ALABAMA DEPARTMENT OF SENIOR SERVICES FISCAL YEAR 2019
ANNUAL REPORTFISCAL YEAR 2019 ANNUAL REPORT 1 THE HONORABLE KAY IVEY GOVERNOR STATE OF ALABAMA
FISCAL YEAR 2018 ANNUAL REPORT | 1 STATE OF ALABAMA DEPARTMENT OF SENIOR SERVICES Dear Governor Ivey and Members of the Legislature, It is my pleasure to present to you the Alabama Department of Senior Services Fiscal Year 2019 Annual Report. ADSS strives to enhance and enrich the lives of Alabama’s senior and disabled populations by meeting a variety of needs, such as providing assistance with prescription drugs, ensuring that those eligible for the meals program receive nutritious food, supporting Alzheimer’s and dementia initiatives, teaming with the UAB geriatric dental project, and a host of other ways. In short, the goal of ADSS is to promote the dignity and independence of those we serve through a comprehensive and coordinated system of quality services. We deeply appreciate your strong support which ensures that our seniors and those who are disabled have the resources they need to achieve their goals and to live as independently as possible.
With warmest regards,
Jean W. Brown Commissioner
FISCAL YEAR 2018 ANNUAL REPORT | 1 FISCAL YEAR 2019 ANNUAL REPORT 1 OUR MISSION To promote the independence and dignity of those we serve through a comprehensive and coordinated system of quality services. OUR VISION To help society and state government prepare for Alabama’s changing aging demographics through effective leadership and stewardship.
OUR VALUES • Promote the worth, dignity, and rights of older and disabled persons • Promote the independence and self-determination of older and disabled persons • Promote the efficient and effective management and utilization of resources • Promote public support and input
The Alabama Department of Senior Services (ADSS) is a cabinet-level state agency with 49 employees. As a planning, development, and advocacy agency for the aging and disabled, ADSS advocates on behalf of our constituents and administers aging programs through thirteen Area Agencies on Aging (AAAs). Each AAA provides comprehensive services through contracts, grants, and through more than 300 senior centers in order to:
• Secure and maintain the independence and dignity of older individuals • Remove social and individual barriers to older individuals • Ensure the provision of a continuum of care for older individuals • Develop comprehensive, coordinated systems for older individuals
2 STATE OF ALABAMA DEPARTMENT OF SENIOR SERVICES ADVISORY BOARD
ADSS operates with an Advisory Board FISCAL YEAR 2019 that functions in accordance with the ADVISORY BOARD MEMBERS requirements of Section 38-3-2 of the Code of Alabama, 1975. This Advisory Ann Anderson Jackie Goggins Elizabeth Anderson The Honorable Jim McClendon Board is composed of the following The Honorable Billy Beasley Dr. Horace Patterson – Vice Chair members: two members of the State Billy Bolton The Honorable Rhondel Rhone Senate appointed by the President The Honorable K.L. Brown The Honorable Randall Shedd of the Senate; two members of the Dr. Steve Donald Candi Williams House of Representatives appointed Thomas Ray Edwards – Chair by the Speaker of the House; and nine members who are appointed by the EX-OFFICIO ADVISORY BOARD MEMBERS Governor and represent the following groups: one representative of Dr. Scott Harris, business, one representative of labor, Alabama Department of Public Health one representative of the medical profession, three representatives of Secretary Fitzgerald Washington, senior citizen organizations, and three Alabama Department of Labor responsible citizens of the state. The Commissioner Nancy Buckner, Alabama State Health Officer, the Alabama Department of Human Resources Secretary of the Alabama Department of Labor, and the Commissioner of the Alabama Department of Human Resources are ex-officio members of the Board.
FISCAL YEAR 2019 ANNUAL REPORT 3 INTRODUCTION
The Alabama Department of Senior Services (ADSS) is the state agency responsible for coordinating state and federal programs that serve Alabama’s senior and disabled populations. Since its inception, ADSS has been best known for its Elderly Nutrition Program; however, ADSS does much more. Our traditional focus is on the more than one million Alabamians who are age 60 and older. However, others who are eligible for ADSS programs and services include:
• Caregivers of older people;
• Caregivers of people of any age with Alzheimer’s disease or a related disorder with neurological and organic brain dysfunction;
• Grandparents or older individuals who are relative caregivers of children not more than 18 years of age or people of any age with a disability;
• People of any age who are residents of a long-term care (LTC) facility;
• People of any age with disabilities who qualify for the Medicaid Elderly and Disabled Waiver;
• Unemployed people age 55 or older who live at or below 125% of the federal poverty level; and
• Individuals age 55 or older or deemed disabled by the Social Security Administration and who are in the 24-month gap for Medicare with income below 200% of the federal poverty level and who have no prescription drug coverage.
4 STATE OF ALABAMA DEPARTMENT OF SENIOR SERVICES CONGREGATE AND HOME DELIVERED MEALS
One of the most successful community-based programs for seniors in ALABAMA America is the Older Americans Act (OAA) Elderly Nutrition Program. Through strong state and local partnerships with AAAs, nutrition ELDERLY service providers, thousands of dedicated volunteers, caregivers, and the private sector, the program provides more than 4.3 million NUTRITION congregate meals in senior centers and home-delivered meals to thousands of seniors every year. Alabama’s Elderly Nutrition Program PROGRAM depends on local community support to cover senior center costs and volunteers for meal delivery, program activities, and staff support. As with other OAA programs, the participants are given the opportunity to make voluntary financial contributions. The program also offers nutrition education and counseling to seniors.
