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HomeMy WebLinkAbout982079.tiff RESOLUTION RE: APPROVE GRANT APPLICATION FOR LONG TERM OMBUDSMAN ADVOCATE/FRIENDLY VISITOR PROGRAM 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 Grant Application for the Long Term Ombudsman Advocate/Friendly Visitor Program from the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Human Services Department, Area Agency on Aging, to the Victim's Assistance and Law Enforcement Board, commencing January 1, 1999, and ending December 31, 1999, with further terms and conditions being as stated in said application, and WHEREAS, after review, the Board deems it advisable to approve said application, 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 Grant Application for the Long Term Ombudsman Advocate/Friendly Visitor Program from the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Human Services Department, Area Agency on Aging, to the Victim's Assistance and Law Enforcement Board be, and hereby is, approved. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 26th day of October, A.D., 1998. BOARD OF COUNTY COMMISSIONERS /) WE COUNTY, COLORADO ATTEST: /b ��' . " > F sY Constan a L. Harbert Ch it Weld County Clerk to t, B.v: T f L ► . ��� ' � W. H. -bster, Pro-Tem BY: ./t l -..0 I <;.f r , .� `S ." Deputy Clerk to the U��s1\ . - r z�r � •e Barr t it APP FORM: :/e!j Dal K. Hall my A orney S arbara J. Kirkmeyer � . hi 5 9820 HR0069 9 ist ‘t"" MEMORANDUM Co nstance onstance L. Harbert, Chair DATE: 10/26 /98 C. Board of Commissioners FROM: Walter J. Speckman, Executive Director Human Services )(-' '( COLORADO SUBJECT: Victims Assistance Grant Proposal Enclosed for Board approval is a grant proposal to the Victim's Assistance and Law Enforcement Board(VALE)for$8,000 to support additional staff time to expand ombudsman visitations to Weld County nursing homes and personal care boarding homes. The request is a $729.00 increase over the 1998 grant. The increase will be used to fund and elder abuse training program with nursing home and assisted living staff. The proposal, if funded, would begin January 1, 1999 and extend through December 31, 1999. Please address any additional questions to Linda Piper, Director Weld County Area Agency on Aging, extension 3320. 982079 Victim's Assistance & Law Enforcement Board Nineteenth Judicial District Fiscal Year 1999 GRANT APPLICATION FORM I. Project Title Weld County Long Term Care Ombudsman Advocate/Friendly Visitor Program II. Lead Agency/Organization Weld County Area Agency on Aging Contact Person Linda E. Piper, Director Phone 970-353-3800, Ext. 3320 Address 1551 North 17th Avenue, P.O. Box 1805, Greeley, Colorado 80632 III. Amount Requested $8.000 IV. Non-profit Status X(Government) Yes No In Process 9�ao79 Victim's Assistance & le Law Enforcement Board =_,t'•. t� � `ij Nineteenth ludicial District j87.6...M'' VICTIM ASSISTANCE AND LAW ENFORCEMENT BOARD GRANT APPLICANT MEMORANDUM OF UNDERSTANDING CONCERNING THE RIGHTS AFFORDED TO CRIME VICTIMS As provided in C.R.S . 24-4 . 2-105 , (4 . 7) , Colorado law requires the following: A REQUESTING AGENCY OR PERSON SHALL ACKNOWLEDGE IN WRITING THAT SUCH AGENCY OR PERSON HAS READ AND UNDERSTANDS THE RIGHTS AFFORDED TO CRIME VICTIMS PURSUANT TO SECTION 24-4 . 1-302 . 5 AND THE SERVICES DELINEATED PURSUANT TO SECTION 24-4 . 1-303 AND 24- 4 . 1-304 . SUCH WRITTEN ACKNOWLEDGEMENT SHALL BE ATTACHED TO SUCH REQUESTING AGENCY' S OR PERSON' S APPLICATION FOR MONEYS PURSUANT TO THIS SECTION. THE BOARD SHALL NOT ACCEPT FOR EVALUATION ANY APPLICATION FOR A GRANT OF MONEYS PURSUANT TO THIS SECTION UNTIL THE REQUESTING AGENCY OR PERSON PROVIDES THE BOARD WITH SUCH WRITTEN ACKNOWLEDGEMENT. The prospective grantee certifies to the VALE Board, by submission of this completed Grant Applicant Memorandum of Understanding Concerning the Rights Afforded to Crime Victims, that the agency or person described herein has read and understands the rights afforded to crime victims as required by C.R.S . 24-4 . 2-105, (4 . 7) . PROJECT DIRECTOR: Linda E. Piper PROJECT: Weld County Long Term Care Ombudsman Advocate /Visitor Program AGENCY: Weld County Area Agency on Aging ADDRESS : 1551 North 17th Avenue(. P .O. Box 1805 . Greeley . CO 80632 • SIGNATURE: 67 L/L�N C14L'--' e. `I - 1_.. DATE: /6/Z -714.9 (NOTE: COPIES OF THE STATUTES DESCRIBED ABOVE WILL BE PROVIDED TO PROSPECTIVE_ GRANT RECIPIENTS UPON REQUEST. ) GRVRA.vnr, Post Office Box 1167.915 Tenth Street•Greeley, CO 80632•(970)356-4010•FAX(970)352-8023 q��69`7 Section A: Summary The Weld County Long Term Care Ombudsman Program has been a consumer voice for the elderly residing in nursing homes and personal care boarding homes(assisted living)for more than twenty (20) years. The authority of the local Ombudsman Program conies from the Older American's Act, Colorado Revised Statutes 25-11.5 and the Nursing Home Reform Law of 1987. The Weld County Ombudsman acts as a consumer voice for the concerns of the elderly living in institutions who may have no one else to speak for them. The Ombudsman also receives and resolves questions, issues, problems and complaints made by, for, or on behalf of residents of long term care facilities. As indicated last year,the increase of facilities has grown to include six nursing homes and sixteen personal care boarding homes to respond the increasing number of frail elders affected with chronic conditions which interfere with their ability to live independently in the community. In 1998 a county wide needs assessment of Weld County's older adults, age 60 and older population, was conducted. (see Attachment E) The findings indicated that during 1998 approximately 240 older adults anticipate moving either to an assisted living facility or nursing home. This number does not include the additional seniors moving into the Weld community already requiring long term care, nor the people who will experience unanticipated changes in their general health status which will require long term care placement. The V.A.L.E. grant has allowed the Ombudsman Program to increase staff time to keep up with the increasing demand for advocacy on behalf of this very vulnerable population. The assistant position is currently working 10 hours per week in the field,visiting nursing homes and personal care boarding homes. By maintaining a constant presence in these facilities,the Assistant Ombudsman has built trusting relationships with residents and staff. The funds have also enabled the program to implement a successful abuse prevention and awareness program aimed at Certified Nurse Assistants(CNAs). This has allowed her to educate residents and staff about the Ombudsman Program, abuse issues and resident rights as well as investigation of complaints of abuse and neglect. Without the V.A.L.E. resource the program will not be able to:continue these imperative services. Long term care residents face both physical and psychological barriers when it comes to expressing and advocating for their needs. This makes residents more likely to be victimized by care givers. The Ombudsman's role through observation and a frequent presence in the facilities; is to insure that resident rights are being respected, that quality