SUA Resource Library: 

Task Force Materials 
Foreword 

In 2012, the Administration for Community Living (ACL), an operating division of the US 

Department of Health and Human Services, began a comprehensive evaluation of its National 

Family Caregiver Support Program (NFCSP). This was the first comprehensive federal evaluation 

of the NFCSP, which serves over 800,000 family caregivers annually. The NFCSP evaluation has 

three broad goals to benefit policy and program decision-making: 

1. Collect and analyze information on program processes and site operations; 

2. Evaluate program efficiency and cost issues for approaches best suited to specific 

contexts; and

3. Evaluate effectiveness of the program’s contribution to family caregivers in terms of 

maintaining their health and well-being, improving their caregiving skills, and 

avoiding or delaying institutional care of the care recipient.

As part of the evaluation survey, State Units on Aging (SUAs) were asked to submit relevant 

documents if they answered ‘yes’ to any of the following five questions: 

 Do you have a statewide task force, commission or coalition specifically to examine 

family caregiver issues?

 Have community needs assessments for caregiver support services been conducted?

 Does your state have a standardized caregiver assessment?

 Does your SUA conduct routine programmatic monitoring of the NFCSP program?

 Do you use a uniform caregiver satisfaction survey across all AAAs?

ACL received assessment tools and grouped them into the following categories:

1. Community Assessment Materials

2. General Customer Satisfaction Survey Materials

3. Grandparent Assessment Materials

4. High-Level Administrative Materials

5. Program Monitoring Materials

6. State Caregiver Assessments

7. State Care Recipient Assessments

8. Task Force Materials

9. Uniform Satisfaction Materials

10. Other Materials

While ACL does not specifically endorse these tools, we are sharing them because they may be 

helpful to other programs. For more information on the NFCSP please go to: 

http://www.aoa.acl.gov/. For more information on the evaluation of the NFCSP please go to: 

http://www.aoa.acl.gov/Program_Results/Program_Evaluation.aspx
Task Force Materials 

Georgia – Caregiving in Georgia .................................................................................................................... 3 

Georgia – Caregiving in Georgia: A Second Report ..................................................................................... 56

Ohio – Lifespan Respite Strategic Plan ....................................................................................................... 94

Oklahoma – Caregiver Coalition Report ................................................................................................... 112 

Tennessee – State Plan on Aging 2014 - 2018 .......................................................................................... 113 

Texas – Report to State Legislature .......................................................................................................... 580 

Utah – State Commission on Aging Annual Report 2013-2014 ............................................................... 617 

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Georgia – Caregiving in Georgia: A Second Report 56
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Georgia – Caregiving in Georgia: A Second Report 
Georgia – Caregiving in Georgia: A Second Report 
Lifespan Respite Strategic Plan

2013 - 2018

Ohio – Lifespan Respite Strategic Plan 94
Lifespan Respite Strategic Plan 1

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CONTENTS 

Executive Summary 1

Mission, Vision and Respite Definition 4

ORC Mission 4

ORC Vision 4

Definition of Respite for Ohio 4

Environmental Scan 5

Background 5

Existing respite services in Ohio 6

Coordination of respite 8

Ohio’s Regional Respite Summits 9

Strategic Goals & Objectives 10

Goal 1: Training, Education, Outreach 10

Goal 2: Develop a statewide respite system with central access point 11

Goal 3: Develop an ORC Business Plan to Ensure Future Sustainability, Growth and Succession 

Plan 12

Contributors 16

Special thanks to Felicia Sherman, Project Manager at the Ohio Department of Aging, for facilitating 

the development of this Strategic Plan. 

Ohio – Lifespan Respite Strategic Plan 95
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Executive Summary 

The Ohio Respite Coalition (ORC) is a statewide collaboration among family members, 

caregivers, advocates, respite providers, agencies, community groups, and state and local 

government officials who believe all caregivers could use a break once in a while. 

This strategic plan highlights the Ohio Respite Coalition’s five-year approach to increasing the 

availability of respite services in the state. The coalition is supported by a three year (2011-2014) 

Lifespan Respite Program grant from the Administration on Aging (AoA) (now part of the 

Administration for Community Living (ACL), administered by the Ohio Department of Aging. The 

goals, strategies and tactics outlined in this plan will set a framework for how the Coalition will 

approach year three of the grant and beyond. More specifically, this plan includes the following: 

Section 1 highlights the Ohio Respite Coalition’s Mission and Vision Statements and provides 

Ohio’s definition of respite. 

Section 2 provides an environmental scan of national and Ohio-specific factors influencing the 

future direction of respite services. Key topics include existing respite services in Ohio, 

coordination of respite services and a summary from Ohio’s regional summits. 

Section 3 outlines the top three strategic issues that emerged during Ohio’s respite summits. 

These issues were further discussed during ORC’s strategic plan development process and the 

group agreed that these issues would serve as the foundation for defining the strategic plan 

goals for this five-year plan. Participants at this meeting further fleshed out strategies and 

tactics to ensure successful completion of these goals. 

Goal 1: By September 2017, develop high-quality training, education, and outreach 

materials for respite consumers, providers and the general public to promote clear and 

consistent messaging about respite and align respite service requirements across 

systems statewide. 

Goal 2: By September 2015, expand the availability of respite services in Ohio, including 

development of a statewide respite system with a central access point for information 

and services. 

Goals 3: By September 2014, develop and implement a business plan for the Ohio 

Respite Coalition to ensure sustainability through membership growth and 

infrastructure enhancements. 

Ohio – Lifespan Respite Strategic Plan 96
Lifespan Respite Strategic Plan 3

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Mission, Vision and Respite Definition 

ORC Mission

To educate, advocate, and promote access to respite options for people who care for a loved one.

ORC Vision

All caregivers regardless of location or circumstances have access to quality, person-centered respite 

services and are able to use them in a timely and effective manner. 

Definition of Respite for Ohio

Temporary relief from the responsibilities associated with caregiving. 

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Environmental Scan 

Background

As the U.S. population ages, demand for long-term services and supports is growing 

dramatically. Family caregivers of older adults are regarded as the backbone of the long-term care 

workforce (Noelker, 2001), and respite is an important resource for alleviating or preventing the stress 

they experience and for maintaining older adults in the community. In order to support and retain 

family caregivers in the caregiving role, a national panel of experts, convened in 2010 by the Benjamin 

Rose Institute on Aging under a cooperative agreement with the U.S. Administration on Aging, 

suggested that an increase in funding for caregiver services, particularly respite services with 24-hour 

availability, is critical (Noelker, L. S., Rose, M., Ejaz, F. K., Castora-Binkley, M., & Browdie, R. (2010)). 

