Event ID: 1399669
Event Started: 8/26/2009 2:48:39 PM ET
Please stand by for real-time captioning.
today we are in listen-only mode, but when our presenter, Suzanne Crisp prompts you, you can [indiscernible] your hand will be raised and Sharon Finney will know you want to ask a question and will select you in the order your question is asked, and you can ask the question when prompted.
Our presenter today is Suzanne Crisp. Suzanne is knowledgeable in home and community-based services. She is with the Boston College national resource center for participant-directed services, where she's the director of program planning.
Suzanne has a long history with home and community services, having created one of the first [indiscernible] counseling service directed programs several years ago in Arkansas.
Today our webcast is sponsored by the federal Department of Education, rehabilitation services administration. No endorsement from the Department of Education should be inferred from the comments or materials presented today.
You have received an announcement for this webcast or teleconference, and in that announcement there is a link to a resource page and you may, if you wish, download copies, and print the materials for this presentation, and go to ILRU.org, go to the calendar, and a link to the presentation page. Those slides are optional and you will still get a great deal out of the presentation without the slides, but you may wish to do that, if you care to.
So, again, our presenter is Suzanne Crisp, our moderator, Sharon Finney, and I am Richard Petty. You can press star 1 and you will be called on in the order you ask your question.
Let's begin with our presentation today. Suzanne?
Suzanne Crisp: Thank you so much for asking me to come. I feel like I have a kindred spirit with you sometimes than my aging counterparts, always refreshing to be here. We are going to talk today about potential opportunities for independent living centers in a variety of modes. A, in the form of information sharing; B, so you can be better serving individuals with disabilities, with information and guidance about receiving services; and also, as we go through this presentation I would like us to look at ways that we think independent living centers might grasp the opportunity for active participation, either in the form of direct of service provider or funding source or valuable resource. I hope you all have made copies of the slides, however I will go through each one of them, so it's not necessary. I will refer to the page numbers, though, if you want to follow along then.
So let's go to slide number two and talk about what we're going to review today.
First, I want to give you an update on money follows the person program. A little about that, the advances and challenges that state and programs are facing. Secondly, after that period of time we have about four or five slides, then an open Question and Answer period then for Money Follows the Person.
The second thing I want to talk about is the administration on aging's new community living program, and how that can inform us as far as what's happening to support home and community-based services. I saved the best for last, the veterans administration, last year started on a new veterans' directed home and community based service program. I believe there could be substant yell subopportunity substantial opportunity here.
Doing research for are this presentation I read something, it struck me. I didn't realize Money Follows the Person is the largest federally mandated program in the history of Medicaid. That shows the importance and critical nature of our activity in Money Follows the Person. To receive such a high designation and recognition from the federal government and Congress.
I think this is a direct result of Olmstead and the work you have been doing. This slide shows it is a major -- in the deficit reduction, the intent is to allow individuals living in nursing facilities and other institutions to return to the community. One of the stipulations of Money Follows the Person, viewed as a positive and negative theme, a person has to be in a institution or facility for at least six months. To return those individuals to community.
There are 31 states that participate. I would like to bring up the fact that those few states that don't participate with money follows the person, probably do have a transition program under Medicaid, either waiver or state plan, so there is some activity. If you are one of the state don't know the have money follows the person, doesn't mean you are stagnant on this issue. The program lasts five years, will end in 2011, and in 2012, Math mat cay, evaluating the program, will issue a report to Congress then. We will talk more about that in a minute.
On slide three let's review who will transition out. Originally the program was going to transition over 38,000 people. That's been revised down due to a number of reasoning. We will talk to that when we get to the slide on challenges.
The slide of Illinois, almost 3500 people to a low of 100 people in Delaware. As the slide shows, the break down is, the majority of the target population who will transition will be 65 years of age or older. You Younger persons disabilities will be twenty six% of the population. 20% will be individuals with intellectual or developmental disabilities. About 4% will be individuals with mental illness, and 3% will be those dually diagnosed.
Let's look at the expectations. What do we hope to gain from this rather expansive high-profile demonstration? One of the major outcomes we all anticipate is do we have enough information, enough positive data in order to go to Congress and say we need to change our law, make sure that, particularly Medicaid waivers do not have nursing facility services and institutionalization as a mandatory service and not home and community-based services. We want to make sure there is at least a level playing field, if not more attention and funding paid to community-based services. We will also gather information to present to Congress, saying we want you to mandate Medicaid programs rebalance their budgets. By that we mean we want to spend at least as much on home and community-based services than institutions. We want that to be a mandate from Congress.
