You asked what functions the area agencies on aging (AAAs) perform in regard to home care for seniors.

SUMMARY

All five regional AAAs in Connecticut engage in various home-care related activities funded by part of the federal Older Americans Act (OAA) money the state receives. They employ care managers to arrange services for clients and make grants to community providers for the direct services. These in-home and related services are provided under Title IIIb of the OAA and include payments for adult day care, chore services, and in-home health care and homemaker services for people over age 60 who do not qualify for such services under other programs. The Department of Social Services' (DSS) Bureau of Aging, Community, and Social Work Services (Bureau of ACSW) is the designated state unit on aging under the OAA. Within ACSW, the Aging Services Division administers the OAA grant programs and distributes the money to the AAAs according to a federal formula.

All five AAAs also administer the purely state-funded Alzheimer's Respite Care Program and the federally funded National Family Caregiver Act program (Title IIIe of the OAA), both aimed at families who take care of their frail older relatives at home. They do this in conjunction with DSS's Aging Services Division. Two AAAs (South Central and Southwestern) contract with DSS to serve as access agencies in their regions for the DSS Alternate Care Unit's statewide Medicaid- and state-funded Connecticut Home Care Program for Elders (CHCPE). Two AAAs (Western and Senior Resources in the eastern region) are involved in the federal Congregate Housing Services Program, which provides funding for in-home and related services at specific federally funded elderly housing complexes. Some AAAs also conduct private case management for people who do not qualify for any subsidized programs.

BACKGROUND

The federal OAA, first enacted in 1965 (42 U. S. C. Chapter 35, § 3001 et seq. ); funds programs for people age 60 and over. The act requires states, in order to receive this federal funding, to provide certain community-based services for the elderly, such as information and referral, counseling, outreach, congregate meal sites and home-delivered meals, transportation, long-term care ombudsman services, legal services, elderly protective services, and senior employment services programs. Each state must have a state unit on aging, designate planning regions and regional AAAs (which in Connecticut are private, nonprofit entities), and periodically develop a State Plan on Aging. The federal Department of Health and Human Services' Administration on Aging distributes the OAA funding to the states, administers the OAA programs, and advocates for seniors.

Connecticut's designated state unit on aging is the Bureau of ACSW. Connecticut has five AAAs (North Central, South Central, Western, Southwestern, and Senior Resources, which covers the eastern region of the state).

Each AAA creates its own area plan for spending the money it receives, and local service providers apply to it for funding their specific projects. It makes decisions about its level of involvement in home care, as well as other services, based on its federally required ongoing assessment of regional needs. Such needs assessment occurs formally through the Area Plan to Serve Region Elders process, which the agency conducts every four years. The five AAAs completed the plans for FY 06 to FY 09 in summer 2005. This process involved a three-stage needs assessment composed of a literature search, focus groups, and a structured questionnaire to interview seniors. The plans include procedural and historical information and objectives and strategies for the future in major areas of need identified through the assessment. AAAs also informally conduct on-going needs assessment through on-site visits to grantees, consumer educational and advocacy forums, participation on inter-agency councils and multidisciplinary teams, and the agencies' experience serving seniors in the CHOICES health insurance and counseling program.

AAA'S USE OF OAA FUNDS FOR HOME-CARE-RELATED ACTIVITIES (TITLE IIIB)

ACSW'S Aging Services Division in DSS administers the OAA in Connecticut and distributes grants to the AAAs according to a federal formula. AAAs use theseTitle IIIb grants to fund, among other services, in-home and related services. These include payments for adult day care, chore services, and in-home health care and homemaker services. These services are for people who do not qualify for such services under Medicaid or other programs. Title IIIb also covers other types of services, as shown in the grantees lists, which we have enclosed.

Examples of Home Care-Related Services

In FFY 05, the Western Connecticut AAA (WCAAA) provided 2,304 adult day care days, 89,792 units of chore services, 398,305 home delivered meals, and 19,112 units of trained volunteer friendly visitor services for homebound seniors through its grantees and contractors, according to Christine Fishbein, the agency's executive director. A “unit of service” is one meal or trip or one hour of chore, home health aide, or homemaker, or other services.

