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HomeMy WebLinkAboutMINUTES - 03161999 - C65-C66 TO: BOARD OF SUPERVISORS s John Cullen, Director •-- � `�" Contra Social Service DepartmeA FROM: • .• Costa CountFebruary 24, 1999 / DATE: ry �arr�-�•u�,•• SUBJECT:APPROVE and AUTHORIZE the Social Service Director, or designee, to accept $80,492 from the Job Creation Investment Fund� gg�r�ant. APPROVE and AUTHORIZE the Social Service Director, or desi nee, to enter into contract with the Contra Costa Economic Partnership for payment of services up to0,492. SPECIFIC REOUEST(S)OR RECOMMENDATION(S)a BACKGROUND AND JUSTIFICATION RECOMMENDED ACTION: APPROVE and AUTHORIZE the Social Service Director or designee to accept $80,492 from the Job Creation Investment Fund grant, Application for the Job Creation Investment Fund grant was approved by the Board of Supervisors March 3, 1998 ,Q,PPROVE and AUTHORIZE the Social Service Director, or desi nee, to enter into contract with the Contra Costa Economic Partnership for payment of services up to 80,492 in the planning and implementation of a Job Creation Plan. FISCAL: No County cost. Funded by the Job Development Fund Grant from the Trade and Commerce Agency as part of the CalWORKS Program. CHILDREN'S IMPACT STATEMENT: The award will support Outcome #3, "Families that are Economically Self-Sufficient" by planning and implementing a county Job Creation Plan. Expected program outcomes are: expansion of the job market and the creation of opportunities for CalWORKS participants to obtain unsubsidized jobs. BACKGROUND: CalWORKS legislation, AB 1542, established the Job Creation Investment Fund and named the Trade and Commerce Agency as the lead State agenvy for the administration of the fund. Trade and Commerce is disbursing funds on a grant basis for planning and/or development of job creation strategies. Contra Costa County applied for and received grant funds totaling $80,492 for the development and implementation of a Job Creation Plan. A Job Creation Task Force was established by the Board of Supervisors with leadership from the Social Service Department and Economic Partnership in developing and implementing the plan. CONTINUED ON ATTACHMENT: SIGNATURE: 4_"0 RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER SIGNATURE S: a> ACTION OF BOARD ON �' f APPROVED AS RECOMMENDED OTHER VOTE OF SUPERVISORS P I HEREBY CERTIFY THAT THIS IS A TRUE UNANIMOUS(ABSENTS/ a:.. ) AND CORRECT COPY OF AN ACTION TAKEN AYES; NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: _ --- OF SUPERVISORS ON THE DATE SHOWN. Cc: Contact: Robert Hofrlann, 3-1593 ATTESTED SOCIAL SERVICE (COIN"iRACTS UNIT) Prase BATCHELOR,CLERK OF Tsar BOARD OF COUNTY ADMINISTRATOR §UPERVISCRS AND COUNTY ADMINISTRATOR AUDITOR-CONTIROLLER CON, CTOR ti M382 (10/88) BY `f DEPUTY TOe BOARD OF SUPERVISORS 6kk �A f T Contra. FROM: JOHN CULLEN, SOCIAL SERVICE DEPARTM NT DIRECTORCosta WILLIAM WALKER, M.D., HEALTH SERVICES DIRECTORCounty ,• BATE; February 18, 1999 SUBJECT: LONG TERM CARE PLANNING TASK FORCE SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION 1. Recommended Action: AUTHORIZE the Social Service Director and Health Services Director to jointly establish a Long Term Care Planning Task Force, in conjunction with the Ad Hoc Long Term Care Coordinating Committee, to prepare an administrative action plan under the auspices of the State of California Long Term Care Pilot Project legislation (AB 1040) to develop an integrated system of long term care in Contra Costa County for seniors and adults with disabilities; and AUTHORIZE the Social Service Director and Health Services Director to jointly submit an application to the California Department of Health Services, Office of Long Term Care for a planning grant in the amount of$50,000 to assist in initial efforts to design an integrated model of care and develop an appropriate implementation strategy. It. Financiallmpac# The cost of initial planning efforts will be provided from resources currently available in the FY 1998-99 budgets of the Social Service and Health Service Departments. The $50,000 planning grant will require a 20% match of$10,000 which we anticipate may be provided from in-kind resources already available within our departments. Ultimately, under the AB 1040 implementation model, funds would be shifted from existing categorical program areas in the budgets of our two departments to an integrated Long Term Care fund. This integrated fund would offer flexibility in the purchase of home care, community-based care and institutional care for covered individuals. CONTINUED ON ATTACHMENT: YES SIGNATURE: � a -RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE —OTHER t SIGNATURES: -" ACTION OF BOARD ON- ��f a s f =sem Zc� APPROVED AS RECOMMENDED OTHER VOTE OF SUPERVISORS -4—UNANIMOUS HEREBY CERTIFY THAT THIS IS A TRUE i, >t 3.