There's a strong direction on consumer participation, and by that we mean not only individually, people are given the opportunity to participate in the planning and management and evaluation of their services, but also we want to see people with disabilities who are participants actually impact program design. In other words, we want people to sit at the table, people who receive services to actually sit at the table and help make decisions.
We also see with Money Follows the Important centers for Medicare and Medicaid services applied more strict standards. A system-wide backup, an individual doesn't show, by that worker not showing would jeopardize the health and welfare of the individual, then the state has to make sure there is a backup available then. Those are some of the expectations.
On slide six, additional expectations. Mathmatcay policy institute will evaluate the program, collecting data, conducting interviews, looking in detail at how operations are working in each of the 31 states. While their final report won't be out until 2012, about every six months they do publish an update and I will be -- their last published update was June of '09, and I will be happy to send that out to Richard and Sharon, they can send that to you, but you can see what math mat cay is saying about the program now.
They want to redefine the home setting. We know some of the specifics can be misread if we include assisted living or group homes. Many advocates feel that is not a true home-based setting. Money Follows the Person wants to help inform CMS on how to define a true home-based setting.
Let's look at lessons learned on slide seven. We know states with previous experiences are farther along than states who are just now looking at transition programs.
CMS has, in the applications, have identified three broad groups of grantees. Those that had substantial infrastructure, already were transitioning individuals; the second group are states that were starting to transition individuals, and the third group are states that had nothing going on at all and Money Follows the Person will be the most recent initiative then.
We know states, and I apologize, I am in a room where there are dogs next door -- I hope you don't hear those dogs. We know that two of the most common services that Money Follows the person has revealed has been transition coordination and first-time expenses with moves. One problem we are seeing is that sometimes states have developed particular services and they haven't had the provider-base in order to make the services happen. In some cases where the states did not have transition services in place it was difficult for states to convene the necessary provider groups.
We also know housing has been probably the major challenge of Mon follows person. We have communication, task force with public housing and web-based housing registries have been of help.
There has been -- I don't know if you have seen it -- I can send you a copy, but June 2, the Secretary for the U.S. Department of Housing and urban development, HUD, sent a letter to the public housing authorities, asked them to please be aware of Money Follows the Person, encourage them to set aside slots for individuals specific to Money Follows the Person. Correspondence included questions about [indiscernible] and language that public housing authorities can use in order to dedicate slots to Money Follows the Person too. That's something I can send to you.
We should have enrolled as of December, 4000 people; but only enrolled 1500. The most recent enrollees are as of April '09, up to 2400 people we found that states are moving slow for a number of reasons. Economic conditions out there, as we know, not pretty and states are really having to grapple with budget crises, hiring freezes, layoffs, things like that.
Another thing that has slowed the development of Money Follows the Person is the criteria mentioned. States have found they would like to work with people who had been in a nursing home, but federal, enhanced match is only available for individuals if they have been in an institution for at least six months.
More lessons learned. I think we all remember a few years ago there was a flurry of real choice system change grants, states making application, and receiving grants for various things. I don't know if CMS really put expectations on all that grant funding, so a lot of people applied for money follows the person thinking oh, this is one more funding source we can use to infuse money into the system. They found states were being held to a higher standard than -- sometimes that surprised state administrators. A few, not many, but a few waivers are using -- have waiting lists. In order for people to come out of institutions they have to not only say they want to come out and go through the test of transitioning, but wait for an available slot. We have seen that as a delay.
Certainly, and this early on we saw resistance from the provider community, facilities saying no, you can't come in, don't want you here, can't talk to individuals here. Most states are working those out through interventions such as high-level meetings and what not.
On slide nine we have Question and Answers. One thing I have you might be interested in, glad to send it to you, there's a list as of April of how many individuals, by the target category, have been transitioned. It's quite interesting. Goes from a high of, in Texas of 1000, to of course a low of zero, a few states have not even implemented their Money Follows the Person grants.
I would like to stop here and see if you have questions about Money Follows the Person, or questions about the associated things I am going to be sending you.
We will pause for a moment and I will make a couple of reminder comments. That is that we will post the pages you are referencing on our telephone conference page on the website. It's the same link in the announcement e-mail you received for this webcast. And there is an optional set of PowerPoints, you don't need them because Suzanne is covering all the material, but if you want to, you can go to the link in the e-mail you received, or you can go to ILRU.org, go to webcast, the webcast calendar and find a link to that page.