care is administered and that abuses do not occur. Continued funding of the Ombudsman Assistant will make it possible for the Area Agency on Aging Ombudsman Program to serve the increasing number of vulnerable long term care residents and their families. We are requesting a modest amount of V.A.L.E. Board Funds ($8,000) to continue to fund the Assistant Ombudsman position and to expand its scope to include elder abuse education to additional target populations. In 1999 the funds will allow the Assistant Ombudsman to increase her presence from 10 to 12 hours per week. This will increase involvement with the CARTE program and aid in the recruitment and training of volunteers. We believe that our request for a continuation of funding relates to the mandate of early crisis intervention and to provide assistance and support to victims and their families. Section B: Project Concept/Design Overall Issues Being Addressed: The purpose of the Weld Cpunty Long Term Care Ombudsman Program is to assist and empower consumers of long-term care services by providing information about those services and furnish support in complaint resolution. These issues or complaints may include,but are not limited to: access to long- term care services, redress of neglectful or abusive care, and information and,assistance with civil and human rights. The Long Term Care Ombudsman program is a resident/patient/consumer-centered advocacy program. 9 ‘270fI Long Term Care Ombudsmen have statutory status under the Older Americans Act of 1965 as amended and are required by federal and state law to visit every nursing home monthly and every personal care boarding home quarterly. They also receive, investigate and resolve complaints, identify needs of long- term care residents and help establish programs to meet those needs. Ombudsman also document and report problems of long-term care and help to stimulate and promote improvement of the system. Currently, Weld County has the capacity to occupy 857 nursing home residents and 491 assisted living residents, and the numbers are expected to grow. For example,the recent growth has resulted in an expansion of assisted living facilities. To meet the demand, in March 1998, The Bridge, a facility licensed for 70 residents opened and Beehive Homes are expecting to open another 12 bed facility in Evans and a 17-25 bed facility in Johnstown in the first quarter of 1999. This growth will increase the Ombudsman responsibilities, including all education and technical assistance components, all required visitations, all complaint investigations, and all documentation and reporting. We hope to meet the need by increasing the Assistant Ombudsman position to .30 FTE funded by this proposal. Due to the increased number of long-term care residents Weld County has experienced in the last two years,the demand for Ombudsman services has also increased. Federal funds, through the Older Americans Act, are not keeping up with the growing need for long term care advocates. With limited current resources available to the Area Agency on Aging, it will be impossible to meet the minimum requirements for a visible presence in all of Weld's long term care facilities. In an effort to keep up with the visitations, the training and technical assistance to the facilities will be negatively influenced. There is continuing evidence from statements made by regulatory agencies that an informed, educated and empowered community presence in long-term care facilities can help to maintain or improve the quality of the facility and thus the quality of the resident's lives. In short,the problem we are trying to resolve is the lack of Ombudsman resources to cover exceptional increases in the growth of long-term care services in Weld County. Project Goals: ➢ To enhance the ability of the Weld County Long Term Care Ombudsman Program to act as a consumer voice for the concerns of the elderly living in nursing homes and personal care boarding homes. By visiting nursing homes and personal care boarding homes,there is an ongoing process of building trust and rapport with the residents and staff so that instances of mistreatment and elder abuse can be identified and addressed promptly. ➢ To enhance the ability of the Weld County Long Term Care Ombudsman Program to receive and resolve questions, issues, problems and complaints on behalf of residents of long-term care facilities. ➢ To enhance the ability of the Weld County Long Term Care Ombudsman Program to provide community education regarding issues of elder abuse and quality of life for residents in long- term care facilities. ➢ To strengthen the ongoing elder abuse training program. The current training being used is a program referred to as CARIE (see attachment F) which stands for Coalition of Advocates for the Rights of the Infirm Elderly. CARIE consists of eight training modules that focus on various aspects of elder abuse. The training program will be used to assist with educating state, residents, and family members regarding victimization. Training and education can be accomplished through CNA conferences or in-services at nursing homes or personal care boarding homes. Currently the CARTE program is being offered to CNAs. However, other model programs who • are providing CARTE training have discovered the benefits of offering the training to administrative and managerial long term care staff. The Ombudsman Program would like to expand the ongoing CARIE training program to this target population. In addition, the 98�?079 Ombudsman Program would like to provide the training to the CNA Training Center on a monthly basis. The students who attend the CNA Training Center frequently work in long term care facilities and home health care agencies. This will give the Ombudsman Program an opportunity to reach a wide variety of future nursing assistants. Project Objectives:. During this grant period we intend to: ➢ Increase Assistant Ombudsman presence from 10 to 12 hours per week in Weld County long term care facilities for the purpose of providing a consumer voice for the concerns of elderly living in institutions and to be able to promptly address any instances of mistreatment or abuse. ➢ Continue and expand implementation of the Elder Abuse Prevention Program (CARTE) ➢ Heighten the volunteer program to recruit, train and maintain an additional 5 volunteers. Volunteers assist the Ombudsman program for increased visibility with friendly visits. Timetable: Visit 500 long term care residents and investigate 50 complaints by December 31, 1999. Continuation of CARIE training. * The implementation of the program to combine training into the CNA Training Center beginning January 15,1999. Ongoing and enhanced Elder Abuse Prevention Program timetable will be as follows: * Develop Preceptor training materials by January 10, 1999. * Expand and develop materials for management staff by March 1, 1999. * Implement the enhanced training for management staff into current training program by April 1, 1999. * Continuous CARTE training to 150 direct line long term care staff along with an increase of 50 administrative and management staff by December 31, 1999. Heighten volunteer program: * Recruitment and marketing to begin