Research consistently shows that having respite time is the most desired and needed service 

reported by caregivers (Lund, Wright, Caserta, & Utz, 2006). A three-year research project conducted 

by the University of New Hampshire's Center on Aging and Community Living found that serving 

family caregivers through discretionary funding and emotional support helped them to maintain 

physical and emotional well-being even as their family members' health or abilities declined. 

(AUCDigest – July 2012; http://www.aucd.org/docs/digest_2012/AUCDigest%20July%202012.pdf). 

Moreover, caregivers who use respite report high levels of satisfaction with the service. Studies on the 

impact or outcomes of respite for caregivers, such as reduced caregiving burden and decreased 

depression, have shown mixed results. This phenomenon has been attributed to variations in research 

design and measures as well as to caregivers using too little respite, for too short a time period, or too 

late into the caregiving process. Consequently, respite service experts recommend that caregivers use 

respite early in the caregiving career, use it regularly, engage in personally meaningful activities 

during respite time, and use respite in conjunction with other services such as education and support 

groups (Lund et al., 2006). 

Nationally, about 11% (3.7 million) of older Medicare enrollees received personal care from a 

paid or unpaid source in 1999. Recent data from the Bureau of Labor Statistics’ 2011 American Time 

Use Survey showed that over a three-month period, 39.8 million people (aged 15 and older) provided 

unpaid care to someone over 65 “because of a condition related to aging.” (Retrieved from: 

http://www.bls.gov/news.release/atus.nr0.htm). 

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The survey, which began in 2003, includes 12,500 respondents who are asked how they spent 

their previous 24 hours; starting last year, respondents were also asked about caregiving. Almost a 

third of respondents reported taking care of two or more older people, and 23% also had a minor child 

in their households. 

Almost all community-resident older persons with chronic disabilities receive either informal 

care (from family or friends) or formal care (from service provider agencies). Over 90% of these older 

persons with chronic disabilities received informal care and/or formal care and about two-thirds 

received only informal care. About 9% of this chronically disabled group received only formal services. 

(A Profile of Older Americans 2011: 

http://www.aoa.gov/AoAroot/Aging_Statistics/Profile/2011/docs/2011profile.pdf). 

Existing respite services in Ohio 

In Ohio, some 1,728 persons received caregiver respite services, and 879,058 service units were 

provided, according to the Administration on Aging’s FY2010 Profile of State Older Americans Act 

(OAA) Programs. Title III expenditures were more than $2.6 million, while total services expenditures 

exceeded $2.7 million. These numbers served through the OAA represent a small portion of the 

estimated 1.31 million caregivers in Ohio in 2010 (Caregiving Across the States: Publically Funded 

Programs, Family Caregiver Alliance. Retrieved from: 

http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=1789 ). Ohio provides respite 

through the National Family Caregiver Support Program, its PASSPORT HCBS Medicaid Waiver 

Ohio – Lifespan Respite Strategic Plan 99
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Program, and its state-funded Alzheimer’s Respite Program. All three statewide programs 

administered by the Ohio Department of Aging offer respite in the form of adult day services and inhome personal care. Overnight and weekend/camp respite are offered by the Family Caregiver 

Support Program and the Alzheimer’s Respite Program. Caregivers do not have to live with the care 

receiver to qualify for respite under any of these programs and there is no respite cap. 

The primary source of funding for respite services in Ohio is through Medicaid waivers.

Medicaid waivers are programs offered through the Ohio Department of Job and Family Services 

(ODJFS), the Ohio Department of Developmental Disabilities (DODD), and the Ohio Department of 

Aging. For individuals with developmental disabilities, DoDD offers both the Individual Options (IO) 

waiver and the Level 1 waiver for some types of respite. The IO waiver covers informal respite 

provided by an approved independent provider or friend, up to 90 days of residential respite in an 

institution, and recently approved by CMS, community respite, which can take place in a variety of 

locations – camp, recreation centers or other places where an organized community program or 

activity occurs. Level 1 provides informal and residential respite. However, there are 27,000 people on 

the waiting list for these waiver services. 

Custodial parents may be able to access respite services through the local mental health board 

if their county board provides funding for that service. The local county boards of developmental 

disabilities receive an annual allotment of Family Support Services dollars. These funds are then 

allocated to families who apply and can be used for respite service. The annual average family 

allotment in 2009 was $869. This amount has been decreasing in each biennium budget. 

The Ohio Home Care Program, through ODJFS, offers services through the Ohio Home Care 

Waiver and Transitions Waiver. These waivers are designed to meet the home care needs of people 

who have certain medical conditions and/or functional abilities that would qualify them for Medicaid 

coverage in a nursing home or hospital. Consumers may receive care and services at home, or they 

may choose to receive their care in a nursing facility. The Transitions Carve Out Waiver is designed to 

meet the needs of consumers who are age 60 and over but is not open to new enrollees. To qualify, 

consumers must first be on the OHC Waiver and be “transitioned” due reaching age 60. 

There are over 92,000 Veterans with disabilities in Ohio. A new program in Ohio for Veterans 

with a skilled nursing facility level of care need called the Veteran-Directed Home and Community 

Based Services Program allows the Veteran to purchase respite services. 

Individual provider organizations provide respite services to families, mostly through private 

pay. Many conduct fundraising to assist families with the cost of respite. Usually this financial subsidy 

is based on financial need. This additional source for providing respite services is critical to meet the 

needs of many more consumers who do not enroll in state or federally funded programs. It is difficult 

to capture the amount of funding and number of consumers covered through private pay options. 

Ohio – Lifespan Respite Strategic Plan 100
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Coordination of respite

Care coordination, an ongoing component of an effective system of care for children and youth 

with disabilities and special health care needs and their families, is not available to all families in Ohio. 

Even those families who receive services through one of Ohio’s governmental systems are not always 

able to access care coordination due to the high costs associated with delivering this service. The 

researchers in “Caring for Children with Disabilities in Ohio” (Goudie, 2010) concluded that improved 

health care coordination and the delivery of family centered health care services for children with 

disabilities would help by offering prevention strategies related to family stress. 