Those are ways you can get optional materials, and we will soon post the materials Suzanne has referenced. Sharon, do we have questions
I want to remind everyone that joined today, if you press star 1 on your telephone keypad you can ask a question. Are there questions from the audience today?
Let's proceed to the next section.
Slide 10, the [indiscernible] program. Administration on aging is comparable, federal agency comparable to the centers for Medicare and Medicaid services. They are funded through the older Americans act, and are a federal cabinet level level, such as -- they are trying to break intro -- using older American act funding. By way of review, created in 1965, along with Medicare and Medicaid through the Social Security Act. Created Money Follows the Person, and additional funding through an infrastructure supporting home and community-based services. There have been three two-year grants, one in 2007, one beginning in 2008, beginning in 2009. The agency awarded a number of grants to State University state -- state units on aging and [indiscernible] Medicaid waivers. Let me make sure everyone understands the aging network structure the Administration on Aging is the federal agency, and at the state level there are what we call State University nits on aging. SUAs. These very local, sometimes county-based area agencies then provide direct services and they contract for services that are funded under the older Americans act. As we go down farther we see the aging network consist of direct service providers such as senior centers and for-profit and non-profit agencies. The community living program infuses money through grants, totaling from $2000 to $1 million per grant to create a home and community-based service environment.
Recently the Administration on Aging issued a new request for proposals, and 35 states responded, and AOA is looking at the Administration on Aging, looking at those proposals now and will award up to 18 to 20 grants. The chances state either had a 2007 or 2001 20072009 grant is fairly high.
The community living program, Congress said it's time for you to modernize your system, long-term care system. You need to more actively identify people who are at-risk of being admitted to a nursing home, and create a better infrastructure in order to support people in the community as opposed to institutions.
If we look at two sides of funding, we have the Medicare/Medicaid side, which supports home and community-based services to an extremely large degree. On the other side we have non-medicaid funding and the bulk of this is either private insurance or programs like the older Americans act funding.
The commune funding -- [bark bark] stop, stop, the community living program is funded, Money Follows the Person, except focus is to identify people not in nursing facilities, but before they go to nursing facilities. I'm sorry, can you hold just a second?
I am terribly sorry that I had that diversion. One of the examples of the community living program is that it hopes to create a flexible self-directed budget issue for home and community based services. The Administration on Aging strongly believes that the self-directed services can provide an efficient service delivery system by which to provide services.
Certainly the community living program will support state and long-term care rebalancing efforts. Let's look on slide 12. What do we hope to achieve with the community living program? We want a flexible dollar tailored to individual needs to be infused in the community. We also want to develop some effective criteria by which to identify individuals who are not Medicaid eligible, who are likely to go into a nursing home or are at risk of Medicaid, receiving or applying for Medicaid. We also want to ensure that people have full choice and control of the services they receive.
On slide 13 we see that we're talking about connecting the dots. I would like to have your input on how you, A, collaborating with the area agencies on aging and state units on aging, or if you are.
I also want to see if we can think of ways to support the AOAs' community living program by directly providing services or providing peer support, training, skills training, because the community living emphasizes self-direction and consumer direction, I feel like the independent living movement and self-direction go hand in hand, what can we do to help our friends in the aging community understand self-direction a little better. We know caregivers and participants are getting older and many people you see now could benefit from the programs as they grow older.
I am going to stop and ask you all for your input as to, A, have you heard of the community living programs; B, does your state have one, and C, what are effective collaboration strategies you are using?
Sharon, I will turn it over to you for Question and Answers.
Again, press star 1 if you would like to ask the question. At that time we will unmute your phone and you can ask your question to Suzanne.
We do have a question from area 706.
This is Doris Thompson at [indiscernible] option.
What's your question?
I wanted to say we have been, continue to work with our ADRC and area agency on aging, serves a number of the counties we do as an independent living center. One of the things we have been doing is a program called operation independence, where we contract with the area agency every year to do home modifications, door widening, building ramps, adding grab bars, so people can age in place, avoid the nursing home, move home with a relative.
That's great.
It's really successful, serves a couple hundred people a year in 14 counties.
That's great. You are doing home modifications, then.
Right, contract with area agencies, a lot of times are the first point of contact. Our ADRC is our area agency on aging, so we work, have had a long-term relationship with them beforehand.
Have you found it easy to work with your friends in the aging network?
Yes, definitely. Been very supportive of what we do. They monitor, we have a contract with them, and they do an audit once a year, look at our records, make sure it matches what they need, a very good relationship.
That's great news. How about others? Have you been challenged in communicating with your agencies on aging and if so, what were the challenges, or if it's been successful, let's hear that.
