EXHIBIT 2. Non-Metro Area Agency on Aging Mission Statement

Transcription

1 Part A: OVERVIEW OF AREA AGENCY ON AGING EXHIBIT 2. Non-Metro Area Agency on Aging Mission Statement Mission: The mission of the Non Metro Area AAA is to assist older individuals and individuals with disabilities to have access to comprehensive, coordinated and cost effective systems that are designed to assist in maintaining their independence. Goal: The goal of the Non Metro Area Agency AAA is take the lead to ensure collaboration and coordination is maintained through stabilization of the Aging Network providers and other community service providers; to assure overall commitment to access and excellence of services designed to meet the needs and enrich the lives of older persons and persons with disabilities. Objective(s) 1. Facilitate cooperative healthy relationships among the Aging Network providers, ( i.e. NM Aging and Long Term Services Department (NMALTSD), Aging and Disability Resource Center, New Mexico Behavioral Health Collaborative, Alzheimer s Association, Legal Service providers, Medicaid and Medicare, etc.) 2. Strive to make programs/services relevant and accessible to underserved communities to include the economically disadvantaged and those with special needs. 3. Coordinate trainings where feasible with other community providers (i.e. NM ALTSD Aging and Disability Resource Center, New Mexico Behavioral Health Collaborative, Alzheimer s Association, Legal Service providers, Medicaid and Medicare, etc.) 4. Encourage and work toward a seamless system of care that is easily accessible to include empowering older adults, their families, and other consumers to make informed decisions about existing health and long term care options. 5. Promote healthy aging and lifelong independence by coordinating with community agencies throughout New Mexico and NM ALTSD. 6. Promote and encourage preventative health care including lifelong health behaviors by making information available on a regular basis, working closely and coordinating with community service providers with the expertise and knowledge surrounding this topic. 7. Increase awareness and participation with Evidence-Based Disease and Disability Prevention programs for older adults at the local level Area Plan Exhibit 2 - Non Metro AAA Mission Statement Page 1

2 8. Improve and update, on an ongoing basis, the Area Agency on Aging web-site for easier access to information and services. 9. Increase opportunities for volunteerism and community involvement by working closely with the aging network to develop and implement a recruitment plan. 10. Require and ensure service providers utilize state -of- the- art management practices that will result in adhering to federal and state policies and the use of performance based standards and outcomes. 11. Ensure that services meet the needs of older individuals and disabled persons by: holding public hearings, conducting surveys, and seeking input from local citizens, their families and other service providers throughout the state. 12. Ensure that services and programs provided enable older people to remain in their own homes with a higher quality of life and less risk of premature institutionalization. 13. Ensure that the services and programs provided will empower older individuals to stay active and healthy. 14. Ensure that the services and programs provided secure and maintain the rights of older individuals and prevent neglect and exploitation. 15. Ensure that contractors are assisted and supported in their endeavors to provide community based services within their contract areas. 16. Ensure that contractors are held accountable for the services they deliver and that they adhere to contractual requirements, program policies and procedures, and organizational policies and procedures. 17. Ensure that the contractors, seniors, members of the Aging Network, Legislators, and other public and governmental entities are informed and educated on the needs and requirements of the senior and disabled population in the state so that they can effectively advocate on their behalf. 18. Ensure that social or individual barriers, such as income, gender, ethnicity, inability to speak English or disability does not interfere with the provision of, or the access to, services Area Plan Exhibit 2 - Non Metro AAA Mission Statement Page 2

3 Part A: EXHIBIT 3a. OVERVIEW OF AREA AGENCY ON AGING AAA Organizational Structure AAA Advisory Council Santa Fe Office Deming Office AAA Director Tucumcari Office Taos Office AAA Asst. Director Clovis Office Records Mgr. /Accountant Assistant NCNMEDD Executive Director Accountant Specialist PT-Clerical Support (SEP) SEP Manager/LTC Manager (Clovis) Consultant Compliance Data Manager Specialist Santa Fe Office AAA Director Deming Office 3 Client Tracking Specialist Taos Office Clovis Office Assistant AAA Director Tucumcari Office 3- Tracking Specialists ½ Nutrition Manager (Clovis) 2 1/2- Client Tracking Specialist (Clovis) ½ - Client Tracking Specialist 1 ½ Client Tracking Specialist Area Plan Exhibit 3a - Non Metro AAA Organizational Structure Page 3

4 The staffing needs of the Non Metro Area Agency on Aging are: A full time Nutritionist to ensure compliance set forth by the Older Americans Act. As result of the reductions in the past three (3) years the AAA was forced to cancel a contract with Global Nutritionist Services. Three (3) full time positions have been lost as a result of the loss of funding in the past three (years). Filling these positions are critical to fully implement compliance of the Four Year Area plan. In addition, three (3) full time client tracking specialist are needed to fully implement data entry for all service providers at Non Metro AAA. This would ensure that the five (5) programs (City of Las Cruces, City of Alamogordo, City of Santa Fe, Rio Arriba County and Chaves JOY) would be transitioned into Non - Metro AAA for date entry Area Plan Exhibit 3a - Non Metro AAA Organizational Structure Page 4

5 PART A: OVERVIEW OF NON METRO AAA EXHIBIT 3 b. Sponsoring Agency Area Plan Exhibit 3b - Non Metro AAA Sponsoring Organization Page 5

