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Home My WebLink About20063176.tiff RESOLUTION RE: APPROVE FOUR YEAR AREA PLAN FOR AREA AGENCY ON AGING AND AUTHORIZE CHAIR TO SIGN WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS,the Board has been presented with a Four Year Area Plan for Area Agency on Aging between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services,Area Agency on Aging, commencing July 1, 2007, and ending June 30, 2011, with further terms and conditions being as stated in said plan, and WHEREAS, after review, the Board deems it advisable to approve said plan, a copy of which is attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the Four Year Area Plan for Area Agency on Aging between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services, Area Agency on Aging, be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said plan. The above and foregoing Resolution was,on motion duly made and seconded,adopted by the following vote on the 20th day of November, A.D., 2006. BOARD OF COU TY COMMISSIONERS E'4a WELD COUN , COLORADO ATTEST: M. ile, Chair Weld County Clerk to art: ( /' ✓ v ' ` David E. Long, Pro--Teem BY: P 7 Dep Cle o the Board Willii H erke 1 APPROVED AS TO FORM: �e ln' Robert/D��, Masden ASS}�Co ty Att net Lcecu! �� Glenn Vaad Date of signature: I iiig16(1r 2006-3176 HR0077 MEMORANDUM f& DATE: November 20, 2006 • ' TO: M.J. Geile, Chair, Weld County Board of Commissioners . V��Di �j O FROM: Walter Speckman, Executive Director, Division of ` ' COLORADO Human Services SUBJECT: Weld County Area Agency on Aging's Four(4) Year Plan Enclosed for Board approval is the Weld County Area Agency on Aging's Four(4)Year Plan Fiscal Year 2007-2011. This plan outlines the programs that are being funded by the Older Americans Act and local priorities and initiatives that have been identified by seniors, community professionals, needs surveys, and the Weld County Area Agency on Aging Advisory Board. This plan is reviewed on an annual bases and revisions are made as needed. If you have additional questions, please contact Eva Jewell, Director of the Weld County Area Agency on Aging at 353-3800, extension 3331. 2006-3176 Attachment G STATEMENT OF INTENT The Four-Year Area Plan Is hereby submitted for Weld County Area Agency on Aging AREA AGENCY ON AGING (AAA) NAME 2B REGION For the period July 1, 2007 through June 30, 2011 This Area Plan includes all assurances plans under provisions of the Older Americans Act during the period identified. The Area Agency on Aging identified above shall assume full responsibility to develop and administer the Area Plan in accordance with the requirements of the Older Americans Act and related State regulations and policy. In accepting this authority, the Area Agency on Aging assumes responsibility to promote the development of a comprehensive and coordinated system of community services and to serve as the advocate and focal point for older persons in the planning and service area. The four-year area plan has been developed in accordance with the rules and regulations specified under the Older American's Act and Staff Manual Volume 10, and is hereby submitted to the Colorado Department of Human Services, Division of Aging and Adult Services for review and approval. SIGNATURES: zL�/a ,vr //-/j'l //-15—b‘o Director, DATE Chairperson, DATE Area Agen on ging Area Agency on Aging Advisory Council �� 11/20/2006 `Chairpe n, 'FI . . Geile DATE Governing Board of the Area Agency on Aging ATTEST: DO �4 EIJd/r't,` Weld ..unty Clerk to the t r. P186L 4,to BY: � IN a '4 I It( • Ir c: k • f D ty C 'rk to the B. ' P , O7696 -3/7G Weld County Area Agency on Aging 2B 1551 North 17th Avenue, P.O. Box 1805 Greeley, CO 80631 (970) 353-3800, Ext 3331 (970) 304-6442 (fax) C STATE OF COLORADO FOUR-YEAR PLANNING & SERVICE AREA AGING PLAN (PSAAP) TITLE III and TITLE VII OLDER AMERICANS ACT Federal Fiscal Year 2008-2011 (CALENDAR YEAR 10-1-07 TO 9-30-11) COLORADO DEPARTMENT OF HUMAN SERVICES AGING SERVICES UNIT 1575 SHERMAN STREET -- GROUND FLOOR DENVER, COLORADO 80203 303.866.2800 TABLE OF CONTENTS SECTION I: Executive Summary 2 SECTION II: Community Input and Stakeholder Involvement 4 SECTION III: Demography 5 SECTION IV: Targeting Programs 7 SECTION V: Strengths and Best Practices 9 SECTION VI: Trends from a Strengths Perspective 17 SECTION VII: Initiatives 18 SECTION VIII: Services and Prioritization 22 SECTION IX: Assurances 79 SECTION X Forms: 35 Attachment A: Four-Year Area Plan Service Projections Attachment B: Four-Year Area Plan Fiscal Projections Attachment C: Direct Service Waiver Request Attachment D: Meal Sites Attachment E: Community Focal Points and Senior Centers Attachment F: Regional Advisory Council Membership Attachment G: Statement of Intent Attachment H: Map- Location of Citizens over 59 Greeley/Evans Attachment I: Map-Location of Minority Citizens over 59 Southwest Weld County Attachment J: Map-Grandparents Raising Grandchildren Greeley/Evans Attachment K: Map-Grandparents Raising Grandchildren Southwest Weld Section I: Executive Summary The overall purpose of 2008-2011 Weld County Area Agency on Aging Four Year Plan is to help the Weld Area Agency on Aging and the Advisory Board determine how to best implement the Older Americans Act, while meeting the regulatory requirements of the Act, the identified service needs in a rapidly growing senior community all within the restrictions of a limited federal budget. This plan includes: an overview of the demography of Weld County, the primary target population for services, senior and community strengths, program best practices, strength based community trends, key initiatives, and programs that will be funded over the upcoming planning period. One of the first steps in the Four Year planning process was to obtain a clear understanding of not only the needs of the senior community but also the strengths that exist in the senior population and within their communities. The Colorado Area Agency on Aging, the Colorado Division of Aging and Adult Services and other community partners financed an extensive Statewide Strengths and Needs Assessment in 2004. Weld County Area Agency on Aging received not only valuable State information but also survey information that related directly to Weld County. This comprehensive survey and other local surveys, informal meetings and one on one contact with seniors and provider agencies, staff and board member input helped us craft the seven (7) key initiatives that will be used to guide the Weld County Area Agency on Aging over the next planning period. In addition, this process identified what services under the Older Americans Act would be funded or continue to be funded. The seven (7) initiatives that were identified are: • Emphasize the facilitator, leadership, coordination, advocacy and resource development role of the Weld County Area Agency on Aging, • Reduce the incidence of reported loneliness and depression by seniors, • Improve transportation resources for at risk seniors, • Increase dental, vision and hearing resources for low-income seniors • Improve access to Information and Assistance for Caregivers • Improve seniors awareness of medication access and general medication issues and concerns • Reduce hunger and malnutrition of seniors These seven initiatives and the actions step outlined in the plan are designed to address a significant number of needs and issues that were identified in the planning process. It is important to note that several of the initiatives listed are currently in the 2003-2007 Four Year Plan; however in most cases the actions steps have been revised or enhanced. The service programs that will be funded during this planning period (unless senior needs change or funding cuts occur) will focus on helping seniors remain independent and healthy in the community. The programs are also designed to empower and inform seniors and their family/friends of services choices within the community. 2 Below are examples of a few of the programs that will be funded during this planning period: • The Adult Day Services program (Eldergarden) not only provide respite to caregivers but also facilitates the possibility of helping the senior to remain in their homes or in their homes of family/friends and avoiding or delaying institutionalization. • The Senior Peer Counseling program (North Range Behavioral Health)helps address the need for senior mental health services in a creative community based manner. Peer counselors provide services directly in the senior's home and help address issues such as depression and isolation. • The Hispanic Senior Outreach program (Catholic Charities Northern) is designed to locate a very high risk population and provide them with information and services that will increase the possibility of remaining safe and independent in the community. • The Long Term Care Ombudsman program (in-house program) advocates for seniors who are no longer living in their homes but have moved to nursing home or assisted living. One of the roles of the Ombudsman is to help facilitate culture change within the nursing home environment. Once culture change truly occurs in facilities the residents are provided an environment in which facilitates choice and independence. The Area Agency on Aging will continue to explore opportunities to partner with traditional senior serving agencies such as RSVP's SHIP program but also to investigate the possibility of partnering with entities that have not been seen as a traditional partner. For example, in 2005-6 the Area Agency on Aging partnered with the local Lowe's and their national Hero's program. The Hero's program, with the assistance of the Area Agency on Aging, provided grab bars and carbon monoxide detectors to low income seniors. The Agency will also continue to educate policy makers and general public about the needs and concerns of Weld seniors and help Weld County communities to mobilize locally and address senior related concerns. 