Four Year Plan

    SECTION I

Executive Summary

The Older Americans Act of 1965 established the Administration on Aging and acknowledged a governmental responsibility for meeting the basic needs of Older Americans.  Under this act, grants were provided to states to plan for and provide community services to older adults that would allow for “retirement in health, honor, dignity-after years of contribution to the economy”.   Reauthorized many times since the original passage, the Older Americans Act continues to provide a framework for state and local governments to develop individual plans to meet the needs of seniors.  The most recent re-authorization, in 2006, includes amendments that emphasize the importance of informed choice at all levels of decision-making regarding utilization of services.

The York County Area Agency on Aging celebrates more than thirty years of providing service and information to older adults.   Officially created in May 1975 by the York County Board of Commissioners, this non-profit organization has served as the core entity to plan and provide services to a growing population with changing needs.  As we move into the next cycle of service provision, we take seriously our responsibility to use the resources that are available to meet the needs identified by the local population. 

This Four Year Plan is the culmination of both an internal and external review of the issues the agency and the population we serve are facing.  It also incorporates the major trends found in the Strategic Action Plan for the U.S. Administration on Aging.  Initial strategizing for the plan began in August 2007 at a retreat for members of the Advisory Council Executive Committee and key staff members from the Agency on Aging.  The full advisory council was involved in a special planning session in September 2007, prior to the development of the survey tool and the questions for the focus groups.  More than 700 completed consumer surveys and diverse participation in four focus group sessions provided the input utilized to formulate the plan.  Final comments presented at the public hearing on April 14 provided closure to the plan as submitted to the Pennsylvania Department of Aging for approval. 

Minimal funding comes to the local agencies on aging from the federal government to partially support community services such as senior community centers and nutrition sites, transportation, education, and caregiver support.  In Pennsylvania, these funds are supplemented by state funding generated by the Pennsylvania Lottery to benefit Older Pennsylvanians.  A small amount of additional funding is provided from the County General Fund.  Combined funding has proved greatly insufficient to provide for even the basic needs of older adults struggling to maintain their independence in the community.  This plan makes no assumptions for increased funding at a level that would fill those gaps.  Instead, the focus is on partnerships and education, fostering a sense of community and neighbor responsiveness. 

Increasingly, the York County Area Agency on Aging relies on private, social, and faith based organizations to share a common mission to promote the continued independence of older adults in our community.   High utility bills, property taxes, and medical and insurance issues were cited as some of the greatest concerns our consumers are facing.  We find that providing information and resources to assist in making informed choices on these issues has become a much more important service over the last ten years.  It is our goal to enlist and train additional staff and volunteers from partner organizations to provide a front line of resources in the communities where older adults live and experience the greatest comfort level.  Our plan embraces intergenerational and peer support programs that are responsive to the diverse cultural and language needs of our consumer base. 

Another critical component of this four-year plan is the focus on Health and Wellness as they relate to healthy and independent living. It is far better for our society if we can empower older individuals to make healthy choices regarding their lifestyles that allow them to live active and quality lives.  We will utilize an array of resources and partnerships to educate, educate and educate.  An expansion of information resources available through additional and innovative mediums will greatly increase our ability to distribute timely and accurate information.  As an increasing number of older adults are comfortable accessing web sites, we will be utilizing more fully those resources to expand awareness of programs and services.  Blogging, You Tube, and e-mail alerts are quickly becoming accepted modes of communication among the Baby Boomer population we are serving as new and pre-retirees. 

While our agency will continue to provide the traditional hands on services such as assistance with personal care, respite, and home delivered meals, we find that funding does not keep pace with the increasing cost of such services.  The same pool of resources will be stretched to provide these services for an increasing group of older adults and there will be no choice but to tighten criteria so that we hold true to our mission statement and serve first those “with the greatest social or economic needs”.  More than eighty percent of Agencies on Aging across the state currently have waiting lists for Home and Community Based services, and without sufficient funding increases to balance population growth; there is little hope that we can avoid that same predicament.

