You asked which New England and Mid-Atlantic states have made recent structural changes in how they address elderly programs and issues and why they made these changes.

SUMMARY

Recent changes have been made in four neighboring states: Maine, Maryland, Massachusetts, and Vermont.

Maine and Vermont have recently engaged in more consolidation affecting their state aging units, which were already part of larger departments. But while Maine has consolidated two large departments, one of which contained its Bureau of Elder and Adult Services, it is refocusing the bureau more on seniors by renaming it the Office of Elder Services and moving most services for younger disabled adults to other locations in the newly merged departments. In 2003 Massachusetts moved its Executive Office of Elder Affairs, which had been totally independent for many years and still remains a cabinet-level agency with its own secretary, under a broader umbrella agency, the Executive Office of Health and Human Services.

General reasons advanced for the mergers include (1) streamlining, integrating, and improving access to services; (2) cost-efficiency by reducing administrative and support costs; and (2) co-location of services at local offices.

Maryland is the only state in the region that recently (in 1998) created a Department on Aging.

OLR Report 2005-R-0800 provides more details on how these and other neighboring states approach aging issues and services, as well as links to their agencies’ websites.

MAINE

Maine recently renamed its Bureau of Elderly and Adult Services, which is located in the Department of Human Services, as the Office of Elder Services (OES). The change (not yet entirely completed) focuses the new office more on seniors by moving most services for younger adults with disabilities into other offices and better coordinating seniors’ services with mental health services, according to Catherine Cobbs, OES acting director.

This reorganization is part of a larger move in which the departments of Human Services (DHS) and Behavioral and Developmental Service (BDS) merged into a new Department of Health and Human Services. The change was authorized by legislation in 2004 and mostly completed in 2005. It was intended to meet several goals, such as streamlining, coordinating, and integrating services; eliminating the “silo” approach (where people have to go to several different agencies to get their needs met); and using a more “holistic” approach for providing services. For instance, under the old system, people who had mental health and other social services needs had to apply to both departments; the merger will apparently allow more coordination in meeting these needs.

The merger law emphasizes the need to “deliver programs and services through a coordinated and efficient administrative structure and an integrated delivery system that focuses on meeting the needs of individuals and families. ” To that end, the new department seeks to optimize efficiencies by co-locating DHS and BDS staff in state and local offices so they can work together to improve accessibility and service-delivery effectiveness. It seeks to provide a single point of entry for the full complement of services that will ultimately be available through the new department (PL 2004, Chapter 689; PL 2005, Chapter 412).

Within the newly merged department, OES will continue to provide Older Americans Act (OAA) services. It will also still manage programs providing seniors with home health and other supportive services, including homemaker services; congregate housing services (to be merged with homemaker services); Alzheimer’s respite; adult day care; Medicaid home and community waivers for the elderly; and the long-term care ombudsman program. For the Medicaid waivers, OES is the lead program agency and has programmatic responsibility for them, but the state’s Medicaid office writes policy (as directed by OES), handles claims, and reports on the waivers. OES also will continue to manage statewide nursing home preadmission assessments through a contract with a private company.

OES currently provides services for younger adults with disabilities and contains the federally funded Disability Determination Division, but many of these services will soon be moved elsewhere in the new department, according to Cobbs. OES will continue to investigate abuse of adults age 18 and over (including seniors), provide protective services, and run a conservator program. And it continues to be responsible for developing publicly assisted residential care facilities, assisted living facilities, and adult family care homes. But its facility licensing functions will be moved elsewhere.

While the general merger of the departments involves projected savings of $ 5 million in administrative and other efficiencies, there are no specific savings attributed to the changes at OES. These changes are being made to emphasize the office’s services to seniors rather than other groups and to better coordinate seniors’ services with mental health services for those who need them, according to Catherine Cobbs, OES acting director. Representative Jim Campbell was instrumental in the legislation creating OES and the refocusing of the office on seniors was also supported by AARP, according to Cobbs.

MASSACHUSETTS

Massachusetts’ Executive Office of Elder Affairs, established in 1973, is a cabinet-ranked agency headed by a secretary. Even though it was placed into a larger umbrella Executive Office of Health and Human Services (EOHHS) in 2003, it remains a cabinet-level agency and keeps its secretary, who still attends all cabinet meetings, according to Elana Margolis, Executive Office of Elder Affairs chief of staff.

Margolis provided us with a document that describes the 2003 reorganization and its results, “Elder Affairs Overview: Reform, Restructure, Revitalize: the New Executive Office of Elder Affairs,” July 2005, enclosed. In the foreword, Elder Affairs Secretary Jennifer Davis Carey describes it as the “most significant reorganization in their histories” for both the larger EOHHS and the Office of Elder Affairs. The changes resulted in elevation of the Office of Veterans’ Services to a secretariat affiliated with EOHHS and the creation of the following new offices in EOHHS: Office of Health Services; Office of Children, Youth, and Family Services, and the Office of Disabilities and Community Services.

Although Elder Affairs was placed under EOHHS, it received enhanced responsibility for long-term care services for elders that the former Division of Medical Assistance, Long-Term Care had administered. The purpose of the change, according to the secretary, was to “fully align the programmatic, fiscal, and policy components of support services for elders” … and to “reduce the fragmentation that previously existed in the service delivery system” for elders. The reorganization “brought together the management of Medicaid funding with the management of state funding for care coordination and non-medical support services that Elder Affairs had previously administered separately. ”

The report states that the Office of Elder Affairs administrative appropriation has decreased 26. 65% from FY 02 to FY 05 and currently represents less than 1% of total appropriated and federal expenditures (. 08%).