3 Section II: Community Input and Stakeholder Involvement The public hearing was held in the Weld County Department of Human Services during the Weld County Area Agency on Aging Advisory Board meeting on November 9, 2006 at 9:15 a.m. The hearing was made public through a press release to the Greeley Tribune, the leading newspaper in Weld County. A total of thirteen (13) individuals attended the meeting. The seven (7) key community initiatives were presented and ultimately approved by the Weld County Area Agency on Aging Advisory Board. The initiatives were developed from information that the Area Agency on Aging obtained from the current strengths and needs survey, the caregiver survey, an in-formal senior survey, community provider feedback, the rural senior coordinators and input from the Area Agency on Aging Advisory Board and from Area Agency on Aging staff The presentation was followed by a question and answer period. As was noted above, information used to establish the initiatives and service priorities was obtained in a variety of ways. The Weld County Area Agency on Aging Advisory Board members played a significant role by visiting a ten (10) senior centers/nutrition sites located throughout the county and meeting with seniors (over 500 seniors) in order to elicit their thoughts concerning not only senior service needs but also strengths that exist in their communities. On August 2, 2006, a meeting was held with the WELDCOs, an association of Weld County rural senior center directors. They provided feedback during the meeting and completed a written questionnaire addressing senior needs. On September 11, 2006, a meeting was held with the Older Americans Act providers in Weld County. They provided feedback and shared information concerning funding priorities and service needs Overall, the participants of the variety of meetings and onsite visits expressed positive comments concerning the availability of services in Weld County and of their own overall quality of life. The following is a brief highlight of the service needs that were identified by both the formal surveys and the multiple meetings and outreach efforts: • Affordable medication • Need for Chore Assistance • Accessible and affordable transportation • Caregiving assistance in form of respite and information and assistance • Services to address loneliness and depression • Dental/Vision/Hearing assistance • Affordable senior housing countywide • Affordable in-home services 4 Section III: Demography Population Profile The total population of Weld County, according to the 2004 population estimates from the Colorado Department of Local Affairs Demography Section is 217,780. Below is an overview of the key areas of interest regarding the population distribution of older adults in Weld County. Overall the population of Weld County has increased over the last several years with special attention to the number of 75+ and minority elderly. In addition, according to the finding in the Weld County Strengths and Needs Assessment Weld County's older adult population is expected to grow by 13, 442 or 60.1% (22,368 to 35,810) between 2000 and 2012 2004 Population Estimates for Weld County Colorado Department of Local Affairs Demography Section 60+ 75+ 60+ 60+ 60+ 60+ Total Poverty Minority Poverty Rural Population (Primarily and Hispanic) Minority 25,591 8,296 2,303 3,623 519 7,659 217,780 12% of the 32% of the 9% of the 14% of the 2%of the 30% of the total senior senior senior senior senior population population population population population population Weld County consists of 31 incorporated municipalities. Five (5) municipalities have annexed portions of Weld County over the last 10 years, such as the City of Longmont and services are primarily provided by their principal counties. Weld County also has several unincorporated small communities such the community of Carr. Weld's communities vary in size (based on the 2000 census) from 97 for the town of New Raymer to 16,280 for the town of Evans; Greeley's estimated population is 85,887, according to the 2005 population estimates from the State Demographer's Office. Geographic Profile Weld County is located on the eastern plains of Colorado, north and east of Denver and is 3999 square miles in size. Greeley, the county seat and major city, is located in the east central portion of the county, approximately 60 miles northeast of Denver and 50 miles south of Cheyenne, Wyoming. Greeley, whose population is over 85,887, serves as a regional hub for medical, educational, employment and retail needs for most of its residents. However, residents of south Weld County tend to conduct business in Brighton, Longmont, Boulder, and the Denver suburbs. 5 The twenty five (25) small towns (not including Greeley) and villages (unincorporated areas) ranging in population from 97 to 16,280 are situated primarily in the west and central and southern portions of the county. There are no major geographical bathers between these communities other than distance. Often services are difficult to deliver to these communities because of the cost of transportation or the cost of stationing human services workers in all of the rural communities. The most isolated communities are located in the far northeastern sectors of the county (See Attachment H). Here residents often transact business in towns across the border in Wyoming and Nebraska. Also, winter storms bring ground blizzards which are hazardous for residents living in small towns and ranches in northeast Weld County. Weld County Demography and the Impact on Service Prioritization and Provision According to the August 22, 2006 article in The Greeley Tribune, the Greeley metropolitan statistical area is the second fastest growing area in the United States. It is important to note that the Greeley metropolitan statistical area includes all of Weld County. To place this growth into perspective from 2000-2005 the Greeley area grew 26.5 percent while Las Vegas only grew 24.3 percent. Unfortunately, the Area Agency on Aging is unable to serve all seniors in need and if Federal and State funding patterns remain the same over the next five years we will fail serve even larger number of seniors. Knowing and understanding these limitations in funding we must continue to focus on seniors in greatest need through our outreach, targeting efforts and partnerships in the community all the while maintaining the spirit of the Older Americans Act. The type of services that the Weld County Area Agency on Aging will fund during this Four Year Planning cycle is dictated largely by the Older Americans Act requirements; however how the delivery system is designed is determined by the local agency staff and boards since they have the greatest understanding of local strengths and needs. For example, to reach the greatest number of both rural and urban seniors in the Senior Nutrition Program there are 21 meal sites located throughout the county (six sites located in Greeley and fifteen located outside of the Greeley city limits). We also have programs that focus on specific regions of the county where we believe our target population resides (Hispanic Senior Outreach Program in South County- See Attachment I). Also, the majority of grandparents raising grandchildren, based on the 2000 census reside in the Greeley/Evans area (See Attachment J) but according to our informal questionnaire we received requests from the Ft. Lupton area to form a grandparent support group (See Attachment K). We will explore the possibility of facilitating the formation of a south county support group. These types of approaches are both time and cost effective and allow the services to be more effectively distributed around the county. 6 Section IV: Targeting Programs The Older Americans Act states that "preference and priority" must be given to: • Consumers with greatest social need; • Consumers with greatest economic need; • Low-income minority consumers; and • Consumers residing in rural areas. Note: Weld County Area Agency on Aging is not required to develop special outreach activities for Native American Elders since we do not meet the population requirement. Based on the 2004 Weld County Population Estimates approximately 2,303 seniors are in greatest economic need, 519 senior are low income minority, and 7,659 seniors live in rural Weld County. The number of seniors in greatest social need remains difficult to estimate since the U.S. census does not capture this data as a stand alone category. Social isolation can take many forms. For example, a senior in greatest social need may be a grandmother raising several grandchildren who is now feeling socially isolation due to her new parenting responsibilities and is experiencing a sense of disconnection from friends and other social support networks. The challenge of the Area Agency on Aging is to successfully reach all of these populations in a fair, cost effective and meaningful manner. In order to reach all target populations, programs that have the greatest flexibility such as the Senior Nutrition Program are located in a variety of sites in the county. For example, nutrition programs are set up in low income senior housing through out the county. The clients who reside in these housing units clearly meet the targeting goal of the Area Agency on Aging. Other programs such as the Hispanic Senior Outreach Program and the Peer Counseling Program are designed to provide service to our targeted population. Each service provider is also required by contract to focus on outreach efforts that address our target populations. No client will be refused services unless they do not meet the requirements under the Older Americans Act or funds are not available to provide the requested services and will be placed on a wait list according to the agency's or provider's wait list policy and procedure. The following targeting efforts will either be maintained or initiated during this planning period unless not found to be effective: • Maintain the funding of the Hispanic Elderly Outreach Program. The goal of this program is to identify and assist isolate and at risk Hispanic seniors in rural Weld County by providing information and assistance. • Maintain the funding of the Senior Peer Counseling Program with North Range Behavior Health. The goal of this program is to provide mental health support to seniors who are dealing with issues such as: stresses of isolation, loneliness, loss and/or health issues. 7 • Maintain the Grandparents raising Grandchildren Program, staffed in-house but coordinated with the assistance of a community task force of grandparents and a sundry of community agencies such as the Department of Social Services, Weld County School District, Catholic Charities Northern and many more. • Maintain requirements in provider contracts that address the need to maintain outreach efforts and to serve identified target populations. All contracts include specific targeting goals and numbers that are adjusted annually to reflect current population estimates. • Maintain senior nutrition programs within Section 8 senior housing in Greeley and surrounding communities in Weld County. Currently we are providing senior meals in five (5) senior housing units. • Distribution of posters and flyers in English and Spanish informing the public of the existence of the Weld County Area Agency on Aging and available services. • Maintain minority participation on the Area Agency on Aging Advisory Board. • Maintain the Options for Long Term Care Program (otherwise known a Single Entry Point) within the umbrella of the Weld County Area Agency on Aging in order to provide a seamless process for provision of services to frail and at risk seniors. • Increase the visibility of the Weld County Senior Health Fair to rural seniors by expanding the media options used to advertise the Annual Senior Health Fair. • Maintain the technical support that is provided by the Weld Area Agency on Aging staff to the rural senior coordinators (the WELDCO's Senior Coordinators) through monthly meetings and a variety of training opportunities. The Senior Coordinators play a key role in the provision of information and assistance to senior community wide. • Participate in the Weld County Health Media committee. The focus of the committee is to enhance Weld County residents' awareness of health related issues such as obesity, diabetes, exercise, disease prevention and other topics through local media options. • Develop stronger relationships with the faith based community through educational outreach efforts. 