As part of this Lifespan Respite grant, the Benjamin Rose Institute on Aging has begun 

collecting information to help Ohio build a network of resources database. 

To date, sources of information that have been identified include: 

 ARCH National Respite Locator 

http://archrespite.org/respitelocator

http://archrespite.org/respite-locator-state-search/227-ohio-search

Ohio – yields 192 results 

 Connect Me Ohio (no longer in service) 

Previous search for respite care yielded 54 results 

 Ohio Respite Coalition Research Committee 

o Alzheimer’s Association (Allison Gibson, Delaware County Social Worker) supplied respite 

provider lists for the Central Ohio, Cincinnati, Cleveland, Miami Valley/Dayton, and 

Northwest Ohio areas 

o Greene County (Renee Lammers, Family Stability Coordinator) 

 Family and Children First Council list of respite care resources and respite policy 

 Description of respite program availability/providers in the county 

o Mahoning County (Pam Petras, Help Hotline Crisis Center [www.helphotline.org], Special 

Navigator for Families with Special Needs) 

 Paper copy of 2012 “Respite and Summer Programs for Families with Special 

Needs”

 Area Agencies on Aging 

Organizations, with contact information, that provide respite services under contract with the 

AAA or in its service network were supplied by four AAAs (4, 6, 7 and 10B) in conjunction with a 

survey of respite funding offered by Ohio Area Agencies on Aging. 

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Ohio’s Regional Respite Summits

During the March 2011 Ohio Respite Summit attendees identified lack of effective coordination of 

care as a primary weakness in Ohio’s system of services. Related to this issue, the group recognized 

the lack of coordination within and across systems such that caregivers have to be their own care 

coordinators, that services are not consistent from one county to the next, that cross-agency 

cooperation is infrequent, that there is limited coordination and linking across funding silos, and that 

service coordinators are not universally informed about what’s available and who’s eligible for 

services. 

Throughout 2011 and 2012, Ohio held regional respite summits in Chillicothe, Cincinnati, 

Mansfield, Columbus, and Cleveland. In all, 247 attendees, including professionals, family caregivers, 

provider agency and government staff, and advocates, from 30 counties participated. A list of 

organizations that participated in the regional summits is in the Contributors section starting on page 

16.

The most critical need areas discussed included education, training and outreach, and a statewide 

respite services network. Consistent feedback from participants focused on the following areas: 

• Improve respite training curricula and programs with certification for providers (paid, unpaid, 

and volunteer)

• Provide specialized training for serving consumers with special needs (e.g., on vents, 

behavioral disorders, autism) 

• Develop public awareness campaigns for families and professionals (including physicians and 

legislators) on the need for and how to access respite 

• Develop education and outreach campaigns for consumers with attention to caregiver age 

differences and emphasis on wellness 

• Develop advocacy campaigns to increase funding for respite 

• Create single point of entry into respite services 

• Develop a statewide inventory or clearinghouse of respite services for caregivers 

• Increase funding through advocacy and policy changes 

• Standardize access to respite across programs and counties, including rural areas 

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• Eliminate waiting lists 

• Create a coordinated statewide system of care 

• Coordinate respite with other health and social services 

• Address caregiver/client guilt and mistrust through education and improved respite workforce 

• Address age eligibility requirements that create service gaps 

• Standardize assessment of caregivers and their respite needs 

• Systematically monitor caregiver satisfaction with and outcomes of respite use 

• Conduct cost-benefit analyses of respite service programs 

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Strategic Goals & Objectives 

On July 15, 2012, the Ohio Respite Coalition held a Strategic Plan Retreat to develop Ohio’s priorities 

over the next five-years. There were representatives present from multiple disciplines including state 

government, local providers, and consumer advocates. The group focused on the following three 

goals for this strategic plan period: 

Goal 1: Training, Education, Outreach 

By September 2017, develop high-quality training, education, and outreach 

materials for respite consumers, providers and the general public to promote clear 

and consistent messaging about respite and align respite service requirements 

across systems statewide. 

Strategies & Tactics 

I. Review existing training programs for commonalities and facilitate communication among 

systems 

a. Develop common curriculum or adapt existing curriculum with a goal of having the 

state adopt a common certification for respite providers 

b. Develop dissemination approaches for curricula (web-based, train-the-trainer, 

mechanisms in place to share resources) 

II. Develop specific training packages for unique populations 

a. Identify what is existing and what is needed and add stackable certificates 

b. Establish PATHS program for direct service providers in DD adult community 

III. Outreach 

a. Develop marketing campaign and messaging targeting I&R, 2-1-1, ADRN, etc. 

b. Motivate/educate providers, caregivers, and general public on respite, benefits of 

respite, how to access (wellness strategies conveyed using respite as a communication 

strategy) 

c. Understand and develop marketing message to address why an individual might not 

want to be a respite provider. Establish federal/state/local forgiveness for nursing 

students who work in home health providing nursing services to pediatric patients. 

d. Using a variety of vehicles, inform people of the needs and opportunities, and create 

awareness of respite 

Ohio – Lifespan Respite Strategic Plan 104
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e. Develop websites, printed materials, PSAs, media placements, and add to story bank 

f. Develop advocacy campaign to increase and sustain funding for respite 

g. Develop a respite roadshow / speakers bureau 

h. Develop consistent message for marketing materials 

Goal 2: Develop a statewide respite system with central access point 

By September 2015, expand the availability of respite services in Ohio, including 

development of a statewide respite system with a central access point for 

information and services. 

Strategies & Tactics 

I. Develop central access point/website as promotional/education/resource tool 

a. Develop education materials for each target audience (consumers, providers, etc.) 

b. Include linkages to available resources (services, training opportunities) 

c. Use existing access points (Red Tree House, ADRN, 211, I&R, etc.) 

d. Develop and use common data system that includes inventory of respite providers 

e. Gather information on funding 

f. Gather information on how to become a provider 

g. Review what other states are doing regarding central access point 

II. Expand Ohio’s Statewide Respite Network 

a. Determine what services can be used for respite 

b. Develop provider inventory/gap analysis 

c. Engage in advocacy with funders for common definition/use of terminology 

d. Define role of unpaid respite providers 

e. Allow respite searches at Central office for those not connected to the web 

i. Data tracking capability 

ii. Personal service for those who need it 

iii. 1-800# 

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f. Locate advocates in existing system who can help direct individuals to 

services/care/support 

i. Identify those with skill, interest, experience 

ii. Use Listserv for information sharing 

g. Offer resources to build skills to provide respite as a career 

i. Link to Direct Service Workforce initiative through Governor’s Office of Health 

Transformation (OHT) 

ii. Advocate to add curriculum for respite providers 

iii. Develop Train-the-Trainer curriculum 

iv. Integrate Curriculum/How-to manual from ARCH 

h. Develop Volunteer Respite Network that connects to volunteer agencies/organizations 

i. Develop a coalition road show on respite 

III. Develop legislative advocacy team (funding, awareness, policy/rules) 

a. Develop and implement sustainable funding strategies 

b. Determine appropriate oversight of certification process 

Goal 3: Develop an ORC Business Plan to Ensure Future Sustainability, Growth 

and Succession Plan

By September 2014, develop and implement a business plan for the Ohio Respite 

Coalition to ensure sustainability through membership growth and infrastructure 

enhancements. 

