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Good morning all, I’m going to give you a presentation on a number of different things
that are initiatives that we have in AOA and some of the newer things that are happening
in our world.
But first, this is where I work. San Francisco is not rural and I won’t even venture to
think any differently.
But this is where I live. I live in rural central California one senior center transportation
is a senior bus. There’s no town bus service, there’s no home health, a few doctors, we
have one dentist, no specialist. The hospital or clinic is an hour and a half away and case
management is usually the meals and wheels driver. As one of my good friends in aging
used to talk about it, out here we have an abundance of scarcity. So why is rural health
and rural outreach important?
Briefly, there are 59 million people who live in rural America. That’s more than one-fifth
the US population, 75% of all the nations counties are rural representing 83% of the
total land mass in the United States. 38% of rural residents live in areas with no public
transportation and 1.6 million rural households don’t even have access to a car. There are
limited resources in work force which make doing more with less kind of the operation
of the day and the Medicare population is increasing by 10,000 persons a day. As this
population increases chronic diseases will increase calling for the need for more health
prevention and services at the community level. Nationally, to date we are seeing trends that
place more emphasis on medical social models of weaving health and human services to address
some of these issues.
To be brief I will only mention three of the many areas in which aging are currently involved
The Patient’s Protection and Affordable Care Act, or ACA as we call it, The White
House Rural Council, and the newly established Administration for Community Living.
The ACA, within the ACA there are several areas that address community aging and consumer
choice. Quite a few codicils you could look up that deal with rural itself. The first
one that I would take a look at though is the money follows the persons this is the
CMS Medicare initiative providing consumer choice by giving consumers the opportunity
of purchasing services that will keep them independent in their community. Two other
examples providing consumer directed choices are the aging and disability resource centers
and the newly let out grant programs of community care transition programs which I’ll talk
a little more in detail about later in the presentation.
The White House Rural Council was established in December of 2011 so it’s brand new. This
council will coordinate president Obama’s efforts in rural America performing three
core functions. It will streamline and improve the effectiveness of federal programs serving
rural areas, engage stake holders on issues and solutions in rural communities, and promote
and coordinate private sector partnerships. In HHS the representative to this council
is the Office of Rural Health Policy’s Tom Morris.
The Administration for Community Living - it’s hard for me to say that right yet it’s because
this was established earlier this month and this is the newly developed Agency that is
my new home. The agency holds beneath its umbrella the Administration on Aging, the
Office of Disability, and the Office of Intellectual and Developmental Disabilities. This agency
is the national progression for aging and disability communities. It supports and provides
new opportunities for the aged and the disabled, the families and caregivers.
What this all boils down to is a system of long term services and supports that provide
better quality, care, and cost—something that strikes a familiar theme with most people
at this point in time working in health and human services.
This is a diagram that shows the newly developed Administration for Community Living. I provide
this not only for illustrative purposes but to specifically point out the 10 regional
support centers in the middle in here. These centers cover the ten HHS regions and serve
as focal points for the aging network and liaisons for the states we serve. You can
learn more about AOA’s regional support centers by going to the AOA.gov website at
www.AOA.gov.
This is the aging network based on the Administration on Aging, State Units on Aging, Area Agencies
on Aging, 256 tribal organizations. This national network of state and local state holders public
and private provide millions of meals, personal care, case management and respite care to
seniors, caregivers, and their families. The network, especially the area agencies at the
local level, can be your new best friends in developing community partnerships.
Through our network, AOA programs and initiatives address our efforts for outreach to rural
areas and provide tools for the toolbox, for your toolbox to health and human service agencies
in the community. However, it is important to process this discussion that even though
the network casts a wide foot print on rural America it should be understood that many
but not all services are available in rural areas.
This is a list of the some of the home and community based and health prevention services
provided by the administration on aging. We start with six core services funded under
the older Americans act that are most familiar to people. One of those is supportive services,
which is a home community based service that links senior center activities, fund transportation
to some extent, case management and other supportive services to our nutrition sites.