� .MOUS(ABSENT '� ' ) AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: - OF SUPERVISORS ON THE DATE SHOWN. ATTESTED Contact: PHIL BATCHELOR,CLERK OF THE BOARD OF cc` SUPERVISORS AND COUNTY ADMINISTRATOR t BY ,DEPUTY CW, 40 lll. Background Under the sponsorship of the County Social Service Department and County Office on Aging, an ad hoc Long Term Care Coordinating Committee has been working over the last two years on issues relating to the development of a seamless system of care for seniors and adults with disabilities in Contra Costa County. This group (consisting of ten individuals representing consumers, public and private providers, and community activists) has researched best practices addressing long term care needs, assessed current local long term care services and unmet needs of county residents, and developed county-wide long term care planning strategies. The committee has identified the California Long Term Care Integration Pilot Project (AB 1040) as an effective road map toward a "seamless system" of long term care for Contra Costa County seniors and adults with disabilities. Long term care is defined as the provision of assistance through services at home, in the community, or in an institution (including medical care), on an intermittent or continuous basis, over a sustained period of time with the intention of improving persons' ability to live as independently as possible. The persons who are targeted for "long term care" are those whose capabilities to live independently are compromised by social, economic, attitudinal, physical, cognitive or mental impairments, irrespective of age. In 1995, California state legislation (AB 1040 was enacted to authorize the Long Term Care Integration Pilot Project (LTCIPP). This statute directed the Department of Health Services to work with counties to develop integrated systems of care for seniors and adults with disabilities. The Project's goals area • To provide a continuum of medical, social and supportive services that fosters independence and self-reliance, maintains individual dignity, and allows consumers of long term care services to remain an integral part of their families and communities d To encourage as much consumer self-direction as possible, given individual capacity and interest • To redirect long term care funds and to consolidate existing programs into a seamless continuum of services . AB 1040 is based upon a grass-roots" approach. Each county is responsible for designing its proposed system of care, taking into account the unique constellation of local resources and infrastructure, consumer characteristics and geographic considerations. The state will provide technical assistance in both planning and in identifying and developing necessary waivers for implementation. The driving forces behind the need for long term care integration area • a growing population of elderly and of adults with disabilities • inappropriate placement of a high number of residents in skilled nursing facilities • gaps and inefficiencies in the current service delivery system • fragmentation and unnecessary duplication of existing services. In order for a truly integrated system to be implemented, funds must be shifted from categorical programs to an integrated long term care fund which would allow for the provision of person directed, rather than program directed, services. This shifting of expenditures may create savings which could be used to expand current services or be expended on less traditional, but greatly needed services. Persons on Medi-Cal who currently have no options other than placement in a nursing facility could find a wide variety of home and community-based options available. Although full integration of medical, psychosocial, and supportive services is an ultimate goal, counties are being encouraged by the State to "phase-in"the implementation in manageable steps. This approach will permit the counties to gain experience incrementally in managing long term care services, The Directors of the Departments of Social Service and Health Services request authorization from the Board of Supervisors to create a Long Term Dare Planning Task Force. This Task Force would include up to twenty-seven (27) members appointed by the Directors of the Social Service and Health Services Departments, encompassing consumers, service providers, community advocates, health care professionals, county agencies, representatives of managed care organizations, hospitals, nursing facilities, housing facilities, businesses, and labor, The Health Services and the Social Service Departments would