Alabama’s Elderly Nutrition Program employs a statewide contract for meal service to senior centers and home delivery. A statewide contract provides efficiency and allows more people to be served. ADSS works closely with the food vendor and ensures all meals provided through its programs are varied, nutritionally balanced, and safe. On-site visits to senior centers by the ADSS Commissioner, Deputy Commissioner, and nutritionists, as well as AAA staff, coupled with the submission of weekly meal reports from the senior center
FISCAL YEAR 2019 ANNUAL REPORT 5 managers, provide needed food comments to the dietitians who oversee the food selections. The meals must comply with US Dietary Guidelines and provide at least one-third of the Dietary Reference Intake level of key indicator nutrients. The vendor provides hot, frozen, breakfast, shelf-stable, picnic, and liquid replacement meals to over 300 senior centers, serving approximately 18,000 meals per day. GA Foods, Inc. was awarded the state contract and provided the meals for the Elderly Nutrition Program in Fiscal Year 2019.
In addition, homebound participants also receive meals through this program. The homebound program serves frail, homebound, ELIGIBILITY CRITERIA FOR or isolated individuals who are age 60 and over, and in some cases, SENIOR CENTER NUTRITION their caregivers, spouses, and/or persons with disabilities. Through PROGRAM the GA Foods, Inc. food service contract, ADSS offers frozen and shelf-stable meals to Elderly and Disabled Medicaid Waiver clients • Age 60 and over throughout Alabama. These clients receive meals with the same nutrient standards as the OAA program meals. The frozen meal • Spouses of individuals age 60 statewide delivery program allows ADSS to meet the needs of the and over target population in all rural areas. • Persons under age 60 residing FISCAL YEAR 2019 ELDERLY NUTRITION PROGRAM in housing facilities primarily HIGHLIGHTS occupied by older individuals or in In Fiscal Year 2019, 4,350,945 meals were served to Alabama’s senior homes of clients age 60 and over citizens. Of those meals, 1,737,348 were served in a congregate setting at a senior center and 2,613,597 were home-delivered meals. • Individuals with a handicap or An additional 2,385,299 meals were served to Elderly and Disabled disability who live in public housing Medicaid Waiver clients. where the program is served
In May each year, Alabama honors Older Americans with festivals • Persons with a disability residing and activities throughout the state. Each event varies, but games, with an eligible client art, music, dancing, and food were all parts of the 2019 gatherings. The contract vendor works with each AAA to provide picnic meals or cookout meals for each function. Events can range anywhere from 100 to approximately 1800 participants in attendance. ELIGIBILITY CRITERIA FOR HOMEBOUND NUTRITION In addition to the provision of meals, nutrition education and nutrition PROGRAM counseling are two required services of the Older Americans Act. The Nutrition Team at ADSS provides quarterly nutrition education • Age 60 or older who are to the senior centers through colorful flyers and fact sheets. The homebound due to an illness or center managers discuss the information and provide education to incapacitating disability congregate and homebound participants. • The spouse of an older individual Each AAA contracts with a local dietitian to provide nutrition counseling. Counseling is provided when a participant indicates they (age 60+), regardless of age want to see a Registered Dietitian and after a physician’s order is • Frail, elderly individuals whose received. This service has been a focus area for 2019 and has seen increased participation. location or condition prohibits participation in a congregate senior center meal program
• Persons with a disability residing with an eligible client
6 STATE OF ALABAMA DEPARTMENT OF SENIOR SERVICES ALABAMA CARES
The National Family Caregiver Support Program (NFCSP), established in 2000, provides grants to states and territories based on their share of senior citizens. This funding provides services to assist caregivers with the duties involved in taking care of their loved ones. Alabama’s allotment under the Older Americans Act Amendment created the Alabama Cares Program, which is administered in Alabama under ADSS through the 13 AAAs.
The Alabama Cares Program provides services to assist caregivers with the duties involved in caring for their loved ones. Although caregiving can be tremendously rewarding, it can also have a detrimental impact on the health and well-being of the caregiver. Caregiving has its greatest impact on one’s emotional well-being. Caregivers of individuals with dementia and stroke survivors are at the highest risk for depression and anxiety disorders. Thus, the purpose ELIGIBILITY CRITERIA FOR THE of this program is to assist caregivers with the issues that may arise CAREGIVER PROGRAM from the role of caregiving. The NFCSP offers support for caregivers across the state by providing services through five basic areas: • Adult family members or other informal caregivers age 18 and older providing care to 1. INFORMATION SERVICES: A service that provides individuals 60 years of age and information on resources and services available to older or of any age if the person caregivers. has Alzheimer’s disease or related dementia 2. CAREGIVER ACCESS ASSISTANCE: A service that assists caregivers in obtaining access to the • Older relatives age 55 and older services and resources that are available within their (not a parent) providing care communities. to children 18 years of age or younger 3. CAREGIVER COUNSELING: Counseling for • Older relatives, including caregivers to assist them in making decisions and parents, age 55 or older solving problems relating to their caregiver roles. providing care for a child with a severe disability 4. CAREGIVER RESPITE: Services that offer temporary substitute support or living arrangements Priority is given to those with for care recipients in order to provide a brief period the greatest social and economic of relief or rest for caregivers. needs and older family caregivers providing care and support to 5. CAREGIVERS SUPPLEMENTAL SERVICES: Services persons with Alzheimer’s disease or provided on a limited basis to complement the care other forms of dementia, as well as provided by caregivers. related disorders.
