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HomeMy WebLinkAbout20191316.tiffRESOLUTION RE: APPROVE FOUR-YEAR PLAN FOR AREA AGENCY ON AGING (TITLE III AND VII) FOR FEDERAL FISCAL YEARS 2020-2023 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 Plan for Area Agency on Aging (Title III and VII) for Federal Fiscal Years 2020-2023 from 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, to the Colorado Department of Human Services, Aging Services Unit, commencing July 1, 2019, and ending June 30, 2023, 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 Plan for Area Agency on Aging (Title III and VII) for Federal Fiscal Years 2020-2023 from 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, to the Colorado Department of Human Services, Aging Services Unit, 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 3rd day of April, A.D., 2019. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, LORADO ' ATTEST: datitio j a: ok Weld County Clerk to the Board ounty Attorney Date of signature: y-a'lQ O !tG arbara Kirkmeyr, Chair Mike Freeman, P -Tem C v can P. Conway Steve Moreno 2019-1316 H R0090 PRIVILEGED AND CONFIDENTIAL MEMORANDUM DATE: March 20, 2019 TO: Board of County Commissioners — Pass -Around FR: Judy A. Griego, Director, Human Services RE: Department of Human Services' Area Agency on Aging (AAA) Four Year Plan Please review and indicate if you would like a work session prior to placing this item on the Board's agenda. Request Board Approval of the Department's Area Agency on Aging's (AAA) Four -Year Plan for Fiscal Year 2020-2023. The AAA Four -Year Plan for fiscal year 2020-2023 will help guide the AAA staff and Weld County Advisory Board in the provision of services and support to seniors of Weld County. The plan has been reviewed and approved by the Advisory Board. The plan includes: public input, demographics, an overview of the Community Assessment Survey of Older Adults (CASOA), current and future Older Americans Act (OAA) programs, specific program questions, primary target population for services, community trends, community input, and key strategies and programs to be funded over the upcoming planning period. These programs include: a. Information and Assistance and Aging and Disability Resources for Colorado b. Outreach Services (Minority Outreach Program and Case Management Services) c. Transportation Services d. In -Home Services (Homemaker and Personal Care Services and Peer Counseling Services) e. Legal Assistance Services f. Ombudsman Services g. Disease Prevention and Health Promotion Services and Evidence Based Programs h. Congregate Nutrition Services i. Home -Delivered Nutrition Services J• National Family Caregiver Support Program k. Other Optional Support Services (Dental, Vision and Hearing Program, Visually Impaired Service Program, and Chore Program) 2019-1316 Pass -Around Memorandum; March 20, 2019 — Not in CMS 413 Page I HRcci o PRIVILEGED AND CONFIDENTIAL The OOA and Senior Services funding level for Federal Fiscal Year 2019 is $2,472,603.11. The funding for FY 2020 has not yet been determined. I do not recommend a Work Session. I recommend approval and submission of the plan. Approve Recommendation Work Session Schedule Sean P. Conway Mike Freeman, Pro-Tem Scott K. James Barbara Kirkmeyer, Chair Steve Moreno Other/Comments: Pass -Around Memorandum; March 20, 2019 — Not in CMS Page 2 Weld County Area Agency on Aging Assistance Advocacy Answers on Aging TABLE OF CONTENTS SECTION I: EXECUTIVE SUMMARY 1 SECTION II: PUBLIC INPUT 2 Older Adult Focus Groups 2 Service Provider Focus Groups 4 Public Hearing 5 SECTION III: DEMOGRAPHICS 5 SECTION IV: COMMUNITY ASSESSMENT SURVEY OF OLDER ADULTS (CASOA) 12 Overall Community Quality: 12 Community and Belonging: 13 Community Information. 13 Productive Activities• 13 Health and Wellness• 14 Community Design and Land Use15 SECTION V: CURRENT AND FUTURE AREA AGENCY ON AGING PROGRAMS AND VOLUNTEERS 15 Older Americans Act Core Services 16 Information and Assistance (I & A) and Aging and Disability Resources for Colorado (ADRC) 16 Outreach Services 17 Case Management Services for At- Risk Older Adults 17 Transportation Services 18 In -Home Services 18 Legal Assistance Services 19 Ombudsman Services 21 Disease Prevention and Health Promotion Services and Evidence -Based Programs 22 Nutrition Services 23 National Family Caregiver Support Program 25 Older Americans Act Optional Services 26 Dental, Vision, and Hearing Program (DVH) and Visually Impaired Service Program 26 Chore Program 26 Other programs: Not funded by the Older Americans Act or State Funds for Older Adults 27 Colorado Options for Long -Term Care Program (OLTC) or Single -Entry Point (SEP) 27 Adult Protective Services 27 Colorado Choice Transitions (CCT) 27 i SECTION VI: QUESTIONS 27 Core Services 27 Ombudsman and Legal Assistance 29 Other Services 30 Targeting and Outreach 30 Innovation and Expansion of Services 32 SECTION VII: TITLE III/VI COORDINATION 35 SECTION VIII: ATTACHMENTS 36 Attachment A: Direct Service Waiver Request 36 Attachment B: Senior Nutrition Site Locations 38 Attachment C: Community Focal Points and Senior Centers 44 Attachment D: Regional Advisory Council Membership 47 Attachment E: Statement of Intent 48 Attachment F: Focus Group Schedule 49 Attachment G: Focus Group Questions for Older Adults 50 Attachment H: Focus Group Questions for Service Providers 51 ii SECTION I: EXECUTIVE SUMMARY The Weld County Area Agency on Aging Four -Year Plan for State Fiscal Years 2019-2023 (July 1, 2019 to June 30, 2023) will help guide the Area Agency on Aging staff and Area Agency on Aging's Advisory Board in providing services and support to Weld County older adults. The plan will be reviewed annually, and adjustments will be made to reflect changes and new opportunities in the coming years. Any significant adjustments to the Plan that may be needed during the planning period will be approved by the Area Agency on Aging staff, the Area Agency on Aging Advisory Board, the Board of County Commissioners and the Colorado Department of Human Services, State Unit on Aging. The Plan is presented in eight sections: the executive summary, the results of input received from community members who participated in focus groups, 60+demographics, highlights of information gleaned from the community assessment survey, a review of current and future Older Americans programs and the use of volunteers, specific program and planning questions; "coordination," and an attachment section. The planning document follows the template developed by the Colorado Department of Human Services, State Unit on Aging. As described in Section II, public input was acquired from survey data and from focus groups. The questions that were presented to the groups were designed to help guide us in our four- year planning process. The demographic section (Section III) of the Plan provides a general overview of the demographic changes within the region. Weld County, like the rest of Colorado, is experiencing a change in the aging population. Between 2018 and 2025, Weld County will experience a 26% growth in 65 to 74 -year -old individuals and a 38% growth in the 85+ age group. This growth will have a significant impact on how the Older Americans Act (OAA) service provisions are implemented and will dramatically affect the community overall. In Section IV, results from the CASOA survey is presented and implications of the data are analyzed. In 2018, the Colorado Association of Area Agencies on Aging applied and received a grant from the NextFifty Initiative. This grant allowed the sixteen Colorado Area Agencies on Aging to individually contract with the National Research Center in Boulder, Colorado to complete a state-wide Community Assessment Survey for Older Adults (CASOA) and a region -specific survey report. The Weld Area Agency on Aging requested additional reports for the Carbon Valley and Erie areas. The Four -Year Plan highlights the key findings in Weld County and in the Erie and Carbon Valley areas. The full reports are available on the Weld County Area Agency on Aging (AAA) website www.weldaaa.orq. Section V provides a detailed overview of the current and future programs and use of volunteers for all programs that will be provided by, or through, the Weld County AAA over the next four years. The section also addresses current and future initiatives for each program area and, when appropriate, discusses the use of volunteers. The question section (Section VI) of the Plan addresses such topics as: program barriers and monitoring, waitlist management, the Ombudsman and legal programs, targeting and outreach, and innovation and program expansion. Each question was addressed based on historical 1 program practice, knowledge of the AAA system, Older Americans Act regulatory requirements, and current and future agency initiatives. Section VII does not apply to Weld County since we do not have a Title VI Native American program in our region. Attachments in Section VIII include the direct service waiver requests, which outlines the programs that are managed within the AAA verses being managed by a community contractor/provider. All programs that are managed internally must be approved by the Weld County Area Agency on Aging Advisory Board, the general public through a public hearing process and the Colorado Department of Human Services, State Unit on Aging. The additional attachments address the location of all Senior Nutrition meal sites, the community focal points and senior centers, Area Agency on Aging Advisory Board membership, the statement of intent, and additional focus group information, and demographics. SECTION II: PUBLIC INPUT The Weld County Area Agency on Aging (AAA) offered multiple occasions for consumers to share the strengths and needs of older adults in Weld County. The Area Agency on Aging Advisory Board members and the AAA staff members played a significant role in gathering information through the focus group process. During July and August 2018, twelve focus groups were held throughout Weld County. Ten of the focus groups were dedicated to obtaining feedback from older adults and two focus groups (one held in Firestone and the other in Greeley) provided an opportunity for senior -service providers from the community to provide information about how their efforts are perceived by the seniors. The questions asked at the service providers focus groups are found in Attachment G and H. A total of 201 individuals attended the groups geared to older adults and 25 attended the two service provider focus groups. In addition, a public hearing was advertised and held to provide the public an opportunity to provide feedback on this Four -Year Plan. Older Adult Focus Groups The purpose of the ten older adult focus groups was to reach out to seniors and obtain feedback regarding their thoughts about their own aging journey, their current use of supportive services, potential future service needs, information and access to senior service, individual community strengths regarding senior services, innovative senior programs and their future residential plans. All focus members were asked the same 10 questions (Attachment G). We found, across the older adult focus groups, that participants shared many of the same positive aspects of growing older. Responses ranged from having less day-to-day stress, time to explore other interests, and increased interaction with family and friends, to getting to know themselves better and yes having wisdom! The challenges of aging ranged from health concerns, loss of independence, financial concerns, and fear of not being able to drive. Some indicated feeling alone, many times due to the death of a spouse. We were also interested in finding out what services the participants were currently using. Those most often mentioned were services related to heavy housework, yard care, general home maintenance, and transportation. When asked what services they thought they might need in the next 4-5 years, 2 many simply repeated those they were currently using. Transportation assistance, whether provided by family, friends, or service providers, was a particular concern as respondents noted their need to access services, get to doctor appointments, and be able to go shopping for food. Other responses mentioned access to long-term care facilities, such as assisted living, to simply downsizing their existing home to something smaller with less maintenance. We were pleased to see that many seniors are successful in locating and accessing senior services, but we are concerned that many seniors indicate that they do not know where to go for information about available services and how to connect with them. We asked the participants how they currently access senior -related information. The top two answers were word of mouth and from their local senior center/community center. The next sources were traditional print media such as newspaper, newsletters, brochures, and other senior information guides such as the AAA's HelpSource and the Blue Book. Other answers included AAA presentations at senior and community centers, physicians, churches, phone book, etc. We followed this question up with how they would like to access and receive information about aging services and resources in the future. We were hoping that this would give us direction in our marketing and outreach efforts. What we found was that many participants still look for information in print form, whether it is in the newspaper, magazine, brochures, or flyers. Some did indicate that they use the internet to access service information. The large majority rely on word of mouth. This information could be coming from friends, family members, senior centers, and, at times, professionals. Because community engagement plays an important part in a person's quality of life, we were interested in knowing what positive things the participants' saw happening in their community. Several of them indicated they were pleased with their senior/community centers and the services, such as a senior nutrition meal program, linked with those centers. Other comments noted access to libraries, walking trails, churches, community cleanup events, movies, farmers markets, tai chi classes, etc. The community activities and the interest in engagement did not seem to differ between rural and more urban communities. Recommendations for how communities could be more responsive to senior needs varied from having a dedicated senior center rather than only a general community center, to providing additional senior housing, having access to more and improved transportation options, getting assistance with yard maintenance, computer and smart phone classes, more wellness classes, and, local resource fairs. The last question asked where the older adult focus group participants saw themselves living five years in the future. It was no surprise that most participants stated that they would be living in their current home. Interestingly this response was consistent with what was reflected in the 2018 Community Assessment Survey. When respondents were asked the likelihood of them remaining in the community throughout their retirement, 83% indicated it was somewhat or very likely. A few seniors stated that they see themselves moving closer to family or downsizing and moving into a senior apartment complex. Since staying in their own home was the overwhelming goal of most seniors, the focus group facilitators encouraged the participants to look at their current home with a critical eye and determine if the home will need thoughtful modifications for them to live safely and comfortably in their home now and in the future. 