Joint Finance Committee Hearing Fiscal Year 2012 Bill Love Division Director

1. Department of Health and Social ServicesDivision of Services for Agingand Adults with Physical Disabilities Joint Finance Committee Hearing Fiscal Year 2012 Bill Love Division Director Thursday, March 3, 2011

2. Division of Service for Agingand Adults with Physical Disabilities The mission of the Division of Services for Aging and Adults with Physical Disabilities is to maintain and improve the quality of life for Delawareans who are seniors or who are at least 18 years of age and have a physical disability. The Division is committed to providing services that maximize independence through individual choice, enabling persons to continue living active and productive lives, and to protecting constituents who may be vulnerable or at risk.

3. Overview & Accomplishments Agency 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)

4. Overview & Accomplishments Services Provided by DSAAPD Staff Services Provided by Contractors Programs Provided by DSAAPD Staff in Coordination with Contractors

5. Overview & Accomplishments Population Growth 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.

6. Institutional Bias in Delaware… Overview & Accomplishments Long Term Care Expenditure Patterns Community care costs Costs for institutional care About 87.5% of long-term care dollars for aging and physical disabilities are spent in facilities. Institutional Bias in the US… Community care costs Costs for institutional care About 66% of long-term care dollars are spent in facilities. Delaware ranks 38th among all states in the percentage of long-term care dollars spent on home and community based services.

7. Overview & Accomplishments Priority Initiatives

8. Overview & Accomplishments Aging and Disability Resource Center (ADRC) • 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

9. Overview & Accomplishments Rebalancing Long-Term Care • 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

10. Overview & Accomplishments Rebalancing Long-Term Care (continued) • 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

11. Overview & Accomplishments Organizational Restructuring

12. Overview & Accomplishments Organizational Restructuring (continued) • 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

13. FY 12 Governor’s Recommended Budget Base 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

14. Thank You.