FISCAL YEAR 2019 ANNUAL REPORT 7 OFFICE OF THE STATE LONG-TERM CARE OMBUDSMAN PROGRAM
Through funding under the Older Americans Act, the Office of the State Long-Term Care Ombudsman Program provides consumer advocacy protection services to individuals residing within nursing home facilities, assisted living facilities, specialty care facilities, and boarding homes. The Office of the State Long-Term Care Ombudsman Program has programmatic oversight of the local ombudsman representatives. The local ombudsman representatives may be employees or contract employees of the AAA. The State Ombudsman trains and certifies all ombudsman representatives. Ombudsmen work to resolve problems of residents and protect their rights by ensuring they receive fair treatment and quality care. Ombudsmen investigate and resolve complaints, educate residents, family, and facility staff, provide information to the public, and advocate to bring about changes at the local, state, and national levels through the practice of person- centered system change for residents in long-term care (LTC) facilities.
Alabama’s Office of the State Long-Term Care Ombudsman Program works with the Alabama Medicaid Agency to support Alabama’s Money Follows the Person demonstration called “Gateway to Community Living.” This partnership utilizes the ombudsman program to assist in transitioning eligible residents from LTC facilities back into the community. Ombudsmen conduct initial baseline surveys with residents prior to transition. They then follow the client after transition by conducting follow-up surveys at 11 and 24 months to ensure clients are receiving the services they need to remain in the community.
FISCAL YEAR 2019 The Office of the State Long-Term Care Ombudsman Program works OMBUDSMAN collaboratively with the Alabama Department of Human Resources Adult PROGRAM HIGHLIGHTS Protective Services Division and the Alabama Department of Public Health Bureau of Health Provider Standards to educate LTC facility staff, • 830 Cases Opened residents, and the general public as to how to report instances of abuse, • 1,679 Complaints Received neglect, and exploitation and to make referrals when appropriate.
• 286 Community Education The Office of the State Long-Term Care Ombudsman Program monitors all involuntary discharge notices issued to residents of LTC Events Held facilities to ensure that residents have the right to remain in facilities • 872 Consultations to Facilities when there is no appropriate discharge plan in place. The ombudsmen work with residents, family members, facilities, ADPH, and Medicaid • 1,526 Consultations to to ensure the best possible outcome in each case. Ombudsmen also Individuals assist with appeal letters as needed.
8 STATE OF ALABAMA DEPARTMENT OF SENIOR SERVICES An ombudsman representative received a referral from an Aging and Disability Resource Center (ADRC) specialist regarding a woman who was in extreme distress. According to the ADRC specialist, the caller was crying and said she was depressed and experiencing caregiver burn-out. The caller stated she was caring for her husband who has Alzheimer’s disease along with several medical ailments.
The ombudsman assisted the caller with her questions and how to best handle the situation. She confirmed the caller was the only caregiver for her husband. The caller stated she was having a difficult time caring for her husband due to a major fall she had recently had which caused serious injuries. The caller also disclosed that recently, her depression had become so extreme that she was contemplating suicide. The ombudsman immediately asked whether the caller had reached out to a counselor/ therapist to address her depression. The ombudsman provided additional information on various programs such as the Crisis Services of North Alabama and the Alzheimer’s Association, which provide support groups for caregivers who are dealing with caregiver burnout. The caller thanked the ombudsman for the suggestions which she said, “were extremely helpful.” She further stated she did not want to harm herself, but had been overwhelmed by her situation.
As requested, the ombudsman provided the caller detailed information about LTC facilities and the services they provide. Because the caller had expressed an urgent need to find placement for her husband in a LTC facility, additional information was given about the transfer process of entering a facility from home. The caller was aware that the process of placement into a facility from home was not a quick process, but stated that she had already unsuccessfully contacted several facilities in the Madison County area.
Because of the caller’s critical situation, the ombudsman contacted several LTC facilities to assess bed availability. After several calls, in three days the ombudsman found a nursing home that had an appropriate long-term bed available.
The caller expressed her gratefulness for the assistance she received from the ombudsman. She stated she had been at her “wits end” with having to juggle care for both her husband and herself. The caller expressed how relieved she felt that her husband will now receive the adequate supervision and care he requires on a daily basis. The caller stated she can now focus on her own recovery so she can be there for her husband.
In closing, the ombudsman assisted the caller with information about the role of the ombudsman, helped the caller with her own health crisis, and intervened in finding placement for her husband. She encouraged the caller to contact the local ombudsman again if ombudsman services were needed.
FISCAL YEAR 2019 ANNUAL REPORT 9 ELDERLY AND DISABLED WAIVER PROGRAM E & D
HOME AND This waiver program provides services to the elderly and individuals with disabilities. Case managers work with clients to develop a COMMUNITY person-centered plan of care based on the client’s medical needs. Depending on their plan of care, individuals in this program may BASED SERVICE receive personal care, homemaker, respite, adult day health, companion services, or home-delivered frozen meals. In Fiscal Year WAIVER 2019 ADSS served 9327 individuals on this program. PROGRAMS PERSONAL CHOICES Personal Choices is Alabama’s option for self-directed home and (HCBS) community-based services. It is designed to offer the elderly and individuals with disabilities more choices and flexibility in the type of care they receive. Clients enrolled in the program are able to use their allotted budgets to get the personal care they need, and they can also ADSS is the operating save for other items that improve their health. By the end of Fiscal agency for three Medicaid Year 2019, 2630 individuals were enrolled in the program. Waiver programs. These ALABAMA COMMUNITY TRANSITION ACT WAIVER PROGRAM programs provide home and community-based services The ACT waiver is designed to provide services to individuals with to individuals whose needs disabilities or long-term illnesses who live in a nursing facility and would otherwise require wish to transition to a home or community setting. The Plan of Care and Case Management services are based on individual client needs. care in a nursing facility. The The individual must have been in the nursing facility for 90 days or services provided through more and be expected to move into the community within 180 days these programs allow after the application date. ADSS works with Medicaid Transition individuals to remain in the Coordinators to facilitate the transition of clients from the nursing community. In order to access home back into the community. In Fiscal Year 2019 there were 263 waiver services, individuals individuals being served in this program and it continues to grow. must meet financial, medical, TECHNOLOGY ASSISTED WAIVER FOR ADULTS TA and program criteria. The TA waiver provides services to individuals age 21 or older with
In March 2019, a client fell and hit her head, causing serious injuries. At that time, she couldn’t feed herself, walk unassisted, or say more than an occasional word. She had a tracheostomy and a feeding tube. During her stay at the facility, the physician and therapists told the family they felt she had reached her maximum potential. Her family didn’t agree with ending therapy and knew she could progress more. The tracheostomy was removed, and she went home on Gateway with her husband and the support of her mother and twin sister. She quickly began to progress. The ACT Waiver has provided her with Personal Care, Homemaker Services, and Case Management for a year now. A year later, she can eat solid foods and can walk with her walker. She bathes herself with little assistance. She uses the restroom on her own during the daytime and her verbal communication has increased significantly. She enjoys calling and talking to her sister daily. Her family continues to work with her to improve her activities. She is a true success story achieved through the ACT Waiver.
