Minutes of June 22, 2010
12:00pm-1:00pm

Present-Jennifer Fenuccio, Debbie Fins, Christine Brown, Julie McMurray, Wendy Nollman, Joanne Gauvin, Carol Potter, Janice Chumsae, Susan Ritz, Deb Dowd-Foley, Cathy Dionne, Ron Racine, Beverly Carter, Stephaine Jackson

Introductions/Minutes-

Introductions were made and minutes of the April’s meeting were approved.

Update from the Alzheimer’s Association- Upcoming Programs:
-Wed, June 23rd-Alzheimer’s Partnership Event, @ Worcester Senior Center
9:30-12pm
-Tuesday, July 27th-Getting Started 10am-12pm @ Mendon Senior Center
-Wed, Aug. 4th-Know the 10 Signs: Early Detection, 10:30am @ Worc. Senior Ctr
-Wed, Aug. 11th-Legal & Financial Issues & Young Onset Dementia, 6-8:30pm
@ Worc. Senior Ctr
-Saturday, July 24th-Memory Ride, Devens Museum Field, Devens, MA
-Sunday, September 12th-MEMORY WALK @ WORC. SENIOR CTR!!!!
Walk begins @ 10am!!

Presentation- Lynn Lazarus Serper spoke about the Serper Method. You may visit the website at www.serpermethod.com or contact Lynn by phone 1-800-240-3778. Also you can email Lynn lynnserper@serpermethod.com . Lynn is always looking for facilities that are interested in working with her to enroll the Serper Method. Contact Lynn for more information!

Lunch Sponsor: Thank You to Blaire House of Worcester for providing lunch!

Next Meeting:
December 28th, 2010
Guest Speaker: Elizabeth Nasser PhD.
Topic: The Benefits of Psychological Testing

Under the supervision of the Director of Elder Affairs, the Client Advocacy Coordinator promotes healthy aging by providing outreach, information, referral, and advocacy to assist seniors and their families to access needed resources.

Minimum requirements: Bachelor’s Degree in Social Work or related field, with at least one year of relevant experience, or at least three years of equivalent experience. Basic computer literacy required. Excellent communication skills; ability to work well with people of all backgrounds; strong organizational skills; and an interest and sensitivity toward working with elders a must. Experience in elder service provision, administration, supervision, working with minority populations, and/or knowledge of Worcester’s elder services network preferred. Candidate must pass a background check.

Please send resume and letter of intent to:
Human Resources Department, Room 109, 455 Main Street, Worcester, MA 01608
or via email to hr@worcesterma.gov on or before August 13, 2010.

An EEO/AA Employer. Preference is given to Worcester residents.

Join United Way of Central Massachusetts as an AmeriCorps VISTA. Members serve for period of one year at organizations throughout the Nation. As a VISTA at United Way you will act as a Program Manager for United Way?s Volunteer Center and coordinate a program that links volunteers with short term, flexible volunteer opportunities. If you enjoy working with volunteers and community organizations, this could be the opportunity for you.

Whether you area new to the workforce or seeking to refresh your professional skills, this position will provide you with the building blocks for a successful career in the non -profit sector. Applicants must possess excellent verbal and written communication skills, computer proficiency and be able to work independently and as part of a team. VISTA members receive many benefits including a living allowance, health insurance and education award or end of service bonus.

This is a full-time professional volunteer position. A one year commitment, beginning in July is required. Please see the link below for more information on the AmeriCorps VISTA Program.

For additional information or to submit a resume please contact Kerri Sandberg at ksandberg@unitedwaycm.org
www.americorps.gov/about/programs/vista.asp

Issue: As part of their FY 2011 budget narrative, The White House is proposing changes to the structure of the very successful HUD 202 housing program. One of the changes proposed appears to be the limiting of service coordination in HUD projects to just one form of service provider: the PACE programs.