Strategies & Tactics

I. Submit Lifespan Respite legislation with funding appropriation 

a. Develop planned strategy for ongoing advocacy to continue appropriation 

b. Identify specific legislators who have influence and interest 

c. Establish a budget for appropriation 

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d. Identify hard objective data available that establishes evidence of need for respite and 

for a coalition 

e. Determine philanthropic opportunities 

II. Develop membership recruitment and retention plan 

a. Develop strategic plan for the coalition 

b. Seek regular contact among members of the coalition 

c. Establish what is needed of members 

d. Develop recognition program for those who participate and contribute 

e. Provide/establish virtual presence for networking and sharing of information (regularly) 

f. Recruit affiliate sponsors with related mission 

III. Determine governance structure with leadership responsibilities and succession plan 

a. Explore most appropriate organization type (e.g., 501(c)(3), LLC) 

b. Establish organizational structure 

c. Consider a stand-alone or part of something larger 

d. Address logistics (office locations, staff, website maintenance, support services, etc.) 

e. Research outside experts who could help with business plan 

IV. Develop / purchase data tracking system to support accountability of the coalition and 

sustainability

a. Gather baseline data 

b. Determine hardware and software requirements 

c. Identify key elements

d. Incorporate in-house research capabilities or hire research consultant 

e. Establish valid measurement tool 

f. Demonstrate cost savings to system 

g. Measure caregiver satisfaction 

h. Develop measurable respite outcomes 

V. Determine need for financial support beyond appropriation 

a. Develop a membership program -- identify benefits for members 

b. Develop a donation program -- financial support structure (e.g., PayPal) 

c. Identify and apply for grants from philanthropic entities 

d. Determine appropriate in-kind support from sponsoring organization(s) or like-minded 

entity(ies)

e.

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VI. Support for delivery of services 

a. Establish how appropriations can used 

b. Determine role of coalition in distributing new funds 

c. Establish central office/regional offices 

Ohio – Lifespan Respite Strategic Plan 108
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Contributors 

Ohio Respite Coalition 

Benjamin Rose Institute on Aging 

Easter Seals of Ohio 

Organizations that participated in Regional Respite Summits during 2011-2012 

Achievement Centers for Children, Camp Cheerful 

Akron Children's Hospital 

Akron Rotary Camp for Children with Special Needs 

All Care Services 

Alzheimer's Association, Cincinnati/KY 

Alzheimer's Association, Greater East Ohio Area Chapter 

Alzheimer's Association, Central Ohio Chapter 

Alzheimer's Association, Cleveland Area Chapter 

Alzheimer's Association, NW Ohio Chapter 

American Cancer Society 

American Red Cross 

ARC Southwest Ohio 

Area Agency on Aging - PSA5 

Area Agency on Aging - PSA6 

Area Agency on Aging - PSA7 

Area Agency on Aging - PSA8 

Area Agency on Aging - PSA10A 

Ashland University/Help Me Grow & Family and Children First Council 

Associated Healthcare of Ohio 

Beech Brook 

Benjamin Rose Institute on Aging 

Brain Injury Association of Ohio 

Brooks House Assisted Living Community 

Camp Allyn for Children with Special Needs 

Campbell Group

Catholic Charities (SWO) 

Cincinnati Children's Hospital Medical Center/Perlman Center/UCEDD 

Cincinnati Public Schools 

Cleveland Clinic Children's Hospital for Rehabilitation 

Compassionate In-Home Care, Inc. 

Connections 

County (Delaware) Council for Older Adults 

County (Licking) Aging Program 

County (Union) Senior Services 

County (Wyandot) Council on Aging 

Ohio – Lifespan Respite Strategic Plan 109
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Crestwood Care Center

DD Board, Delaware County 

DD Board, Huron County 

DD Board, Knox County 

DD Board, Licking County 

DD Board, Ross County 

DD Board, Union County 

DD Services, Butler County 

DD Services, Hamilton County 

Department of Job and Family Services, Geauga County 

Department of Job and Family Services, Richland County 

Down Syndrome Association of Greater Cincinnati 

Easter Seals Northern Ohio, Inc. 

Easter Seals (Goodwill) Miami Valley 

Elmwood Assisted Living 

Epilepsy Foundation of Greater Cincinnati 

Family and Children First Council, Butler County 

Family and Children First Council, Crawford County 

Family and Children First Council, Cuyahoga County 

Family and Children First Council, Dayton 

Family and Children First Council, Gallia County 

Family and Children First Council, Scioto County 

Family and Children First Council, Vinton County 

Family Voices of Ohio 

Firstlight Home Care of Columbus 

Franklin Woods Nursing Rehab. 

Griswold Special Care 

Hearth Consultants LLC 

Home Instead Senior Care 

Hospice of the Western Reserve 

Inner-Circle Communities 

Joyful Acres 

Judson at University Circle (Judson Park) 

Kindred Transitional Care & Rehabilitation - Newark 

Linking Employment, Abilities & Potential (LEAP) 

Long Term Care Ombudsman, Cuyahoga County 

Mental Health Services for Homeless Persons 

Michael Carter Group 

Mid-Ohio Board for an Independent Living Environment 

Mill Run Place 

Montefiore/The Weils 

Mount Carmel Health System/Hospice 

NAMI, Richland County 

Ohio – Lifespan Respite Strategic Plan 110
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National Church Residence/Ashland University 

National MS Society, Buckeye Chapter 

National MS Society, Ohio Valley Chapter 

Nationwide Children's Hospital 

New Avenues to Independence 

Northwest Counseling Services 

Ohio Care Planning Council 

Ohio Center for Autism and Low Incidence 

Ohio Department of Aging 

Ohio Federation for Children's Mental Health 

Ohio Senior Health Insurance Information Program 

Partners of Marion Care & Rehab. 