3 Service Pr vider Focus Groups For the two service provider focus groups, representatives from all Weld County organizations and businesses that provide senior services were invited to attend focus groups held in Firestone and in Greeley. °articipants at both service provider focus groups were given the same set of questions (Attachment H). We were interested in knowing how older adults were made aware of the services that are provided, what service gaps they feel exist in the community, what improvements in the service network they would like to see, whom they feel is being underserved and why, innovative services they would like to see developed, and any additional thoughts and/or ideas that we did not ask about. The service provider focus groups in Greeley and Firestone were well attended and very interactive. As we heard from the older adult focus group participants and also from 2018 CASOA survey, many seniors are unaware of the plethora of senior services available in the community. In addition, most are unsure of where to go to obtain the service information. So, we were especially interested in learning from the service providers about their marketing techniques and how they think seniors learn about their services. The responses were not clear cut. Some providers advertise their services in the newspaper and on the radio, others reached out to key hospital staff, physicians, the faith -based community, other health care providers, and others indicated they use social media and a business website. They also stated that they try to reach out directly to the potential client and to the senior's family members. No one seemed to have the answer, but all agreed that getting the information to seniors who need services is challenging. The service providers were asked about their views regarding what gaps exist in senior services currently offered in the community and what improvements could be made within the current network of services. cene important theme coming out of the discussion was the providers' concern that seniors and their families/friends found it difficult to access information about service options. In part, they attributed this issue to the confusing processes that exist to access entitlement and other government programs due to the cumbersome application processes and confusing regultions. The service providers also thought there should to be greater collaboration between agencies and providers so that seniors and family/friends do not get lost in the system. They also were concerned that there are too few professionals in the network providing impartial information and assistance, and that intensive case management scrvices are lacking. Other issues discussed related to lack of transportation services throughout the county, limited number of Medicaid beds in assisted living, limited affordable and accessible housing options for all seniors throughout the county, lack a of adult day care services, a general lack of consistent livable community planning in all cities and towns in the county, limited services to rural seniors, and gaps in services for seniors who live alone. Providers wero also asked who they thought were the underserved senior. Seniors who live in rural areas, seniors who have Alzheimer's or other forms of dementia, isolated and lonely seniors, and seniors who fall in the "Utah Gap" (term used to describe individuals who make too much money or have too many resources to qualify for assistance but do not have enough money to purchase services), non-English speaking seniors, and seniors who need transportation on the weekends were mentioned most frequently. 4 We also asked the participants to dream and share what innovative programs or services they would like to see. Their ideas included a more robust Aging and Disability Resources for Colorado (ADRC) program, an enhanced Project Connect Event that reaches out to homebound seniors, an event focusing on senior information and resources, a transportation "urgent care team," and the implementation of a Livable Communities concept throughout the county. At the conclusion of the focus group, we asked the participants what additional questions we should have asked. The group stated that we should have asked more questions concerning homelessness, the concept of reframing aging, and the possible need for additional health promotion and prevention programs. Public ES' gain 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 March 20, 2019, at 9:15 a.m. The public hearing was made public through a press release to the Greeley Tribune Beyond 60 Page, the leading newspaper in Weld County. A total of twelve individuals attended the meeting. At the public hearing, the plan was reviewed, highlighting the programs funded and managed either by internal staff or through contracted community providers. Direct waiver information was discussed and approved. SECTI ii : IJ SG AHWWS Weld County, located in the northern part of the state, is the third largest county in Colorado covering 3,987 square miles. The county is home to 304,435 people, 50,935 who are 60+ years old (Table 1 2017 Population Estimates American Community Survey of the U.S. Bureau so the Census). Weld County, like the rest of Colorado, is experiencing a change in the aging population. As noted in Table 2, Weld County will be seeing a 26% growth in 65 to 74 -year -old individuals and a 38% growth rate in the 85+ year- old group between 2018 to 2025. Table 3 provides an overall comparison of the 60+ population growth when compared to the overall population growth anticipated over the next four years. This overall change in population will have a significant impact on the type and scope of services that the AAA and the community at large must address. Table 1 2017 Final Population Estimates for Weld County -- _-- ' 60+— 50,935 — 14,12.4:. --. 75+ - ' Poverty 60+ 3,683. I Ethnic Minority 60+ 9,180 ,, Rural 6p+ Low Income 10,967 (185%) 60+ 17% Population total of the 28% Senior Population of the 8% Senior Population of the 80 of Population the Senior 30% Senior Population of the 22°/0 of Population the Senior Source: American Community Survey of the U.S. Bureau of the Census County Pr jecte P • Table 2 pulatbon Chan ire by Age Group 2018 to 2025 5 Projected Population Change by Age roup-, 2018 to 2025 400000 350000 300000 250000 200000 150000 100000 50000 0 AU ages; 0to17 16 to 24 >-25to54 55 to 64 24 '° 17 %; 65 to 74 23 fl 29 % 13 % 85 & over 38 15 20 25 Percent Change 40 Source: Colorado State Demographer, Department of Local Affairs 55324 Table 3 Projected Age 60-100 verses Total Population p jecte 323765 Year 2019 333149 57562 Year 2020 yes6 T taA P 59800 u 343956 Year 2021 E1 Ages 60+ B3Weld County All Ages fl 355073 62032 Year 2022 Source: Colorado State Demographer, Department of Local Affairs The AAA strives to reach and address the needs of the most at -risk older adults in our region. One indicator of risk that we pay special attention to is poverty. We have mapped the location 6 of older adults in the county based on 1 and 2 times the poverty level and the location of our senior nutrition sites throughout Weld County. - 4 - vat tea .,` - Id.,County Percent of Individuals 65 Years and1Overwith Income Less Than 1.0 Federal Pove BERTHOU0 MEAD PIERCE---- SEVERANCE WINDSOR EATON GILCREST P LATT EV IL LE FORT LUPTON • BRIGHTON L SALLE LOCHBUIE _HUDSON KERSEY KEEN ESBURG 65 and Over Less Than Al Times Poverty Level 0.00% 0.01%- cs 10.01 % 20.01% ED 30.01% 40.01% 50.01% 60.01% - 70.01% 10.00% - 20.00% - 30.00% - 40.00% - 50.00% - 60.00% -70.00% - 100.00% Senior Nutrition Sites This product has been developed solely for internal use only by "Weld County. The GIS database, applications, and data in the product is subject to constant change and the accuracy and completeness cannot be and is not guaranteed. The designation of lots or parcels or land uses in the database does not imply that the lots or parcels were legally created or that the land uses comply wth applicable State or Local law. UNDER NO CIRCUMSTANCE SHALL ANY PART THE PRODUCT BE USED FOR FINAL DESIGN PURPOSES. WELD COUNTY MAKES NO WARRANTIES OR GUARANTEES. EITHER EXPRESSED OR IMPLIED AS TO THE COMPLETENESS. ACCURAC Y. OR CORRECTNESS OF SUCH PRODUCT, NOR ACCEPTS ANY LIABILITY, ARISING FROM ANY INCORRECT. INCOMPLETE OR MISLEADING INFORMATION CONTAINED THEREIN. sours& uS.CensusBureau -2017ACS5-Yearsunmarytie seg56 7 NUNN air GLOWS WS FCRT itz a i LE 'CA 4 4-2 ova -A RrEBME ?LER 2.0 Fet'eral P v\PI it+;ir ..,,,,.,.i.. a . ....... C100% C101%. ,..,. D 2 ca % 3a01% ''A 0 o..0 --J iaat.011%. Weld o MI ptee..,,a,41tas JegisiiipSlia(afiiyit; Mb! LSO. ra; , ittyVoted i i :. iliovail Ocultklx,::c. r&*t. :s ri gins is: to poritoz leaswee rs, sznaterto lifli irteliV Mill laaiRati Ind t`:•brr 4 casa.sw&aSad at a cat I.adn.^a►r aat:. at tifibetii.0! kithrsfi llebsdtiLirea,Ar.terdietkiikimitcittiia `: *katthie: Mai ve-pe ifiaid 3}' moralX-° efait,itid 3*nab. aa[a•r?L,�c1tii> •. jiIt Ate 3:, :3 ;TP .feP .ILIW€tsWirFite Rei0..LC' ' M VIED Mt Pa Itteareht PIAFiCkS a. WELD COLATTY iiatti xat .$Miff&• 4 a thumarrres., MAUI:EitOM d Et: it* faiktila TOMElE ieiRblyM^E:t iI, 7: Y `'o'.ac rZaPiPe2b:::11.714E.tit CsfivItiCii4 kli eg .WitlitZeiPTSAler art, ftikisia i iviF1'tib , 55:.'i`'iiversaPiz rainii t i itiebleti d1I�L'aitiMMAMED .,''!aaam:xiti.aoisuli Sasauc-^Xs^...1:fePint Mama Iry :OSs;Fla . ,..... 8 Many of the nutrition sites are located near or within the higher poverty areas. On addition to providing meals several times a week, nutrition sites offer additional senior resources/services, social support, and provide criticI information regarding senior services in the community. Since we know age is another risk factor, we have identified where the 65+ older adults reside within our county. Understanding where seniors arc growing old in our community will help with the development of future programming and targeting opportunities. FIRESTONE GIL.CFEST FORT 1:UPT€ IN HUDSON KrENESL'IJR Senior Nutrition Sites % of Total Population > 60 4:97% - &85% 8.86% - 12,27% 11' 25% - 14,95% 14.96% _ 18.09% - 21.66% 21.67% - 25,98% v.tsn - 1 This product has been developed solely for internal use only by Weld County. The GIS database, applications, and data n the product Is subject to constant change and the accuracy and completeness cannot be and is not guaranteed. The designation of lots or parcels or land uses in the database does not imply that the tats or parcels were legally created or that the land uses comply with applicable Sate or Local law, UNDER NO CIRCUMSTANCE SHALL ANY PART THE PRODUCT BE USED FOR FINAL DESIGN PURPOSES. WELD COUNTY MAKES NO WARRANTIES OR GUARANTEES, EITHER EXPRESSED OR IMPLIED AS TO THE COMPLETENESS, ACCURACY, OR CORRECTNESS OF SUCH PRODUCT, NOR ACCEPTS ANY LIABILITY. ARISING FROM ANY INCORRECT. INCOMPLETE OR MISLEADING INFORMATION CONTAINED THEREIN. 9 Weld County Senior NutritionSites NIA AERESToNE ..... Senior Nutrition Sites of Total Population > 75 0.00% - 0.73% 0.74% - 1.75% 1.76% - 2.75% 2.76%--3.74% 3.75% - 5.32% 5.33% - 7.24% 7.25% - 9.98% This product has been developed solely far internal use only by Weld Counts. The GIS database, applications, and data in the product is subject to constant change and the accuracy and completeness cannot be and is not guaranteed. The designation of lots or parcels or land uses in the database does not imply that the lots or parcels were legally created or that the land uses comply with applicable State or Local law UNDER NO CIRCUMSTANCE SHALL ANY PART THE PRODUCT BE USED FOR FINAL DESIGN PURPOSES. WELD COUNTY MAKES NO WARRANTIES OR GUARANTEES. EITHER EXPRESSED OR IMPLIED AS TO THE COMPLETENESS, ACCURACY, OR CORRECTNESS OF SUCH PRODUCT NOR ACCEPTS ANY LIABILITY, ARISING FROM ANY INCORRECT, INCOMPLETE OR MISLEADING INFORMATION CONTAINED THEREIN. 