National Perspective

1. National Perspective 2008 NW-AIRS Conference

2. ADRC Grantees

3. National Vision for ADRC Program • To truly embrace the vision of the Americans with Disabilities Act (ADA) – serve all ages & income levels • To continue the vision of President Bush’s New Freedom Initiative • To create synergies between the Aging Network and CMS to implement consumer-directed care • To increase visibility of long term support within state government • To offer a variety of different models for other states to replicate

4. National Expectations for ADRC Program • Broad mandate • Information & Awareness, Assistance and Access • Serve people of all ages and income levels, older adults and at least one target disability population • Specific expectations • Seamless system for consumers • Integrated access – streamlined eligibility • Shift of institutional bias – critical pathways • Meaningful involvement of consumers & other stakeholders • Partnership between Aging Network and Medicaid • Investment in MIS that supports goals of ADRC • Performance measurement – Continuous Quality Improvement (CQI), outcomes • Sustainability

5. Functions of an ADRC • Awareness & Information • Public Education • Information on Options • Assistance • Options Counseling • Benefits Counseling • Employment Options Counseling • Referral • Crisis Intervention • Planning for Future Needs • Access • Eligibility Screening • Private Pay Services • Comprehensive Assessment • Programmatic Eligibility Determination • Medicaid Financial Eligibility Determination • One-Stop Access to all public programs

6. What is Different about ADRCs? • Joins aging and disability communities • Coordination to determine commonalities and system overlap, and acknowledge differences and system gaps • Enhances outreach and availability of resources to previously underserved populations • Requires multiple partnerships on all levels • Practical strategy to do one stop shop concept • Leveraging of strengths • Makes effective use of technology to streamline access • Front end/Consumer-responsive systems (Web-based resource databases; online applications; decision support tools) • Back end/Administrative efficiencies (Information exchange protocols and software across partners)

7. What is Different About ADRCs? • Has strong consumer orientation • Make it easier for consumers to understand their options and get what they need • Simpler to navigate the system – high level of coordination and more uniformity and standardized processes to eliminate unnecessary steps • Offers more than information and referral • Follow through and tracking of consumers • Proactive response to consumers needs as they change over time • Focuses on appropriate setting for services & supports • Intervention in critical pathways • Options counseling • Conducts or facilitates eligibility for public programs

8. Background on ADRC Progress Based on ADRC-TAE Interim Outcomes Report, published November 2006. Features information on 2003 and 2004 grantees.

9. ADRC Coverage (as of January 2008) • Over 147 pilot sites open in 43 states and territories • Approximately 61 million Americans live in ADRC coverage areas • 28% of U.S. population • Over half of the 43 ADRC grantees have passed legislation, developed executive guidance, and/or contributed state funds to enhance/expand ADRCs. • 11 grantees have achieved statewide, territory, or district ADRC coverage • Alaska, Guam, Iowa, Kentucky, Minnesota, New Mexico, Rhode Island, District of Columbia, Northern Mariana Islands • Others plan to go statewide with 2007-08 grants or other funding

10. Target Populations Served

11. Sources of ADRC Pilot Site Funding Consumer and Other Charitable 5% 2% Private grants 2% ADRC grant 25% County or local government 8% State general revenue 18% Medicaid 13% Other federal funding Older Americans 12% Act (including NFCSP) 15% 2003-04 grantees, n =37 pilot sites

12. Urban/Suburban Rural Av g. Annual ADRC Pilot $1,399,129 $5,542,481 Site Operating Budget Annual Dollar Amount $9.77 $5.14 Budgeted per Resident in Service Area Avg. Total Full Time 8.75 FTE 18.96 FTE Equivalent (FTE) Program Budget

13. ADRC Staffing 2003-04 grantees, n=49 pilot sites

14. Management Locally-driven State-driven Organizational Structure Decentralized Centralized Three Dimensions of ADRC Model Type Mode of Consumer Access Physical Virtual

15. Distribution of Pilot Sites by Model Types

16. The Number of Individuals Served Continues to Grow, ADRC Contacts March 2004-March 2006

17. Average Monthly Enrollment per 1,000 Residents in ADRC Service Area 2003-04 grantee, n =5 grantees and 8 pilot sites

18. IT/MIS Challenges and Facilitators

19. Partnership Challenges and Facilitators

20. Staffing and Leadership Challenges and Facilitators

21. Streamlining Access Challenges and Facilitators

22. Consumer Involvement Challenges and Facilitators

23. ADRC Consumer Satisfaction “I feel the counselor will do everything she can for me.” “I like to get answers and this is where I know I can come for them.” “I got information I would not have otherwise known about.” 2003-2004 grantees, n=22 pilot sites

24. 24 Brochures and fliers Earned/unpaid media coverage 8 Health fairs 19 18 Newsletters and direct mailings Newspaper advertisements 16 Press releases 15 19 Provider forums and presentations Public forums and presentations 24 Public service announcements 12 12 Radio advertisements TV advertisements 13 Other 10 0 4 8 12 16 20 24 2003-2004 grantees, n=24 grantees Raising Visibility: Many Different Marketing and Outreach Strategies Used