8 Section V: Strengths and Best Practices A number of methods have been used over the last two years to determine not only the service or resource gaps in our community but also the strengths that lie within the community. The real question for the Area Agency on Aging is how the existing community strengths can be used to facilitate the improvement or development of needed senior services. Below is an overview of the strengths that were identified by seniors who participated either in a formal survey process or attended a variety of group meetings, or were asked one on one what they thought were the strengths found in their community. A. Strengths Overview Strengths and Needs Assessment of Older Adults in Weld County September 2004 In April and July of 2004 8,903 Colorado seniors completed a 20 minute phone survey that was designed to discover the strengths and needs of older adult. Each of the sixteen (16) Area Agencies on Aging was provided statically sound information specifically for their region. In Weld County the total number of surveys completed was 375. The results of the survey were grouped in four major categories: basic needs, physical and mental health and well-being, social and civic engagement and maximum independence for frail and disabled seniors. In each category both strengths and concerns were identified. The following is an abbreviated overview of the finding: A. Basic Needs: Strengths 1. Housing • 92% of seniors 60+ reported having no problem having housing suited to their needs • 78% of seniors 60+ own their own home • 66.3% of seniors 65+ live in family households with a spouse or other relative • 91% of seniors 65+ want to continue to live in their own homes for a long as possible. 2. Finances • 73% of seniors 60+ stated that finances had been no problem in the past year • 70% of seniors 60+ stated that they had no problem affording needed medications • 96% of seniors 60+ stated that they had not had a problem affording enough food to eat. 3. Safety • 97% of seniors 60+ stated that they have not been physically or emotionally abused in the past year • 94% have not been a victim of crime in the past year 9 • 87%have not been financially exploited in the past year 4. Nutrition • 94% stated that they did not have a problem having enough food to eat in the past year • 96% stated that they were able to afford enough food to eat B. Physical and Mental Health and Well-Being 1. Mental Health • 73% of seniors 60+ stated they have not had feeling of depression over the past year • 78% stated that they have not felt lonely, sad or isolated in the past year • 98% state that they are generally happy 2. Health • 43% of seniors 60+ stated their health is excellent or very good • 47% stated that their physical health has not been a problem for the past year • 92% stated they had been to their doctor or health care provider • 61% had a dental exam • 63% had an eye exam • 20% had a hearing exam • 86% engaged in moderate physical activity 3. Well-Being • 85% of seniors 60+ rated their quality of life as very good or good • 93% agreed that their community values their language and traditions • 86% agreed they were willing to ask for and accept help form others • 95% were satisfied with the relationships in their life C. Social and Civic Participation 1. Participation • 58% of seniors 60+ stated that they participated in a least one of the following activities: volunteering, employment or caregiving • 92% stated in a typical week they visit with family or friends in person or on the phone 2. Social Support • 59% of seniors 60+ stated during a typical week they spend some time providing help to friends or other relatives • 81% agree their family and friends rely on them • 89% agreed their community values seniors • 94% agreed that they could handle about anything that life throws at them. 10 D. Maximum Independence for Frail and Disabled Seniors 1. Assistance with Everyday Activities • 77% of seniors 60+had no problems performing everyday activities in the past year • 54% are able to do heavy house work • 52% can do interior or exterior repairs without problem • 58% can do yard work and snow shoveling with out help • 97% are able to mange their medications without any help • 94% are able to prepare their meals without any help 2. Transportation • 90% of seniors 60+ stated having they did not have problems with inadequate transportation in the past year • 89% needed no help getting or arranging transportation • 94% stated that they did not have difficulty arranging transportation for medical trips in the past year • 95% stated that ye did not have difficulty arranging transportation for shopping or for recreational or social trips 3. Caregiver Support • 54% of caregivers 60+ did not feel burdened in the past two months by their caregiving role • 18% of seniors 60+ stated they provide care for one or more family members or friends on a regular basis. Local Questionnaires The Area Agency on Aging developed a brief questionnaire that encompassed both strengths based and needs based questions. These questionnaires were given to the twenty one (21) rural senior center coordinators and were also used more informally with seniors who attended functions such as the senior nutrition program at the senior or recreation centers through out the county. Area Agency on Aging Board members and Area Agency on Aging staff went to multiple meal sites and visited with seniors one on one or in small groups in order to elicit information. The same general set of questions was also used with key provider agencies. The following is a summary of the strengths that were identified: 1. Positive comments from seniors (and service providers) regarding their community (Note: seniors comments most frequently referred to their town or city verses Weld County): • Available Senior housing • Access to the county transportation system • Great Senior Center 11 • Grocery store that provides home delivery service • Pharmacy that provides home delivery service • Good doctors and medical facilities • Senior Nutrition Meals • Weld County Area Agency on Aging • Community churches • Bookmobile • Recreational trips through the senior center • Senior Shape Up classes • Loan Closet • Good law enforcement • Easy access to DIA • Positive working relationship between the senior servicing agency network • The availability of student interns from the University of Northern Colorado • Responsive fire department and paramedics • Community Food Bank 2. Strengths seniors offer the community: • Seniors providing support to other seniors • Community volunteering • Knowledge gained by age that can be shared with the younger generation • Committees organized and run by seniors 3. Why seniors like living in their communities: • Small town • Low crime rate • Paved roads • Strong sense of community • People willing to help each other in times of need • Affordable • Good schools • Assortment of churches • Located nearby larger communities • Friendly people • Location • Dynamic community • Great recreation center • Golf course • Good volunteers • Mild climate • Close to their children • Quiet and peaceful community • Good neighbors 4. How seniors find out about senior services: • Newspaper • Chamber of Commerce 12 • Senior events • Mailing from senior centers • Senior Centers • By word of mouth • Senior publications • Recreation Center • Area Agency on Aging's Resource directory • Senior Coordinator • Town Hall • Staff from durable medical supply companies • At the senior nutrition meal Overall, the surveys show that many seniors are feeling very comfortable in their communities and are living active and very productive lives. The strengths Weld County seniors have outlined include strong family and friendship support systems, strong connection to their faith based community, easy access to many services including grocery stores, physicians, hospitals and they have also stated that they are in overall good health. These strengths and others are very important if and when a senior experiences a change in their health or financial situation that threatens their independence. We know that seniors who have many strengths in their lives deal more successfully in times of difficulty than those who have few informal support systems. The role of the Area Agency on Aging is to encourage the development of the informal support system and to develop services that will help sustain the informal support systems. In addition, the Area Agency on Aging must also identify those seniors who are at greatest risk of not having these informal support systems and provide services that will provide the opportunity to maintain the senior in the community as long as possible. The needs or gaps that have been identified through formal surveys and questionnaires and various informal group meetings are addressed in Section VII Initiatives and Section VIII Service and Priorities. B. Health Promotion and Disease Prevention Programs Eight Annual Weld County Senior Health Fair Several years ago a committee was formed to evaluate the effectiveness of the multiple senior health fairs that were occurring in Weld County. Many of the events were poorly attended and were frequently in competition with each other. The committee of interested agencies agreed that due to everyone's limited resources and the lack of success of the multiple fairs that the committee members would join forces and sponsor one senior health fair in the fall of each year. The cost of the event is covered through partnerships with leading business and agencies in the community and Part D of the Older Americans Act. The primary goal of the Senior Health Fair is to expose seniors not only to a variety of senior service resources but also to free health screens including such items as: Blood 13 Pressure Screening, Vision, Hearing, Depression and Anxiety Screening, Diabetes Awareness, Glucose level Screening etc. The Senior Health also provides at a nominal fee a wide variety of blood work that will provide key information about a senior's health status. In addition, flu, pneumonia and tetanus vaccinations have been made available at no cost for seniors who have Medicare Part B and at market price for who do not have health insurance coverage for vaccinations. The Senior Health Fair committee, in recent years has focused on reaching younger seniors in hopes of encouraging health lifestyles changes and disease prevention. The committee has also provided, through vendors and presenters, in depth information concerning diabetes since Weld County has a high number of diabetics or boarder line diabetics (disease management). These types of changes will continue to occur as the needs of our community change. Other Health Promotion and Disease Prevention Activities The Health Care Committee, a subcommittee of the Weld County Area Agency on Aging Advisory Board meets on a regular basis to outline new Part D programs that meet the objectives of health care related initiatives identified in the four year plan. In the last year projects such as medication awareness trainings to senior who attend the multiple senior centers through out the county was provided. In addition, extensive work was done in developing partnerships with the University of Northern Colorado's nursing program and nutrition program to encourage student internships with the Area Agency on Aging and senior centers, especially in rural Weld County. During this new four year planning period activities such as these will continue to occur. C. Weld County Area Agency on Aging's Best Practices The following four programs are examples of programs that have been very successful and have creatively addressed a variety of needs within the Weld County community: Grandparents raising Grandchildren Program The Weld County Area Agency on Aging formed a Grandparents Raising Grandchildren Task Force several years ago to raise community awareness about this growing and diverse population, provide support and tools to grandparents to help them raise their grandchildren and to improve the quality of life for grandparents. Based on the 2000 census Weld County had almost 3,500 children living with grandparents and there are indications that this number has continued to increase. The task force provides materials in English and Spanish, and offers support groups, a resource library, annual conferences, free legal clinics and information and assistance. Task force members represent more than a dozen community agencies, including the county health department, school district, social services, legal services, a parent education organization, Catholic Charities, the Weld County Area Agency on Aging and several grandparents who are raising their grandchildren. This program is currently being funded by Part E Family Caregiver dollars and significant in-kind support from the other task force members. 