HomeMy WebLinkAboutAgenda - 05-04-2006-7aORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: May 4, 2006
Action Agenda
Item No.
SUBJECT: Master Aging Plan Process Update and Priority Issues Approval
DEPARTMENT: Aging/ Advisory Board on Aging PUBLIC HEARING: (Y/N) No
ATTACHMENT(S): INFORMATION CONTACT:
1) Steering Cam. Minutes -Feb, 2 & Mar. 23 .lerry M, Passmore, Project Manager, 245-
2) MAP Accomplishments & Unmet 2009
Objectives for 2000-2005 Pat Sprigg, Task Force Co-Chair
3) MAP Timeline Update & Meeting Dates Florence Soltys, Task Force Co-Chair
4) Subcommittees' Priority Issues
5) Senior Friendly Community Initiative
6) Major Key Issue Areas for MAP Update
7) Special Meeting Minutes on Major Key
Areas/Issues --April 20, 2006
PURPOSE: To update the Board of County Commissioners on the Master Aging Planning
progress and to request approval of the priority issues identified by the Task Force Aging Plan.
BACKGROUND: At the request of the Orange County Advisory Board on Aging, the Orange
County Board of Commissioners approved on June 23, 2005 updating the Master Aging Plan
(M.A.P,) for the Years 2006-2010, On October 18, 2005, the Board of County Commissioners
approved the recommended M,A.P, Task Force charge, structure, membership and time frame
-including the designation of two commissioner board members, Barry Jacobs and Alice
Gordon, to serve on the Steering Committee, The MA,P. Steering Committee will guide the
activities of the three subcommittees charged with review and research around specific issues
of the elderly, and help develop the comprehensive M,A,P, Pat Sprigg and Florence Soltys, co-
chairs, held a M.A.P. Task Force Orientation on December 1, 2005, This kick-off event
(Meeting #1) covered highlights of M,A,P, accomplishments for 2000-2005, recognized the key
leaders, and reviewed the process, structure and proposed time frame for updating M,A,P.
During the months of December and January, the three functional subcommittees: (1) Well/Fit
Older Adult, (2) Disabled /Moderately Impaired Older Adult and (3) the Severely Impaired
/Institutionalized Older Adult ,met to begin identifying and prioritizing issues. The M.A,P.
Steering Committee held its Meeting #2 on Febnaary 2, 2006 to begin its review of the
Accomplishments and Unmet Objectives for 2000-2005 (Attachment), review updated profile of
older adults and to identify elements for being a more senior-friendly community, In addition,
the subcommittees gave progress reports. On March 23 2006, the M,A,P, Steering Committee
held its Meeting #3 to complete the identification and prioritization of issues for 2006-10.
Presentations by the subcommittees were given on their priority issues and accepted. The
top five issues are as follows: (Attachment-Complete priority listing)
Well-Fit Older Adult Subcommittee:
1. Home-based Community Services
2. Community Assessments/Outcome Evaluation
3. Driver Safety (education/road conditions)
4. Access and Affordable Healthcare (including oral health)
5. Greater Budget Appropriations for a growing Aging Population
Disabled/Moderately Impaired Older Adult Subcommittee:
1, Lack of Mental Health Treatment (depression, etc,)
2. Isolation and Loneliness (25% of older adults live alone)
3. Lack of Case Management Services
4. Lack of Collaboration with Faith communities
5. Dementia (Increasing as the population becomes older)
Severely Impaired/Institutionalized Older Adult Subcommittee:
1, Quality of Life and Care Issues
2, Caregiver Support/ Work Force Issues
3. Education /Outreach
4. Person-directed Care
The Steering Committee also heard and approved a special Senior Friendly Community
Initiative to be part of the updated M.A,P, (Attachment) However, after discussion the
approved recommendation was broadened as follows:
Senior Friendly Community: Engage all departments of Orange County Government as
well as the broader community (Towns, Chambers, developers, etc.) in the process of
improving the infrastructure and services to meet the needs of moderately-impaired older
residents.
Due to a medical emergency of a participant requiring 911 first responders, the March 23rd
meeting was cut short and the agenda was not completed, However, the Steering Committee
held a special meeting on April 20, 2006 to complete the review of the four key areas (Housing,
Transportation, Information/Access, Community Transitional Care) that were identified as most
important that affect all alder adults and were not covered by the subcommittees, (Attachment)
As indicated in the special meeting minutes, some of the priority issues in these four areas
are:
Housing:
1. Need for affordable housing for seniors in central and north Orange
2, Property tax breaks or deferments for elderly to age in place
3. Need for support services in newly-planned senior communities,
4, Need for education/forums on how to "age in place"
5. Change regulations, covenants, zoning that prevent seniors to age in place
6. Need for community volunteers to help with home repairs and accommodate increased
disabled older persons,
3
Transportation:
1, Expand OPT service level to equal to or better than Chapel Hill/ Carrboro E-Z Rider
2, Expand transportation to senior centers (hours of operation and expansion of clients)
3. Review fare Structure -route costs in order to serve all seniors.
4, Identify and seek new sources of funding to support expansion of transportation
5. Consider combining OPT and E-Z Rider service.
Information/Access:
1. Need for increase Marketing of aging services (Dept, on Aging -logo, newspapers,
brochures, etc„ new staff)
2. Increase and improve website information on senior services
3. Increase outreach information meetings (community roundtables)
4. Increase newcomer information and ways to reach out to them
5, More specialized information access- volunteering and job seeking
Community Transitional Care:
1. Support creation of database (elderly health information)
2, Support development of PACE Program (HMO for low income persons)
3. Review and re-institute "blue sheet" form far nursing home to hospital transitions
and "pink sheet" from hospital to nursing home transition
4. Create information resources for discharge planners & far patient/caregiver to improve
transitions
5. Implement specific recommendations from state Mental Health Reform
6, Expand adult day health services - (Medical -CAP program)
7. Explore expanding assessment and care planning using home setting (similar to Hubbard
and Mobile SHAC)
FINANCIAL IMPACT: None at this time.
RECOMMENDATION(S): The Manager recommends that the Board accept the report as
information, provide any comments or questions, and consider approval of the identified priority
issues, bath from the subcommittees and steering committee.
~~~~~
Orange County Master Aging Plan Update: 2006-10
M.A.P. Steering Committee Minutes
February 2, 2006
Introductions
The meeting was called to order by Pat Sprigg, co-chair for the Master Aging Plan i.Jpdate, at 8:00 a.m, at Cazol
Woods Retirement Community, Lookout Room, Chapel Hill, North Carolina. Everyone introduced themselves,
Pat Sprigg gave introductory remazks and the project timeline with projected meetings dates were distributed.
Co-chair Florence Soltys updated everyone on the mission and development of M.A,P. and purpose of the
vazious the subcommittees, Florence Soltys indicated that we used the Guiding Principles of the United Nations
as the background in preparing the M,A.P. report. (See manual, section 1),
Jerry Passmore indicated that the meeting ground rules were in their manual (section 8) and included try to
attend all meetings, be on time, only one person speak at a time, everyone has input value, follow a preset
agenda and begin and end on time, Everyone agreed to the ground rules.
Review Past M.A.P. Accomplishments and Unmet Obiectives -2000-OS
Florence Soltys highlighted the report distributed on the MAP goals and the accomplishments and the unmet
objectives that have been achieved during these past five yeazs, The Goal One (lA) was to improve access to
services information assistance and social activities for all older persons in Orange County. She feels that they
have done fairly well with these objectives, However, this is an ongoing process that will never stop because
we need to provide information on a consistent and long-term basis. One of the areas that we did not achieve
which she feels is very important and one that they will take a serious look at as not achieving is multi-lingual
and cultural sensitive areas of the website and their guide, Tlris is essential and needs attention. Also, they
would like to get a campaign going whereby the University, private businesses, County government and the
schools would donate computers to the Senior Centers when they are upgrading their computers so they will
have plenty of them, Another objective we need to work on is to provide quarterly training courses for
internet access at the Senior Centers so the seniors can use the internet and be aware of what is there. We still
have a ways to go on this training. An assessment of community awareness -evaluating how effective we are
in reaching all seniors with information needs to be done. Florence Soltys discussed urunet facility access
objectives. Again a community survey that will evaluate the effectiveness of the senior centers and outreach
programs is needed. This has been partially done, but is something they need to look at. The questions aze (1)
are we doing what we need to be doing and (2) are we reaching the people we need to reach, etc. A new Central
Orange Center facility has been approved and we need to look at the satellite outreach program spaces and
they relate centers. Committee waited to discuss transportation issues at this point in the agenda until AI Terry,
O.P.T Manager arrives, Florence Soltys feels transportation is one of the big issues for seniors.
Goal Two (1B) is to have each older person in Orange Countxperceived for their value and uniqueness.
According to Florence Soltys we have done some things to achieve this goal (In Praise of Age TV Show,
newspapers), but still have a ways to go. We need to work on obtaining commitment from three counties or
State education or aging institutions to provide training and continued education for programs to educate
service providers about the strengths and the tremendous assets of elders and maximize their contributions to
the community, Another one is the need to increase the number of intergenerational volunteer programs,
We need to do more of this with UNC, youth civic organizations, the schools and RSVP in utilizing the talents
of seniors as a two-way street with an intergenerational program.
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One of the things people have felt is that there is no mechanism in the University to better utilize the skills
and talents of seniors for teaching students.
Seniors absolutely have so much to offer and we need a more formalized program which captures these talents,
The medical school has done some noon conferences on Thursday and a few bring older adults in for classes but
there is not enough being done. We need to develop a mechanism for a recognition program for
intergenerafional programs within the community. We also need to work with the North Cazolina Institute on
Aging, Community Colleges and the public school system on developing a curriculum model on aging which
could be taught to high school health classes, retirement planning, etc. These are things we have not done
and need to spend some time doing.
Goal Three (1C) is to assure that adequate mental health services and educational programs are available for all
older Americans in Orange County. According to Florence Soltys, this is a big big issue due to changes with
mental health system in this state, and what is happening in the nursing homes and in the adult care homes or
assisted living homes, there are very serious problems, If the Orange County Deparhnent on Aging is to assume
more responsibility for delivery of mental health programs for the elderly, they will need additional
resources. Inmost counties, the mental health system is not providing these programs, particularly for the
elders,
Ann Johnson said that we should not assume that the State is not going to address this issue, She asked that this
be put high on the list when they start discussing these issues, It was decided that mental health and
transportation would be at the top of the list for further discussion. They also need to think about the
resources they can get, Barry Jacobs stated he could give the committee an update on mental health.
I.Jnder seiuor socialization we did not form six neighborhood groups to help provide assistance to older or
disabled people in neighborhoods to provide for safe neighborhoods, etc. There has not been enough staff to
do this, but it still needs to be done. Ann Johnson stated that it could be done different ways by using
volunteers like they do in Durham, They designate geographical azeas within the county and a neighborhood
adviser is usually an older person who is accepted in the neighborhood,
____
osp Bible, We do have the wellness program. One of the objectives we need to look at includes strategies and
promotions to make the at risk population more aware of health issues.
Jerry Passmore said that at the next meeting each of the subcommittees will be giving reports on several of
these issues, Kate Barrett suggested having these issues identified for each subcommittee so they would not
duplicate, Ann Johnson suggested that whenever they can, they should look at the goals from the standpoint of
the older person (not just the providers) Ellen Hayes mentioned that the Advisory Board on Aging wants to do
community speakouts to hear from older persons on the needs/issues as part of the M.A.P. process,
Barry Jacobs suggested having OPC give an update on mental health service system. Orange County will be
grouped with Durham County. It looks like the County will be paying mare for mental health, He also noted
that the BOCC has extended and paid for the Chapel Hill Senior Center rent through the end of the year,
Regarding health promotion, we need to identify more retired health professionals. There is some
volunteering up to 20 hours a week helping with the Wellness Program but we need to find more to supplement
the staff.
Next Goal Five (IIBj was to ensure an adequate supply of affordable safe and suitable housing for Orange
County elderly residents.
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Florence Soltys stressed that this is again a top priority goal, particularly in the northern part of the county.
Jerry Passmore said that at the next meeting of the Aging Boazd, they will have a presentation by developers on
senior housing in Hillsborough and requesting input from the Aging Boazd and the Friends Boazd. Anyone can
attend the meeting.,
Another houshrg issue she raised is to work with architects and builders to retrofit older homes and also
when they build new homes to retrofit them for elders. We also need to do more education for the
consumers who need housing and to formulate a strategy for increasing the number of affordable houses.
In northern Orange, there is no HITD 202 housing for low income seniors. Chapel Hill has three such units.
Another azea is to identify seniors who do not have adequate plumping, A/C, bathroom and kitchen
facilities. We need support services for senior housing units (Age in Place).
The other housing issue is property taxes. Many elders (living longer) over time cannot afford to pay their
taxes anymore and did to look at how their assessments are done, They are not able to maintain their
homes and pay their taxes. This is becoming an increasing problem hi parts of the County.. Senior Care of
Orange County, Inc, is really looking at this very carefully to see what they as a nonprofit can do to help these
people, realizing that everything can't be on county government.
Another Goal (IIIAI is to support the efforts of informal caregivers. According to Florence Soltys this is a big
issue and identified Kate Bazrett has an expert in this area. We need to develop a support mechanism like
chat rooms, availability of computers, etc, Also, information for those who cazmot read and write, Also,
training in multi_languages is very important.
For severely disabled and institutionalized, anGoal IVA is for people in long-term care to have access to a
continuum of quality care and be treated with dignity and respect, One of the issues is guardianship law and
statutes in North Carolina. Last year the Aging Study Commission did produce a bill that asked for a task
force to study the statute on guardianship, Everyone has been appointed to serve on this commission except the
president of the senate has not named anyone, so they are moving to introduce another bill through the house, so
the house with just have a bill. Hopefully they will get something from this session of the legislature, At the
county level, we need to look at how guardianships are managed,
With regards to Financing retirement and long-term care possibilities, they have a lot of problems with the
nursing homes in this area, We need sensitivity training for first responders. One of the things the State
recommended yesterday on mental health was the training of law enforcement to go into nursing homes and
assisted living facilities to help with the mental health problems. This would help law enforcement to
understand about elders,
Another issue is exploitation of seniors (families, neighbors, banks, insurance, home care, etc.). This is
becoming one of the biggest crimes in this country and need further attention.
Further investigation is needed on a career ladder for care providers (without health insurance) of elders.
Ann Johnson brought up the point that for many of the M.A.P, issues the County has not power to correct, but
aze state and federal responsibilities and authority. She suggested that the functional subcommittees keep that
in mind as they formulate their objectives. Jerry Passmore said that more effort needs to be placed at the state
and federal level. We need to keep the County Commissioners informed as they recommend state and federal
legislation annually. Linda Tuday mentioned that when the new M,A.P, plan is approved, the lead
organizations for each objective needs to know what is expected of them and kept informed of their
responsibilities. Arm .Tohnson mentioned the idea of establishing agreements with the lead organizations.
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Barry Jacobs said that a lot has changed since the last MAP was developed and we need to utilize these
resources to meet the unmet objectives. Examples, Durham Tech is opening up a satellite campus. We need to
talk to them about a eazeer ladder for care providers. The County will provide computers at the new senior
centers, We now have an Affordable Housing Advisory Board, so we can invite their chair to one of our
meetings and tell them what we need. There is an affordable housing trust fund setup now and we need to look
at how it can help low income seniors with urgent housing repairs. We need to know what resources are now
available which were not available before.
Florence Soltys highlighted other issues such as County Commissioners endorsing the'recognition of
outstanding programs for elders, living wage, expansion of Friend to Friend program, more adult care
homes which will accept special assistance (one opened in Oct. in Hillsborough). This could lead to
partnering with I.)NC and UNC hospitals on developing anon-profit long term care nursing home.
Alice Gordon expressed that one big theme is helping seniors to age in place and helping them with
resources to stay in their homes and transitions. Once they reach the point of needing assistance it should be
available. We need to look at things through the perspective of seniors.
Barry Jacobs said that new federal legislature has been approved for financial disclosiu•e for moving people into
nursing homes and we need to find out what this means.
To the issue of aging in place, Jerry Passmore said that the Senior Centers are not just a place for active
older adults activities, but are individual service centers. Eldercare services is a part of this for the frail
adults who are dealing with transitional issues. This is a critical element we must provide and communicate
that senior centers are full service centers.
Pat Sprigg continued highlighting the M.A,P. report since Florence Soltys had to leave, She indicated that the
dental service objective is still active and efforts aze underway to bring new life to it, The next Goal (IVB)
raised was Orange Count being a model county which addresses the residents' rights. quality of caze and
quality of life in long term care facilities. Pat Sprigg indicated this goal needs further attention especially the
adult care homes (Assisted hiving) and their increase growth in meeting the needs. Following on Barry
Jacobs remarks, Pat Sprigg indicated a major work of the committee is knowing what has been done,
Next area was the Baby boomer goal NA) to develogpror?rams and services for future older persons that
promote personal responsibility for their health and well beingand utilize their skills and talents. None of the
objectives were accomplished to lack of staff time and resources, Pat Sprigg indicated that this is a huge issue
that needs to be approached in a proactive and preventive way due to the tremendous growth in this population.