share a leadership role in this task force. The Task Force would develop an administrative action plan (as specified in AB 1040) including, but not limited to, the following elements: • Identify a cost effective model for service delivery in Contra Costa County. • Provide methods of cooperation, collaboration, and integration among public and private providers. • Define the target populations. • Identify all programs and funding sources that would be necessary within a local LTCIPP. • Identify needed program rules, changes and waivers and funding transfers between Federal, State and local programs necessary to support the local model. • Evaluate options for a governance structure which will manage any future LTCIPP. • Develop a schedule, work plan, and evaluation plan for the various phase-in implementation steps. The Task Force shall present its recommended plan to the Directors of the Social Service and Health Services Departments in approximately 18 months, with regularly scheduled interim reports. In December, 1998 the California Department of Health Services, Office of Long Term Care issued notification that it would soon release a Request for Application for grants to assist in the planning phase for Long Term Care Integration Pilot Projects. Grants will be awarded to individual counties for assistance with the initial planning phase in the amount of$50,000. Applicants will be required to demonstrate support from the County Board of Supervisors and that project planning provides for consumer involvement, It is anticipated that this Request for Applications will be released in the spring of 1999. Grantees will be required to provide a 20% match for this planning grant. Additional background information is attached in the form of the summary report and recommendations prepared by the ad hoc Long Term Care Coordinating Committee summarizing their work and findings under the title of A Seamless System with Consumer Choice. Contra Costa Lang-Term Care Coordinating Committee 2.530 Arnold Drive, Suite 300 Martinez, Ca. 9553 (925)313-1700 ON RMcAk INTEGRIATION,.N! T�+C `� R��+C'�' (AD .1��i�) porfand_�t. commen�lati0nS 7anuary 1999 4 EAMLMSISYS.T M- ons C1 ANT 3 rTE+ TI(► �'IT' P1T � a�r►ericl�t� s anRA ry i. Many people who currently reside in nursing facilities do not belong there. The reasons vary. Often, the person has no choice. The LTCCC is an ad-=hoc committee dedicated to creating choice through the development and support of high quality,consumer driven and coordinated, home-,community-and institutional - based long-term care systems within Contra Costa County. This report is the culmination of two years of committed teamwork which includes: • National research and exploration of the best practices of addressing long--terra care needs, • Assessment of the current local long-term care services and the unmet long-terra care needs of county residents, • Creation of a long-term care vision for Contra Costa County, • Development of county-wide long-term care planning strategies. The committee has identified the California Long-Term Care Integration Pilot Project(AP l 040)as an effective road map toward a Seamless System of Long-Term Care for Contra Costa County seniors and adults with disabilities. This report presents an overview of the committee's findings and recommendations. erte the `tiAuwng Cup► : L "hat is meant on -Term!,CA . t s the Long-Term Care Ince tt of�U �t 3. 'Is Contra Costa bounty positioned to develop nd, uaetg- ` rrna Lntegration 'ilot Project? 4. Who wouldbeti tv6dby,a ung-T nIC a re IR gr on l i lot�'roje t`1 5. ''lrVhat arethe driving forces behind the reed for hg;Tera ire 146 refion? 6. What are the fiscal implications of a Long-Term Care Integrated System? ?, What are the recommendations of the Laing-Tern. Care Coordinating Committee? 1 Contra Costa Long-Term Care Coordinating Committe ROSTER Joanne Best Sharon Johnson Independent Living Resource Department of Social Services 3200 Clayton Road 2530 Arnold Drive, Suite 300 Concord, Ca. 94519 Martinez, Ca. 94553 (925) 363-7293 (925) 313-1711 Deborah Card Bill Liskam CCC Home Health Agency Paratransit Coordinating Council 597 Center Avenue, #380 19 olive Avenue Martinez, Ca. 94553 San Rafael, Ca. 94901 (925) 313-6151 (925) 939--9722 Dorothy Clinton Ilene 'Lubkin Consumer Advisory Council on Aging 2400 Nevin Avenue, #323 2893 Ptarmigan Drive, #1 Richmond, Ca. 94801 Walnut Creek, Ca. 94595 (510) 236-7122 (925) 935-8687 Kathleen Dorosz John Metzler Elder Abuse Prevention Consumer 1015 Nevin Ave. #102 3200 Clayton Road Richmond, Ca. 94801 Concord, Ca. 94519 (510) 233-3427 (925) 363-7293 A.C.Hollister, M.D Trudi Riley Committee Chair Community Advocate Advisory Council on Aging - Consumer 47 Rick Court 14 Boies Court Moraga, Ca. 94556 Pleasant Hili, Ca. 94523 (925) 284-2868 (925) 944-1872 Committee Facilitator Rath Goodin 3211 Afountaire Drive Antioch, Ca. 94509 (925) 753-1494 January 1999 � �" . M :iLill Y1, -f Ung-Term Care is the provision of assistance through services which are home-,community-, and institutional-based(including medical care),on an intermittent or continuous basis,over a sustained period of time.The persons who are targeted for"Long-`Perm Care"are those whose capabilities to live independently are compromised by social,economic,attitudinal,physical, cognitive or mental impairments,irrespective of age. SmVtlliY1i i !I d Y 4Y.!f 4 ill ip i t,L.