HISTORY & PROFILE of Area Agency on Aging District 7, Inc.
Area Agency on Aging District 7, Inc. (AAA7) has grown from a small group of dedicated volunteers to one of the most successful regional entities in southern Ohio during the past 44 years (as of 2016). The region it serves, located in the most rural part of Ohio, covers over 5100 square miles of relatively undeveloped countryside, and is characterized by high unemployment, high poverty levels and a significant loss of younger people leaving the area to find employment. Since 1972, AAA7 has continued to incorporate many programs as a part of their directive through the Older Americans Act to plan for and provide a comprehensive and coordinated system of care through in-home and community-based supportive and nutritional services. The agency continues to look for other opportunities to improve and/or expand the services available to the targeted populations served in the district.
Building a Strong Foundation
In 1972 Rio Grande College was selected to sponsor one of only four model projects in Ohio that were funded by the U.S. Administration on Aging. This selection followed over a year’s worth of meeting and planning by a 12-member District Council on Aging formed to represent a five-county area including Gallia, Jackson, Scioto, Meigs and Vinton counties. The council focused on ways and means to assist elderly individuals living within the district. The Area-Wide Model Project developed social services, such as transportation and information and referral, for older Americans. Two years later the Model Project was officially designated the Area Agency on Aging District 7, Inc. by the Ohio Commission on Aging, the forerunner of the Ohio Department of Aging. At that time, the area served by the agency was expanded to cover the present ten counties in southern Ohio (no longer including Meigs County). The counties served are: Adams, Brown, Gallia, Highland, Jackson, Lawrence, Pike, Ross, Scioto and Vinton. At that time, the Ohio Commission on Aging designated area agencies on aging throughout the state of Ohio to plan and implement services statewide. Grants from the federally legislated Older Americans Act of 1965 and related amendments provided the funding for services and agency operations.
Expansion of AAA7 services began in 1978 with the addition of the Nursing Home Ombudsman Program, a service mandated in the Older Americans Act (OAA). The program receives, investigates, and acts on complaints by older individuals who are residents of long-term facilities and advocates for the well-being of such individuals. Since that time additional responsibilities, such as investigating complaints of individuals receiving home and community-based services, has been put into state law that broadens the scope and requirements of this program. The Regional Long-Term Care Ombudsman Program now continues to expand into programs such as Home Choice, a transition program to assist from moving from the nursing facility to a more independent living situation; the Music and Memory program with nursing facilities, adult day services, and the veteran’s administration hospital in Chillicothe, Ohio and other person-initiatives encouraged by the Ohio Department of Aging. AAA7 continues to maintain the Regional Long-Term Care Ombudsman Program as a program “in-house” versus contracting the program out to another organization or agency. AAA7 also contracted with the Ohio Department of Health to operate the Nursing Home Area Training Center (NHATC) to provide training to long-term care facilities staff in southern Ohio. This program was discontinued at the state level several years later. Part of the pre-1980 expansion also included the responsibility for the planning and supervision of facility improvements to multi-purpose senior centers. The state legislature had passed a bill providing for such improvements and/or expansions and designated the Ohio Commission on Aging and their related area agencies on aging as the responsible agent for these projects throughout the statewide. This program was discontinued during state budget negotiations in the late 1990s.
Rio Grande College continued to sponsor Area Agency on Aging District 7, Inc. until 1980 when the AAA7 Area Advisory Council (formerly the District Council on Aging) formed a separate, private non-profit organization. Governance is provided by a Board of Trustees made up of not more than two individuals from each of the ten counties in the service area. Appointees to the board consist of a wide variety of community, business and organizational leaders. The AAA7 Area Advisory Council, composed of individuals representing agencies and organizations from across the district, advises the Board of Trustees on service needs and other areas of concern to older adults and other frail and vulnerable populations. They also provide advocacy activities for constituents living within the district.