Again, you can press star and the 1 key on your telephone keypad to raise your hand and ask your question.
Area code 361.
Hi, what's your question?
Question: Hello? This is area 361 -- sorry, 316. Is the community living program the source of funding for the ADRCs?
No, it is not. Good question. ADRC's funding is a [indiscernible] funding source. It has a different purpose. It's to centralize resources in the community for one-stop shopping. The community living program, and let me say it was the nursing home diversion program. You may have known it as that name. They changed the name three or four months ago, really have been encouraging us not to call it the nursing home diversion. It is a separate, but related, in the grant opportunity that AO adjust released it did say if you are working with ADRCs or independently living centers, area agencies that kind of stakeholder collaboration, you would receive additional points and it's an expectation of the grant, so ADRCs, simply a resource, community living is more a direct service.
Okay, good. Thank you for clarifying that, and let me add that, as a center for independent living, we actually get started before we become a center for independent living and it was in large part due to collaborating to the area agency on aging. They recognize the center for independently living before we became one, which was nice. One of the ways we collaborate is because their mandate is to serve people age 60 and up. Well, what happens, when there's a request for certain types of resources, they will take the ones 60 and over, and we take the ones below. Different services, ramps, modifications, any other INR, transportation, housing in particular. That's some of the ways we have shaken out our collaboration. This is a [indiscernible] area of Texas.
I see.
Good know.
With this new program you also have the option of serving people of various ages and receiving some payment from the area agency on aging if you can negotiate the arrangement with them.
That's a good point, Richard
I think A, outreach and resources, you can do a lot, and then I think, see great potential for skills building with the staff at area agencies on aging. If we can -- and here we might want to think about another call on, just what terminology do we use? For example, you use independently living, whereas the aging network is using person-centered planning. I think we talk about some very common philosophies, service delivery methods, and sometimes when we call them different names we think they are different animals. I think there's a lot of potential for cross-training here. I don't know that our area agencies on aging are really familiar with self-direction and independent living. I think they could learn a lot from you all.
Let me ask if there are other questions.
This is Ann.
We must have had a lightning bolt strike or something, Richard and I got knocked off. I have another question from area code 706.
What's your question? question: Hi, this is Donna Backsly from Rome, Georgia. We have a really good relationship with our area agency on aging, and are trying to work with the ADRC also. Right now -- I did a presentation out there, at an annual meeting they had, we have had really good feedback, I get a lot of education as far as what centers do, really good questions, really good input, and I have had some referrals. We would love to look at having some kind of contracts with them and in fact I am going to talk with them about maybe looking at doing a home mod contract as [indiscernible] does.
Great. Sounds like home modifications and assistive devices is a natural fit, then.
Yeah.
Okay. Are there any other questions?
I will say, I was looking at your Money Follows the Person, you guys were identified as one of the slow movers initially, and you all have transitioned about hundred people out, which is really good, I have to commend you in your state there.
So if there are no other questions, let's move on to the Veterans Administration. Here, this is the greatest opportunity for collaboration for the independent living centers. The structure of the Veterans Administration, you may not know, they are the federal agency by which veterans receive both benefits as well as healthcare. There are currently 24 million Americans who are veterans, and here I am on slide 15.
They provide financial assistance, as well as disability compensation and healthcare through Veterans Health Administrations and they call their local hospitals veterans medical centers or VNCs. They are not only a provider of services, they also are a payer of services. If an individual in a community needs community resources and are not available at the medical center, then it's my understanding veteran's administration will contract currently to provide acute care as well as institutional care.
We are seeing a lot of -- there are over 1300 medical centers throughout America. They provide mostly acute care in the form of hospitalization and in-patient services. I am so sorry -- [barking] stop.
Pardon me. Now let's move to the next slide, slide 16 shows that VA services spend a lot of money on nursing homes, almost $4 billion, about 84% of the long-term care budget. It is a huge drain on the VA system to provide long-term care. They have provided most of the long-term care just as Medicaid did some years ago, not through home and community based services, but through institutionalization.
On slide 17, we know that the need for veterans healthcare and community services is really, really growing. I don't think any of us have any idea about the number of younger persons with disabilities who are coming home from the Iraqi wars and conflicts in Afghanistan.
What we are seeing is individuals who are fairly young, who have severe disabilities, many, many post-traumatic stress disorder diagnosis, as well as traumatic brain injuries. Communities are being stressed to manage services for all of those individuals.
Furlgt Further, sad to report, but it is a reality, our improved battle field medical care has decreased combat deaths and increased severe disabilities. So a lot of people are coming back home that need support and the Veterans Administration is really hard-pressed to provide long-term care and maintenance services to these individuals, except in an institution.