`W1 J.G i sir, 4 M1 -J y i t ,f /fir} �y C�p� t 9 ! ; �,'Ii`CI l�Y i r �' 1(iW' � �j`i i7'—yam } Y *"F i'n liq I5!4 - ..Y '''' IJ.,,i�. ^.!_.JCt;'�. :_!'..i �.. ,.�......... i�N,. ":i: Gi,�lll� Nl�ii4-:��- ' _ '!R� dmill.ijw,lptii iiilhifi<<<ku lh�L.�in,r,.:.,.� In 1995,California State Legislation(AB 1040)was enacted to authorize The Long-Term Care Integration Pilot Project(INCIPP). This statute directed the Department of Health Services to work with counties to develop integrated systems of care for seniors and adults with disabilities. (See Appendix I for an overview of AB 1040) The Project's goals are. • To provide a continuum of medical,social and supportive services that fosters independence and self-reliance,maintains individual dignity,and allows consumers of long-term care services to remain an integral part of their families and communities • To encourage as much consumer self-direction as possible,given individual capacity and interest • To redirect long-terra care funds and to consolidate existing programs into a seamless continuum of services AB 1040 is based upon a"grass-roots"approach. Each county is responsible for designing its proposed system of care,taking into account the unique constellation of local resources and infrastructure,consumer characteristics and geographic considerations. The state will provide technical assistance in bath planning and in identifying and developing necessary waivers for implementation. 2 3. Js:'c6utra,COA4c it Positioned toD.,vele d �►0 est Loin `erm dare I tegration F''lr e t' . Contra Costa County is strongly positioned to develop and augment an AB IM Long-Term Care Integration Pitot Project. • Contra Costa County Health Services Department,referred to by policy makers as a model system for health care reform,offers a vast array of health services for the elderly and for disabled adults. (See Appendix 2) • The Office of Aging and Adult Services(OAAS),of the Contra Costa County Social Service Department,is increasing its current myriad of home and community based services with the addition of a Multi-purpose Senior Services Program(MSSP), Linkages and an expansion of Adult Protective Services. • The OAAS is redesigning its structure toward a coordinated system of Home and Community Based and Long-Term Care Services via a centralized in-tape system. • The Contra.Costa County Health Plan(a division of the Health Services Department)and the OAAS have recently been awarded a planning grant from the California Health Care Foundation to collaboratively foster the development of a cost effective model for a Medicare managed care system which will integrate acute,long-term,home and community-based and institutional care services. (See Appendix 3) • The OAAS operates a state-of-the-art Information and Assistance referral service for seniors. • As the result of eight years of grass roots advocacy,the Board of Supervisors has approved an In-Home Supportive Services Public Authority;and an implementation team is currently developing this Public Authority. • A strong network of regional and county-wide advocates;home and community based services for the elderly and disabled adults as well as consumers,exists within the county. • The Long Term Care Coordinating Committee,with membership representing consumers, providers, and community advocates has been working toward a vision for long-term care integration for the last two years. (See Appendix 4) 3 ld s .E,71 ir}: R►i,v i � y ' t SAF a nS i` 1 � i The target population for the long-term vision of this pilot program includes persons 18 years of age and older requiring long-term care whose capabilities to live independently are compromised by social,economic,attitudinal,physical,cognitive or mental impairments. Initially,the Pilot Project would most likely serve those most severely affected including those individuals who are IviediCal eligible and require assistance with activities of daily living(ADI..S). • The greatest number of recipients of long-term care are older adults because this population has a