Providence Baptist Church, Alzheimer's Support Group 

Providence House 

Rehab & Nursing Center @ Firelands 

Rehab Center, The 

REM Ohio 

Resident Home Corporation (RHC) 

Richland Newhope 

Rose-Mary Center 

Senior Independence Home Health and Hospice 

Silver Lining Group 

Southeastern Ohio Center for Independent Living 

Southwest General Health Ctr. Hospice, Geriatric Assessment, and Home Health Services 

St. Augustine Health Ministries 

St. Catherine Manor of Washington Court House 

St. Joseph Home of Cincinnati 

Stepping Stones Respite Center 

T. C.'s Helping Hands Inc. 

University Hospitals Case Medical Center 

Visiting Nurse Association of Mid-Ohio 

Vitas Innovative Hospice Care of Columbus 

Wesleyan Village 

Willow Brook Christian Communities 

Winchester Place Nursing and Rehabilitation Center 

Wingspan Care Group/Applewood Centers, Bellefaire JCB 

Zangmeister Center

Ohio – Lifespan Respite Strategic Plan 111
OKLAHOMA DEPARTMENT OF HUMAN SERVICES

2401 N.W. 23rd St., Ste. 40

Oklahoma City, OK 73107-2422 

(405) 521-2281 • www.okdhs.org

03/12/15

The last meeting of the Oklahoma Respite Resource Network (ORRN) was September 23, 2014.

Four meetings were held in 2013 (May 3, June 13, August 14, and October 9) and the last meeting 

convened was September 23, 2014. The Oklahoma Respite Resource Network began in 1997 as a 

public and private partnership including state agencies and organizations such as the Dept. of 

Human Services/Family Support Services Division, Developmental Disabilities Services Division, 

Division of Children and Family Services, Office of Child Care, Oklahoma Health Care Authority, 

Oklahoma’s University Center for Excellence, Center for Learning and Leadership, the 

Developmental Disabilities Council, Oklahoma City Veterans Administration (Coordinator of 

Geriatrics and Extended Care Social Work) and Oklahoma Area-Wide Services Information System 

(OASIS). In 2010, the Department of Human Services Aging Services Division, in conjunction with a 

few of the leaders of the ORRN applied for the Lifespan Respite Grant with the Administration for 

Community Living and began to focus on new start projects or expansion of existing respite 

programs for Caregivers across Oklahoma. Oklahoma Aging Services has conducted the respite 

voucher program and awarded seed grants for new start and expansion of existing respite programs 

around the state during the grant period. A second Lifespan Respite Grant was received in 2013 and 

focused on “sustainability” of existing and funded programs as well as continued funding seed

grants to make additional opportunities for respite for caregivers available across the state. 

The Oklahoma Respite Resource Network (ORRN-the former Respite Coalition) has begun a major 

change. Where in the beginning, the network was committed to respite voucher programs to cover 

the whole state and writing for grants with Aging Services, the network is now re-thinking its 

mission. There were retirements in key positions of leadership in the Department, which affected 

the leadership of the coalition. Although still involved in the network, those people have had to 

reduce the time spent on support and leadership of the coalition. That meant that new leadership 

would need to be developed for the changing coalition. The group has every intention of continuing 

its work. One of the last meetings, the group was reviewing its mission and voted to 1) change the 

name of the coalition/organization and 2) broaden its mission. There was discussion of too much 

focus on respite vouchers and recommendation that the coalition adjust its mission and activities to 

a broader scope of supports for caregivers, with less of a focus on “respite”. The fact that the 

respite voucher programs are well established and varied in their target audience of caregivers is 

part of this shift in focus. 

The coalition members see that there is quite a bit of support and focus on “respite” by the solid 

respite voucher p

Oklahoma – Caregiver 

rograms within the Department of Human Services and the Area Agencies on 

Coalition Report 112
 

 Tennessee State Plan on Aging 

 2014 - 2018

2014 - 2018

Submitted to the U.S. Administration for

Community Living by the Tennessee

Commission on Aging and Disability

Tennessee – State Plan on Aging 2014 - 2018 113
Tennessee – State Plan on Aging 2014 - 2018 114
ACKNOWLEDGEMENTS 

The Tennessee Commission on Aging and Disability would like to acknowledge the assistance of 

the following persons and agencies in the development of the 2014-18 State Plan on Aging. 

Ken Kisiel, Chair of the Tennessee Commission on Aging and Disability and Chair of the 

Strategic Planning Committee 

The members of the Tennessee Commission on Aging and Disability 

First Tennessee Area Agency on Aging and Disability 

East Tennessee Area Agency on Aging and Disability 

Upper Cumberland Area Agency on Aging and Disability 

Greater Nashville Area Agency on Aging and Disability 

South Central Area Agency on Aging and Disability 

Southeast Area Agency on Aging and Disability 

Southwest Area Agency on Aging and Disability 

Northwest Area Agency on Aging and Disability 

Aging Commission of the Mid-South 

The Senior Centers of Tennessee 

Patti Killingsworth, Bureau of TennCare 

The Policy Academy on Aging, Substance Abuse and Mental Health 

The Staff of the Tennessee Commission on Aging and Disability 

Jean Renfro, Consultant and Writer 

All the Citizens, Service Providers, and State Agencies that participated in the Listening Tours 

and Public Meetings held across the State 

Tennessee – State Plan on Aging 2014 - 2018 115
Table of Contents 

 Page Number 

Executive Summary 1 - 3 

Chapter 1: Tennessee Commission on Aging and Disability 4 – 5 

 Mission 4 

 Foundation 4 

 History & Current Status 4 

 Long Term Care Community Choices 4 – 5 

Chapter 2: Focus Areas and Programs 6 - 9 

 Older Americans Act 6 – 7 

 Options for Community Living Program 8 

 Public Guardianship for the Elderly Program 8 

 State Health Insurance Assistance Program 8 

 Other Grants, Projects & Statewide Programs 8 – 9 

Chapter 3: Statewide Needs Assessment 10 – 13 

 Overview 10 

 Survey Findings 10 

 Aging and Disability Issues 10 - 11 

 Impact of Baby Boomers 11 - 12 

 What Works in the Community 12 

 Small Group Focus Sessions 12 - 13 

Chapter 4: Challenges 14 - 16 

 Fiscal Challenges 14 

 Capacity of Programs Services 14 

 Baby Boomers 15 - 16 

 Learning New Things 16 

 Adults with Disability 16 

 Tracking In-Kind Funding and Volunteer Services 16 

 Additional Challenges 16 

Chapter 5: Planning for the Future 

 Goals, Objectives, Strategies, Performance Measures 17 – 30 

Tennessee – State Plan on Aging 2014 - 2018 116
Attachments 

Attachment A: State Plan Assurances and Required Activities 

Attachment B: Information Requirements 

Attachment C: Intrastate Funding Formula Requirements 

Attachment D: State of Tennessee Policy of Non-Discrimination 

Attachment E: Demographic Data 

Attachment F: Statewide Comprehensive Needs Assessment Data and Analysis 

 