Concern: For Massachusetts, such a decision would stifle the important progress being made at the community level with HUD 202 projects in which Area Agencies on Aging/Aging Services Access Points serve as the service coordinators. Not only are PACE programs in Massachusetts limited in number and location, omitting large parts of the state, but their access to support services does not include some sources that are complimented by the ASAP/AAA network, such as state home care funding and the Older American Act. ASAPs and AAAs already have a strong track record in helping to create 2020 housing (see list below) and have demonstrated that they can work with housing developers and elderly consumers. The ASAP/AAAs can also work with people who are not yet meeting the definition of nursing home eligible, which gives them more flexibility to work with a broader range of consumers. PACE programs can make a good support service coordinator, but they should be one option for consumers from a longer list of experienced and qualified agencies.

Background: HUD provides capital advances to finance the construction, rehabilitation or acquisition with or without rehabilitation of structures that will serve as supportive housing for very low-income elderly persons, including the frail elderly, and provides rent subsidies for the projects to help make them affordable. The Section 202 program helps expand the supply of affordable housing with supportive services for the elderly. It provides very low-income elderly with options that allow them to live independently but in an environment that provides support activities such as cleaning, cooking, transportation, etc. The Cranston-Gonzalez National Affordable Housing Act of 1990 explains the purpose of the program: to enable elderly persons to live with dignity and independence by expanding the supply of affordable housing that (1) is designed to accommodate the special needs of elderly persons and (2) provides a range of supportive services that are tailored to the needs of elderly persons occupying such housing.

HUD’s administrative data show that, as of 2006, over 6,000 Section 202 facilities housed approximately 263,000 households headed by older people. Occupancy in Section 202 housing is open to any very low-income household comprised of at least one person who is at least 62 years old at the time of initial occupancy.

According to a June, 2008 study by HUD of the 202 Supportive House program, the median age of Section 202 residents as of 2006 was 74 years, and 31 percent were age 80 or older. For elderly persons admitted to Section 202 housing that year, the median age was 70 years, and about 19 percent of all persons admitted to Section 202 housing were age 80 or older.

A critical aspect of Section 202 housing is that it can accommodate residents with supportive services as they become more frail. A majority of facilities (73.9 percent) have grab rails, and 91.1 percent have a ramp or a level entrance. In the newer projects (built since 1990), nearly 100 percent of projects have at least one accessible unit, and 43 percent of all units are wheelchair-accessible.

A majority of Section 202 projects have the capacity to provide an array of communal services for their residents. Community space for social and recreational facilities is available and used in 90.2 percent of projects. Spaces for congregate dining and supportive service providers are used in about half of projects.

Costs of formal services are generally not paid by HUD, but instead are paid through a variety of other sources, principally through Medicaid. Examples of formal services are meals, housekeeping, assistance with medications, bathing, etc. A service coordinator is a person trained to work with residents and their families when supportive services are needed. In 2006, 38 percent of all Section 202 properties reported having a service coordinator on staff.

Residents who move into a Section 202 project between the ages of 75 and 79 typically reside in the project for 6.28 years. If the alternative to provision of housing plus supportive services is to permanently live in a nursing home, then for the entire 6.28 years that a person would have stayed in Section 202 housing, the total cost of institutionalization would be an estimated $329,000. This amount is nearly twice as expensive as the cost of providing Section 202 housing with a full set of personal services, and is almost four times the cost of providing Section 202 housing with less intensive services.

Service Coordination: 202 Project sponsors are required to make available necessary services that may include meal and nutritional services, housekeeping aid, personal assistance, transportation aid and health-related services. Virtually all of the cost of these services is paid for through external sources, although the program does make funding available to pay for the cost of service coordinators. Project rental assistance covers the difference between reasonable operating costs and the portion of the rent paid by tenants. Project rental assistance can be used to pay for fifteen percent of supportive services costs, not to exceed $15 per month per unit. Tenants contribute on the basis of their income, generally paying 30 percent of monthly income for rent and sometimes paying additional amounts for services. Program eligibility is limited to very low-income households with a head, spouse or co-head age 62 or older.

