Department of Aging & Youth

1. Department ofAging & Youth Promoting independence, dignity, health and quality of life

2. Value of Home-based Long Term Care Services • Federal, state and locally funded community based services, such as case management, personal care aide services, personal emergency response units (PERS) and home delivered meals offered through the Department of Aging and Youth is an average cost of $9,600 annually per person. • A frail senior receiving these services can generally delay entry into a nursing home by approximately 2 years or more, saving $135,400 per person per year for nursing home care. • Without these valuable services, at least half of the 500 seniors that receive the above community based services would require nursing home placement. • $145,000 (skilled nursing home cost) X 250 seniors = $36,250,000 annual Medicaid costs. A portion of this significant expense is a local cost passed on to Wayne County taxpayers.

3. Department of Aging & Youth 2018 Long Term Care Services Personal Care Assistance (PCA) 113 seniors served -10,891 Aide hours. Home Delivered Meals (HDM) 251 seniors served- 41,143 meals Case Management (CM) 322 seniors served-2410 CM hours. Personal Emergency Response System (PERS) 195 seniors served-1842 Units

4. Aging and Youth’s Efforts to Meet the Demand for Long Term Care Services • PERS waiting list has been eliminated due to Medicaid clients being served by DSS and additional CSE funding (160 clients in 2018 to 197 clients currently being served at no additional county cost). • Home Delivered Meals waiting list has been eliminated in 2019. More eligible seniors are being served due to the reduced HDM meal cost. The additional county cost that was allocated in 2018 is no longer needed. Meals increased from 36,000 to 42,000 annually. • Case Management has no waiting list (caseload of @50 per worker) although we started 2018 with a waitlist of 11 clients.

5. Current PCA Status • AY has two contracts for non-medical aide services. • Home Instead (HI) contract is $43,403 annually. Currently 31 clients are assigned 176 hours per month. HI provides only PCALevel I (chore services). HI is working to capacity. • Lifetime Care (LTC) annual contract is for $225,000. LTC provides bothPCA Level I and II. Currently 4 clients are receiving PCA I and 43 PCA Level II, approximately 609 hours per month. • For the first quarter of 2019, the LTC only served only 13% of the 25% designated need. At this rate, Lifetime Care will only serve 52% of AY referrals. • The problem is not lack of funding resources, but is due to workforce shortage.

6. Personal Care Assistance Level IIIE. Showering, feeding, transfers to chair/bed/toilet and grooming Waitlisted • Personal care Level IIhas a waiting list of 10 clients tentatively assigned 30 hours per week not receiving service. • About 18 active clients are assessed eligible for the higher level personal care services but are only receiving housekeeping level services, due to lack of aides • The average time on a waitlist is 6 months. • Over the course of 2018 there were 30 people affected by waitlists;totaling 218.5 months of waiting for 110 hours of weekly service • In 2018, there were 8 people on the waitlist for a year or more in the hard to serve areas in Wayne County.

7. Continued • 14 of the 30 people were closed to services prior to ever receiving PCA service (2 died, 4 went into nursing homes or on hospice, 5 made other arrangements with family or hiring privately, 3 applied for Medicaid and Managed Long Term Care Services) • A monthly average of 37 scheduled shifts were not covered for active clients. No substitutes were provided. If an aide is not available to keep her regularly scheduled appointment, frequently no substitute is assigned, leaving the frail senior and/or their caregiver in the lurch. • About 6-8 people lost their aide service as a result of going in to the hospital and having their aide reassigned and no aide being available when they were discharged • NY Connects received 665 calls for information about in-home/aide services in 2018. NY Connects staff report that a large % of those callers do not request a referral for A&Y PCA services when they hear about the wait list because their needs are more immediate.

8. Mr. M – 64 - Newark Services receiving: • Mr. M had received case management and Personal care aide (Level II) from Nov. 2017 to Oct 2018 • Lost Aide service 10-1-18 due to hospitalization – aide was reassigned and no aides were available. While he was receiving Aide Service: • 2 ED visits and one hospital admission in 11 months • Did not use PERS • Did not need home delivered meals After losing Aide Service: • 6 hospital admissions (35+ days in the hospital), 1 NH admission, 6 ED visits in 6 months • Used PERS pendant 8 times to summon help • Now required HDMs • No informal supports, bathes at the sink or using wipes • Housekeeping services being offered, but no personal care available.

9. Mr. & Mrs. L - 84 & 79 - Walworth Services Receiving: • HDM – 7/14/14 (Both) • CM – 1/26/2015 (Mrs.) • PCA – 5/18/2015 (Mrs.) • PERS – 4/11/17 (Mrs.) He has dementia; She is physically disabled. The paranoia which is a part of his dementia caused him to refuse outside assistance in making some needed home repairs and as a result they had to move out of their home. During this transition from their home to their apartment, her aide service was discontinued. Now that they are settled, there are no aides available to resume the service she had come to depend on these past 4 years.

10. Concerns: • Lifetime Care Inc. has declined to renew contracts with four other Finger Lakes regional OFA’s effective 4/1/2019. The AY Department contract year runs from Jan 1-Dec 31, 2019. The AY contract is very likely be terminated at the end of 2019 contract period. • Currently Lifetime Care is the only PCA Level II provider serving Wayne County. • If the LTC contract is terminated, this will leave 76 clients (including waiting list) without PCA Level II services in 2020. • AY has sought contracts from the other additional home health care agencies that are certified to serve Wayne County residents. They have all declined because they have no staff available in Wayne.

11. Options According to Title 10, Section 3610 of the Public Health Law: • Department of Health exempts NY State regulated Offices for Aging (OFA) from home care licensure requirements, because the PCA aide services are designated and funded as a non medical model. • Department of Health (DOH) does require background checks, home health aide licensure, record retention for PC aides administered by OFA. • Orleans County has already implemented a successful direct service PCA model.

12. Recommendations: • Utilize EISEP funding allocated to LTC to hire 8 PT (25 hours) PCA aides to provide level II personal care services. • PCA aides would be hired at pay grade 7($15.17 per/hour)=$23,665 x 8=$189,320. • Start up services to begin September 2019 to alleviate disruption in service and expend existing funding. • AY would be able to purchase 3 cars in 2020 and budget for fuel to accommodate PCA travel. • PCA training costs would be covered with the available funding. • Space will available in our office suite to house the additional positions. • AY would have more flexibility and control over scheduling and tasks to be done. • AY would continue to contract with Home Instead to provide PCA Level I services. • The aide scheduling would be conducted in-house with existing staff.

13. FUNDING • AY contracts with LTC at the rate of $24.75 per PCA hour/ $225,000 annually. • If the LTC contract is terminated at the end of 2019, the budgeted $225,000 could be utilized to fund internal PCA II positions. • 15 million in additional 100% funding was authorized in the 2019 NY State budget to help address the waiting list crisis statewide. • The new allocation is based on county’s waiting lists. Specific county allocations and program instructions are due to be released in May 2019. • No additional County cost will be necessary.