Regional Needs Assessment Reports 

Attachment G: Description of TennCare CHOICES and “Money Follows the Person”

Attachment H: Map of Area Agencies on Aging and Disability 

Attachment I: Aging Network 

Attachment J: Map of State Agency Services 

Attachment K: Tennessee Commission on Aging and Disability Members 

Attachment L: Cost Sharing Rule 

Attachment M: Financial Plan—Operational Budget for FY2014 

Attachment N: Public Hearing 

Tennessee – State Plan on Aging 2014 - 2018 117
1

Executive Summary 

The Tennessee Commission on Aging and Disability (TCAD) has reached a milestone. TCAD 

has provided services to the aging population for 50 years. In celebration of its anniversary and 

as TCAD prepares for the future, TCAD is taking on the task of re-evaluating its programs and 

services to make certain that they continue to be efficient and cost effective. 

In 2011, the first baby boomer achieved the age of 65 and it is estimated that 10,000 individuals 

will turn 65 each day. Currently, an estimated 75 million individuals are identified as baby 

boomers. In the next 15 years, an additional 1,245,064 Tennesseans or 20 percent of the current 

population will reach the age of 65, representing an 65 percent increase in the number of 

Tennesseans who will require programs and services. Programs and services will be required to 

address this emerging population with a different orientation toward aging. However, while the 

Tennessee State Plan on Aging 2014-2018 looks forward, it must also address the needs of the 

current population. In addition, the needs of adults with disabilities must be addressed. As of 

December 2011, 179,325 individuals in Tennessee are disabled. Of that number, 121,844 

individuals are between the ages of 18 - 64 (68 percent) and 32,142 are 65 and older (18 

percent). 

The Tennessee State Plan on Aging 2014-2018 will provide the framework for a 

comprehensive and coordinated system to begin to address programs and services that will be 

required. The Older Americans Act and other home and community based programs 

administered by TCAD will continue to play an important role in addressing the growing needs. 

The Tennessee State Plan on Aging 2014-2018 will allow for changes in demographics, new 

funding opportunities and resources, and the budgetary challenges that Tennessee will face in the 

coming years. 

Programs and services such as, but not limited to, health promotion and prevention, elder rights, 

long term care, home and community based services, self-directed care, affordable and 

accessible programs and services, respite, a healthy aging plan and a guide to healthy aging, and 

an array of community services and programs will be required to meet the current and future 

needs. Independent living options for those at risk of assisted living or nursing home placement, 

self-directed care, self-determination, single point of entry, CHOICES (Tennessee’s Medicaid 

program for long term care services), private pay options, Alzheimer’s disease and related 

dementia, care transitions, and Veterans’ Directed Home and Community Based Services have 

all become a part of aging programs and services and are included in the Tennessee State Plan 

on Aging 2014-2018. 

The Tennessee State Plan on Aging 2014-2018 will continue to target minority, low-income, 

low-income minority, and rural populations as well as the newer populations, initiatives and 

terminology outlined in the 2006 amendment to the Older Americans Act. According to the 

2010 census, 16.9 percent of Tennesseans are below the poverty level as compared to 14.3 

percent for the United States. The median income is also lower than the national average. 

During February and March 2013, the Tennessee Commission on Aging and Disability (TCAD) 

conducted a Listening Tour across the Tennessee in each of the nine (9) regions served by the 

Tennessee – State Plan on Aging 2014 - 2018 118
2 

Area Agencies on Aging and Disability (AAAD). The Listening Tour was conducted to allow 

community members to discuss the challenges facing the aging and disability population; to 

gather suggestions about addressing these challenges; and to provide input on what can be done 

to make programs and services more accessible, efficient, and effective. At each of the sites, 

participants completed a survey focusing on 1) current aging and disability issues, 2) issues faced 

by “baby boomers” as they age, and 3) programs and services that are currently working in the 

community. Participants also participated in small focus groups. The data from Public Hearing 

on the Tennessee State Plan on Aging 2014-2018 held on May 7, 2013 is included.

 The comprehensive needs assessment consists of the results of the surveys and the small focus 

groups, stakeholders’ meetings, review of literature of the differences between the current senior 

population and baby boomers, and a review of the previous data provided by the State Plan 

2009-2013. Utilizing the data from the comprehensive needs assessment and other identified 

sources, the Tennessee State Plan on Aging 2014-2018 was developed. The Tennessee State 

Plan on Aging 2014-2018 provides policy makers, service providers, and the general population 

with appropriate data about trends and implications for the current population as well as the 

impact of the increase in the aging population due to the aging baby boomer population. 

Tennessee will be facing many challenges in addressing the aging and disability populations 

according to the multiple data sources used to develop the Tennessee State Plan on Aging 

2014-2018. The long-term challenge will be the ability to keep up with the increasing demand 

for programs and services with stagnant or decreased funding. With the baby boomers reaching 

retirement age and the “frail elderly” aged 85 and older becoming the fastest growing segment of 

the aging population, TCAD’s ability to keep up with the demand is compromised. 

The primary challenges were identified: 

TCAD’s infrastructure must be ready to support the increase in the programs and services 

that will be needed by the growing population of adults age 60 and over and adults with 

disabilities; 

aging and disability programs, services, and funding are currently beyond maximum capacity 

while the growth of the baby boomer population has not yet achieved maximum demand; 

current discretionary grant funding has ended or is ending September 30, 2013, for 

Alzheimer’s Evidence Based, Alzheimer’s Innovation Grant, Care Transition Grant, Chronic 

Disease Self-Management Program, and Lifespan Respite Grant and the future of 

discretionary grant funding is unclear, however, TCAD will be poised to apply should further 

grant opportunities become available; and 

the need for a more integrated system of services and programs to meet the needs of the 

growing aging and disability population will require that current partnerships become more 

inclusive of the public and private sector and strengthened through cooperation and 

coordination.