10 STATE OF ALABAMA DEPARTMENT OF SENIOR SERVICES complex skilled medical conditions who are ventilator dependent or have a AGING AND tracheostomy and who would otherwise require care in a long-term care setting DISABILITY to remain in the community. The Plan of Care and Case Management services are based on individual client needs. ADSS RESOURCE provides targeted case management for the TA program. This program was CENTERS transferred to ADSS in April 2015, and is approved to serve 50 individuals, increasing to a total of 80 by 2020. Aging and Disability Resource Centers (ADRCs) provide a single “no Services include private duty nursing, wrong door” access point for information, long-term care options, personal care/attendant service, medical benefits counseling, referral, and follow-up for clients of all ages, supplies, assistive technology, and incomes, and disabilities. ADRCs also offer assistance with enrollment, targeted case management. In Fiscal counseling, referral, and follow-up to ensure the individual’s needs Year 2019, there were 36 individuals on are met. In Fiscal Year 2019 ADRCs across the state conducted this program and outreach is ongoing benefit enrollment events, farmer’s market voucher sign-ups, to expand waiver services to eligible diabetes prevention programs, and Mayfest to celebrate Older individuals. Americans Month. ADRCs also held dementia-friendly training for law INTEGRATED CARE NETWORK enforcement officers across the state. In addition to these statewide events, each ADRC also collaborated with partner agencies to conduct In Fiscal Year 2019, ADSS worked with the local events such as Santa for Seniors, AARP safe driver classes, Tai Chi Alabama Medicaid Agency to implement classes, Neighbors for Seniors, and various health fairs and workshops. a system of case management called Primary Care Case Management (PCCM), which promotes a person-centered approach to care delivery while assisting in the management of the medical ADRC SUCCESS STORY and Long-Term Services and Support (LTSS) needs of Medicaid clients. It A man contacted his local ADRC stating that he and his supports clients receiving LTSS in the wife needed food. They had struggled for a long time least restrictive setting of their choice. The program operates as a 1915(b) and couldn’t “hang on any longer.” He informed the waiver and includes participants in the ADRC worker that his wife was in very poor health and Elderly and Disabled Waiver Program said he had promised years ago in their wedding vows and the Alabama Community Transition that he would always be there for her. He stated that Program, as well as individuals residing promise had become harder and harder to keep. The in institutional settings. The program is client is a former minister and said that although the called the Integrated Care Network and community had been helping them as much as possible, the provider selected to manage the program is the Alabama Select Network. he didn’t want to burden them. The client and his The goals of the program are: wife were screened for ADRC benefits and the couple qualified for several programs. The biggest benefit they • Improved education and outreach were qualified to receive was the Medicare Savings about LTSS options Program, which pays for the Part B Medicare premium. • More comprehensive and This program alone saved them $270 per month. The integrative case management couple was extremely thankful for this help. • Increased percentage of the LTSS population residing in the HCBS setting
FISCAL YEAR 2019 ANNUAL REPORT 11 The Senior Medicare Patrol (SMP) program is designed to empower SENIOR and assist Medicare beneficiaries, their families, and caregivers to prevent, detect, and report health care fraud, errors, and MEDICARE abuse through outreach and education. Federally funded through the Administration for Community Living (ACL), SMP staff and volunteers build and expand the capacity of a trained, professional, PATROL statewide network of SMP volunteers. The SMP program responds to and resolves inquiries and reports of suspected fraud and abuse. Referrals of documented complaints are sent to the proper authorities which include ACL, CMS, and the Office of Inspector General. Reporting outcomes are required by the U.S. Department of Health and Human Services and the Office of Inspector General for tracking, cost avoidance, savings, and recoveries of the Medicare and Medicaid programs. Alabama SMP is also responsible for improving coordination of similar projects with other federal, state, and local officials. Alabama SMP has a multitude of key objectives that includes an increase in training to conduct statewide outreach, education, and technical assistance to Medicare beneficiaries. The program also provides annual fraud summits across the state in partnership with the Alabama Securities Commission. Through individual counseling sessions and community outreach, the SMP program served nearly 32,000 Alabamians in Fiscal Year 2019.