Nutrition services are also funded under the older Americans act and most people would
know this by either the congregate nutrition centers or our Meals on Wheels programs. We
also fund disease prevention and health promotion services, care giver services that provide
information, support, counseling and respite care for caregivers and nutrition and care
giving services to 256 Native Americans, Native Hawaiians, and Native Alaskan tribes. We also
fund vulnerable elder rights activities such as the nursing home ombudsman, legal services,
and senior Medicare patrol programs. These core programs meet the mission of ACL in helping
people maintain the health and independence in their homes within their communities. Now
let’s talk about a few of the initiatives, aging and disability resources or ADRC. Why
do we have them? Well because the system, because of fragmented systems and referral,
multiple access points services and agencies eligibility criteria, and funding sources
navigating this system is difficult.
The number of long term service support options has increased dramatically over the last two
decades which gives more choice but also gives more confusion. A professional friend or a
family member may refer an individual to one known service, consumers then may never know
what other options are available. ADRCs build consumer trust through objectivity and by
enhancing individual choice through options counseling, supporting information and decision
making and streamlining the access process.
New to us in 2010 were the community care transitions programs they were established
out of the ACA section 20-36 as I said within the last two years. Transitional care is defined
as a set of actions designed to ensure the coordination and continuity of health care
as patients transfer between locations at different levels of care within the same location.
In many parts of the United States this program joins together a partnership of community
health centers with local non-profit organizations in many cases the local areas on aging to
reduce hospital readmissions and provide transitional care between community institutions and home.
New to us in consumer direction is our new Veterans Directed Home and Community Based
Service program. What is VDHCBS? It’s a program grounded in the evidence that based
on cash on counseling money follows the person model that we talked about a little earlier.
It’s a program that provides veterans of all ages with consumer directed home and community
based services options and empowers veterans to direct their own services and support.
It also supports families and family care givers of veterans and helps veterans stay
in their homes and be engaged in their communities. To date 23 states are working with 31 veterans
medical centers and 91 area agencies on aging and aging disability resource centers to link
673 veterans who are being served currently or have been served.
AOA also deploys a broad range of national distribution of health promotion and disease
prevention programs from local health fairs to sponsorship of chronic disease health management,
falls prevention programs, to support of people with Alzheimer’s disease, caregivers, and
their families. At AOA elder abuse has always been on our radar for quite some time.
And advocates have been trying for years to pass the Elder Justice Act. They were successful
in March 23, of 2010. Although not funded to date this act sects a place holder for
a range of programs and services and brings important federal leadership, coordination
and resources to a growing problem of elder abuse, neglect, and exploitation.
AOA also has additional support by funding a number of resource centers designed to provide
to consumers information and technical assistance to professionals on a variety of topic areas.
As you can see within the classification of information for professionals the resource
centers include a broad range of categories areas of emphasis to make it simpler to navigate
for more information on our resource centers you can go to the AOA.gov website.
In carrying out the services I’ve discussed AOA works through a large array of partners
through HHS and local rural communities this list is not exhaustive but names some the
many great organizations we partner with to bring structure to this diverse network. A
linchpin of all the AOA services are state units on aging regional centers and at the
local area on aging.
As you can see the areas agencies on aging are everywhere with the majority of them in
either a mix of rural and urban or rural areas. I like to talk about area agencies as the
best kept secret. You may know them as departments of aging, councils of government or the AAA
- not be confused with the car service but they may be in a county government, private
non-profit but they are out there. Bottom line they are our boots of the ground and
they are for you a valuable resource.
It’s all about the network we are fast entering an age of promoting health and human services.
Each group brings to this collaboration its own uniqueness, language, and culture. To
better serve our communities we will need all the tools we can get. And as I stated
before some services may not be offered in all the rural areas but we continue to endeavor
to provide the access to them.