higher prevalence of chronic illness.As can be seen from the table below,the number of persons 65+in Contra Costa is projected to rise dramatically. Year 2000 Year 2010 Year 2020 Total Population 971,262 1,0196,253 1,212,788 Persons 65+ 123,974 (12.7%) 166,375 (15.2%) 236,466 (19.5%) Persons 75+ 58,732(6%) 75,752 (6.9%`0) 1011,524 (8.3%) Person 85+ 15,759 (1.6%'0) 24,446 (2,2%) 307,435 (2.5%b) State a,f California,Department of Finance, Official State Projections, 199 • Although specific data regarding the disabled population in Contra Costa is not available it is known that approximately 1 in 5 Americans have some type of disability,and 1 in 101 have a severe disability. U.S.Bureau o,f the Census, 1997 An individual with a disability is a person who. Has a physical or mental impairment that substantially limits one or more"major life activities", Has a record of such in impairment,or => 1s regarded as having such an impairment. The Americans with Lhsabilities Act, 1992 • The State Department of Health is currently working on data analysis which will give a clear picture of MediCal enrollees in Contra Costa and their current use of long-term care services, ***The figures in this chart reflect gross data. This data is being further researched for snore specific information regarding income level,ethnicity,location within county,and household size. 4 VYhat a � the 1riv ng; F�►�rc+� .. in + e l � -" t rc, tj te „A + r r inr Population of Elder_ and Adults wl Disa�iil�ties • Due to the increasing size of Contra Costa's elderly and disabled population,the demand for long-term care will continue to grow. b A _High Number of Residents in Nursing ,Facilities are Ina r r' lel Placed • Many consumers cannot afford the cost of alternative living facilities and MediCal will not pay for room and'board except in a nursing facility setting. • Many isolated consumers are unable to navigate the service system which could assist them in living more independently because it is currently fragmented and uncoordinated. c)Cio_psand In ,ficiencies in the Current Service Delivery S ystem • The Contra Costa Area Agency on Aging Four Year Area Plan(1997-2001)has identified the following gaps in services for seniors: Accessible transportation Health related issues and medical care =a Affordable and accessible housing Adequate finances Communication about,and access to,services and support In-home care and support services Isolation and loneliness Proper nutrition Long-term care needs Protection from crime • In addition,consumers currently receiving long-term care services in Contra Costa County have identified the following issues: A Lack of overall management,coordination,or integration of services ==t- Geographic and cultural constraints within the county,as well as ethnic-related barriers The lack of access to home modifications and an inability to obtain adequate housing =t> Inability to get adequate transportation to medical and other necessary appointments Unnecessary emergency room visits Anxiety and depression 5 d) Fragmentation and Unnecessary Duplication • Uncoordinated and redundant eligibility standards and requirements of programs set by a myriad of local,state,and federal agencies limit the ability of these programs to provide the most appropriate services to the target populations. Many consumers who have no one to assist them find it impossible to negotiate this fragmented system which has duplication of: Screening Eligibility => Assessment Case 1 care management functions Paperwork Documentation Management information systems The eligibility requirements and application process to receive a meal at home differs from those to get a ride to a medical appointment;or getting in--home supportive services differs from getting visits from a nurse. Such redundancy leads to frustration for consumers,the inability to provide a seamless continuum of services, unnecessary administrative work for service providers,and excessive financial costs for management. 6, ' the `Isc a ��» v i -'Ter The I.TCIPP initiative is driven more by the desire to improve quality-of-life than to reduce expenditures for long-term care services. • In order for a truly integrated system to be implemented,funds must be shifted from categorical programs to an integrated long-term fund which would allow for the provision of person directed, rather than program directed, services.This shifting of expenditures may create savings which could be used to expand current services or be expended on less traditional, but greatly needed services. Persons on MediCal who currently have no options other than placement in a nursing facility could find a wide variety of home and community-based options available. • In addition to providing more consumer choices,the shifting of funds from categorical programs to an integrated system would also reduce the redundancies in program administration, assessments and record keeping. 