6 Part A: EXHIBIT 4a. OVERVIEW OF AREA AGENCY ON AGING Non-Metro Area Agency Advisory Council Composition of Advisory Council Advisory Council Members Age 60 or Older Total Minority Total with Disabilities Total Caregivers Total Age 60+ Black Age 60+ Hispanic Age 60+ Asian Age 60+ Indian Age 60+ Disabilities Age 60+ Income Age 60+ Recipients Age 60+ Total Members Advisory Council Name Organizational Affiliation County E. Glenn Hancock Amer. Legion, VFW, UNM Alumni, Teacher retired Catron Vacant Chaves Richard L. Mace Elks Board of Trustees Cibola Bill Hickman Chairman, Colfax County Senior Programs Colfax George Lee Curry Bea L. Killough DeBaca Marsha Anne Burr City of Las Cruces Advisory Council Member Dona Ana Vacant Eddy Vacant Grant Vacant Guadalupe Leroy Maes Senior Citizens Harding James Hassenger Senior Center-HMS Hidalgo Betty C. Rickman Treasure Chamber Lea Sue Garrett City Council Candidate Lincoln Vacant Los Alamos Martha J. Skinner Deming Luna Board Member Luna Joe Vargas Participants at Senior Centers McKinley Ruth M. Ford Senior Center, Alcohol Treat. Ctr. Board Mora Norma Andreoli Alamogordo Mayor's Committee on Aging Otero Christopher Maestas Retired Educator Quay Edward E. Mose Treasure Senior Center Rio Arriba Joyce Cox Foster Grandparent volunteer Roosevelt Ward Keller Sandoval Senior Program Council-Alternate Sandoval Raymond Huffman Blanco Senior Center Advisory San Juan Francis Gonzales Senior Center Council Member San Miguel Vacant Santa Fe Tony Mc Robert South Central Council of Governments Sierra R.J. Griego County Commissioner Socorro Area Plan Exhibit 4a - Non Metro AAA Advisory Council Page 6

7 Aaron A. Eichwald Taos County Board Member Taos Gloria S. Pohl Secretary/Treasurer Estancia Senior Citizens Torrance Edwin Neil Bush Historical Society, Library Board, and Retired Union Wayne Gallegos Elected City Official Valencia Area Plan Exhibit 4a - Non Metro AAA Advisory Council Page 7

8 Part A: EXHIBIT 4b. OVERVIEW OF AREA AGENCY ON AGING Advisory Council Dates Below is a list of all Advisory Council meeting dates schedule for SFY September 27, 2012 March 28, 2013 September 26, 2013 March 27, 2014 September 25, 2014 March 26, 2015 September 24, 2015 March 24, Area Plan Exhibit 4b - Non Metro AAA Advisory Council Dates Page 8

9 Part A: Overview of Area Agency on Aging EXHIBIT 5. Public Meetings Regarding Area Plan 1. Location of Public Meeting Attendance Date a. Clovis 51 February 6, 2012 b. Deming Senior Center 15 February 7, 2012 c. Santa Fe Rodeo Grounds 159 February 8, 2012 d. Tucumcari Convention Center 16 February 9, 2012 Participants were also given the opportunity to submit written comments at all locations. 2. Methods used to publicize meetings: s to all providers Newspaper Advertisements (i.e. New Mexican, Albuquerque Journal, Las Cruces Sun, etc.) Radio Public Service Announcements Flyers posted at all senior centers Flyers sent to other agencies Amber Care Hospice Arroyo Vista Senior Living Gila Regional Home Health Services Mimbres Memorial Hospital Coordinated Care Health Border Area Mental Health Services Mountain Shadows Home Health Care At-Home Personal Care Service, LLC Beehive Assisted Living Be Archer Health Center Mimbres Valley Home Health and Hospice 3. Description of how meetings were conducted: Non-Metro AAA (NM AAA) staff from each of the PSA s facilitated the public hearings at all the locations. Non Metro AAA introduced the staff and the audience introduced themselves and the agency or program they were affiliated with. The facilitator then described the purpose of the Public Hearings and the process that would be followed. The facilitator then begin the slide show presentation, the audience was given a copy of the slide show Area Plan Exhibit 5 - Non Metro AAA Overview of Area Agency on Aging Page 9

10 The slide presentation included the following information: A description of the Non Metro AAA and its role as it relates to programs and seniors. A description of what Non Metro AAA does to identify, educate and advocate on behalf of seniors. A description of the role of Non Metro AAA in developing a comprehensive service delivery plan, based on the intent of the Older American Act of 1965, the Aging and Long Term Service Department and the service system available through Non Metro AAA. A description of the current contractors with Non-Metro AAA which include: Non-profit, for profit, cities, counties, villages and towns. The facilitator also explained the role of Non Metro AAA in regard to ensuring contract compliance which includes but is not limited to policies, rules, regulations, monitoring, program assessments, program visits, meetings and technical assistance. NM AAA conducts these public hearings to listen, document and address the needs identified at the hearing. The facilitators described the current services contracted through Non Metro AAA which include: congregate meals, home-delivered meals (lunch, evening and weekend); assisted transportation, transportation, adult day care services, chore, respite, homemaker, case management, health promotion, home safety and grandparents raising grandchildren. The facilitators also explained that not all services are available in all programs. The programs themselves determine what services they will be providing. The organizational structure from the Federal level to the consumer level was reviewed. The organizational structure also included the flow between the Aging and Long Term Service Departments, Planning and Service Areas, North Central New Mexico Economic Development district and Non-Metro AAA and the 32 counties. 4. Summarization of comments from public meetings: Planning and Service Area II (PSA II): Summary of Comments: (86% of those that attend were 60+ seniors) Can a 50 year old disabled person qualify for Title III services? Who determines funding allocations to the programs? There is a need for low cost senior housing. There is a need for congregate meals in smaller more rural communities. A need for more diabetic friendly meals. A need for chore services. A need for handicap accessible vans. A need for Adult Day Care Services in the rural areas. A need for more entertainment at centers Area Plan Exhibit 5 - Non Metro AAA Overview of Area Agency on Aging Page 10