in January, 1999. * Screening and orientation of new volunteers to begin in February, 1999. * Training and support to continue on a monthly basis from March - December, 1999. How Goals and Objectives will be accomplished: Under the guidance of the Lead Ombudsman the Assistant will continue to be assigned a specified number of long term care facilities to visit on a regular basis. Twelve hours per week will be allotted for visitation and travel time. The average visit per facility will be one hour; however the visit could take longer if there is a need. During the first three quarters of 1998 the Assistant Ombudsman made visits to 459 residents of long term care facilities and investigated 52 complaints The Assistant Ombudsman willcontinue to train staff at long term care facilities and residents regarding victimization and expand to administrative and managerial staff. The program will also be incorporated into the Preceptor Training.Course. Abuse issues include physical, emotional, sexual, financial, abandonment, and neglect. Training individuals about elder abuse is very important for several reasons. The Lead Ombudsman and the Assistant Ombudsman will develop a Volunteer Ombudsman recruitment and marketing plan. Once the desired number of volunteers have been recruited and trained the Assistant Ombudsman will provide ongoing supervision and training. 9gao79 Anticipated problems in implementing goals and objectives: Implementing the extension of our current ombudsman program in 1998 did not pose any problems. The Assistant Ombudsman position met the goals and objectives within the appropriate time lines. We do not anticipate any problems of reaching the new goals and objectives for 1999. The Assistant Ombudsman will be able to fulfill the original goals and objectives while enhancing the Volunteer program. Effectiveness Evaluation: To evaluate the effectiveness of the CARIE program, the Assistant Ombudsman will collect data from a survey that will be distributed at the end of the training session. The information gathered will be used to determine if the goals and objectives of the program are being met. This information will also be used to enhance and modify the program if needed. The Long Term Care Coordinator and Lead Ombudsman will monitor the timeliness and appropriateness of all complaint investigation on a quarterly bases by reviewing all client documentation. The Assistant Ombudsman will develop a satisfaction survey that will be given to the Volunteer Ombudsman by December 1, 1999 to determine the volunteers' level of satisfaction regarding their volunteer experience, ongoing training and any other issues that may be appropriate. Program goals as related to the V.A.L.E. statute: This program continuation request most relates to 24- 4.2-105, Section 2, part a and part b. Part a addresses provision of service for early crisis intervention. As mentioned earlier, there is evidence that when there is constant and continuing community presence in long term care facilities the potential to improve the quality of life and prevent abuse and exploitation is reduced for the residents. We propose to continue advocate contacts with long term care residents as a preventive move. We know that there may be many barriers to the elderly, particularly those in long term care facilities, to express their particular needs without assistance from others. Some of these barriers are physical due to loss of sight, speech, or hearing. Some barriers are psychological due to a sense of isolation, fear of retaliation, or disorientation. Barriers to self advocacy can also be because of the lack of information about rights, alternatives, and legal remedies. Part b addresses assistance programs for victims and their families. A key role of the long term care Ombudsman is complaint investigation and complaint resolution. Long term care residents must be assured that the Ombudsman will be able to follow up on their complaints in a timely and professional manner. With the continued increase in long term care beds, the ability of the present Ombudsman to respond appropriately to complaints will be jeopardized. The extension of the friendly visitor/advocate under this proposal will continue our Ombudsman hours insuring that the Lead Ombudsman will be able to respond to residents and their families in a timely and appropriate manner. This year the Assistant Ombudsman was referred to a case of a Hispanic female resident who resides in a nursing home. The family had many concerns about the quality of care she was receiving and had some suspicions of abuse and neglect by the nursing home staff. This woman had developed a rash/abscess, related to improper hygiene. The woman was transported to the hospital, where it was investigated and determined that possible abuse/neglect had occurred. Unfortunately, this woman continued to decline in health status and expired from a massive infection that had developed in the abscess. The Assistant Ombudsman played a crucial role in the investigation, reporting and support system to this resident and her family during this imperative time of crisis.. The Assistant Ombudsman attended meetings, coordinated information with the Adult Protection team and the State Health Department and continues to be a support system to the family who is dealing with the devastation of losing a family member under such extreme circumstances. The Assistant Ombudsman continues to educate and monitor the nursing home to insure that this issue is properly examined and measures are taken to protect the residents remaining in that facility. 982o762 Section C: Service Information Population and geographic area targeted: Population targeted are 60 plus elderly residing in nursing homes and personal care boarding home located in Weld County. Numbers of persons in need of these services: Approximately, 1,300 Weld County residents live in long term care facilities. All of these residents receive services through the Ombudsman program either directly with visitations and complaint resolution or indirectly through training and technical assistance provided to staff to improve the quality of care. By extension, the program also may represent the concerns of relatives and/or friends of long term care residents as long as the concern reflects the concerns of the resident. Continuation of support will make it possible for the Area Agency on Aging Ombudsman Program to continue to serve all of the long term care residents and their families with the same type and degree of services that we currently are providing. Duplication of Services: There is no other program which provides services equivalent to the Ombudsman Program. Cost Savings: When an advocate visits a long term care facility and discovers issues that affect the direct health of a resident, the advocate can facilitate and coordinate care with the facility to enhance the resident's plan of care to help reduce the problem from escalating. There is considerable medical savings to the taxpayer(most nursing home residents are on Medicaid) when extreme medical procedures can be avoided. When long term care patients are restrained, not only is it a violation of individual rights, but an