10 RFRICH ION • Minority % of Population 65 and Over 0.00% - 2.19% 2.20% - 5.54% 5.55% - 9.89% 9.90% 13.96% 13.97% - 17.91% __ 27.61% - 43.10% 43.11% - 60.80% t a. . X0.81%-89.14% 'Weld Coun This product has been developed solely for internal use only by Weld County. The GIS database, applications, and data in the product is subject to constant change and the accuracy and completeness cannot be and is not guaranteed. The designation of lots or parcels or land uses in the database does not imply that the lots or parcels were legally created or that the land uses comply with applicable State or Local law. UNDER NO CIRCUMSTANCE SHALL ANY PART THE PRODUCT BE USED FOR FINAL DESIGN PURPOSES. WELD COUNTY MAKES NO WARRANTIES OR GUARANTEES, EITHER EXPRESSED OR IMPLIED AS TO THE COMPLETENESS, ACCURACY, OR CORRECTNESS OF SUCH PRODUCT, NOR ACCEPTS ANY LIABILITY,ARISING FROM ANY INCORRECT, INCOMPLETE OP MISLEADING INFORMATION CONTAINED THEREIN. source: us. Census Bureau -2017ACS 5YearSummary MleSeg2and 3 ill SECTION IV: COMMUNITY ASSESSMENT SURVEY OF OLDER ADULTS (CASOA) In summer 2018, a statewide Community Assessment Survey of Older Adults (CASOA) was completed by the National Research Center of Boulder Colorado. This is the second Colorado statewide older adult survey to be completed by the National Research Center in the last 18 years. Each AAA received a custom report that focused on responses from participates in their catchment area. The Weld AAA requested additional reports for the Carbon Valley and Erie areas. Carbon Valley and Erie are two areas that are rapidly growing in population and we were interested to see if their needs varied significantly from the rest of the county. The overall objectives of the survey were to: • Identify community strengths in serving older adults. • Articulate the specific needs of older adults in the community. • Estimate contributions made by older adults in the community. • Determine the connection that older adults have to their community. The survey was mailed on May 25, 2018, to a random selection of 1,900 older adult households in Weld County. A total of 346 individuals completed and returned the survey. This return rate provided an overall response rate of 19%, with a margin of error of plus or minus 5% around any given percent and three points around any given average rating for the entire sample. The 2018 report compared findings with the 2010 survey, where the same questions were asked. The differences between the two survey years are considered statistically significant if the variance is seven percent or greater when percentage points are provided and four points or greater when reference is to an average rating. We are also able to compare the 2018 data with a national sample based on a National Research Center (NRC) dataset that collates responses to CASOA, and related surveys, administered in other communities. This NRC national sample allows Colorado responses to be compared against national benchmarks. The findings of the report were arranged in six community dimensions. Each dimension explored the senior's rating of the community, participation in community activities, and potential problems faced by older adults in relation to each dimension: • Overall Community Quality • Community and Belonging • Community Information • Productive Activities • Health and Wellness • Community Design and Land use The key findings for all of Weld County, Carbon Valley, and Erie for each of the six dimensions are listed below: Overall Community Quality: • Most of Weld County's older residents, including those in Carbon Valley and Erie, gave high ratings to the community as a place to live. • Seven in 10 older adults would recommend Weld County to others. Carbon Valley and Erie respondents also recommended their community to others. 12 • About half of the respondents had lived in the community for more than 20 years and over 8 in 10 planned to stay in the community throughout their retirement. Carbon Valley and Erie seniors have lived in the community for fewer years but over three quarters of all seniors see themselves staying in their community. • Weld County, Carbon Valley and Erie older residents tended to rate aspects of Overall Community similarly to how that item was rated in other communities across the nation. Community and Belonging: • About two-thirds of respondents reported "excellent" or "good" overall feelings of safety, but 8% to 30% indicated they had experienced safety problems related to being a victim of crime, abuse, fraud, or discrimination. In Carbon Valley and Erie almost 9 in 10 seniors reported excellent or good overall feelings of safety. In Carbon Valley between 5% and 16% of seniors experienced safety problems related to being a victim of crime, abuse, or fraud while 20% experienced some form of age -related discrimination. Between 2% and 6% of Erie seniors had experienced safety issues and 27% experienced age -related discrimination. • In Weld County overall, more than 5 in 10 older residents rated the sense of community as "excellent" or "good." Similar ratings were provided for the county's neighborliness and valuing of older residents. Interestingly, Carbon Valley seniors rated their community higher on these topics than did Weld seniors generally and seniors in other parts of the country. Erie seniors also rated their community high in both areas. • When compared to other communities in the United States, older residents in Weld County, Carbon Valley, and Erie provided similar ratings for aspects of Community and Belonging. Community Information: • About half of survey respondents in Weld County reported being "somewhat" or "very" informed about services and activities available to older adults in their community. That proportion is similar to the percentage reported nationwide. Carbon Valley and Erie seniors responded in a similar manner. • Four in 10 older adults gave "excellent" or "good" ratings regarding the availability of information about older adult resources and financial or legal planning services. Similar responses were given by Carbon Valley and Erie residents • About two-thirds of respondents had problems knowing what services were available and feeling like their voice was heard in the community. Similar responses were given by Carbon Valley and Erie residents. • About 4 in 10 reported having problems with finding meaningful volunteer work, a rate that was similar in Weld County (and in Carbon Valley and Erie separately) to other communities in the United States. Productive Activities: • About three-quarters of older adults felt they had "excellent" or "good" opportunities to volunteer, but only about one-third participated in some kind of volunteer work --a volunteer rate similar to other communities in the United States. Erie's reported 13 volunteer rate was higher than Carbon Valley's and higher than the overall average in Weld. • About 2 in 10 respondents had used a senior center in the community, which was similar to the reported senior center use in other communities. Similar percentages were found in Carbon Valley and Erie. • About half of seniors in Weld and in both Carbon Valley and Erie said that they had at least "minor" problems having interesting social events or activities to attend. • Two-thirds of older residents rated the recreation opportunities in Weld County as "excellent" or "good." Participation in recreational and personal enrichment activities tended to be similar in Weld County to other communities. Percentages of "excellent" and "good" responses were slightly higher in Carbon Valley and Erie. • About half of older residents in Weld County said they were caregivers. Respondents averaged between 10 and 15 hours per week providing care for children, adults, and older adults. The number of hours of caregiver time was slightly lower in Carbon Valley and in Erie compared to the Weld County average. • At least 17% of older adults in Weld County felt physically, emotionally or financially burdened by their caregiving. In Carbon Valley between 12% and 20% of respondents reported feeling caregiver burden versus 2% of the Erie respondents. • Two-thirds of respondents were fully retired and 4 in 10 respondents experienced at least minor problems with having enough money to meet daily expenses or in dealing with financial planning issues. Carbon Valley and Erie reported similar results. • The value of paid (part- and full-time work) and unpaid (volunteering, providing care) contributions by older adults in Weld County totaled about $974 million in a 12 -month period. Health and Wellness: • The proportions of older residents reporting problems with doing heavy or intense housework (63%), maintaining their yards (51%), and staying physically fit (63%) were similar in Weld County when compared to elsewhere in the country. Carbon Valley and Erie results were similar. It was interesting to note Erie respondents reported fewer problems with maintaining a healthy diet. • About 3 in 10 older residents felt there was "excellent" or "good" availability of mental health care in Weld County while about 8 in 10 rated their overall mental health/emotional wellbeing as "excellent" or "good." It is important to note only 17% of the Carbon Valley respondents felt there were "excellent" or "good" mental health services available in their community. • The most commonly cited mental health issues included feeling bored and feeling depressed, while the least cited issues included figuring out which medications to take and when. These mental health problems experienced by older adults tended to be similar to the problems experienced by older adults in other communities. The 2018 findings indicate, when compared to the 2010 Weld County survey results, that older adults in Weld County are expressing an increase in feeling depressed, feeling lonely or isolated and having fewer friends and family to rely upon. • Compared to other communities across the nation, older adults rated the availability of preventive health services in Weld County similar to the availability of these services found elsewhere. Carbon Valley's responders indicated that seniors are seeing an 14 improvement of preventive services in their community when compared to the 2010 survey. • Half of older adults reported at least minor problems with having adequate information about or dealing with, public programs such as Social Security, Medicare, and Medicaid. Carbon Valley and Erie respondents gave similar responses to this question. • One in five respondents reported spending time in a hospital, while about one-third had fallen and injured themselves in the 12 months prior to the survey. Falls and hospitalizations also occurred at similar rates in Weld County as in other communities. Carbon Valley seniors did show an increase in falls when compared to the 2010 survey results. • At least 14% of older adults reported at least minor problems with aspects of independent living, including about one-third who reported having problems with performing regular activities, including walking, eating and preparing meals. Community Design and Land Use: • Respondents were generally pleased with the ease of getting to the places they usually visit. The ease of car travel and the ease of walking received the most positive responses with almost 6 in 10 rating each as "excellent" or "good." • About 2 in 10 respondents felt they had "excellent" or "good" availability of affordable, quality housing, while about one -quarter rated the variety of housing options this way. Carbon Valley and Erie respondents also reported issues locating available affordable quality housing and experiencing a limited variety of housing options. Carbon Valley's rating has shown significant decline from the 2010 survey. Erie's ratings are also below their peers from across the country. • One -quarter of older adults experienced problems with having safe and affordable transportation available or having housing to suit their needs. Fewer (11%) reported issues with having enough food to eat (11%). Daily living problems tended to be similar in Weld County when compared to other communities across the nation. Carbon Valley and Erie seniors expressed similar concerns in all three areas. • Eight in 10 older residents rated their overall quality of life as "excellent" or "good," a similar rating in Weld County when compared to other communities in the United States. Carbon Valley and Erie seniors responded in a similar manner. SECTION V: CURRENT AND FUTURE AREA AGENCY ON AGING PROGRAMS AND VOLUNTEERS This section provides an overview of the core and optional programs that we anticipate funding over this four-year planning period. We will also identify where and how we are using volunteers to either enhance the services provided or show that volunteers are vital to the delivery of services. The services and priority planning for the Weld County Area Agency on Aging (AAA) was guided by the information obtained from senior groups, individual seniors, volunteers, professionals, AAA staff, and the Area Agency on Aging Advisory Board, as well as by the requirements under the Older Americans Act. Every four years the Weld County AAA releases a Request for Proposal (RFP) for all major program areas that are not provided directly by internal staff. For this bidding cycle, the RFP 15 was released by the Weld County Department of Human Resources in February 2019. The bid proposal outlined the expectations, goals, and objectives of the specific programs the AAA was interested in funding. Once the proposals were received from interested bidders, they were reviewed by a subcommittee of the Weld County Area Agency on Aging Advisory Board. The subcommittee will present their findings and recommendations to the Area Agency on Aging Advisory Board in April 2019. The Weld County Board of County Commissioners will review the bids in May 2019 and, upon on their approval, provider contracts will be written, signed, and sent through the county contract process. Below is a detailed outline of the service areas that will be funded during this four-year planning period. Programs that are available through the Weld County AAA but are not funded by the Older Americans Act are also included in the plan but are clearly identified as programs funded through other funding streams. Volunteers are used in several program areas listed below in order to enhance or increase the volume of services provided. The AAA encourages the use of volunteers by all contracted providers, and in the AAA internal programs, as long as the volunteers are adequately supervised, trained, and meet the requirements of the program. Older Americans Act Core Services Information and Assistance (I & A) and Aging and Disability Resources for Colorado (ADRC) The AAA will continue to ensure that all older adults have reasonable and convenient access to information and assistance regarding key services. As outlined in the 2018 CASOA and from the formal focus groups, Weld County older adults have expressed a lack of knowledge regarding access to information and assistance. To increase reasonable and convenient access to information and assistance about services, the AAA will: • increase numbers of internal staff providing information and referral services. Volunteers are not currently used in this program. • add a rotating schedule of