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HomeMy WebLinkAboutAgenda - 02-08-2000 - 4ORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: February 8, 2000 Action Agenda Item No. 4 SUBJECT: Outstanding Issues from January 20, 2000 Retreat - Review of Selected 1999- 2000 Goal Updates DEPARTMENT: County Manager PUBLIC HEARING: (Y /N) No ATTACHMENT(S): 1/20/00 BOCC Retreat Notebooks (previously distributed) 1/20/00 Retreat Agenda MAP Background Information INFORMATION CONTACT: John Link or Rod Visser, ext 2300 TELEPHONE NUMBERS: Hillsborough 732 -8181 Chapel Hill 968 -4501 Durham 688 -7331 Mebane 336- 227 -2031 PURPOSE: To continue discussion from the January 20, 2000 retreat of selected 1999 -2000 BOCC goal updates. BACKGROUND: At the January 20, 2000 annual planning retreat, and at their "brainstorming" work session on February 1, 2000, the BOCC worked through most of the items they had planned to discuss at the retreat. However, the Board was able to deal with only a few of the Board goals that had been identified for review, and indicated the intent to discuss the remaining goals at the February 8 work session. Moreover, the Board may wish to discuss any of the other goal updates that were provided in the Board's retreat notebooks. Board direction on any of these goals will assist staff in developing the Board's set of 2000 -2001 goals for formal adoption later this spring. One specific goal which the Manager recommends the Board address at this time is the Master Aging Plan. The MAP sub - committees have prepared their recommended priorities, and request that the BOCC provide endorsement of those priorities (in accordance with the MAP goal action plan) so the MAP task force can continue working towards completion of their final report by June 2000. FINANCIAL IMPACT: None at this time. RECOMMENDATION(S): The Manager recommends that the Board discuss the selected goal updates and provide appropriate direction to staff. 2 ORANGE COUNTY BOARD OF COMMISSIONERS ANNUAL PLANNING AND GOAL SETTING RETREAT SOUTHERN HUMAN SERVICES CENTER January 20, 2000 3:30 — 10:00pm 3:30 Agenda items from the January 18, 2000 Regular Meeting 5:00 Review agenda and agree on process for conducting retreat 5:15 Fiscal Review /Outlook for 1999 -2000 and 2000 -2001 (staff presentation w/handouts provided at meeting) 5:30 Dinner Break 6:00 Discussion of BOCC structure and procedures for working as a Board (e.g. sub - committee /task force approach, legislative initiatives, rotation of officers, and agenda changes) 7:00 Review of Selected 1999 -2000 Goals (review by exception those goals which need discussion or fundamental changes in preparation for adoption of BOCC goals for 2000 -2001 later this spring) • Affordable housing • Water /Sewer Service Boundary • IT Plan • Strategic Communications Plan • Solid Waste • Comprehensive Plan Update • Lands Legacy/Parks • TDR • Intergovernmental Efforts with Hillsborough • Adequate Public Facilities 8:30 Review of Input from Advisory Boards /Commissions 9:00 Brainstorming and Identification of Topics for Future BOCC Meetings /Work Sessions (to include discussion of an update component at the start of each meeting; a work session with Planning Board) 9:45 Closed Session 10:00 Adjourn ORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: February 8, 2000 Action Agenda Item No. SUBJECT: Master Aging Plan Task Force: Status Update; Presentation of Priority Issues DEPARTMENT: Aging/ Advisory Board on Aging PUBLIC HEARING: (Y/N) No ATTACHMENT(S): 1) Statement of Charge to the Task Force 2) MAP Flow Chart of process /timeframe 3) Summary of Prioritized Issues 4) Priority Issue Presentation INFORMATION CONTACT: Jerry M. Passmore Florence Soltys, Chair, Aging Board TELEPHONE NUMBERS: Hillsborough 732 -8181 Chapel Hill 968 -4501 Durham 688 -7331 Mebane 336 - 227 -2031 PURPOSE: To present the work done to date by the Master Aging Plan Task Force. To gain approval of the priority issues identified by the three MAP subcommittees. BACKGROUND: At the request of the Orange County Advisory Board on Aging, the Orange County Board of Commissioners adopted a plan for the development of a Master Aging Plan (M.A.P.) for the County for FY99 -2000 on May 11, 1999. Advertisement in the local newspaper done for membership on M.A.P. Task Force's four committees: (1) Steering Committee, (2) Well/Fit Older Adult Subcommittee, (3) Disabled /Moderately Impaired Older Adult Subcommittee and (4) the Severely Impaired /Institutionalized Older Adult