opportunity is missed to administer therapies which can help the patient become more independent. The ombudsman, again, can identify these situations and work with the staff to develop alternate interventions which will respect individual rights and give the patient care that may increase his/her potential to be independent. Dependence costs society. Elder abuse education is invaluable to reduce incidences that occur. When a resident is exposed to an abusive situation the experience can cause not only physical, but also emotional, psychological, and social damage. The resources used to investigate and monitor these incidences are costly and limited, the Ombudsmen become a valuable resource to assist and prevent abuse in long term care facilities. Repercussions from abuse result in expensive and time consuming therapies and utilize valuable resources allocated for the community. The abuse education provided by the funds from this grant help to raise awareness and allow intervention before abuse situations occur. Management Plan : The Director of the Weld County Area Agency on Aging will be accountable for the administration of this project. The part time Ombudsman advocate will be trained and supervised on a daily basis by the Lead Ombudsman under the supervision of the Long Term Care Coordinator who reports to the Area Agency on Aging Director. Service Providers: Lead and Assistant Ombudsmen will provide the proposed services. The 1998 Weld County Needs Assessment determined that four in ten senior respondents volunteer in the Weld community. Senior Volunteers provide about 17 hours of service a month. Interestingly 19.7 of the current volunteers indicated they would be interested in increasing the number of hours currently volunteering. The respondents stated one of the primary reasons for Volunteerism is they feel useful when helping others. In order for the Ombudsman program to continue to meet the needs of the ever growing long term care population, we must explore the use of volunteers in the program. The Assistant Ombudsman could take the lead in regard to volunteer recruitment, training and supervising. The increase of Ombudsman presence in all of the long-term care facilities may allow intervention to transpire before abuse situations occur. G q 90 ,y07 / Section 1): Efficiency Evaluation of project: The Ombudsman Program maintains files which generate monthly, quarterly, and annual reports. Data is kept on numbers of visits, complaints, referrals and technical assistance contacts. Data is broken down further to reflect types of interventions,types of complaints, types of facilities, and actions taken. This data is analyzed by the state Ombudsman office to assist in determining the efficiency of the program. At the conclusion of the current grant period, the Ombudsman Program will have provided CARTE training for CNA staff representing all nursing home and a majority of PCBHs in Weld County. In addition, the Assistant Ombudsman will exceed the targeted facility visitation and complaint investigation objectives of 1998. This is evidenced by the number of contacts made by the end of the third quarter, 459 residents visited and 52 complaints investigated by the Assistant Ombudsman. This would not have been possible without the funds from the V.A.L.E. grant. Cost/benefit ratio: Due to the complexity and uniqueness of the program the current cost benefit ratio is difficult to determine as we provide a combination of training, technical assistance and direct service to an unlimited number of residents and family members. Based on the types of services this grant will cover the following cost break outs show anticipated cost/benefit ratios. a. $8,000 divided by 1348 maximum number of long term care residents equals about 17 cents per client. b. $8,000 divided by 50 anticipated complaint investigations equals $160.00 per complaint investigation. c.$8,000 divided by 200 trained long term care staff equals $40.00 per individual. Section E: Budget Future funding needs: Future funding needs will correlate with how much growth occurs in long term care beds in Weld County. The current growth spurt is statewide and is reflective of the rapid increase in numbers of elderly 75 years of age and older who are frail and in need of some type of long term care. Assisted living continues to be a fast growing industry in all areas of Colorado and the nation.Area Agencies on Aging nation—wide are working to bring this to the attention of federal and state governments emphasizing the need for support of the Ombudsman Program. See attached budget Budget Narrative: We are requesting$8,000. dollars for a .30 FTE advocate/friendly visitor at$7.86 per hour for 12 hours PER week—$4905. for hourly salary and $490. for fringe (taxes and benefits). Travel reimbursement will be at .27 cents per mile for 5,500 mile or $1,485 dollars. Mileage records will be kept by the advocate for documentation. $620. is requested to cover overhead, supplies and operating expenses. Training is $500 and includes cost to attend ombudsman training sessions in Denver and other local and state training required by the Area Agency on Aging. This year we are requesting an additional funds to increase the number of hours for direct service (2 hours per week) and implement a .36 per hour wage increase. Additional funds are also being requested to support the expansion of the Elder Abuse Prevention Training. There is also a slight increase for mileage to address the needs of the new facilities in rural Weld County. 99.97029 VICTIM ASSISTANCE AND LAW ENFORCEMENT BOARD DETAILED AGENCY BUDGET 16. DETAILED PROJECT BUDGET: Include the estimated cost of all resources needed to undertake the project. round off figures to the nearest dollar. This budget page must include all monies available. In-kind services need to be listed only in the budget narrative, not on this page- CATEGORY TOTAL TOTAL a. Personnel (Employees) (11 salaries (list each ositiGn with salary rate and percentage 2f `ime devoted) l. Eva Jewell 133 , 993 5t 1 700 /YR t i I Diana Hutcheson i22. 564 99 v7 '1'tR % I Julie Clemens 4 , 90 irn I inn } i n , anr , I /YR I t I I $ 2S .944 Suhrnta) of Per40Pnei k ' (2) pIc1+. Retirement._Fringe Benefits. etc 6 .020 Total Personnel Costs I % I 5 34 963 C4 963 • b. Supplies and Other 4oeratiag Exoerses (communications reorod'c"-^r, Supplies / 011erating / Overhead I 4, rsnnl Training 1 1 ,semi, Total Supplies and Operating Expenses I 5 I s nun d. Travel (itemize rranannrtarinn and subsistence/ Mileage / Out of town travel / mpalh 4 ,0n0 • s s 4 000. Total T;rayel casts d. Rmr(pment (iremire) I I I I I I ( s Is -0 Total Fnuioment Cnvty e. professional services iifami.ze i14"tidua)s and organizations) ( I I _0_ Tnral Professional Services costs S s s 43 .963 . E. TOTALPR(1TRfT COST g. Total Percent by Source (1) Federal Funds • s35 . 963 . 82 % (2) VALE Funds S 8 000 . 