11 A need for menus that are more culturally sensitive without so many restrictions to avoid waste. Facility expansions and renovation and new facilities. Parking expansion. Better wages for staff as well as more hours. More funding for in-home support (Homemaker-Respite). Technology (Computer up-grades). A need for more transportation services to take seniors to medical appointments in the area and out of town. Need funding restored for home-safety services. That consideration is given to menu planning which would include soup and salad bars to draw in younger seniors. The need to streamline reporting requirements by using technology such as swipe cards to sign-in instead signatures required for each service. More grandparent raising grandchildren funding. The need for food stamp advocacy seniors who qualify who are getting as little as $20. Priorities were voted on by the audience were in order of importance: SERVICE PRIORITIES: Provider: 1. In-Home Services-Homemaker City Santa Fe, County of Rio Arriba, & County of Santa Fe 2. Respite Care (In-home/Adult Day Care) County of Rio Arriba, Open Hands Inc., Addus Healthcare, & Northwest NM Seniors, Inc. 3. Home Safety Issues Open Hands, Inc. 4. Menu Planning and flexibility Ancianos Inc., Mora, Northwest NM Seniors, Inc., County of Rio Arriba, & County of Santa Fe 5. Transportation Services Ancianos Inc., County of Rio Arriba, County of Santa Fe & Addus 6. Assisted Transportation Ancianos, Inc., County of Rio Arriba, County of Santa Fe & Addus Healthcare, Inc. 7. Visually Impaired Services Addus, Healthcare, Inc. 8. Better Wages for Staff Ancianos, Inc. 9. Grandparent Raising Grandchildren City of Santa Fe 10. Recreation County of Santa Fe Area Plan Exhibit 5 - Non Metro AAA Overview of Area Agency on Aging Page 11

12 CAPITAL OUTLAY 11. Capital Outlay Needs a. New Buildings Ancianos, Inc. b. Repair/Renovation old buildings Ancianos, Inc. c. Handicap Vehicles Ancianos, Inc., County of Rio Arriba, & County of Santa Fe d. Regular Vehicles Ancianos, Inc. & County of Rio Arriba e. Parking Lot expansion Ancianos, Inc. f. Technology (computers) County of Rio Arriba & Northwest NM Seniors, Inc. 1. Grocery Assistance (CHAS) County of Santa Fe,Ancianos, Inc., Mora, City of Santa Fe, & County of Rio Arriba 2. Utility Assistance (CHAS) County of Santa Fe, Ancianos, Inc., Mora, City of Santa Fe & County of Rio Arriba 3. Prescription Support (CHAS) County of Santa Fe, Ancianos, Inc. Mora, & County of Rio Arriba 4. Debt Assistance for Seniors Ancianos, Inc. 5. Food Stamp Advocacy City of Santa Fe 6. Low Income Housing Ancianos, Inc., County of Rio Arriba, & County Santa Fe 7. Medicaid Financial Assistance City of Santa Fe All the audience wanted to see the continuation of congregate and home-delivered meals. Planning and Service Area III (PSA III): Summary of Comments: Adult Day Care. Help for grandparents raising grandchildren. What is available for D&E Waiver Clients? Stop the waiting list or evaluate the waiting list on a more regular basis. Safe affordable housing for seniors only. Food Stamps processing and amount. Medication Banks to be more accessible. Transportation for the Medicare population. Assisted Transportation. Diabetic Menus. Chore Services. Homemaker Services Area Plan Exhibit 5 - Non Metro AAA Overview of Area Agency on Aging Page 12

13 Personal Care. Senior Center community involvement. Caregiver Program. Utility assistance Priorities Tucumcari Public Hearing SERVICE PRIORITIES: Provider: 1. Assisted Transportation (Medical) City of Tucumcari 2. Diabetic Menus City of Tucumcari 3. Chore Services City of Tucumcari 4. Homemaker Services City of Tucumcari 5. Personal Care City of Tucumcari 6. Caregiver Program City of Tucumcari 7. Utility Assistance (CHAS) City of Tucumcari 8. Senior Center Community Involvement City of Tucumcari Priorities Clovis Public Hearing SERVICE PRIORITIES: Provider 1. Expand program to shorten waiting list for in-home (homemaker services) La Casa de Buena Salud, Inc. 2. Transportation for medical appointment in-town and out-of-town La Casa de Buena Salud, Inc. 3. Adult Day Care Clovis Home Care 4. Evaluate waiting lists for programs La Casa de Buena Salud, Inc. 5. Help for grandparents raising grandchildren Not Identified 6. Food stamps application process and amount received La Casa de Buena Salud, Inc. 7. Safe and affordable housing for senior residents. La Casa de Buena Salud, Inc. 8. Assistance with medication programs such Med Bank. La Casa de Buena Salud, Inc. 9. Waiting lists for CLTS Waiver Program through Aging and Long Term Services Dept. La Casa de Buena Salud, Inc. Planning and Service Area IV (PSA IV): Summary of Comments: Lack of funding for medical transportation. A need to have service delivery at meal site five days a week. Can funding that is not used in one county be transferred to another county? Adult Day Care Services Need affordable senior housing that is not substandard. Need Guardianship services Area Plan Exhibit 5 - Non Metro AAA Overview of Area Agency on Aging Page 13