14 This program obtained national recognition when it received a National Association of Area Agencies on Aging (n4a) Aging Achievement Award: Intergenerational Category in 2005. Peer Counseling Program Over twenty-five years ago the Weld County Area Agency on Aging developed a non- traditional partnership with the local mental health care agency that addressed the mental health needs of some older adults. Older adults who are having difficulty with major changes in their lives such as health care changes, loss of partners and friends, retirement frequently do not reach out to formal mental health services. They are afraid of being labeled as mentally ill and are embarrassed that they are unable to cope with late life challenges. The peer to peer paraprofessional counseling program became a viable option that seniors were more apt to accept. The peer counselors are supervised by a licensed counselor and are provided ongoing relevant training. The peer counselors are paid employees of North Range Behavioral Health and have a wide variety of backgrounds and education. Many of the counselors are retired university professors, former community agency directors, counselors, etc. The peer counselors have stated that they feel that they are valued and needed and that make a difference in seniors lives. Vale Program/Long Term Care Ombudsman The Weld County Ombudsman Program has successfully obtained the Victim Assistance Law Enforcement (V.A.L.E.) Grant for 10 years, 1996-present. The V.A.L.E. funding originates from penalties paid by convicted criminals. The purpose of the V.A.L.E. grants is to provide a variety of services to potential or actual victims of crime. Older adults living in the long term care system are clearly an at risk group who unfortunately have been victimized not only by long term care staff but also members of the community at large. In Weld County over the last six years two elderly female residents were sexually assaulted and in both cases the perpetrator was caught and prosecuted. The V.A.L.E. grant has allowed the Weld County Ombudsman Program to increase staff time to keep up with the increasing demand for advocacy on behalf of residents who reside in nursing homes and assisted living facilities. By maintaining a consistent presence in these facilities, the Ombudsman has built trusting relationships with residents and staff. The funds have also enabled the program to maintain and abuse prevention and awareness program aimed at educating Certified Nursing Assistants and other long term care staff. Single Entry Point (Options for Long Term Care) In the late 1980's the Weld County Area Agency on Aging was one of several sites within Colorado that received AOA funding through Colorado's Aging and Adult Services unit to develop a case management program. The case management program was designed to provide services to at risk seniors who needed assistance accessing services in the community. During the multi-year grant period plans were made to expand the target population and explore other funding sources for case management services. 15 By 1989 the Area Agency on Aging contracted with the Weld County Depaitinent of Social Services to provide case management services for the Home and Community Based Services Elderly, Blind and Disabled waiver and in 1993 the Area Agency on Aging was designated Single Entry Point for Weld County. Housing the Single Entry Point (Options for Long Term Care) within the umbrella of the Weld County Area Agency on Aging has been very successful and cost effective. Clients are easily referred between program areas and staff members are aware of the programs that are available from a variety of funding sources. Also, this program design has the potential of incorporating the Aging and Disability Resource Center concept. If funding for these centers become stable, services such as case management or enhances information and assistance for clients who do not qualify for existing service options could become available through the Area Agency on Aging. 16 Section VI: Trends from a Strengths Perspective According to the current surveys completed, seniors overall find Weld County a good place to live. Weld County, even with the current growth, remains primarily rural and seniors have indicated that they enjoy living in the smaller communities in the county. Seniors wanting or needing more variety of services have easy access to the Greeley/Evans area where many additional service options exist. Below are a few of the positive trends that are currently occurring in Weld County that are affecting the lives of seniors: • The most significant regional trend impacting Weld County is growth. Most small rural Weld communities whose population has remained fairly stable for many years are experiencing growth such as the community of Tri-town area, Windsor, Mead, Erie and many others. The growth has been occurring over the last several years and was noted by seniors in the 1998 Needs Assessment of Weld County Older Adults. At that time 28.6% of respondents cited growth as the most pressing problem facing Weld County. Many of the respondents were concerned that unbridled growth would cause living expenses to rise and force fixed-income persons into poverty. Many others were concerned about the loss of farm land to housing and industrial expansion. Now eight years after the 1998 needs assessment was completed we continue to see growth in Weld County and seniors continue to express concerns that the growth is impacting the community in many ways. Water issues and loss of farm land are two of the ongoing concerns. However, there are positive aspects of growth. With growth comes an increased diversity of services within a community. Weld has seen a steady increase in the number of business from large grocery stores and restaurants to multiple home health care agencies and other health related businesses. More options translate into more choices for seniors and their family and friends. • Colorado's most recent available unemployment rate is slightly higher at 4.8 percent; however, statistics from Colorado's Department of Labor and Employment show that Weld County has gained jobs. The biggest increases are in fields that grow as population increases, such as construction and health care. This economic strength not only results in the additional options a community has to offer to seniors(as was noted in the first bullet) but may also offer job possibilities for seniors who are in or want to return to the work force. • In the last few years several Weld County communities have invested in the construction of multi-purpose community/recreation centers. These centers will help us provide services to all seniors but will hopefully attract the new seniors who have demonstrated an interest in diverse activities including travel and exercise programs and other health oriented activities. 17 Section: VII: Initiatives The Weld County Area Agency on Aging has identified seven (7) community initiatives to focus on during the next four(4) years: These initiatives are intended to address several significant needs or service gap findings from the 2004 Strengths and Needs Assessment, the 2002 Caregiver Needs Assessment and the 2005 Weld County White House Conference on Aging, staff, advisory board, providers and general public input. (1) Emphasize the facilitator, leadership, coordination, advocacy and resource development role of the Weld County Area Agency on Aging. Issue: Area Agencies on Aging do not have and will not have the financial resources to address all of the unmet needs of older adults in our planning and service areas. Area Agencies do, however, have over twenty (25) years of experience in planning and organizational activities to help organizations and communities improve the quality of life of older adults and respond to the most serious unmet needs of the most frail and isolated elder. How Issues will be addressed: • Increasing community-wide education/training, opportunities to the public on a wide variety of aging issues (i.e. medications, caregiving issues, senior empowerment etc) • Partner with other community organizations to help address gaps in the long term care system • Seek out best practice models and implement programs that are feasible • Explore grant writing opportunities with both local and national funding sources • Increase the visibility of the AAA by updating current media plan • Improve the AAA's infra-structure in order to more adequately meet the administrative needs of the agency and improve the agency's ability to serve the Weld County community by allocating a reasonable percentage of new dollars on infra-structure development over the next 4 years. • Develop a partnership with emergency response entities and other appropriate agencies (such as: American Red Cross, Weld County Public Health, Weld County Office of Emergency Planning, United Way of Weld County etc.) to address senior needs and clarify the role of second level responder agencies. • Continue to effectively advocate for senior needs with local, state and federal elected officials. • Explore the concept of"Livable Communities" and determine Weld County's readiness by using tools such as The Maturing of America: Getting Communities on track for an Aging Population study. 18 (2) Reduce the incidence of reported loneliness and depression by seniors. Issues: The issue of loneliness was reported by 22 percent of older adults 60 plus as a problem and 27 percent stated that depression was a problem for them. Pervasive loneliness can be the root cause for depression and many physical health problems. How Issues will be addressed: • The Area Agency will continue to allocate non-federal funds to projects designed to find creative approaches for increasing connections between communities and lonely and isolated seniors. • Maintain funding to the Peer Counseling Program through North Range Behavioral Health • Maintain a strong working relationship with Retired Senior Volunteer Program (RSVP) and encourage seniors to participate meaningful volunteer activities. (3) Improve transportation resources for at risk seniors. Issue: Ten (10) percent of adults 60+ stated having inadequate transportation during the past year. How Issues will be addressed: • Overall marketing of transportation options must be increased county-wide. The Area Agency on Aging will continue to work closely with the Weld County Transportation Department and support their efforts in seeking additional transportation funding from the Colorado Department of Transportation and other appropriate funding sources. • Work closely with rural senior centers and assist them in developing local community options. • Investigate the possibility of developing a more formal volunteer transportation program than currently exists in Weld County. (4) Increase dental, vision and hearing resources for low-income seniors. Issues: Weld seniors (7.2%) reported in the 1998 Needs Assessment that the most common health service they had difficulty procuring was dental care. The most common barrier to dental care is cost. Unresolved dental problems decrease the quality of life of an older adult by decreasing food choices and overall nutritional intake, decreasing socialization particularly when associated with eating activities and by increasing exposure to discomfort and pain. In addition, in the 2004 Strengths and Needs Assessment 4% of the respondents indicated a need for eye glass assistance and 2% needed assistance with hearing aides. 