1 8 t (3) Other Funds• 5 -0- -n-4 TOTAL $4 9r l 100 % Please explain the source of "Other Funds" in the budget narrative. , 17. BUDGET NARRATIVE: Explain and justify the project budget and relate the item budgeted to project activities (use continuation sheets) . • GRVAPPL.VW 9,5',70 79 Attachment A SECTION C: GRANT APPLICATION Type of Application 02B-88 FY97 2B Gram Award No. Region No. — Initial _ Revision of Application Grant Application Period: submitted on 4/13/98 From 01/01/98 to 12/31/98 TITLE III AWARD REQUEST Potential Award Transfer Request NOGA Award Request: SO : Admin Carryover over $33,691 Admin New Alloc $33.691 TOTAL ADMIN $33.691 $33,691 $35.212 $35,212 A Part BAlloc Carryover Part B Alloc $118.869 S20.134 $139,003 TOTAL PART B $154.081 S20.134 $174,215 Part C1 Carryover $0 Part Cl Alloc $153.852 (539.436) $114,416 TOTAL PART Cl $153,852 ($39 436) $114,416 $0 Part C2 Carryover $0 2 S19.302 $67,634 Part C2 Alloc $48,33_ S19.302 $67,634 $48.332 TOTAL PART C2 $5,700 Part D Carryover $5,700 $5 203 Part D Alloc $5,203 $10.903 $10,903 TOTAL PART D $11,374 Part F Carryover $11,374 Part F Alloc $8,593 R x'° $8,593 v -i $19,967 TOTAL PART F $19,967 _ $19,967 $52,286 ' `` 'z Tot Svc Carryover _: .::�:,,,_;�..,:.,,.:._. .�, „„ ::..:.>� Tot Svc New Alloc $334,849 $0 $334,849 TOTAL SERVICES $387,135 $0 $387,135 Part D, and Part F are excluded from all transfers AAS 200 (2/97) • 982o79 Attachment A Region 2B FY 1998 AREA AGENCY ADMINISTRATON BUDGET Line Item Budget Cash Budget In-Kind Budget Total Budget 30,469 Personnel 30,469 890 890 Travel 0 Equipment 2,300 2,300 Other Direct Overhead 12,382 12,382 Total $46,042 $46,042 $ $33,691 33.691 Federal Local $12,351 $01 $12,351 " • Must be 25%of total budget: l 1,230 This is the minimumFederal Funds = 33,691 / 3 = local match required. AAS 220 (2/97) 9 2o7'7 ATTACHMENT B IS A COPY OF THE COMPREHENSIVE ANNUAL FINANCIAL REPORT FOR WELD COUNTY YEAR ENDED DECEMBER 31 , 1997 # gSll (od 9Ya20 79 Attachment C Weld County Area Agency on Aging Advisory Board Membership - November 1998 Member Age Greeley Rural Mi Expertise Other nori ty Mary Ellen 60 X Insurance State Medical Faules plus Services Board John Cruz 60 Windsor X Retired plus Bernie Olivas 60 Pierce X Retired Social plus Services Priscilla X Gerontology - UNC-Graduate School Kimboko Ph.D Mary Fox Kersey Senior Coordinator John Lee X Transportation City of Greeley Rep. Jim Riesberg X Gerontology Weld Food Bank Graduate Peg Scott 60 Ft. Lupton Senior Program plus Shirley Ianelli Keenesburg Liason to Community Judy Yamaguchi Platteville X Educator Caregiver Donald Feldhaus X Educator I lospital Board Mary Jane Lang 60 Frederick 2 yrs college Active in community plus Don Beirbach 60 X Accountant Rotary/Chamber plus Real Estate Active Mary Eastwood 60 X Insurance Wants to give back to plus? community Dale Hall X County Commissioner Mary Jones Ault R/N Homemaker Active Boy Scouts/Girl Scouts 9��v 79 OCT-22 98 11:59 FROM: T0:970 356 3975 PAGE:02 • ' Attachment D • ' . • 1 ^ Assisted l.iwvling, • • at Life Care Center, of Greeley bctober 22, 1998 - . . . - Dear V.A.h.E Grant Board,, This letter is in support of the Victims Assistance in Law' , ' Enforcement Grant for the Ombudsman Program ,through the Weld County Agency on Aging. . - -The elderly' population of Weld County, living in long term care:. ' facilities, is at risk for criminal abuse and neglect: By , providing education to the caregivers of this frail population the grant is' able 'to be a • source of elder abuse prevention. ' , Please consider funding this very worthy program: As our elderly, population continues to grow in Weld County it is a. vital service to prevent risk to our parents and grandparents and provide them a safe and secure life in long term care facilities. Sincerely, . . , 11 , Mindy, Rickard . ' General Manager, The Bridge Assisted Living • • • 1 ' S - • 4750 25th Street •• Greeley, CO 80634 • (970)'339-0022 • FAX (970) 506-9031` . gfav79 . Attachment E Weld County Area Agency on Aging 1 Needs Assessment of Weld County Older Adults 1998 91207e, Weld County Area Agency on Aging Needs Assessment of Weld County Older Adults 1998 Executive Summary Introduction As mandated by the Older Americans Act of 1965,the Weld County Area on Aging (WCAAA) is the coordinating entity serving the needs of persons age,60 and older residing in Weld County. Every four years, the State requires the 16 Colorado AAAs to develop a comprehensive plan addressing the needs of older adults in their respective regions. The WCAAA Board decided that a statistically-representative survey assessing the unmet needs of older adults would provide the data necessary to develop her four-year plan. The 1998 Needs Assessment of Weld County Older Adults was conducted by Dr. Robbyn R. Wacker and Dr.Carol A. Gosselink from the University of Northern Colorado. The goal of the needs survey was to collect sufficient data through telephone and mail surveys to assess the needs of Weld County residents age 60 and older. Methodology To provide a"triangulation"of methods, the needs survey directors used three types of data collection: telephone survey,mail survey, and focus groups. Telephone surveys were conducted between March 9 and April 10, 1998, with 10 Spanish-speaking seniors being interviewed the third week in May. Mail surveys were first sent out March 16, 1998 with two follow-up reminders. The cut-off date for accepting mail surveys was May 25, 1998. The two focus groups comprised of Hispanic elders were conducted on February 18 and 27, 1998. According to the 1993 revised census, Weld County's 60-and-older population is 18,982. To achieve a statistical reliability of±5.0% at the 95% confidence level, 360 respondents needed to be surveyed. By May 25, 1998, a total of 360 respondents had completed either a telephone or mail survey. Methods were used to ensure the over sampling of rural respondents. Survey Findings Sociodemographic Characteristics of Respondents Of the 360 respondents completing the survey, 66.4%were females and 33.1%were males. Six in 10 (59.7%) respondents were 60-74 years of age, 33.6%were in the age group of 75 or older, and 24-four respondents (6.7%) did not provide their age. The mean age of respondents was 71.7. The vast majority of respondents(84.7%) were white; people of color represented 16.5%of the respondents. Six in ten were married (58.9%). Widowed respondents represented the next largest group (29.4%), followed by divorced/separated (8.9%), and never married (2.2%). The largest percentage (35.6%) of respondents reported their highest level of education as being high school graduates (or GED recipients). The rest reported their educational attainment(in descending 9Sae79 frequency)as having some college(24.4%); 6th through 11th grade (21.4%); a graduate degree (8.6%); a bachelor's degree(6:9%0); or less than 6th grade (2.2%). One-half(53.3%) of resppndents lived in a two-person household, one-third (33.9%) lived alone, and 11.8% lived in households with three or more persons. The average length of Weld County residency was 38.7 years,with a range of less than 12 months to 93 years. One-hundred-seventy respondents(47.2%) resided in urban locations and 188 respondents (52.2%), in rural locations. Thirty-eight respondents (10.6%) reported 1997 annual incomes of less than $8000; 11.4%, $8000-$10,499; 18.1%, $10,500-$14,999; 41.7%, $15,000-$49,999, and 9.7%, $50,000 or more. Thirty-one respondents (8.6%)refused to divulge their annual household incomes. Fifty-eight of