Additional discussion of these challenges is contained in the narrative of this document. 

The goal and objectives in the Tennessee State Plan on Aging 2014-2018 reflects the work that 

must be done to maintain and grow programs and services for the current population while 

planning for the resources that will be required to meet the increased needs of the baby boomer 

population. To meet the challenges of the present and the future, infrastructure of the State Unit 

Tennessee – State Plan on Aging 2014 - 2018 119
3 

on Aging (SUA) must be effective and efficient and personnel have the necessary skills, 

knowledge, and competencies. Goal 1 will begin the process by ensuring the current SUA 

programs and services for adults age 60 and over and adults with disabilities are cost effective 

and meet best practices. 

In order to accomplish Goal 1, the following SUA programs and services will be reviewed, 

evaluated and modified, as needed: the internal structure of the SUA to ensure effective and 

efficient management and monitoring of programs and services and of state and federal funding; 

the state and federally funded home and community based (HCBS) programs; Family Caregiver 

program; Nutrition program; Ombudsman; Elder Rights program; Legal Assistance; 

Guardianship program; Senior Center program; emergency preparedness plan; and SUA’s fiscal 

policies and procedures to ensure all reports are accurate and meet state and federal guidelines. 

Goal 2 addresses funding and resources by diversifying funding and partnerships to sustain 

effective services and programs to meet current needs and to expand and/or implement additional 

services and programs to meet the emerging needs of the baby boomer population. The SUA 

will continue to identify and pursue sources of funding; maintain and grow relationships with 

partners and stakeholders with statewide influence; and build infrastructure and capacity at the 

state and area agency level to include marketing, grant writing and grant management expertise, 

and other payment options and capabilities. 

Goal 3 is directed toward building the capacity of program and services utilizing strategies that 

can be cost effective, implemented incrementally, and integrated into the current programs and 

services. SUA will partner with agencies and organizations addressing Alzheimer’s disease and 

related dementia; implement evidence based programs for healthy aging and disease prevention; 

enhance transportation services that are easier to access; identify and maintain professional 

volunteer coordinators at the SUA and nine (9) AAADs; develop and implement a healthy aging 

plan; and promote healthy aging through a healthy aging guide. 

Goal 4 will ensure that the AAADs, serving as the Aging and Disability Resource Centers 

(ADRC) in Tennessee provide easily accessible, user-friendly access to programs, services, and 

resources regardless of payment type so that individuals can get help quickly and without hassle. 

This goal will be achieved by ensuring that the ADRC/AAADs meet the fully functioning 

criteria and standards set by the Administration on Community Living (ACL), market the ADRC 

as the single point of entry/first stop for aging and disability issues, provide objective one-on-one 

counseling, information, distribution, and assistance, and ensure that the ADRC Options 

Counseling program meets the national standards, collaborate with local hospitals and other 

healthcare organizations to implement the care transitions concept, and partner with VAMCs in 

Tennessee for Veterans’ Directed Home and Community Based Services. 

Goal 5 focuses on collaborating with state agencies to develop a seamless system of accessible 

services and programs for adults age 60 and over and adults with disabilities. This will include 

mapping the current service system and the state agencies providing aging services, and 

establishing a seamless system of accessing and delivering services and programs that reduces 

and prevents fragmentation and curtails duplication of cost and services. 

Tennessee – State Plan on Aging 2014 - 2018 120
4 

Chapter 1 

Tennessee Commission on Aging and Disability 

Mission 

 

The Tennessee Commission on Aging and Disability brings together and leverages programs, resources, 

and organizations to protect and ensure the quality of life and independence of older Tennesseans and 

adults with disabilities. 

Foundation 

Tennessee should be a state where all people are respected and valued regardless of their age or disability; 

are able to reside in livable communities that are safe, affordable and accessible; and are able to live a 

healthy lifestyle with access to information and support. Care provided by dedicated family and friends is 

vital to helping people remain in their homes and independent for as long as possible. 

History & Current Status 

The Tennessee Commission on Aging and Disability (formerly the Commission on Aging) was created 

by the Tennessee General Assembly in 1963. The commission is the designated state unit on aging and is 

mandated to provide leadership relative to all aging issues on behalf of adults age 60 and over in the state. 

The Tennessee Commission on Aging and Disability (TCAD) has been administering the Older 

Americans Act services and providing oversight as mandated by the United States Administration on 

Aging (AoA) since 1965. In 2001, the Tennessee Legislature expanded the authority of the TCAD to 

provide home and community based services to older persons to include adults with disabilities under age 

60 in the state funded Options for Community Living Program. The Options Program was designed for 

individuals who do not qualify for long-term care services under the state medical assistance program. 

TCAD has administered federal funds from the Centers for Medicare and Medicaid Services to operate 

the statewide State Health Insurance Assistance Program (SHIP) since 2003. In 2004, the state Medicaid 

Agency, the Bureau of TennCare, designated TCAD as the operating agency for the Statewide Home and 

Community Based Services Waiver for Elderly and Disabled. In 2008, the CHOICES Act enabled 

TennCare to contract with Managed Care Organizations (MCO’s) to manage Medicaid-funded long-term 

support services. TCAD also administers state funds for multi-purpose senior centers, public 

guardianship, homemaker and personal care services, and home-delivered meals. 

Long Term Care Community Choices 

In 2008, the Tennessee 105th General Assembly unanimously voted into law the Long Term Care 

Community CHOICES Act of 2008 (CHOICES Act) to rebalance and reorganize Medicaid long-term 

care in the state. CHOICES is an integrated Medicaid Managed Long-Term Services and Supports 

(MLTSS) program that serves persons who are age 65 and older and adults age 21 and older with physical 

disabilities. Managed Care Organizations (MCO’s) are responsible for coordinating physical and 

behavioral health and long-term care services. Members who qualify for nursing facility care have 

freedom of choice of the setting in which care will be received, so long as their needs can be safely met in 

the community at a cost that does not exceed institutional care. 