Jan Wassel stated that she hoped that these objectives can be revisited and revised that would focus on baby
boomers not just a volunteer resource, but as a work force issue.
The last t*oal (VIA) mentioned was the planning, administration and coordination of aging services. Pat Sprigg
indicated that we need to adopt a formalized evaluation program to understand we are getting for the
resources we are putting in and where are the unmet needs. (Performance measures) She hopes the task
force will look at what has transpired, and whether the priorities identified in the past are still important goals,
Review Uadate Profile of Older Adults
Jerry Passmore wallced them through the profile, He distributed two profiles of older adults in Orange County -
GIS maps. There were two versions, Additional information will be forthcoming. He recognized the experts
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who were in attendance, Yoko Crume with the N.C. Division of Aging and Jan Wassel who also is a
demographer, He also thanked Joan Pellettier ,Triangle JCOG who provided information about older adults
and where they live. He has also been working with Bob Bacon of Triangle J COG. We are looking at the
distribution of older adults of 65+ who live alone, who live in poverty and who are minority,
Ann Johnson hopes that all of the subcommittees will include in their discussion what we will need if we have a
disaster for the population they are reporting on. Jerry Passmore said that we are be looking at the new centers
as potential emergency centers (backup generators) when a disaster occurs, Alice Gordon stated that we also
need evacuation procedures for everyone, but especially for seniors. Barry Jacobs said that now that Shazon
Harris is going to expand, we may push for more regional planning, Linda Tuday mentioned the United Way
and .Joan Pellettier, TJCOG are working on putting in a regional proposal on disaster planning from funds
available from Blue Cross-Blue Shield. Ann .Johnson indicated that it was important for everyone who lives
alone has some communication with another human being. We could establish a buddy system at little expense,
Jerry asked which GIS maps they liked the best -small or big dots, The larger dot means a bigger
concentration of people. They decided they liked both, He made reference to a township map which shows the
spread of people within each township. The township of Chapel Hill (includes towns of Carrboro and Chapel
Hill) has the highest concentration of 65+ which is 59% of total older county population. When you add the
township of Hillsborough with 13% (includes the town of Hillsborough), we get 72% of atl older adults 65+ in
the county, The next highest township is Efland-Cheeks with 8%, Jerry Passmore discussed the issues of
people 85+, living alone, and poverty distribution within the county. He said that seniors in the rural areas
should not be forgotten as it relates to these demographics, Ann Johnson indicated the need to look at family
support in rural and urban settings. Jerry Passmore indicated that the demographic information will be given to
the subcommittees, Linda Tuday felt that trends ate what are really important. The growth areas aze in
Hillsborough and Efland Cheeks because there is not any available laud in Chapel Hilh Jerry Passmore that we
can get overall population projection trends, but more difficult within the county, The LTS Census snap shot is
every ten yeazs.
Barry Jacobs said that a lot of the senior growth in Efland Cheeks is coming out of Town of Mebane, The
County Commissioners are trying to improve their relationship with Mebane officials. They need to know that
they have an impact on senior services in Orange County.
Jerry Passmore went over the future projected meeting dates. In the process, once the County Commissioners
approve the draft M.A,P,, we will have public meetings for citizen input, We then will go to the towns to
present the plan for review and comment, Mebane will be included in the input process.
Jan Wassel wanted to know the percentage of the older population in each township to its total population in
order to better identify aging issues. Yoko Crume agreed to research it and report back, Also, institutional
enrollment in each township.
Jerry said that we aze concerned about the baby boomers. He asked what other demographic information the
steering committee would like, Ann Johnson asked how many older adults aze grandparents raising
grandchildren, Barry Jacobs asked to look at trends for 1995, 2000, 2005 and prgjections for 2010. The
Planning Dept. may have these figures,
Oranee County as Senior Friendly Community
Ann Johnson indicated that there was awards for developing a senior friendly community? Maybe Orange
County could research and apply to win one, Pat Sprigg directed everyone attention to the manual (section 3) to
review the Senior Friendly information chart, the Powerpoint presentation and 6 key issues, health and support
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services, transportation, accessibility and affordability of health care, does that community provide a workplace
volunteer opportunity and the last has everything to do with keeping the person active.
She suggested that as we work in our groups that we look at these particulaz areas and ask the question if the
plan we create will address these areas. She feels the plan has accomplished a tremendous amount. She feels
the focus for the next five years should on the critical needs, a couple of really important issues in the general
population of older people. Also, take a look at what the White House Conference on aging has surfaced,
especially the top ten. Also, the federal council on aging has some things that have to do with the larger
community being handicapped accessible, hearing impaired, eyesight impaired -does it really allow someone
to function at a level of independence as they move about in the community. It has everything to do with
housing, transportation, accessibility, affordability and the awazeness of services which are available. She
urged that we use the Senior Friendly Community templates and ask what are the key critical fundamental
things that must be in place for an older person to be successful.
As part of the Senior Friendly Community, Jerry Passmore indicated that the broader issue is aging in place,
There is a need for more diversified transitional living arrangements. We have to value what older people want.
What is important is to have these key, critical fundamentals that are necessary in place.
Alice Gordon made reference to the list inside the Senior Friendly folder and said that she hopes that all three
committees would look at that and pick out a few things which are most important for that particular group.
Pat Sprigg indicated that there are a lot of good background work for the subcommittees in terms of looking at
this document, going back and looking at the unmet objectives of the prior plan and doing some critical thinking
as if it is really a priority. Maybe it was at the time, but not now a priority.
Pat Sprigg said that if there is progress on these unmet needs, it needs to be documented. The baseline issue is
that the service delivery to older people and the aging friendly communities to older people is $agmenfing. The
hope is that this plan will bring together a pathway to bring all these resources together, focus on the critical
fundamentals, apply what is working well and not spend our resources on the unmet needs.
Joan Pellettier mentioned that the State Division of Aging is looking to the local community in developing a
regional and state aging plan. Yoko Crume stated that the NC Division of Aging received a federal planning
grant to look at better coordinating local, regional and state planning process. In term of local coordination,
Barry Jacobs made reference to the Boazd of Health and their strategic plan and the expansion of dental caze.
He asked if this committee wants the report or wants a representative to come and talk about this issue. Yoko
Crume spoke about the exchange of information. She would like to have the report and then have them come to
review the report.
it was indicated that a member of the Health Dept, should be on the Steering Committee. It could be the Chair
of the Board of Health. Jerry Passmore stated that the Health Director, Rosemazy Summers was a resource to
the Steering Committee and would be willing to come when needed, Barry Jacobs will follow up on this and ask
for representation from the Dept. of Health and Department of Social Services, adult services. Jerry Passmore
will prepare some information for Barry, Also, It was indicated that someone from Mental Health to serve on
the Steering Committee or one of the subcommittees.
Resort from M.A.P. Subcommittees
Pat Sprigg has each subcommittee to give a brief five minute report on their activities, From the Well fit
Subcommittee, they distributed a report. A lot of their meeting was focused on the definition of a well fit
senior. There was also a lot of emphasis on what it means to be independent. The top three things they
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summazized in terms of Well fit were: (1) It meant optimal choices, (2) the ability to live undependably
and fully functional, mentally, physically and spiritually. They went through the goals and accomplishments
which were more relevant to well fit in the MAP. Some of the things that came out from lessons learned based
on the former MAP was that they need to prioritize the issues; they need to quantify the issues in terms of how
many people they reach and who is accountable if a goal was not met. We need to have periodic meetings with
the stakeholders who are identified in this process. There was no mention in the plan of how to involve the faith
community. It was also pointed out that about half the goals were accomplished and half were not.
Linda Tuday said that this is an opporinnity to make a community agenda for older adults, not perceived as a
County agenda and that it have measures and outcomes and how do we determine the progress and keep it up
front, Myra said that they talked about the change in population of older adults. They tallced about more older
adults moving to the azea, issues of retirement and retirement community, transportation, isolation of Waal
seniors, changes in the Medicaze policy. They also looked at senior friendly communities and how they should
strive toward that.
The Moderately Impaired/Disabled Subcommittee which is facilitated by Kate Barrett indicated they looked at a
definition of what issues belongs in each group. They viewed the well seniors as those people who aze living
independent and would look at the maintenance of health and prevention of disability, Kate Barrett wants to be
sure the groups are identified for purposes of the subgroups. The Moderately Tmpaired/Disabled Subcommittee
would focus on the frail elderly who are not in long-term care, assisted living or nursing homes, These people
would have problems with the activities of daily living including bathing, grooming, taking medication, eating,
communication, walking and also problems with instrumental activifies of daily living.. Transportation is the
big key word, doing their own bill paying, yard work, house work, etc. would be included in this category. This
would also include those people with mental health issues or dementia,
Kate Barrett indicated that transportation is a huge issue, particularly in the northern pazt of the County where
some people cannot get transportation, including to our senior centers. As staff, we have so many daily things
to do; we don't have enough time on educating people where to go for information, Another issue is how do the
senior centers not be just for seniors who are well, but how do the senior centers meet the needs of others who
may have a need or be handicapped. How do you get people out of the house? Kate Bazrett read from a list that
had been distributed indicating that Mental Health was a huge issue. A lot of physicians do not know how to
treat depression which causes a lot of suicides. There are also "men issues".
Jerry reported for the institutional subcommittee, He said that transportation was a big issue for this subgroup.
There will be clinic space at the new senior center in Chapel Hilh Some of the big issues dealt with the fact that
there are not enough people to help people in nursing homes, etc. Also, better education and information for
seniors was an issue. Long-term care was an issue, The facilities do not have enough beds for those with
Alzheimer's. The ratio between training staff of adult homes and nursing homes is an issue, The caregivers aze
not getting paid enough, Families are not involved enough with the care of seniors. The PACE program was
discussed which is a HMO for low income elderly, The eldercare program is not the same as PACE, The
startup costs for a PACE program would be enormous. Elder abuse and protective services were issues, Most
long-term care facilities are for profit except for one,
They agreed to begin to think about what are the fundamental needs of the seniors in this azea and where aze the
gaps to address these particular needs and start in terms of looking at the unmet objectives of the previous plan
and determine if this is really a priority or are there other things happening in this objective that we may not
have known about.
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Pat Sprigg asked the committee to take a look at the brainstorming notes that they have received and look at
where they think the gaps aze and what do they think is not really being addressed that needs to be addressed.
Begin to think about who is missing in this dialogue. What other venues might be used to connect people
sitting here.
The next meeting is Mazch 23, 2006 from 10:00 -noon at a location to be determined at Carol Woods.
Jan Wassel indicated that she would like material in a more timely fashion if at all possible. She would like to
have enough time to thoroughly read the information.
Everyone was asked to fill out the evaluation and leave it on their way out.
Prepared by Beverly Blythe
Ellen Hayes
Jerry Passmore
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is
ORANGE COUNTY MASTER AGING PLAN UPDATE: 2006-10
M.A.P. STEERING COMMITTEE MEETING #.3
MARCH 2.3, 2006
MINUTES
The M.A.P.. Steering Committee held a meeting on March 23, 2006 at the Southern Human
Services Center on Homestead Road in Chapel Hill at 10:00 a.m.
PRESENT: The list of those present is attached to these minutes. The list includes members,
staff and visitors.
MEETING OBJECTIVE: Complete identifying and prioritizing issues for 2006-10
I. Welcome and Introductions
Florence Soltys welcomed everyone to the meeting. Everyone gave their name and their
occupation/reason for serving an this group.
A. Recognition of Guests
.Terry Passmore noted that Cazol Gunther-Mole is a member of the Moderately Impaired
Committee and is on the agenda to speak about senior friendly issues.
B. Demographic and Membership Information (handout)
Jerry Passmore said that some members have already received some of the demographic
information on persons 65 years of age and older living alone, persons 60 years of age and older by race
and population 65 years and older for whom poverty status is deterniined. He has extra copies for those
who did not receive these GIS maps.
C. Approve Minutes -Meeting
The minutes for the meeting held on February 2, 2006 were approved as presented with a
motion made by Amy Gorely, seconded by Mariah McPherson and a unanimous vote.
D. Other Items
NONE
2. Presentation of Subcommittees' Issues and Priorities
A. Well-Fit Functional Group: Priority Issues -Myra Austin
Myra Austin called attention to the two attaclunents in the agenda -the minutes from the
Well-Fit Subconm~ittee Meeting dated March 7, 2006 and the list of MAP Transportation Issues which
are attached to the official copy of these minutes for reference.
Myra Austin said that the minutes indicate that they tallced at length about senior fiiendly
comrnunities. We started with what we are most proud of in Orange County in our senior friendly
conununities and she read those items. We tallced a lot about transportation -both Chapel Hill and OPT.
she said that they are proud that we have both of these available for the seniors. They are also proud of
the Meals on Wheels and Congregate Meal sites. They have a few HUD 202 housing in the County and
aze proud of the offerings at the senior centers in Orange County. Myra Austin continued listing those
items in the attaclunent. These included faith community support, Senior Times, spirit of volunteerism,
beginning of relationships with the University, Extension and Community Associations and pool
facilities.
Second, they looked at what improvements are needed to be a more Senior Friendly
Community, These included access to preventative and primary health care for Northern Orange as well
Page 1 of 8
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as general access to medical care. The mental health issue was referred to another subcommittee. She
mentioned
other improvements like job training, housing for middle income elders, long-term care costs and driver
safety which was one of their top issues. The issue with economic development dealt with the concern of
the ability of people to pay their property taxes. Also, one of flieir top issues was the availability of more
home-based preventative care and more education on "Choices" staying in your home/aging in place
which they are going to have a session on today, They also feel that the faith-based orgatizations need to
be involved.
Third, they looked at possible solutions. Tlris has to do with livable and senior friendly
communities which Carol Gunther-Mole will be talking about later in the agenda. The committee feels
that the entire cotrutnmity -not just County government needs to focus on the idea of older adults as they
age, She did receive Carol's proposal and although she sent it out to her subcontinittee, she did not get
many continents -probably because the County is going through an email transition period,
At their meeting, Myra Austin had asked each committee member to write down five (5)
issues they wanted to see addressed and each member had four (4) votes to cast on one item or all four (4)
on the sanre item. The attaclunent to the minutes identified as " 2A" has the results of this priority listing:.
The first ranking was home-based community services for well elders including an increase in the number
of retired healthcare providers/volunteers and enviromnental modifications. The next one was community
assessment/outcome evaluation to assess how we are doing so far and what is still needed in the
commm~ity. The third item was driver safety which included what the roads look like as well as driver
education. The fourth item was access to affordable healthcare which is a huge issue and also ranking
with five (5) votes was greater budget appropriations for the aging population.: These were the top five
issues. The attaclmrent is made a part of these minutes by reference,
Ann Johnson said that of all the committees, the Well-Fit Subcommittee will be responding
to 95% of the population and that certainly senior centers which are not listed are the backbone of that
population. Myra Austin said that it is listed as an item we are most proud of but is not listed as a need..
lanice Tyler noted that this item is listed further down on the priority issue list. Ann .Johnson feels it
should be a higher priority.
Gwen Harvey asked for the definition of a community assessment and asked who would do
it, Myra Austin said that they did not identify who would do the assessment. It could be something that
is done by the Department on Aging and it would be used to identify the needs in the community and of
the things that aze being done already - what is being done well.
Jan Busby-Whitehead asked what was meant by driver safety. Myra Austin said that this
would include driver education, working with older adults, roadways, etc.. Janice Tyler said that they
based this from two incidents which recently happened -the person going the wrong way on a divided
highway and also an issue at the mall.
A reference was made to the issue of access to affordable health care and it was suggested
that this maybe something the Utiversity might partner with the community to help provide.
Alice Gordon made reference to access to affordable healthcare and accessibility/affordability
for oral health care and noted that these should both be priority issues.
Florence Soltys said that not only is this a countywide problem, it is an Orange County
problem,
Jack C.heshrut said that as a member of the Well-Fit Committee, the first day was spent trying
to identify the issues. They could have spent a lot of time on how to fix these issues but did not, He
asked if the next cotttinittee will start working on how to fix the issues which have been identified and
Florence Soltys said that the next step would be to make recommendations..
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Amy Gorely said that when this conunittee reaches the point of discussing possible solutions,
she hopes they will use the University as a resource - in particular the Department of Public Health..
Jerry Passmore said that the County Health Department does do an assessment and maybe
this could include senior issues as well and Myra Austin said that the next assessment will be done in
2007.
Yoko Cnune said that the corrununity assessment outcome measures are tied to the
appropriation issue so these are really important..
B. Moderately Impaired Functional Group: Priority Issues -Kate Barrett
She made reference to the attaclunent 2B and said that they are talking about anyone who is
dependent in an ADL or IDAL and live in their own home. They separated out those who live in long
term centers which is the group that Jill Passmore is working with. On the list of issues prioritized,
caregiver relief cazne in as #7, However, they are bowrd through their funders through the federal
government and tluough Triangle J to have a community group wonting on cazegiver issues so they can
continue to fund their National Family Caregiver program. They have two current caregivers in their
group and they will be combining with other caregivers to look at their current cazegiver program and
how they want to spend the funding they will receive for next year. Kate Barrett said that the top three
issues were very close with a tie for isolation and loneliness with lack of case management services -
accessibility across the population for case management for those people who have some Medicaid
programs which provide for private case management.. The #1 issue was lank of mental health treatment.