community face time with internal staff to include community focal points, senior centers, independent living centers, and community events. • continue to provide training and assistance to the senior coordinators (WELDCOs) who are located throughout Weld County. The senior coordinators are well known to seniors in their communities and can provide information and assistance to seniors in a cost- effective and timely manner. The senior coordinators are either employees of the towns/cities they represent or are dedicated volunteers. • continue to disseminate information and assistance to the community through multiple forms of media including: the quarterly AAA newsletter, the 50+ Marketplace News, the Greeley Tribune (the Beyond 60, Active Living page), the Senior Nutrition quarterly newsletter, local rural weekly publications, local radio stations, agency service directories, agency program brochures, the Department of Human Services' website, Facebook, other potential social media, etc. • continue to form strong community partnerships with various agencies and organizations to offer workshops and trainings available to the public on topics that 16 address current senior issues or needs such as Senior Law Day, Project Connect, a Shred Event with AARP, a caregiver appreciation day event, and is actively assisting in the planning of other county -wide resource events and fairs. • maintain a presence at community networking meetings such as the Northern Colorado Coalition looking at hospital admission rates and networking groups that focus solely on the issues of older adults. • continue undergoing a rebranding effort to include a new marketing logo, a bigger online presence, and expansion of the HelpSource Program and Resource Guide that will increase visibility of the agency and general information and assistance. • continue to support the efforts of the ADRC as it provides Options Counseling to nursing home residents that are interested in transitioning back into the community. The AAA will continue to explore partnership opportunities over the next four years as the long- term care system restructuring continues to evolve. • explore additional funding streams- including the possibility of accessing Medicaid funding through the Federal Financial Participation process. This is being explored with the Department of Health Care Policy and Financing and the Department of Human Services. Outreach Services The Weld County AAA will ensure that outreach efforts are conducted throughout Weld County to identify older persons and to inform them of the availability of services by: • maintaining the Minority Outreach Program. This service is currently being provided through a contractual agreement with a community provider. The contractor's responsibility will be to identify isolated and at -risk minority seniors and provide information and assistance regarding community services to enable the seniors to remain independent in the community. A specific focus will be on seniors residing in hard to reach and poverty areas in Weld County. Volunteers are currently being used on a limited basis in this program. • training the WELDCO coordinators, which is a 501c3 organization whose members are senior center coordinators providing services within senior/community centers throughout Weld County, on outreach techniques and providing incentives for local communities under the leadership of their rural senior programs to identify and maintain continuous contact with all seniors with emphasis on the oldest, most frail, and/or impoverished. • providing technical assistance on the services available to seniors in Weld County to a wide range of community leaders, including church leaders, service clubs, elected officials, and key personnel in other volunteer organizations. Case Management Services for At- Risk Older Adults Due to increasing numbers of at -risk seniors struggling to remain safely independent in the community, and to address the issue of limited case management service availability in Weld County, the AAA will continue to fund a non-profit case management services provider. This need was identified and discussed during the Provider Focus Groups in July and August of 2018. 17 • Maintain the Case Management Program: identify at- risk older adults who need short or long-term case management. This service is designed to help older adults remain as independent as possible in the community by providing and facilitating access to community- based supportive services. • Volunteers are not being used in this program due to the scope of services provided. Transportation Services The AAA will continue to fund transportation services. The 2018 CASOA survey indicated that (26%) of older adults have experienced at least a minor problem accessing safe and affordable transportation. This is not significantly different from the 2010 CASOA survey that identified 25% of seniors as having experienced at least a minor problem accessing safe and affordable transportation. Thirty percent (30%) of the 75+ responders stated that not being able to drive was at least a minor problem. As the senior population continues to increase (specifically the 85+), service needs will rise and there will be an even greater need for a variety of transportation services throughout the county. At the time this Plan is being written, transportation service is being provided through a contractual agreement with a non-profit community service provider. The contractor provides rides to seniors using volunteer drivers. The challenge this contracting agency faces is the increasing demands for services and the need for additional volunteers throughout Weld County. Over the last several years, the provider has expanded their volunteer team outside of the Greeley/Evans area, with an emphasis in the southern regions of the county. The overall success of this program is primarily contingent on the ability to attract and maintain a robust volunteer staff. No current traditional transit system exists in the county that has the potential of reaching older adults in all parts of the county. The Weld County community receives additional transit services from a variety of entities: • The City of Greeley/Evans provides transportation services (fixed route and paratransit services) within the cities of Greeley and Evans. • Individual senior centers/recreation centers and long-term care facilities provide limited transit services either through their own vans or volunteer drivers. Also, Envision, the community center board, provides transit services to older adults with developmental disabilities. • Traditional taxi companies and rideshare companies such as Uber and Lyft are present in parts of Weld County. In -Home Services The AAA will provide homemaker/personal care and mental health in -home services through contractual agreements with non-profit community providers. The 2018 CASOA found that 43% of the respondents reported at least a minor problem with feeling depressed. Thirty-six percent indicated that they needed assistance with performing regular activities including walking, eating, and preparing meals. Finally, 63% stated that they are having at least minor issues with heavy or intense housekeeping. We believe the following services are designed to give older adults access to a variety of homemaker/personal care provider services through a voucher program and the ability to access mental health services in an innovative and effective avenue: 18 • Maintain homemaker and personal care services to frail older adults who have no other source of third -party reimbursement for such services through a person -centered voucher program. The AAA has transitioned funding for homemaker and personal care services from a single contracted program to an internal voucher program that contracts with multiple provider agencies. This effort has expanded AAA's reach to older adults throughout the county. Unique partnerships with agencies, for example in north Adams County, that can serve southern Weld County residents has proven to be quite successful. The program will continue to work with multiple provider agencies within and outside of the county to increase availability of services to older adults residing in even the most isolated and rural parts of the county. • Future additions to the homemaker/personal care voucher program may include a grab bar installation program, assistance in accessing medical alert systems, and an evidence -based prescription review program. • Maintain funding for in -home one-on-one peer counseling services to at- risk seniors. Providing counseling in a home setting, versus office or mental health center, has been very successful with the senior population who often hesitate to access mental health services. This service addresses issues related to loneliness, isolation and loss, and other life changes that impact many seniors. • Due to the nature of the services being provided, volunteers are not being used in either of the in -home service programs. Legal Assistance Services The AAA will continue to fund Legal Services through a contractual agreement with a non- profit legal services provider. According to the 2018 CASOA, 39% of the responders indicated that they experienced at least a minor problem with legal issues. To address these needs, the contractor will provide services that are aligned with the scope of services and priorities, outlined below. The priorities and scope of services will be reviewed annually by internal staff, the provider, and state staff during the program audit process, and formally every four years during the four-year planning process. To ensure that the provider is providing services that address the identified priorities, the provider will complete the Legal Services Tracking form. This form outlines the units of services given, the type legal issues addressed, the type of services given to address the identified legal issue and a list of services they were unable to provide and why. The AAA will review this information monthly and report the cumulative quarterly information to the State Unit on Aging. Due to the confidentiality issues related to this service, no volunteers are used. The following are the priorities that guide the Legal Program: • Public Assistance Benefits Provide legal assistance and advice in applying for and determination of eligibility for public assistance benefits, including but not limited to Long -Term Care Medicaid, Medicare Savings Plans, Old Age Pension, the Low -Income Energy Assistance Program (LEAP), and Supplement Nutrition Assistance Program (SNAP). This will include providing advice and information on specifics of Medicaid Programs and payment of long-term care, including Medicaid Qualifications, Medicaid Coverage, Spousal Protection (Community Spouse Resource Allowance, Monthly Income Protection) and Medicaid Estate Recovery. Assistance will consist of advice and/or 19 administrative representation for overpayments, reductions, termination or denial of Public Assistance Benefits. The Legal Services Provider will provide in -person representation before an administrative tribunal to appeal the reduction, termination, or denial of a senior client's long-term care Medicaid. • Consumer Matters Provide legal advice, negotiation and brief service regarding debt collections, breach of contract, garnishments, utility shut -offs, and other contract disputes. Services may consist of assisting senior clients in preparing for self -representation, including, but not limited to: Small Claims Court, objections to garnishments, interrogatories, etc. • Housing Issues Provide legal advice, negotiation, and brief service on matters related to landlord - tenant -renting and subsidized housing. • Powers of Attorney and Living Wills Provide assistance with document preparation of General Durable Power of Attorney, Medical Durable Power of Attorney, and Living Wills. Additional services beyond the basic priorities include: • Community Education Provide community legal education presentations as requested from Weld County senior centers, Weld County senior housing complexes, and long-term care facilities on legal topics of interest to senior clients. Those topics might include preventative measures against consumer fraud, consumer debt issues, housing issues, advanced directives for healthcare, financial powers of attorney, and related issues. • Community Outreach Provide legal assistance and meet the needs of senior clients unable to travel. This will include visits to rural sites (e.g., senior centers, senior housing complexes, nutrition sites, etc.) and to institutionalized, isolated and homebound older adult residents of Weld County as needed. This can be accomplished by phone, e-mail, on-line resources, or in the client's home. Assistance will include the capacity to reach minority senior clients by providing legal assistance in Spanish. • Administrative Duties The legal services provider shall ensure service quality and maintain professional standards by providing the following: 1. Establish a system of filing, record keeping, system for conflicts checks, docket control, and updating case activities. 2. Provide for the supervision of legal workers by an attorney. 3. Establish a system of review to evaluate the quality of legal work, determine what pertinent issues have been identified, to assure the timely handling of cases, to ensure that clients are involved in establishing case objectives, and that the client is kept informed of developments in the case. 4. Track unduplicated clients on a quarterly basis including units of services, types of cases, and demographics. 5. Document those senior clients the legal service provider is unable to represent and the reason why they cannot be served. 6. Give appropriate resources and referrals. 7. Provide training for legal workers based on responsibilities and skills. 8. Ensure the confidences of clients are preserved from unauthorized disclosure. 