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2006-09-29 Planning Retreat Notes
Area Agency on Aging for Lincolnland

Attending: The following AAA's were represented: 01, 02, 03, 04, 05, 06, 07, 08, 09, 10, 11, and 13. Representing the Illinois Department on Aging were Shelly Ebbert, Rance Carpenter, Mary Mayes, Betsy Creamer, Bert Weber, Susan LaTourelle, and Dave Vinkler.

Welcome and Introductions I4A President Joy Paeth welcomed participants from the Area Agencies on Aging and the Illinois Department on Aging and introduced Julie Hubbard as a presenter and Mike O'Donnell as the facilitator.

Review of Agenda - O'Donnell reviewed the agenda and asked participants for any changes or additions to the agenda. Participants had no further agenda items.

Presentation Hubbard, Executive Director of the Area Agency on Aging for Lincolnland, reprised a Power Point presentation by Sandy Markwood, CEO of N4A, entitled, The Maturing of America Getting Americas Communities on Track for the Aging of the Population. The presentation challenges the States, Area Agencies on Aging, and local leaders to assess the impact of the aging of the population on every aspect of community development including:

1. health,
2. housing,
3. transportation,
4. land use planning,
5. public safety,
6. parks and recreation,
7. workforce development,
8. education,
9. volunteerism,
10. civic engagement,
11. arts and cultural activities, and
12. economic and fiscal development.

After the presentation, O'Donnell asked: Is your PSA ready? The following is a summary of responses:

1. The Central Illinois Agency on Aging invited Sandy Markwood to give this presentation at their annual meeting. CIAA invited County Board members, city manager, the Heart of Peoria Board. Preparing for the aging of the population will be the subject of future forums.
2. AAAs should share this presentation with planning and zoning departments of cities and counties.
3. AAAs provide demographic data to county, township and municipal officials for planning purposes.
4. Local leadership is critical.
5. AAAs need to be at the table.
6. AAAs need access to the latest Census data. Rance Carpenter advised AAAs to check the website for the Illinois Department of Community and Economic Development.
7. Age Options (PSA 13) is currently involved in a Community Partnership grant project with the Robert Wood Johnson Foundation.
8. Every community is unique. AAAs can assist communities in assessing their assets.
9. Emergency preparedness should be part of the planning agenda.
10. It is critical to involve community organizations in emergency preparedness planning, e.g., churches, local units of government, neighborhood associations, private sector, volunteer sector, etc. These organizations have a can-do spirit - the ability to cut through red tape and get things done quickly.
11. There is a need for a registry of individuals with disabilities for emergency response. The Illinois Home Care Association has developed a tool to help home care providers prioritize their clients in case of emergency.
12. The group discussed the pros and cons of the concept of a statewide registry. The group noted the role of local disaster officials ESDA, Red Cross, Police, Sheriff, Fire Department, etc. The group noted the role of the CCU's.
13. The West Central Illinois AAA (PSA 06) noted its work with local officials in Adams County to develop a plan for emergency preparedness for persons with special needs.
14. The group discussed the feasibility of accessing the management information system for the Community Care Program during emergencies through a safe source.
15. A statewide registry may not be logistically possible. Local emergency response officials tend to rely on local human service agencies who know the identity and location of vulnerable clients.
16. The group questioned how to get people in the epicenter and outside the epicenter of an emergency event to respond. The regional coverage of Area Agencies on Aging is an asset in such cases.
17. The group generally agreed that we need to get organizations in the Aging Network prepared to respond to emergencies and disaster.
18. The group discussed the need for a state repository of program data and computer access codes.
19. Jon Lavin noted that the recent compromise reached in Congress on reauthorization of the Older Americans Act will not benefit future allocations of federal funding to seven states which are no-growth or low-growth in terms of their 60+ populations. These states include: Illinois, Michigan, New Jersey, New York, Wisconsin, Massachusetts, and Ohio.
20. AAAs have a lot on their plates and need additional resources to respond to emergencies.
21. AAAs must partner with local units of government, state government, and private sector organizations to plan for emergency preparedness.