25. Strategic Partnerships Play a Key Role in Establishing ADRCs

26. Elements and Activities of Partnership

27. 211 9 Advocacy or Consumer Group 9 Aging Services 24 Adult Protective Services 24 Disability Services 24 Employment 10 Housing Services 7 Medicaid 24 LTC Providers 9 SHIP 24 Social Security Administration 6 Social Services 12 Task Force or Advisory Group 5 Transportation Services 5 Other 24 0 4 8 12 16 20 24 Grantees Partnering with Different Organizations 2003-04 grantees, n=24 grantees

28. 15 Hospital Discharge Planner 13 Nursing Home/Rehab Facility 3 Emergency Room 9 Physician's Office Provider Association 12 6 Other Critical Pathways Any Activity 17 0 4 8 12 16 20 24 Reaching Out to “Critical Pathways” 2003-04 grantees, n=24 grantees

29. Other 2% Friends/ Family 26% Critical Pathways 55% Marketing Materials 17% Major Sources of Referral to ADRC 2003-04 Grantees, n = 35 pilot sites

30. Using Specialized I&R Software 17 Enhancing Client Tracking Systems 15 Integrating IT Components 11 2 Building New ADRC Websites 12 1 Enhancing Existing I&R Websites 4 9 0 4 8 12 16 20 24 State Level Both Levels Pilot Level Enhancement of Information Technology Capacity is a Major Activity of the ADRC Initiative 2003-04 grantees, n=24 grantees

31. Grantees are Making Significant Progress in Streamlining Access to Services

32. Streamlining Outcomes • Some ADRCs were positioned to integrate several of these screening and eligibility functions across programs with Medicaid and other entities, while others were more apt to streamline the process by closely coordinating with their partners. • The strength of the partnership between ADRC grantee and Medicaid agency is closely correlated with streamlining access. • The current division of responsibilities for eligibility determination makes achieving the streamlining access goal more difficult. • ADRC model type moderately influences the implementation of streamlining activities; management dimension has strongest correlation with streamlined outcomes. • State-driven initiatives were more likely to complete activities to improve the efficiency and timeliness • Decentralized structure is positively related to the completion of streamlining activities designed to improve consumer easeof access

33. Marketing and Outreach Lessons Learned • Need to find out how to see ADRC through the consumer’s eyes • ADRC planners & staff see things differently than consumers • How to ultimately sell the center to the public • ADRC name, Website name, Logo and tagline, Brochures • Communicate messages that are easy to understand, relevant and actionable • What do you want people to do? • What is in it for them? • Targeted outreach to the most likely consumers • Directly – word-of-mouth may be most effective • Through referrers -- hospital discharge planners, physicians, pharmacists • Mass media venues – radio, TV print

34. Sustainability Strategies • Strategies to Maximize Resources: • Securing Medicaid reimbursement – 19 of 24 grantees • Pursuing/Implementing cost share – 8 • Building private sector partnerships – 9 • Engaging in sustainability-specific strategic planning – 9 • Seeking private sector investment opportunities – 9 • Development of programmatic infrastructure • Standardized screening and eligibility determination processes • Continue to integrate project with broader systems reform • Expand responsibility for project success across stakeholder groups and agencies • Enter into formal partnership agreements with collaborating agencies and organizations

35. Implications • There is no one right model • IT/MIS Investment • Obtaining funding for ongoing investment in IT/MIS • Maintaining IT/MIS partnerships as ADRCs expand • Requires ongoing investment in staff training and learning to use new systems of information management – is staff intensive • Strategic Partnerships • Strategic partnerships, whether formal or informal, provide the supporting framework for the ADRC initiative • Solidifying relationships at the federal, state and local levels will continue to be important • The aging and disability communities need to strengthen and solidify their working relationships • Grantees are in the early stages of establishing systematic processes for empowering consumers and their families to make informed decisions about long-term support options

36. Implications, continued • Opportunities to have greater focus on health promotion and disease prevention • ADRCs are ready infrastructures to respond to new programs or times of need • By offering objective information and beneficiary enrollment support, ADRCs clearly played a vital role in the successful roll-out of Medicare Part D • Responsiveness during and after Hurricanes Katrina and Rita • ADRCs are important long term care system change agents an can served as catalysts at the state and local levels for other long-term reform efforts • Opportunity to educate policymakers and demonstrate beneficial outcomes to a greater extent

37. Resource Links • ADRC Technical Assistance Exchange: http://www.adrc-tae.org • Administration on Aging:http://www.aoa.gov • Washington State ADRC: http://www.aasa.dshs.wa.gov/professional/ADRC • National Information and Referral Support System: http://www.nasua.org/issues/tech_assist_resources/national_aging_ir_support_ctr/index.html

38. Questions? Susan Shepherd, Program Manager Washington State Unit on Aging Aging & Disability Services Administration Department of Social & Health Services shephsl@dshs.wa.gov 360.725.2418