They are talking about what the Worlds Health Organization has determined as an enormous problem
among the seniors which is depression. The Organization has said that by 2020, the second disabling
condition among seniors will be depression which will be the cause of premature deaths. The lack of
collaboration with faith communities cone in as #.3, They decided that as the group looks at isolation and
loneliness, they will look at the faith community. They are very fortunate to have Bob Seymour on their
subcommittee. They will be focusing their efforts on the first 4 issues as listed on #2B. They have
divided their comrnittee into three smaller work groups to focus on lack of mental health treatment,
isolation and loneliness and care management, Kate Barrett mentioned that dementia was the 4`h issue
and is something that fits with the first three issues and something that cannot be ignored. Whenever she
goes to a meeting, she hears that Orange County has great services but enough people don't know about
them. Money and energy needs to be put into letting people Irnow what services are available in Orange
County.
Carol Gunther-Mohr talked about the importazice of doing a much better,job of letting people
know about what is available in general and within the County, Transportation is another huge issue for
the seniors in this County,
Jerry Passmore said that he feels the word is getting out about eldercare and some of the other
services, However, there are other services people are not aware of which are available.
Yolco Crunre made reference to health promotion and said that the whole idea is to funnel
federal funding to the agencies for this but that if the President's budget is approved, the funding will be
gone.
Kate Barrett said that many seniors who have mental health issues overuse the health system so
what they need to do as a local community is to work with these doctors who are incredibly overwhelmed
and Medicaid is cutting funding there also. flr her office they receive so many calls from physicians, so
instead of relying solely on federal money, they need to work with these physicians.
Yoko Crume said that prevention is so important and there is no reason for the federal
government cutting that portion of the budget.
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In response to a question about the Mental Health Department, Kate Barrett said that she had a
meeting with Sarah Lueger who works for OPC and they have a planning person for adult services who is
very interested in what the subcommittee is doing and is willing to come and sit on this steering
committee as a consultant. She said that the majority of people who are seniors in that system are people
with cluonic severe long-term mental health issues. When Uiese people turn 65, they have Medicaid
which pays only 50% of mental health services. The senior who has done very well tluoughout life but
suddenly has become widowed or get a chronic illness and all the people around in their social network
have died and they end up with depression and that person, for lack of reason, is not going to go to OPC.
Jan Busby Whitehead said that what these people do is go to their primary doctor who has tried to
get them into a mental health setting or on a medical antidepressant which, if they stay with it and take it
correctly, the numbers drop off dramatically, You also have the older adults who don't want to go to a
psychiatrist,
BREAK
Note: Adelaide M, Spitsbergen left at this point in the meeting,
Ann .Iolmson said that she feels it is important to make a difference between depression and
institutional depression which are experienced by both older men and women when they lose a,job, etc.
Women usually stay active but men do not when something stressful happens in their lives, She does not
feel that the Department on Aging should take on the responsibility for treatment for mental health but
that it should stay with OPC and Mental Health Departments. She does feel that in order to determine
what is appropriate there does need to be a dialogue and an agreement on what situational depression is
and how this is different from those who really do need treatment. She does not feel it is sufficient to,just
say that as soon as you reach 70 years of age that 50% will be in depression,
Florence Soltys said that according to Bill Warden, a researcher in this area, 35-40% of people
who see their primary physician are going because of depression symptoms and they are using physicals
to cover it, It is overwhehning and a new study which came out yesterday also talks about the extend of it
as a major issue.
C. Institutionalized/Severely Impaired Functional Group: Prio-•ity Issues -Jill
Jill Passmore made reference to the minutes she distributed during the break and said that this
is the group that deals with the institutionalized residents -both in the nursing homes and adult care
homes which are less than 5% in this County? The first issue was quality of life and care issues which
includes improving basic oversight, continuity of care, dental care, being treated with dignity and respect
and end of life and dementia care issues for residents and staff. The second issue which received a lot of
votes was caregiver support and workforce issues which includes recognition issues, recruitment, staffing
(current requirements are inadequate to meet the needs of the current residents), retention, training
(scholarships and education), support, pay and benefits, career ladder (provide a professional culture for
personnel including use of best practices), leadership training and support for administrators and nurses,
foster personnel training and supervision acrd UNC medical conununity involvement and combining
resources including the Orange County Long Term Care Roundtable (OCLTC).
The #.3 priority was education and outreach, This is for families, family councils, resident
councils and doctors on the appropriate placement of residents which is not necessarily facilities -
especially for those who have adequate support at home.
The #4 priority was person-directed care which can be rolled into quality of life and quality of
care issues. Jill Passmore made reference to the second page of the report and noted that the
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housing/capacity issue maybe turned over to the full steering committee because they are dealing with
housing issues azid having more options for people who need long-term caze. Right now the facilities
with good reputations tend to stay full and the facilities that are poor performers and sited for deficiencies
often have open beds, She wonders if we need to look at the certificate of need process because the state
only allows us to have a certain number of beds in the County in the current nursing homes. She asked if
they should look at the current population or plan for the future population. Laws were another issue as
well as adult protective services. Thanks to Kate and Florence, the laws pertaining to adult protective
services are being reviewed and a lot of changes will be forthcoming which will enable the adult
protective workers to screen in more calls than previously. With reference to the Transportation issue, the
committee would like to forward it to the full subcommittee.. Getting help from EMS workers was
another issue, This would be for long-term care facilities..
In answer to a question from Ami Johnson on the difference between a day hospital and
daycare, Jill Passmore said for the daycare you can have the social model or medical model where a
person is fairly healthy and able to interact with the group, They are talking about more acute medical
conditions with a day hospital. They may not be a danger to others, but a danger does exist.
Alice Gordon asked what nursing homes do if doctors won't provide medical care for the
patients, .Jill Passmore said that facilities are required to have a medical director. What she heazs is that
there are a few medical directors working in a lot of the facilities and are not providing adequate care to
the residents. There is one medical doctor who is serving two or three of the facilities in the County
which is a big load for one doctor who also has a practice,
Kate Barrett said that when a director is overloaded, it is almost impossible for a family
member to talk with the doctor. It is really very questionable medical care.
.Jill Passmore said that many physicians will discharge their patients once they are admitted
into a nursing home or long-term facility because the family member wants to talk with them and they do
not have the time to devote to caring for the person and also talking with family members, It encourages
people not to speak up because they do not want to move their family member to another facility,
Ann Johnson asked if there is a list of the demerits that occur in Orange County annually
because they keep talking about evidence-based outcome and if they had this nwnber it would verify that
they have a serious problem. Jill Passmore said that there is a website - medicare,gov which lists all the
defciencies for nursing homes but it varies how often they update this website, The Community
Advisory Committee actually turned over to the County Commissioners a list of deficiencies for one
specific facility that at that point had 28 deficiencies and the average in North Carolina is four or five.
The Community Advisory Committee turned over a number of complaints to the County Commissioners
who wrote a letter which Irad never been done in North Carolina. This got the corporations attention that
brought people in from other states to address the problems. Tlis one place has had 12 administrators in a
year and a half.
Jazr Busby-Whitehead said that she feels one of the big problems is that these nursing homes
are run by people who ar'e out of the state.
.Jill Passmore said that this one corporation has three facilities -one in Chapel Hill, one in
Durham and one in Raleigh. They also have two other facilities that have none or only one deficiency and
doing a great,job. It has to do with a constant administrator who takes an interest.
Barry Jacobs said that we did scare them.. They made promises and we said that we would be
monitoring it. They did bring four people in from out of state. They said that their eastern division had
very few problems, but that this facility is considered in their western division which had chronic
problems. They tried to say that they needed additional time but were told that they were required to
provide continuity of care, quality of life and quality of care at all times because these people have paid
Page 5 of 8
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for this care and it nntst be provided. Barry Jacobs said that they will ask them for an update in six
months,
NOTE: Barry Jacobs announced that he has asked the County Manager to buy a defibrillator out of the
County Commissioners' contingency fund for the Southern Human Services Center based on the medical
emergency that occurred today.
Jetry Passmore made reference to bed occupancy rate and said that they are full in the northern
part of the County but not full in the southern pazt of the County, .Jill Passmore mentioned that there is a
waiting list at Brookshire and because of their reputation; some of their residents are from out of County,
Florence Soltys said that one of the problems with UNC Hospital is that the management
making the referral to nursing homes are just sending people to wherever there is an empty bed and not
really communicating with the family, This is a major problem,
Jan Busby-Whitehead said that you get people who need to leave the hospital but need
rehabilitation so you get people going to facilities away from home. We need more quality facilities so
the hospital can be assured that the people they send will receive the care intended. She seriously thinks
that something has to be done about long-tenn facilities that are grossly incompetent.. Maybe to solve this
problem, the County and Utuversity need to form a partnership of some kind,
In answer to a question from Ann Johnson, Florence Soltys said that the Department of Social
Work was cut way back and now there is what is called care management that discharge people and sends
them to where they have an open bed.
Carol Gunther-Mohr said that they do have a social worker in the Acute Unit who meets with
them on a daily basis to,jointly decide where to send people for rehabilitation. They should have a social
worker for the aging unit.
3. Approve with a~ chances tl-e Subcommittees' Priori Issues
All of flee reports were accepted as presented.
4. Consider Approval of the Senior Friendly Community Initiative
A. Wlrat planning process/structure would help develop a more senior friendly community
for 2006-10?
.Deny Passmore said that this is basically saying that a plan needs to be developed to deal with
the issue of Senior Friendly Communities.
Carol Gunther-Mohr said that the real question is how we can engage all of the departments in
County Government to determine if they are addressing the needs of the senior population. How can a
mechanism be developed so that all the departments can look at creative ways to make our commmrities
senior friendly. It is a leadership issue in part -looking 5-10 years ahead - in making system changes
including infrastructure changes to make housing safe for al] ages, etc. She is not sure of the appropriate
mechanism,
Ann Johnson said that this effort needs to include businesses as well as all of County
Government. Since this is a Master Aging Plan, she urged that one of the recommendations be that a
special committee address ways in which Orange County cur achieve better Senior Friendly
Communities.
Jack Chestnut said that you can build Senior Friendly Commrmities, but there are already
communities that can be made senior friendly. It may be the homeowners association that does it, It does
not have to be just govenmlent, It could be churches, other organizations, etc. malting a conununity
senior friendly.
Yoco said that at the state level, they expanded the tens Senior Friendly Communities by
adding the word "livable". It came out in committee meetings that in order for seniors to live well in a
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community, everyone else had to live well. They really need businesses and the younger aged population
to support this because it is community driven because there is such a broad array of issues. They aze
putting together a web page for better senior practices. As of this morning, they have a new state logo for
livable and senior friendly communities and she encouraged this group to use a logo to promote this idea.
Jack Chestnut said that the senior friendly conununity logo bothers him. He feels it should be
an easy living design because the same obstacles are there for a young mother with a child. If a developer
concentrates only on senior friendly, the intergenerational aspect is last. There will be senior only homes
and the seniors will be isolated in one location which is not what we want,
Yoko Crume said she was just offering the use of the logo and the word livable was added so
that it would be intergenerational. It is a compromise.
Gwen Harvey said that there maybe some confusion between the NORR (Natural Occurring
Retirement Community) which is a concept in design of a physical community - a neighborhood. She
rmderstands that this is more of a conscious approach of looking at how other County departtnents can be
aware of how they too can contribute to supporting senior planning to help all of us as we age in our
conununities, She made reference to the economic development priority and being able to provide
support for small businesses and provide a range of services for people who want to age in place. She
said that Dr..Ian Wassel with iJNCG is sponsoring a Silver Industry Conference in April because they see
with the growth in the number of seniors who are well-fit and not improvised a lot of dunking power but
with needs and issues that they want businesses to be able to respond to and cater to. Gwen Harvey
continued saying that one thing this reminds her of is the concept of conservation and what can be done to
be more energy efficient.. The Environment Resource Conservation Department is putting together an
action committee to look at what all the County departtnents can do to help be good stewazds of
resources.
Yolm Crume said that in Cumberland County today, they aze having their big living and
friendly senior center conference which is jointly sponsored by their Aging Deparhnent and Planning
Department. This is being used as a vehicle to get the word out about senior friendly communities. At
the heart of this initiative is that they (T.1COG) are involved in this process.
Cazol Gunther-Mohr made a motion that the MAP Steering Committee engage Orange County
government in the process of all County departtnents looking at all issues that the Steering Committee is
addressing acrd perhaps identify the Senior Friendly Livable Conmrunity program as a mechanism to do
that.
Ann .Iolmson said that this does put the responsibility for development on the County
Commissioners which would make some sense because it is broad and it also helps the Department on
Aging and anyone who volunteers solely in aging to think in terms of our expertise to be used in anyway
to assure that older peoples needs are going to be heard, respected and meant in some fashion. This
motion is a way to see the broader picture but saving for the Deparhnent on Aging energy -the aging
portion of it. Ann Johnson made an amendment that the County Commissioners set it up to include other
things and this was included in the main motion.
Jack Chestnut said that there is a large development being built at Waterstone - 800 homes. If
it is easier for retail to also be included, it could be made friendly for everybody. The County through
their Planning Department could assure this mix of homes and retail.
Bazry Jacobs noted that this development is in the Town of Hillsborough who has very little
knowledge about these kinds of issues. The County Commissioners have an Assembly of Governments
meeting in September and he can put the MAP update on the agenda as one of the items for discussion..
Alice Gordon said that it is important to make it broad. The Chamber of Commerce and the
other entities should be involved. Also, the overall livable concept needs to be emphasized for Senior
Friendly Communities. When they were nanring the new senior center on Homestead Road, they decided
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on Robert and Pear] Seymour Center and they aze waiting to see if another word can be used for "senior".
It is important to have all generations in the community included.
The motion was seconded by Connie Mullinix and the vote was unanimous,
All the reports were accepted as presented. The cormnittee decided to have another meeting to
break out into the major key area issues groups: Housing, Transportation, Information/Access and
Cornmunity Transitional Caze. Jerry Passmore distributed materials for each group to committee
members to take home.
Ann Johnson asked to use full names of what it is.
ADJO UItNMENT
The meeting was adjourned at 11:55.. The next meeting was set for April 20 from 10-12 at the
Southern Human Services Center.
Beverly Blythe, Secretary
Page 8 of 8
~~~- a ~~
ORANGE COUNTY MASTER AGING PLAN - 2000-2005
LISTING OF ACCOMPLISHMENTS AND UNMET OBJECTIVES
Prepared by Jerry Passmore, Dept. on Aging Director
March, 2006 -Update
The Master Aging Plan (M.A.P..) for 2000-OS covered ten major goals that focused on the
general population, baby boomers, special functional groups and planning issues. There
were 126 specific objectives that attempted to achieve these goals. Because of the large
number of objectives and limited time and resources to accomplish them all, the Boazd of
County Commissioners requested that they be prioritized by the County Advisory Board on
Aging throughout the five-year period, For easy identification, each objective has been given
a unique number and at the end of each in parentheses is the goal number it addresses.
Following the M.A,P. outline, the objectives have also been group to those accomplished to
some degree, as well as unmet objectives.
I. The General Population of Older Persons
GOAL I-A: To improve access to services, information & assistance, and
social activities for all older persons in Orange County.
Accomplishments -Information and Assistance
Objective #l: Update, redesign and publish the existing Orange Co~mty Information Guide
twice per yeaz and evaluate its use. (Goal I-A)
Accomalishment :DOA L'ldercare staff updated the care guide in summer/fa112001, it was
redesigned by a professional in DecJJan. 2002, and is currently available online through the
OCDOA webs•ile at h~://ivu~iv.co.orcuzQe.nc.zrs/crQin~/elderccrre.ndj The 2006 Cruide has heen
placed on county web in Dec., 200.5 and SOOprinted copies to be available Feb.,2006. No. formal
evaluation done on arse.
Objective #2: Place hard copies of the Orange County Information Guide in health
and social service provider agencies (public and private), monitoring and
evaluating access points such as phazmacies, physicians'offices, dental offices,
health clinics, churches/synagogues/temples, health department offices, UNC
Work Life Office, senior centers, and DSS offices, (Goal I•-A)
Accomnlisbment: (Multi-,yeaz continuation objective 2001 - 2005)
The Orange County Information Guide is available online at
httn'//wwtiv.co.orange.nc. us/aging/eldercare.pdf but due to state and county hudgetary
consb•aints, hard copies of the Guide will not be distributed widely until additional resom°ces
are available, Hard copies were printed by a grant through Pfizer and distributed at a
IJniversiry of North Carolina conference on memory in September 2002. Hard copies have been
dish•ibuted to senior centers and selected sites, including law enforcement officers a»d other
frrst responder attendees at a training about elder mish•eahnent. The new Guide, for• 2006 will
be published in February with agency ads to help cover the cost ofprinting 500 copies for
distribution, approx. $4500. Currently, the Guide is distributed at no cost
~~
Obiective# 3: Implement a marketing and community awareness campaign to promote
existing Information and Assistance services: (Goal I-A)
Information acid Help Line--968-2087;
Orange County Information Guide,
Orange County Website
United Way's 211 Telephone Initiative
Accomplishment: The resource guide and the Information and help line have
been publicized in the Senior Tirnes, in a monthly Chapel Hill Herald article
written by the Information and Assistance Specialist, and on In Praise of Age,
Additionally, Eldercare staff routinely refers community members and aging
and healthcare professionals to the resource guide online. The United Way 211
telephone initiative was implemented United Way advertised in newspapers and
with magnets and,Jlyens. The information and assistance specialist distributed
this information and materials to all senior centers and meal sites.