In conclusion, if I were to leave you with one thought I’d like it to be that you have
new tools that now arm you with information that there is a network out there and there
are dedicated individuals who are eager to partner with you.
If I leave you with one request that would be to call them, get in touch with them contact
them make a connection.
Thank you
Thank you Dennis for setting that up so nicely. Dennis talked a lot about the network and
I’m going to draw on what he has been talking about to go into some more of the resources
that can be accessed through that network and some outreach strategies to reach rural
seniors.
So I’m going to go into a little bit more of a snap shot of some of these rural and
isolated seniors. I also want to focus on the relationship between health and economic
security for seniors because those are so intertwined for this population before I launch
into some of these resources and solutions. So, Dennis talked about the fact that about
20% of the people who live in rural areas are seniors.
And we know that according to the most recent census that about 14% on Medicare or over
the age of 65 do live in rural areas. But one of the really interesting things that
NCOA really likes to drill down is that not only just the people in rural areas but the
people that we talk about as being geographically isolated and we make a distinction between
just rural residents and the geographically isolated. Because the ones who are isolated
are those who live alone and they don’t live with a sort of network of family and
they live in communities with less than 20 people per square mile. So we’re talking
about the really extremely rural, living alone, may not know anything about this network and
resources out there and there’s over half a million of these seniors that are geographically
isolated. We know that they have a higher rate of poverty than just seniors in general.
Approximately 20% have income levels below the poverty level, below $11,000 a year. Now
what does the mean? Now obviously Dennis kind of identified some the barriers that are facing
rural seniors related to transportation and access to services.
But we also know that isolated seniors are more likely to skip meals because they don’t
necessarily have access to a grocery store or meals on wheels might not particularly
service their area or they might not know about that. We know they are less likely to
receive public benefits that they qualify for that can help them pay for some of those
food and prescriptions and home energy assistance. They are also more likely to keep their homes
at unsafe temperatures which can have an adverse effect on their health. And we know that many
of them, a higher number of them, have chronic conditions.
I want to talk about the relationship between health and economic security because we really
know that for people who have very little in income and resources they are far more
likely to suffer from chronic conditions. As you will see on this slide we know that
of the 56 million people who are over age 60 in this country 21.8 million have incomes
below 250% of the federal poverty level. That’s about $27,000 a year. Now, I know that if
you live in a rural area $27,000 a year may be quite a bit of money but we’ve really
identified this as being the kind of threshold because it’s usually when people are one
event away from economic catastrophe – a foreclosure, a job loss, or a medical crisis
and they are really sort of plunged into that poverty level. Now, 18.8 million of these
people have one or more chronic conditions and 14.5 million have more than two chronic
conditions. NCOA did a survey in 2009 about people with limited incomes and chronic conditions
and one of the things that the survey found was that 38% of those with a chronic condition
did not have the money to do things that would improve their health.
If we look at this next visual what you will see is that the most common chronic conditions
amongst this population - hypertension, arthritis, diabetes - are conditions that really have
a significant sort of economic impact. They’re expensive, they require medications if left
un-treated, they have significant cost ramifications as far as hospitalization and surgeries are
concerned.
So what can you do to connect people with some resources – Dennis mentioned one of
these already the chronic disease self-management programs.
These are for people who have chronic conditions and they’re really about empowering them
to manage those conditions and deal with those difficult symptoms. They are evidence based
developed by Stanford University and I’m happy to say that in addition to being offered
in the community through senior centers and area agencies on aging. NCOA recently received
a license to be able to offer it online so for people who live in rural areas who may
have fairly decent internet access. They are able to sign up for these for free and participate
in these programs. They are about six weeks long. You can see the sign up there www.restartliving.org
that website will also help people find community workshops if they prefer to do in person as
well. Another resource center I really want to point out and this is particularly useful
for people who may not have internet access who may feel far more comfortable trying to
connect with someone over the phone.