6 The State's commitment to LTCIPP is multifaceted. The Department of Health Services Office of Long-Term Care is working at the state level to facilitate a simplified intake 1 assessment process and reporting system. In addition,the ice of Long- Term Care will work toward making the necessary departmental and state budget changes to create consolidated funding pools for participating counties and to develop modified site monitoring requirements. The State will also assist participating counties in identifying appropriate federal waivers and obtaining those waivers. • To assist the county in understanding the potential budget and financial base for an integrated system,the State is researching,linking and analyzing data regarding current MediCal,Dome-,and community-based and nursing facility usage,and expenditures within Contra Costa County. Medicare data will eventually be added to this research. This information will assist in determining the size and the characteristics of the potential integration"target population",this group's health and long-term care service utilization,and the associated service costs. • It is important to note that although full integration of medical, psychosocial,and supportive services is an ultimate goal,counties are being encouraged by the State to "phase-in"the implementation in manageable steps. This approach will permit the county to gain experience incrementally in managing long-term care services. A "phase-in"strategy is necessary given the staffing,administration,and system changes involved. Waivers exist which complement this phase-in approach. An example is the Freedom of Choice Waiver which allows counties to approve or disapprove services. The State would pay the county for assuming these administrative duties while the state continues to pay the benefits,alleviating county risk. This waiver gives the county the opportunity to develop expertise and infrastructure for providing a seamless system. Other waivers,allowing for an integrated system,could follow. . hn hire the! o�mt'�i�nt irlon' n C nr Inatiog Cowmi t e? The ad-hoc Long Term Care Coordinating,Committee has been working over the last two years on issues relating to the development of a seamless system of care for seniors and adults with disabilities in Contra Costa County. This group consists of ten individuals representing consumers, public and private providers,and community activists. 7 The Long-'Term Care Committee is requesting the Board of Supervisors to accept this report and the following recommendations. . Endorse the Creation o a on -Term are 1 nein �k Force hat Quid a tart o T e ire rs of the oval Ser 'ce an the Health Services Departments This Task Force would include up to twenty-seven(27)members appointed by the Directors of the Social Service and Health Services Departments,to include consumers, service providers,community advocates,health care professionals, county agencies, representatives of managed care organizations,hospitals,nursing facilities, housing facilities,businesses,and labor. The Health Services and the Social Service Departments would share a leadership roll in this task force.(See Appendix S for recommended governance structure of the Planning Task Force.) The Task Force would develop an administrative action plan(as specified in AB 11340) including,but not limited to,the following: • Provide methods of cooperation,collaboration,and integration among public and private providers. • Identify a cost effective model for service delivery that enhances consumer choice and maintains consumer quality-of-life. • Define the target populations. • Identify all programs and funding sources that could be integrated into the LTCIPP. • Evaluate options for a governance structure which will: =� negotiate appropriate waivers and budgets investigate and evaluate potential financial risk => provide oversight and accountability for the LTCIPP. • Develop a schedule,work plan,and evaluation pian for the various phase-in implementation steps. 2. Time Line The Task Force shall present its recommended plan to the Directors of the Social Service and Health Services Departments in approximately 18 months,with regularly scheduled interim reports. 3. Fixture Role of the Task Force The Task Force may be terminated after the plan is presented,acted upon by the Directors of the Social Service and Health Services Departments,and the Board of Supervisors,and implementation has begun. This beady may transition into an alternative role as a steering committee or advisory group. 