14 Need affordable home health services. Need assisted living facilities that are affordable. Need compassionate and sensitive staff to assist the disabled. The need to have more flexible rules so people would volunteer more. Need more help for caregivers that are at risk of burnout. Some seniors felt that the portions served at meal sites are too small. Need to advocate putting a freeze on property taxes. The loss of funds had created a crisis in service delivery and many more people have been placed on waiting lists. Provider voiced the concern that seniors are tired of having to sign in everyday for congregate meals and even Adult Day Care. A need for more utility assistance. Priorities were voted on by the audience were in order of importance: SERVICE PRIORITIES: Provider 1. Additional funding for affordable medical and regular transportation SER de Dona Ana Inc., City of Alamogordo, Sierra Joint Office on Aging, County of Grant 2. Need more meal site services-expand days of service SER de Dona Ana Inc., Sierra Joint Office on Aging, Sacramento Mountains Senior Services, Inc. (Cloudcroft) 3. Need for affordable home health services for seniors. County of Grant 4. More senior employment opportunities and job training SER de Dona Ana, Inc. 5. Adult Day Care Programs County of Grant 6. More support services for caregivers like medical and financial County of Grant 7. Training to staff to help them deal with disabled and senior population in more sensitive and compassionate manner Hidalgo Medical Services, Inc. (Lordsburg) 8. Provide enough food to seniors meal portions too small SER de Dona Ana, Inc. 9. More funds should be targeted for at-risk seniors and those who live alone County of Grant 10. Greater flexibility in developing menus SER de Dona Ana, Inc. 11. Diabetic and Special menus should be considered County of Grant 12. Relax some of the rules and regulations in providing services to seniors, too many signature requirements. 13. Local and credible guardianship programs County of Grant Sierra Joint Office on Aging Inc, Deming/Luna Commission on Aging Area Plan Exhibit 5 - Non Metro AAA Overview of Area Agency on Aging Page 14

15 14. Affordable Assisted Living option for families and caregivers. County of Grant 15. Assistance with addressing licensing procedures for Adult Day Care and the need to address funding barriers. County of Grant 16. Property tax freeze for veterans. SER de Dona Ana, Inc. 17. More energy assistance County of Grant 18. Assistance for weatherization County of Grant 19. Promote more collaboration with all agencies and providers that provide services to seniors. SER de Dona Ana, Inc. 5. Changes made in Area Plan as a result of public meetings The service delivery plan for Non Metro AAA does reflect changes as they relate to the comments derived from the variety of public hearings held. It is interesting that the resolution to many of the comments can easily be resolved through improved and enhances collaboration with the following agencies, NMALTSD, ADRC, Medicaid and Medicare, COLTS Waiver Program, Department of Human Services, New Mexico Legislature, etc. The Non Metro AAA and its providers/vendors will promote capacity building with these and other agencies that have an impact in the lives of seniors. Nutrition came up in every one of the public hearings. Seniors are requesting more diabetic friendly menus, flexibility with portion controls, lower sodium menus, and more flexibility with the restrictions that come with menu preparation. Non Metro AAA does have diabetic menus that are made available through the web site but currently are not easily accessed. The NCNMEDD website has been modified and Non Metro AAA will continue to make improvements to ensure that information and links are easily accessible. The flexibility of rules and guidelines for nutrition (menus) will be explored in coordination with NM ALTSD. Non Metro AAA does strongly recommend that flexibility with accountability in relation to nutrition should be considered. The suggestion of serving the meal buffet style versus limiting the portions to the seniors was an option provided by the seniors themselves. We do need to think outside the box and this suggestion should be given serious consideration. This could be done as a pilot program. The Direct Purchase of Service (DPS) process has allowed the flexibility to target more funds for the at-risk population. Non Metro AAA will continue to work diligently to enhance these services (i.e. homemaker, respite, adult day care, home repair, etc.) The Cooperative Health Assistance Program (CHAS) that Non Metro AAA administers through a waiver from NM ALTSD assists with prescription medications, eye exams, dental exams, supplemental nutrition provisions, etc. Non Metro AAA will continue to seek resources to expand this service. Coordination with the Med Bank and Non Metro AAA providers/vendors would provide additional resources in this area Area Plan Exhibit 5 - Non Metro AAA Overview of Area Agency on Aging Page 15