Emerging Strategic Issues participants identified the following points for further discussion:

1. Implement new provision in the Older Americans Act Amendments of 2006 allowing AAAs to assess their Planning and Service Areas preparedness for the aging of the population.
2. Promote role of AAAs in the Older Adult Services Act planning process.
3. Define role of AAAs as Regional Administering Agencies in developing and implementing policies, procedures, protocols, and services in responding to reports of self neglect of older adults, in accordance with the provisions of the 2006 amendments to the Elder Abuse and Neglect Act (P.S. 94-1064).
4. Implement new provisions and mandates in the OAA Amendments of 2006, e.g., dietary reference intakes, targeting language, etc.
5. Provide information and develop skills of AAAs to meet new statutory mandates, e.g., Census data for 60+ limited English speaking population, etc.
6. Foster role of AAAs and the Aging Network in implementing Medicare Part D implications for human and financial resources for the provision of Information & Assistance, administrative functions, and administratively related direct services, i.e., advocacy, program development and coordination.
7. Assure food security and safety in senior nutrition programs.
8. Assure that criminal background checks are done for professionals and volunteers who provide services to older adults, caregivers, and children.
9. Implement comprehensive care coordination, a.k.a. comprehensive case management.
10. Implement Alternative Senior Services.
11. Assure quality customer services in the provision of Information & Assistance, e.g., AIRS certification for I&A providers serving older adults.
12. Develop an effective management information system from the local level to the federal level.
13. Promote succession planning to develop future leaders in the aging network and assure effective administration and management of core AAA functions as personnel retire in the future.
14. Develop a skilled workforce for the provision of supportive services to older adults.
15. Promote advocacy on aging within other state departments, e.g., Department of Human Services, Department of Healthcare and Family Services, Department of Public Health, etc.
16. Recapture leadership on aging issues in Illinois.
17. Prepare all relevant state agencies for the aging of Illinois, e.g., New York State Office on the Aging's Explore Aging Project 2015.
18. Reverse the fragmentation of the aging network in Illinois.
19. Cultivate the most valuable asset of the Aging Network: our mission of service to older adults.
20. Reposition AAAs and the Aging Network to have an impact on older adults at all levels.
21. Focus on increasing money to influence the service system without leverage there is no impact.
22. Conduct an asset analysis of the Aging Network.
23. Strengthen the AAAs partnership with the Illinois Department on Aging.
24. Strengthen the Illinois Association of Area Agencies on Aging.
25. Promote statewide consistency in the provision of services.
26. Constantly improve the quality of services and assess the relevance of our programs and services.
27. Conduct program evaluations and assess impact of our programs and services.
28. Need for consistent evaluation tools that can be used statewide.
29. Share best practices and evidence-based practices.
30. Strike a balance between consistency and flexibility (don't kill creativity).
31. Move toward consumer-directed services.
32. AAAs know the needs and resources in their PSA's this is a strength.
33. Demonstrate the impact of aging services to local funding sources.
34. Use MIS service tracking to demonstrate impact of programs and services on our clients.
35. Increase the visibility of the Aging Network to realize our potential in reaching caregivers.
36. Cultivate local support for aging services. How good is our intelligence about the state of local funding, e.g., the United Way allocation policy on community impact? Has our influence with community programs on aging diminished as federal and state funds have remained flat and the burden of shouldering operational costs has shifted to the local level? Who's doing what, and why? We have to repackage what were doing to respond to policies and priorities of funders at all levels federal, state, local both public and private. We have to be fresh and innovative to attract new money.
37. The Department on Aging can be creative within the structure of state government; the Area Agencies on Aging can be creative within many structures. This is the beauty of the Older Americans Act. AAAs take a leading role in promoting creativity at the local and regional levels.
38. Leadership is crucial. Where will leadership come from? What should be the role of I4A?
39. The Illinois Act on Aging and the Older Adult Services Act gives the Illinois Department on Aging the authority to be a catalyst for change within state government. This authority and leadership role are assets for the Department on Aging.
40. The Illinois Aging Network has established effective partnerships among the Illinois Department on Aging, Area Agencies on Aging, and service providers this is an asset.
41. Area Agencies on Aging have established credibility at the local level through our planning processes this is an asset.
42. AAAs should invite AARP and other organizations to participate in and support community programs on aging, e.g., volunteers.
43. Faith in Action programs coordinate congregational volunteers which have expanded the availability of services to seniors, e.g., individualized transportation to medical appointments.
44. AAAs should reach out to new audiences by promoting public input sessions and public hearings statewide.
45. AAAs need to get input on the front end of the planning process.
46. AAAs should involve consumers in the design of programs and services.
47. AAAs should consult with providers of case management and information and assistance in the development and implementation of Coordinated Points of Entry.
48. AAAs should demonstrate the impact (outcomes) of preventative services.
49. The traditional strength of Area Agencies on Aging and the Aging Network has been as an Access Network and as a provider of supportive, nutrition, and preventative services (soft services versus medical services).
50. One of our biggest challenges will be securing an adequate work force to provide home and community-based services. How realistic are our expectations?
51. Professionalize our workforce through the development of career ladders and certifications of workers. AAAs can play a lead role in promoting professional growth of home care workers, providers of information & assistance, and other workers in the aging network.
52. Empower consumers and they will shape the marketplace: Ill tell you what I want.