20 Ombudsman Services The AAA will continue to maintain the Ombudsman Program internally. The Lead Ombudsman reports to the AAA Division Manager 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 nine (737 beds) Weld County nursing homes and twenty- six (761 beds) assisted living facilities. The community will be seeing several new facilities (private pay nursing home and memory care) coming online in the next year and will increase the bed count by at least 150 beds. Due to this anticipated growth, the Ombudsman Program is planning on adding an additional full-time Ombudsman in July 2019. The Ombudsman staff will continue to participate in all required training sponsored by the State Long -Term Care Ombudsman Program, or other approved training that will help meet the annual training requirements for certification. The Ombudsman Program uses volunteers on a very limited basis due to the sensitive and confidential nature of the program and the high level of supervision required. When utilized, volunteers receive all required ombudsman training. Results from the 2018 CASOA showed that 28% of those surveyed felt that they have good or excellent accessibility to long-term care options that are open and accepting toward people of diverse backgrounds. And 38% felt that they were "very" or "somewhat" informed about their long-term care options (i.e. nursing homes, home care). In response to those low percentages, the Long -Term Care Ombudsman Program will explore ways to educate the community about the types of long-term care options available in Weld County. The Ombudsman Program continues to see an increased number of residents in nursing homes and assisted living facilities, who are impacted by mental health issues and traumatic brain injury. These residents are frequently a challenge for staff. There is a need for appropriate training and support for staff and family, as well as having more mental health services and other related services for residents. Cases involving these individuals are often challenging for the Ombudsman Program to resolve and require extensive staff time. Also, residents who display difficult or high -risk behaviors, regardless of diagnosis in facilities, frequently are faced with transfer and/or discharge issues. The Ombudsman Program advocates for these residents, but when their behaviors are extreme and are a threat to other residents, the Ombudsman Program is placed in a precarious position. Limited residential options for the resident places a burden on nursing homes, assisted living facilities, as well as hospital systems. The Ombudsman Program will continue to work closely with facility staff, the State Long -Term Care Ombudsman's office, the Ombudsman network, Adult Protective Services, and local community providers to address this issue. The Long -Term Care Ombudsman Program priorities include: • Investigate Long-term Care complaints and concerns • Maintain accurate documentation in PeerPlace 21 • Encourage facilities to develop and maintain appropriate Emergency Preparedness plans. This includes discussing actual emergency plans, policies and procedures, communication plans and staff training with the management teams at area facilities. • Maintain involvement with resident, family and dietary councils. • Maintain awareness of staffing challenges in facilities. • Monitor and respond to Involuntary discharge notices. • Monitor Person -centered education within facilities. • Assist with contract issues related to services provided by facilities. • Monitor issues related to mental health and traumatic brain injury residents of LTC facilities • Provide Long-term Care information to the community at large. • Educate staff, the aging network, and the public on the referral procedures to the Ombudsman Program and Adult Protection. • Maintain membership on the Weld County Adult Protection Networking Team. • Participate in community victim advocacy groups. • Continue involvement with the Weld County Long -Term Care Bio-Ethics Committee. • Collaborate with local nurse aide programs, such as those at UNC and Aims Community College. Disease Prevention and Health Promotion Services and Evidence -Based Programs The Disease Prevention and Health Promotion Services and Evidence -Based Program will remain an internal program. The program has been marketed to the community as Weld Aging Well. The program has undergone a reorganization and is now coordinated by a full- time employee dedicated to offering more workshops and evidence -based wellness classes to older adults. With the increase in staff time dedicated to health promotion services, our goal is to increase the overall number and types of classes offered to older adults in a variety of settings across the county. Classes that are currently being provided are: • A Matter of Balance • Stanford's Chronic Disease Self -Management Program and Diabetes Self -Management • Powerful Tools for Caregivers • Strong Women • Tai Chi: Moving for Better Balance • Stress Busters • Tomando Control de su Salud The 2018 CASOA shows that 35% of the respondents have fallen and sustained an injury at least once in the 12 months prior to the survey. In response to this need, the AAA will explore opportunities that could expand our reach during the fall prevention awareness week event and will continue to explore the possibility of forming a robust fall prevention coalition. 22 Evidence -based program that are being explored in the next four years are: • Healthy Moves for Aging Well (targeting homebound client) • Aging Mastery • Financial Wellness • HomeMeds • Walk with Ease The Weld Aging Well program can only grow if we are successful in recruitment and retention of our volunteers. We currently have 25 volunteers who have very diverse education and professional backgrounds. It is critical that we take excellent care of our wonderful volunteers and provide support, acknowledgement and guidance, if retention and growth are our goals! Nutrition Services The Weld County AAA will assure the provision of the congregate and home delivered meal programs in Weld County. The congregate program will remain an internally managed program using contractors for two key program activities. The AAA will continue to fund the home - delivered program through a contractual agreement with a non-profit home delivered meal provider. Congregate Meal Program - The Friendly Fork The congregate meal program (The Friendly Fork) is an internally managed program. The staff consists of one -full time supervisor, a part-time registered dietitian, a part-time warehouse manager, and an administrative assistant. Our service area is nearly 4,000 square miles and is both urban and rural in nature. To meet the needs of our senior population, twenty-three (23) congregate meal sites were established. These sites were carefully chosen to give access to seniors throughout Weld County, paying special attention to the locations of our targeted populations. The congregate sites are in a variety of settings including low-income housing, senior centers, recreation centers, town halls, and community buildings. The program is very reliant on dedicated and skilled volunteers. The Friendly Fork volunteer staff include a meal site coordinator, registration desk staff, individual kitchen workers, and greeters. All the volunteers are equally important, and most of the volunteers are cross - trained, so they can work in many of the positions. Each meal site requires a minimum of five volunteers, but the larger sites require up to 10. As of 2018, the Friendly Fork has approximately 300 volunteers who have been trained on program policy and procedures, food safety and sanitation, customer service, and a variety of other pertinent topics. Many years ago, the MA decided it was not cost efficient to manage and staff a kitchen and therefore decided to contract food purchasing and meal preparation with existing providers in the community. The University of Northern Colorado has been our sole provider for over 35 years. The delivery of food to the meal sites has always been provided by a professional transportation company, rather than by volunteers. In addition, it is important to note that due to our successful partnership with our local communities, all meal site locations are provided at no cost to the program. 23 In the last four-year plan, it was noted that the program was seeing a downturn in the number of seniors attending the nutrition program, a theme that appeared to be occurring across the country. We are excited to report that in 2017-18 the data shows an increase in the number of clients and meals served. Based on our current 2018-19 meal and participation numbers the program should once again grow. We attribute this growth to offering evening meals at targeted sites, having new menus, increasing our nutrition counseling, improved educational opportunities, the addition of salad bars, a rebranding of the program to be called the Friendly Fork, and advertising and marketing to new clients. To keep the program viable and relevant to seniors over the next four years we plan to: • Market the nutrition program across the county to attract new customers to the program. • Maintain a financial contract with the University of Northern Colorado or like provider to prepare hot meals for the congregate meal program. • Maintain a financial contract with a community provider to deliver food from the meal provider to the designated meal sites. • Maintain a positive relationship with the Weld County Department of Public Health and Environment. • Maintain nutrition education and counseling services to all congregate senior nutrition participants through educational presentations and written material and offer counseling services to all participants, targeting those participants who are nutritionally at risk. • Maintain and support the AAA staff who will continue to provide the required oversight needed to ensure that the program meets federal, state and local regulations and guidelines. • Improve supportive services at the senior nutrition sites. • Explore adding new nutrition sites and increasing the number of days meals are served at existing sites. • Explore adding an additional evening meal site during the summer. • Offer senior nutrition counseling and education to seniors who are not participants of the senior nutrition program. Home -Delivered Meals Program The AAA will continue to fund home -delivered meals through a contractual agreement with a non-profit home -delivery meal provider. Nationally and locally the aging network is anticipating an increased need for home -delivered meals due to the growing number of adults 85 years and older. Historically, the local community provider has used volunteers extensively in their program. Almost all the client meals are delivered by a fleet of volunteers. Staff will cover routes if a volunteer is unavailable. To maintain the program as it is currently structured, the following must occur: • Maintain a financial contract with Meals on Wheels or like provider to provide home - delivered meals to Weld County seniors. • Maintain nutrition education and counseling services to all home -delivered senior nutrition participants by providing participants with educational material and offer counseling services to all participants, targeting those participants who are nutritionally at risk. These services will be provided by a registered dietitian. 24 • Explore expanding home delivered service to parts of the county that are currently not served. • Explore the possibility of providing an evidence -based wellness program geared to homebound seniors who participate in the home -delivered program through the AAA's Weld Aging Weld Program. National Family Caregiver Support Program The AAA will continue to internally manage the National Family Caregiver Support Program. The program provides enhanced information and assistance to caregivers, periodic training and workshops, as well as respite voucher program services. According to the 2018 CASOA, one in five Weld County older adults feel burdened by their caregiving responsibilities and provide about 12 hours of care each week on average. As our 85+ population continues to grow, we anticipate the request for services will increase. Over the last five years, we have seen an increase in the number of caregivers that still work and an increasing number of children caregivers. In State FY18, 55% of all voucher caregiver clients, were spouse caregivers and 42% were children caregivers. In State FY19 to date, 63% are spouse caregivers and 35% children caregivers. Eighty percent (80%) of the program's caregivers use non -agency -based respite services. We believe the reason for this trend is related to the cost of formal service providers and the caregiver and recipient's comfort level with a known and preferred informal provider. The program continues to offer evidence -based programs such as Powerful Tools and Stress Busters. These classes, taught by internal staff and trained community volunteers (see numbers of volunteers in the Disease Prevention and Health Promotion Services and Evidence -Based Programs section), are held in a variety of locations throughout the county. These classes, as well as our other evidence -based classes, frequently attract individuals who might otherwise have not reached out the AAA. Several Area Agency on Aging Advisory Board members attended these classes and later became volunteer instructors! The Caregiver Appreciation Day, a collaborative event with several community network providers, has been an annual event for many years and will continue to be offered if attendance and interest remain steady. Over the last several years we have seen an increase in the number of younger grandparents raising grandchildren that sadly do not meet the age requirements of the Older Americans Act. Many of these grandparents are experiencing very complex and diverse challenges with their grandchildren. These situations frequently result in referrals to North Range Behavioral, family law attorneys, and similar agencies. AAA staff and the AAA Grandparents Raising Grandchildren Committee members will continue to monitor the trend and evaluate the AAA's continued role with this program. To maintain the program as it is currently structured, the following must occur: • Maintain the consumer -directed caregiver voucher program structure and process. • Explore additional caregiver evidence -based classes. • Maintain strong ties to the caregiver community provider network. • Explore the need for specific services for older grandparents who are raising their grandchildren. 