16 Non Metro AAA staff will continue to work with providers/vendors during the monitoring process and throughout the year to secure funding needed for equipment, facilities, and vehicles through the Capital Outlay process. Coordination and Collaboration will be built with ADRC to better provide resources/information to providers/vendors (i.e. Medicaid, Medicare, Colts, NM Behavioral Health, etc). Non Metro AAA will work toward developing stronger relationships with other community agencies impacting the lives of seniors. (Refer to Part C Exhibit 9). Other comments received may be addressed through advocacy efforts of Non Metro AAA and the providers/vendors. Comments received included: Medical Marijuana, affordable housing, freezing property tax for Veterans, Food Stamp issues, Services for the Visually Impaired, affordable home health care outside PCO, and Medicare premiums. Expansion of services such medical transportation, respite, homemaker, and chore services requires the seeking of additional funding from all sources. This will be an ongoing process at the provider/vendor and the Non Metro AAA level Area Plan Exhibit 5 - Non Metro AAA Overview of Area Agency on Aging Page 16

17 EXHIBIT 6. AAA Accomplishment The four major accomplishments during in developing and implementing a comprehensive, coordinated delivery system: 1. Non Metro AAA is very proud to announce that one major accomplishment is the development, implementation and approval of the Direct Purchase of Services Manual. This was made possible through the collective efforts of all providers throughout the thirtytwo (32) counties. The Direct Purchase of Service (DPS) manual, ultimately, is driven by the need to address the required services of a growing population of seniors, in a cost effective manner, while maintaining the quality of those services. The DPS manual serves the purpose of defining the process that should be adhered to by all interested parties. This process takes into consideration the diversity of the communities and programs. 2. The revision of the Non Metro AAA policies and procedures is another major accomplishment. This critical document now defines the policy with standards. It clearly reflects the practices of Non Metro AAA as they relate to implementing a comprehensive and coordinated delivery system. This document may be accessed through the web site at www. ncnmedd.com. The following are the various components included in the policy and standards manual. Section I Introduction and Structure Section II Operations and Administrative Responsibilities Section III Amendment Process Section IV Contingency Plan Section V Program Operations and Management Section VI Financial Standards and Management Section VII Service Delivery Forms Acronyms 3. The compliance section is yet another accomplishment of the Non Metro AAA. Implementing the compliance office has allowed for on-going technical assistance to providers in the comprehension of the costs of individual services. Prior to the compliance office, providers continued to negotiate a cost with NON METRO AAA with no concept of how to arrive at actual costs. It is fair to say, that approximately 70% of providers/vendors budgets for services being purchased are maintained by each individual service versus the old method of applying percentages and hoping for the best. This agency was also successful in partnering with the State Auditor s office in providing a full day of training to providers/vendors. Mr. Hector Balderas was also present at this training. An audit process was developed and implemented. A copy of this process is included in the addenda of this plan. With the DPS process it has allowed us to redirect funds to the non traditional services; provide services to those communities who have identified needs but do not have the capacity within their agency to provide the services; and to compensate providers/vendors Area Plan Exhibit 6 - Non Metro AAA Accomplishments Page17

18 who exceed their projected goals in order for them to be able to continue providing the services at the same level without disruption to services. It is the intent of the Non Metro AAA to contract for the highest quality, most cost effective services possible. Ensuring that a contractor has calculated and contracted for the correct unit cost and the correct number of service units is crucial to service delivery. Finally, it provides a means by which Non Metro AAA can address performance-based measurements. 4. With the creation of the DPS manual the Non Metro AAA has required certified training for all providers/vendors contracting with Non Metro AAA. This will also be a requirement for potential new contactors. The required trainings are the minimal standards set forth by Non Metro AAA. The sister to this training is the in house training which are suggested topics only but must be provided on an on-going basis by all providers/vendors. The implementation of the required certified training will ensure that providers/vendors must have qualified staff to carry out the Agreement effectively. Required Certified Training In-House Training Older Americans Act Nutrition/Meal Preparation Non-Metro AAA Policies & Procedures Kitchen Safety Contract Compliance CPR /First Aid/Emergency Financial Management Vehicle Safety/Maintenance SAMS Overview Code of Conduct * Reporting Process Proper Documentation Advisory Council Training Sanitary Methods Board of Director s Training Provider Policy & Procedure Compliance Customer Service * Confidentiality/HIPAA * Program Code of Conduct * Customer Service * Service Definitions * Personnel/Supervisory Confidentiality/HIPAA * Fire Safety/Prevention/Evacuation, Etc. Legislative Process Continuing on with the accomplishment of the trainings, Non Metro AAA has also made available to the providers/vendors Webinar trainings. This process has been cost effective due to the fact that all involved can participate in the trainings without leaving their locations. All that is required for Webinar trainings are a computer and access to the Internet. This has been a life saving technique as it relates to SAMS. Much training around SAMS has revolved around the Webinar trainings. The Webinar training has also been used for other areas of trainings (i.e. budgeting, nutrition, etc.) Area Plan Exhibit 6 - Non Metro AAA Accomplishments Page18