This is the elder care locator and this is funded through the Administration on Aging
it’s administered through the national association of area agencies on aging and it’s a toll
free number that people can call Monday through Friday and they can get connected through
what we call warm transfers meaning that even though they are calling a 1-800 number where
someone might be sitting in Washington, that person in Washington will get on the phone
with someone in rural Montana for example and connect them via the phone via three way
call to a person at an area agency on aging, an aging and disability resource center, any
one of those community resources that Dennis mentioned and they can get help with finding
financial assistance, figuring out how to apply for benefits if they need help with
health services or home repair or weatherization options, finding out about transportation,
legal assistance a wide variety of services and it’s really just a wonderful resource
and completely free. All you need to have is a telephone number and a telephone.
Another really wonderful resource out there are these State Health Insurance Assistance
Programs which are called SHIPs. These are federally funded but are administered in each
state and are required to provide free and objective counseling on Medicare and other
related benefits to people who have Medicare. And they are also charged with helping people
who have limited incomes to apply for specific benefits that help make Medicare affordable
such as the part D prescription drug low income subsidy and the Medicare savings program which
can help people pay their Medicare premium. SHIPs are also charged with educating seniors
about preventive benefits. There are a wide range of preventive benefits that are now
free as a result of the Affordable Care Act. The SHIPs are charged especially with going
into rural areas and talking to people about those and making sure that they use them because
they are there for them. All states have their own toll free number and many of them have
local offices including in the rural areas so if you want to get the details for your
state SHIP we encourage you to go to your medicare.gov and look it up for your state
but they are a wonderful resource. I want to point out a couple online resources as
well that are administered on the national council on aging now I know that I said before
that rural seniors don’t necessarily always have online access so some of these may be
useful depending on where you live but they can also be accessed pretty much anywhere
so If a person you’re working with, patients, or clients who are coming into your health
care facility or a clinic you can also sort of use these tools there.
NCOA has administered benefits check-up for 10 years now and this is a web based tool
that screens for over 2,000 public and private benefits so everything from food assistance
to prescription assistance to respite care to state tax relief programs and anyone can
use it and you can also use it to help a client or if you are a care-giver for an elderly
parent or a relative anyone can go on.
It will ask you a series of questions about income and health situations, drugs that you
are taking. At the very end of this screening it comes up with a list of all the programs
that a person is potentially eligible for as well as in very basic English kind of what
those programs are, as you see here. And how to get information about applying for them,
local resources if there’s a local office where somebody can go into apply for that
program it will tell you that address it’ll give the website for a program. Also, if the
application form is available online you can download it if its available in other languages
you can download it so it’s really a wonderful tool for people to use especially for those
of low incomes who may be eligible to receive lots of assistance and we’ve done some data
analysis with benefits checkup and really found that about 80% of the people who use
the tool are missing out on multiple benefits and really if they apply for these benefits
could save millions of dollars collectively millions of dollars every year.
Another tool that NCOA has launched is home equity advisor at homeequityadvisor.org and
this is for older home owners to look at and determine how to use and protect the value
in their home. So we’re not selling any products I want to make that perfectly clear
this is really a type of financial education tool. I don’t know if you can see well in
that screen shot but under the tab that says my situation people can look up information.
For example, if they have a disability and are looking at home repair or modification
because of that disability or if they’re potentially interested in a reverse mortgage
they want to check and see if that might be an option or facing unfortunately, foreclosure
or bankruptcy or trying to find cash for health or other expenses. There’s a little quick
check on this site that they can just fill in some information about what their situation
is and get the advice and learn where to go to for more information. As of yesterday we’ve
actually just launched this site in Spanish as well so if you go onto this site you will
be able to see the Spanish link for it.
