Statewide Implementation New York State

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Statewide Implementation - New York State

• Presented by Laurie Pferr
• Executive Deputy Director, New York State Office
  for the Aging
• Gail Koser
• Assistant Director, New York State Office for the
  Aging
• Claire Murphy
• Director of Office for the Aging,
• Washington County, New York State
• May 7, 2007

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Complexity of New York State

• Five large urban hubs
• Many rural areas
• Numerous suburban regions
• 62 Counties
• 59 local Area Aging Agencies
• Including 2 Indian Nations
• 58 Local Department of Social Service

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Current System
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The Need for Change
NYS - Projected Population Growth
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NYS Population DIVERSITY Ethnicity / Race
Change from 1990
2000
Year
5.5
18,976,457
All Groups
- 5.6
11,760,981
White
14.6
2,945,427
Black
29.5
2,867,583
Hispanic
71.7
1,191,050
Asian
Source New York State The Community Context
(2002, PowerPoint presentation) by Dr. John R.
Logan, former Director, Lewis Mumford Center,
University at Albany
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Olmstead Decision

• Requires the most integrated setting appropriate
  to the needs of qualified individuals
• Intake and admissions processes

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Long Term Care

• Long Term Care is a high stakes public arena with
  huge implications for all levels of government.
• Long Term Care includes medical, home and
  community based services and non-medical supports.

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A State-Level Partnership

• NYSOFA and DOH
• Collaboration and partnerships are essential
  components of addressing change within long term
  care service delivery, due to the broad range of
  populations and networks that are affected by it.
• It takes determination, recognition of different
  organizational cultures, missions and language.

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NY Connects Vision

• Promotes Self determination and Personal
  Responsibility
• Is Consumer-Centered and Meets Consumer Needs
• Provides High Quality Care
• Ensures Efficiency and Affordability

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New York States Efforts to Reform the Long Term
Care System

• Health Care Reform Working Group
• Most Integrated Setting Coordinating Council
• Spanning two Gubernatorial Administrations

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What is NY Connects

• To create a consumer-centered local entry point
  for information and assistance about long term
  care services for all age groups, regardless of
  payor source across NYS

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Goal of NY Connects

• To make it easier for consumer to access needed
  long term care services and supports.
• To reduce fragmentation within service delivery.
• To empower individuals to make informed choices.

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Partnerships

• Area Agencies on Aging and Local Department of
  Social Services
• Independent Living Centers
• 211
• Early Intervention
• ..and growing

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Funding and Staff

• State Appropriations
• Complicated funding mechanisms
• 2006-07
• 2007-08
• NYConnects is directed and administered by NYSOFA
  working jointly with NYSDOH
• Staffing at the state level

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Our Timeline for Change

• 2006
• Contract year began October 1, 2006
• 2007
• Phase one, contract year one ends September 30,
  2007
• 2007-2008
• Phase one continues

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• Gail Koser
• Assistant Director,
• Executive Division
• New York State Office for the Aging
• [phone]

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Taking NY Connects Statewide

• Request for Applications
• May 2006 NYSOFA and NYDOH released Request For
  Applications for county level long term care
  Point of Entry system.

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Elements of the RFA

• Partnership between AAAs and LDSSs
• Narrative, Budget, Action Plan
• A and B Counties

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Elements of NY Connects

• For Whom
• Public and private pay consumers
• Aged and disabled children and adults
• What
• A trusted resource that provides impartial,
  unbiased information and assistance
• Removes silos and creates partnerships
• Where
• Connected with their community
• Place call center, on-site locations, off-site
  consumer visits, Web site within the community

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Phase I

• Information and Assistance
• Screening
• Public Education

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Infrastructure to Move Initiative Forward

• Dedicated Staff
• Training
• Technical Assistance
• IT RFP

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The Countys Role In NY Connects

• To design their system specific to their
  locality.
• To foster collaboration among County Departments.
• To conduct outreach to stakeholders, providers
  and the general public.
• To streamline existing local LTC service delivery.

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Collaboration carries forth to the Local Level

• Allocate resources to provide the core functions
  and maintain the standards
• Maintain an infrastructure
• Maintain financial records
• Develop an annual budget and action plan

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Standards

• Standards are applied uniformly statewide,
  however, there is local flexibility on how
  counties implement the standards.
• Designation of Lead Agency,
• Conflict of Interest

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COOPERATIVE RELATIONSHIPS

• NY Connects collaborative partnerships and
  linkages must work toward sustaining a
  coordinated long term care system by
• Developing and maintaining relationships
• Formulating and communicating policy
  recommendations
• Participating in community planning

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Long Term Care Council

• Membership
• -representative of community it serves
• Community Assessment
• to determine services available and entry
  points
• System Analysis
• to cultivate solutions that will foster
  seamlessness
• Recommendations
• for a consumer-centered long term care system

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Benchmarks and Reporting

• All applicants work toward achievement of
  benchmarks.
• Benchmark are comprised of two or more tasks
• Successful achievement of benchmarks leads to the
  pro-rated payment as set forth in the contract.

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Reporting continued

• I and A reporting commences third contract
  quarter
• Topics are based upon AIRS taxonomy

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Notable Accomplishments

• MOU/MOA/contract has been developed
• Established Long Term Care Council Structure
• Resource inventories development
• Collaboration with Stakeholder Agencies
• Beginning to provide I and A

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NY ConnectsDesired Outcomes

• Improved access to LTC services and information
• Improved coordination via partnerships and
  collaboration
• Early intervention in the provision of services
  to support the consumers ability to remain at
  home and in the community.