19 The major challenges in carrying out the previous Four-Year-Area-Plan and how these challenges have been addressed: Without a doubt, we can all agree that losses of revenues have domino effects impacting goals and objectives set forth in the Four- Year Area Plan. The Non Metro AAA has continued to face difficulties in adhering to the goals that were included in the service delivery plan. It is the commitment of the Non Metro AAA to excel in overcoming these challenges. The nutrition contract with Global Nutrition was cancelled as result of funding reductions. This creates issues as they relate to our nutrition programs revolving around trainings, menus, etc. Due to the loss and staff transitions, current staff have had added responsibilities without added compensation resulting in staff burn out. Unable to complete transition of providers/vendors for SAMS data entry to Non Metro AAA staff. The programs not transitioned are City of Alamogordo, City of Las Cruces, City of Santa Fe, Chaves JOY Centers, Inc. and the County of Rio Arriba. Assessment of providers/vendors in a timely manner has been difficult due to inadequate staffing. Provider/Vendor on-going request of training due to management positions constantly changing at the local level has been a challenge for Non Metro AAA due to inadequate staffing and funding. The current requirement reflects that an assessment must be conducted for home delivered clients based on the NSI scores. This has placed a burden on the provider/vendor and the Non Metro AAA staff entering the data. If the NSI scores are high this could mean possibly assessing the same clients every three months. For example, if a client is permanently disabled, this client will always be permanently disabled and is likely to always have a high NSI score and a requirement to continue assessments is unrealistic due to the condition of the client not changing. Reductions to the Senior Employment Program (SEP) was and continues to be a detriment both to the providers/vendors and Non Metro AAA. Non Metro AAA has begun to revisit its current structure regarding staff responsibilities. Non Metro AAA has started to explore options with its IT consultants on how to meet the constant demand for trainings. Non Metro AAA will ensure that closer collaborations are initiated to ensure that necessary areas of the Four Year Area Plan are met. Adequate funding will be critical in the next four years to address such challenges as reduction in staff. In the past four years a total of three (3) full time positions have been eliminated due to funding cuts and several positions have had staff transitions due to burn-out from added responsibilities from the reduction in staffing Area Plan Exhibit 6 - Non Metro AAA Accomplishments Page19

20 The reinstatement of the contract with Global Nutrition Services LLC will assist in meeting the nutritional requirements set forth and training demands. In reviewing the proposals from the providers/vendors it has become apparent that the collaboration with the NM Behavioral Collaborative is non existent in the following communities and/or providers: Catron County, Clayton, Clovis Home Care, Curry Residents Senior Meals (Clovis), Deming, Dora, Des Moines, Elida, Floyd, Ft. Sumner, Gallup, Hobbs, Guadalupe, Harding, Melrose, Socorro, Southeast NM Community Action (Carlsbad, Artesia), Tularosa and Vaughn. Non Metro AAA in coordination with NMALTSD/ADRC implemented a pilot program utilizing SAMS. The ADRC will make referrals to Non Metro AAA; Non Metro AAA identify the client s residency to determine what provider/vendor to make the referral to; Non Metro AAA sends to perspective provider/vendor; provider/vendor conducts assessment and provides service if feasible. Unfortunately, this pilot program has proven to be more of a challenge due to inadequate funding and inadequate staffing at Non Metro AAA. New directions or changes that have occurred: November, 2010 started a new chapter for NCNMEDD; Ms. Barbara Deaux retired from her position as NCNMEDD, Executive Director. Mr. Tim Armer was hired as NCNMEDD Executive Director. Tim Armer was born and raised in Albuquerque, New Mexico and received his degree in City and Regional Planning from New Mexico State University in He was first employed as a County Zoning and Subdivision Administrator for Doña Ana County and had the opportunity to be involved in the initial planning and development efforts for the Santa Teresa Border Crossing. Tim has spent the last 15 years working for the Council of Governments in Tulsa, Oklahoma leading the transportation planning effort for the metropolitan area and contributing to comprehensive planning, Community Development Block Grants, rural water and wastewater development, and economic development efforts for that region. In November 2010, Tim returned to New Mexico to lead the North Central New Mexico Economic Development District, the Council of Governments for Colfax, Los Alamos, Mora, Rio Arriba, San Miguel, Santa Fe, and Taos counties and their respective communities. Mr. Armer has welcomed the many challenges that have come with his Executive Director position. After being housed at the College of Santa Fe in the old military barracks for over forty-four (44) years, NCNMEDD, Non Metro AAA has moved to a new location. Our new home is the Santa Fe Business Incubator located at 3900 Paseo Del Sol. Although, we will miss all our friends that made our work nothing less than exciting at our old quarters (i.e. rabbits, foxes, prairie dogs, baby birds, snakes, etc.), we are most excited about our new office space. The conversion of SAMS to HARMONY is a change that has occurred and is still happening. This is expected to be fully implemented by the end of FY In order to make this a reality the conversion of one statewide database had to be implemented. This provides easier access to Area Plan Exhibit 6 - Non Metro AAA Accomplishments Page20