Shortly after becoming an independent not-for-profit agency, AAA7 took responsibility for the Nutrition Program funded through the Older Americans Act. The nutrition program provides congregate dining opportunities and home-delivered meals through a network of dining sites and rural routes throughout the ten-county area. Contracted nutrition providers maintain commercial kitchens that comply with all state and federal regulations regarding food preparation in order to prepare and distribute these meals. AAA7 has, since 1982, maintained the services of a registered dietician through independent contract to develop menus meeting all the dietary requirements, to develop and present nutrition education, and to complete on-site monitoring of all nutrition providers on a regular basis.
During the developmental years of Area Agency on Aging District 7, Inc., one individual’s contribution and commitment stood out. It is during this time that William A. Jenkins from Gallia County, having retired from state service, became instrumental in laying the foundation for the area agency organization and especially the development of a service delivery system throughout the ten-county region. As a member of the Advisory Council of AAA7, he guided the council through the process to become an independent not-for-profit agency. His tireless work towards developing an aging network that could provide much needed services, such as transportation and information and referral, set the standard for being an advocate for senior citizens. Following his death, the AAA7 Board of Trustees established the William A. Jenkins Award. Given at the annual meeting of AAA7, the award is given to an individual(s) who exemplifies the commitment to seniors that William Jenkins personified during his tenure with AAA7.
A New Era in Service Delivery to the Most At-Risk Populations
The largest expansion of services to older adults came in 1990 when AAA7 became the administrative agency for the PASSPORT (Pre-Admission Screening System Providing Options & Resources Today) Medicaid Waiver program. The AAA7 region was one of the last to be included in this statewide program. The PASSPORT program provides in-home services to older adults age 60 and over who medically qualify for nursing home placement and meet specific financial eligibility requirements. This three-way contract between the area agency, the Ohio Department of Aging (ODA), and the Ohio Department of Medicaid (ODM) serves to provide in-home, case managed services including personal care and home-delivered meals as well as medical transportation, adult day care, emergency response systems, and durable medical equipment. By arranging the most appropriate mix of in-home services to add to the care provided by family members and friends, individuals are able to delay nursing home placement. As Medicaid Waiver options expanded in Ohio, AAA7 embraced both the self-directed alternative and the Assisted Living program as viable service arrangements for eligible individuals. AAA7 was one of two AAAs to have the Choices self-directed program initially. This self-directed alternative is now statewide through the PASSPORT Medicaid Waiver Program. Another cooperative venture in which AAA7 participated was also between these three entities--the Residential State Supplement Program. Through this program, the Ohio Department of Job and Family Services (ODJFS) provided a cash supplement to low-income aged, blind, or disabled individuals who need assistance with daily activities such as bathing, eating, or dressing, but do not require skilled nursing care provided in a nursing home. These cash supplements complemented an individual’s personal resources so they can live in a more home-like, congregate setting. The recipient was assigned a personal case manager from AAA7 and was eligible for a Medicaid card to pay for medical expenses. This program has since been transferred to the Department of Mental Health.
AAA7 has a wide range of other services and programs to complement the core mission of the agency. Care Coordination provides case management and in-home services for individuals who need assistance but choose not to enroll in other programs, such as PASSPORT. Service Coordination, available in three separate sites throughout the district, places a qualified individual in apartment complexes to help elderly and disabled residents access services and programs they may need. The coordinator is on-site weekly to offer assistance and information, make referrals, promote healthy lifestyles and wellness, encourage common interests and activities and improve quality of life. The Home Repair Program provides actual home repair to eligible older adults through funding from the Ohio Development Services Agency (formerly Ohio Department of Development). Repairs can include anything from installation of sanitary sewer systems and access to potable water to major structural and roof repairs. The National Family Caregiver Support Program is designed to take care of those who care for others by assisting in preparation for the role of caregiver or providing ongoing information, support, referral and assessment as individuals provide care and support to loved ones.