the 360 respondents, or 16.1%,reported an income below the poverty level, which in 1997 was $7,890 annually for one individual and $10,610 for a couple. Current Employment Nearly one in five (18.9%) of the respondents reported being employed. Males are twice as likely as females to be employed (28.6%vs. 14.2%,respectively). Among those 60-65 years of age, 38.6% are employed compared.with 3.6% of respondents age 81 and older. Respondents who worked outside the home for pay averaged 33 hours per week, with a range of two to 65 hours per week. Three-fourths of the employed respondents were satisfied with the hours they worked. When asked to identify the reasons they continued to work, the largest percent(64.7%) of the 68 employed respondents stated that they needed the income. Looking for work All respondents who were not currently employed were asked"Have you been looking for work?" Only five respondents stated that they were seeking employment. The five respondents had been looking for employment an average of 18.4 weeks, with a range from two to 36 weeks. Volunteerism More than four in ten respondents volunteer in their community. Females are more likely that males to volunteer(45.2% vs. 37.0%, respectively). Volunteering remains relatively high for those age 60-75. At age 81 and older, about three in ten respondents volunteer. White elders are almost twice as likely as are elders of color to volunteer(45.2% vs. 25.5%). Respondents living below poverty level are significantly less likely than the rest of the respondents to volunteer: only about one in four(24.1%)volunteers. Volunteers averaged 17 hours a month. Primary Caregivers When asked, "Are you the main helper for someone who needs assistance with everyday activities, such as bathing, feeding, or helping someone to walk?" 30 respondents said yes. The largest percent of caregivers were providing assistance to a spouse/partner(60.0%). The rest were caring for a parent (16.7%), child(23.3%), other relative (6.7%), or a friend/neighbor (16.7%). About one-fourth of the caregivers were providing care to more than one individual. The average number of hours spent each day as a primary caregiver was 10.4 hours. Eight of the caregivers stated that assistance with meal preparation would be helpful. Four caregivers noted that two hour respite was desirable. Help with bathing and weekend respite were each cited by three caregivers, and vacation respite was requested by two caregiving seniors. 9g 20 7? Transportation' Forty-five individuals (12.5%)stated that they don't drive. When asked if they currently experienced times when they needed to go somewhere but had to stay home because they had no means of transportation, 16 (4.4%) of the respondents replied yes. While only 3.4% of those age 60-65 have had to stay home on occasion due to lack of transportation, three times that many seniors age 81+have experienced this unmet transportation need. Elders of color are nearly twice as likely as white elders to have unmet transportation needs (7.3%for elders of color as compared with 3.9% for white seniors): Being below poverty level makes respondents nearly four times more likely than respondents above poverty level to encounter situations in which they cannot obtain the transportation they need(12.1% vs. 3.3%). Housing The majority of respondents (75.6%) currently lives in a free-standing home. The rest of the respondents live in apartments (9.7%), mobile homes (8.6%),townhouses/condos/duplexes (5.0%), rooms in private homes (0.3%), or some other type of housing (0.6%). Nearly all the participants own the dwelling in which they live(84.2%), 13.9%rent, and 1.4% live with others. Sixty-eight percent of the.303 current homeowners said maintaining the upkeep of their home was not very difficult at all; 26.4% stated that it was somewhat difficult, and 5.6% said it was very difficult. The most common repair needed was outside work, which was noted by 28.4% of the homeowners. When asked why they could not get the outside repairs completed, 29 respondents stated that the repairs were not a priority right now. About one-fourth of the 86 respondents needing home repairs reported that they just hadn't had time to get the repairs done. Cost was cited as an obstacle by 19 respondents, 12 stated that the people who were going to do the repairs hadn't finished the job yet, and two respondents stated that they didn't know whom to call for the repairs. The second most common repair needed, cited by 76 homeowners, was inside work. Plumbing repairs were needed by 14.2%of the 303 homeowners,heating repairs by 10.2%, electrical repairs by 9.9%, and other housing accommodations (e.g., bath rails, etc.)were needed by 5.6% homeowners. All respondents were asked whether they were experiencing a variety of housing problems. Having difficulty paying rent or mortgage most months was reported by 1.4% of the respondents. Living in a place where the space was not right, either too large or too small, was mentioned by 14.2% of the respondents. Sixteen respondents (4.4%) said they were having trouble moving around their home because of some physical condition(s). Worrying about crime in their neighborhood was an issue for 7.2%. Nine respondents(2.5%) stated that they were having trouble getting along with their neighbors. Snow removal was a problem for 6.7%of the respondents and getting yard work done was a concern for 10.6%of the respondents Only 10.6% of the respondents anticipated moving in the next year. They said they might move into another house, four stated they would consider moving into an assisted living residence, 14 thought they could move into an apartment, five, into a condo, seven into senior apartments, and 10 into low-income apartments. Moving in with family and moving into a nursing home were 933079 each mentioned once by a respondent. Ten of the 38 respondents who expected to move would relocate due to health reasons,five said their current housing situation was too expensive, four noted that they needed an easier place to get around in, seven said their current home is too large and two said their current house was too small. Knowledge and Use of Services Respondents were read a list of 16 services that are available to seniors in Weld County. They were first asked whether they had ever heard of the service. If they had heard of the service,they were asked whether they had ever used the service. The service with which the greatest numbers of respondents were familiar was senior centers. Most respondents had heard of the senior center (91.1%6); 31.4%had used the service, and 20.2%had gone to a senior center in the past six. months. The second most recognized service was Meals on Wheels,which was identified by 85.3% of respondents. However,actual service use was low, with only 3.9%of the respondents ever having used the program, and only 0.6%having used Meals on Wheels in the last six months. The programs With the smallest amount of name recognition were the Brown Bag Program (recognized by 23.1% of respondents),the ombudsman program (known by 27.2%), and the senior companion program(recognized by 29.2%). For both the senior companion and ombudsman program, respondents had never used either program. Other Unmet Needs Next, respondents were queried, "In the last six months, have you experienced any of the following situations?" Thirteen percent had been discharged from the hospital. 