In FFY 05, the North Central AAAA (NCAAA) served 141 clients in the chore program, 96 in companion services, 582 in adult day care, 531 in homemaking services, and 231 in home health aide services, according to assistant director Maureen C. McIntyre. These are the overall number of clients using home care and home care-related services through a variety of programs, including Title IIIb.

The South Central Connecticut AAA (SCCAAA) served 54 people through its Bridge Program in FY 05. This older Title IIIb-funded project provides care management and payment for home care services for those ineligible for either the Alzheimer's Respite Program (see below) because they have no diagnosis of dementia or Title IIIE because they have no family caregiver), according to assistant director Kate McEvoy.

Senior Resources, in the Eastern Connecticut region, during FFY 05 provided 2,278 hours of companion services to 35 clients, 23,424 hours of homemaker services to 325 clients, 5,227 hours of home health aide services to 110 clients, 15,290 hours of hospice services to 387 clients, 944 visits for personal care assistance to 13 clients, 373 months of personal emergency response service to 47 clients, and 293,631 home-delivered meals, according to Joan Wessel, its executive director.

STATEWIDE ALZHEIMER'S RESPITE PROGRAM

The purely state-funded Connecticut Statewide Respite Care Program (also known as the Alzheimer's Respite Care Program) gives families who care for relatives with Alzheimer's or related disorders an occasional break by paying for up to $ 3,500 of respite services per year. Services can take the form of occasional in-home care, attendance at an adult day care center, or short-term stays in a nursing home. The program is run by the Aging Services Division in DSS, in partnership with the AAAs. Alzheimer's patients are eligible for this program if they have annual incomes under $ 30,000 and assets under $ 80,000. They cannot be receiving Medicaid or be eligible for it. Participants can receive the respite care in their home, at an adult day care center, or other out-of-home service (out-of-home services other than adult day care are limited to 30 days annually). There is no age requirement for eligibility, but these diseases affect more seniors than non-elderly people.

Potential clients are referred to the AAAs' care management staff, who send the client the brief application form. After the form is returned to the AAA, the care manager conducts an in-home assessment and if the client is eligible for the program, the AAA orders services consistent with the caregiver's wishes. The AAA then monitors the services, pays the bills, and collects the required 20% copayment.

Examples of Services

In FFY 05, WCAAA provided 103,086 units of service through its contracting process totaling $ 195,446 for 94 people with Alzheimer's or related dementia, according to Fishbein.   Senior Resources, which covers the eastern Connecticut region, has about 105 clients on the program, according to Wessel. SCCAAA provided respite care for 131 clients in FY 05 through this program, according to McEvoy.

AAA FUNCTIONS UNDER NATIONAL FAMILY CAREGIVERS ACT FUNCTIONS (OAA TITLE IIIE)

The National Family Caregiver Support Act, passed by Congress in 2000 as an amendment (Title IIIe) to the OAA gives grants to states to provide information and referral, training, counseling, respite care, and other supportive services to (1) people caring at home for chronically ill, frail, elderly relatives or relatives with mental retardation or other developmental disabilities and (2) grandparents and other relatives caring for children at home. The states must provide the services through their existing area agencies on aging.

Under the program, states must give priority to services to older people with the greatest social and economic need (with particular attention to low-income older people) and to older people who are taking care of relatives with mental retardation or other related developmental disabilities. Each AAA must coordinate its activities with community agencies and voluntary organizations providing similar services.

The DSS Bureau of ACSW's Aging Services Division allocates the money to the five AAAs through the existing OAA spending process and distribution formulas. AAAs or their contractors provide the services, which include caregiver counseling, help in accessing services, respite services, and limited supplemental services not available through other programs, as well as information and referral services.

Examples of Home Care-Related Services

In FFY 05, WCAAA provided $ 101, 327 in respite care services for 135 clients, as well as 50 training, educational, and support type events for caregivers and providers, according to its executive director, Christine Fishbein. It provided $ 69,845 in supplemental services to 187 clients, according to Fishbein, including payments for personal emergency response systems, lift chairs (which help people rise from a sitting position), chair lifts (which let people ride up stairs in a sitting position), home modifications to accommodate disabilities and durable medical equipment not financed by other sources.