A service coordinator is a person trained to work with residents and their families when supportive services are needed. His or her role is to assist residents in obtaining supportive services, coordinate service delivery to maximize independent living, and monitor the quality and quantity of services to fit the wants and needs of residents. Originally authorized by Congress in the housing acts of 1990 and 1992, service coordinators have emerged as staff members at many Section 202 facilities in the past decade. In Massachusetts, resident service coordinators are most often employees of the Area Agency on Aging (AAA/ASAP) who work with housing authority staff and others on behalf of the residents.

The reported impact of service coordinators on residents has been very beneficial. Less than 4 percent of facility managers reported “no impact” on residents from the introduction of service coordinators. On the other hand, more than three-quarters reported that service coordinators had increased the range of services (90.5 percent), increased the quality of services (78.3 percent), and allowed residents to stay independent longer (81.1 percent).

Other public sources of funds for personal care services are local governments, Older Americans Act funds, the Federally Qualified Health Center Program (for community health centers), PACE (adult day health care) and the Medicare program. However, Medicaid is still by far the largest source of funds for publicly financed home and community-based care. Following the Supreme Court’s 1999 Olmstead decision, States made increased use of the Medicaid program to increase both the amount and share of its resources going to home and community services.

The White House Proposal: The White House budget for FY 2011 states that “HUD is exploring the possibility of a partnership with HHS to combine HHS funding for supportive services with Section 202 funding. Programs such as the All-inclusive Care for the Elderly/All Services in One Location (PACE model) may be used to fund the supportive service component of the redesigned program. Developed in the mid-1980’s, PACE provides comprehensive services to enable elderly residents to remain in independent, rather than institutional, living environments. It became a permanent program under Medicare in 1997. PACE provides social and medical services primarily in an adult day health center, supplemented by in-home and referral services based on the participant's needs. As of 2003, approximately one-third of the currently existing PACE program sites are co-located with HUD assisted housing.

PACE Program

The PACE program is a capitated managed care benefit for the frail elderly provided by a not-for-profit or public entity. The PACE program features a comprehensive medical and social service delivery system using an interdisciplinary team approach in an adult day health center that is supplemented by in-home and referral services in accordance with participants' needs. Participants must be at least 55 years old, live in the PACE service area, and be certified as eligible for nursing home care by the appropriate State agency. The PACE program becomes the sole source of services for Medicare and Medicaid eligible enrollees.

An interdisciplinary team, consisting of professional and paraprofessional staff, assesses participants' needs, develops care plans, and delivers all services (including acute care services and when necessary, nursing facility services) which are integrated for a seamless provision of total care. PACE programs provide social and medical services primarily in an adult day health center, supplemented by in-home and referral services in accordance with the participant's needs. The PACE service package must include all Medicare and Medicaid covered services, and other services determined necessary by the interdisciplinary team for the care of the PACE participant.

PACE Locations: The federal CMS lists only 70 PACE sponsors in the country. In Massachusetts, there are currently 6 PACE programs:

Elder Service Plan of the Cambridge Health Alliance, Cambridge
Uphams Elder Service Plan, Boston
Elder Service Plan of the North Shore, Lynn
Elder Service Plan of Harbor Health Services, Dorchester
Summit ElderCare (Fallon), Worcester
Elder Service Plan of the East Boston Neighborhood Health Center, Boston

Aging Services Access Points/AAAs

Massachusetts has 23 Area Agencies on Aging, and 27 Aging Services Access Points (ASAPs). 20 of the ASAPs double as AAAs. Every city and town in the Commonwealth is covered by an AAAs and ASAP.

The AAAs, under the Older Americans Act, coordinate and purchase a wide range of community based services, including social support services, nutrition services, family caregiver support, etc. Each AAA develops an area plan for the elderly constituents in their area that addresses local need, including housing and support services.