Subcommittee. Over 100 membership requests were received and reviewed by the Advisory Board on Aging on September and with BOCC members Alice Gordon and Barry Jacobs. The three subcommittees have completed Phase I of the process: strategic issue identification (summary attached). As required by the MAP Taskforce "Charge," the taskforce will be presenting an overview of the strategic issues they have identified for inclusion in the strategic plan. Phase II of the MAP process will focus on recommendations and action plans for the resolution of the priority issues. FINANCIAL IMPACT: Funds have been budgeted to cover the expense of the committees operations and preparing the Master Aging Plan. RECOMMENDATION(S): MAP Steering Committee recommend approval of the issues identified by the subcommittees and reviewed by the Steering Committee in order to begin Phase II. FN:/H1bocc /ab00214.doc Master Aging Plan 4 Summary of Priority Issues I. Well -Fit Subcommittee a) Maintenance of well -fit health status b) Availability of information and access to certain services c) Housing II. Moderately Impaired Subcommittee a) Support for caregivers and family b) Mental Health/Emotional Well -being c) Information, Education and Societal Attitude III. Severely Disabled Subcommittee a) Quality and Continuity of Care - delivery - planning - accountability IV. Steering Committee Additions a) Information and Communication of Resources was identified as an issue in all three subcommittees and will be dealt with as a priority issue b) Accessibility, affordability, acceptability and availability are critical factors in each of the priority issues and must be addressed when determining solutions and action plans for the priority issues. Additionally, these factors should be addressed when a review of any new or existing services is undertaken by the County. A template will be developed to aid in this assessment 01/31/00 M F ON u BOCC Appointments to MAP November 1999 1. Revise Issues 2. Devise Strategies 3. BOCC Approval of strategies March -April 2000 1. Draft Strategic Plan 2. BOCC Approval of Draft Plan May -June 2000 Identify Issues December 1999 Community Feedback February 2000 H. M IA�P' �p�lOiJ j Research/ Background On Issues December 1999 BOCC Approval of Plan .June 2000 I. �.a Advisory Board on Aging to update annually 10/20/1999 X Attachment A: Statement of Charge to the M.A.P. Task Force (Revision 2) The Orange County Board of Commissioners has authorized the formation of a team of individuals, from the public and private community, to develop a Master Aging Plan (M.A.P.) that will provide a comprehensive and coordinated delivery of community services to senior citizens who have different levels of functional capacity. To complete this task, a Task Force comprised of a Steering Committee and three Functional Subcommittees (the term of membership is from November 1999 thru June 2000) is being submitted to the Board of County Commissioners for review. Ms. Florence Soltys is to be the Chair of the M.A.P. Task Force and staff assistance will be provided by Jerry Passmore (Director, Orange County Department on Aging) and Mari Pitcher (MSW intern) The Advisory Board on Aging will be responsible for monitoring the approved plan after June, 2000 and will submit annual updates to the BOCC. The charge to be given to each of the committee /subcommittees is: I. Steering Committee Charge: ■ To establish the overall goals and objectives for each subcommittee. ■ To present the goals and objectives to the BOCC for review and approval. ■ To develop and implement the process by which the M.A.P. will be developed. ■ To establish the guiding principles to which the M.A.P. team will adhere. ■ To monitor the work of the functional subcommittees and provide feedback and direction as necessary. • To hold public forums to garner feedback from the community and policymakers • To approve the work of the functional subcommittees and submit it to the BOCC for review and approval: ■ List of prioritized issues ■ Strategies and accompanying objectives ■ Draft strategic plan (complete with a set of prioritized plan elements and approximate costs) ■ Final M.A.P. • To update the Orange County Board of County Commissioners on the status of the M.A.P. project. • To review and recommend approval of the final M.A.P. proposal prior to its submission to the BOCC. II. Functional Subcommittee Charge: (this charge applies to all three subcommittees, as it relates to their particular functional population) ■ To identify the issues relevant to their assigned functional population. - based on their own expertise and experience - based upon objective data provided through an environmental scan - based on feedback from community members Attachment A: Statement of Charge to the M.A.P. Task Force (Revision 2) • To research relevant issues through the use of focus groups, constituent group member feedback, interviews (when possible). • To prioritize the issues pertaining to their assigned functional population • To present their findings to the Steering Committee for review and approval • To revise issues based on feedback • To develop goals and strategies, for the next five years, that will meet the needs of their functional populations. Review of innovative programs and feedback from experts and community members. • To submit their proposed goals and strategies (plan elements) to the Steering Committee for review. The prioritized strategies will be accompanied by approximate implementation costs. • To review and provide feedback on the draft M.A.P. The draft and final M.A.P. will include a list of prioritized plan elements with an approximate cost associated with each. 7 Master Aging Plan a Meeting Objectives: 1. To review Committee's role 2. To review the updated planning process 3. To hear presentations on Issues and approve for submission to BOCC Logistics: Group Members: DATE: January 21, 2000 1. MAP Steering Committee TIME: 3:00- 4:30pm 2. LOCATION: So. Human Services Center 3. BRING (MATERIALS): Issues Report and updated planning process. 4. Handout copies of Issues presentation. 5. 6. 7. PREPARATION REQUIRED: 8. AGENDA ITEM I PROCESS I TIME 2. Introductions Round Robin 3:02 3.Steering Committee Role Presentation/Discussion 3:07 3. Review updated planning Presentation, discussion, 3:15 processJfuture meeting date 4. Review and approve the Presentation by Subcom. 3:20 Subcommittees' Issues. discussion, modification A. Well/Fit B. Disabled /Moderately Imp C. Severely Impaired/ Instit. 5. Discuss Issue Report to the Discussion 4:20 BOCC on Feb.14d,7:30pm 6. Decision on Public Meetings discussion, and vote 4:30 F. Adjourn 4:35 PERSON(s) RESPONSIBLE F. Soltys ALL F. Soltys F. Soltys & members J Passmore/R. Hudson/ M. Pitcher All ALL 01/21/00 FN:H/MAP:SC1109 • (TI Well -Fit: Issues Socioeconomic Status lire! Well -Fit: Priority Issue 1 � Issue Identifying and reaching isolated, pocketed, disenfranchised, historically underrepresented populations or those who have unique health needs. Definition • Many preventive health care services and programs exist in Orange County • There are pockets of older persons who do not have access to the services that exist within the county. They need to be reached. 0 (TI 0 • Well -Fit: Priority Issue 1 CONSEQUENCES of INACTION • Health resource equity will not exist within Orange County 33% of Asian Americans have never seen a Western doctor or dentist 8% of Hispanics have no public or private medical insurance • Health care costs will increase for those who are unable to access services. - When Hispanics enter nursing homes, they tend to be functionally and physically more impaired than their White counterparts -The prevalence of chronic disease is estimated to be twice as high among African Americans as among Whites • Well -Fit individuals will become moderately impaired and /or severely disabled. 34.7% of persons 65+ are overweight 59% of older persons have sedentary Lifestyles - 9.1% of Orange County Seniors report having problems with alcohol r (TIO Well -Fit: Priority Issue 2 Issue I The lack of availability of information and access to services creates deterioration of health and quality of life, further isolating the senior from available services. Definition Lack of accessible multi- purpose Senior Centers inhibits socialization . and access to information and to preventive health services, recreation, and social services. Preventive foot, eye care, hearing and dental services are not readily available (at an affordable cost). Non - availability of transportation N • Well -Fit: Access to Services &Resources. r w �o Well -Fit: Priority Issue 3 Issue • A lack of public and private, affordable, housing alternatives for older . persons exists • Aging in place is difficult due to lack of home maintenance, repair, and modification (Include5home safety and security) • Housing is not built to accommodate changing needs of older persons I.