21 end users (providers/vendors) thereby reducing the duplication of consumers. The Non Metro AAA discovered missing data that led the Non Metro AAA to the remediation project databases for PSA2, PSA3 and PSA4 from June 2010 through May 31, This was a lengthy process identifying and recovering missing consumers; identifying and recovering missing consumers care plans and identifying and recovering missing consumer s assessments. With additional resources the Non Metro AAA will complete the transitioning of providers/vendors for data entry by Non Metro AAA staff. The providers/vendors that will be transitioned are referred to as the BIG 5. These are the City of Alamogordo with a total of 94,339 units and 2,663 consumers; City of Santa Fe with a total of 347,322 units and 3,708 consumers; City of Las Cruces with 276,670 units and 12,284 consumers; Rio Arriba County with a total of 134,681 units and 1,227 consumers and Chaves Joy with 184,428 units and 3,286 consumers. We do need to brag that even through the difficult times of losing Grant County as a provider, Non Metro AAA staff worked diligently and proved to be successful in securing a provider/vendor and services were not interrupted. The current structure of one of our providers, the City of Santa Fe was yet another change. The City of Santa Fe was contracted to provide services within the City of Santa Fe and Santa Fe County. The two local governments reached an agreement after many meetings and discussions which included the Non Metro AAA and NM ALTSD. The final result being that we now have an additional provider for the County. The City of Santa Fe will provide services throughout the City and Santa Fe County will provide services throughout the County. This change is one of the many beauties of our DPS process allowing various providers within communities to deliver services. The commitment and support of all the providers/vendors of Non Metro AAA made it possible to not only successfully develop the DPS manual but most importantly to implement this process. We all recognized that developing a manual was only the beginning of this endeavor. The critical segment of this was to ensure that all involved (i.e. providers/vendors, AAA Advisory Council, NCNMEDD Board of Directors, NMALTSD, etc.) completely understood the purpose of the manual. A total of four (4) trainings were held state wide. The training curriculum included all components of the manual. The training team included the Non Metro AAA staff and providers/vendors. Ms. Barbara Borden, Executive Director for the Deming/Luna Commission on Aging took the lead representing the providers/vendors and as a member of the DPS committee at all trainings. The trainings were successful and having those in attendance understand that this document was as a result of their input and participation only enhanced the discussions during the two-day trainings. We would also like to extend our gratitude for the NM ALTSD staff who attended our trainings. In summary we had 98% of all providers/vendors attending the trainings. This was a total of 206 individuals in attendance, including Board members, directors, supervisors, cooks, drivers, and staff at all levels and representing al services of the various providers/vendors Area Plan Exhibit 6 - Non Metro AAA Accomplishments Page21

22 New proposed directions and changes: To create a brighter future for the aging population, we recognize that new changes and directions are inevitable. Much discussion has surrounded this initiative and as a result we propose the following for the next Four Year Area Plan. The proposed directions and changes will definitely need to address the overwhelming influx of the population of Baby Boomers. It is no secret that we are a Graying America. We have all heard the statistics; 78 million reached the age of 65 in the year 2011 and over the next 18 years between 3 and 4 million of us will do so each year. Our capacity to meet the demands that will come with leaps and bounds will be tested in the very near future. This means, the continuous discussions about the Baby Boomers can no longer just be a conversation piece; an action plan must be developed and implemented. Addressing this type of plan may or may not be that simple. The plan of action that will need to be developed cannot be developed or implemented without partnerships. Any plan of action will largely rest on our success in cultivating and sustaining creative ideas, leveraging resources, and of course collaborating and building strong partnerships with state, local, public and private entities. This means transforming the structure to meet the needs of the new aging generation of older adults who bring a new world of attitudes, challenges and opportunities as well as some of the same historic issues. By responsible aging, we will promote financial self-sufficiency that comes with the awareness of making healthy aging choices, and demands personal accountability. It is a given that Non Metro AAA must not only encourage but ensure that providers/vendors enhance and expand Healthy Lifestyles. A reorganization of the Non Metro AAA is necessary to better utilize staff with their expertise and knowledge. It has become vital to this agency to review and revise current staff responsibilities. This change will enhance the trainings to providers/vendors; promote effective collaboration; equitable distribution of responsibilities among all staff; ensure contractual compliance; stronger advocacy efforts; and improved transparency and accountability. Make changes in the area of nutrition by ensuring a full time individual is available to respond to the needs of the providers/vendors relating to menu development. Currently, the employee responsible for nutrition only does this on a part-time basis and the balance of her time is for data entry. The change may be reinstating the nutrition contract with Global Nutrition and/or ensuring a full time staff is available for nutrition. Once again, all is dependent on adequate funding. The funding lost with the Senior Employment Program (SEP) continues to be a challenge. This impacted the providers/vendors as well as the Non Metro AAA. A reduction of twenty nine (29) positions was drastic across the state. According to New Mexico Aging and Long Term Services Department (NMALTSD), the solution to address the budget reductions was to transition a total of twenty-five (25) enrollees to the Title V program administered by NM ALTSD. As NM ALTSD began the transitioning process of these enrollees to Title V they discovered they did not meet income eligibility. The outcome was that the enrollees went back to the State SEP with the NM ALTSD. This appears to be somewhat confusing since the Non Metro AAA Area Plan Exhibit 6 - Non Metro AAA Accomplishments Page22