19 How Issue will be addressed: • The Area Agency will look for non-federal funding to provide funding sources for seniors who are unable to pay for their dental needs. • Will maintain current dental/vision/hearing program (if funding remains available) • Refer clients to programs such as the Old Age Pension Program when appropriate. (5) Improve access to Information and Assistance for Caregivers providing care to older Adults and Grandchildren Issue: According to the 2002 Caregiver Needs Assessment, caregivers are in need of a central source of information easily obtain guidance and information about medical conditions, mental health concerns, senior programs and services. In addition, according to the 2004 Weld Strengths and Needs Assessment, over one-half of the caregivers indicated that they felt burdened by their caregiving duties over the past two months. How issue will be addressed: • Research clearing house models and chose a model that can be reasonably replicated at the AAA • Enhance current marketing plan that will be cost effective and reach a broad base of caregivers • Maintain training workshops that will address the need for caregiving skill enhancements • Maintain the Respite Voucher Program to address the need of respite services • Maintain community based educational efforts that address the growing issues and needs of grandparents raising grandchildren. • Develop "Caregiving Relief Missions"within the faith based community. This program is designed to train members of the church congregations to provide respite or relief services to caregivers either within their own churches or in the community. (6). Improve seniors awareness of medication access and general medication issues and concerns Issue: Seniors are experiencing many types of issue concerning medications. Some seniors are finding it difficult to obtain medications due to cost. Others are obtaining medications but are not using them as prescribed. Misuses are also occurring with supplements and other over the counter medications. 20 How the issue will be addressed: • Enhance staff knowledge of the changes in the Medicare Part D program by attending all appropriate local trainings • Provide information to seniors concerning the changes in Medicare Part D and how seniors can enroll in Medicare Part D plans. • Enhance the relationship between the Area Agency on Aging and the local SHIP program by providing the SHIP counselors with in-kind office space and supplies and computer access during the Medicare Part D enrollment periods • Provide information about existing medication assistance programs, as needed • Provide community training on medication management and awareness of the dangers and usefulness of supplemental vitamins, herbs etc. • Promote senior participation in community wellness programs in order to avoid chronic illnesses resulting in the need for medication (7) Reduce hunger and malnutrition of seniors. Issue: Eighteen percent of older adults 60+with incomes less than $15,000 annually report not getting enough or the right kinds of food to eat and 6% of all older adults reported not having enough food to eat. How this issue will be addressed: • Develop a strong partnership with the Weld County Food Bank and local community Kitchen Pantries. • Increase the community's awareness the Senior Nutrition Program and the Meals on Wheels program. • Increase older adults' awareness of the food stamp program and other food assistance programs in the community. 21 Section VIII: Services and Priorities Services and priority planning and development for the Weld County Area Agency was based on the information obtained from the 2004 Strengths and Needs assessment, the 2002 Caregiver Needs assessment, 2002 Grandparents Caring for Grandchildren needs assessment, the senior serving network, senior groups, AAA staff input, funding limitations and the required program options dictated by the Older Americans Act. The programs that we anticipate funding over this planning period will not be significantly different from the current four year plan program areas due to little change in overall identified senior needs or service gaps. Every four year the Weld County Area Agency on Aging releases a Request for Proposal (RFP) for all major program areas that are not provided directly by in-house staff. The RFP process is outlined in the Area Agency on Aging policies and procedures and the RFP packet clearly outlines the expectations of the potential provider agency and the goals and the objectives of the specific programs that the Area Agency on Aging and the Area Agency on Aging Advisory are interested in funding. The Weld County Area Agency on Aging Advisory Board committee plays a significant role in the evaluation of the RFPs and the allocation of designated funds. Below is a detailed outline of the services areas that will be funded during this Four Year Planning period, if funding remains stable and continues to be a needed service. Programs that are available through the Weld County Area Agency on Aging but not funded by the Older Americans Act are also included in the plan but they are clearly identified as programs funded through other funding streams. Information and Assistance The Area Agency on Aging will ensure that all older persons within Weld County have reasonable and convenient access to information and assistance about services through the following means: • Ongoing training will continue to be provided to in-house staff so that they will be able to provide current and timely senior related information and assistance to the community. The staff will also continue to work closely with United Way 211 to insure that the 211 system has the most current AAA program information and will continue to respond quickly and timely to all callers who are referred to the AAA by the 211 staff. • The AAA staff will continue to provide training and assistance to the rural senior coordinators (WELDCOs) who are located in nineteen (19) rural senior aide stations throughout Weld County. The rural senior coordinators are well known to seniors in their communities and are in a position to provide information and assistance to seniors in a cost effective and timely manner. The rural coordinators are either made employees of the towns/cities they are located in or are dedicated volunteers. 22 • Based on the information obtained from the surveys completed in 2002 and the 2004 the community remains in need of general and specific types of information related to older adults. Special attention will be paid to the needs of caregivers (including grandparents raising grandchildren) and the emerging baby boomer population over the next 4 years. • Disseminate information to the community at large through multiple forms of media including the 50+Marketplace News, the Greeley Tribune, local rural weekly publications, local radio stations, agency service directories, agency program brochures etc. In addition, the AAA will support or form partnerships with other agencies to make workshops and trainings available to the general public on topics that address current senior issues or needs. Outreach Services The Area Agency on Aging will ensure that outreach efforts are conducted throughout Weld County to identify older persons and to inform them of the availability of services by: • Designate a minimum of one trained, bilingual Area Agency staff person for one on one outreach and for Spanish interpretation services as needed and appropriate. • Maintain the Hispanic Elderly Outreach Program: a contracted service with Catholic Charities of Northern Colorado. The contractors responsibility will continue to be to identify isolated and at risk Hispanic seniors (and other minority seniors) and provide information and assistance regarding community services to enable the seniors to remain independent in the community. • Training rural senior coordinators on outreach techniques and provide incentives for local communities under the leadership of their rural senior programs to identify and maintain continuous contact with all seniors with particular emphasis on the oldest, most frail, minority and homebound. • Providing technical assistance to wide range of community leaders including church leaders, service clubs, elected officials, and other volunteer organizations on the implications for health and well being of seniors who feel lonely and isolated. 23 Transportation Services According to the 1998 Needs Assessment of Weld County 60 plus, 4.4% indicated that they currently experience times when they need to go somewhere but stay home because they have no means of transportation. This is particularly true for females, elders of color, those below poverty and the 81 plus. The transportation barrier was reported to affect the ability to see a doctor, go shopping, attend religious activities, and attend other activities such as a senior center or library. The 2004 Strengths and Needs survey identified 1, 532 ( 6% ) seniors that stated they had difficulty (frequently or sometimes) arranging transportation for medical trips in the past year and 5% reported difficulty arranging transportation for recreational or social trips. We anticipate as the senior population continues to increase (specifically the 85+) service needs will rise and there will be a need to increase transportation services. The Weld County Area Agency does not provide Older American Act funding for transportation. Instead the County uses Community Services Block Grant (over $95,000 annually) for senior transportation; however the Area Agency on Aging staff continues to works closely with the Weld County Transportation Program concerning transportation needs. The Weld County Area Agency on Aging will: • Increase awareness (through outreach efforts) of specific transportation options available to seniors and how to access the service— specifically demand-response service offered by the City of Greeley and the Weld County Mini Bus services • Coordinate more closely with other transportation systems, particularly the City of Greeley and neighboring counties' transportation programs. • Encourage public officials in rural and urban communities to actively address the current and future transportation needs of the seniors residing within their towns and cities. In-Home Services The Area Agency on Aging will provide in-home services (through provider contracts) to seniors in the community to help them remain in their own homes with a maximum degree of independence and choice by: • Maintain funding for homemaker and personal care to frail seniors who have no other source of third party reimbursement for such services and who cannot financially afford the full cost of the service. The amount of Area Agency on Aging funds allocated to this program continues to fall short of the true needs in the community however the current AAA contract provider continues to explore additional funding partners in order to serve additional seniors. 