Obiective #4: Implement an evaluation plan to gauge the effectiveness of the
marketing strategies regazding "How people hear about it," (Goal I-A)
Strategies-promote such media as:
- Radio and television
- Community publications: Senior hiving, Senior Times, Triangle
Pointer, Chamber of Commerce literature
- Place in pharmacies, physicians' offices, health clinics,
churches/synagogues/temples, health department offices, senior
centers, and DSS offices.
- Place on OPT and Chapel Hill buses,
Accomplishment: Partially achieved. RSVP, JTyler, and Student Intern; An evaluation,form
has been developed to gather client information and level of satisfaction with Senior Center
opportunities. Other evaluations developed target specific programs such as Senior Net
computer classes taught by seniors for senior and RSVP-VITA the free tax preparation prograrn.
Unmet Information and Assistance Objectives
Obiective #5: Design, update and evaluate (e.g, number of hits and user comments) the
county web site to include information available in the Orange County Information Guide
(monthly updates). (Goal I-A)
Comment: In 2005 Information Technology Department has transferred the website
updating responsibility to each county deparment. The Department on Aging has designated
a webmaster who is now in the process of being trained to do all updating.
ObiecHve #6: Develop multi-lingual, culturally sensitive versions of the website and
Community Caze Guide. (Goal I-A)
Comment: Not done due to lack of sta, ff and low priority due to. few senior Latinos at this time..
Obiective #7: Provide access to the Internet at public community facilities: libraies, senior
centers, Southern Human Services Center. (Goal I-A)
Strategy: Start a giving campaign that encourages I1NC, private
businesses, and county government to donate computer equipment to
the Orange County Senior Centers and other public facilities,
Comment: Partially achieved, Access at county libraries and only one senior center-
Chapel Hill Senior Center.
as
Objective #8: Provide quarterly training courses for Internet access at same facilities. (Goat I-A)
Comment: Partially achieved. SeniorNet classes at the Chapel Hill Senior Center have
been offered on Internet access,
Objective #9: Perform an assessment of the community awareness campaign, evaluating the
effectiveness of various elements and recommend changes.(Goal I-A)
Comment: Lack of staff time and resources.
Accomplishments -Facility Access
ObiecHve #10: In partnership with Friends of the Senior Center for Central Orange, and the
Town of Hillsborough, support the establishment of a small, multi-purpose drop-in Senior
Center site serving Central Orange County for the yeaz 2001 until construction of a large
facility. (Front door parking with easy access) (Goal I-A)
Accomplishment: Orange County rented and renovated space at the Meadowlands in
September 2001.. Contract for .space began September 2001 and ends ,June 2006. Opening
Date of Senior Center was January Z9, 2002,
Objective #11: Submit a funding proposal for the construction of the new Southern and Central
Orange multi-purpose Senior Centers, Est, cost: $5 Million (based on 125 sq. ft,) (Goal I•-A)
Accomplishment: Consh•uction of two new senior centers was place on the county bond in
May 2001 and voters passed a successful $4 million senior center bond in Nov, 100E
Objective #12: Re-establish a,joint study commission with LINO, Friends, Towns of
Carrboro and Chapel Hil] to plan for a new 25,000 sq.ft. Southern Orange Multi- purpose
Senior Center operational by June 2006. (Goal I-A)
Acccomplishment: The Southern Orange Senior Center Design Committee was formed in
May, 2004 by BOCC and the architect hired in August, 2004.. Committee provided input and
approved final construction in spring, 200.5. The projected completion date was July, 2006
for• the new senior center, but likely be in December, 2006.
Objective #13: Establish a planning committee (including Friends, Town of Hillsborough)
to determine the shape, and scope of a new 12,000-15,000 sq. ft. multi- purpose Senior
Center for Central Orange be operational by June 2006. (Goal I-A)
Accomplishment: Orange County purchased the Sportsplex in Hillsborough in December,
200.5 which will be the site. for consh•uction of the Central Orange Senior Center. A center
design committee was appointed, and will meet in 2006 in order, for the county to construct a
new center by late 2006 or early 2007,
Unmet Facility Access Objectives
Objective #14: Perform a community survey that will assess the effectiveness of senior
centers and satellite outreach programs in meeting the needs of older persons in Orange
County. (GoalI-A)
Comment: Graduate Student implemented community survey in Summer/Fall, 2001. Survey
results were not completed in to a report.
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Objective #15: Locate land and begin design for the Central Orange Senior Center,
exploring co-location with senior housing and an adult day facility.
Comment: With the purchase of the Sportsplex property in Dec, 2005 for the Locations of the
Central Orange Senior Center there needs to be an assessment of as to the co-location
possibility on the praperty. for senior housing and adult day facility and other public uses..
This information to reported back to BOCC for approval.
Objective #16: Construct approved multi-purpose senior centers in Southern and Central
Orange to be completed by June 2006. (Goal I-A)
Comment: Two senior centers have been approved and is anticipated to be constructed and
operational by December, 2006,
Objective #17: Study the space and service needs of satellite outreach programs in the
Efland Community Center, Northern Human Services Center, Carrboro, and the need for
other community programs. (Goal I-A)
Comment: Lack of staff time and resources.
Accomplishments -Transportation Access
Objective #18: Review the current availability of non-emergency ambulance services and high
costs within the county, and make recommendations for resolution of the issue. (Goal I-A)
Accomulishment: Aging Director and OPT Supervisor reviewed the currentinadequateanl
high cost ($125 per trip plus mileage) non-emergency ambulance service offered by a private
provider in the Summer 2001. Meetings were held with local nursing home ndministrators
and EMS, for their input and documentation of need OPT employees were trained and a test
pilot was provided on three non-emergent ambulance moves and associated costs were
tracked. In .Ianuary 2002, Aging/OPT Director submitted a proposal, for OPT to provide
non-emergency ambulance service to Orange County residents. Results- EMS established to
contracts with two ambulance services for improved service response. However, costs are
still high because there is one cost for non-emergency non medical sd•etchen• b•anspor•t and
non-emergency medical stretcher. The assumption is that i.s need, for a meditech, for any
stretcher transport and higher charge, for it.
Unmet Objectives --Transportation Access
Objective #19: Establish an OPT customer user survey and/or a forum that will identify
changes needed to routes, additional service needs, customer satisfaction issues and will meet
annually before budget preparation. (Goal I-A)
Comment: Partially achieved, Customer satisfaction survey has been done and forums have
been held but not on a consistent annual basis.
Objective #20: OPT, TTA and E-Z Rider to develop and implement a plan for providing
affordable and seamless transportation within and outside Orange County, (Goal I-A)
Comment: Lack of staff time and resources.
Objective #21: Provide annual training for all transportation service employees on the
special needs and cultural issues associated with older persons. (Goal I-A)
Comment: Partially achieved This has been done, but not annually.
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Objective #22: Maximize existing opportunities in RSVP, Volunteer Orange, Peer Learning,
Shared Learning, Village Elders by providing transportation from senior housing to senior
centers. (Goal I-A)
Comment: Lack of resources.
Objective #23: Provide shelters and benches at all OPT pick-up/drop-off locations.(Goal I-A)
Strategy: Institute a sponsorship program that encourages businesses and other
orgaiuzations to donate shelters acid benches (which will display their names
in recognition of the donation), OPT will also seek NCDOT funds.
Comment: Lack of staff time and resources..
GOAL I-B: To have each older person in Orange County perceived as and
valued for his/her uniqueness.
Accomplishments -Education & Societal Attitude
Objective #24: Establish a local television program ("In Praise of Age") to develop and air a
minimum of two programs per month portraying seniors in a positive light, (Goal I-B)
Accomplishment: In spring, 2000, the "In Praise of Age"weekly TV program was
established with a group older adults and graduate student who helped coordinate this new
initiative.. In July, 2001 the program expanded its sponsorship and funding with Carol Woods
and the Friends of the Chapel Hi115enior Center. In addition, the Aging Director and
graduate student have expanded to four program tapings a month on a variety of informative
topics,
Objective #25: Work with local newspapers to print a minimum of one feature article per
month on older persons, their contributions and accomplishments. (Goal I-B)
Accomplishment: Regular, feature articles have been written monthly by OCL1oA
staff, often highlighting programs.. The information and assistance specialist writes a
monthly column, for• the Chapel Hill Herald. She regularly includes information and
positive messages about aging.
Objective #26: Develop increased opportunities for L1NC Health Professionals to be
exposed to aging through senior centers, (Goal I-B)
Accomplishment: Fldercme staff provides fteld placements for occupational therapy
students and MSW students with concentrations in aging. UNC School of Nursing places
with the Wellness Program first and second year students in their community nurse rotation.
Unmet Objectives-Education & Societal Attitude
Objective #27: Obtain commitment from a minimum of three county and/or state
educational and aging institutes and associations to provide annual training and continuing
education unit credits (CEUs) for programs that educate service providers on the strengths of
older persons and how to maximize their contributions. (Goal I-B)
Comment: Lack of staff time and resources,
as
Objective #28: Expand the number of intergenerational volunteer programs in the
community by 30% in partnership with the i.INC, civic and youth organizations, as measured
by Retired Senior Volunteer Program (RSVP). (Goal I-B)
Strategies:
^ High school English classes interviewing older persons and writing their personal
histories (Senior Education Corp)
^ Elementary school children becoming pen pals with older persons
• Older persons as guest speakers in relevant classes
^ Older artists participating as guest instnictors in music, art, photography, etc. classes
^ Community service hours with older persons
^ Physical education classes to volunteer at the Senior Games
Lead agency: O.C. Dept. on Aging (OCDOA)
Staffing: Existing/ Volunteers
Comment: Lack staff time and resources.
Objective #29: Develop a mechatusm in the University to better utilize the skills and talents
of seniors. (Goal I-B)
Comment: Lack staff time and resources.
Objective #30: Develop and implement a recognition program for intergenerational
programs in the community (Volunteers for Youth, churches/synagogues/temples, scouts,
etc.). (GoalI-B)
Comment: Lack.staff time and resources.
Objective #31: Work with the North Carolina Institute on Aging, community colleges, and
the public school system to develop a curriculum model on aging that could be taught in high
school health classes, retirement planning courses, eta (Goal I-B)
Comment: Lack staff time and resources.
GOAI, I-C: To ensure that adequate mental health services and educational
programming are available to all older persons in Orange County.
Accomplishments -Mental Health Service
Wellness/Eldercare Annual presentations/programs at Senior Centers and Community
Centers with older adult programs provided by local mental health experts, including
eldercare social workers. .
Objective #32: Conduct and evaluate impact of one mental health educational group
program per year for older persons and their families. (Goal I-C)
Accomnlisbment: OCL)OA Eldercare Services: Group for caregivers of individuals with
dementia has been long- standing. Second Caregivers group added in 200.3 at Hillsborough
has been implemented. In 2004 a third caregivers' support group was added at The Cedars.
It is staffed by OCDoA staff and open to the public. Evaluations are mailed to group
members. All evaluation ratings have been very good to excellent. A two day Zementia
education training were held and evaluated in Hillsborough in 2004,
~~
Objective #33: Provide educational media programming (a minimum of one program per
quarter) on normal aging and good mental health through a wide variety of print and
broadcast media (potential outlets for the programming are television, website, newspaper
articles, radio programs, and symposia). (Goal I-C)
Accomplishment: Eldercare licettsed clinical social worker presented a session at the
senior centers and meal sites on using cognitive strategies to mitigate depressive symptoms..
Senior Wellness Program with OC Mental Health Associative and private providers offered
at least one educational programs to the general community per year on normal aging and
mental health, Center prvgrarns are evaluated as offered beginning.7uly 'OS. OCDOA
Eldercare Administrator (LCSW) made presentations at UNC on dementia (2005) and on
geriatric depression (2006).
Objective #34: Develop and distribute culturally appropriate flyers on: a) Delirium vs,
Dementia, b) Cognitive Disorders, c) Signs and Symptoms of Depression. Distribute at local
pharmacies, physicians' offices, health clinics, churches/synagogues/temples, health
department offices, senior centers, and Department of Social Services (DSS) offices and
evaluate impact. (Goal I-C)
Accomplishment: Senior Wellness Program.• -Sept '03 a Mental Health Representative
appointed tv the Wellness Advisory Board. Spring '04 Commmunity Resources Contact Scripts
available in Senior/Community Centers. Resources available at Senior Centers and upon
request, In addition, educational brochures on the signs and symptoms of dementia were
distributed to physicians offices and pharmacies.
OCDOA Eldercar•es developed an early dementia screening tool which was developed and
used in local MD offtces.
Unmet Objectives -Mental Health Service
Overall Comment: There is no staff devoted full time to senior mental health issues even
though this is a growing azea.
Accomplishments -Senior Socialization
Obiecfive #35: Create and maintain senior to senior telephone networks, (Goal I-C)
Accomplishment: Telephone reassurance program continues 5 days per week with SO
seniors called daily. A, feature article was published on this as well as an editorial praising
the program. Two senior volunteers call isolated seniors on weekends and in the evening.
During severe weather (e.g. the ice storm in December 2002) eldercare .staff contacts all
clients to check on well-being and provide information about shelters..
Objective #36: Implement a new senior center service that can meet the needs of individuals
who aze not independent, but do not need adult day caze service levels. (e,g,, an
interdisciplinary model using occupational therapy (OT), physical therapy (PT), nursing,
social work, medicine, divinity, psychology, dentistry, and pharmacy ). (Goal
Accomplishment: Afirst initiative has been the group respite program at the Nvrthside
Senior Center, It is managed by an occupational therapist, with donated time, from a physical
therapist. Staff also includes an MSW, NA, and rehabilitation counselor. It ended in 200.3
with opening of the Adult Day Health Center in Hillsborough. With effort from, facility
managers and OCDOA Eldercare staff seniors with mild cognitive impairment are welcomed
into the lunch and activity sessions.
a-~
Unmet Objectives -Senior Socialization
Objective #37: Form a minimum of six neighborhood groups to help provide assistance to
older and disabled persons in the neighborhood. (Involve faith communities, schools,
neighborhood associations, students/volunteers, etc.)
Comment: No staff or time necessary to meet various groups..
Accomplishments -Mental-Physical Health Integration
Overall: The eldercare staff is often called by local physicians to provide in-home
assessments and counseling for impaired seniors and/or their stressed caregivers
Objective #38: Provide a minimum of one educational program per year for health care
providers in identifying, referring, and managing mental illness in older persons,
Accomplishment:_E2dercare supervisor presented a workshop, for professionals at the NC
Conference on Aging on how to assess and treat caregivers of individuals with dementia
using individual and group modalities, Eldercare supervisor presented on behavioral signs
of dementia at the 2005 Program on Aging Conference; Challenges in Geriatric Medicine.
She is scheduled to present at the 2006 IINC Challenges in Geriatric Medicine in 2006 an
managing geriah°ic depression.
ObiecHve #39: Develop and implement a mental health service access model within the
Orange County Senior Centers,
Accomplishment: Currently there is a licensed clinical social worker (LCSW) who can
assess, treat, or refer seniors and caregivers with psychological problems. A growing
mm~fier of physicians refer depressed or anxious seniors for clinical services. Additionally,
there the number of caregivers seeking individual counseling from the OCDoA LCSW is
increasing, However, there is no system for payment for clinical services. At present, services
are provided on a voluntary contribution basis only.
I. THE WELL-FIT OLDER POPULATION
Goal II-A: To improve and/or maintain the health status of Orange County's
Well-Fit Seniors for as long as possible.
Accomplishments --Health Promotion
Overview: Wellness, Dec. '03 - A1116 Agencies identified in the MAP -Well-Fit Objectives
requested to attend an open, forum to discuss accomplishments/outcomes of goals to date.
Solicits presentations/hands-on demonstrafions/programs cooperatively with the following:
Cooperative Extension Services (Heart Health Prevention Program) , U1VC Hospital's
Cardiac Rehab, ZINC Wellness Center, OC Rec & Parks Dept, OC Health Dept -Nutrition
Education (OCHD- Nutrition measures behaviors/monitors lifestyles,for improved
behaviors), ZINC-CHSchool of Public Health- Nutrition Program
~~
Objective #40_ Seek funding to employ one additional health and wellness professional, to
focus on the provision of community outreach programs to the most at-risk seniors.(Goal II-A)
AceomnGshment: DOA Eldercare Services, Margaret Hudson, R.N, Ph.D., has volunteered
her time to conduct in-home assessments hvice a week to monitor, frail clients' medication
usage. She submits client notes electronically and communicates with social work staff and
clients' physicians,
Wellness Program: Currently, funds are requested annually through philanthropic
organizations for one paid nurse in each of the 4 Fit Feet Clinics, this program serves in a
limited capacity to reach at risk seniw•s. A portion of funding is utilized for one part-time
administrative position (10 hrs.. per week)..