There are some existing community-based programs that are out there. One you may be familiar with, slide 18, we see there is a program entitled home improvement and structural alterations. These are grants the VA offers to individuals, and they are able to perform, have construction done to modify their homes and some limited assistive devices. They are currently, and I would like us to keep track of this, there's a congressional bill that will increase the amount of money that goes into the program. One thing I can give you is a tracking device on these pending bills within Congress. I would like to keep track to see if funding is increased. That might be an opportunity for us to go and meet with the individuals at the veteran's administration, either our local Veterans Affairs office or the veterans medical centers.
There's also a program, before I leave that, this Bill 2193, a real neat website you can look at and track the bill numbers and tell you when they have gone to committee, outcome of the conversations, and you can track that bill.
Another service you may or may not be aware of, the Wounded warriors, I heard about from an independent living center in New York, the first to share with me. I did research for this conference call, according to that, the wounded warriors is a nonorganization that gives direct support to veterans and care givenners caregivers with disabilities, funded from the federal government and contributions from the public. There is a bill in Congress directly related to Wounded Warriors and that will be to provide some funding for telemedicine and for support and encouragement for caregivers of veterans with disabilities.
There's the aid in attendance program. This is a program that provides, actually probably the original [indiscernible] counseling program, provides a grants of around a little over $15 00 to individuals with disabilities, veterans, who need assistance with the activities of daily living such as bathing, dressing, grooming, things like that. Again, referrals can be made directly to the Veterans Affairs local office.
Of course the medical centers provide ought-patient clinics. But what has happened, the VA has realized that they are going to have too many people, not enough money and have to modify the way they do business. In 2008, a law was passed to create the veterans directed home and community-based services. This provides funding for the Veterans Administration to infuse into communities to create a veterans home and community based structure. The partnership includes state units on aging as talked about under the older Americans act, every state has a unit in the state office, the primary contact is the state unit on aging, in collaboration with area agencies on aging. What will happen, this program will identify veterans who are at risk of institutionalization, in other words identify people who have severe enough disabilities they require assistance with activities of daily living and are at risk of going into a nursing home.
It can be service-connected or non-service connected. And individuals then will be afforded services that are consumer directed. The veterans administration for whatever reason recognizes only consumer-based services in the home and community-based environment. In other words, they, the veterans administration is not necessarily supporting provider, traditional providers. They are more supporting self-directed services for their veterans. Which is a nice thing for [indiscernible] my focus, but it is this is the first time the federal government specified the service delivery is [indiscernible] as opposed to direct services.
The veterans who are eligible, includes veterans of all ages, and here is an important distinction. The older Americans older Americans act is usually 65 and older, the Veterans Administration will serve veterans of all ages. They are going directly to state units on aging and the aging network in order to manage the delivery system and build infrastructure. Some area agencies are needing some help with understanding how to -- provide services and support younger people with disabilities. Clearly there is an opportunity for some collaboration here with the veteran's directed home and community based services program. Individuals, veterans will be given an individual budget that is based on their need, and that individual brj budget will go to the area on agency, and the area agency on aging will work with that, veteran in order to find a worker that the veteran can hire. They will also be able to purchase good and services with their individual budget. The individual budgets are going to be fairly sizable, from between, at least, say 1800 to more per month, so it will be a sizable amount for individuals to manage.
Currently there are active programs in Washington state, Texas, Arkansas, Michigan, Florida, Virginia, New Jersey, Connecticut, Massachusetts, and New York.
With the veterans administration collaborating with the administration on aging, offering additional grants, $11 million to states who want to come forward and payment in this program.
Slide 20, let's talk about the individual budget and what veterans can do with their money. As I say, the veterans administration has done research on cash and counseling, consumer direction, and decided they wanted that service delivery system to be the way to provide services. The services we're talking about are personal care, either physical or verbal assistance, queuing, eating, bathing, adult daycare, assistive technology, home modifications, home delivered meals, caregiver support. Here let me apologize, I know that you all are progressive in your terminology. Care giver has some negative consequences I think. But the aging community still uses caregiver and caregiver support, routinely.
Other services under this individual budget can be environmental supports, other goods and services and including respite services.
So, also, as an additional opportunity for independent living centers, the area agencies on aging will provide or contract to provide support for self-direction. Those supports are typically counseling in the form of assistance and information to help individuals build skills to manage their own care.