24 • Maintaining funding for in-home one on one peer counseling (seniors helping seniors) services to at risk seniors. Providing counseling in a home setting verses office or mental health center has been a very successful with the senior population who frequently does not access mental health services. This service addresses issue related to loneliness, isolation and loss and other life changes that impact many seniors. This creative partnership with North Range Behavioral Health has been in place for over 25 years and continues to remains dynamic and relevant to seniors today. • Colorado Options for Long Term Care Program or SEP (Single Point of Entry) which gives community based long term care options to persons qualifying for Medicaid and passing a medically needy screen. Maintaining the Options for Long Term Care within the Area Agency on Aging increases the likelihood that clients (many who are the most disabled, frail and low income in the community) are referred appropriately and quickly to the appropriate AAA program or service Legal Assistance Services The AAA will continue to maintain a paralegal on staff under the supervision (by contract) of a qualified attorney to provide advice and consultation to older adults with economic and social needs. Since the paralegal is a member of the AAA staff all seniors requesting legal assistance are either received directly by the paralegal or staff forward the appropriate calls to him. The paralegal consults with the supervising attorney on regular basis (and as needed). Based on the 1998 Needs Assessment and the 2002 Caregiver Assessment seniors are requesting assistance regarding legal issues. Due to the cost of these services in the community, many seniors would be forced to go without this type of assistance if these services were reduced or eliminated. Ombudsman Services The Area Agency on Aging will maintain the ombudsman program in-house. The Lead Ombudsman will report to the Area Agency on Aging Director and will have all the authority vested by the Federal Older Americans Act and State of Colorado Statutes to carry out the activities of a long term care ombudsman. Oversight will include seven (7) Weld County nursing homes and seventeen (17) assisted living facilities. A team of approximately three- four volunteers (3-4) will be trained and supervised to assist the Lead Ombudsman and her staff. Current level of staffing allows the Ombudsman team to meet all the current requirements of the Ombudsman Program. In an effort to protect the rights of senior in long term care facilities and stretch limited resources, the Ombudsman program works closely with the Department of Social Services' Adult Protection team and other community groups by: 25 • Maintain membership on the Weld County Adult Protection Networking Team • Coordinate with local groups such as TRIAD on elder abuse education activities • Train staff and the aging network and the general public on the referral procedures to adult protection. • Participate in community victim advocacy groups • Maintain funding from V.A.L.E Disease Prevention and Health Promotion Services The AAA will participate in community efforts to promote disease prevention by: • Educating the community on health care issues of seniors as per the assessment results or more current requests • Coordinating with North Colorado Medical Center and other key agencies to provide a Senior Health Fair in the fall of every year • Promoting, through the Weld rural senior coordinator system, health related activities and encouraging the development of more health related activities at the senior centers throughout the county • Provide educational opportunity concerning medication issues and other relevant topics Nutrition Services The AAA will make awards for congregate and home delivered meal services that will have the capability of serving Weld County by: • Maintaining a financial contract with the local home delivered meals provider to serve hot meals Monday through Friday and frozen meals for reheating on weekends and some rural communities - available in Greeley and through two satellite sites in South Weld County. • Maintaining a financial contract with the University of Northern Colorado Food Service to prepare hot meals for delivery throughout Weld County to 2ldesignated congregate meal sites. • Contracting with Weld County Transportation Program to deliver meals in bulk to congregate meal sites throughout Weld County. • Maintaining the in-house part time registered dietitian to develop menus and provide nutrition education and counseling to meal participants. • Maintaining and supporting the Area Agency on Aging staff who will continue to provide the oversight needed to insure that the senior nutrition program meets the federal and state guidelines. 26 Advocacy, Coordination, and Program Development Emphasis will be placed on these activities with the clear intent of strengthening the Area Agency on Aging's leadership and technical assistance role to Weld communities. The Area on Aging believes more time and resources must be directed to enabling and partnering activities that could result in creative community approaches for helping elders and their caregivers. Therefore the Area Agency on Aging will: • Redirect resources as available and appropriate to give greater support to advocacy, coordination, and program development activities. Other Optional Support Services • Maintain funding for adult day care services to provide a safe and secure environment for frail seniors who are trying to remain either in their own homes or in the homes of family members and avoid inappropriate nursing home or assisted living and provide respite services for caregivers. • Peer Counseling Program (see in-home section above) • The Area Agency will continue to sponsor the Options for Long Term Care Program serving approximately 700 frail, low-income, at-risk seniors and disabled individuals. • The Area Agency on Aging will continue to support a .35 FTE rural senior center technical advisor using Community Service Block Grant funds (CSBG). This position plays a key role in providing education and technical assistance to all rural senior site coordinators. • Support through non-federal funds a sundry of programs such as: I. dental/vision/hearing program 2. chore program 3. loneliness outreach program 4. telephone reassurance program National Family Caregiver Support Program The Area Agency on Aging will continue to support the in-house .60 FTE Family Caregiver position. The goal of the program will be to continue to provide information and assistance to caregivers, provide appropriate and needed caregiver training/workshops, and maintain the respite voucher program. In the 2002 Caregiver Needs Assessment, caregivers expressed a need for a central source of information for care caregivers at all stages to access. Over the next four years the AAA will continue to work diligently to become that central information site for caregivers and the community 27 at large. This will require additional in-house staff and resources and effective marketing strategies to reach a broad base of caregivers. Due the increase number of grandparents raising grandchildren in Weld County the Area Agency on Aging staff will continue to work with other key agencies in the community to provide educational opportunities such as legal clinics, resource fairs, support groups, newsletters, legal handbooks etc. Title VII Vulnerable Elder Rights Activities Program For the last several years the Title VII funding has been used to enhance the in-house Ombudsman Program. The dollars are used to help fund the Assistant Ombudsman positions and the Volunteer Ombudsman Program. In addition, the Ombudsman program is active in providing community education relating to elder abuse and exploitation. The Ombudsman team will continue to participate in the Adult Protection Networking Team, the Long Term Care Bio-Ethics Committee and the Senior Service Network group. The Ombudsman team works closely with the in-house legal paralegal and the contract attorney regarding appropriate legal issues involving long term care residents. The Ombudsman also works closely with the Options for Long Term Care case managers in order to help long term care residents explore the opportunity of returning to independent living in the community. 28 Section IX: Assurances Older Americans Act, as was amended in 2000 Sec. 306(a), AREA PLANS (2) Each area agency on aging shall provide assurances that an adequate proportion, as required under section 307(a)(2), of the amount allotted for part B to the planning and service area will be expended for the delivery of each of the following categories of services- (A) services associated with access to services (transportation, outreach, information and assistance, and case management services); (B) in-home services, including supportive services for families of older individuals who are victims of Alzheimer's disease and related disorders with neurological and organic brain dysfunction; and (C) legal assistance; and assurances that the area agency on aging will report annually to the State agency in detail the amount of funds expended for each such category during the fiscal year most recently concluded. (4)(A)(i) Each area agency on aging shall provide assurances that the area agency on aging will set specific objectives for providing services to older individuals with greatest economic need and older individuals with greatest social need, include specific objectives for providing services to low-income minority individuals and older individuals residing in rural areas, and include proposed methods of carrying out the preference in the area plan. (4)(A)(ii) Each area agency on aging shall provide assurances that the area agency on aging will include in each agreement made with a provider of any service under this title, a requirement that such provider will-- (I) specify how the provider intends to satisfy the service needs of low-income minority individuals and older individuals residing in rural areas in the area served by the provider; (II) to the maximum extent feasible, provide services to low-income minority individuals and older individuals residing in rural areas in accordance with their need for such services; and (III) meet specific objectives established by the area agency on aging, for providing services to low-income minority individuals and older individuals residing in rural areas within the planning and service area. (4)(A)(iii) With respect to the fiscal year preceding the fiscal year for which such plan is prepared, each area agency on aging shall-- (I) identify the number of low-income minority older individuals and older individuals residing in rural areas in the planning and service area; (II) describe the methods used to satisfy the service needs of such minority older individuals; and 29 (III) provide information on the extent to which the area agency on aging met the objectives described in clause (a)(4)(A)(i). (4)(B)(i) Each area agency on aging shall provide assurances that the area agency on aging will use outreach efforts that will identify individuals eligible for assistance under this Act, with special emphasis on-- (I) older individuals residing in rural areas; (II) older individuals