Another tool that NCOA provides - we have funded 22 benefits enrollment centers across
the state now some of them are in urban areas but as you will see from the map here some
of them are actually working state wide in particularly rural states. For example in
west Virginia, in Maine, in Montana, and what these benefits enrollment centers are charged
with doing is being a one stop shop for people to access all of the benefits that they are
potentially eligible for. So it’s not just Medicare, it’s not just Medicaid they have
community networks with their Medicaid agency with their social security office, with their
food stamp office, with all those sort of administering agencies for benefit and the
person can go into or call the benefits enrollment center and really get a comprehensive screening
and assistance and follow-up to try and access those benefits. We’re really hoping to be
able to expand this into more geographic areas you’ll see at the very end of this presentation
the link to the NCOA site you can look up and see if there’s a benefits enrollment
center in your area and find the contact information.
So I do want to just emphasis a few really interesting and creative ways that we have
heard from not only from our benefits enrollment center but also from the aging network regarding
how to reach rural seniors and how they’ve been effective. So let me just highlight some
promising practices that we’ve heard from the field. In Manchester Township New Jersey
the township has a significant senior population and they have a commitment to helping the
vulnerable seniors in that population to access benefits and services.
What they did is the local area agency on aging kind of partnered with the 911 system
so like the police 911 call center and they developed this system of reverse 911 calls.
They identified households in this township that have seniors and used the 911 system
to make calls from 911 to the households to invite them to special breakfasts that were
being held at community centers as part of health fairs and to really tell them you know
you need to come to this were going to be helping people get farmers market vouchers
we are going to be helping people apply for food stamps it was an incredible success and
an excellent example of how the aging network and the kind of health clinic and the police
force actually partnered to reach this population. Many of you have probably been involved in
out stationing of workers at community sites we hear about this a lot and we know that
this continues to be a very successful practice a lot of area agencies on aging or senior
centers or anybody who is doing kind of health or benefits access work will connect with
community groups churches, for example, faith-based organizations, cultural groups particularly
if you are looking at an area with a high percentage of seniors who may come from a
different culture for example. In the pacific northwest there is a lot of rural Korean and
Asian seniors but being able to outstation someone at the sites - maybe it’s once a
week maybe it’s once a month, but helping answer questions, make referrals, do screenings
for benefits - has always been quite a successful tool for reaching those sort of rural seniors
getting them basically at an area or location where they already have trust in that community
site. In Maine, the area agency on aging and elder law services decided to use benefits
checkup in a really creative way they purchased these computers and printers in a really kind
of mobile rolling cart and they set up these mobile benefits kiosk and they partnered with
for example, Goodwill stores, Community centers, Churches, and driving around rural Main and
setting up these stations in libraries and all these places they would have a volunteer
set down with seniors in these areas and help them to complete a benefits checkup screening
and then follow up with them. They would provide a phone number where the person could follow
up as far as applying for the benefits but they had a tremendous success with that again
with reaching people where they are and not having to obviously rely on transportation
and that sort of thing. And something similar in Connecticut the SHIP program purchased
an RV thanks to a state pharmaceutical assistance grant and it was a wheel chair accessible
vehicle which they called “The Bus” and it’s equipped with a satellite dish for
internet access, it has four computer workstations, it has TV, VCR, DVD, all this kind of technology
and brochures and they drive around rural Connecticut and they use the Medicare plan
finder tool to help rural residents to select their prescription drug plans every year.
They would do benefits check-up screenings they will help people access the state Medicaid
system online and really do a lot of outreach and education through this bus. I know that
some resources are scare and not a lot of states can afford to get a bus but if you
do find a sort of partner organization that might be able to help with a grant for something
like that it’s a really wonderful and effective method to reach out to this population.
So with that I want to leave you with my contact information and again encourage you to visit
NCOA.org. A lot of these promising practices that I just mentioned are available on the
center for benefits website which is under NCOA.org if you want to look those up. As
well as more information on the benefits enrollment centers. You’re welcome to use benefitscheckup.org
do a test case use it with somebody you know. And again the homeequityadvisor.org if you
know patients or clients who are struggling to pay for issues related to their housing
that we encourage you to use that site. �