During a community outreach event, a Medicare beneficiary reported suspected fraud relating to genetic testing. Because of her report, multiple beneficiaries were educated on the approach utilized by scammers and were empowered to decline the fraudulent services. A major goal of the fraud summits and community outreach is to educate and empower Medicare beneficiaries to prevent health care PERSON fraud by creating a safe space to share their experiences and acquire CENTERED knowledge about Medicare-targeted frauds. LONG-TERM CARE
SUPPORT • Transition coordination that assists those who choose to participate with development and implementation of an SYSTEMS individualized transition plan • Assistance with costs related to transition, such as utility and rent deposits
The Alabama Medicaid Agency was awarded • Advocacy to increase the availability and easy access of safe, a Money Follows the Person Rebalancing accessible housing, and assistive technology resources Demonstration Grant from the CMS in • Resources for the promotion of employment opportunities October 2012. In Alabama, this program is called the “Gateway to Community Living.” • Option of Self-Directed Care Working in partnership with other long-term care providers and stakeholders, the services ADSS works with the ADRCs, the Long-Term Care Ombudsman and support for the transition of individuals Program, and targeted case management through the Home from long-term care settings to community and Community Based Services waivers for transition services as living are as follows: partners in the Gateway to Community Living Program.
12 STATE OF ALABAMA DEPARTMENT OF SENIOR SERVICES The State Health Insurance Assistance Program (SHIP) is intended to strengthen the state’s capability of providing STATE HEALTH all Medicare-eligible individuals with information, counseling, and assistance on health insurance matters. INSURANCE This grant from the Administration for Community Living (ACL) helps ensure that Alabama has a network of staff and volunteers to provide accurate and ASSISTANCE objective health insurance information and assistance to Medicare beneficiaries so that they can make informed PROGRAM/ health coverage decisions. SHIP counseling also helps beneficiaries understand related rights and protections MEDICARE under their Medicare coverage. IMPROVEMENTS The Medicare Improvements for Patients and Providers Act (MIPPA) is a grant provided by ACL. The purpose of the MIPPA grant is to support outreach and assistance FOR PATIENTS efforts directed toward Medicare beneficiaries with limited incomes. The specific target population for MIPPA AND PROVIDERS is Medicare beneficiaries who may be eligible for low- income subsidy or the Medicare Savings Program. ACT
There are currently 1,007,423 Medicare beneficiaries in Alabama who are enrolled in both Medicare Part A and Part B. There are 222,299 who are under age 65, many of whom require some assistance and counseling regarding their benefits and plans.
ADSS has an extremely effective partnership with the Auburn University Harrison School of Pharmacy (HSOP) for the SHIP and MIPPA programs. The partnership has two objectives, one of which uses SHIP funds, and the other which uses MIPPA funds. The SHIP HSOP project objective is to train pharmacy students to work during open enrollment as certified SHIP counselors at enrollment events. This student training program is extremely well received by all partners and ADSS intends to expand the program over the next several years due to its success.
Alabama’s MIPPA funding objective is to create a statewide education and outreach campaign to enhance awareness of Alabama’s local ADRCs and SHIP programs. Over the past six years, ADSS has had a unique partnership with HSOP utilizing MIPPA funds. In 2015, the partnership was expanded to include a new online continuing education pharmacist training system. This ensures that rural, underserved areas of the state have access to professionals with a knowledge base and awareness of SHIP and other core benefit programs offered through the ADRCs. ADSS expects to expand this beneficial program to more counties, and to partner with other programs.
FISCAL YEAR 2019 ANNUAL REPORT 13 SenioRx coordinators conduct outreach on an ongoing basis at SENIORX doctors’ offices, health departments, churches, community centers, senior centers, hospitals, health fairs, and workshops across the state. SenioRx is involved in benefit enrollment events as well as Medicare enrollment events on an annual basis. SenioRx also conducts outreach through social media posts, magazines, newspapers, radio, and television segments. In addition to statewide outreach and activities, SenioRx also conducts community events. This allows SenioRx to host events in rural counties with populations that are hard to reach and most at risk.
SENIORX SUCCESS STORY
“I think one of the most ‘pivotal’ outreach moments for us in Fiscal Year 2019 was when I was able to visit a local pulmonologist’s office. I have assisted several of their patients over the years, but when I was able to visit with the head nurse it was very helpful. This office serves patients from all our counties (it is located in the medical tower at our hospital). I was able to explain the different companies that offer inhalers and what the requirements for receiving them are. Since that meeting, there have been times when the nurse will call and say, ‘Okay, which one can we get them approved for without an out-of-pocket requirement?’ She really cares about her patients, and the office understands just how expensive the inhalers can be each month.”
The Masters Games of Alabama is a non-profit MASTERS organization dedicated to promoting healthy lifestyles for active adults age 50 and older through social, mental, GAMES and physical activities. The games were developed in Oxford, Alabama in 1989 to provide adults age 50 and older an opportunity to maintain an active lifestyle by participating in a variety of events. While the games provide an Olympic-type atmosphere, the focus is not on competition, but on fun and fellowship. Each year there are approximately 500 participants from across the state.