Our plan has us refocusing and redirecting to touch as many lives as possible and connect individuals with the resources and information to make informed choices regarding services, health care and active living opportunities. We have the support of a community that will continue to work side by side to achieve the common goals that are a part of this plan.  None of the goals listed below are achievable without that support.

GOAL I           EMPOWER OLDER YORK COUNTY RESIDENTS TO STAY ACTIVE AND HEALTHY THROUGH THE PROMOTION OF HEALTH AND WELLNESS

GOAL II          ENABLE OLDER YORK COUNTY RESIDENTS TO REMAIN IN THE SETTING OF THEIR CHOICE THROUGH THE PROVISION OF HOME AND COMMUNITY-BASED SERVICES

GOAL III         EMPOWER OLDER YORK COUNTY ADULTS TO MAKE INFORMED DECISIONS THROUGH AWARENESS AND EDUCATION

GOAL IV        EMPOWER OLDER YORK COUNTY ADULTS, THEIR FAMILIES, AND OTHERS TO ADVOCATE FOR RIGHTS AND BENEFITS FOR ALL SENIOR CITIZENS

SECTION II

Agency  Overview

            The mission statement of the York County Area Agency on Aging continues to provide the framework for the agency as we look to the changing demographics and identified needs of our older population.

As we look to the next four years, it is increasingly important that we focus educational and advocacy efforts on the community as a whole if we are to successfully empower older individuals to better maintain their health and preserve maximum independence.  The goals and objectives in our plan are specific to this.  The investment of resources in low cost prevention programs has been proven to reduce the health care and placement costs that accompany advanced disease processes and functional impairment. 

Organization:

            The York County Area Agency on Aging is structured to provide staffs and resources to respond to the questions, problems and ongoing needs of a diverse older population.  We are a county-based non-profit organization, one of 52 Area Agencies on Aging located across the state.  We are governed by the York County Board of Commissioners, and the 65 staff members are employees of York County.  The department is one component of the County Human Services Department, operating under the direction of the Executive Director of Human Services.  Providing additional oversight and direction is the Advisory Council for the agency, whose members are appointed by the Board of Commissioners.

            The Pennsylvania Department of Aging has primary oversight for the administration of services directed and funded under the Older Americans Act.  This department also administrates an additional subset of services and programs unique to Pennsylvania. Primary funding for planning, programs and services comes to our local county entity under the terms of a cooperative agreement with this department.  This plan, which requires the approval of the Pennsylvania Department of Aging, is the local link in the chain of planning that is occurring at the state and federal level.

            The York County Area Agency on Aging is comprised of three departments, Administrative, Social Services and Program Development.  A five-member senior leadership team work together to provide oversight for the agency in general and administer the programs and services under our direction.  In addition to managing the human resource component of 65 staff persons, there are an additional more than 200 volunteers that provide service with varying degrees of time commitment, and a full complement of contracted service agencies that have daily contact as direct service providers.

            Our Program Development Department administers perhaps the greatest variety of services available on the local level.  Many of their activities are collaborative efforts involving numerous community partners and volunteers.  Staffs from this department answer questions on everything from housing options to complex insurance issues.  There were almost 20,000 information and referral contacts handled by the agency in 2007.  This department manages the local APPRISE program, which deals with the Medicare Part D Prescription Drug program as well as other insurance issues facing older adults.  The Medicare Part D program has required a complete shift in human resources to deal with the demand of education and one-on-one assistance to navigate increasingly complex programs.   In 2007 alone, more than 5000 Medicare Beneficiaries were assisted at 126 Medicare Drug Benefit counseling events.  Other programs and events managed by this department include publication of the bi-monthly New Horizon newspaper with a 29,000 subscription, organization of the annual Senior Games, distribution of Farmers Market Nutrition vouchers, administration of the annual local Flu Vaccine program along with other health promotion activities, and provision of countless educational seminars, benefit and health fairs, culturally diverse events, and organizational speeches. 

            The Administrative Department includes the Agency Director, Deputy Director, Director of Administrative Services, and supportive staff to administer the budgetary, contractual, and computer support functions of the agency, as well as provide advocacy and mediation services to residents of long term care facilities.  The agency currently administers an annual budget of 9.6 million dollars and contracts for direct service provision with 45 different vendors.  