with greatest economic need (with particular attention to low-income minority individuals and older individuals residing in rural areas); (III) older individuals with greatest social need (with particular attention to low-income minority individuals and older individuals residing in rural areas); (IV) older individuals with severe disabilities; (V) older individuals with limited English-speaking ability; and (VI) older individuals with Alzheimer's disease or related disorders with neurological and organic brain dysfunction (and the caretakers of such individuals); and inform the older individuals referred to in (A) through (F), and the caretakers of such individuals, of the availability of such assistance. (4)(C) Each area agency on agency shall provide assurance that the area agency on aging will ensure that each activity undertaken by the agency, including planning, advocacy, and systems development, will include a focus on the needs of low-income minority older individuals and older individuals residing in rural areas. (5) Each area agency on aging shall provide assurances that the area agency on aging will coordinate planning, identification, assessment of needs, and provision of services for older individuals with disabilities, with particular attention to individuals with severe disabilities, with agencies that develop or provide services for individuals with disabilities. (9) Each area agency on aging shall provide assurances that the area agency on aging, in carrying out the State Long-Term Care Ombudsman program under section 307(a)(9), will expend not less than the total amount of funds appropriated under this Act and expended by the agency in fiscal year 2000 in carrying out such a program under this title. (11) Each area agency on aging shall provide information and assurances concerning services to older individuals who are Native Americans (referred to in this paragraph as "older Native Americans"), including- (A) information concerning whether there is a significant population of older Native Americans in the planning and service area and if so, an assurance that the area agency on aging will pursue activities, including outreach, to increase access of those older Native Americans to programs and benefits provided under this title; (B) an assurance that the area agency on aging will, to the maximum extent practicable, coordinate the services the agency provides under this title with services provided under title VI; and 30 (C) an assurance that the area agency on aging will make services under the area plan available, to the same extent as such services are available to older individuals within the planning and service area, to older Native Americans. (13)(A) Each area agency on aging shall provide assurances that the area agency on aging will maintain the integrity and public purpose of services provided, and service providers, under this title in all contractual and commercial relationships. (13)(B) Each area agency on aging shall provide assurances that the area agency on aging will disclose to the Assistant Secretary and the State agency-- (i) the identity of each nongovernmental entity with which such agency has a contract or commercial relationship relating to providing any service to older individuals; and (ii) the nature of such contract or such relationship. (13)(C) Each area agency on aging shall provide assurances that the area agency will demonstrate that a loss or diminution in the quantity or quality of the services provided, or to be provided, under this title by such agency has not resulted and will not result from such non-governmental contracts or such commercial relationships. (13)(D) Each area agency on aging shall provide assurances that the area agency will demonstrate that the quantity or quality of the services to be provided under this title by such agency will be enhanced as a result of such non-governmental contracts or commercial relationships. (13)(E) Each area agency on aging shall provide assurances that the area agency will, on the request of the Assistant Secretary or the State, for the purpose of monitoring compliance with this Act (including conducting an audit), disclose all sources and expenditures of funds such agency receives or expends to provide services to older individuals. (14) Each area agency on aging shall provide assurances that funds received under this title will not be used to pay any part of a cost (including an administrative cost) incurred by the area agency on aging to carry out a contract or commercial relationship that is not carried out to implement this title. (15) Each area agency on aging shall provide assurances that preference in receiving services under this title will not be given by the area agency on aging to particular older individuals as a result of a contract or commercial relationship that is not carried out to implement this title. 31 Sec. 306(a), AREA PLANS (2) Each area agency on aging shall provide assurances that an adequate proportion, as required under section 307(a)(2), of the amount allotted for part B to the planning and service area will be expended for the delivery of each of the following categories of services- (A) services associated with access to services (transportation, outreach, information and assistance, and case management services); (B) in-home services, including supportive services for families of older individuals who are victims of Alzheimer's disease and related disorders with neurological and organic brain dysfunction; and (C) legal assistance; and assurances that the area agency on aging will report annually to the State agency in detail the amount of funds expended for each such category during the fiscal year most recently concluded. (4)(A)(i) Each area agency on aging shall provide assurances that the area agency on aging will set specific objectives for providing services to older individuals with greatest economic need and older individuals with greatest social need, include specific objectives for providing services to low-income minority individuals and older individuals residing in rural areas, and include proposed methods of carrying out the preference in the area plan. (4)(A)(ii) Each area agency on aging shall provide assurances that the area agency on aging will include in each agreement made with a provider of any service under this title, a requirement that such provider will-- (I) specify how the provider intends to satisfy the service needs of low-income minority individuals and older individuals residing in rural areas in the area served by the provider; (II) to the maximum extent feasible, provide services to low-income minority individuals and older individuals residing in rural areas in accordance with their need for such services; and (III) meet specific objectives established by the area agency on aging, for providing services to low-income minority individuals and older individuals residing in rural areas within the planning and service area. (4)(A)(iii) With respect to the fiscal year preceding the fiscal year for which such plan is prepared, each area agency on aging shall-- (I) identify the number of low-income minority older individuals and older individuals residing in rural areas in the planning and service area; (II) describe the methods used to satisfy the service needs of such minority older individuals; and (III) provide information on the extent to which the area agency on aging met the objectives described in clause (a)(4)(A)(i). (4)(B)(i) Each area agency on aging shall provide assurances that the area agency on aging will use outreach efforts that will identify individuals eligible for assistance under this Act, with special emphasis on-- (I) older individuals residing in rural areas; 32 (II) older individuals with greatest economic need (with particular attention to low-income minority individuals and older individuals residing in rural areas); (III) older individuals with greatest social need (with particular attention to low-income minority individuals and older individuals residing in rural areas); (IV) older individuals with severe disabilities; (V) older individuals with limited English-speaking ability; and (VI) older individuals with Alzheimer's disease or related disorders with neurological and organic brain dysfunction (and the caretakers of such individuals); and inform the older individuals referred to in (A) through (F), and the caretakers of such individuals, of the availability of such assistance. (4)(C) Each area agency on agency shall provide assurance that the area agency on aging will ensure that each activity undertaken by the agency, including planning, advocacy, and systems development, will include a focus on the needs of low-income minority older individuals and older individuals residing in rural areas. (5) Each area agency on aging shall provide assurances that the area agency on aging will coordinate planning, identification, assessment of needs, and provision of services for older individuals with disabilities, with particular attention to individuals with severe disabilities, with agencies that develop or provide services for individuals with disabilities. (9) Each area agency on aging shall provide assurances that the area agency on aging, in carrying out the State Long-Term Care Ombudsman program under section 307(a)(9), will expend not less than the total amount of funds appropriated under this Act and expended by the agency in fiscal year 2000 in carrying out such a program under this title. (11) Each area agency on aging shall provide information and assurances concerning services to older individuals who are Native Americans (referred to in this paragraph as "older Native Americans"), including- (A) information concerning whether there is a significant population of older Native Americans in the planning and service area and if so, an assurance that the area agency on aging will pursue activities, including outreach, to increase access of those older Native Americans to programs and benefits provided under this title; (B) an assurance that the area agency on aging will, to the maximum extent practicable, coordinate the services the agency provides under this title with services provided under title VI; and (C) an assurance that the area agency on aging will make services under the area plan available, to the same extent as such services are available to older individuals within the planning and service area, to older Native Americans. (13)(A) Each area agency on aging shall provide assurances that the area agency on aging will maintain the integrity and public purpose of services provided, and service providers, under this title in all contractual and commercial relationships. 