8 APPENDIX I Overview of AB 1040 California Long-Term Care Integration Pilot Program California Long Term Care Integration Pilot • # gram Background In 1995,California state legislation What Makes This Pilot Unique-Califomia Is was enacted to authorize and implement the certainly not alone In undertaking this type of Long Term Care Integration (LTCI) Pilot effort to Irftrate the delivery of its medical, Pmoram.The statute direr they Department of social and supportive services to Medicaid He@th Services (DHS)to select tip to five pilot (Medl-C al In Califbmia) recipients. Arizona. sites to participate In LTCI. Minnesota,Wisconsin,and Colorado are among the states that already have or are lir the process The progmm's goals are; of Implementing such programs. Wham sets Cai"rl`ornia3 apart Is.that their process,as specified ♦ Provide a continuum of medical, social and In the authorizing legislation, Is based on a supportive services that fosters "grassroots up' approach. Independence and self-reliance, maintains Individual dignity, and allows consumers of Interested countle►s, rather than ate publicly funded long term care(LTC)services govemment,are responsible for designing their to remain an integral part.of their family and proposed sYstpm of care,taping Into account the community life; unique constellation of local 'resources and Infrastructure, consumer characteristics and + Encourage ars much consumer self-direction geographic consider-ations. The Impetus for as possible, given Individual capacity and CaiifomlVs program has also been fowsed on Interest, and involve them and their family Improving the current LTC system rather than members as partners in developing and cost cravings, although the }pilots are required to implementing the pilot project; and be budget neutral. t Test a variety of models Intended to serve Starts and County Implementation Rales different geographical areas, with differing populations and servloa available. Given the °graSsroatts upx approach of this California program,the relationship between the The legislation defined the pilot sites as single state and counties in Implementing this program county, multi-aunty, or subcou tty traits. must be a partnership. Interested counties must Participating sites would be required to Identify a develop a proposal detailing the program's local entity(elther a govemment or not-for-profit governance structure, service package and agency) that would administer this program delivery system, trek sharing arrangements with through a contract with the State. subcontractors, data reporting, and quality assurance mechanisms. unties are required By In ting the delivery system for medical, to demonstrate that the proposal Is a Wil,and supportive services,consolidating the collaboration that Includes the local health and funding for these services, and adopting a social services agencies and consumer Input. If capitated payment system, the pilot program selected to participate, counties will be required seeks to empower counties to build a system out to submit a detailed-administrative action plain of the,currently fragmented public services laying out their Implementation steps and available, to overcome the buiit4n cost shlfting timellnes. Incentives in the current payment structures,and -ire state's role Is mutttfaceted. It Includes group to provide services !n the most appropriate and Individualized technical' assistance to the setting and most cost effective manner. counties as they aro working through developmental Issues. It Involves substantial APPENDIX 2 Services in the Health Services Department for Seniors and Adult Disabled Persons APPENDIX 2 m 5C ° u E is s CL rs m v a N Y � LEL ts` U 87 S C ami ds I, m d1S t � £3. L`d Qt! to m w c m C m CL d r O :2 d ' C m C- C7 o d d ani C W.. c ' w cit z a m _ N fl N !BZ d ra C fLj S � m � CS .r+ C Gi pg � c 03 NO G u m � N C m n C9 0 ro L Y.+ APPENDIX 3 Overview of Planning Grant from the California healthcare Foundation APPENDIX 3 c CL °> m C% L CL err •y +ten � !`� ,� +�� �t� +�'�„" •C � vim. a.+ t,h � L u • 'L'Y ..—. Etj tJ to 4J CJ Cl v► �'' wc vtLi tj to w CSU CJ to V ! E .,.. E � E t51 H ..� fG tC .� tA th m ICA t� Gi Ci Cl. . ♦.+ i-u E 44 lu • O C? ' tri w M M til13 tJ tt1 -z E ' + CL i .m. W E C w £3 CL *�- •�S C7 C2. -' .. tl bA CL h 'moi Gt. «... fir (f'+ yr YAR LJ'gwsF �ltta/ e l3 C�1 C� v''` WtA � «� rQj tLi CJ th to off+ L.. d Qw LLt t!� tla � vs cSi m 7- L.L CL 44 tj 4.0 tCi t! 13_ r • • 6 Z Lu LLJti �- *15 � V to 411 c a. E 40o V n E c� is � L en �' to m cn . 