So is a case management opportunity for providing those services, because individuals will hire their own workers, payroll taxes have to be considered. There will be a financial management services entity tied to each of the programs in order to help an individual manage the state and federal income tax and unemployment tax and Social Security, Medicare taxes, what not. Hopefully budgets will be sufficient in order to purchase worker's compensation and even benefits for workers who are hired. If we could put our resource hat on, schedule worker registries and [indiscernible], the referral process for the new veteran's program.
Our ages and disability resource centers, ADRCs will be key to referring people over to the medical center for them to start this process.
Triple-As also will be in a position to refer. Certainly independent liver livering centers are in a position to refer to VA medical centers
The VA medical center then will establish eligibility, determine if this person is physically, financially eligible for the program and will also set the individual budget. In other words, the amount the individual will receive.
The collaboration will be local in that the local veteran's medical center will collaborate with the local area agency on aging and negotiate a service agreement by which to provide the funding for the individual budget.
What we are seeing is that every medical center in Triple-A are coming up with different reimbursement rates, some a different set of services or service package. But eligibility should be standardized throughout the nation then.
The VA medical center will be responsible to fund the program and monitor the program make sure it's working the way it's intend -- and ensuring the quality of those services.
Let's look on slide 22 for implications for you.
This is a new category for Triple-As, younger persons with disabilities is a brand-new target population. We know about 40% of veterans over 65, that remains the majority being under 65, so the idea that this will appeal to individuals with disabilities who are younger and not typically served by the aging network is high.
Some cross training and collaboration on developing resources and sharing information about community options would be a good role for independent living centers. Certainly, traumatic brain injury and post traumatic stress disorder is something that area agencies are not typically used to dealing with. So if you have the capacity to help there or could even build the capacity to help, know they are going to have a need for that.
Certainly, the independent living movement, which in my mind started the whole self-directed concept, and person-centered planning, and all of that; I think the area agencies on aging could learn a lot from you about independence and skill had-building toward independent living. There may be opportunity toward case management, self-directed counselors, providing case management. Some area agencies are currently stretched to provide case management interest might be looking to contract out some of this, particularly for individuals who are younger with disabilities.
Purchasing goods and services, as we talked a minute ago, many of you have already achieved collaboration with the aging network on home modifications, providing those services or resources to purchase those services. I think that is, could be a wonderful opportunity for you.
Certainly networking with your sister organization, going to the local Veterans Affairs or state veterans medical centers, and working with your state units on aging, local area agencies on aging could do a lot in promoting the strength of your advocacy and what you provide.
ADRCs are going to be again looking for information about resources and that would be a good point for you all to, if you are not already collaborating with your local ADR croirks. The Administration on Aging has been very busy. They just released a new grant proposal for ADRCs. So if your state doesn't center ADRCs or you want to strengthen those, expand those, there is currently an opportunity for states to do that. You work through your area agency on aging and state unit on aging for that.
Let me stop here and ask if you have about the veterans home and community based initiative, if it's up and going yet in your area, and also like to talk about potential collaboration points; how you can help your friends in the area agency on aging staff to manage this rather high-profile influx of service dollars.
Sharon, you might want to remind everybody how to raise your hand.
If you would like to ask a question today please hit the star 1 key on your telephone, and your hand will be raised and we will put you in the question queue. And unmute your phone for questions.
First question is from area code 618.
Hi, this is Lynn. From the staff of independent living here in Illinois. Our question is, actually I guess we are a little ahead of the game. We have established an ADRC position here, so we have that position already ready and up and going. Our question is, because centers for independent living provide most of the services to people under 60, why then is the funding going through aging and -- that doesn't really make sense to me.
You know, I would have to agree with you. It is very peculiar. I have to say in working with the Veterans Administration, they felt like if they turned to their friends with the Administration on Aging and because they had this recent good history in '07 and '08 with the community living program, they felt like it was a natural fit. The independent living centers, you deserve a place on the national side, and I would encourage you to think of ways that you could achieve that placement.
In the meantime, though, know that on a local level you can be very effective in meeting with your state unit on aging, aging agencies and your medical center. What we found is that nationally many are aware of this program but many other medical centers don't have a clue as to what the VA is trying to do, the availability of the funding, so I think while it's not a top-down situation, it can be a bottom-up situation, and I don't mean to be pejorative when I use top and bottoms, but I think it can be a grassroots level. This all happened very, very fast. I think the Veterans Administration was in sort of a panic about oh my gosh, we have too many people, not enough dollars, or will have, we have to get this done. I think it was just a federal partnership that was not quite as inclusive as it should have been.
