programs are culturally and linguistically competent Seek out expertise and integrate efforts with clinical and academic partners Support families and caregivers by providing services including respite care and education Raise the Public Profile for Multiple Audiences Develop and implement an agency-wide marketing initiative Expand public relations, marketing, and outreach efforts to promote and increase visibility Create a system to educate the public about timely and relevant issues Establish a Leadership Role in the Community Advocate for seniors and adults with disabilities Collectively address gaps in service: Transportation, Mental Health, and Housing Engage in successful aging initiatives that foster volunteering, civic engagement, and lifelong learning opportunities Strengthen Funding and Service Delivery Capacity Eligibility Determination: Assess eligibility requirements for services and to communicate clear guidelines for eligibility Maximize reimbursement for services Service Delivery Capacity: Evaluate service capacity of programs and ensure financial accountability

5. 5 DSAS Strategic Plan-Key Western Reserve Plan Principles Goal 4 - Human Service Needs - Aligning and coordinating both public and private resources around our most pressing human service needs • Collaboration with community partners, such as United Way 211, and Health and Human Service agencies • Initiatives to obtain grants Goal 5 - Education - Identifying education from early childhood forward, as the central factor in individual and community success • Expand education opportunities at Senior Centers • Explore collaborations with colleges to provide education opportunities for seniors Goal 12 - Good Government - Creating a culture within county government which implements nationally-recognized good government practices and innovations • Create Centers of Excellence • Utilize technology to streamline case management and provide enriched data • Develop performance and process-based outcomes, comparing data to established benchmarks

6. DSAS Strategic Plan Phase 3-Performance Measurement The mission of DSAS is to empower seniors and adults with disabilities to age successfully by providing resources and support that preserves their independence Performance Measures-Process Improvements Performance Measures-Client Outcomes Centralized Intake Client Satisfaction Case Management System Health and well-being outcomes • New SMART Objectives in 2014 will include: Calls received through Centralized Intake (and measures associated with this); Services provided through Information and Outreach Unit (IOU)/Aging and Disability Resource Network (ADRN); Reduction in ER and Hospitalization (Home Support Unit) • Complete analysis of more than 500 customer satisfaction surveys received in 2013 will be completed by March 2014 • 2013 Statistical Performance Report will be completed by March 2014

7. Action Item-Website Improvements Meeting held with DSAS Office on Aging and County DOIT on 12/9/13 • Website will be re-designed to be more interactive and user-friendly • Links to County social media sites, including You Tube and Twitter , with DSAS media, will be available • Website landing pages will be redesigned to make them more "senior-friendly” • Options for enlarging the type size • Minimizing the use of jargon and technical terms • Providing a speech function to hear text, functions to minimize scrolling, and bilingual scripts • A searchable database of services and resources will be created • A series of videos will be produced and uploaded to website and will include: • An introduction to DSAS video • A"Call to Action" video about Adult Protective Services and other policy issues relevant to seniors • Avideo announcing our new Centralized Intake number (“One Call Does it All” campaign); and videos highlighting signature events • A portal for Advisory Committee Members to log-in to for special updates will be developed

8. 8 Adult Protective Services Unit Adult Protective Services (APS) is mandated to protect and assist adults who may be victims of abuse, neglect, self-neglect, and financial exploitation. SMART Objective By 12/31/2013, APS will reduce the rate of recidivism of reported cases of alleged abuse, neglect, self-neglect, and/or exploitation to 25%. * Data through 09/30/2013

9. 9 Allegations and Validations Adult Protective Services Unit *Hoarding Allegations and Validations were tracked beginning in mid-2011. ** 2013 Data through 9/30/2013

10. Adult Protective Services Unit-Benchmarking Data • Highlights • New reports to provide better statistical information and supervisory oversight have been developed * Data as of 9/30/13