14 STATE OF ALABAMA DEPARTMENT OF SENIOR SERVICES The Alabama Senior Citizens Hall of Fame (HOF) was created in 1983 by the Alabama Legislature to honor Alabama citizens who have made ALABAMA significant contributions toward enhancing the lives of Alabama’s elderly citizens. In 2008, the HOF became part of ADSS. An induction SENIOR ceremony is held each year to honor new members into the HOF. Also honored are citizens who are 100 years of age or older and couples who have been married for 65 years or more. CITIZENS HALL OF THE SENIOR CITIZENS HALL OF FAME, CLASS OF 2019 Doris Ball Dr. Arlene Morris FAME Thelma Dianne Harris Meloneze D. Robinson Governor Kay Ivey J. D. Weeks Faye Lacagnina Herbert White John McMillan Agatha Sylvia Windsor
PERMANENT POSTHUMOUS
Thomas Champion
LIFETIME ACHIEVEMENT
Annie Bascomb Viola Lee Hollis Dorothy Bell Carol Knight Geraldine Seales Burford Sue Mathis Boyd Christenberry James Young
CENTENARIANS
Louise Callen Marquerite Logan JoAnne G. Casey Thelma E. Miller Annie Marie Heidt Crow Clara Neely Pearlie Mae Drake Lonnie Neely Etta Freeman Lula Mae Ott Ethel Graves Copeland Price OTHER AWARDS Edith S. Hallman Edna M. Peck Katherine Hightower Sara “Sue” Ruehl Joseph Dean – Public Service Ola Mae Hudgins Wallace Smith, Jr. Evergreen Freeman – Education Sallie B. Jackson Dessie O. Thomas Marshall Goggins – Military Jewel Keller Mary Alice Watson Don Greene – Public Service Nella King Eloise Wilson Dr. Dale Huff – Religion John “Jay” Jerman – Public Service Charlie Jernigan – Art 65TH ANNIVERSARY Richard LaGrand – Local Government Cleveland & Gertrude Barren Edward & Maude Jenkins Lawrence McRae – Medical William & Rosie Blue Orien & Wyvette Ledford Wilbert Payne – Military Reuben & Emma Cole Bud & Joy McDonald Dean Scott – Benevolence Tom & Donnis Cox Fettus & Faye McGriff Billy Jo Stallworth – Veterans Warren & Betty Dillard Bob & Diana Miller Kate Strickland – RSVP Norman & Winona Hale Lonnie & Clara Neely Guy Trammell – Community Service Harold & Louise Hartline David & Betty Sport Nancy Waller – Military Guy & Jeanette Holcomb Daisy Washington – RSVP
FISCAL YEAR 2019 ANNUAL REPORT 15 Demographic and other information was collected by a written survey UNIVERSITY OF completed by each participant. The dental and medical information was collected by examination and written records of each person. ALABAMA AT Third and fourth-year dental students from the UAB SOD, supervised by a UAB faculty member, performed the oral examinations, dental BIRMINGHAM cleanings, and provided one-on-one educational information. The UAB SOD faculty member provided a short educational program DENTAL at each rotation site that was linked to an oral health knowledge quiz. The participating seniors took a fifteen question Dental Knowledge PROJECT quiz prior to hearing the educational program and their individual examinations. After their oral examinations and appropriate dental cleanings, the participants were asked to complete a post-test to be able to compare their answers and see if their oral health knowledge had improved. Each participant was given written information about The University of Alabama the importance of oral health to overall health, as well as a brochure at Birmingham (UAB) School specific to dental health in addition to the oral presentation. of Dentistry (SOD) Geriatric Outreach Rotation (GOR), The UAB SOD examined 95 people at the senior centers and one with financial support from senior living apartment complex in 2019. Each of the participants received the complete exams, screenings, and dental cleanings the Alabama Department as detailed above. They also received home care dental cleaning of Senior Services (ADSS), supplies, including toothbrushes, toothpaste, dental floss, and oral has been tasked to provide health information. The participants who did not have teeth and wore oral health education, oral dentures were counseled about proper denture wear and were given examinations, dental cleanings, denture cleaning supplies.
oral cancer, and blood pressure The SOD found a significant level of oral disease in their examinations. screenings to senior citizens It ranged from soft tissue problems to decay to indications of in counties within a two-hour infection and severe periodontal disease. Several of the people were drive of Birmingham. The sites in need of prostheses (dentures or partial dentures) or had prostheses were chosen and support in need of repair, replacement, or relines. Many people had broken personnel were provided teeth or only remaining root tips in need of extraction and tooth replacement. Several of the people stated they were in pain the day by NARCOG (North Central they were screened, or had been recently experiencing pain. Alabama Regional Council of Governments), Central Alabama Many of those screened reported that they only went to a dentist Aging Consortium (CAAC), and when they were in pain because they could not afford the services. A M4A (Middle Alabama Area few reported that they had been to the emergency department of a hospital due to dental problems and pain. Overwhelmingly the main Agency on Aging), as well as the reasons these people did not see a dentist were due to the cost of the senior center managers. 2019 care and fear of procedures. was the third year the program has been operating and the The people with the most urgent dental needs were referred to the SOD urgent care clinic, the UAB/Fair Haven Oral Health Center, and second year the SOD has had another low-cost clinic in Birmingham. The people who had medical the portable equipment to issues that needed review were referred to their personal physicians provide onsite dental cleanings. for a consultation. These included suspicious skin lesions, high blood pressure readings, questions about medications, or other issues posed by the participant that were not appropriate for the SOD to answer.
16 STATE OF ALABAMA DEPARTMENT OF SENIOR SERVICES ADSS administers the Senior Community Service Employment Program (SCSEP) in eleven Public Service Areas (PSAs) throughout the SENIOR state. SCSEP is authorized under Title V of the Older Americans Act and is funded by the U.S. Department of Labor. COMMUNITY SCSEP is a community service and work-based training program for older workers that provides useful community services and fosters SERVICE individual economic self-sufficiency through training and placement into unsubsidized jobs. ADSS serves a coordinating role as the state grantee EMPLOYMENT and ensures equitable distribution of employment through its SCSEP program. SCSEP is a partner in the Workforce Investment Opportunity PROGRAM Act. ADSS’s mission is to do all it can to ensure that senior citizens who want to return to work can fill vital roles in today’s workforce.