- 41 (TIO Well -Fit: Housing CONSEQUENCES OF INACTION • Older persons will not be able to continue to live independently - In a recent survey commissioned by the United Way, Orange County residents listed affordable housing as the number one issue - Only 313 HUD and FHA housing units exist for older persons in Orange County • Older residents may be forced to move out of Orange County the likelihood of renting increase with age and is higher for minority populations An Orange County task force found that 17 care facilities will need to be developed over the next 20 years • Older persons will be forced to live in sub- standard housing - Building codes do not address the needs of the elderly - A 1990 study found that 30 % of older person residences lacked central heat, 6 % lacked complete plumbing, and 5% lacked kitchen facilities • 0 Well -Fit Pervasive Issue: Economics • Adequate income is needed for successful retirement • Jobs for seniors using life skills are needed • Training and re- tooling of skills are needed to enable seniors to return to work • Lack of affordable health care insurance • Financial planning services are needed Economic issues cut across all issues facing o/derpersons, Moderately Impaired: Issues h, ACCESSIBILITY = ' Caregiver &Family Support: respite, counseling, resources and education ' Mental Health/ Emotional Well-being ' Information, Education and Societal Attitude ' Intangible Services Needs not Adequately Addressed Q Y i V 0* Moderately Impaired: Priority Issue 1 ISSUE SIIF I Maintaining moderately impaired persons independence and ability to live at home as long as possible, requires on going support for the caregiver and family DEFINITION • Respite • In home chronic care • Out- of- home daycare • Short term respite (institutional • Counseling for caregiver ��ndrviduaiandyrou,o> • Resources and Education: whattoexpect, how to app /y • Preparation and training of caregivers Moderately Impaired: Caregiver &Family Support CONSEQUENCES of INACTION • From home care to institutional carem*economic impact - home health care can be about 40% less . than nursing home care • Productivity of caregiver decreases - 50% or more make changes at work to accommodate caregiving - income of caregivers is about $1500 -2000 per year less than peers. • Mental and physical health . of caregiver suffers - Increased levels of depression and deterioration of physical health - Medical costs for caregiver begins to outweigh cost of medical care for recipient of care • Abuse and neglect of .older . person may result - caregiver stress is one of the primary factors leading to abuse I Lack of attention by society to the mental health of older adults Symptoms• Iso /ation, depression, lack of motivation &desire Definition Mental health issues are neglected as indicated by: � /ack ofsoca /ization and suppoltservices (preventative) � under identification of mental hea /ih diagnosis � lack oftrained personae /in geriatric menta /hea /th � inadequate /inappropriate treatment N O ►�i Moderately Impaired: Mental Health CONSEQUENCES OF INACTION • Increase in suicide 17 -25% of all suicides in USA occur in persons 65+ Highest rate in USA found among older white males • Overuse of medical system - 20% of all admissions to psychiatric hospitals are persons 65+ - more likely to require longer periods of inpatient treatments • Economic burden - less likely than young to use outpatient clinics, more likely to enter system in crisis • Increase in homelessness - older persons comprise 10 -20% of the homeless population many suffer from psychiatric disorders, alcoholism, and dementia prevalence of chronic disease is higher than with older persons • Increased dependency N► nursing home placement N Moderately Impaired: Priority Issue 3 .Issue Lack of readily available information on where to go or whom to talk to (Includes lack ofpub /icity on information that May be aVai /ab /e) Negative perception of older adults in the community Lack of utilization of skills and knowledge of older • persons h�p Definition • No central location /portal for persons to access information and services related to aging and aging issues • Lack of educational services to assist older persons adjust to changes and to continue to grow as individuals • Skills and talents of older persons are not drawn upon by the community at large N N Moderately Impaired: Info &Education CONSEQUENCES OF INACTION • Older person will not access the services that are available and degradation of health and quality of life will result. Hispanic and African American elders are less likely to