Building on Experience, We Embrace a New Vision
The 21st century brought new challenges and opportunities. The Administration on Aging (AoA) developed a new focus to address the explosion in the numbers of older adults as the “baby boomers” entered the age of retirement. This “new vision” from AoA required area agencies across the nation to adjust their thoughts on program development and implementation. The Older Americans Act (OAA), as the cornerstone of the aging network, was to be realigned with the new purpose. With the 2006 OAA amendments, came the phrase “Choices for Independence.” In response to that initiative, which outlined the broader concept of more flexibility in service delivery, the National Association of Area Agencies on Aging (N4A) joined forces with the National Association of States United for Aging and Disabilities (NASUAD) to launch “Project 2020.” Project 2020 is a three-pronged approach: 1) Person-Centered Access to Information; 2) Evidence-Based Disease Prevention and Health Promotion; and 3) Enhanced Nursing Home Diversion Services. Both organizations developed legislative strategy for additional funding from Congress in support of the new initiative.
AAA7 embraced the new initiatives by implementing the Aging and Disability Resource Center (ADRC) component to address the Person-Centered Access to Information. We embraced both Chronic Disease Self-Management and A Matter of Balance to reflect our commitment to Evidenced-based Disease Prevention and Health Promotion and, in 2009, was the only area agency in the state to partner with the Ohio Department of Aging and be awarded a federal Nursing Home Diversion grant in only the second round on funding.
When discussion at the federal level began between the Veterans Administration and the Administration on Aging about consumer–directed care options for veterans case managed by the area agencies, AAA7 saw an opportunity to serve this special population. After much hard work, AAA7 has the largest and most successful Veterans- Directed Home and Community-Based Services Program in the nation in agreement with the Veterans Administration Medical Center in Chillicothe, Ohio.
During 2013, significant changes occurred at the federal level. Based on their belief that all Americans—including people with disabilities and older adults—should be able to live at home with the supports they need, participating in communities that value their contributions. To help meet these needs, the U.S. Department of Health and Human Services (HHS) created a new organization, the Administration for Community Living (ACL).
ACL brings together the efforts and achievements of the Administration on Aging, the Administration on Intellectual and Developmental Disabilities, and the HHS Office on Disability to serve as the Federal agency responsible for increasing access to community supports, while focusing attention and resources on the unique needs of older Americans and people with disabilities across the lifespan. Their mission is to maximize the independence, well-being, and health of older adults, people with disabilities across the lifespan, and their families and caregivers.
In 2012, AAA7 launched a hospital-based project with two other area agencies, AAA8 (Marietta) and AAA6 (Columbus) through funding from the federal Centers for Medicare and Medicaid. The Care Transitions Program provides the bridge between hospital and home in an effort to reduce re-hospitalizations. AAA7 works with three area hospitals: Holzer Medical Center, Adena Medical Center and Southern Ohio Medical Center. This particular Care Transition Program has been nationally recognized as one of the top performers in the nation.
In keeping with AAA7’s commitment to serve the most vulnerable individuals, as of January 1, 2014, AAA7 entered into a contract with Care Source, a managed care company, to provide case management services to individuals under the age of 60 who are enrolled in the Ohio Home Care Waiver. This intensive case management has challenged AAA7 to stretch, changing some aspects of our response to consumers, and has been a successful service throughout 2014. As of 2016, AAA7 will also be providing Specialized Recovery Services for severely mentally ill individuals through this contract with Care Source.
Through the development of a four-year strategic plan, AAA7 will continue to review the mission of the agency, service needs and gaps, the current environmental factors that will influence programs and services either directly or indirectly, and analyzes the opportunities available, and the capacity of the agency to embrace these opportunities. This internal and external review will provide the process by which AAA7 can more readily be prepared to respond to any changes and new developments that impact programs and services to the older adults and at-risk individuals.
The AAA7 management team and staff are looking forward to ensuring that the significant progress already achieved is continued. The future is bright and we remain committed to building on our strong foundation of partners as we work toward our agency’s vision.