Fall ' 03 Staff cooperated with SHAC(Student Health Advocacy Coalition) to develop a
Foot Care Clinic replicating OCDoA's Foot Care Clinics in northeastern Orange
County
FY '06 - OC Health Department: In collaboration with the Wellness Program has
developed a new Adult Chronic Disease Nurse position to serve older adults in rural
areas of the county.
Objective #41: Identify the barriers that prevent older persons in Orange County from
accessing health and wellness services, (Goal II-A)
Accomplishment: No large formal community assessment was done to ident~ the barriers
to accessing health and wellness services, due to lack of staff time and ftnancial resources..
However, lots of surveys have been done over the lasl f ve years as indicated below,
FY '01 - A Wellness Program Impact Survey, designed by staff of and administered with
Nursing student assistance, with Sl people r°esponding from each the 3 senior centers,
indicating a lifestyle change in 62% of the respondents, was completed; however there
were, few results relative to barriers of accessing health & wellness services identified.
Summer '04 -Another Impact Sarrvey to be completed Plans to reach a larger audience
by promoting and disseminating survey through the Senior Times (Behaviorial Risk
Factor Survey-NC Centers for State Health Statistics should be used to complement
existing questions to help id barriers).
Staff periodically surveys Wellness Program participants for program satisfaction and
program ideas.
Other agencies identified to i.d barriers -OPT, LJNC-CH Nursing School Students who
spend lime with seniors, through the Community Health Nursing Program, Meals on
Wheels-Northern and Southern Orange..
Fall '03 - OCHD -Completed Community Health Assessment. L/NC-CH School of
Public Health completed an evaluation of the Fit Feet Foot Care Clinics.
Beginning FY ` 0.5 - Staff surveys Wellness Program participants for program
satisfaction and program ideas -per session and quarterly as Senior Center policy
regreires.
Objective #42: Develop strategies and promotions to make those populations most
at-risk aware ofpotential health and wellness services. (Goal II-A)
Lead Agency: OC Servor Wellness Advisory Board and Health Dept.
Staffing: Existing/Student Interns
Aecomnlishment: As described below, efforts have been made, but the still need
improvements, especially to those who do not receive (or read) the Senior Times and
connected to local churches, Wellness Program, Limited number ofpromotional tools, i,e.
individual program flyers, staff presentations, and written notices to r•ur•al.faith-based
9
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organizations throughout the county and coordinate with Northern Orange Meals on
Wheels to deliver program, flyers and the Senior Times to their clients.
Staff periodically presents info to faith-based or civic groups, Staff continually
cooperates and shares information/resources with other county staff/agencies serving
older adults -Recreation & Parks (OCRPD, CHPRD, CRPD), JOCCA, Meals on
Wheels, Health Department -Nutritionist and Health Promotion Staff, and a host of
other care providers both in general medicine and specially areas -vision, hearing,
mental health, etc.
'OS -Enhanced working relationship with UNC Program on Aging Geriatric Assessment
Clinic(clinic scheduled to move to new SOSC CY2006)
OC Adult Day Care, ZINC Hospitals -Division of Geriatric Medicine, ANC's Heart
Center and Wellness Center, Access Mobile Dental Program (in process of forming are
all venues in which at-risk older adults receive services and may be exposed to health
and wellness services in the community.
Objective #43: Provide coordinated educational programs and services to those senior
populations most at risk. (Goal II-A)
Accomnlishment: Much as been done, but still needs improvement to better
coordinate agencies outreach to the at risk populatior:.
Wellness Program (Multi year continuation objective 2001-2005)
Monthly and weekly health education programs (Offered a minimum of 12 health
education programs at S different senior programming sites during 1005) and services-
.screening and/or clinical services are offered at the senior centers and rural senior
programming sites utilizing a variety ofprofessional and community resources.
If a service is not offered at a senior programming site we work to make the service
accessible to the client by utilizing area d•ansportation sezvice providers-OPT or E-Z
ridez•, 2002 -Staff increased bulletin board space at the Senior Centers, initiated
updating the County's AgingDepartment Web pages. Coordinate with other appropriate
Departments and community resources.. - OC Friends of Senior Center groups, OCHD-
Nutritian Ed, Cooperative Ext., IJNC Wellness Center, UNC Heart Center Clinic,
Triangle United Way Issue Teams, Chapel/Carrboro Residency Council, Churches,
Parrish Nurses, and community connections to provider programs and services
Annually -Wellness Program Coordinator is preceptor to UNC-CHNursing Students
and Summer'04 -Wellness Program served as a preceptor to Health Promo Intern from
NC Appalachian State University in an effort to move toward reaching the most at-risk
Fall '04 -Expanded Fit Feet Clinic to rural areas- increased % day clinic at COSC and
introduced % day clinic at Northern Orange Human Services Center.
Objective #44: Provide innovative age, gender, and culturally appropriate screenings to
senior populations most at-risk, (Goal II-A)
Accomnlishment: Wellness Program (Multi-year continuation objective 2001-2005)
1, Hearing-quarterly, Vision-bi-annually, Crlucose/Cholesterol-bi-annually, Blood
Pressure-weekly or bi-weekly, etc, per each of 3 Senior Centers and 2 community
centers, Screenings are provided at rural sites on a periodic basis and transportation
provision are made when screens are not offered in all geographic locations,
2, 2002 -Developed and implemented the ABC Wellness Screen a comprehensive
sczeening series that reviews older adults wellness in the areas of physical
functioning ability. 2003 -Negotiations began with the UNC- CH Department of
Allied Health Sciences to provide physical, firnetioning ability screens by students in
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allied health, f elds• with supervision of faculty. 2004 - i1NC School of PT provides
physical function screens at COSC and C.HSC. for, fee ($30.00 per/hour).
3. Sept. '03 -Implemented the Cognitive Screening Too, CNS Vital Signs, for early
assessment of clients cognitive functioning, early sign/symptoms of memory loss,
Dementia or Alzheimer's Disease. (Service currently discontinued due to concerns
about the screening tool and client human/subject use). Currently offer information
on community resources with experts in the feeld of cognitive impairments..
Promote ZINC Women's Annual Health Fair and other screening tools in the
community.
Objective t#5: Offer and evaluate behavioral change prograzns and services for at- risk
seniors. (Goal II-A)
Accomplishment: Wellness Program (Multi-year continuation objective 2001-2005}
While services for flee at-risk services /lave been offered, no overall behavioral chm:ge
programs Irave been developed Recommendations: Develop Protocol for All Screens
Fall '0.3 -Evaluation of the Fit Feet Clinic through UNC-CHSchool of Public
Health, Begin Spring '04 - Diabetes Education classes offered twice per year at each
of 3 senior centers and once per every other year at ECC.C and NOHSC
Fall ` 04 -Fall 'OS Z-ACED (Active Living Every Day)pr•ograms offered- ZO -week
exercise/activities health education program offered
Summer '04 -PACE (People with Arthritis Can Exercise) offered at COSC & NSC
Spring 'OS -work with ZINC-CH Certificate in Aging Students/Faculty to initiate
evaluation of select program areas in Wellness. Continues in 2005/06 academic yem•.
Spring/Summer 'OS -All Wellness exercise/fitness classes goals & objectives documented.
Unmet Objectives -Health Promotion
Objective #46: Develop afact-based accounting of the unique needs of Orange County
older persons regarding: support for services such as medications, eye glasses, dental
appliances and hearing aids. (Goal II-A)
Comment: Some efforts bave been made, but lack staff and resources.
Reco»tmendations: -Host future Community Screeuireg Clinics/Follow-up wt unmet
needs. Wellness Program: Request for participant services/programs noted and records
kept on when and which site received services.
Other lead agencies identifying needs -ZINC School of Pharmacy, ZINC Hospitals
(Support C,enter), Access Dental (mobile dental unit), ZINC Dental School, local private
providers, OC DoA Information & Referral, and Carol Woods.
Objective #47: Support, through tax deductible contributions, needed services not
covered by other resources. (Goal II-A)
Comment: Sorne contributions were received tbrot+glr designated United Way gifts.
Recommend more be done.
Wellness Program Staff continually seeks grant opportunities to fund programs,.
Completed annually since 2001- TUW Application for Membership and Funding
Request, Combined Federal Campaign Application, SECC
Combined Campaign, BCBSNC Request, for Proposals and 1 full grant (Fit Feet)
application and 1 mini grant app. to ZJNC Center for Public Service (Fit Feet)
FY'03 initiated standing Application with Triangle Community Foundation (Fit Feet),
FY '0.3 - Strowd Roses Grant (Fit Feet)
31
Objective #48: Identify and recruit retired health professionals as volunteers who would
expand health services. (Goal II-A)
Comment: Partially achieved, but more needs to be done. However, DOA Eldercare
recruited an retired RN for home based services. The Wellness Program recuited
Volunteer RN's and 1 podiatrist (2004/Spring '0.5) serve the Fit Feet Foot Care Clinics,
volunteer RN's/LPN's serve in the Blood Pressure Screening Clinics; utilize retired
pharmacist, dentists, physicians, and nurses for screens/health education programs,
some recruited through OC RSVP Program, OC Health Department Reserve Coz ps,
ITNC Health Cm•e Volunteer Program. Recommendations.• iINC Hospitals -extensive
volunteer program, OCHD -Reserve Corp RN's.
Accomplishments - At-risk Health Promotion
Objective # 49: Provide educational materials and/or programs designed to teach older
persons and their caregivers such as "How to Get the Most Out of Your Visits to
Health Care Providers." (Goal II-A) (materials available in English and Spanish)
Accomplishments: Wellness Program_(Multi-year continuation objective 2001-2005)
Department on Aging Information and Referral staff have provided several presentations
to seniors through senior center, senior programming sites and senior community
housing visits. Thez•e has also been a special presentation on this subject at the senior
centers provided by a geriatric clinical nurse specialist.
Staff has designed programs to address these topics and presented annually at Senior
Centers. Still need materials in Spanish print.
Staff worked with the local Area Agency on Aging to provide a "Living Well "Series of
Classes offered in Spring & Summer '0.3- CHSC and in Summer '04 at the COSC
Summer '0.3 presented "How to get the most out of Doctor Visit" at all S Senior
Programming sites. and "55 Alive"AARP Driving Program is offered annually at the
OCDOA. '04/'0.5 -Brochure distributed "Ask Me 3 " -Good Questions for Your Good
Health.
Objective #50: Assure the availability and accessibility of health and preventive
information at all county health facilities, librazies, senior centers, and public
facilities.. (GoaIII-A)
Accomplishments: Efforts have been made as described below, but difficult to monitor.
Senior Wellness Program(Multi-year continuation objective FY 2001-2005)
Information is available and accessible at all.senior centers, county health, facilities,
limited information is available at libraries and other public facilities..
Resource Library »~ith up-to-date pez•iodicals on health-related topics and other sout•ces
of information., i.e. brochure/pamphlets, etc.. available at the CHSC and limited at the
other centers.. DOA Eldercare have worked with some private providers who are willing
to share OCDOA information and available programs with private clients or post in
private medical offices. Recommendations for other resources - OCHD -Public Health
Education Materials at Senior Centers, ZINC Hospitals -Women's resource library,
Wellness Resource Center, and OC'/CHPublic library.
Unmet Objectives- At-risk Health Promotion
Objective #51: Implement, monitor, and evaluate a community outreach effort, based on
research, that will attempt to enroll all eligible older persons in Medicaid. (Goal II-A)
tz
3a
Comment: Not done due to lack of staff resources. However, OC Department on Aging
Eldercare staff informs and refers clients to Department of Social Services.
GOAL II-B: To ensure an adequate supply of affordable, safe, and suitable
housing exists for older residents in Orange County.
Accomplishments -Housing Services
Objective # 52: Complete an assessment of housing needs, quantities, and amenities, for
older persons in Orange County for the years 2001.2020. (Goal II-B)
Accomplishment: A UNC Social Work Student working with volunteers prepared a
housing assessment survey. Data collected and tabulated in 2005. A report will be prepared
Dept. on Aging staff in 2006 on the survey results.
Objective #53: Assist the HUD 202 Housing for the Elderly Project (Manley Estates) in the
provision of support services, and study contracting provision of services such as case
management or service coordination. (Goal II-B)
Accomplishment: Since 2002, OC DOA Eldercare division has provided First Baptist-
Manley Estates with on-site service coordination through contract staff for 10 hours per
week. Supplying staff through the OCDoA makes service coordination smooth and
encourages resident contact with the agency when the part-time coordinator is not present..
Objective #55: Educate cons~uners on need to select and buy "Aging in Place"(AiP) homes.
(Goal II-B)
Accomplishment: In May, 2005, a large, forum was held on "Senior Choices: Housing
Options" with over 175 persons in attendance along with community agencies, While the
forum focused on all ,types of housing from independent Ziving to nursing horne care,
selecting and buying a AiP home was discussed. More time and staff resources is needed for
this objective.
Objective #56: Formulate a strategy to increase the number of available and affordable
housing units designed and built to meet the needs of older persons, by a level commensurate
with the predicted growth rate (include public and private housing needs). (Goal II-B)
Accomplishment: The Orange County Affordable Housing Advisory Board includes
consideration and discussion of the housing needs of special populations including the
elderly.
Objective #58: Reduce the number of Orange County housing units without adequate
heating. (GoaIII-B)
Comment: Housing units without adequate heating facilities are addressed through the
C.ounty's Urgent Repair and C_.omprehensive Housing Rehabilitation Program.
iJnmet Objectives -- Housing Services
Objective #54: Develop incentives for architects and builders to build houses that allow for
easy retrofitting later for "Aging in Place" or disability modifications. (Goal II-B)
Comment: Lack of staff time and resources..
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Objective #57: Reduce the number of Orange County housing units for seniors that
lack complete plumbing and kitchen facilities. (Goal II-B)
Comment: OC Health Dept. explored low-cost loans for residents. New initiative/Objective
to be considered -accessibility issues, i. e. ran7ps, widening doors, handrails.
Objective #59: Develop multi-unit housing with support services, with assistance
from the N.C. Housing Trust Fund, (Goal II-B)
Comment: Lack staff time and resources
GOAL II-C: To enable older persons to age in place, in their own residences,
as long as possible.
Accomplishments -Residential Support Services
Objective #60: Advocate legislatively to increase the coverage and allowance for
Homestead (Goal II-C)
Accomplishment: The Homestead Act was changed in 2002 to include qualifying homeowners
with a gross income of $18, 000 or less. The greater of $20, 000 of the permanent residence's tax
evaluation or .SO% is forgiven, for calculating the tax amount. For 2003, the grass income was
changed to $18,.500. The OC tax ojjrce has made it possible for citizens to pay their taxes on a
monthly basis through regular payments or bank drafts.. The information and assistance
specialist has worked with the local AARP to educate the public on this resource,
GOAL II-B: To ensure an adequate supply of affordable, safe, and suitable
housing exists for older residents in Orange County.
iJnmet Objectives -Residential Support Services
Objective #61: Develop and print a list of service providers who perform home
repairs/renovations and maintenance for in older persons. (Goal II-C)
Comment: Lack of staff time and resources.
Objective #62: Develop funding and reimbursement mechanisms (e.g. grants) that
encourage the provision of services to older persons at an affordable IeveL (Goal II-C)
(housekeeping, retrofit of home, outside repair, yard work, grocery delivery, etc.)
Strategies:
^ Implement programs in vocational education classes at OC high school and
community college level that provide credit for the provision of "x" number of
service hours to older persons in Orange County.
Lead agency: OC Department on Aging in partnership with, but not limited to,
Community College System and the Homebuilders Association.
^ Establish a volunteer pool of retired trades people willing to provide home
maintenance services on a sliding scale.
Lead agency: OC Dept, on Aging.
^ Apply for state and federal monies available for services.
Comment: Lack of staff or resources
Objective #63: Study and establish property tax policies enabling older persons to pay
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according to their ability to pay and to defer payment until property settlement. (Goal II-C)
Comment: Currently, the State Homestead Exemption is available for• the very poor, but
only reduces property tax by .50 per cent. Issue needs further study.
Obeective #64: Provide assistance for senior housing projects in planning for
supportive services. (Goal II_C)
Comment: Currently, DOA Eldercare Services provides a service coordinator under
contract, for 10 hours per week at Manley Estates, a low income senior housing facility.
Issue needs further study, especially new, facilities being consriucted
III. THE MODERATELY IMPAIRED OLDER POPULATION
GOAL; III-A: To recognize and support the efforts of informal caregivers in
providing care to older persons in Orange County.
Unmet Objective -Formal Caregiver Services
Obeective #65: Offer sufficient and affordable certificate training and placement program for
certified nursing assistants (CNAs) and personal care aides (PCAs), throughout the
community (e,g., internships and co-op programs). (Goal III-A)
Comment: Lack ofstaff time and resources..