I also wonder why, of course I love consumer direction, but I wonder why that is the only service delivery system available here. Why traditional provider system is left out. I think we will learn a lot from the grants that were awarded last year. I think we will learn a lot from grants awarded this year, but now is the time to make community contacts. I certainly would have to agree with the statement of why.
Why so non-inclusive.
Lynn, Steve, others with the national council on independent living have made in-roads at a national level, continuing to do that. Steve will be conducting a telephone conference in September, we will send out an announcement about that. He will report on some of the national initiative, but in the meantime there are many opportunities at the local level that center are can pursue.
Yeah, I can't emphasize that enough. Don't be surprised if you go to the local medical center and they go what? What are you talking about?
I will send Sharon some websites you can share with the medical center. The area agencies on aging should probably be aware of this because of the community living program, because the proposal went out -- two proposals went out at the same time same package, the community living program, AOAs, and the veterans directed community based services. Triple-As will hopefully have some sense of this. We are seeing it has not trickled down to the veterans medical centers yet, but hopefully the information I will give you will give you the information to share with them.
We have another question from area code 705 -- 570.
We are all inverting, aren't we.
This is Tina, can you hear me?
I can.
I am from the center for independent living in Pennsylvania. My question is how can we find out when this initiative is coming to our area. I am aware of it, in Ohio, other states; but I haven't seen it in Pennsylvania, New Jersey, Maryland. How can we get on a list, if you are in an area for Cash and counseling model for an RFP to come out to provide the service. I also agree with the [indiscernible] in Illinois, the under-60 providers have had no notices of this. None. All of these grants are secured in all of these states, how do you find out about it?
One thing I certainly will be notified of who receives a grant, and I can send that notice, as soon as I get that, to Richard and Sharon. Would be happy to do that. You can go on AOA's website. I will tell you where, at least the 2009 grants are. They were submitted by August 3, have been reviewed, I was a reviewer for six of the grantees. I have say in a couple states, couldn't tell you which until the awards are made, but strong collaboration with independent living centers in the community living program.
Many, many of these community living applications also included the veterans. So I think they will probably announce toward the end of -- I think they go from October 1 to September 30, fiscal year. It will have to be before October 1. I am stuttering to say probably the first part of September we will know who the awardees are, both for the VA and community living. I will be glad to share that with Sharon and Richard. Once you know if your state has been selected, I believe the proposals then will be public information and you can actually read those at the AOA website, the ones that have been approved will be listed, and you can see who the players are I can commit to feeding information over.
Keep checking back to the link that we have provided in our announcement, and we will be posting what Suzanne provides to us.
The question is, what is that web page that will show us what round of states are being chosen next?
It would be the AOA -- www.AO appointOAappoint gov, that's when on
For the Veterans Administration that's when the requirement for financial management services entity be involved. Whether -- states are all over the map on this. Area agencies are thinking about providing financial management services, some are contracting out, some are using the existing cash and counseling. Cash and Counseling, SMS, financial management services entities, so yes. Once you know if Pennsylvania has received an award, then you will know to contact -- probably the state unit on aging would be the best.
Okay. Thank you.
Sure.
I think that's all of our questions. For now.
Okay.
Suzanne, just to clarify a couple other questions. It is at least possible that a center for independent living, if the state unit on aging or Triple-A wished for this service to be provided to become a fiscal intermediary in the program?
Yes. We know it's going to be, for the Veterans Administration, we know there is a requirement for financial management services. As we know, there are many forms of manifesting that service. Those include agency with choice, fiscal employer agent. The selection of those can either be through contract, through an RFP or invitation to bid, or I assume that it would be okay to simply go to the Medicaid financial management service and say we would like to add on, see a lot of that. In New Jersey they are adding on to the CAU. I am forgetting what -- consumer assistance -- something. I forgot what that is. They are simple using the existing Medicaid, cash and counseling financial management services entity. Simply adding on them.
Yes. It would be possible to both be a provider of case management supports, as well as the fiscal side, financial management side.
So for the veterans who are being served by this program who are those people who were injured in operation Iraqi freedom and operation OEF and OIF, enduring froim and -- sorry, I have forgotten the correct term.
The Middle East conflicts.
Yes, those people who were injured in those conflicts, there's a high prevalence of persons with brain injury, centers that have expertise in that area might be well-positioned to assist their area agencies on aging, state units on aging who have limited expertise in serve people with those kinds of disabilities.