The Elder Affairs Office is the state’s designated unit on aging and receives federal and state money for its programs, which include the usual OAA services. The office coordinates local councils on aging. In addition, it (1) regulates and certifies assisted living facilities, (2) monitors and audits homecare corporations, (3) administers Medicaid long-term care for seniors, (4) works on policy issues for elderly housing, and (5) runs the state’s Prescription Advantage program for seniors and younger disabled people. For the latter program, the Office works with the University of Massachusetts Medical School, Commonwealth Medicine – Public Sector Partners, which provides enrollment and eligibility services, customer and call center services, premium billing, material development, production and mailings, plan design, and development of the information system and reports.

Elder Affairs Office services are administered through a statewide network of regional and local agencies. Twenty-seven nonprofit regional Aging Services Access Points (ASAPs) subcontract on the Office’s behalf with service providers for a broad spectrum of services; 23 area agencies on aging (AAAs), 20 of which are also ASAPs, provide OAA services. The Elder Affairs network also includes numerous volunteers and many other private and public organizations throughout the state, including 348 municipal councils on aging and 290 senior and drop-in centers, most of which are affiliated with councils on aging.

VERMONT

Vermont currently has a Department of Disabilities, Aging, and Independent Living (DAIL) in a broader umbrella Agency of Human Services (AHS). As a result of recent reorganizations, completed in 2004 and 2005, DAIL now consists of the following major divisions: Disability and Aging Services, Vocational Rehabilitation, Blind and Visually Impaired, and Licensing and Protection. The reorganizations were intended to streamline services and provide better access to them.

DAIL resulted from the consolidation of the former Department of Aging and Disability Services, which was in AHS, and other agencies. The former department had administered programs and services for seniors and adults with physical disabilities, including the OAA; Medicaid waivers (aged and disabled and traumatic brain injury); vocational rehabilitation; services for the blind and visually impaired; and licensing and protection. The new DAIL includes all of these plus developmental services, medicaid high technology services, and children’s personal care (which is part of the federal Early and Periodic Diagnosis and Treatment provisions of the Medicaid program).

Aging & Independent Living

Vermont’s reorganization began in 2003, which, coincidentally, was the first legislative session for the state’s new governor. The idea originated with Jane Kitchel, AHS secretary under the previous governor, and was adopted by the new administration, according to Stephanie Barrett of Vermont’s Legislative Joint Fiscal Office. In fact, the legislature hired Kitchel as a consultant (who, incidentally, is now a state senator serving on a legislative committee overseeing the reorganization). Act 45 of 2003 authorized the reorganization “process,” which was envisioned to take three to five years, as well as an oversight committee.

The reorganization was intended to streamline services and provide better access to them. According to Barrett, it was very plainly stated that it would not save money and, in fact, would cost more. The strategic plan for the AHS reorganization suggests that the “categorical structure” of the agency and resulting duplication of administrative functions and fragmentation of services to individuals and families also served as an impetus for the reorganization. Barrett asserts that the main reason for the addition of services was the desire to put all disability services (except for mental health) in one agency. She also noted that the change would bring more consistency in the way personal care services are delivered and paid for.

Since the reorganization affected the entire agency, Barrett notes that every advocacy group was interested and numerous public meetings were held during 2003 and 2004. DAIL deputy commissioner Joan Senecal notes that the aging advocates expressed concern about their interests being lost in an even larger department, but that these concerns abated and none have been expressed since then. The strategic plan points to a number of strategies the agency has employed to obtain comments from a broad range of interest groups. This effort culminated in a number of reports that AHS submitted to the legislature in early 2004.

It is too soon, suggest both Barrett and Senecal, to know whether the changes have been successful. Follow up surveys, the results of which are due soon, will show beneficiary satisfaction with the new agency.

MARYLAND: ONLY NEIGHBORING STATE THAT RECENTLY CREATED A DEPARTMENT OF AGING

Maryland’s Department of Aging, headed by a secretary of aging, was established in 1998. But it had already existed since 1975 as the Office on Aging, an independent cabinet-level executive branch agency, according to Mike LaChance, Aging Services Analyst in the department. Creating the department improved the visibility and coordination of aging issues, according to La Chance. One of the department secretary’s major tasks is to serve as an advocate across different departments and programs.

The department is the conduit for OAA funds and is designated the state’s unit on aging. It oversees the delivery of OAA programs, services, and benefits through the state’s network of 19 area agencies on aging, which are simultaneously county agencies on aging.

The department administers a number of home and community-based programs, including the Medicaid waiver home care program and a congregate housing services program. The Department of Health has delegated it authority to regulate small group homes for four to 16 seniors, and it also regulates continuing care retirement communities. It runs the Senior Information and Assistance Program, which provides a single point of entry for the elderly to various state services. It also has recently developed an Aging and Disabilities Resource Center, and has contained a health insurance counseling program for seniors since 1987.

A Commission on Aging advises the secretary of aging about the needs of the elderly in Maryland and the department’s work. In addition, an Innovations in Aging Services Advisory Council in the Aging Department advises the secretary on the annual Innovations in Aging Services Program Plan. The plan sets priorities for funding innovative aging services and training personnel who serve the elderly.

HN: dw