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FY 2012 Performance Measures: Office on Aging (DCOA)

FY 2012 Community Integration (Olmstead) Performance Measure:

  1. DCOA and its Aging and Disability Resource Center (ADRC) will transition 60 residents from District nursing homes or hospitals back into the community through its Money Follow the Person and Hospital Discharge Planning programs.
  2. DCOA/ADRC will partner with local District hospitals and the Delmarva Foundation to develop a discharge planning framework designed to identify people at risk for institutionalization and assisting them with locating the necessary home and community-based services to prevent long-term stays in health care facilities.

FY 2012 Community Integration (Olmstead) Plan Outline:

Agency Mission:

The mission of the DCOA/ADRC is to assist the District’s elderly and persons with disabilities in maximizing their independence and improving their quality of life by linking people with a range of quality services. In addition, the DCOA/ADRC provides assistance and information to seniors and persons with disabilities about their current situation and helps them explore options and benefits available to them.

Vision:

The vision of the DCOA/ADRC is to be a highly visible and trustworthy resource center and primary point of contact in the District for public and private-pay elderly and persons with disabilities, their families, friends, and health care providers who are seeking assistance and information on public and private long-term support programs and benefits.

Agency Future Planning:

The DCOA/ADRC has a two-prong approach for addressing institutionalization in the District: hospital discharge planning and nursing home transition. Through the hospital discharge planning efforts, DCOA/ADRC will educate people about institutionalization, nursing home diversion, and about the importance of getting an effective plan of care and discharge plan if one must go to a nursing home from a hospital. DCOA/ADRC will collaborate with government agencies and private nonprofit organizations to identify individuals who are able and desire to return to the community. Such individuals will receive assistance from DCOA/ADRC in beginning the transition process and identifying resources for moving them back into the community. The transition process also consists of identifying a home for the client and securing furnishing and other household items that are essential for living in a new home.

Agency’s Population and the Definition of this Population:

The Office on Aging and its Aging and Disability Resource Center are designed to assist older adults and persons with disabilities in locating supportive services and eldercare resources in order to continue living as they choose in their community.

Agency’s Barriers Unique to each Population:

  1. Housing: Lack of accessible and affordable housing units.
  2. Transportation: Lack of adequate wheelchair equipped transportation. Also, restrictions of pick up location – clients must be able to enter transportation from the curb rather than receiving “door to door” assistance from driver.
  3. Other barrier issues and service needs unique to the populations that the Agency serves in institutional settings: There is not an identified case management agency that provides wrap-around services for the targeted population under 60 years of age who is transitioning from an institutional setting back into the community. Also, some informal caregivers are unable to pay for respite care services. Thus, some type of subsidy program may be beneficial to this population. Lastly, the lack of a client’s social support network may lead a client to be without the necessary assistance to maintain an independent, quality life in the community.
  4. Barriers to providing self-determination and transitioning and diverting the Agency’s population away from institutions: The lack of public knowledge about home and community-based services and the cost and programmatic restrictions associated with respite care programs make it difficult for family caregivers to support a loved one with special needs in the community.
  5. Available resources to be used in order to safely transition or divert these individuals: grant funding through the Money Follows the Person and Hospital Discharge Planning programs.

Service Needs that Challenged the Agency to Comply with the Olmstead Initiative:

The following unmet service needs have hindered DCOA/ADRC from complying with the Olmstead Initiative:

There is a lack of available services for individuals with disabilities that support self-determination, transitioning, and/or diverting from institutional placements of persons with disabilities. As part of the Olmstead Initiative, DCOA/ADRC and its co-located agency staffs offer options counseling, which is a decision making approach, that empowers its consumers with the necessary information to make informed decisions about receiving long-term care services in an institution or at home.