72 Jo- � a 10 i i cn +r� Lu C.3 APPENDIX 4 OverviewLong-Term Coordinating Committee APPENDIX 4 L -TE tM ___ CJS D T DMMI'T'TEE The Long-Term Care Coordinating Committee is an Ad-Hoe Committee which is committed to the development and support of coordinated and high quality,home,community and'institutional based long-term care systems within Contra Mosta County. Principles which underlie this commitment are: • prevention of inappropriate and premature institutionalization • provision for consumer choice and self-determination • provision of flexibility to respond to the needs of individuals,their families and caregivers • provision of consistent policies with local,state and federal organizations The purpose of the Ad-Hoc Long Term Care Coordinating Committee is to develop and implement a Long-Tenn Care System in Centra Costa County.This free-standing committee will: Compile information on Long Term Care. Identity Long-Terns Care needs Analyze existing Long-Term Care services and structures Develop a Long Term Care Vision Develop a Long-Terra Cane Strategic flan which will include,but not be limited to: a) dialogue with the community to: * seek input • inform b) research resources leadership needed to develop and implement a Lang-Term Care plan and demonstration pilot project c) provide advocacy for services and resources for individuals and for the community's Long- Term.Care needs d) work with Federal, State and Local representatives and groups Representation on this Ad-hoc Committee is comprised of representatives from the Social Service Departments,the Health Services Department,the Advisory Council on Aging,the County Transportation Commission. Community Based.Organizations. Community Advocates,and Consumers. Meeting facilitation is provided by the Social Service Department. APPENDIX 5 Recommended Outcomnes, Objectives, and Governance for the Long-Term Care Planning Task Force APPENDIX S OUTCOMES, OBJECTIVES AND GOVERNANCE OF THE CONTRA COSTA COUNTY LONG-TERM CARE PLANNING TASTE FORCE as Recommended by the Long-Term Care Coordinating Committee January 1999 OUTCOMES AND OBJECTIVES • The Task Farce shall develop an administrative action plan as specified in AB 1040 that does the following: 0 Provides methods of cooperation and collaboration among public and private providers. 4 Identifies a model for service delivery that enhances consumer choice and maintains consumer quality-of-life. Q Presents a mechanism for shifting financial resources to appropriate cost-effective services and encouraging home-based and community-based programs 0 Obtains waivers needed to obtain and coordinate services. • The Task Force shall present its recommended plan to the Directors of the Social Service and Health Services Departments. • The Task Force will be terminated after the plan is presented,acted upon by the Directors of the Social Service and.Health Services Departments and.the Board of Supervisors,and implementation has begun. This body may transition into an alternative role as a steering committee or advisory group. GOVERNANCE • The Directors of the social Service and Health services Departments shall create a Long Term Care Pilot Project Task Force to develop a comprehensive long terra care plan based on the requirements of the State's Long Terra Care Integration Pilot Program(AB1040). The Task Force shall be a public and private partnership that receives operating money from the Social Services and Health Services Departments,as well as from private funds. • The Social Services and.the Health Services Departments shalt share the leadership role for this Task Force. • Each member of the Task Force shall have an equal role in the decision making process. • A quorum for decision making shall be determined. • Standing subcommittees(Design Tums)of the Task Farce shall include: Scope of Services, Consumer Issues,Resource Allocation and Financing,Housing,Transportation,and Integration and Service Delivery. • These subcommittees are to be chaired by members of the Task Force who are selected by the Task Force. Each Design Team will include members from the community. • Ad hoc committees,can be appointed by the Task Force to take care of short term issues • The Task Force will have regular monthly meeting.The Resign teams are to meet monthly and report to the Task Farce. • The Task Force shall be governed by operating principles such as ground rules,decision making procedures,meeting formats,and so forth. • The Task Force shall have an EXECUTIVE COMMITTEE that consists of two cochairs, a vice-chair,a secretary,and a treasurer drawn from members of the Task Farce,and the chairpersons of each standing subcommittee.This committee shall meet as necessary between scheduled regular meetings of the Task.Force.' Needed action shall be taken by the Task Force and not by this committee. • The Task Force shall be staffed by a contractor selected by Lo be determined.