Under Chapter 19A, 4b of the Massachusetts General Laws, the ASAPs are responsible for a “coordinated system of care (which) shall be administered by agencies… known as aging services access points, hereinafter referred to as ASAPs. ASAPs shall be designated by the department and may be operated nonprofit agencies, home care providers as defined in clause (c) of the third paragraph of section 4, a combination of home care corporations acting jointly or by state agencies. Pursuant to the terms of those contracts, ASAPs shall coordinate services on behalf of Medicaid eligible elders.”

ASAPs are mandated to provide the following services: ASAPs shall be responsible for: (1) providing information and referral services to elders; provided, however, that referrals for terminally ill elders shall include referrals to licensed and certified hospices for determination of eligibility, appropriateness and consumer interest in services; (2) conducting intake, comprehensive needs assessments, preadmission screening and clinical eligibility determinations for elders seeking institutional and community care services from Medicaid or the home care program, which in the case of hospice clients, shall adhere to Medicare and Medicaid conditions of participation pursuant to 42 C.F.R. 418 and 114.3 C.M.R. 43.00; (3) developing a comprehensive service plan based on the needs of an elder, provided, however, that a medical plan of care for an elder shall be developed by a licensed or certified health care provider; (4) arranging, coordinating, authorizing and purchasing community long-term care services called for in the comprehensive service plan; and (5) monitoring the outcomes of and making periodic adjustments to a service plan in consultation with service and health care providers. 202 Housing coordination is just another setting for the core care management services that ASAPs and AAAs have been providing in Massachusetts for 36 years.

In Massachusetts, ASAPs/AAAs have served as a major source of service coordination, and have worked closely with housing developers to create a number of very successful projects. A total of 932 housing units under the 202 program in Massachusetts have access to service coordination through the ASAP/AAA network:

TOTAL     932 units

The LGBT Bereavement Support Group is the first state wide initiative to address loss in the LGBT community. The program is funded by the Department of Public Health and it is facilitated by Ethos, and elder service agency in Jamaica Plain and The LGBT Aging Project.

This initiative consists of six free LGBT Bereavement Groups each in different parts of the state. Each group will run for six consecutive weeks and will be led by a licensed clinical social worker who specializes in bereavement issues in the LGBT Community. The free group is open to any lesbian, gay, bisexual or transgender individuals who have experienced the loss of a loved one (family member, friend, partner/spouse).

Three agencies – Central Massachusetts Agency on Aging, Elder Services of Worcester Area Inc. and the Worcester Senior Center – have teamed up to create the Worcester LGBT Elder Network (WLEN). The Boston-based LGBT Aging Project gave the network the benefit of its many years in the LGBT aging field. WLEN was funded in part by a grant from the Greater Worcester Community Foundation’s GLBT Partnership Fund.

Why an LGBT elder network?

Lesbian, gay, bisexual and transgender elders tend to age in isolation for a variety of reasons:

• Many LGBT elders who were previously out, think that when they need services they have to go back into the closet to be eligible for them.
• Many of them are estranged from their families of origin because of their sexual orientation or gender identity or expression and have no one to help them in old age.
• Many gay men, especially, are alone because they have lost their families of choice (partners and networks of supportive friends) to the HIV/AIDS epidemic.
• Like other elders, many single LGBT people have outlived their contemporaries, but unlike their straight counterparts they may be hesitant or afraid to ask others for help.

The current generation of elders experienced virulent discrimination as younger adults that required them to hide their orientation or gender identity or risk violence or loss of employment. Despite the myth about gay people having large disposable incomes, many LGBT seniors were unemployed or underemployed during their working years and have small or no savings to fall back on.

Partnered gay people, even if they were married here in Massachusetts, do not qualify for survivor benefits from Social Security because of the federal Defense of Marriage Act (DOMA). The mainstream elder community has not typically welcomed people who are LGBT to programs at senior centers or meals sites. The same is true for long-term care facilities. Many agencies and institutions that work with elders are unprepared to incorporate LGBT seniors into their client base because of lack of training or lingering prejudice on the parts of administrators and staffs.