Accomplishments -Respite Services
Obeective #66: Fetid and coordinate a program to provide housekeeping and heavy cleaning
services once a month for 25 clients on a sliding scale fee. (Goal III-A)
Accomalishment: FY 2000-2002-With the BOCC approval, $1.3,500 was set aside
and cleaning service began by DOA Eldercare Services in January 1002. However, state anc!
county budgetary constraints, the program was discontinued in June 2002. Clients wha
wanted to retain the service and could provide the matching,funds were referred directly to
the cleaning service companies. Hopefully, with budgetary improvements, the program can
be re-instituted in FY 2004 or beyond
Obiective #67: Expand existing in-home respite services (Goal III-A)
Accomplishment: (Multi-year continuation objective 2001- 2004)
FY 2001-With assistance of [he MA. P. Steering Committee and Aging Board, the Aging
Director prepared a successful proposal, for National Caregiver Funds, for $39, 256 to the
TJCOG in Dec. 2001. The Respite Plan was submitted to BOC.C for approval in January
2002 and covers four caregiving areas volunteer in-home respite (subcontract with A
Helping Hand agency), group respite, institutional respite, and professional in-home respite
reguiring personal care,
FY 2002- A successful proposal for National Caregiver Funds, submitted by the supervisor of
Elderem•e, was approved by TJCOG in June 2002. A grant in the amount of $73, 500 from
the National Family Caregivers' Support Program Funding is being utilized as, follows:
1, Caregiver Respite Choice Program - $40, 000 (services include adult day care,
volunteers, aides, and institutional overnight respite)
1. Group Respite (Caregiver Day Out Program continued) - $1.3,500
3. C.'aregiver Training and Counseling - $20, 000
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Objective #68: Expand respite programs in nursing homes and assisted living facilities to
include a respite bed reservation service, (Goal III-A)
Accomplishment: National Family Caregiver Program has, funded some respite. for
seniors in institutions.. Although a reservation service has not been developea;
facilities have been open to short-term stays funded by OCDoA respite program.
Objective #69: Provide a new group respite program tluough the Orange County
senior centers. (Goal III-A)
Accomplishment: A group respite program was done using National Family Caregiver
Support Program funds at the Northside Senior Center in 2002-03. The program was
discontinued when the Central Orange Adult Day Health Center in Hillsborough was
established in 2003,
Accomplishments -Adult Day Health/Social Service
Objective #70: Research the need for ati adult day program (social and health model) and
design a program based on the results of the research. (Goal III-A)
Accomplishment: Agraduate student and Aging Director collected demographic information
and surveyed agencies in determining the need.for a adult day service in 2007.02,
Objective #71: Develop a funding plan for the provision of adult day services for
central/northern Orange. (Goal III-A)
Accomplishment: Based on research, a graduate student and Aging Director, designed a
combination adult day HealtWSocial Model. for Central Orange and prepared funding plan
for the Aging Board and BOCC approval in Spring 2003..
Objecfive #72: Implement an adult day (social & health) program through Orange County
Eldercare Services and the Orange County Dept. of Social Services. (Goal III-A)
Accomplishment: With the BOCC approval, $50, 000 was set aside in the Department on
Aging's budget to implement adult day care with Carol Woods and Friends of the Senior
Center~nancial support in July, 2002.. Joint space with the Central Orange Senior Center at
the Meadowlands was renovated and final staff arrangements were completed and began
operating in March 2003, In July, 2004, the Central Orange Adult Day Health Center was
transferred from the Dep.. on Aging to Senior Care of Orange County, Ina, a new non profit
senior agency that, focuses on the issues of frail and disabled older adults in Orange County.
(New objective for FY 2003: Implement and operate adult day (social health) program by
new non-profit agency,)
Accomplishments -Support for Caregivers
Objective #73: Offer annually, amulti-cultural education program on abuse, neglect and
exploitation. (program audience: county residents, caregivers, Adult Protective Services, and
long-term caze service providers) (Goal III-A)
Accomplishment: A program was presented by the Coalition Against Elder Mistreatment
and the Chapel Hill Police Department in December 2002. for police,.fire, and EMS
personnel.
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Objective #74: Develop and maintain at least one support group for caregivers (consider
Internet- based support groups) (Goal III-A)
Accomnlishment: DOA Eldercare- Along-running caregiver support group, which provides
educational and behavioral strategies in a confidential sharing session, continues to grow in
Chapel Hill. Members share their phone numbers and email. Staff facilitators encourage
email communications between sessions as well. Group members participated in the creation
of a teaching video on how to, facilitate a caregiver support group. Additional groups have
been added in Hillsborough at the Central Orange Senior Center and at the Cedars in
Chapel Hill.
Objective #75: Provide county-sponsored counseling/education services for caregivers in
order to reduce cazegiver stress & to improve quality of cazegiving in the home. (Goal III-A)
Accomplishment: (Multi year objective 2002 - 200.5) DOA Eldercare Licensed clinical
social worker provides in-off ce or in-home counseling, involving education, cognitive-
behavioral strategies, emotional issues, and environmental changes, Occupational therapist
provides hands-on training to caregivers.
Objective #76: Seek funding to employ one full-time mental health professional to provide
individual and group therapy and educational programs, to reduce cazegiver abuse. (Goal III-A)
Accomplishment: DOA Eldercare Services provides professionally trained staff for [his
purpose. No staff is assigned to this role only. However, this needs further study to meet the
growing need such as a billing. for services, for those who can pay or have insurance.
Objective #77: Start a "cazegiver card" program that provides personal care tips on portable
reference cazds. Provide materials in culturally relevant language and pictorials. (Goal III-A)
Accomnlishment: Eldercare office has awide-variety of educational materials for
caregivers. These are put together in an individualized manner to focus on the needs of the
caregiver and presented carefully to avoid "information overload. "
Unmet Objectives --Support for Caregivers
Objective #78: Establish a caregiver support network (e.g. using telephone networks, Internet
chat rooms or listservs) with a no cost cooperative respite service among cazegivers.(Goal III-A)
Comment: No Internet neria~orks, However, group mernber•s are encouraged to share
telephone numbers, but is not, formalized
Objective #79: Provide a minimum of two mini multi-cultural training courses per yeaz for
informal caregivers on basic in-home cazegiving skills (perhaps in partnership with a support
group for caregivers). (Goal III-A)
Comment: In 2004 a two day training for dementia caregivers was provided by DOA
Eldercare Services, the OC Long term Care Facility Roundtable, T.ICOC Area Agency Long
Term Ombudsman Program and the Alzheimer's Association..
IV. THE SEVERELY DISABLED/ INSTITUTIONALIZED
OLDER POPULATION
Goal IV-A: Orange County residents who require long tern: care services
will have access to a continuum of quality care and will be treated with
dignity and respect
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Accomplishments ~- Long Term Care Service
Obiective #S0: Establish an Orange County Long Term Care Facility Roundtable
(OCI,TCR) comprised of service providers, consumers, advocates, and regulators, who
will work to define, address, and resolve Curren[ priority issues related to the quality of
care and guality of life of the long term care. facility population, (Goal IV-A)
(Revisions to objective in italics -July 2002)
Accomplishment: The formation of the Roundtable was postponed until Summer, 2002
when the Aging Director, the TJAAA Long Term Care Ombudsman and a graduate
student organized and held two task, farce meetings to deftne the target population,
purpose, representatives, and initial meeting agenda, for the LTC Facility Rvundtable.
Objective al was revised as indicated above to rejlect the Roundtable's main. focus on the
LTC facility population,
The Roundtable had its kickoff meeting on May 7, 2003, during which three working
subcommittees wez•e, formed to review Master Aging Plan goals, deftne priority issues
and .set an action plan for 2004 - 200.5. The three subcommittees were advocacy,
policy/legislative and staff/recruitment/z•etention. Participants included long term care
facility residents, providers, advocates, and family members; Triangle JArea Agency on
Aging Ombudsman Program,° the Orange County Department on Aging; Orange County
Nursing Home and Adult Care Hozne Advisory Committees; Orange County
Commissioners; Orange County Deparhnent of Social Services; the Orange County
Elder Mistreatment Coalition; L/NC Hospitals; Home Health agencies; OPC Mental
Health; First Responders; geriatric teamwork graduate students; consumers; researchers
and others.
The Roundtable held its second annual full membership meeting on April 31, 2004 with
approximately 65 people in attendance.. Each of the three subcommittees presented their
work, for the past year.
^ The Advocacy Subcommittee compiled an admissions handbook, which was
distributed to all long term care facilities in the county for use by residents and
family members. The handbool~ divided into 3 sections, covered resident
empowerment, family empowezment and, facility best practice. The best practice
sections included best practices in facilities, best practices to assure continuity of
cure between, facility and hospital, facility, home health and others..
^ The Policy/Legislative Subcommittee, with input from local and state elected
officals, developed an agenda of policy and legislative actions needed to address
areas of concern in lung term care. facilities. The agenda was submitted to the
Board of County Commissionezs and the legislative items were approved and
included in their legislative agenda packet. Many of the legislative items have
been addressed.
^ The Staffing/Recruitment/Retention Subcozn»zittee encouraged spo»sorship of
two Alzheimer's/Dementia Trainings in the county for caregivers family
,volunteers, stajf members from.facilities, home health, hospice, adult day centers,
hospital and others.. The h~ainings were sponsored by the Orange County
Department on Aging Elder Care Division, the Triangle JArea Agency on Aging
Ombudsman Program, the Orange County Long Term Care Facility Roundtable
and the Eastern NC Alzheimer's Association.
Comments: Due to lack of'staff and resources, the Roundtable has not had additional
meetings since 2004. The bulk of'the work and the cost were absorbed by the Triangle J
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Area Agency on Aging Ombudsman Program, to schedule meetings, develop
subcommittees, facilitate those subcommittees and fake minutes. The structure and
,functioning of the Roundtable need to be revised.
Obieetive #81 Expand a "vial of life" type program in Orange County, which provides
personal medical information sheets accessible to emergency medical personnel. (Goal N-A)
Aecomnlishment: The Chapel Hill AARP, Chapel Hill Police and OCDoA developed
a red ,sleeve to keep on refrigerator doors. These hold current medical, medication,
and family/MD contact information for seniors. These have been available at all senior
centers and meal sites and at the Chapel Hill Police Scam Jam in September 2002
Obiective #82: Support State legislative reform of the Guazdianship statutes to provide
greater protection of wards' rights. (Goal IV-A)
Accomntshment: Legislation was passed to appoint a Statewide Guardianship
Taskforce in 200.5.. One legislator has not appointed his members and the process has
stalled
Obiective #83: Provide and market educational opportunities for Orange County
residents regarding planning and fmancing retirement and long term caze possibilities.
(Example: a series of courses/workshops on all aspects of aging, retirement, and
financial planning) (Goal N-A)
Accomplishment: Two large workshops, entitled Senior Choices, were held at the
Chapel Hill Senior Center in May, 2005. These were highly successful and should be
repeated at the new senior centers once there is more space and parking to accommodate
the participants.
Unmet Objectives -Long Term Care Service
Obiective #84: Require "sensitivity training" for First Responders (Emergency Medical
Services, police, fire, and health department personnel on the appropriate approach to older
persons with potential medical and cognitive impairment issues (Triangle J Area Agency on
Aging Regional Ombudsman currently offer training in this area). -(Goal IV-A)
Comment: Lack staff time and resources,
Obiective #85: Modify existing county-municipal staff training programs to include a
segment on "working with older persons." (Goal IV-A)
Comment: back staff time and resources.
Obiective #86: Develop a program endorsed by the County Commissioners that will
subsidize quality caze in adult care home facilities with 20 beds or fewer to prevent
further closings. (Example: cover cost reporting, assistance with paperwork and
computer reporting). (Goal N-A)
Comment: Lack staff time and resources. Low priority. These, facilities are for profit.
Obiective #87: Support recommendations made by the North Carolina Institute of
Medicine's Long Term Caze Task Force to the General Assembly to enact "a carefully
monitored `labor enhancement' to publicly funded long term care reimbursement
rates to improve staff recruitment and retention...The NC DHHS should develop
safeguards to ensure that the enhanced reimbursement rates are used for staff
recruitment and retention." (Goal N-A)
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Comment: Legislation, for a wage pass-through has not passed in previous legislative
sessions.
Obieetive #88: Develop a career ladder for care providers (Consider the North Carolina
Institute of Medicine's Long Term Caze Task Force Report) (Goal IV-A)
Comment: DHHS and the Institute on Aging on Aging have partnered to develop the
"WIN-A-STEP-UP Program ". It "is aimed at improving the situation of nursing
assistants in the long term care industry in NC WINA STEP IIP stands, for Workforce
Improvement, for Nursing Assistants.' Supporting Training, Education, and Payment. for
Upgrading Performance, " In the recently completed pilot phase, "the primary objective
was to conduct a comprehensive assessment of the current situation of nursing assistants,
to develop educational and incentive programs to improve job quality and reduce
turnover in various sectors of the long term care workforce, including nursing homes,
adult care homes, and home health, home care and hospice settings. With the close of a
successful pilot program, we have begun the second phase of the WINA STEP UP
program, in which we hope to improve job quality and increase the retention of nursing
assistants through the implementation of an educational and reward system in nursing
home settings. Our second phase only includes nursing homes, but rnany of the lessons
learned here may be applied to other long term care settings. " (F.xcerpted.from the UNC
Institute on Agingwebsite, wwwa~irrQ.unc.edidresearch/winastepup/about.hhnl)
Obiective #89: Apply for grant monies to enable the provision of technical assistance
and support for a series of demonstration projects that will test new processes for improved
CNA and PCA retention rates (e,g. multi-disciplinary care planning that involves CNAs
and PCAs, career ladders, training requirements tied to incentives) (GoaIIV-A)
Comment: Lack of staff and resources.. See objective # 86.
Objective #90: Reseazch and evaluate the current county guardianship program's ability
to meet anticipated future guazdianship case growth (including temporary guardianship)
and options for provision of service. (Goal N-A)
Comment: No formal research and evaluation have been done, due to lack ofstaff time.
Objective #91: Develop and implement a County Commissioner endorsed recognition
program for long-term care personnel and family caregivers. (Goal N-A)
Comment: Lack of staff and resources.
Objective #92: Advocate for a living wage for all Long Term Care personnel, hospital
staff, and home health employees. (Goal IV-A)
Comment: Lack of staff and resources
Objective #93: Provide quarterly training for long term care activity directors in
partnership with the L1NC Schools of Education, Recreation, & Occupational Sciences,
Regional Ombudsman, and OC Dept. of Social Services. (Goal IV-A)
Comment: Lack of staff and resources. Low priority.
Objective #94: Expand the "friend-to-friend program" to include L,TC residents. (Goal N-A)
Comment: Friend-to-Friend Program coordinator position tivas cut due to FY 2002-
2003 budget cuts, The Nursing Home Community Advisory C."ommittee has a friendly
visiting program with limited volunteers.
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Objective #95: Develop incentives approved by the County Commissioners for more
adult care homes to accept special assistance monies in order for residents not to be
place in out -of -county facilities. (Goal IV-A)
Comment: Carillon, a new adult care home that accepts some residents on special
assistance, opened in Hillsborough in October 2005.
Objective #96: Partner with the UNC-CH and IINC hospitals to look at the potential for
developing a hospital affiliated long-term care teaching nursing home facility. (Goal IV-A)
Comment: Lack of staff time and resources.
Objective #97: Implement a recruiting campaign for qualified health care and other
service providers who specialize in meeting the needs of older persons. (Goal IV-A)
Comment: Lack of staff time and resources, The long term care facilities in the area
are for profit facilities.
Accomplishments -Dental Services for Long Term Care
Objective #98: Support the Senior Tarheel Legislature's resolution which asks the
N.C. General Assembly to allocate $1.:35 million to fund 3 Dental Access Units for
which regions can compete based on need (Region J has the most acute shortage of
dental caze services in LTC facilities than any N.C. metropolitan azea.) (Goal IV-A)
Accomalishment: Multi year objective 2002 - 2004. Supported legislation to
increase dental access (mobile unit) services in LTC facilities.
Objective #99: Establish a committee to pursue the proctirement of the funds
(grants/corporate gifts) necessary to obtain an Access (Mobile) Dental Unit to serve
Grange County and Region J. (Goal IV-A)
Accomplishment: Procured grant monies to obtain/operate a dental access mobile unit
in Orange Coun[y. A van and equipment have been obtained A dentist has been found.
The program will hopefully begin in 2006,
I7nmet Objectives _ Dental Services for Long Term Care
Obiecfive #100: Begin operation of mobile Dental Access Unit for senior residents in
Orange County, Chatham and Durham counties, with priority given to long term care
facilities (2002), Senior Centers (2003) and homebound (2004). (Goal IV-A)
Comment: Delayed because offunding. Procured grant monies to obtain/operate a
dental access mobile unit in Orange County. A van and equipment have been obtained,
A dentist has been found. The program will hopefully begin in 2006.
Objective #101: Promote good oral health, nutrition and disease prevention via
community outreach program and senior centers. (Goal IV-A)
Comment: Lack of stafj time and resources,
Objective #102: Provide in-service instruction in oral hygiene procedures to long term
caze facility personnel. (Goal IV-A)
Comment: Lack of staff time and resources. This training will be provided to facilities
that conh•act with the ACCESS Dental program,
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GOAL IV-B: Orange County will be a model county in adhering to or
surpassing federal and state guidelines (eg.1987 OBRA) which address
residents' rights, quality of care, and quality of life in long term care
facilities.