Even developing the expertise now is not a bad thing. I will send you the aging and disability resource center issued a brief in July. Prepared by Lou in group, excellent resource for understanding the Veterans Administration. Focusing on what ADRCs can do, but it would be beneficial for independently living centers also. They say the traumatic brain injury has become the signature injury for Iraqi veterans Traumatic stress syndrome, the major diagnoses for younger veterans coming back from the war Not tied to age, not tied to service-connected disability. It's service-connected or non-service connected. We are going to be seeing a lot of, a new population that are seeking home and community-based services. It is going fast. Just to revisit our friend in Illinois, this was a fast mover, a shock to all of us. This was even in the works. Every -- last year they awarded 10 veterans grants and next year 10 more. Depending on the success of the program we could see more grants coming down. It's not too late. Now would be a supreme time to make some contacts. Just remember it is not age-specific.
Could you review again some of the services that are covered, might be options for centers to provide?
To actually provide, sure. Certainly personal care or attendant care, broader attendant care; homemaker services, chore services, respite services, case management, financial management services; adult daycare. The service package will be negotiated between the area agencies on aging and the medical center. Some are even negotiating the provision of skilled care, unique to what's negotiated between the two entities. Can be as broad as what we are talking about, including skilled care; or it could be as narrow as personal care and goods and services. But regardless, individuals have to have an individual budget and what that can do at a minimum, have the ability to hire, manage, dismiss a worker to provide personal care assistance and purchase good and services. Home modifications, assistive devices will be very, very big.
Because this is a consumer directed program, centers are uniquely qualified to provide services and are probably in some ways much more qualified than area agencies on aging because they have been slower to adopt a consumer-directed approach to service delivery. That may make this a very possibility for centers where the program is available.
Most certainly. One thing we are seeing is that states who had the cash and counseling, Michigan, Washington state, New Jersey, Arkansas; have already an infrastructure built, have their case management, financial management services, but still lack resources and skills training. Even in far advanced states there's an opportunity for a position at the table for independent living centers.
Sharon, do we have questions?
Again, if you would like to ask a question, we have about 10 minutes left in the call, press star 1 on your telephone.
I will share another website with you, if you ever want to track a bill, congressional bill this, is a really easy website. It'ss www.waitingroomusa.com, you can put the number of a bill in and it will tell you what the tracking will be. It's real interesting. I will also send information about the Wounded Warrior resource center, in case you want to look about that. One thing, researching that, that website, I thought it had an excellent summary of the compensation and benefits for a veteran. Very easy to access and understand.
Even if you are not interested in implementing a program, it's a good resource for veterans, to help them become aware of what services they may be eligible for.
I think most definitely. Also, I want to give one more boost for it is -- the home improvement and structural alterations grant. If there's going to be additional funding come through for vrng veterans to access, they need someplace to go in order to figure out what they need and who can provide that. Either a position of networking or providing services. I will give you the bill number to track on waitroomusa.com. It's a real good website, even I understood it.
We will post all the links Suzanne mentioned on the website included with the announcement for this telephone conference, and you may also go to the ILRU website at ILRU.org, go to webcasts, the calendar, and click on the link for today's telephone conference, and we will find a direct link to the page where all of these resources will be posted and we will be adding to that page just within the next day or so and add as new resources become available.
I want to put a plug in for continuing to attract, track the public housing authority slot, encouragement for Money Follows the Person, great resource for independent living personnel to be familiar with too.
Those on the call, Steve Golds', we talked about that resource, will post that link here too.
Good.
That was long overdue, should have been done three years ago. That encouragement.
There are no questions.
Okay, well, Suzanne, we will like to thank you, and we always learn a great deal when you make presentations for ILRU and the IL-Net, and we look forward to others in the future.
We will be posting this webcast on the links I described, and I will mention in conconclusion that this webcast was a presentation of ILRU and the IL-Net, CL net, center statewide independent living centers, ILRU, national counsel on independent living and the program for rural independent living.
This webcast was sponsored by the federal Department of education, rehabilitation services, no endorsement of statements or content should be inferred from their sponsorship of this program.
Stay tuned for, watch for e-mail announcements from us about future webcasts. We will have webcasts on employment programs and additional information on housing through webcasts, teleconferences, and as a mentioned, watch for an announcement, update on the national information about veteran services for a telephone conference to be held in late September.
Again, watch for e-mail announcements. If you would like to be on the e-mail list, if you found your way to this telephone conference, were not on our e-mail list, you can write us at ILR UAT ILRU.org. And we will place you on our mailing list.
Thank you all for participating, Suzanne, sharing, and again, for an excellent telephone conference.
Good-bye everyone.
Bye-bye.
Good-bye.
[event concluded].