Asset Analysis Discussion identified the following assets of Area Agencies on Aging, the Department on Aging and the Aging Network in Illinois:

1. Statutory authority Older Americans Act, Illinois Act on Aging, Older Adult Services Act, etc.
2. Mission of service to older adults and family caregivers.
3. Knowledge of needs and resources within each PSA.
4. Local support for community programs on aging.
5. Advocacy role.
6. Leadership role.
7. Planning role.
8. Role as catalyst for change.
9. Ability to build effective partnerships.
10. Credibility.
11. The Access Network for Illinois Seniors and Caregivers.
12. Providing supportive, nutrition, and preventative services for older persons.
13. Performance in Medicare Part D and Illinois Cares Rx.

Strategic Issues The facilitator grouped 52 discussion points into the following issues (not in priority order):

1. Assess the preparedness of the State of Illinois and the thirteen Planning and Service Areas for the aging of the population, including emergency preparedness.
2. Implement goals and objectives established by the Older Adult Services Act Committee including.
• Comprehensive Care Coordination.
• Alternative Senior Services (flexible services).
• Management Information System functionalities include: resource data base, tracking services, and reporting services.
• Development of Coordinated Points of Entry.
• Provision of quality information & assistance services.
• Role of AAAs in quality assurance of aging services.
• Changing existing services, service expansion, and development of new services.
3. Implementation of new provisions in the Older Americans Act Amendments of 2006 including: community preparedness, new targeting requirements for Limited English-Speaking Elderly, nutrition program dietary reference intakes (DRIs), expanded eligibility for Title III-E services.
4. Quality Assurance, Quality Improvement, and Program Evaluation, specifically: consistent statewide tools, and sharing best practices and evidence-based practices.
5. Consumer directed services, consumer empowerment, and consumer advocacy.
6. Increase funding at the federal, state and local levels, including the public and private sectors.
7. Improve planning processes, including: greater consistency, sharing best practices and tools and reaching a wider audience.
8. Building and strengthening partnerships among Federal agencies, State agencies, AAAs, and local services providers, and within and among State agencies in Illinois.
9. Workforce Development including: succession planning for AAA staff, career ladders for home care workers, and AIRS certification for providers of Information & Assistance for seniors.
10. Fostering leadership in the Aging Network including the roles of AAAs, the Illinois Association of Area Agencies on Aging and the Illinois Department on Aging.
11. Providing quality customer services including role of AAAs and Aging Network in providing information & assistance, benefits counseling, access to Medicare Part D and Illinois Cares Rx., etc. The group discussed the pros and cons of including SHAP funds into the Area Plan. No consensus was reached on this issue.

Management Information System

The group discussed current efforts to develop a management information system to integrate functions of several existing systems including the billing functions of eCCPIS data base, the client level data base used by Case Coordination Units (CMIS), and the functionality needed to satisfy NAPIS reporting requirements. The Department on Aging has received an appropriation of $2 million for the development of a management information system. The Department plans to integrate the eCCPIS and CMIS systems to achieve the following objectives: (1) import care coordination data into eCCPIS and make the system more user-friendly, and (2) export care coordination data for NAPIS reporting. The Department on Aging plans to contract with a consultant to take a more comprehensive look at the MIS needs of the Aging Network in Illinois.