Accomplishments -Quality of Care Provision
Objective #103: Advocate and promote the establishment of family councils in long term
caze facilities. (Goat IV-B)
Accomplishment: Triangle JArea Agency on Aging Regional Ombudsman currently
offers assistance to families in establishing councils.
Objective #104: Support/Advacate for the state initiative to develop a grading system for
long term care facilities similar to the five star program for child caze facilities. (Goal IV-B)
Accomplishment: Legislation was passed in 200.5. A star rating system for adult care
homes was authorized to be developed by the L)epartment of Health and Human Services
(L)HHS) to improve the guality of care and give consumers some guidance when selecting
an adult care home, for a family member.
Objective #105: Promote, via television, print media, and radio, long term care
residents' bills of rights and the services of the Regional Long Term Care
Ombudsman's office, Orange County Dept, on Aging, County DSS, Division of
Facility Services, and North State Legal Services. (Goal 1V-B)
Accomplishment: The In Praise of Age TV Show during the past, four years have had
special half hour programs featuring the services of these organizations..
Objective #106: Develop a standazdized residents' rights and orientation admissions
package to be used at all long term care facilities within the county. (Goal IV-B)
Accomplishment: An orientation and admissions manual was developed, for all adult
care homes in the county. The lack of interest from Nursing Homes did not warrant the
development of a manual solely, for them.
Unmet Objectives --Quality of Care Provision
Objective #107: Present "business excellence awards", endorsed by the County
Commissioners to long term care facilities that meet and/or surpass federal and state
guidelines concerning residents' rights/ quality of caze/ quality of life. Award to include
media recognition for the winning facilities. (Goal IV-B)
Comment: Lack staff time and resources,
Objective #108: Assess the need for additional adult home specialists for the Dept, of
Social Services based on caseload, (Goal IV-B)
Comment: Lack of staff time and resources.
Objective #109: Provide information, referral, and technical assistance related to
residents' sights, to older persons and their families. (Goal IV-B)
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Comment: This is provided by the Triangle JAr•ea Agency on Aging Ombudsman
Program, with assistance from the Nursing Home and Adult Care Home Community
Advisory Committees.
Objective #110: Develop and implement county-wide quality of life standards that long
term care and service providers must meet or be subject to county ordinance penalties
adopted by Orange County Board of Commissioners. (Bx. Lincoln Co.. model) (Goal IV-B)
Comment: Meetings were held regarding the Lincoln County Model, and the task force
deemed the development of a separate ordinance unnecessary.
Objective #111: Drawing on the contents of Senate Bill 10, implement county ordinances
that require truth in advertising for all long term caze services: adult day, hospitals, adult
care homes, nursing homes, home health agencies, hospice, etc. (Goal IV-B) (Reference
Senate Bill 10-Long Term Caze Safety Initiative-Special Care Disclosure Act section)
Comment: Senate Bill 10 reguired a Special Care I/nit Disclosure Act for all adult
care homes who advertise or put themselves out to be a Special Care Unit (Alzheimer's/
Dementia Care). The Disclosure Acl reguires specialized b°aining, specialized slaffng,
specialized activities, specialized care plans, etc.. The state Division of Facility Services
has allowed a loophole for, facilities, enabling them to be exempt, from the reguirements
of the Special Care Unit Disclosure Act if they don't "advertise "themselves as a special
care unit. Advocates contend that locking your doors constitutes 'putting yourself out to
be" a Special Care I/nit (SCII). Residents who are locked behind closed doors must
have a diagnose that supports a locked unit. This loophole must be closed Another
caveat is the cost,for specialized staffing. Staffing 1 stafffor every 8 residents, as
reguired in SCUs, is more expensive than staff ng 1 stafffor- every 20 residents, as
required in a typical adult care home setting. For this reason, very, few facilities
accepted Special Assistance (government assistance) for• residents residing in SCIIs.
Legislation was passed in 200.5 to increase the Special Assistance reimbursement rates
,for SCT1s.
Objective #112: Study the need for an increase in the number of Community Advisory
Committee members (grassroots ombudsmen) who visit adult care homes and nursing
homes to advocate for resident rights. (Goal IV••B)
Comment: Lack of staff.' Additional CAC members would require additional training
from the Long Term C"are Ombudsman program, which is already stretched thin.
V. BABY BOOMERS: THE FUTURE OLDER POPULATION
GOAL V-A: To develop programs and services for future older
persons (baby boomers) that promote personal responsibility for
their health and well being and utilize their skills and talents.
Accomplishments -None for Goal
Unmet Objectives
Objective #113: Plan and implement an annual pre-retirement educational workshop(s)
for Baby Boomers. (Goal V-A)
Comment: Lack .staff time and resources.
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Objective #114: Investigate and implement, if needed, a "senior jobs" program at the
senior centers or other appropriate location to promote or "semi- retirement", (Goal V-A)
Comment: _Lack stuff time and resources..
Objective #115: Expand opportunities for current Baby Boomers to utilize a variety of
wellness services in senior centers, offering evening and weekend programming. (Goat V-A)
Comment: Lack staff time and resources..
Objective #116: Study and implement creative ways to utilize the Baby Boomers as a
volunteer resource. (Goal V-A)
Comment_Lack staff'time and resources.
VI. PLANNING, ADMINISTRATION & COORDINATION
OF AGING SERVICES
GOAL VI-A: To improve the efficiency and effectiveness of Orange
County's administration and funding of aging services now and in the
future.
Accomplishments
Objective #117: Investigate the feasibility of dividing the responsibilities for Orange Public
Transportation and the I)epartrnent on Aging into two separate enfities. (Goal VI-A)
Accomplishment: The county transportation plan update in 2004 look at the, feasibility and
recommended that it remain under the Dept. on Aging until the r°egional transportation study
is completed in 2006..
Objective #118: Assist the Triangle United Way in its new issues identification, planning
and funding process with improved public-private service coordination, (Goal IV-A)
Accomplishment: In 2002 the Triangle United Way endorsed the M.A.P. process and
agreed to have, joint meetings of its Orange County Senior Issues Team have bi-monthly
meetings with the O.C, Advisory Board. It has continued to date,
ObiecHve #119: Provide administrative support to the new O C Long Term Care Roundtable.
(Goal VI-A)
Accomplishment: The Department on Aging Director has provided limited administrative
support to get the Roundtable operational, but additional staff support and resources is
needed to make it effective.
Objective #120: Review and revise the process, if necessary, by which Community Block
Grant Funding is allocated and administered to various programs within the county, Funding
allocation should be directly linked to priority issues, (Goal VI-A)
Accomplishment: Annual meetings held each spring between the OC Community Block
Grant Committee and the TJCOG Area Agency to review the block grant funding, The
Advisory Boazd on Aging also reviews the Committees recommendation and approves its
allocation before submitting it to the BOCC in May-June each yeaz.
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Objective #121: To establish anon-profit agency to operate the adult day health caze center
(Goal III-c3) and offer training and placement for certified nursing assistants (CNAs) and
personal care aides (PCAs) in a community-based and institutional setting, (Goal III-A -al )
Accomplishment: Carol Woods agreed in November 2001 to assist Orange County in
establishing a non profit agency, for, frail senior services. The County Attorney and BOCC
was consulted and completed the incorpot°ation process and began operation in July, 2004.
Objective #122: Design and develop Orange County Senior Centers to meet the state criteria
for Centers of Excellence" and recognized as "focal points" for aging services. (Goal VI-A)
Accomplishment: Orange ('ounty Senior Centers have met the state criteria, However,
funds were allocated [o apply, for National Accreditation that meets and surpasses the state
criteria for Centers of Excellence. The process will be completed in spring, 2006.
Unmet Objectives
Objective #123: Establish a formalized evaluation program to oversee the evaluation of
County Aging programs, and the state of older adults living in Orange County, (Goat VI-A)
Comment: Lack of staff time and resources.
Objective #124: Establish an Aging Services E & E Task Force to investigate ways to
improve the effectiveness and efficient delivery of all county government services to older
residents. (Goal VI-A)
Comment: Lack of'staff time and resources,
Objective #125: Study the feasibility of establishing a marketing program within the County
Dept. on Aging to oversee the promotion of all aging services. (Goal VI-A)
Comment: Lack of staff time and resources.
Objective #126: Monitor the progress of the Master Aging Plan by the Advisory Boazd on
Aging by making necessary annual revisions and priorities for the BOCC approval. The lead
agency for each M,A.P. objective will prepare asix-month progress report to the Advisory
Board on Aging indicating the funds spent and progress toward its objective to be shazed
with the BOCC, (Goal VI-A)
Comment: GVhile the Aging Board monitored the progress and priorities, there was not enough staff
time and resources to follow up with each lead agency, for all objectives,
Updated March 23, 2006
25
,9-~~,~~.+- 3 ~-S
Master Aging Plan Update -2006-10
Timeline- Proposed Meeting Dates
Thursday, Dec. 1, 2005 -Kickoff Mtg#1 -ALREADY HELD
Thursday, Feb. 2 - 8-10 am Full MAP Steering Committee Mtg #2
Focus: Review Goals/Accomplishments & unmet objectives
and identify issues.
Friday, Feb. 24 - 10-12 noon -MAP Leadership Team Mtg Only
(Co-chairs of all the committees and staff)
Focus: Progress Report on issues prioritization from subcommittees
before presentation to Steering Committee in March.
Thursday, Mar, 23 - 10-12 noon -Full MAP Steering Committee Mtg #3
Focus: Identify/prioritize issues including subcommittee presentations
Thursday, Apri120 8- 10 am - MAP Leadership Team Meeting Only
(Co-chairs of all the committees and staff)
Focus: Progress Report on development of subcommittee action plans
Thursday, May 11 - 10-12 noon - Fu11 MAP Steering Committee Mtg #4
Focus: Review draft Overall Action Plan for submission to BOCC
Tuesday, .Tune 13 - 7:30 p,m. (Hills.)- BOCC Meeting -Present Final Draft MAP
BOCC Approval Draft MAP for Public Input
Months of June, July and August devoted to Public Input meetings and
Town Council Presentations.
Tentative Dates:
Northside Senior Center - Friday, June 16 - 10-I 1 a.m.
Central Orange Senior Center- Wednesday, June 21 - 2-4 p.m.
Chapel Hill Senior Center -Thursday, June 22 - 2-4 p.m.
Other locations - ?
Town Council Presentation and Input
Town of Chapel Hill -Monday, June 26 - 7:.30 p.m. (Do not meet in July& August)
Town ofHillsborough -Monday, July 10 - 7:30 p.m (Do not meet in August)
Town of Mebane -Monday, August 7 - 6 p.m.
Town of Carrboro -Tuesday, August 15 or 22 - 7::30 p.m (Do not meet in July)
Thursday, August 24 -10-12 noon -Full MAP Steering Committee Mtg #5
Focus: Review Input from Public Meetings and Town Councils
and recommend final changes to the Plan for submission to BOCC
Tues.., Sept. 19 or Tues.., Oct. 3 - 7:30 p.m. (CH) - BOCC Meeting -Present Final MAP
Update for approval
M.A.P Well-Fit Subcomittee
Priority Issues Vote as March 7, 2006
-Home-based Community Services .................................................. ..15 votes
(For° Well Elders including au inci°ease in the number of retired healthcare
providers/volunteers and environmental modifications)
-Community Assessments /Outcome Evaluation ................................... ...8
(Including ties with Healthy Carolinians, tJNC-CI-I Hospitals,
Private Groups-Civic, Faith, etc.)
-Driver Safety ..............................................._............,,,.,...,...... ...6
(better alter°natives/ driver "friendly" education)
-Access to Affordable Healthcare ..................................................... ...5
(Including clinic for senior adults paid by Medicare & includes sliding fees)
-Greater Budget Appropriations for Aging Population ............................. ..5
-Job Training/Placement Service ...................................................... ..4
-Senior Center Expansion .............................................................. ...3
(Foundation for Community Caze Systems -including all community
venues throughout the county/ Awell-publicized and understood information
& assistance system that is county-wide)
-Food Security ........................................................................... ..3
(Quality and Quantity for Good Health/CJtilization of locally grown produce)
-Increase in Taxes ....................................................................... .3
(Need for Political advocacy for older adults/increases aze making hazder
for older adults to stay in their own homes.)
-Utilization of local universities to improve/create senior programs ..............3
-Accessibility/Affordability for Oral Health Care ...................................3
-Liveable Communities: Ownership by Government/Community ................2
(Communication Policies created/Senior Issues should be constantly
in the public-eye, Total community Awazeness of Senior Issues)
-Adult Education/Enrichment ..........................................................2
(Continuing Education- DTCC, DILR, Life-long Learning, Computer Access)
-Assistance with End of Life Issues ...................................................1
~-1
-Ombudsmen Office ....................................................................1
(Expansion of Eldercare services)
-Meals on Wheels Expansion ...........................................................1
-Buddy System/One-on-one with homebound ......................................1
-Create Greater Community Consciousness in Aging .............................0
-Walkability around Senior Centers andtowns .....................................0
-Holistic Health/Wellness ..............................................................0
The following are referred to appropriate sub-committee(s):
_Community Transportation ......................................................7
-County-wide Nursing Home .....................................................1
-Mental Health Needs not requiring hospitalization. , .... , „ .. ... .... ... . ... ..0
(substance abuse, griefing, depression, elder abuse, etc.)
2
~~
M.A.l'. ModeratelymImpaired Subcommittee
Voting on Brainstorming Issues, as of March 23, 2006
ISSITES
# of votes
1. LACK of MENTAL HEALTH TREATMENT .................. 15
2. ISOLATION ANI) LONELINESS ................................ 14
2. LACI{ OF CASE MANAGEMENT SERVICES .............. 14
3. LACK OF COLLABORATION WITH FAITH COMMiJNITES.... 9
4. IDEMENTIA ..................................................................... 7
5. Many at risk for abuse/self neglect ........................................ 6
6. Inadequate communication collaboration among county
agencies ................................................................ 5
6. Negative perception of SENIOR centers ........................... 5
7. Limited number of programs for caregiver relief ................ 4
7. Mental Health Stigma ................................................ 4
8. Assistance with financial matters ..................................... 3
8. Cultural sensitivity to OC community diversity ................... 3
8. How do we reach isolated seniors that need help, but are not
aware of/or are afraid of services? ................................. 3
8. Intergenerational programs ............................................ 3
8. Senior Friendly Communities .......................................... 3
9. End of life issues ........................................................... 2
9. Meals at home .............................................................. 2
10. Internet access very limited among seniors ......................... 1
11. Long-term care centers to provide services to community ...... 1
12. Rehab services (in-home) ............................................. 1
13. Shortcomings of Senior Centers ....................................... 1
14. Transitions/Decisions ................................................... i
The burden of too much stuff ............................................ 0
Men's issues .................................................................. 0
Substance abuse ............................................................. 0
/i C~
M.A.P. Institutional/Severely Impaired Subcommittee
Priority Issues Vote as of reb 23, 2006
1. Quality of Life and Care Issues (7 votes)
• Improve oversight
• Continuity of care
• Dental care
• Treated with dignity and respect
• End of Life/ Dementia Care
2. Caregiver support/ Worldorce Issues (7 votes)
• Recognition
• Recruitment/ Retention
• Staffing (Current req. inadequate to meet needs of residents)
• Retention
• Training (Scholarship, education)
• Support
• Pay, Benefits
• Careei° Ladder (Provide a professional culture for personnel,
including use of best practices)
• Leadership training/support for Administrators and nurses
• Foster Personnel Training and supei°vision
• UNC Medical Community Involvement and Combining resources,
including OCLTC Facility Roundtable
3. Education/Outreach-(7 votes)
• Families, family councils, resident councils
• Doctors re: apps°opriate placement of residents-not necessarily
facilities
• Address institutional bias?
4. Person-directed care- 5 votes
Questions: Combine #4 with #1?
Add mixed population issues in facilities to #1?
SO
MAP Severely Disabled /Institutionalized Older Adult Subcommittee
February 23, 2006
Revised Categories of Concern:
Care Issues:
1 End of Life Care (Hospice services)
2. Dementia Caz'e (bed availability)
3. Affordability (Eligibility and Financial Issues)
4. Navigating the LTC System; lmowledge of rights, rules, regulations
5. Institutional bias
6. Education. & Outreach (Family/Resident involvement in plan of care)
7 Caregiver Support (Respite Care, support of family and paid caregivers, education)
8. Quality of Life
9. Continuity of Care (Hospital to facility, Facility to hospital, facility to facility, witlrin
CCRCs)
10, OttalityofLife
I1.. Person Centered Cm-e
12. Activities
Workforce Issues:
1. Culture change is needed
2. Turnover
3. Inadequate CNA training, support, pay, benefits
4. Inadequate staffing requirements (Nursing Home and Adult Care Home rules)
5. Nurse ttairring and support
6 Med Techs giving meds in nursing homes beginning summer 2006
7. Orange County Long Texm. Care Facility Roundtable (communication among facilities
and community; must review structure)
8. UNC Medical Community's Involvement & Support of local facilities (Teaching facility,
need for medical directors, student placement....)