33 (13)(B) Each area agency on aging shall provide assurances that the area agency on aging will disclose to the Assistant Secretary and the State agency-- (i) the identity of each nongovernmental entity with which such agency has a contract or commercial relationship relating to providing any service to older individuals; and (ii) the nature of such contract or such relationship. (13)(C) Each area agency on aging shall provide assurances that the area agency will demonstrate that a loss or diminution in the quantity or quality of the services provided, or to be provided, under this title by such agency has not resulted and will not result from such non-governmental contracts or such commercial relationships. (13)(D) Each area agency on aging shall provide assurances that the area agency will demonstrate that the quantity or quality of the services to be provided under this title by such agency will be enhanced as a result of such non-governmental contracts or commercial relationships. (13)(E) Each area agency on aging shall provide assurances that the area agency will, on the request of the Assistant Secretary or the State, for the purpose of monitoring compliance with this Act (including conducting an audit), disclose all sources and expenditures of funds such agency receives or expends to provide services to older individuals. (14) Each area agency on aging shall provide assurances that funds received under this title will not be used to pay any part of a cost (including an administrative cost) incurred by the area agency on aging to carry out a contract or commercial relationship that is not carried out to implement this title. (15) Each area agency on aging shall provide assurances that preference in receiving services under this title will not be given by the area agency on aging to particular older individuals as a result of a contract or commercial relationship that is not carried out to implement this title. 34 Section X: Forms 35 c • o y \ N en C� R U m — Vr oC 0 OC �'J T ..N (0 r n N N N O OC 00 N J tri >, < v O CO E a w >- O M x0 A = r CD r �.. C N — r ...e, M r_; �„ N N N CO N V v Z T, E r r N `.S r� a N M' O �. v NI ° r r-.1 r'' N N O�. O e---- v1 N R D E h W Q ro >r. R M Cl �' 00 M N O 00 'V r-' O �? cn N N �� N r r ill r - N = rr,, b N o0 M N N N N GC O v, Q! To U 00 M O M N4 O N N l� Or ° o 00 N `T N N CJ n Y. U ^ ' ^ W E J 0 w W > N M N N V"7 M E---- oo r "1 r CZ N r1 x �. x (A b e) 00 l!1 �-3 0 M M vl [� N x ,-D N N b Q - - 2 N C E Q w m O 0 O vl N ry > m - r v a r1 a C N v - - 0 p •c a 1� N- .. ��, N [� M V '� it r-,-1 a O. 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(-4 M r. c.} E d 0 0 O o 0 0w x 2 0 0 O O O O 0 0 O 0 0 0 0 O O a 06 c:,- -7t- kr, rkr) av L O O O 0 O 0 0 0 VIn N co CD 0 O O� 0 0 0 0 0 O un V] in 00 O� O\ 00 ckr) N .r L=I Z Q d 00 r- O O N v Crn 0 p 00 M OM CD O 04 -8v vii oo O O oo a an- e-- to O ON p N ON O O y . 0 0 N •� ' M N M - 'C — N M p a Q O O 0 ad F2 E O p 0 O Q F S O O O O p o p 0 0 O O O O O O c 00 O 4' r O O O O O O O O q O ♦O w o m O O O O d 0 O- O O O O O , '� N w N J f (T) 06 '� d O\ 00 O6 \0 - n A d _ '° 00 i� O CD cr ON 0 0 ^ N O 0 O v c 00 00 p O N o O oo M M O O w Ln V 1 O O o0 0 " i 1 O OT p N a1 O O N To ' co o v) N �D N M M 00 M w " M N M N M '0 ^ N M O O p e d O O O O S, 8 Q p E O O O O 0 O CD O O O O O O w c 00 O kr) a -I- � _, V • _ 0 0 O p O 0 0 0 e W �p " 0 0 O O p Q O o Q O O p O 'C v') oi 2S _o d T f° 00 N O O R' O\ 0 0 ^ l— O O p 1E 6 00 00 O O 000 O r— kr)O O Go N C) O_ O LL F kin ,n o O VI v ,i O p — v'i N �,,,.^ N M - M 00 en- w M N N M � N M H V V .51t.'" c M c V c aQ V L C E g V d O g d p, W a %f',-) P. '8 d $ u g o � `�.� g u h rn � �v� W CC m s ¢ 2 m W d 4 0 . .2 . Y c f, ongr'E c c > ^' C1 'O,1-2.02 _ U_ U N U U E 'E7 C� YI W b W A Q W V dN rW SF {2J f0 u -X01 LL C 2 LL Z ' to N U alt t ak d +i g a V W y 7 C ,U a .D. E W N z F WF i z E r Z g >z 2 z N NJ Q y. W N Q O W O gg N W € ,n O W a t' to W N C V N U U 2 ti S N d y U p 6 U 5 in 5c 6 DE g cc c a K 6 O Ra ¢ it i— $ U z z Attachment C REGION: 2B DIRECT SERVICE WAIVER REQUEST We hereby request approval of a Waiver to provide the direct services listed below. 1. Legal Services-Paralegal Services (attorney services are contracted-Title Ill Part B 2. Caregiver Program-Title III Part E 3. Health Promotion and Disease Prevention- Part D 4. 5. 6. Please attach documents describing the direct service to be provided including organizational structure and planned methods of program services delivery. PLEASE NOTE: If the Waiver Request is incomplete, this may result in a delay of the approval of the Area Plan. Attachment C Direct Service Provision Waivers The Weld County Area Agency on Agency is currently administering three programs that require waiver approval, the Part E Caregiver program,the Part B Paralegal Program and Part D Health Promotion/Disease prevention Program. The Family Caregiver program is currently being administered by the Area Agency on Aging. A part-time Family Caregiver Coordinator is providing information and assistance and training to the general public and is coordinating the caregiver respite voucher program. In addition, programs for grandparents raising grandchild are being coordinated out of the Area Agency on Aging. The paralegal program has been administered out of the Area Agency on Aging for over seventeen (17) years. In order to meet the requirements of attorney oversight the Area Agency on Aging contracts with a local attorney. The program is highly successful and cost effective. The Area Agency also manages the Part D Health Promotion/Disease Prevent program. The majority of the funding has been designated to training and the Senior Health Fair(with the help of a community committee). The program is coordinated by the Area Agency on Director with the assistance of other staff such as the registered nurse and registered dietitian. The program continues to be cost effective and a reaches a significant number of clients even though the funding is very limited. Attachment D REGION: 2B MEAL SITES SITE NAME/ADDRESS SITES WITH AT SITES WHICH SERVE SITES WHICH SERVE DAYS OF MEAL SITE COORDINATOR LEAST 20%OF 60+ 50%OR MORE MORE THAN ONE WEEK MEALS PHONE/FAX/EMAIL ADDRESS POPULATIONS MINORITY CLIENTS COMPLETE MEAL ARE SERVED BELOW THE PER DAY POVERTY LEVEL C-I C-2 C-1 C-2 C-1 C-2 Birchwood Apartment x M,W,F 2830 West 27th St Lane Greeley,CO 80631 970-330-6206 970-330-2545 no email Broadview Apartments X T,Th 2915 West 8th St Greeley,CO 80631 970-353-9305 970-378-7845 no email Greeley Manor X M.W,F 1000 13th St Greeley,CO 80631 970-304-1833 no fax no email Greeley Senior Housing X M, Th 1717 30th Street Greeley,CO 80631 970-395-0822 970-353-9050 no email Rodarte Community Center X X Th 920 A St Greeley,CO 80631 970-350-9430 970-346-8486 no email Th Erie Senior Center 635 Well St Erie, CO 80516 303-926-2717 303-833-2099 no email Attachment D REGION: 28 MEAL SITES SITE NAME/ADDRESS SITES WITH AT SITES WHICH SERVE SITES WHICH SERVE DAYS OF MEAL SITE COORDINATOR LEAST 20%OF 60+ 50%OR MORE MORE THAN ONE WEEK MEALS PHONE/FAX/EMAIL ADDRESS POPULATIONS MINORITY CLIENTS COMPLETE MEAL ARE SERVED BELOW THE PER DAY POVERTY LEVEL C-I C-2 C-I C-2 C-I C-2 Evans Commuinty Center T, F 1100 37th St Evans CO 80620 970-339-5344 x131 970-330-3472 no email Ft.Lupton Community Center M 203 S.Harrison Ave Ft.Lupton,CO 80621 303-857-4200 303-857-6421 jemslie(@ftluptonreo.co Hill N Park 4205 Yosemite Drive Greeley CO 80634 970-330-8619 no fax no email Johnstown Senior Cener 1011 Jay St Johnstown,CO 80534 970-587-5251 970-587-0141 no email Kersey Community Center T, Th 415 IstSt Kersey,CO 80644 970-352-8394 970-353-2197 kerseniori gwest.net LaSalle Community Center T 101 Todd Ave LaSalle,CO 80645 970-284-5714 no email no fax Attachment D REGION: 2B MEAL SITES SITE NAME/ADDRESS SITES WITH Al' SITES WHICH SERVE SITES WHICH SERVE DAYS OF MEAL SITE COORDINATOR LEAST 20%OF 60+ 50%OR MORE MORE THAN ONE WEEK MEALS PHONE/FAX/EMAIL ADDRESS POPULATIONS MINORITY CLIENTS COMPLETE MEAL ARE SERVED BELOW THE PER DAY POVERTY LEVEL C-I C-2 C-I C-2 C-I C-2 Lochbuie Senior Center X T 501 Willow Dr Lochbuie,CO 80603 303-659-8262 303-659-8262 no email Mead Senior Center 441 3rd St Th Mead,CO 80542 (970)535-4502 970-535-0942 dickl( prodigy.net Milliken Senior Center M,F 1101 Broad St Milliken,CO 80543 970-587-2484 970-587-2678 lots(@town.milliken.co.us Nunn Senior Center Th 775 3rd St Nunn,CO 80648 970-897-2459 no fax no email Pierce Senior Center 221 Main St Th Pierce,CO 80650 970-834-2655 970-674-0193 drurooseveltt aol.corn Platteville Senior Center M 508 Reyolds Av Platteville,CO 80651 970-785-6274 970-785-2476 ndefoc©plattevillegov.org Attachment E REGION: 2B COMMUNITY FOCAL POINTS AND SENIOR CENTERS LIST ALL FOCAL POINTS AND SENIOR CENTERS INCLUDING NUTRITION SITES IF IT IS A FOCAL POINT CHECK IF FACILITY IS: CHECK IF LOCATION SERVES: CENTER NAME A A FUNDED PREDOMINANTLY PREDOMINANTLY ADDRESS,CITY,ZIP CODE FOCAL SENIOR THROUGH LOW INCOME LOW-INCOME PHONE NUMBER POINT CENTER TITLE III-B ELDERLY MINORITY CONTACT ELDERLY 1. Ault Senior Center x x PO Box 1338 Ault,CO 80610 970-834-1325 Margorie Gieck 2. Erie x 635 Well Street Erie,CO 80516 303-926-2717 Position is currently vacant 3. Evans Community Center x x 1 100 37th St Evans,CO 80620 970-339-5344 x131 Betty Grauburger 4. Ft.Lupton Community Center x x 203 S Harrison Ave Ft. Lupton.CO 80621 970-857-6421 Jean Emslie 5. Greeley Senior Center x x 1010 6th St Greeley,CO 80641 970-350-9440 Sheri Lobmyer 6, Grover x 211 Laramie St Grover,CO 80729 970-895-2367 Betty Gage 7, Hill N Park x x X 4205 Yosemite Drive Greeley,CO 80634 970-330-8619 Frank Weaver x x Attachment E REGION: 26 COMMUNITY FOCAL POINTS AND SENIOR CENTERS LIST ALL FOCAL POINTS AND SENIOR CENTERS INCLUDING NUTRITION SITES IF IT IS A FOCAL POINT CHECK IF FACILITY IS: CHECK IF LOCATION SERVES: CENTER NAME A A FUNDED PREDOMINANTLY PREDOMINANTLY ADDRESS,CITY,ZIP CODE FOCAL SENIOR THROUGH LOW INCOME LOW-INCOME PHONE NUMBER POINT CENTER TITLE III- ELDERLY MINORITY CONTACT B ELDERLY 8 Johnstown Senior Center x x 1011 Jay St Johnstown,CO 80534 970-587-5251 Shirley Newsom-Gamez 9 Kersey Senior Center x x 415 1st St Kersey.CO 80644 97-352-8394 Tym Lynch 10 Lochbuie Senior Center x x 331 Cherry St#4 Lochbuie,CO 80603 303-659-8262 11 Mead Community Center x 441 3rd St Mead,Co 80542 970-535-4477 Maggie Cornell 12 Millliken Senior Center x x 1101 Broad St Millliken,CO 80543 970-587-2484 Lois Onorato 13 Nunn Senior Center x x 755 3rd St Nunn,CO 80648 970-897-2459 Tony Vella 14 Pierce Senior Center x x 221 Main St Pierce,CO 80650 970-834-2655 Dru Roosevelt Attachment F REGION: 2B COMMUNITY FOCAL POINTS AND SENIOR CENTERS LIST ALL FOCAL POINTS AND SENIOR CENTERS INCLUDING NUTRITION SITES IF IT IS A FOCAL POINT CHECK IF FACILITY IS: CHECK IF LOCATION SERVES: CENTER NAME A A FUNDED PREDOMINANTLY PREDOMINANTLY ADDRESS,CITY,ZIP CODE FOCAL SENIOR THROUGH LOW INCOME LOW-INCOME PHONE NUMBER POINT CENTER TITLE III-B ELDERLY MINORITY CONTACT ELDERLY 15 Platteville Community Center x 400 Grand Ave Platteville,CO 80651 970-785-2245 x1106 Nancey Defoe 6 Wattenburg Community Center x x 1917 Grace Ave Ft.Lupton,CO 80621 720-685-7093 Becky Pino 17 Windsor Community Center x 250 N 11th St Windsor,C) 80550 1 970-674-3515 ! 1 Jay Eckhardt 1 If Attachment F REGION: 28 REGIONAL ADVISORY COUNCIL MEMBERSHIP List all persons presently serving as members of your Regional Advisory Council. NAME ORGANIZATION AFFILIATION Michelle Adler State Farm Adella Andrijeski Retired Al Arriessecq Youth Services Susan Bromley Pyscologist Bev Daniels Retired Don Beirbach Retired MaryPat Eastwood Insurance David Long County Commissioner Lorna Losh Retired Nancy Meek Retired Elmer Montoya Retired Betty Jones Retired Marcia Osborn Retired Pam Shaddock Greeley City Counsel Josie Sanchez University of-Northern Colorado Phil Shovar Retired Ken Whitney Anderson& Whitney Accounting Please indicate on the chart below how many members are low income, minority, or over 60 LOW-INCOME MINORITY 60+ cn ti Q { III 1� T itt ! ct 111P11'ii llico 40 3l! i i4HJ nv1SlN fH1SL & al CO G 3aItitWhiiI Mil(D 111��_ 11 't�� Mi d Vy al r�1:tr il O. O .Q V it 1g I pinit ‘ JEe L AVHlr: z Ilit 1 Tifi 44 O L W nb H1SZ N Ny nv Fig co 2 N nv oi#w4. in . nvHltt I.. 43 W w w O = . Cri C 0 AVHIr, CD umt. N — nuts:. .m. 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