The group offered the following recommendations:

1. As we move toward comprehensive care coordination, all players need access to data. We need to blur the silos which has fragmented the Aging Network.
2. The Administration on Aging needs to define NAPIS reporting requirements.
3. AAAs need a management information system with functionality beyond the limits of NAPIS reporting.
4. NAPIS should be one of many reports that can be produced by a more comprehensive system.
5. Providers want to reduce the frequency and redundancy of entering data.

The group discussed current efforts to establish the ESP Resource Data Base a statewide, web-based data base of services. IDOA will follow-up with the vendor. The AAAs reiterated the need for funding to cover the cost of managing the data base in the future to keep the data base up to date and assure quality, e.g., password protection, use of a common taxonomy of services, issuing licenses, etc.

Statewide Issue for Area Plans for Fiscal Years 2008-2010

The group discussed current methods of public accountability including the Area Plan document, Public Information Documents, Public Hearings, compliance with assurances in grants and contracts, program and fiscal reporting, and publication of annual reports by AAAs.

The group discussed methods of assessing need. The group questioned the usefulness of the Illinois State Needs Assessment Survey of Elders Aged 55 and Over conducted by the Heartland Center on Aging, Disability and Long Term Care, School of Public and Environmental Affairs, University of Indiana, and the National Center for Senior Living and published in May, 1991.

The group asked about the status of the statewide assessment of senior services being conducted by Paul Bennett at the University of Illinois Chicago.

The group discussed the report entitled, The Maturing of America Getting Communities on Track for an Aging Population, published by n4a and MetLife Foundation in partnership with the International City/County Management Association, National Association of Counties, National League to Cities and Partners for Livable Communities. The report is available on the National Association of AAA website.

The group reached general agreement that AAAs would use the methodology used in The Maturing of America survey to assess the preparedness of each planning and service area for the aging of the population.

The group reached general agreement that developing Livable Communities for All Ages would require a much longer time period than just the next three-year Area Plan cycle. The process could take ten years or more.

The group reached general agreement that Livable Communities for All Ages would be the focus of the Area Plans for Fiscal Years 2008-2009-2010 and that each AAA could tailor their response to this issue to reflect the unique conditions in their planning and service area.

Critique of Area Plan Format

The group devoted fifteen minutes for a critique of the Area Plan format. The following is a summary of comments, questions, and recommendations for further discussion:

1. Exhibit 1.A the State of the Planning and Service Area offers a useable format for describing how prepared the PSA is for the aging of the population over the next ten years.
2. The group questioned how Exhibit 2.C is used. The Department on Aging stated that the exhibit is used to respond to inquiries from the Governors office and the General Assembly and other sources. The Department noted that efforts have been made to streamline this exhibit and not require the submission of the exhibit in the second and third year of the planning cycle with the exception of HDM's.
3. The group discussed the need for public hearings every year. The group asked if public hearings were required every year by the Administration on Aging. AoA does not require annual public hearings. The group noted that public hearings are opportunities for communication with the public and a visible means of accountability. To eliminate annual public hearings may send the wrong message.
4. The group advised the Department on Aging to eliminate redundancies in the Area Plan format, i.e., unnecessary repetition of information across exhibits.
5. The Department on Aging is considering incorporating the annual home delivered meal survey in the Area Plan format. The AAAs concurred.
6. Most AAAs will provide Information & Assistance as a direct service in the Area Plan.
7. The State Plan on Aging and the Area Plans on Aging should address common strategic issues.
8. Review and update service definitions in Section 600 of the IDOA Policy and Procedure Manual.
9. Include Excel formulas in Critique Instrument to calculate minimum allotments for priority service, Title III-E services, etc.

Follow-up and Adjournment The group agreed to continue discussions on strategic issues and the Area Plan for FY2008-2010 at next meeting of I4A on October 24 and the IDOA-AAA Meeting on October 25, 2006 in Springfield. The retreat adjourned at 3:00 p.m.