25 Older Americans Act Optional Services Dental, Vision, and Hearing Program (DVH) and Visually Impaired Service Program The AAA will continue to manage the Dental, Vision, and Hearing Program (DVH) internally. The program is a consumer -directed voucher program that allows the older adult to select the provider of their choice. Over the years, the AAA has effectively streamlined the process and reduced internal paperwork which has allowed for greater consumer contact and assistance. We have also been successful in encouraging some providers to give reduced rates to our clients. Most of the clients we serve do not have private dental or vision insurance. Clients who receive Medicaid do have limited dental coverage but finding a Medicaid provider in Weld County can be a challenge. Other dental assistance programs, such as the Colorado Dental Health Program for Low -Income Seniors have few accessible providers in Weld County. The administrative time needed to explore payer of last resort options has added delays in clients accessing services. Volunteers are not used in either of the programs in this section. Since 2015 the Visually Impaired Service Program has been funded by State General Funds and implemented by the AAAs and/or their subcontractors. The program was designed to provide services to older adults who are blind or visually impaired. The designated funds can be used to purchase assistive technology, visual aids, and adaptive aids. The funds cannot be used to purchase eyeglasses or cover the cost of eye examinations. The program is managed by the same coordinator that oversees the Dental, Vision, and Hearing Program. The staff works closely with agencies such as the Curtis Strong Center, Ensight Skills Center, and Connections for Independent Living Vision After 55 Program, Audio Information Network, and the Greeley/Evans Lions Club to connect clients with the most appropriate services and/or equipment. These funds help increase the number of services that we can provide to clients who have specialized equipment and service needs. The shortcoming of this funding source is that it does not allow the AAA to charge an administrative fee for the management and coordination of the program. Chore Program The Chore Service Program will continue to be managed internally. The Chore program is managed by the same coordinator who oversees the Caregiver Voucher program. The program is a consumer directed voucher program that allows the older adult to select the chore provider of their choice. The chore services are designed to help frail seniors stay safe and independent at home. The chore services that may be included are lawn maintenance, snow removal, fall or spring yard clean up, and heavy housework. The 2018 CASOA found that overall 63% of seniors interviewed indicated at least a minor problem doing heavy or intense housework, 51% indicated at least a minor problem maintaining the yard work, and 45% stated that they had at least a minor problem maintaining their house. Across the board, the seniors who most frequently stated that they had at least a minor problem were 75 years+. We anticipate that we are going to see an increasing need in chore services over the next four years as the 75+ senior numbers continue to grow. Volunteers are not used in this program. 26 Other programs: Not funded by the Older Americans Act or State Funds for Older Adults Colorado Options for Long -Term Care Program (OLTC) or Single -Entry Point (SEP) Options for Long -Term Care Program provides community -based long-term care options and case management services to persons qualifying for specific Medicaid waivers and state programs. Maintaining the Options for Long -Term Care Program within the AAA increases the likelihood that clients (many who are the most disabled, frail, and low-income in the community) are referred correctly and quickly to the appropriate program or service. This program has continued to see growth over the years, and we anticipate a steady increase over the next four years. Adult Protective Services The Adult Protective Services Program (APS) moved under the umbrella of the AAA in 2013 to streamline adult services within the Department of Human Services. The purpose of APS is to support and protect at -risk adults from self -neglect or mistreatment by investigating allegations, advocating for clients and, when needed, arranging for services to stop or prevent harm by using the least restrictive intervention and respecting the client's self-determination. The APS team is growing in number to reflect the increased number of at -risk adults in our community. Colorado Choice Transitions (CCT) Staff members of the Aging and Disability Resources for Colorado have participated in in the Colorado Choice Transition project by providing Options Counseling for residents of long-term care facilities who have indicated formally that they would like to leave the institutional setting and return to a less restrictive living situation within the community. Due to the funding changes that have occurred related to the project, it is unclear what our role will be in the next four years. We will remain open to continuing our partnership with the Colorado Department of Health Care Policy and Financing and look forward to exploring other program opportunities. SECTION VI: QUESTIONS Core Services 1. Which Core Services are funded by the Area Agency on Aging (AAA)? See Section V for detailed information on all Core and Optional Services. 2. In your region, are there any situations, not including funding, that are barriers to innovation within the core Older Americans Act programs (OAA)? If yes, please elaborate and be as specific as possible. 27 The Older Americans Act does allow some flexibility and innovation within the Core Program areas. Creativity and innovation can be easily seen when you compare core programs across the state and national AAA network. The National Association of Area Agencies on Aging (n4a) does a wonderful job supporting Innovations and Achievement by acknowledging, awarding, and promoting outstanding programming in the AAA network at the annual n4a conferences. N4a also disseminates information about the award -winning programs so that other AAAs can learn about opportunities that might work for them. Program innovation can be stymied when AAA programs are unable to meet the Federal requirements or the State's interpretation of the Federal regulations. Restrictions can also occur depending on where a AAA is located (within a county government, a council of governments, or a standalone 501c3). Weld AAA is located within Weld County government. In our setting, we must seek approval for major changes in our programs and for any staffing increases or decreases. We must also obtain approval if we want to seek other funding opportunities. All contractual relationships must be formally approved by the Board of County Commissioners. Prior to requesting approval for program changes or enhancements, the AAA leadership and staff must determine if the innovative program can be supported either internally or through a community partner. If adequate funds are available, who will be served, and how will we determine program effectiveness, cost efficiencies, and client satisfaction? We have revamped several of our core programs and optional programs by implementing a voucher approach to increase client choice and service availability. These changes have successfully created a larger provider network and formed new and exciting relationships. Clients have also appreciated having greater choice in providers. Many of our programs are heavily reliant upon volunteers. Locating, training and managing volunteers can be challenging. When developing or expanding programs that are volunteer based, we must make sure that we have a process in place that can effectively locate a strong volunteer team and have the administrative time to provide training, oversight and ongoing recruitment. 3. What is your current process for monitoring providers and what plans do you have to update it and improve over the next 4 years? Currently, all community providers submit a monthly invoice by the 10th of the month for services provided in the previous month. Once the invoices have been received, the AAA Quality Assurance Specialist reviews the information provided to assure that the information on the invoice matches the data in PeerPlace as well as meets other requirements such as units requested, required cash or in -kind match, overall program costs, etc. The AAA Division Head also reviews the invoices and signs off on each invoice. The invoices are then given to the Department's fiscal office where the fiscal staff reviews the information again and if correct, will in a timely manner, pay the provider. Annually the AAA conducts a formal onsite review of every community contractor. Each contractor must complete the AAA onsite evaluation form and return the completed form to the AAA prior to the onsite visit. The AAA onsite evaluation team consists of the AAA Division Head, the Community Outreach Manager, the AAA Quality Assurance Specialist, a member of the Weld Department of Human Service's fiscal team, and several Area Agency on Aging Advisory Board members. For the onsite visit to be productive, key contractor staff members are requested to be 28 present at the onsite visit. During the onsite visit, the evaluation form is reviewed, and additional information is obtained if need. Policies and/or procedures, program issues/concerns, need trends and other relevant topics are discussed. The goal of the on -site visit is to ensure that all contractors are providing appropriate services in a manner that meets both the AAA's and the State Unit on Aging's regulatory expectations but also that they are meeting the expectations of the clients. The AAA has recently enhanced the duties of an existing AAA staff member (job description and job title change) to help focus on quality assurance, for both internal and external programs throughout the fiscal year. This will help identify issues or concerns or any difficulty implementing new regulations prior to the AAA or the State Unit on Aging onsite evaluations. 4. What services currently have a waitlist? What is the process for monitoring the waitlist and how are individuals prioritize to receive services? This question is a bit difficult to answer since the waitlists fluctuate given the time of year and funding availability. Historically, we have seniors on waitlists for the following internal voucher programs: • Chore services • Caregiver Respite services • In -Home (homemaker and personal care) services • Dental, Vision, and Hearing services Contracted Services that have had periodic waitlists: • Transportation • Home delivered meals All providers have a written policy and procedure in place that guides how they monitor and prioritize individuals on the waitlist. For all internal programs, we monitor the waitlists minimally every six months and we use the state approved prioritization worksheet to help guide our prioritization process. All waitlist information is gathered from internal and external program areas and reported in CBRES monthly and reviewed quarterly for accuracy. Ombudsman and Legal Assistance 5. What long-term care issues will your AAA's local Ombudsman Program give priority to as a systems' advocate during the next four years? See Section V Ombudsman 6. In addition to resident council meetings, family council meetings, and training to facility staff, what other activities will the local Ombudsman participate in during the next four years to educate the community regarding ombudsman services? The Weld County Ombudsman staff will continue to be involved with networking and working committees. These committees include Aging and Disability Resources for Colorado, Options for Long -Term Care Committee, Weld County Bio-Ethics Committee, Weld County Senior Services Network, Weld County Coordinating Committee for Victims of Crime, and other future 29 appropriate committees. For example, the Ombudsman Program staff will explore becoming involved in the Aims Community College Board. The staff will also provide information and assistance regarding the program by doing presentations at local colleges, participating on panels, workshops and attending other appropriate community and agency events. 7. Specifically, what legal issues will be given priority for receiving representation for the Legal Assistance Program during the next four years? How will the AAA ensure that the local Legal Assistance provider is able and willing to provide representation to these issues? See Section V Legal Assistance 8. How will the AAA ensure that the legal advice from the local Legal Assistance Provider is able to provide the representation for these issues? During the Request for Proposal process, we clearly outline priorities and scope of services. We also are assured that the services will be provided by, or supervised by, an attorney or attorneys who are able to address the legal issues/concerns appropriately. We will also verify that services are provided in the manner requested during our annual onsite evaluation process. Other Services 9. What evidence -based health promotion or disease prevention programs does the AAA currently provide and plan to provide during the period of the Area Plan? See Section V Disease Prevention and Health Promotion and Evidence -Based Programs 10. In addition, to funding received through the Older Americans Act and the State Funding for Senior Services (SFSS), what other funds are received by the AAA to provide services for older Adults (e.g. Senior Health Insurance Assistance, Colorado Choice Transitions, etc.)