            The Social Services Department represents the largest segment of staff resources.  Care Managers, Supervisors, and Support Staff are responsible for the intake, assessment, and individual care plan monitoring functions of the Agency.  Consumers of service are not limited to the older adult population.  Care Management Assessors conduct level of care assessments for any individual, aged 18 or older, to determine eligibility for long-term care services which may partially require public funding.   In addition to assessment responsibilities, Care Managers provide ongoing support and service management for more than 1300 older adults receiving in Home and Community Based Services on any given day, and investigate and resolve reports of older adults who may be in need of Protective Services.  In 2007, this department received 369 such reports.   

Our Community:

 York County is a mix of rural and urban neighborhoods, each with their own challenges and strengths.   Rural and urban seem to be meeting in the middle as an influx in population creates a demand for new housing developments in every area of the county.  The total county population currently exceeds 416,000. 

Total York County Population and Growth Rates, 1990 -- 2006
Age	Total Population 1990 Census	Total Population Census 2000	Total Population (July 1, 2006)	Growth Rate, 1990-2006	Growth Rate, 2000-2006
Total	339,574	381,751	416,322	22.6%	9.1%
Age 85 years or older	4,493	6,107	8,102	80.3%	32.7%
Age 65 years or older	44,443	51,492	56,154	26.4%	9.1%
Age 55 to 64 years	31,000	36,018	48,028	54.9%	33.3%
Source: 1990 Census; Census 2000; 2006 Population Estimates (July 1, 2006) (U.S. Census Bureau Population Division)

We are located in one of the fastest growing areas of Pennsylvania, if not the nation, in terms of older adult population numbers.  We have seen a particular surge in the number of individuals aged 85 and older, who traditionally have the most intense needs for services and resources.  How do we cope with a 33 % increase in that population over the six-year period from 2000-2006 and prepare for the even larger surge in those currently aged 55-64? The services we currently have in place seem grossly inadequate to meet the challenges we face.  Our plan for the next four years and beyond must lead us outside of the traditional roles played by local Agencies on Aging.  We must strengthen existing relationships with partners in the community, creating new ones where appropriate, and embrace new technology that will allow us to more fully increase awareness of resources and choices.

Not only are we serving and preparing for huge increases in number of older adults, we are also well aware of the increased racial and cultural diversity present in this group. Total minority representation in York County approaches 10 % of the total population.  From 2000-2006, York County has seen a 1% increase in the number of individuals of Hispanic or Latino origin.  Those individuals are currently estimated at 3.9% of the total population.  Many of the goals in the current plan are dependent on our effectiveness in reaching and educating older adults. We are committed as an agency that language or cultural barriers should not compromise access to service.  We continue to increase our supply of informational resources for Limited English Proficient adults, secure translation services for the programs and services we provide, and strengthen our relationships with organizations with direct ties to diverse population groups.  Additionally, we strive to balance our workforce to be representative of the community and hope to increase the diversity of staff at all levels.

Residence:

            As is typical across Pennsylvania, older adults in York County prefer to engage in and receive services in their own homes and communities. Even though there are currently an additional 2,000 older adults in York County aged 85 and older as opposed to eight years ago, we have seen only a minimal increase in the number of skilled nursing home beds.  There are currently 2,173 beds available in 15 Skilled Nursing Facilities across the county, with five of those existing as part of a continuing care community.   While the number of beds has not grown significantly, the number of individuals entering and exiting these facilities for short-term stays has increased.   The agency focuses upon the population in need of some assistance to return home through our Nursing Home Transition Program, staffed by a Long Term Living Counselor who works directly with all Skilled Nursing Facilities in the county.  Administrators of local facilities describe admissions occurring with more of a “revolving door” practice as consumers increasingly seek rehabilitation services that will strengthen their ability to return to independent living.    For these individuals, Medicare pays for much of the short-term care they receive.  Those who experience long term stays in Skilled Nursing Facilities tend to be those aged 85 and older. The great majority of long-term residents in Skilled Nursing Facilities will at some point qualify for Medical Assistance payments that
exceed $5,000 per month.