23.3%had an illness that lasted more than two weeks, 3.3%had experienced a problem with their Social Security or other type of income benefit, 5.8%had encountered a problem with Medicare or other health insurance, 8.6% felt as if they needed to talk to someone about a personal matter but had no one to turn to, 3.6%had had trouble making a payment on a bill, 6.4%had been "ripped off' by a business or person, and 6.9%had experienced difficulty making meals or shopping. Attitudes about Service Use In an attempt to discover what some of the attitudinal barriers to service use might be, respondents were read a set of 10 attitudinal statements. After each statement,they were asked to indicate whether they strongly agreed, agreed, disagreed, or strongly disagreed with the statement. It appeared that respondents were somewhat divided in their views on the appropriateness of service use. The statement with which there was highest agreement was, "If I can't find a way to solve the problem on my own, I would consider seeking help from a program or service." About nine in ten respondents concurred with this statement. The statement over which respondents were most divided was, "I would be reluctant to use a community program or service because I have been self-sufficient all my life." In response to this statement, 51.1% agreed while 42.0% disagreed. Social Contact Contact with Children The average number of children was 3.05,with a.range of none to 11 children. The largest percent of respondents with children(44.8%)had contact with one or more of their children one 99fo"?a 7`1 to six times a week. The rest had contact once a day (37.3%), 1-3 times a month(12.7%), once a month(2.4%), 1-11 times a year(1.8%), or once a year or less (3%). Only two respondents with living children claimed to never have contact with any of their offspring. Contact with,Siblings The average number of living siblings reported by respondents was 2.7, with a range from zero to 14. The largest percent of respondents with siblings (27.8%)had contact with them one to three times a month. The rest had contact once a day (7.2%), one to six times a week(22.5%), once a month(16.3%), 1-11 times a year(16.7%), or once a.year or less (5.2%). Thirteen respondents with living siblings (4.2%) claimed to never have contact with any of their brothers or sisters. Contact with Grandchildren/Great Grandchildren The average number of grandchildren(including great grandchildren) was 6.3, with a range of none to 77 grandchildren/great grandchildren. The largest percent of respondents with grandchildren (33.9%) had contact with them one to six times a week. The rest had contact once a day (14.2%), 1-3 times a month (24.8%), once a month(14.8%), 1-11 times a year(8.4%), or once a year or less (2.6%). Only four grandparents claimed to never have contact with any of their grandchildren. Respondents with grandchildren were queried, "Have you ever been denied visitation with your grandchildren by their parent(s)?" Of the 306 respondents with grandchildren, only nine (2.9%) said that visitation had been denied. Contact with Friends About four in ten respondents (42.5%) had talked to a friend two to six times in the past week. About one-fourth(26.1%) had talked with friends by phone once a day or more, 15.0%had talked with friends once in the past week, but 16.4%of the respondents had not talked with any friends by phone in the past week. Forty percent of the respondents had spent time with a friend two to six times in the past week. Fifty respondents (14.0%)had spent time with friends once a day or more, and 23.3% had spent time with friends once in the past week. Seventy-nine (21.9%) of the respondents had not spent time with any friends in the past week. Health Needs When asked to rate their current health, 17.5% of respondents said their health is excellent, 47.5% said their health is good, 26.1% stated that their health is fair, and 8.6% rated their health as poor. Elders of color were twice as likely as whites to be in poor health. About one in seven elders of color indicated that their health was poor. In comparison, only about one in 13 whites were in poor health. Individuals living in poverty were twice as likely as respondents living above poverty to classify their health as poor(15.5%vs. 7.2%). Of seven health conditions presented to respondents, the most common complaint was arthritis, affecting 60.8% of the respondents. The arthritis interfered with the activities of those with arthritis a great deal (17.8%), 50.2% of arthritis sufferers said it interfered a little, but 60 (27.4%) respondents said the arthritis didn't interfere with their activities at all. Attitudes Towards Life In response to the statement, "I feel I am useful and needed," 35.6%of the respondents strongly agreed, 54.7% agreed,5.3%disagreed,and only .8% strongly agreed. In response to the statement,"I feel hopeful about the future," 26.4% of the respondents strongly agreed, 55.0% agreed, 10.3% disagreed, and only 1.7%strongly agreed. Only 13 respondents(3.6%) strongly agreed with the statement, "I often feel lonely." Sixty-five respondents (18.1%) agreed, 52.8% disagreed, and 15.6% strongly disagreed: The statement,"I worry about becoming a burden to my family or friends,"evoked a strongly agree response from 9.7% of the respondents, 31.7% agreed, 42.5%disagreed, and 8.6% strongly disagreed. The final statement was, "Older people are valued in my community,"19.4%strongly agreed, 60.3%agreed, 9.4% disagreed, and 1.4% strongly disagreed. Health and Health Care A. Activities of Daily Living The most common activity for which respondents needed assistance was housework, affecting 16.2% of the respondents. Of these respondents, only five stated that they sometimes had difficulty finding someone to help them. The second most frequent activity for which help was needed was shopping for groceries or other necessities. This affected 11.7%of the respondents. Of these, six stated that they sometimes experienced difficulty in locating assistance. B. Health Care When asked, "Do you have a family doctor that you see on a regular basis when you need health care?"nearly all respondents answered yes (89.4%). The 36 respondents (10.0%) who said no were queried about why they don't have a family doctor. Five of the 35 respondents (18.9%) said they couldn't afford a physician. Four respondents said they couldn't find a doctor that met their needs. One respondent said that finding a physician who would accept Medicaid was a deterrent. The 322 respondents with a regular family doctor were asked to evaluate their satisfaction with the health care they were receiving. Most respondents were either very satisfied(66.8%) or satisfied (26.4%), while 4.3% were somewhat or very (0.3%)dissatisfied. Among those who were somewhat or very dissatisfied, reasons for their dissatisfaction included that the doctor didn't spend enough time with them(nine respondents mentioned this) or that the doctor didn't seem to be able to help them (mentioned