? See Section V Other programs Targeting and Outreach 11. What are some successes the AAA has used that improved access and utilization of services by individuals who are at greatest social and or economic need? Historically, we have sought to open senior nutrition sites in a variety of settings throughout the county. Several of our sites are located within low-income housing and in rural communities. We continue to explore expanding days (including evening meals) and site locations to increase our accessibility. We have been able to expand our evidence -based wellness program, Weld Aging Well, in the rural areas of our county. Half of the classes that were offered in 2018 were outside of the Greeley/Evans area. The number and types of evidence -based classes are slated to increase over the next year. Due to the success of our wellness program and our desire for continued 30 growth, the Wellness Coordinator position was restructured in late 2018 and will be focusing only on wellness projects. We have also worked diligently to reach seniors throughout Weld County through both our traditional core programs as well as through our multiple voucher programs. We have successfully reached seniors in all parts of the county by increasing the number of contractors in our in -home (homemaker and personal care) voucher program and by allowing clients to choose their own provider in voucher programs such as our Chore, Caregiver Respite, and the Dental, Vision, and Hearing program. We also have successfully contracted with community non -profits whose primary mission is to reach out to seniors who are in social and economic need For years we have required that all contractors/providers who provide direct services to older adults, actively market to and report on the number of at -risk clients served. This request is formally included in all appropriate provider contracts and is included in the formal Request for Proposals process every four years. 12. What strategies will the AAA use to raise awareness of the services provided and increase the number of services provided and the number of unduplicated clients over the four years of the Area Plan? Our goal is to connect and serve all seniors who are eligible and could benefit from OAA services. We have and will continue to market our services to our community members in sundry of ways. The following information outlines our current and future marketing and outreach efforts: • Maintain our informative and user-friendly Weld AAA website. • Distribute the updated AAA HelpSource Resource Guide (available both in hard copy and on the AAA Website) www.weldaaa.orq • Maintain the weekly AAA senior -focused page called Beyond 60 Active Living in the Greeley Tribune (the page contains short articles and information concerning the senior nutrition meal program and other educational and social events geared to older adults). • Distribute our newly updated free quarterly agency newsletter. • Continue to submit senior -related articles in the 50+ Marketplace News, a free publication available throughout Weld County and continue to seek other media opportunities. • Participate in a variety of community events geared to older adults. • Partner with institutions of high learning (University of Northern Colorado and Aims Community College) and hospital systems (Banner and UC Health). • Continue to support and fund programs that have shown to be successful in reaching out and serving our target population. • Explore increasing the number of meal days at current senior nutrition meal sites. • Increase the number of Long -Term Care Ombudsman staff. 31 • Increase awareness of senior resources by increasing the physical presence of our ADRC staff at senior nutrition sites, food banks, book mobile, low-income housing sites and other potential locations in the county. • Continue to work with United Way of Weld County's Collective Impact Initiative. Innovation and Expansion of Services 13. What type of innovations is the AAA planning to try during the next four years to improve the quality and availability of services provided or funded by the AAA? The AAA is always open to looking at enhancing existing services or exploring new service opportunities that will help meet the mission of the agency. Below are projects that we are either actively working on or exploring. • Due to the success we have seen in the Weld Aging Well program, as was noted in Section V, we now have a full-time staff member dedicated to the wellness program. We will continue to offer new evidence and wellness -based programs to Weld County seniors. We have also invested in marketing efforts that effectively informs the community of our available program options. We will continue to explore non-traditional partnerships that will help us expand our program availability to locations throughout the county. https://www.weldgov.com/UserFiles/Servers/Server 6/File/Departments/Human%20Ser vices/Area%20Aoencv%20on%20Aginq%20(AAA)/Weld%20Aoinq%20Well/Brochures/ WeldAgingWell-2019ProoramGuide1.pdf • Over the last couple of years, the Senior Nutrition Program has offered evening meals during the summer months. The evening meals have been favorably received and we have attracted new clients, as well as regular attendees. We find that many individuals enjoy the opportunity to share an evening meal with others. The menu for summer of 2019 has been developed and seniors will be offered new and exciting meals! • Currently, the AAA is supporting and working with a local community partner to apply for participation in the Colorado Dental Health Care Program for Low -Income Seniors. This provider, if approved, will have several locations in urban and rural areas. This expansion will help address the high demand for dental service for low-income older adults in Northern Colorado. • The AAA is currently engaged in the United Way of Weld County's Collective Impact Initiative. United Way is exploring a new process of funding their identified priority areas. Older Adults and Healthy Aging is one of United Ways four community focus areas. The other priority areas address early childhood, youth development and homelessness/household stability. Following is a summary of the collective impact process as was provided by United Way of Weld County to all community partners and interested community members. The collective impact process is most successful when all interested partners are working together to achieve a shared goal and when key stakeholders embrace 32 specific, well-defined roles. The backbone, convener and facilitator, and lead volunteers are key players in the Collective Impact initiatives. Backbone (United Way of Weld County): Backbone organizations pursue six common activities to support and facilitate collective impact. These activities help to distinguish this work from other types of collaborative efforts. Over the lifecycle of an initiative, they: 1. Guide vision and strategy 2. Support aligned activities 3. Establish shared measurement practices 4. Build public will 5. Advance policy 6. Mobilize funding Convener and Facilitator (Weld County Area Agency on Aging): These are the experts in the field. They are passionate, well -versed in the targeted issue, and have a relationship with most, if not all, of the other partners doing work in the field. They are frequently a neutral partner and/or have such a broad scope of work that they can contribute in meaningful ways in several key areas of work. In partnership with the backbone stakeholder and lead volunteers, they help develop agendas and ensure that work is happening between meetings. They help to keep the group motivated and always have an eye on driving the work forward and ensuring that progress is being made. Lead Volunteers (Julie Cozad, community member and former Weld County Commissioner and Ron Heil, Area Agency on Aging Advisory Board member): The job of lead volunteers is to help those at the table focus on the big, broad picture. Lead volunteers are not employed at partner non-profit agencies, but instead are community leaders that are passionate about the identified topic or issue. They may be board members or volunteers for the organizations involved and are there to help guide the work and connect it to the broader community. They are the strongest advocates and people the backbone can reference when trying to build public will. The Collective Impact Initiative for Older Adults and Healthy Aging (Collective Impact Group) started in June 2018. A significant number of interested community providers and service agencies attended the meeting. The group received an orientation to the Collective Impact process and the roles attendees could play. They were also informed of existing and future reports such as the Strategic Action Planning Group on Aging, initial plan from November 2016 and the 2018 Community Assessment Survey for Older Adults that would be completed by late fall of 2018 for all the AAA regions in the state, that would be helpful in the impact process. The November 2018 meeting of the Collective Impact Group focused on the CASOA results. After a robust discussion, the group tentatively agreed to use the 6 domains identified in the CASOA to help guide the collective impact process. During the January 33 2019 meeting, the facilitator (United Way) reviewed the domains more thoroughly to help guide the participants in exploring key issues, needs, concerns and opportunities that were identified in the CASOA. Monthly meetings are planned throughout the winter and spring and the goal is to have a proposed project that will be presented to the United Way Board of Directors late spring for approval and funding. This process is exciting on many levels. As a AAA, we are very encouraged that United Way made the decision to include senior issues in their funding priorities. We are extremely interested in seeing the outcome of this non-traditional funding and planning strategy and what the AAA's role will be in the future with this initiative and the final recommended project. Due to the overall population growth, economic changes, and increased housing demands in Weld County, the availability of affordable and accessible housing has become a major concern for many people in our community. Homeless numbers have increased in Weld County; a contributing factor is the limited amount of affordable and accessible housing. While the number of individuals and families experiencing homelessness can be difficult to ascertain, more recent Point -in -Time counts of people experiencing homelessness in Weld County have found 300+ people living out-of- doors/in cars or in emergency shelters. This and other surveying have shown that Weld County's number of chronically homeless individuals and families has increased over the past five years. Given that the 60+ population is rapidly growing in Weld County, we can assume that the number of homeless who are 60+ is also increasing. Weld's Way Home, a collaboration of 25+ organizations led by United Way of Weld County, is working to address homelessness and household instability through an application of the Housing First method. Housing First focuses on rehousing people experiencing homelessness in non -time -limited homes as quickly as possible, then providing supportive services as is needed/wanted by the resident. Once in a safe and secure housing situation, it has been shown that individuals are more receptive to utilizing and benefitting from support services that will help them reach their personalized life goals. A key part of Housing First is assessing people for increased vulnerability from continuing to live without a permanent home, and for this task, Weld County agencies use the VI-SPDAT (Vulnerability Index - Service Prioritization Decision Assistance Tool). Once assessed, those experiencing homelessness are prioritized for a return to housing based on their vulnerability score. For many years, the homeless serving agencies that partner through Weld's Way Home have assisted older adults experiencing homelessness with basic needs such as overnight sheltering, obtaining identification, meals, and more. For instance, during the current 2018-2019 cold weather, 20% of the guests staying at the Housing Navigation Center cold weather overnight shelter have been age 55 or older. Additionally, since its founding in February 2016, the Northern Colorado Continuum of Care Coordinated Assessment and Housing Placement System has helped dozens of older adults move into and maintain their housing. While it is intolerable that anyone aged 60+ should lose 34 their housing and find it necessary to live out of doors or in a vehicle, the homelessness response and homelessness prevention system in Weld County is available to assist older adults in this most difficult of circumstances. During the upcoming 4 -year plan period, the AAA is interested in understanding the homelessness issue as it impacts older adults in Weld County and exploring what role, if any, the AAA may have in the homelessness and/or affordable and accessible housing arena. 14. What plans, if any do you have to measure the effectiveness, efficiency, outcomes of your programs and services? Client satisfaction surveys are completed for all contracted and internal services (except for the Information and Assistance program). For evidence -based wellness programs, formal and informal fidelity visits are conducted to monitor to assure that the standard of the classes is maintained. For many of the classes pre- and post -assessments are completed to identify changes in behavior and health status. We are always evaluating and reviewing our internal program processes to assure that we are as efficient and effective as possible. The Senior Nutrition program staff will explore implementing the LEAN strategy in 2019-2020 to evaluate and streamline the senior nutrition program and site operations. We remain open to new means to measure effectiveness, efficiency, and outcomes for all of programs and services. We will continue to attend conferences and workshops that may present new methods and/or idea that address all these key issues. SECTION VII: TITLE III/VI COORDINATION This section does not apply to Weld AAA since we do not have the Title VI Native Americans program in our region. 35 SECTION VIII: ATTACHMENTS Attachment A: Direct Service Waiver Request We hereby request approval of a Waiver to provide the direct services listed below. 