Source: 2005 statistical abstract of the United States

            Assisted Living Facilities and Personal Care Boarding Homes have seen an increase in census over the past several years and many have expanded the scope of services available to residents.  Multi level services, including dementia care, are available with costs dependent on the level of services provided. Presently, in York County, 32 facilities exist to provide residential and personal assistance services to individuals determined to need support that is less than would be provided in a Skilled Nursing Facility.  New regulations are in place that governs the operations of Personal Care Boarding Homes, and new regulations are pending following the recent passage of Assisted Living legislation.  The goal of both is to improve the safety and well being of residents and enforce a consistent set of minimum standards. 

            There is a significant cost difference between Skilled Nursing Facilities and Assisted Living Facilities.  The average daily rate of the private room rate for York County Nursing Homes is $251.00. The average monthly rate for York County Assisted Living Facilities is $2678.00. The chart below shows a sampling of similar current cost comparisons in other areas of the state.

NURSING HOMES			ASSISTED LIVING FACILITIES
REGION	PRIVATE ROOM AVERAGE (PER DAY)		REGION	AVERAGE                    (PER MONTH)
Pittsburgh, PA	$234.00		Pittsburgh, PA	$2,578.00
Scranton, PA	$198.00		Scranton, PA	$2,133.00
Philadelphia, PA	$233.00		Philadelphia, PA	$3,419.00

Source:  The 2007 MetLife Market Survey of Nursing Home and Assisted Living Costs

There is an even wider disparity in payment between facilities that accept the Personal Care Boarding Home Supplement and those that do not.  The current reimbursement for a Personal Care Boarding Home provider if the resident has a total monthly income of less than $1,076.30 is $1016.30 month.  The resident retains $60.00 of their income for all other personal expenses.  Fewer and fewer homes in York County are willing to accept the state supplement as payment in full, which reduces the options that low income older adults as well as younger, functionally disabled adults have regarding shelter.  The increased monitoring by the Department of Public Welfare and the enforcement of the Personal Care Boarding Home Regulations is well intentioned, however the end result is that several homes no longer have a license to operate, and many more are operating with provisional licenses.  If a plan to increase reimbursement to providers does not materialize that is sufficient to cover the costs associated with providing minimum standards of quality care, our county will find itself in a crisis situation.  This issue surfaces as an objective for advocacy in the current plan.

In addition to the many facilities that offer choices for long term living, York County has a countywide distribution of subsidized housing options available to older adults who meet the financial eligibility criteria.  We have been fortunate in recent years to add several new buildings in various parts of the county dedicated to low/moderate income senior populations as the result of tax credit partnerships.  These complexes provide safe affordable housing and on site social service assistance, as well as foster a genuine sense of community among the residents.  The influx of new apartments has not, however, kept pace with the population surge in our county, nor has it addressed the increasing need for safe housing for the very low-income group.  There are long waiting lists for both income based rental units and Section Eight Rental Assistance.

The Demographics of Poverty:

            Addressing the need for low-income safe housing leads us to the next discussion on local poverty realities.  From first look at updated census numbers one might determine that poverty among older adults is less an issue than previously experienced.  The percentage of adults aged 65 and older at poverty level has decreased from 6.8% in 1999 to 5.6% in 2006.

Ratio of Income to York County Poverty Level for Individuals 65 +, 1999
	Number	Percent
Total 65+	48,753	100.0%
Under .50	1,155	2.4%
Under 1.00	3,332	6.8%
Under 1.25	5,480	11.2%
Under 1.50	8,472	17.4%
1.50 and over	40,281	82.6%
Source: Census 2000 SF3, Table PCT50

Ratio of Income to York County Poverty Level for Persons 65 +, 2006
	Number	Percent
Total 65+	53,666	100.0%
Under .50	931	1.7%
Under 1.00	3027	5.6%
Under 1.25	5646	10.5%
Under 1.50	7656	14.3%
1.50 and over	40821	76.1%
Source: ACS 2006, Table B17024