by four respondents). C. Use of Medications When asked whether they ever use any medications, either prescription or over-the-counter drugs, 46 said no. The remaining 314 respondents were asked about their customary behaviors with respect to seven different situations dealing with medication. The behavior of most concern is that only 43.1% check whether there will be drug interactions, despite the fact that 26.1%have prescriptions from more than one doctor. D. Use of Other Health Services The most common health service for which 7.2%of the respondents had difficulty procuring service was dental care. The most common barrier to dental care, mentioned by 66.7% of the ycfao 79 respondents having difficulty, was cost. Not knowing whom to see for dental care was the primary barrier for 20.0% of the respondents having difficulty procuring dental care. Transportation was the third most common reason,cited by 13.3% of the respondents having difficulty obtaining dental care. The second most common health service that respondents had difficulty obtaining was eye care, affecting 4.7%of the respondents. The most common reason noted by the respondents who had difficulty obtaining eye care was cost, mentioned by 70.6%, followed by transportation, cited by 17.6%of the respondents. Major Financial Concerns Respondents were asked, "Do you have any major financial concerns?" Ninety-five respondents (26.4%)answered yes and 255 (70.8%)answered no. The greatest single financial concerns were retirement(4.7%) and doctor/health care (4.2%). Needs of Weld County Respondents were read the following paragraph: "As you probably know, Weld County is currently in the process of growing and changing. What do you see as the most pressing problem facing Weld County?" The problem mentioned most was growth, cited by 28.6%of respondents. The second most common problem cited was that of transportation, traffic, and road maintenance (11.4%). The third highest response category, into which 10.0% of the respondents fell, was that Weld County is a great place to live and that no pressing problems are interfering with the quality of life of residents. The fourth highest category,mentioned by 9.7%, was concern about crime, teen drugs, gangs,juvenile delinquency, and the judicial/legal system. Focus Group Although results from focus groups are not statistically representative, the following trends were noted during the participation of Hispanic seniors at a focus group in Greeley and another focus group in Fort Lupton. • Approximately half of the Hispanic seniors experience transportation difficulties. Many cannot drive or do not have a car and so rely almost totally on their adult children. • Housing was not a major issue for participating seniors except for one individual who could not afford the high rent and utility payments. • Getting appropriate eye care appears to be problematic for several Hispanic elders due to cost and eligibility barriers. • Loneliness affects some of the Hispanic seniors, especially those who have lost a loved one. • Many participants claim not to have been affected by racism and discrimination, although two individuals have had extremely difficult interactions with Anglos. Several individuals noted that the racism of Hispanic human service agency workers against other Hispanics is more of a problem. g,,2o79 • Most participants did not have difficulties with legal issues. • Many participants feel that problems exist in the elder community of Hispanics and that such services as counseling, legal assistance, or relocation assistance are needed. • Most participants did not have difficulties with legal issues. For More Information or Purchase of the Complete Study Contact: Linda E. Piper, Director Weld County Area Agency on Aging 1551 North 17th Avenue\ P.O. Box 1805 Greeley, CO 80631 Phone: 970-353-3800, Ext. 3320 Fax: 970-356-3975 Email: 1piper@co:weld.co.us ATTACHMENT F QUALITY OF CARE PROJECT "ENSURING AN ABUSE FREE ENVIRONMENT" Module 1 A.Overview nl Abuse in Nursing Hnmaq In this module an overview of abuse in nursing homes is presentee. Topics include general characteristics of nursing home residents and the events that usually precipitate placement; societal perceptions of nursing homes;organization of the nursing homes;and nursing home legislation, Including residents'nghts. Afailthe 2 /tf pntitrarinn end Rem gnifinn at A Fv1'P The curriculum uses six categories of abuse: physical,psychological,sexual, financial exploitation, and active and passive neglect. Examples are provided of each type, as are indicators of abuse. Walla Passible Causes al Aturyt • Topics include understanding factors that place residents at risk of abuse. This module presents behavioral problems and communication deficits In residents that can precipitate abuse. Problems that affect nursing aides, such as lack of training, inadequate supervision,work stress. and the facility environment are discussed. Module 4 llndnrci nettpp Footings About Coranivjan A stress indicators exercise Is used to assist staff in identifying their own areas and levels of stress within and outside the workplace. This is followed by a discussion about different causes of stress,systems of stress,and the need to use self control when laced with a difficult situation. The danger signs of stress and the relationship between stress and the potential for abuse are covered. Staff then explore methods and ideas about developing more healthy responses to stress. Aliztth,L5 neural.=;i Fth ltc Pa rth'es and in,nlirations tor Sf°H-fieit10nt Dynseninc A review of the meaning of culture and ethnicity is followed by a cistxussion of the various cultural backgrounds and the ethnic diversity of the residents and staff in the facility. Staff then discuss how understanding of these differences can enrich both staff and resident relationships. eta, AEuse_nt Staff by Residents- Understenefinn vPrartc Perannalisjp�i This module covers causes of resident anger and verbal and physical aggression. Nonviolent approaches to defusing anger and minimizing resident aggression are presentee through group discussion and role play. mMtIA 7 Fthiral and I Aral hence of Reporting.Sucpartnd At/t4A This module encourages staff discussion of what they perceive their ethical responsibility to be regarding the reporting of abuse. Pressures against reporting are discussed. Trainers are encouraged to review reporting procedures for their facilities and the Colorado laws. A review of the possible consequences of not reporting suspected abuse is included. d�G.dul� fntnrvenNnn Slratggiss Inr Ab mse Prevention • This module provides a review of topics covered throughout the curriculum, and gives participants the opportunity to practice intervention strategies through rote-playing. Content includes the appreciation of challenging residents,expectations of staff and residents,accepting Individual differences,understanding versus personalizing resident aggression, and the use of creative intervention strategies to manage challenging behavior. IN.veining Is bons pnsd In nursing name dmngat ee Denver OAS arm es ORCOG Guinn/et Cie Praha The non Min.1-. to PA p tna Cartlan r AdSCCYn tarts Woe Pidartlr(WW1 • • As g5:e 79 Hello