Participants gain work experience in a variety of community service activities. Participants work an average of 20 hours a week and are QUALIFICATIONS FOR SCSEP paid the highest of the federal, state, or local minimum wage. This PARTICIPANTS: training serves as a bridge to unsubsidized employment opportunities for participants. No resource/asset limit is required. • Be an Alabama resident • Be age 55 or older
Approximately 253 low-income older Alabamians • Be unemployed received paid employment and training opportunities through the SCSEP program in Fiscal Year 2019. Of • Have an income level of less those, 91% reported that their physical health was than 125% of the federal the same or better than before they entered the poverty level. SCSEP program, and 75% reported that their outlook on life was a little more or much more positive.
The Legal Assistance Program is a statewide system of legal LEGAL professionals who assist older adults with personal legal problems. These legal professionals provide advice and counseling, legal ASSISTANCE representation, legal research, preparation of legal documents, negotiation, legal education, and community outreach to Alabama’s older adults. The Legal Assistance Program works on a non-fee- PROGRAM generating basis and strives to protect and secure the rights, benefits, and dignity of adults age 60 and older.
Older adults, especially those in poverty, are less likely to seek the The top services provided by advice of an attorney because often they do not have financial the Legal Assistance Program in resources to pay for legal services, or they do not realize they have a legal issue. Legal problems facing older adults are often more critical Fiscal Year 2019 were: than those facing any other segment of our population. • Powers of Attorney/Wills • Collection • Medicaid • Consumer/Finance • Guardianship/Conservatorship • Estate/Other Probate
FISCAL YEAR 2019 ANNUAL REPORT 17 ADSS is tasked by the State Legislature with establishing and overseeing ELDER the work of the Interagency Council for the Prevention of Elder Abuse. The Council’s mission is to strengthen partnerships to protect elders and raise JUSTICE AND awareness of elder abuse issues through education, advocacy, and outreach. ADSS has the responsibility to empower, protect, and advocate on behalf of the state’s aging population. The Council provides education and awareness ADVOCACY to seniors, their caregivers, professionals, and the general public on the rights of elders and elder abuse prevention. The Council meets bi-monthly and invites speakers who discuss topics related to elder abuse and elder justice.
Through the collaboration and work of the Council, Alabama passed some of the most stringent criminal elder abuse laws in the nation in 2013. In 2016 statistics showed that approximately 400 individuals had been prosecuted under the elder abuse statute. In 2017, the Council worked to pass another piece of legislation, the Elder Abuse Protection Order and Enforcement Act (EPFA), which further strengthens the law. This new law creates an expedient method by which elder abuse victims can obtain a In Fiscal Year 2019 there were protection order against their abuser/exploiter. It creates an enforcement 89 civil EPFA cases filed and mechanism allowing criminal prosecution for violation of an elder abuse 19 criminal violation domestic protection order. The Act also permits warrantless arrests for violations violence protection orders issued, of elder abuse protection orders under the same circumstances currently with 6 convictions. allowed for violations of domestic violence protection orders.
ALZHEIMER’S HELPING STATES SUPPORT AND DEMENTIA FAMILIES CARING FOR INITIATIVES AN AGING AMERICA INITIATIVE
The Dementia Friendly Communities In 2019, Alabama was one of six states (AL, IA, ID, NH, SC, and Project, better known as “Dementia VA) chosen to participate in an initiative related to family Friendly Alabama,” was adopted and caregiving called Helping States Support Families Caring for an has been sustained by the Central Aging America. The Center for Health Care Strategies, a non- Alabama Aging Consortium (CAAC). profit group based in Hamilton, NJ, is providing technical Alabama has adopted “Dementia assistance to states to help them achieve their goals to develop Friendly Alabama” state-wide to create strategies to support family caregiving. The project is funded welcoming, comforting communities by the John A. Hartford Foundation, the Milbank Memorial where those diagnosed with dementia Fund, the May & Stanley Smith Charitable Trust, and the Gordon and their caregivers feel respected & Betty Moore Foundation, and runs through January 2020. and supported and where they can live, age, and thrive. Through a state Alabama’s team is working to promote respite care and has grant provided by ADSS, CAAC has received recommendations for the Legislature regarding standards worked with other AAAs to expand this for respite providers. To address workforce shortage and with initiative statewide. support from Speaker of the Alabama House of Representatives Mac McCutcheon, the team is working to establish an educational/ certification pilot program through a local community college to help students get the needed training for working in respite care.
