aging which have undertaken initiatives to coordinate long-term care programs for the elderly may be in good position to assume some responsibilities. Balance Between Long-Term Care Services and Other Aging Services Some observers are concerned about the development of long-term care services through the title III network at the expense of funding for other services that are perceived as essential to assist the non-frail elderly retain their health and independence. Such services include health promotion activities, congregate nutrition services, and senior centers. As some State and area agencies move further in the direction of managing home and community-based long-term care, some observers have become concerned about the balance between providing long-term care services and other services. In addition, in the past, others have expressed concern about the increasing interest by aging network agencies in the administration of case management programs. They have indicated that to the extent area agencies are involved in the direct administration of case management services within long-term care programs, other traditional functions of area agencies under title III, such as advocacy and outreach, on behalf of a broader elderly constituency may be compromised. The degree to which the elderly use any social services-senior centers, congregate and home delivered meals, and home care-is related to their functional and health status. A 1984 national survey by the National Center on Health Statistics (NCHS) obtained data on the use of community services by all persons aged 65 and over. The survey found that while a relatively small proportion of the total elderly population used any service, certain services were used more frequently than others. About 22 percent of the elderly, representing 5.8 million persons aged 65 or older, reported using one or more community services. Senior centers and senior center meals were by far the services most frequently used by older persons. Senior centers were used by about 15 percent of the elderly and senior center meals were used by 8 percent.16 Other research has demonstrated the importance of certain services to the subset of the elderly population who are functionally impaired. A 1987 national survey by the Agency for Health Care Policy and Research obtained data on the use of a variety of home and community-based services by the functionally inpaired elderly-including home care, senior centers, and congregate and homedelivered meals. The survey found that a little more than a third of the functionally impaired elderly received any service. Home care services were the riost commonly used services among those who used any service. Home care vas used on a regular basis by 20 percent of the impaired elderly compared to senior centers which were used by 7 percent, congregate meals by 6 percent, and home-delivered meals by 6 percent. 17 16Stone, Robyn Aging in the Eighties, Aged 65 Years and Over-Use of Community Services. Working Paper, no. 124, Sept. 30, 1986. National Center for Health Statistics. US. Department of Health and Human Services. 17Short and Leon, Use of Home and Community Services, 1990. Given increased demand for Federal and State funding for a growing elderly population, the future direction of support for various types of social services may depend upon what Federal and State policymakers view as higher priorities and on what the elderly themselves demand. Support for various Federal and State aging programs may also depend upon perceptions as to which groups of elderly should be given higher priority for services. I appreciated very much the opportunity to testify before your Senate Subcommittee on Aging an April 26 in Washington, D.C. I feel the reauthorization of the Older Americans Act is a very important event. I bpe I can be of some assistance to you in improving the Older Americans Act to best serve the older persons of our country. I would like to use this letter to expand on three points I discussed with you during the recent hearing in Washington, D.C. They are: (1) the issue of cost sharing; (2) Senator Pryor's recent amendments to the Older Americans Act; and (3) the Long-Term Care Resource Centers. Our First, the issue of cost sharing. I recognize that cost sharing will be a controversial topic during the Older Americans Act reauthorization. The state of Washington implemented a cost sharing mechanisa in 1976 when our state legislature established the state funded Senior Citizens Services Act. cost sharing system was developed using four principles congress may wish to consider if it requires cost sharing in the Older Americans Act: (1) use of a declaration method for determining income and resources rather than a means tests that requires in-depth verification; (2) allow persons below a certain income level to receive services free of charge; (3) use of a sliding scale for those who can contribute; and (4) determination of services that should not be subject to cost sharing, e.g., information and referral. I do not feel that the type of cost sharing procedure used in the state of Washington discourages low-income and minority persons from using our services. In fact, I believe our services are more focussed on the population in need than many other states. I encourage Congress to include a cost sharing requirement in the reauthorization language and allow states the flexibility to design the system focusing on those most in need with an emphasis on better serving low income and minority people. The second issue I would like to comment on is Senator Pryor's amendments to the Older Americans Act that you discussed at the Senate Subcommittee on Aging hearing. I feel the demonstration projects called for in the amendments could present problems for states especially in terms of long-term care eligibility. While the amendments clearly change the Older Americans Act, it is not clear in the language proposed that the Medicaid law would be amended to allow for agencies other than state agencies to perform the eligibility function for Medicaid. Also, it is not clear who is held fiscally responsible if Medicaid eligibility is not applied correctly-the Area Agency on Aging, the State Unit an Aging, or the State Medicaid Agency. In many states, the delegation of the assessment and eligibility function to non-state agencies would become a substantial union issue because these functions are now performed by unionized state employees. The third issue deals with the Administration an Aging funding for the LongTerm Care Resource Centers. As you are aware, State Units on Aging are increasingly trying to address the need for good long-term care systems. Currently, the Administration on Aging (AOA) funds six Long-Term Care Resource Centers that provide valuable technical assistance to states. I understand AOA intends to reduce the number of centers to only one at a lower funding level. I feel this is a mistake. If the Congress and the AoA truly want states to be significantly involved in long-term care issues, the states need assistance in long-term care system development and implementation issues. I encourage Congress to provide funding for the continuation of the Long-Term Care Resource Centers. Again, thank you for the opportunity to testify. If I can be of any further assistance, please call me at (206) 586-3768. Thank you very much for the opportunity to testify before your subcommittee on the most important issue of Long Term Care and the Older Americans Act. Through your efforts and those of other Congressional leaders policymakers are becoming aware that the futures of the Aging Network and Long Term Care are inextricably entwined. During our testimony you asked that we send to you the mechanisms we use to target our case management efforts. At the Region IV Area Agency on Aging we restrict case management to those persons with "multiple and complex needs." We use a pre-screening instrument, usually over the phone, to ascertain eligibility. Enclosed are copies of the form and the instructions for the use of the form. If you have any further questions about them, you or your staff may contact Tim McIntyre, our project manager. We appreciate very much the opportunities to help as you move toward reauthorization of the Older Americans Act. If we can be of any further assistance, please do not hesitate to call on us. Sincerely, Chalte Do Robert Doisen 2919 DIVISION ST. • ST. JOSEPH, MICHIGAN 49085 1-616-983-0177 1-800-442-2803 Care Management I. Description This is a guide to use in determining how to score each question on the Pre-Screening Tool. A score of 0, 1, 2, or 4 is given as point value or score to each question Definitions describing possible responses are presented below to determine a person's present situation or condition with corresponding point values for each. The tool is structured to be used for interviewing potential client's or referral sources. Ask all questions on the pre-screening tool Check yes or no for each question asked. Choose one answer (from the guide) for each question that best describes the client's present condition or situation. Record the corresponding point value or score for each response at the end of each question in the Comment and Score section on the right hand column of the page. Add comments as necessary to reflect the client's situation more definisively for your own use on the pre-screening tool. Add the total points or scores for all questions at the end of the pre-screening tool. If the total score is 20 points or above, the client is eligible for care management/PAS. If the total score is below 20 points, the client is not eligible for care management/PAS. Yes, but receives help as needed and assistance will continue.....Score = 0 2 Are there any stairs or other obstacles in your house that make No. Score = 0 Yes, is receiving help, but caregiver is stressed or assistance is not Yes, does not have assistance or help that will continue. . . . |