23 operates the State SEP it would have made more sense to replenish those funds. Now, we have two entities providing the same type of funding for the same programs. This creates more work for the local providers who now have to adhere to a separate contract and report to a separate entity, when this was already occurring with Non Metro AAA. If these funds would be provided back to Non Metro AAA they would be used to hire client tracking specialist, who are needed to enter the data from providers/vendors. Currently there are a total of twelve (12) providers/vendors requesting SEP positions. Develop and manage a Program and Services Training Team made up of Non Metro AAA staff and experienced providers/vendors to develop, design, and implement a training curriculum targeted to meet the specific demands for requests for training. The beginning stages to this goal were initiated during the DPS training by utilizing providers/vendors as trainers. With the constant demand for training the Non Metro AAA will utilize the Internet for a more cost effective method to meet this need. This will be made possible with Go To webinar trainings. This type of Webinar training can accommodate up to 1,000 individuals. Presentations are possible through the use of integrated audio conferencing (via computer and telephone). In addition to conducting these webinar trainings we also can develop a library of training videos accessible through the website, on various topics and services. We will also film or document other trainings conducted in person by Non Metro AAA staff which will be accessible through our website. These webbased trainings will be accessible to providers at their convenience and address the demand for trainings. It has become evident for quite some time that the operations of senior centers by providers/vendors are not totally understood. A reason could be that employees that have been in the aging network for quite some time are leaving their positions and the appropriate trainings are not occurring. The requests have been so overwhelming that another initiative will be the development of a senior center operations manual for providers/vendors. While the adoption and implementation of the DPS manual continues to ensure an enhanced cost-effective, quality driven, comprehensive and coordinated system of support services, we have come to recognize that not all providers/vendors have the capability to fulfill the obligations of DPS. Rest assured that we are not implying a reduction in the delivery of services; providers/vendors do an amazing job in delivering services to the targeted population. Some providers/vendors do not have the staff or resources to ensure compliance as it relates to finances (i.e. budgeting by service, accounting, etc.). To ensure full compliance and not interrupt the great services provided, Non Metro AAA continues to have discussions on how we can assist these providers in fulfilling their contractual obligation. Implementing a plan allowing Non Metro AAA to be responsible for the administrative piece with the options of contracting this out or hiring additional staff to oversee this segment would be part of the plan. (The funding to make this possible would come from the provider/vendor.) Discussions and agreements will take place with the individual provider/vendor. This Area Plan Exhibit 6 - Non Metro AAA Accomplishments Page23

24 would allow the small rural communities to continue as the service provider and ensure compliance of contractual obligations. Assessing all providers/vendors in a twelve- month period continues to be a challenge. In some cases, we are assessing programs in all the areas of compliance (i.e. financial, program, compliance, property management, Senior Employment, etc.) This takes more than a few days. Some programs being assessed have no major issues and operate good programs. Implementing a rating system (report card) would identify what types of assessments, if any, are needed for such programs. Non Metro AAA would then be able to concentrate on providers/vendors that are having difficulties or who require extended assessments, follow ups, technical assistance, etc. This process would not eliminate assessments it would only improve and provide for a cost effective way of ensuring compliance through a tiered system of conducting assessments. Requesting information from providers/vendors who are not requiring a full assessment for review would still be a method of assessing such programs. Harmony has created a new solution platform which includes a new, modern version of SAMS Case Management and new business intelligence and reporting module. This includes a Customer Portal which will enable all end users to access all Harmony Products in one central location. Non Metro AAA staff participated in the pilot testing of Harmony for Aging 3.0 (SAMS) product and provided valuable feedback to Harmony regarding their product. Prior to Roll out of Harmony for Aging the following will occur: AAA staff will be trained Train the data entry staff of the five (5) providers/vendors responsible for entering their own data Train the data entry staff at AAA Provide Dual Access to all data entry staff Begin using Harmony for Aging 3.0 platform With the directions and changes being proposed in this plan we also included solutions for the challenges. We request your approval of this plan to move forward in meeting the challenges of delivering services to the older individuals in the three (3) PSAs. Monitoring and tracking the progress of the Area Plan: To ensure that the Four Year Area Plan is successfully implemented, the Non Metro AAA will assign an individual to review this document on an on-going basis. Upon approval of the Plan by NM ALTSD, the progress will be tracked internally by Non Metro AAA through the identification of specific performance measures and conducting an annual review at a minimum and more frequently if practical. Non Metro AAA will provide updates on progress to NM ALTSD through the monthly coordination meeting or other mutually agreeable means. If and when changes are necessary the proper procedure will be followed in notifying NM ALTSD Area Plan Exhibit 6 - Non Metro AAA Accomplishments Page24

25 Currently, the Non Metro AAA tracks performances of the service delivery plan by quarterly reviews conducted on providers/vendors. A few of the areas that are closely being monitored are the financial status, performance measures, program challenges/barriers, etc. Non Metro AAA will continue to perform assessments, provide technical assistance, trainings, and improve current relationships with all providers/vendors to ensure that the service delivery plan is followed. Request for Waiver(s) Non Metro AAA would like to once again request a waiver to administer the Cooperative Health Assistance Program (CHAS). The (CHAS) program continues to assist low-income individuals, age 55 and older with vouchers to off-set the cost of receiving health care services, which prevent or alleviate the financial burdens brought on by acute and chronic illnesses thereby improving their emotional wellbeing. Health services include, but are not limited to: prescription medications, eye exams, prescription eye wear, dental exams, and dentures, hearing aids, medical office visits and supplemental nutritional provisions. The application is included in the Addenda section of this plan. Non Metro AAA is requesting a waiver as it relates to the assessments of home bound clients. Based on existing condition(s) and/or assessments history (as documented and justified), a consumer s individual circumstances may be considered permanent; therefore, a yearly review of their SAMS Consumer Registration Form (Advanced) will be conducted annually eliminating the need to perform the Nutritional Health Screening and the ADL/IADL Assessments. Consumer s information will be reviewed and/or updated more frequently as the need arises or otherwise determined. This would provide a sense of comfort to consumers not having to answer the same questions which continue to have the same results; allow assessors to assess more consumers who do not have permanent conditions for determining eligibility for services; and would reduce paperwork and we would all be working smarter and not just harder Area Plan Exhibit 6 - Non Metro AAA Accomplishments Page25