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Logic Model for Phase One of the Long Term Care
Point of Entry Initiative NY Connects
Choices for Long Term Care
A S S U M P T I O N S
I N P U T S
S T R A T E G I E S
O U T P U T S
O U T C O M E S
I M P A C T
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NY Connects County Contracts

• 56 Contracts have been
• developed and sent for
• signatures
• 53 Contracts have
• been fully executed
• NYC is currently under
• development
• Oswego is not applying

Fully Executed Contract Developed,
Not Fully Executed Contract Pending Not
Applying
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Local ImplementationWashington County

• Claire Murphy, Director
• Washington County Office for the Aging

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Collaboration is a Contact Sport
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A game for energetic peopleplayed by
professionals
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Washington County

• Small Rural County in upstate NY
• Population 63,000
• 17 townships separate population centers
• Supervisory Government with County Administrator
• Agricultural Economy
• County agencies provide much of the home and
  community based services
• Larger non-county providers are still thought of
  as county entities
• Outside agencies exist in neighboring county or
  are community centered

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Why Change?

• Project 2015 Local Imperative
• 60 population to grow to 35 of population by
  2015
• 58 of those people will be over 85
• Population lt21 will remain stable at 33
• High out-migration of college educated and
  skilled young adults
• In-migration of snowbirds for LTC needs

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The Crisis

• 2002 30 County Tax Increase
• Rising Medicaid Share (25)
• Increased cost for employee related health
  coverage
• 2003 Only hospital in the county closed
• Focused attention on where would services come
  from

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Let The Games Begin

• 2003 Department Heads got together for lunch we
  started with introductions
• The Team
• Office for the Aging
• Public Health/Home Care and Hospice
• Social Services
• Veterans Services
• Youth
• Mental Health
• County Nursing Home/Medical Day/Adult Home

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Determining the Rules

• General recognition of limitations of each of us
  doing our own thing
• Acknowledgement of duplication of service and
  process
• Looking for common ground and opportunities to
  work together

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The Game Plan

• Consultant hired to work with county departments
  to facilitate .Working toward coordinated
  services.

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We Developed a Vision

• Creating the Future.
• (sounds pretty doesnt it)

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We Developed a Mission

• Success Independence through education and
  shared responsibility
• (sounds strong doesnt it)

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We even had a Play Book

• Reduce Duplication within County Agencies
• Better use of technology
• Better use of existing staff
• Determine what services are appropriate to be
  provided by the county
• Look for opportunities to use outside providers
  more effectively

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The Ball went into Play!

• We ate a lot of TURF!
• My program
• My money
• My job

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• We displayed a remarkable lack of team work
• My customers
• My information
• My Mandate

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• And fear
• If things are so bad then I must be doing a bad
  job
• How come you got something and I didnt- maybe
  they dont like me

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But some skills did come through

• Emergency planning became a multi agency effort
• County participated in a regional health
  assessment
• Public Health and OFA organized and led a
  bi-county discussion on the need for community
  mental health services for older adults
• We prepared an interagency response to the
  States request for information on Point of
  Entry

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Back to the Game Plan

• 2005- Consultant came back to assist with a
  survey of county services and the process
  involved for each agency
• We learned that in our differences where in fact
  similarities that we could not change, ignore or
  fight about.

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We learned some valuable lessons

• Change is difficult Trust is built not given
• Identification of Opportunities requires an
  understanding of each organizations culture and
  operation
• The development of a common language leads to a
  better understanding of each agencies needs and
  functions
• Current structure makes coordination difficult,
  but we do a better job than found other places

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But Most Importantly We Learned .

• We all did the same thing!

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What?
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(No Transcript)
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Washington County Answer to Point of Entry

• County Needs
• Single access to info about all county services
  with eye toward 211 services
• Shared staff across departments do a job once
  and do it well
• Open connections to other providers

• POE Needs
• Single access to LTC Services regardless of age,
  disability or payment source
• Shared Responsibility OFA/DSS other agencies as
  able
• Coordination with all providers or LTC services

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Bringing the Community Providers into the Game

• Establishing a Local Long Term Care Council
• Local Providers enthusiastically curious about
  Point of Entry
• 114 invitation to providers in region
• 60 of providers came for a day long session
• First LTCC meeting October 21, 2006
• Monthly Meeting since Bylaws adopted in April

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Provider Concerns

• POE will limit access to their services
• Education will not be adequate to ensure
  comprehensive access
• POE in individual Counties would make for
  multiple LTCCs especially in rural areas where
  providers served multiple counties

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Function of the LTCC

• Identify the opportunities for improvement,
  dissemination or information, coordination and
  planning for long term care services
• Identify alternative approaches and/or service
  gaps in the long term care system
• Develop and update long term care policies that
  would facilitate the needs of programs and
  facilities, and
• Review and discussion of current issues,
  policies, program services and legislation that
  impact the system of long term care in Washington
  County

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And What Are We Doing?

• Washington County CARES
• Your Link to NY Connects
• Choices for Long Term Care

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Washington County CARESAging and Disabilities
Resource Center

• CARES Coordinated Access Referral, Education
  and Services
• Phase 1 Functions
• Information for All Services regardless of age,
  disability or payment source
• Eligibility screening, Counseling, Coordination
  of Educational Resources and Supportive Services
• Care Coordination of County provided Services

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Creating the Future

• ADRC to merge OFA and DSS programs
• ADRC will be designated AAA by Board of
  Supervisors and State
• ADRC will be fiscally sheltered by DSS but
  separate, identifiable and independent of DSS
• We will start with LTC services and move to the
  larger 211 scope

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Collaboration Works

• Additional Opportunities
• CHHA nursing referrals
• Future Growth and Coordination
• Staffing and Service Needs
• Better Fiscal Control
• Funding and reimbursement
• Better Service

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Washington County CARES!

• Questions?