Senior Resources currently has 95 clients on the program, according to Joan Wessel, its executive director.   A case manager on staff coordinates services, which can include respite, supplemental services such as assistance with special equipment or assistive devices, and services for a few grandparents on the program caring for their grandchildren.

SCCAAA provided respite services under Title IIIe to 129 clients in FY 05 and supplemental services to 138 clients, according to McEvoy.

CONGREGATE HOUSING SERVICES PROGRAM (CHSP)

This federal program, funded by the Department of Housing and Urban Development (HUD) tries to keep seniors living in specific HUD-funded housing out of institutions by providing and coordinating in-home and other services. Clients pay for the services, up to 10% of their adjusted gross income. Care plans are reviewed by a professional assessment committee, which includes medical personnel. The program requires assessments and monthly monitoring visits. Services are financed with a split of 40% HUD funds, 50% local sources, and 10% client fees.

The program is run through HUD and DSS Aging Services Division. WCAAA and Senior Resources are the only two AAAs involved in this program.

Examples of Services

In FFY 05, WCAAA provided direct services for 225 clients of HUD financed low-income housing with funds from HUD, Social Services Block Grant money, and client donations.

Senior Resources currently has about 70 clients on the program.   Its resident services coordinator coordinates services (including in-home services, transportation, and congregate meals for residents meeting specific eligibility criteria) for individuals living in seven specific housing complexes in Plainfield, Putnam, Danielson, Moosup, and Willimantic, according to Wessel.

ACCESS AGENCIES FOR CONNECTICUT HOME CARE PROGRAM FOR ELDERS

Two of the AAAs contract with DSS to serve as access agencies for the Alternate Care Unit's statewide Medicaid- and state-funded Connecticut Home Care Program for Elders (CHCPE). These are the SCCAAA (about 3,500 clients) and the Southwestern Area Agency for Aging (SWCAAA) (about 1,500 clients). Each agency employs both clinical (care management staff) and administrative staff (data, processing, billing) in support of the CHCPE contract. Another nonprofit agency, Connecticut Community Care, Inc. (CCCI), with 10,000 clients, is the access agency for the rest of the state.

The CHCPE program pays for home- and community-based services for infirm elderly individuals over age 65 who might otherwise require nursing home care and meet certain financial and functional criteria. It provides services such as in-home health care, care management, adult day care, adult foster care, homemaker, transportation, meals-on-wheels, minor home modifications, and certain assisted living funding services.

After the Alternate Care Unit in the Hartford office determines financial eligibility and does a quick health screen, it refers the applicant to an access agency. The agencies performs three primary functions (coordination, assessment and monitoring). Its care manager performs a thorough in-home assessment of the patient's situation, provides information about the program, helps the patient fill out required forms, and develops a care plan for the patient. If the patient agrees to the

plan, the agency arranges for the services, monitors their provision, and modifies them as needed over time. More details on the CHCPE program and the area agencies' role in it are available in OLR Report 2005-R-0931.

PRIVATE CARE MANAGEMENT

Western area seniors and younger disabled people who are not eligible for the CHCPE, OAA, or other programs can receive private care management from the WCAAA by paying privately for the services, according to Fishbein. The agency's staff registered nurse conducts a home assessment, negotiates services with the client and caregiver if applicable, and orders the services through the agency's regular contracting process. The client pays for the services directly. In the one and a half years this service has operated, the agency has served 88 private clients, according to Fishbein.

SCCAAA also provides private care management on a situational basis, according to McEvoy.

AAA WEBSITES

More information on each AAA is available at the following websites. Some have their FY 2006 lists of grantees (also enclosed) on the websites.

North Central Area Agency on Aging http: //www. geocities. com/ncaaaus/

Western Connecticut Area Agency on Aging http: //www. wcaaa. org/

Senior Resources http: //www. seniorresourcesec. org/. Grantees http: //www. seniorresourcesec. org/funding/grantees. html

Southwestern Connecticut Area Agency on Aging http: //www. swcaa. org/ List of 2006 grantees

http: //www. swcaa. org/grants/list-grantees. asp

South Central Connecticut Area Agency on Aging (also referred to as Agency on Aging of South Central Connecticut)

http: //www. agencyonaging-scc. org/About/about_sccaa. htm

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