1. Chore Program 2. Congregate Meal Program 3. Evidence -Based Wellness Programs 4. In -Home Services -Homemaker and Personal Care 5. Information and Assistance 6. Material Aid: Dental and Vision, and Hearing Program 7. National Family Caregiver Program Direct Service Waiver Request: Program Information Direct Service Program: Chore Program Organizational Structure and Delivery System: The Chore Program has been housed within the Weld County AAA since its inception. The Chore Program is managed by the Caregiver Coordinator, who also manages the National Family Caregiver Program. The Chore Program is a voucher program that allows the client to use the vendor of their choice. Direct Service Program: Congregate Meal Program Organizational Structure and Delivery System: The Congregate Meal Program has been housed in part within the AAA since 1980. The manager of the program, a registered dietitian, and additional administrative staff coordinate the program. The Weld County AAA purchases all prepared meals from the University of Northern Colorado and the meal transportation service is provided by another community - based provider. There are twenty-three (23) meal sites located throughout Weld County in a variety of community settings. A team of volunteers facilitates the meal service at each meal site. See a full description of the program within the Four -Year Plan document. Direct Service Program: Evidence -Based Wellness Programs Organizational Structure and Delivery System: The Evidence -Based Wellness Program has been managed internally since the designation of Part D of the Older Americans Act. The program is managed by the Wellness Coordinator who oversees the program and volunteers. The Weld County AAA currently offers multiple 36 evidence -based programs under the name Weld Aging Well. The programs are: A Matter of Balance, Stanford's Chronic Disease Self -Management Program and Diabetes Self - Management Program, Powerful Tools for Caregivers, the Strong Women Program, Tai Chi: Moving for Better Balance, Stress Busters, and Tomando Control de su Salud. Direct Services Program: In -Home Services: Homemaker and Personal Care Program Organizational Structure and Delivery System: Historically, the Homemaker and Personal care program was provided by one community home health care provider. In the last two years, the AAA moved away from a one provider program system to a voucher program. An internal staff member, the Community Services Coordinator, coordinates the program and completes all client evaluations, approvals, the invoice process, etc. Clients are provided a list of approved home health care agencies from which they can obtain services. Each of the home health care agencies has a contract with the AAA. Currently nine agencies are participating in the program. Direct Service Program: Information and Assistance/ Aging and Disability Resources for Colorado Organizational Structure and Delivery System: The Information and Assistance (I&A) Program has been managed internally since its inception over ten years ago. These positions are funded by State Funds. The Information and Assistance Coordinator (full time) and two additional staff members (approximately 50% of their time) provide l&A services. All program staff are supervised by the Community Outreach Manager. In addition to l&A, the full-time staff member also coordinates the Aging and Disability Resources for Colorado (ADRC), as well as, the Grandparents Raising Grandchildren Program under Part E. Direct Service Program: Material Aid (Dental, Vision, and Hearing Program) and Visually Impaired Program Organizational Structure and Delivery System: The Community Resources Coordinator manages the Dental, Vision, and Hearing Program and the Visually Impaired Program. Both programs are run as a voucher program, which allows the client to use a vendor of their choice. The Dental, Vision, and Hearing Program has been an internal program for over fifteen years. The Visually Impaired Program was added in FY 15 and for efficiency was added to the duties of the Community Resources Coordinator. The Community Resources Coordinator also provides Information and Assistance services. Direct Service Program: National Family Caregiver Organizational Structure and Delivery System: The National Family Caregiver Program has been managed internally since the initial funding of Part E of the Older Americans Act. The Caregiver Coordinator manages the voucher respite program and provides information and assistance to caregivers. This coordinator also manages the Chore Voucher Program. 37 Attachment B: Senior Nutrition Site Locations Site Name/Address Meal Site Coordinator Phone/Fax/Email Address Which Program(S) Operate Out of This Site? Is This Site A Central or Commissary Kitchen? Are Meals Prepared on Site? If Meals Are Not Prepared on Site Where Are They Transported From? Which Meal Is Served/Delivered Each Day? Days of The Week C-1 Meals Are Served Days of The Week C-2 Meals Are Delivered N/A for Weld C-1 C-2 YES NO YES NO BREAKFAST LUNCH DINNER Birchwood Apartments X X X UNC X M, W, F 2830 W 27th St Lane Greeley, CO 80634 Elizabeth Renfro 970-308-7859 Fax: n/a Email: n/a Broadview Apartments X X X UNC X T, Th 2915 W. 8th St Greeley, CO 80634 Frances McKay 970-356-5864 Fax: n/a Email: n/a Carbon Valley Recreation Center X X X UNC X T, Th 701 5th St Frederick, CO 80550 Lee Athmann 303-833-3660 Fax: 303-833-7068 athmannlj@yahoo.com Eaton Area Community Center X X X UNC X W 38 1675 3r° St Eaton, CO 80615 Bryan Kentfield 970-454-1070 Fax: n/a bryankentfield@eaprd.com Erie Recreation Center X X X UNC X Th 450 Powers St Erie, CO 80516 Cindy Hickman 303-926-2795 Fax: 303-828-0661 chickman@erieco.gov Evans Community Center X X X UNC X T, F 1100 37th St Evans, CO 80620 Dorothy Hoff 970-475-1132 Fax: 970-330-3472 bgrauberger@ci.evans.co.us Fort Lupton Recreation Center X X X UNC X M 203 S. Harrison Ave Fort Lupton, CO 80621 Laura Kudma 303-857-4200 x 186 Fax: 303-857-6421 ikudrna@fortlupton.org Greeley Manor X X X UNC X M, W, F 1000 13th St Greeley, CO 80631 Gail Cooper 970-356-5489 Fax: n/a 39 Email: n/a Greeley Active Adult Center X X X UNC X M, W Dinner in the summer 1010 8th St Greeley, CO 80631 Doris Gilreath 970-350-9440 Fax: 970-350-9898 Tiffany.skoglund@greeleygov.com Greeley Senior Housing X X X UNC X M,Th 1717 30th St Greeley, CO 80631 Rita Blatter 970-395-0822 Fax: n/a Email: n/a Hill N Park X X X UNC X W 4205 Yosemite Drive Greeley, CO 80634 Sharon Strausser 970-330-8619 Fax: n/a seniors2222@gmail.com Johnstown Community Center X X X UNC X W 101 W. Charlotte Johnstown, CO 80534 Shirley Newsom-Gamez 970-587-5251 Fax: 970-587-0141 sgamez@bajabb.com Kersey Senior Center X X X UNC X T, Th 415 1 St Kersey, CO 80644 40 Adella Andrijeski 970-352-8394 Fax: 970-353-2197 recreation@ci.kersey.co.us LaSalle Community Center X X X UNC X T Proposed additional meal for Thu 101 Todd Ave LaSalle, CO 80645 Victoria Perez 970-284-0900 Fax: 970-2846483 vperez@lasalletown.com Lochbuie Senior Center X X X UNC X T 501 Willow Drive Lochbuie, CO 80603 Nancy Kauffroath 303-659-8262 Fax: 303-659-8979 afterglows501 @skybeam.com Mead Community Center X X X UNC X Th 441 3rd St Mead, CO 80542 Janet Torres 970-535-4477 Fax: 535-0548 curriecaboose@gmail.com Milliken Community Center X X X UNC X M, F 1101 Broad St Milliken, CO 80543 Kathy Kindsfather 970-660-5040 Fax: 970-587-2678 41 klaindsfatheri@millikenco.gov Nunn Senior Center X X X UNC X Th 775 3rd St Nunn, CO 80648 Cheryl Vogel 970-897-2459 Fax: 970-897-2459 cherylvogel@yahoo.com Pierce Senior Center X X X UNC X Th Proposed additional meal M or T 221 Main Ave Pierce, CO 80650 Dixie Hansen 970-834-2655 Fax: n/a dhbh415@msn.com Platteville Senior Center X X X UNC X M 508 Reynolds Platteville, CO 80651 Dinner in the summer Christy Landry 970-785-2245 x 1106 Fax: 970-785-2476 dandry@plattevillegov.org Rodarte Center X X X UNC X Th 920 A St Greeley, CO 80631 Vicky Medina 970-350-9430 Fax: n/a Email: n/a Wattenberg Community Building X X X UNC X T 42 1917 Grace Ave Fort Lupton, CO 80621 John Venegas 303-854-8349 Fax: 303-857-6421 Ivwasc@yahoo.com Windsor Community Center X X X UNC X W, F Proposed additional meal on T 250 N. 11th St Windsor, CO 80550 Jay Eckhardt 970-674-3500 Fax: 970-674-3535 jeckhardt@windsorgov.com 43 Attachment C: Community Focal Points and Senior Centers CHECK IF FACILITY IS: CHECK IF LOCATION SERVES: CENTER NAME ADDRESS, CITY, ZIP CODE PHONE NUMBER CONTACT EMAIL A FOCAL POINT A SENIOR CENTER FUNDED THROUGH TITLE III -B PREDOMINANTLY LOW-INCOME ELDERLY PREDOMINANTLY LOW-INCOME MINORITY ELDERLY 1. Ault Senior Center x PO Box 1338 Ault, CO 80610 970-834-1325 Pat Farmer Email:n/a 2. Carbon Valley Recreation Center x x 701 5th St Frederick, CO 80550 303-833-3660 Alex Cox Acoxl cvord.com 3. Erie Community Center x x 4450 Powers Street Erie, CO 80516 303-926-2795 Cindy Hickman chickman(a>terieco.00v 4 Evans Community Center x x 1100 37th Street Evans, CO 80620 970-339-5344 x 132 Dorothy Hoff bgrauberger@ci.evans.co.us 5 Ft. Lupton Community Center x x 203 S Harrison Avenue Ft. Lupton, CO 80621 303-857-4200 x 112 Linda Kudrna Ikudrna(difortluoton.orq 6. Greeley Active Adult Center x x 1010 6th Street Greeley, CO 80631 970-350-9440 Tiffany Skoglund tiffanv.skoglundt Greelevaov.com 44 7, Hill N Park x x 4205 Yosemite Place Greeley, CO 80634 970-330-8619 Sharon Strausser seniors2222Ca omail.com 8. Johnstown Community Center x 101 W Charlotte Johnsontown, CO 80534 970-587-5251 Shirley Newsom-Gamez sgamezabalabb.com 9. Kersey Senior Center x 415 1st Street Kersey, CO 80644 970-352-8394 Adella Andrijeski recreationeci.kersev.co.us 10. LaSalle Community Center x 101 Todd Avenue LaSalle, CO 80645 970-284-0900 Victoria Perez recreation. lasalIe(comcast.net 11. Lochbuie Senior Center x x 501 Willow Drive Lochbuie, CO 80603 303-659-8262 Nancy Kaufroath afterolows501l skvbeam.com 12. Mead Community Center x 441 34rd Street Mead, CO 80542 970-535-4477 Janet Torres janettorres(5 townofinead.orq 13. Milliken Community Center x 1101 Broad Street Milliken, CO 80543 970-587-0671 Kathy Kindsfather kkindsfathernmiliikenco.gov 45 14. Nunn Senior Center x 775 3rd Street Nunn CO 80648 970-897-2459 Cheryl Vogel chervlvocielc vahoo.com 15 Pierce Senior Center x 221 Main Avenue Pierce, CO 80651 970-834-2655 Dixie Hansen dhbh415l msn.com 16. Platteville Community Center x 508 Reynolds Platteville, CO 80651 970-785-2245 x 1106 Christy Landry clandrvt olatteviIleaov.orq 17. Windsor Community Center x x 250 N 11th Street Windsor, CO 80550 970-674-3515 Jay Eckhardt jeckhardtCalwindsoroov.com 46 Attachment D: Regional Advisory Council Membership NAME ORGANIZATION AFFILIATION Mary Achziger Community LeAnne Bodine Community Nancy Culbreath Community Bruce Fitzgerald Community Juliet Fried Community George Heath Community Ron Heil Community Scott James Weld County Commissioner Mary Jones Community Larry Matson Community Ken Norem Community James Riesberg Community Joan Schulz Community Teresa Schunter Community Roberta Speyer Community Katherine Swafford Community David Villagran Community Please indicate on the chart below how many members are low income, minority, or over 60 LOW-INCOME MINORITY 60 + 0 0 18 47 Attachment E: Statement of Intent The Area Plan is hereby submitted for Weld County Area Agency on Aging Region For the period July 1.2019 through June 30.2023 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 t 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. BOARD OF COUNTY COMMISSIONERS COUNTY, COLOARDO AGI Ke OUNTY AREJrt AGENCY Y BOARD sNOY ON Attach Fo Focus Group Schedu Date e The Power of Voice! The Weld County Area Agency on Aging invites you to participate lin a Focus Group. Are you interested in the future of your aging co mu it Do .you care What your community has to offer as you age? Come have a conversation with us and share your isd n of the future, what you enjoy about aging welt and 'Mat you might need in order to age wet llt_ Yo Time r input help p shape the Wel ► cu rte Four Year Plan_ Lotation Address f July 19 July 24 ally 25 August August 7 August 8 August 16 August .20 August 1:30 pm 10:00 am 1:30 !pm :00 pm 1_:30 pm 1:00 pm 1:2.30 pm 1.00 pm 1_00. pm 12:30 Providers July 18 2:00 pm August 17 10:00 am rahZcNa 4 Nottlo{at 'tip, ...Aid Cuuv:r .'iILL :tvc.:II /403 3 + Ir foil. l Vallhey Active Adult Center Jhoe P Martinez Gardens Ault Sen6or Center i► mst►n wi n Senior Center Fort Lupton Recreation Center Wattenb'ei gSeniors Wilndsc,r Ccmm'i. fifty Center rile Community Center Greeley .Active Mutt Center � I lll-wit-Pa Senior Center Carbon Valley Regional Library reid County Adrrain Building 6615 Frederick Way., Frederick 17012 St, Greeleir 2041' St; Ault 101.w. Charlotte St:.. iohnstoure: 203 S Harrison Ave..: Fort Lupton 1958 Grace Ave_., Fort LJaptotn. 250 riq irb St„ Windsor 450 Powers St, Erie 101W Ch St_,, Greeley 4205 Yosemite Cr-r Greeley 7 ParParik Alta., Firestone 1150 0 Street Greeley Call the Area: Agency on Aging for more information at MD) 400-6200 Attachment G: FocusGroup Questions for Idler Adults Weld Countyyg{{ Area Agency on Aging A zttn ! Advocacy Answers cri Aging 2O18Focus Group Questions for Weed Comfy Older Adults I. What's better about your lite as you age? 7. What's more di [tut for you as you age? err Are ,you currently using supportive eMcesto stay services? What. services `o you think yo might need n your h .Ire€e? lf yes" whSt kinds of in the next 4-5 years to stay in your home? S. How did you fund or get connected .to that su future? 6. How doNfoSu1H d resources? ppor ive se :gee or how would you in. the you prefer to access/receive information about agiing servicesor 7r What is t #1thing your communes could do to .suppo≥rt you in ;aging well? E S. What do ' currently enjoy/or w positive things, .are happening in your commun Sr Have you heard about any successfugcreativelinnovative rises or prow inother areas that you would lade to see here in Wd.d Coun ICI Five r s from now,. + where do you see yourself Hu ur 1 and why? _sc am H: Focus Group uestions r Service Providers dtd Cumraty Alta Ag ricy cit Aging. AlstitanceA Advocacy AYISVICr5: on Aging .018 Focus 'Group Questions for Weld ou Service Providers ers L, How .do oil der adults find out about: your sates in the c -o un . Where do you see gaps in senor services or Were can improvements in. services be, made in the community? 3. Do any of the above gaps 'hinder your effectiveness in providing services to seniors? „ Who do you think in this cc mniiu nderserved and why? 5. '+'mst additional services would you Mato see in the community (consider achievable/Creative on :a: callevel)? 6. What did we NOT ask that we. should have? Hello