By contrast, the next generation of LGBT retirees, part of the so-called baby boom generation, is more accustomed to acceptance and to advocating for themselves. They have a different sense of entitlement than the generations who preceded them. At 80 million strong, the population of baby boomers is estimated to have from 1.6 million to 8 million LGBT people. Gay “boomers” are not as reticent about their sexual orientation or gender identity and expect social acceptance and respect in old age.

Same-sex marriage is now or will soon be allowed in five states: Connecticut, Iowa, Massachusetts, New Hampshire and Vermont. A sixth, Maine, passed a law allowing gay marriage, but voters will consider a challenge to it next month. A few other states and municipalities have laws that allow gay people to register their long-term partnerships through civil unions or domestic partnerships. LGBT elders whose relationships have been legally recognized in these ways expect them to be respected by providers of aging services.

Premier Home Health Care of Massachusetts, Inc. is launching a new Service Program called 1-800-Companion. The program is designed to help individuals as they begin to recognize a need for assistance with daily activities which preserve an active and social lifestyle.

As part of the Worcester County Community for 5 years, Premier has seen a recent shift in the needs of the County’s senior residents. “Our 1-800- Companion Service program addresses the increasing need of residents looking for opportunities for social activity and mobility. The program’s name is designed to be memorable and improve community access to this much needed service”, says Kimberly Arms, Office Administrator of Premier’s Worcester Office.

Companion Service is generally paid for by the client and or clients’ family’s personal private funds. In some instances Long Term Care Insurance policies may pay for the service. “Premier has priced the Companion Service so it is affordable and accessible” says Ms. Arms. “We want seniors to live well and independently at home as long as possible”.

“The Companion Service program enhances the Homemaking, Personal Care, Live-in, and Lifeline services already provided by Premier”, adds Ms. Arms “For the last 17 years, Premier’s company mission has been to design services and programs that provide compassionate care and enhance the lives of individuals and the communities we serve. Based on the amount of inquiries we received from seniors seeking this type of service over the last 12 months, Premier believes the service will enable a great many of our seniors to maintain their social and active lifestyle” Ms. Arms explains.

Premier’s Companion staff is screened and trained to provide escort, transportation, safety monitoring, and household tasks such as escorting clients to the theatre, luncheons, church events, medical appointments, shopping outings, visits with friends and family, meal preparation service, and safety monitoring among other activities.

14 October, 2004
West Boylston, MA

Central Massachusetts Agency on Aging (CMAA) is pleased to announce that Ashdown Technologies, Inc. (www.AshdownTech.com), SeniorConnection.org web manager and host, has offered to temporarily underwrite an expanded Connection for Caregivers. This generous offer came as CMAA was prepared to downsize the website due to lack of funding. According to a statement from Ashdown,

"Ashdown Technologies, Inc. is a web design and hosting company that has been working closely with CMAA since 1998. The Connection for Caregivers website, including it’s interactive components, was developed with personnel from both organizations working hand-in-hand to offer a unique tool that met the needs of caregivers and the people they so courageously support.

Because of the effort and time invested in this project, we were very sad when we learned earlier this year that funding had run out for the site. Knowing the unique benefits of the site and not wanting to see it disappear, we began discussing how we could help. We quickly decided that offering our capabilities at no-charge was the right thing to do. To that end, as of September 1st, Ashdown Technologies began donating the necessary Internet services to keep the Connection for Caregivers website moving forward in its entirety. It is our great pleasure to be able to help CMAA and the community that they serve so well."

The Board and Staff of Central Massachusetts Agency on Aging would like to thank Ashdown Technologies, Inc. for its generous support of this important effort to educate and assist caregivers of elders.

Your help, however, is still needed to keep the Connection for Caregivers going. For more information on how you can help, go to www.SeniorConnection.org, or call Central Massachusetts Agency on Aging at 508-852-5539V/TDD or 1-800-244-3032V/TDD.