access services than their White counterparts. Cultural issues and mistrust are the primary reasons. At least 50 % of the MAP participants were unaware of the a majority of the services available to Seniors in Orange County • Society will lose a valuable resource by isolating older persons. Manpower needs will go unmet and older persons will suffer a loss; of dignity and 'purpose. The unemployment rate of older adults who wish to work is 1 -2% higher than the national average - "Perceptions of activities as useful are a major contributor to satisfaction in retirement I N W Moderately Impaired: Accessibility Acceptability: services are not offered in a way that is cu /tura //y acceptable - Pride inhibits some from accessing services Need a way to honor stoic attltudes and still encourage Seniors to access serv/ces Economics: - Equal accessibility to a// levels of care Transportation: Lack ofavailab /e, affordab le, easy to use transportation - Rural areas have strongest need Services are not accessed because transport is not avalab /e Accessibility issues cut across all issues facing older persons. r . :MAP Severely Disabled Taskforce: Issue Prioritization ISSUeS (descending order) e Severely Disabled Issues: Priority 1 I Quality and Discontinuity of Care: a. PI an n i ng: ' Coordi nati on of I nterdi sci pl i nary and I nterfaci I ity Care ' Ensuri ng adequate number of qual ity choices for al I payor sources ' Cu I ture of the f aci I i ti es and heal th systems Long term resource management and coordination b. Delivery: ' T rai n ng and ex peri ence of pri mary prow i ders ' A v ai I abi I i ty of trai ned and stabl e staff ' L ack of f ocus on i ndi v i dual i zed care ' Recognizing special needs of older persons w /cognitive impairment ' V al ue of direct care staff (culture) ' Enforcement and addition to existing regulations N I O� I f Priority 1: Quality and Discontinuity of Care c. A ccountabi I ity (regulations mnitoring /enforcement) ' Lack of enforcement' - ' Peopl e gi v en a di ff i cu l t ti me w hen they comp) ai n ' No effective recourse for consumers ' No accountabi I i ty to the resi dents ' Beauty does not buy good care" N I V °' Priority 1: Quality and Discontinuity o f Care lop ` � ,• The Consequences ofDoing Nothin g o� L oss of i ndependence, di gni ty, —• Displacement identity Few, if any, farm I care homes Homelessness Medication errors Total loss of qual ity of I if Depression ncreasi ng l ev el s of mal nutri ti on, Frustration of staff, dehydration, & pressure ulcers increased turnover Revolving door Elder abuse, Debilitation �.. neglect, exploitation Resident sl eepi ng naked in own feces 1"k Caregiver impact, 19 Financial cost to farri I ies cost to community Loss of functioning, One C.N.A per 16 patients increase in health care in an A l zhei rer' s unit costs L oriel i Hess, hopelessness, boredom " Priority 1: Quality and Discontinuity of Care The Consequences of Doing Nothing ■1 I n 1990, 7 M i I I i on peopl e used some form of I ong term care, by 2040 the number will i ncrease to 18 rri I I i on *The people who are most likely to be institutionalized are those who are extremely difficult to sustain in the community ♦ 1% of persons 65 to 74, 6°/o of persons 75 to 84, and 220/0 of persons age 85+ resi de i n nursi ng homes (45% have been there more than two years) *There i s al most no i nstructi on i n nursi ng home care duri ng medi cal school and resi dency ♦ M any of the problems resi dents suffer f rom i n a nursing home requi re sped al di agnosi s and treatment: i Iecti ons, i nconti nence, fal I s, depressi on, conf usi on, mal nutri ti on and pressure ulcers M any hospi tal admi ssi ons of nursi ng home pati ents are a resul t of : I ack of adequatel y trai ned staff, a I ack of di agnosti c sere i ces, phyd ci an cony eni ence, and pressure f rom staff and f ami I y to "transf er" of der persons w i th "di ff i cul t" compl i cati ons • T ransfers back to nursi ng homes are f requently a prod em due to: del ayed or i ncorrpl ete transfer of information from the hospital • Readrni ssi on to the hospi tal w i thi n a short ti me occurs i n 30- 4010 of the cases • H i gher hospi tal i zati on rates hav e been f ound among resi dents of f or- prof i t nursi ng homes • 8810 of nursi ng home residents are white (US figure) • C.N.A. turnover rates are 9010 Source:: Williams, Mark (1995). The American Geriatric Society's CoMlete Guide to Akins and Health Hooyman, N.. & Kiyak, H.A., (1999), Social Gerontology. N