9. First Responder Training-sensitivity+provision of support to facilities
10. Activity Director Training
1 L Increase # of Adult Home Specialists who monitor Adult Care Homes?
12. Increase # of Community Advisory Committee members-grassroots volunteer
Ombudsmen (Nursing Home, Adult Caz'e Home)
13. Leadership tr°ainirzg and support, for• adrrzirzistrator•s and nurses
14, Cultural Competence (also important at end of life)
1 S. Best Practice Models
16. More Onzbudsmert
17. Affordable transportation, for employees (even on holidays)
Housing/Capacity Issues:
1. Institutional Bias
51
2. More options for placement of people with mental illness, including times of an acute
episode when commitment is not possible
3. a need for day hospital vs. day care
4 More options for acute care placement (not related to mental illness)
5. Do we have adequate beds for the aging Baby Boomer population? Review Certificate of
Need process? (F3ow does state determine how many beds aze allotted to a county? Does
the process look ahead 5 to 10 yeazs?)
Laws:
1. Adult Protective Services Laws/ Enforcement (plus education re: abuse, neglect and
exploitation)
2. Staffing rules in nursing homes and adult raze homes
3 Guardianship statutes
Transportation
1 Lack of resources and education
2. Could EMS workers provide additional service to long term care facilities?
~~~- 5 s a
Recommendation:
Engage all departments of Orange County Government in the process of improving the
infrastructure and services to meet the needs of moderately-impaired older residents
Background:
The problems facing the moderately-impaired older population in Orange County will
greatly increase over the next 20 years due to the projected population growth of
residents over age 60 and the number of older residents without local familylsocial
supports, adequate health insurance, or financial security..
Solutions:
The solutions are not just the responsibility of the Department on Aging, but all
departments of county government can help make the marketing campaign ring true -
"You'll be a fan for life". With all departments identifying long-term infrastructure and
services to address the needs of the aging population and orchestrating their efforts, we
can impact the future.. A process for engaging all departments should be
undertaken as part of the planning and budgeting process. The county staff are
familiar with potential opportunities to better serve older residents, particularly if they are
aware of the problems facing older population and the projected trends. The framework
and recommendations ofthe "Senior Friendly Communities" program, which addresses
a broad range of issues, may be a valuable resource to assist with this process.
Examples:
Some examples of potential actions to make long-term improvements for moderately-
impaired older residents include:
Planning -Monitor and map the location of the alder population (70+) as part of
planning process for roads, side walks, shopping, housing developments, etc..
Budget Office/Inspections -Consider new fees on building permits to encourage
homes to be built using "universal design principles" to help make housing more
accessible and livable to future residents. (e.g. Plans that met criteria for
universal design would have no additional fees levied.)
Economic Development -Provide support (advice, liability protection, incentives,
etc) for small business to provide a wide range of services needed by moderately-
impaired older residents from yard/chore to personal care and transportation
Public Works _ Review all new/modifications to county buildings to improve
accessibility (public transport routes & ramps), sound systems (for hearing
impaired), eta.
In addition to the departments listed above the functions of Human Services, Public
Safety, Culture and Recreation, Education, General Services, and Management all
need to be involved. With leadership from the Board of Commissioners, all functions of
government can identify innovative ways to improve the services to meet the needs of
growing moderately-impaired older population and then effectively implement and
communicate these services.
~ac~w~~
53
List of MAP Housing Issues to Consider for 2006-10
March 23, 2006
Drawing from the MAP Accomplishments and unmet Objectives from 2000-OS (see attached),
the following is a list of Housing Issues to consider for 2006-10 that are not in any priority order.
Also, there is space to write down additional issues,
1. Need to expansion of support services for 55+ Retirement Community in order for older
adults to age in place, (Example-#53 DOA- Manley Estates agreement)-,#59, #64
2. Lack of senior consumer education on the need to select and buy "Aging in Place" (AiP)
homes. #55
3. Need for a clear strategy to increase the number of available and affordable housing units
designed built for the needs of older persons, #56
4, Lack of a HUD 202 Senior Housing project (low income) for central/northern Orange
County. (No project exists in northern Orange)
5. Lack of incentives for architects and builders to construct homes that allow for easy
retrofitting for disabflities and "Aging in Place". #54
6. Need for tax relief for older adults who over time have difficulty paying their property tax on
their home. (Example- tax burden in Chapel HilUCarrboro who pay county tax plus a special
district school tax even though they don't have children in the system) #60, #63
7. Need to find reliable/honest service providers for home repairs/renovations and maintenance.
-#61
8. Need for a more walkable community and access to public transportation.
9. Need to assist older persons to age in their home with housekeeping, retrofit home, outside
repair, yard work, etc., especially those with low incomes. #62
10. _ __
11.
~~
List of MAP Transportation Issues to Consider for 2006-10
March 23, 2006
Drawing from the MAP Accomplishments and unmet Objectives from 2000-OS (see attached),
the following is a list of Transportation Issues to consider for 2006-10 that aze not in any priority
order. Also, there is space to write down additional issues.
1. Need to expansion the scope, available and hours of specialized senior transportation from
medical to other services. (Example-Currently outside CH Transit- OPT is limited to Medical
and one non-medical trip to per week, 8-5 pm)
2. Improve ways to identify what older persons want in transportation service such as needed
routes, hours, etc. #19
3. Need for an easier transportation service within and outside Orange County. #20
4. Need for more training of transit employees on the special needs of older adults,#21
5. Need to expand transportation to new senior centers from the rural areas not being served..
6. Need for shelters and benches at OPT pickup locations to encourage/help older adults to used
existing public bus routes. #23
7, Review ways to lower the cost for non-emergency non medical stretcher transport. # 18
8.
9.
10
55
List of MAP Information/Access Issues to Consider for 2006-10
March 23, 2006
* -Marketing
# -Item not accomplished /or partially in fast MAP
Below aze informative access issues that need fiu•ther attention. After discussion, a
vote will be taken to prioritize them to be included in the MAP.
1, How can the TV media be better used -such as the In Praise of Age show that
currently shown on the community access TV channel 8 every week? *#24
2. How can the The Senior Times be better used to get information to seniors?
3. How can the Internet be better utilized -including the list serve for the Chapel
Hill senior center?* #5,#6
4. How can specialized information, such as Seniors Health Insurance Information
Program (SHIIP) and Medicare Part D be better publicized and delivered?
5. What can be done to help people in retirement planning? #11.3
6, What can be done to help people access the job market, including part-time
jobs?*#114
7. What information and how it should be given to newcomers to the area?
8. Haw can we better promote the senior centers and the services they offer?
Transportation? RSVP (Retired Senior Volunteer Program)? Eldercaze? #14*
9, Haw can we perform a community awareness campaign of the DoA's services,
evaluating the effectiveness of various elements and recommend changes?
Survey?* #9
10.
11,
12.
13,
Transitional Care
Older frail elders, who suffer from a variety of health caze problems often need services
from a variety of sites and professionals.
During these transitions they are at risk for medication errors and not receiving right
services. This may precipitate a visit to the ER or a hospital stay where further errors may occur,
Upon leaving the hospital the elders may not understand how to manage their health care
conditions or who and when to call. Poorly managed transitions can lead to physical and
emotional stress for both the individual and their caregivers. During a transition, the individual's
preferences or personal goals my not be passed on to the next setting. This often results in the
important elements of the Care Plan "falling through the cracks."
Suggestions for the Patient and Caregiver:
- Keep a personal file of important health information and show to each new health
professional. Keep a list of your health conditions, names and Qhone numbers of your
healthcare professionals, medications you are taking, and any aller ies that you have.
- Take charge of your medications (both prescribed and over-the-counter) and know why
you take each one, how to take each one, and any possible side effects to watch for.
- Make sure you understand what services you will get at each new setting and how these
will benefit you. Let people know your preferences and ask that they are part of the
overall plan.
- Bring a friend of relative with you to act as an advocate.
- Before leaving each health care setting, make sure you have the name, telephone number,
or email of the professional you should contact if ,you have a problem, questions, or your
condition worsens.
- Before leaving each setting ask what type of follow-up care you will need and how this
will be scheduled..
- Knowing what Medicaze (and any other insurances you have) covers is a positive step
toward making sure future transitions go smoothly.
- Before leaving, aslc what type of follow-up care you will need and how it will be
scheduled.
The .Jolm A. Hartford Foundation defines the four pillars as:
1. Patient or caregiver lmowledge about medication and has a medication management
system..
2. Patient and/or caregiver understands and utilizes the Personal Health Record to facilitate
communication and ensure continuity of care across providers and settings. The PHR is
managed by the patient and/or caregiver,
3. Patient and/or caregiver schedules and completes follow-up visit with the primary care or
specialist physician and is an active participant in these interactions.
4. Patient and/or caregiver is laiowledgeable about indicators that suggest his or her
condition is worsening and how to respond.
S(~
www.carelransitions. orb
www.caregivina.ora
www.medicare.aov
s1
Life is transitional not static and beyond the formal transitions
within institutions, one moves to changes within the community.
Two areas that serve as one move fiom self care to dependent care
are (a) Protective services (b) Guardianship.
A sudden acute illness such as a major stroke followed by
depression and or dementia may trigger the need for guardianship.
If the burden of care giving (without adequate support) becomes
overwhelming because of dementia, protective services may be
needed.
These services may be needed for short or long term. Being
familiar with the services acrd how to access are crucial.
The statute concerning protective services was recently revisited
and updated. Hopefully, the guardianship statue will receive the
same scrutiny with a recently proposed bill in the legislature.
5~,
Transitions: what are the issues:
Relocation trauma and the adverse effects is well documented. and is a part of every
transition,
Issues in transitions can start with the well elderly moving to independent senior housing
and retirement communities
Transitions within a CCRC: when to transfer /when not, legal latitude - if you transfer
against resident desires it can be seen as a breach of resident rights; if you don't
transfer and something happens, can be sued for negligence: what's the solution?
Regulations cause us to deliver in silo style of service rather than seamless continuum -
very prescriptive on what we can and cannot deliver
Hospitals discharging medically complicated persons sooner, lack of appropriate follow-
up and lack of support services results in high probability of re-admission; there is
an absence of adequately finance Home and Community Based services to
respond to seniors after hospitalization. Many may no longer be acute but yet not
independent and many lank the informal support system necessary to heal.
Medicaze/Medicaid pay for medical intervention not prevention
Transfers are being made to the ER that might be avoided with better assessment
incentives
Hospice and palliative caze are not core competencies of hospitals
What national aspect(s) does AALISA needs to address:
1. Transitions within L,TC: are they resident centered - how to measure that
decisions are being made to assure a person in the least restrictive environment
getting the most appropriate level of service, while assuring safety, How does one
balance personal choice with cost and availability of staff? How can policy,
regulation, payment source and quality service come into alignment allowing
flexibility?
2.. In hospital settings, reimbursement pressures prompt discharge of patients sooner.
Complex peripheral needs make an immediate return home difficult (just the
physical task of securing transportation to get home can he difficult). In adequate
communication by caregivers [doctors, nurses, social workers, etc] at the point of
dischazge. The community services are fragmented particularly challenging for
elders who do not have advocates negotiating the maze. Receiving uncoordinated
Gaze places them at risk of medical error, adverse effect of pharmacology,
inability to physically get to follow-up visits, and other such complications can
result in costly re-admission to the hospital. Traditionally payment is only for
services within the medical model rather than addressing a less costly support
service model and more attention to discharge planning and transition
management
How are ER's being used? Using ER's as service respondents for those who are
recipients of inadequate assessments is a very costly option.. What aze the reasons
that elderly being transferred to ER? Gould better assessments, negotiated risk
agreements, and physician response decrease this costly (monetarily and
emotionally, sometimes physically) costly transition..
5~
Initial information that would be helpful to further define the issue:
1, Are there any predictable trends to hospital discharges (and possibly admissions)
Is there specific clustering around days of weel:
Z. Are there any statistics to elder use of ER's as it compares to percentage resulting
in admissions
3. Are there solid demonstration models that have solid assessment programs that
result in fewer transfers?
4. What can we leazn from the VA model, SHMO, PACE, Erikson, Evergreen
5. Are there projects that addressed the culture change that might prevent ER
transfers or hospital admissions that address the "don't die on my shift" syndrome
6 Are there projects that have incorporated the Denmazk, coordinated care within
(municipalities) towns or counties that work together to coordinate successful
models for transition
7. Is there a body of literature speaking to research that has been conducted which
might suggest models, e,g. Rosalie/Robert Kane, University of Minn.; other
Universities, International models in addition to those mentioned in #6?
I ~aWY~'N~ /
~~1
ORANGE COUNTY MASTER AGING PLAN UPDATE: 2006-IO (C9 C7
M.A.P. STEERING COMMITTEE MEETING #4 -- - '
APRIL 20, 2006
MINUTES
The M,A,P. Steering Committee held a meeting on Apri120, 2006 at the Homestead Community
Center on Homestead Road in Chapel Hill at 10:30 a.m,
PRESENT: The list of those present is attached to these minutes. The list includes members,
staff and visitors.
MEETING OBJECTIVE: Complete the agenda from March 2.3, 2006 with breakout groups on four key
areas to identify and prioritize issues
Florence Soltys welcomed everyone to the meeting.
1. Breakout GrOUAS on Four Key Areas to Identi and Prioritize Issues that affect alt older
adults and are not covered ~ subcommittees (60 minutes)
A, Housing -facilitator/resource -Jack Chestnut/Taza Fikes
B. Transportation -facilitator/resource - Al Terry/Jerry Passmore
C, Information/Access -facilitator/resource -Janice Tyler/I{atherine Leith
I). Community Transitional Care -facilitator/resource -Florence Soltys/Pat Sprigg
2. Reports from Breakout Groins on Priori Issues (30 minutes)
A. Approve priority issues for submission to BOCC for approval
HOUSING
• Possibility of affordable housing for seniors north and west of Hillsborough
• What is water supply? Sewer
• Idea of "rural villages with services"/Shaping the Future of Orange County (needs to be
explored further)
• Mecklenberg County's "Strategic Planning Report" (Senior Friendly Mecklenberg) -good
example of what can be done
• Property Tax breaks or deferments for elderly to age in place (Must be statewide)
• Lien onproperty -Heirs? Reverse Mortgages
• Medicaid/Medicaze dollar is shrinking
• Services need to be community~based
• Should senior housing developers provide on-site services?
• Need support services in newly-planned communities (especially in rural azeas)
• Lack of incentives by and for developers
• Need education/forums on how to "age in place" (need public support)
d• If "aging in place" services need to support this, plan for high concentration azeas
• Transportation is needed for elders in rural azeas who aze "aging in place"
• What does it take to "age in place"
• Need to identify volunteers/others in the community who aze able & willing to do repairs
on homes and to upgrade structures to accommodate increase in disability (churches, etc.)
• We da not have to reinvent the wheel. Let's see/look at what other communities have done
-draw from other success stories
• Regulations, covenants, zoning modified to help people age in place
Page l of 2
c~ i
TRANSPORTATION
• Expand OPT service level to equal to or better than Chapel HilUCarrboro E-Z Rider
• Expand Transportation to Senior Centers (hours of operation and expansion of clients)
• Review faze structure- route costs in order to serve all seniors
• Identify and seek new sources of funding to support expansion of transportation
• Consider combing E-Z Rider and OPT service
• Consider a separate Aging and Transportation Departments
INFORMATION/ACCESS
• Mazketing Campaign- (Increase and improve with funds)
^ Include a logo (rnlctg agency)
^ Secure funding for
• The Senior Times
o Brochures
• Items like pens, etc. for advertising
• New staff
• Website Information (Increase and improve)
• Help promote senior centers
• Include special items
• Make "In Praise of Age" a link
• Expand "In Praise of Age" -broadcast on local radio stations
• Expand Senior Times -list serve (one time a week)
Increase outreach information meetings (ex, community Roundtable- 4 times a year)
More specialized information access -volunteering and,job seeking
Newcomers -Increase information and figure out a way to identify newcomers to the
community
e Chamber
• Realtors
• Newcomers
• Visitors Bureau
• Sales offices and new developments
COMMUNITY TRANSITIONAL CARE (Plus 2 worksheets attached)
• Support creation of database (elderly health information)
• Support Development PACE Program (HMO for low income persons)
• Review and reinstitute "blue sheet" form from nursing home to hospital transition and
"pink sheet from hospital to nursing home transition
• Create two resources for dischazge planners
o Brochure for patiendcazegiver -suggestions for smooth transition
o Information Sheet for dischazge planners (where to fmd survey reports, etc.)
• Expand adult day health services -CAP program
• Implement specific recommendation from State Mental Health Reform (B/C mixed
population ER and Nursing Home) committee - "Senior Friendly" space in ER
• Long Term -explore expanding assessment and Gaze plam~ing using home setting (similar
to Hubbazd and Mobile SHAC)
3. Adiourument
The meeting was adjourned at 12:12 p.m, The next meeting is scheduled for May 11 at the
Southern Human Services Center from 10-12 noon.
Page 2 of 2