18 STATE OF ALABAMA DEPARTMENT OF SENIOR SERVICES FINANCIAL OVERVIEW: FISCAL YEAR 2019
ALABAMA DEPARTMENT OF SENIOR SERVICES FISCAL YEAR 2019 ESTIMATED PERFORMANCE In Fiscal Year 2019, ADSS expended approximately $160 million on aging programs. Approximately 20 percent of these expenditures came INDICATORS from the State General Fund, with the remaining 80% of expenditures TOTAL PERSONS coming from Federal (78%) or other sources (2%). The primary sources SERVED ...... 136,363 of the Federal funds were grants from the US Department of Health and Human Services, ACL, CMS, the US Department of Labor, and TOTAL REGISTERED programs administered by ADSS for the Alabama Medicaid Agency. PERSONS SERVED ...... 64,658
ADSS can proudly state that over 96% of its budget is used to provide Congregate Meals services to older Alabamians and individuals with disabilities. The Meals Served ...... 1,737,348 majority of services are provided statewide through grants to the Persons Served ...... 20,392 13 AAAs that, in turn, contract with local service providers. Not only Home Delivered Meals do these grants provide needed services to Alabama’s seniors, they Meals Served ...... 2,613,597 also add to local economies because the AAAs contract directly Persons Served ...... 16,463 with service providers in every county. In Fiscal Year 2019 the AAAs Total Meals Served ...... 4,350,945 contracted with over 400 direct service providers. By focusing on Total Persons Served ...... 36,855 keeping people healthy and independent, Alabama’s aging programs benefit the state as well as its citizens. Transportation Persons Served ...... 4,063 Under the Older Americans Act (OAA), ADSS provides services with 1-Way Trips ...... 429,602 the goal of promoting the independence and dignity of those we serve through a comprehensive and coordinated system of quality Assisted Transportation services. In Fiscal Year 2019, ADSS served approximately 4.35 million Persons Served ...... 174 meals at a cost of $15.5 million through our Elderly Nutrition Program Units ...... 6,026 (ENP) funded under Title III of the OAA. Included in this amount Legal Assistance is approximately $690,000 in funds received through the “John L. Persons Served ...... 6,696 Buskey Senior Meals Program.” These funds were derived from fees Units ...... 13,664 on distinctive driver license plates. Case Management Additionally, Alabama’s seniors provided $1.5 million in voluntary Persons Served ...... 6,636 contributions toward meals and other services. This money is Units ...... 18,533 reinvested back into the local programs from which the donations were received. ADSS also earns additional federal subsidies from the Chore Services Nutrition Services Incentive Program (NSIP) by serving meals that Persons Served ...... 40 meet one-third of the Dietary Reference Intakes. In Fiscal Year 2019 Units ...... 1,526
FISCAL YEAR 2019 ANNUAL REPORT 19 ADSS received NSIP funding of $3.3 million. In total, costs related to FINANCIAL ENP accounted for 10% of ADSS’s expenditures for services. Other aging programs comprised approximately 9% of Fiscal Year 2019 OVERVIEW: expenditures. These included such services as senior employment, FISCAL YEAR ombudsmen, legal services, transportation, and family caregivers. As noted earlier, ADSS was the Operating Agency for three Medicaid 2019 Waiver programs in Fiscal Year 2019. These waiver programs include the Elderly and Disabled Waiver (E&D), Alabama Community Transition Waiver (ACT), and the Technical Assistance Waiver (TA). The E&D Waiver represents the largest of the waivers with 9,205 slots available Adult Day Care annually. Additionally, ADSS expanded its Personal Choices program Persons Served...... 21 option under these waivers statewide in Fiscal Year 2019 from 1431 Units...... 10,336 to 2270 clients. The Personal Choices self-directed option is a popular program and enrollment is expected to continue to grow. Total Homemaker expenditures for all Medicaid programs totaled over $125 million with Persons Served...... 840 State Funds accounting for approximately $23 million of this total. In Units...... 27,636 Fiscal Year 2019, ADSS’s E&D and ACT Waivers were included in a new Primary Care Case Management (PCCM) model created by the Alabama Personal Care Medicaid Agency. This model was designed to promote a person- Persons Served...... 20 centered approach to care delivery while assisting in the management Units...... 366 of the medical and Long-Term Services and Support (LTSS) needs of Senior Medicare Patrol (SMP) Medicaid clients. The PCCM supports clients receiving LTSS in the least Persons Reached...... 31,966 restrictive setting of their choice. The goals of this program include:
State Health Insurance • Improved education and outreach about LTSS options Assistance Program (SHIP) • More comprehensive and integrative case management Persons Served...... 35,765 Units...... 62,044 • Increased percentage of the LTSS population residing in the HCBS setting
Senior Employment The Alabama SenioRx program provides the highest rate of return for Persons Served...... 228 its $1.7 million annual budget. In Fiscal Year 2019 the SenioRx program Number of Hours...... 128,583 assisted 8,629 older and disabled Alabamians, resulting in a savings of over $35 million in prescription drug costs. Evidence Based Health Prevention Persons Served...... 2,374 Number of Sessions...... 21,817 Hours...... 103,550 Supplemental Service SenioRx Persons Served...... 665 Persons Served...... 7,774 Units...... 14,643 Prescriptions submitted...... 40,931 Refills submitted...... 29,668 Long-Term Care Ombudsman Savings to Elderly & Disabled Cases Opened...... 830 ...... $35,914,213.48 Complaints addressed...... 1,679 Consultation to Individuals...... 901 Caregiver Program (CARES) Consultation to Facilities...... 1,642 Caregivers Served...... 8,535 Access Assistance Claims...... 5,194 Access Alabama (Aging and Disability Note: Persons Served Units...... 135,446 Resource Centers - ADRC) are unduplicated Education Persons Served...... 4,681 Persons Screened...... 29,272 except for ADRC Units...... 91,858 Contacts...... 50,398 Information and Respite Persons Served...... 1,368 Information/Referral Units...... 218,509 Referral
20 STATE OF ALABAMA DEPARTMENT OF SENIOR SERVICES ADSS ORGANIZATIONAL CHART
Governor Kay Ivey
Long-Term Care Ombudsman Division Jean W. Brown, Commissioner Virginia Bell State Long Term Care Ombudsman Director
Legal Division Deputy Executive Todd E. Hughes Commissioner Assistant
General Counsel Adam Thompson Stephanie Vaught
Medicaid Administrative Information Waiver and Finance Technology Public Programs Human Programs Division Division Nutrition Information and Planning Resources Division Division Division Division Division Todd Cotton Travis Wyatt Jean Stone IT Hardware Bobbie Morris Kathie Blaze Nick Nyberg Jessica Chief Fiscal Director Dollerson Assistant Officer Nutrition Public Programs Commissioner Karen Taylor Director Information and Planning Personnel for Medicaid Accounting IT Software Manager Division Chief Officer Waiver Director Director Programs ALABAMA DEPARTMENT OF SENIOR SERVICES 201 MONROE STREET SUITE 350 MONTGOMERY, AL 36130 www.AlabamaAgeline.gov f i l