11. Adult Protective Services Unit 11 Abuse / Neglect / Exploitation Validated? Referral Sources 1) Mandated reporters 2) Non-Mandated reporters 3) Self referrals 4) After hours hotline referrals 696-KIDS Case assigned for an APS Investigation APS initiates the Investigation No: Protective Not Needed Case Terminated Yes Yes: Protective Needed No Does adult have capacity? Non-voluntary intervention: APS involves Assistant Prosecuting Attorney (APA) Adult willing to accept services? No Probate Court Hearings: Protective Service Orders Conservatorships Guardianships Educate the adult and/or family members Implement safety plan – service referrals & linkages Alleviate risk to client Yes

12. Action Item-Adult Protective Services (APS)-Source of Referrals • Data based on 1,593 referrals from January through September 2013 • 10% of APS clients are veterans

13. 13 The Information Outreach Unit improves the economic well-being of seniors and disabled adults by helping them to navigate through, link with, and enroll in the complex network of social service benefits. Information Outreach Unit SMART Objective By 12/31/2013, Information Outreach will link clients with a total of $500,000 in cost-saving benefits. Target 2013 Target in 2012 was $350,000. Due to additional staff and planned events, goal was raised for 2013 Target number of clients served in 2013 is 5,000; Through 3Q 2013, IOU has served 3,784 clients * YTD as of 9/30/13

14. 14 Home Support Unit Home Support provides home-based personal care (such as assistance with bathing, dressing, and grooming) and homemaking (such as light housekeeping and laundry) to high-need clients. SMART Objective By 12/31/2013, 90% of clients will have a completed home assessment within 10 days of referral.

15. Home Support UnitBenchmarking Data • New measures to be collected and benchmarked will include: • How often clients receiving home health care need any unplanned ER care • How often home health clients had to be admitted to the hospital • Falls screen (individual client information and aggregate data) • Depression screen (individual client information and aggregate data) * Cumulate YTD Data as of 9/30/13 ** Source Data: http://www.medicare.gov/HomeHealthCompare

16. 16 Options serves seniors with limited income who need help coordinating and financing their multiple home care needs, but are not eligible for PASSPORT services or Medicaid reimbursements for services to assist in maintaining independence. Options Unit SMART Objective By 12/31/2013, the Options Unit will increase the number of clients who report being linked to additional (non-Options) services to 90%. * Data as of 9/30/13

17. Options UnitBenchmarking Data • * YTD Data as of 9/30/13 • ** Source Data: http://agidnet.org/CustomTables/NPS/Data/ (Aging Integrated Database) • ***ILOC (Intermediate Level of Care) and PLOC (Protective Level of Care)

18. 18 DSAS Overview * 2013 YTD as of 9/30/13

19. Universal Measure - Staff Accountability 19

20. 20 Administrator ( 2 FTEs ) Deputy Director Deputy Director Community-Based Clinical ( 2 FTEs ) ( 2 FTEs ) Adult Protective Home Office on Aging & Services Unit Support Unit Operations ( 41 FTEs) ( 70 FTEs ) ( 7 FTEs ) Options Unit (19 FTEs) Information Outreach Unit (9 FTEs) Financial Services ( 5 FTEs ) Records Procurement & Professional Development Unit (0 FTE) Management Contractual Services ( 1 FTE ) ( 8 FTEs ) Division Organizational Structure Performance Management (2 FTEs) 168 FTEs

21. 21 Universal Measure - Personnel * Staff totals through November 2013

22. 22 Universal Measure - Personnel *Data not available from Human Resources.

23. 23 Universal Measure - Productivity Data obtained from: http://intranet.cuyahoga.cc/en-US/CountyStat.aspx

24. 24 Universal Measure - Budget * Action Item #3, Provide more information on $700,000 variance in revenue was based on a 2013 projection and is not shown in the above chart

25. 25 Universal Measure - Budget HHS Senior and Adult Services History • The decrease in 2010 and 2011 was due to staff participation in the Early Retirement Program (ERIP), in which 55 staff participated. The budget was also reduced due to drops in State funding. • The decrease in 2011 and 2012 is due to the transfer of the Medicaid Benefits unit to Cuyahoga Job and Family Services.

26. 26 Universal Measure - Budget HHS Senior and Adult Services by Expense Category