TennCare was awarded the “Money Follows the Person” (MFP) demonstration project in 2011 to 

transition 2,225 individuals over five (5) years, primarily persons in nursing facilities, but also including 

50 persons in intermediate care facilities for individuals with intellectual disabilities. As of March 2013, 

Tennessee – State Plan on Aging 2014 - 2018 121
5 

the State has transitioned 536 people under MFP, including 279 adults age 65 and over, 234 adults with 

physical disabilities, and 23 adults with intellectual disabilities. 

The nine (9) Area Agencies on Aging and Disability (AAADs) in Tennessee serve as the Aging and 

Disability Resource Centers (ADRCs), the single point of entry for the services provided through the 

Older Americans Act, the Options for Community Living Program, the State Health Insurance Assistance 

Program, and the Public Guardian for the Elderly Program. In CHOICES, they serve as the single point 

of entry for non-Medicaid eligible individuals seeking long-term services and supports (LTSS). (MCOs 

assist their current members who need LTSS.) Non-Medicaid eligible persons seeking home and 

community based services must go through the single point of entry (SPOE) in order to enroll in 

CHOICES; persons in a nursing facility may go through the SPOE, but are not required to do so. 

The AAADs provide counseling and assistance, screening and intake, and facilitated enrollment for 

Medicaid financial as well as medical (or level of care) eligibility. In addition, TennCare contracts with 

AAADs to conduct face-to-face Quality of Life Surveys for the State’s Money Follows the Person 

Rebalancing Demonstration, and more recently, for an expanded CHOICES Quality of Life Survey which 

is part of the State’s Quality Improvement Strategy. 

The ADRC/AAADs reach out to the public to foster understanding and use of all long term care and 

health options available to help keep people as independent as possible for as long as possible. The 

public has easy access to information, counseling, and assistance, and linkage to a full range of long-term 

support services and living options. 

TCAD has provided leadership in advocating for and implementing a statewide system to provide inhome services for people who choose to stay at home rather than being cared for in a long term care 

facility. The average annual cost of nursing home care per patient is significantly higher than in-home 

care. By providing a system for in-home services, TCAD has not only championed the cause for 

Tennesseans age 60 and over and adults with disabilities to be cared for in the setting of their choice, but 

has also saved taxpayers millions of dollars. 

Tennessee – State Plan on Aging 2014 - 2018 122
6 

Chapter 2

 Focus Areas and Programs 

Older Americans Act Programs (OAA) 

The Older Americans Act (OAA) funds provide a comprehensive array of services and the administrative 

infrastructure to deliver all OAA programs. As the designated State Unit on Aging (SUA), TCAD 

receives an annual allotment under Title III of the Older Americans Act as amended, from the 

Administration for Community Living (ACL) in the U.S. Department of Health and Human Services. 

TCAD allocates OAA funds to nine (9) Area Agencies on Aging and Disability (AAADs) based on an 

approved intrastate funding formula. The AAADs plan, develop, and implement a system of services for 

persons age 60 and over in their respective Planning and Service Areas (PSA). They also oversee multipurpose senior center activities. This comprehensive and coordinated system of services is described in 

the AAAD’s Area Plans. OAA programs administered by TCAD include: 

OAA Title III–B Supportive Services/In- Home Services 

Supportive services funds provide a wide range of social services aimed at helping adults age 60 and 

over remain independent in their own homes and communities. Some of the services offered under 

Titles III-B of the Act include services such as information and assistance, transportation, case 

management, legal assistance, adult day care, and activities in senior centers. 

Information and Assistance: TCAD contracts with the nine (9) Area Agencies on Aging and 

Disability (AAADs) for the Aging and Disability Resource Center (ADRC) that provide 

information, assistance, referrals, initial screening for program eligibility, and long term care 

options counseling. The ADRC/AAADs act as a single point of entry for federal and state 

programs. Information and Assistance is provided directly by the ADRC/ AAADs. This service 

may be accessed through the toll free, statewide number 1-866-836-6678. 

Transportation: AAADs contract with senior centers or human resource agencies to provide 

limited transportation services that assist adults age 60 and over with accessible rides to medical 

appointments, senior center activities, meal sites, grocery stores, and pharmacies. 

Case Management: AAADs provide case management for clients who receive home and 

community based services funding through the Title III-B and State Options. The in-home 

services primarily include case management, personal care, homemaking, and home delivered 

meals. 

Legal Assistance: Provides legal advice and representation by an attorney to older individuals 

and also includes counseling or other appropriate assistance by a paralegal or law student under 

the supervision of an attorney. Clients may be referred to a private attorney after screening by 

legal staff to determine if the needed services fall within the predetermined case-handling priority 

guidelines. Referrals may also be made to another community service provider. Public education 

is also provided. 

Adult Day Care: AAADs contract for adult day care, as needed. 

Senior Centers: An important part of Tennessee’s Aging Network is multipurpose Senior Centers 

that serve as local community focal points for information on aging and aging activities in at least 

Tennessee – State Plan on Aging 2014 - 2018 123
7 

one location in each of Tennessee’s 95 counties. They offer a wide variety of group and 

individual services that promote healthy lifestyles, provide learning opportunities, and provide 

social interaction and volunteer opportunities. Senior Centers in Tennessee are supported through 

a combination of federal, state, and local funds. 

OAA Title III–C Nutrition Services 

Nutrition Services provide meals, nutrition education and counseling, and socialization to adults age 

60 and over in congregate settings such as senior centers or senior housing. Home-delivered meals 

are also provided to eligible adults age 60 and over in their own homes. The purposes of the program 

are to reduce hunger and food insecurity, promote socialization among adults age 60 and over, and 

provide meals to frail consumers in their homes. 

OAA Title III–D Disease Prevention and Health Promotion 

TCAD contracts with the nine (9) AAADs to provide health promotion activities across the state that 

are evidence-based best practices. Individual or group sessions, most often conducted at senior 

centers, assist participants to understand how their lifestyles impact their physical and mental health 

and to develop personal practices that enhance their total well-being, including physical, emotional 

and psychosocial factors. Examples are programs such as Chronic Disease Self-Management, Silver 

Sneakers, Matter of Balance, and Tai Chi. 

OAA Title III–E National Family Caregiver Support Program 

This program provides assistance to family caregivers caring for adults age 60 and over or to 

grandparents or other older individuals who are relative caregivers. The Caregiver program provides 

information and assistance, individual counseling, respite and supplemental services on a limited or 

one time basis. 

OAA Title IV Activities for Health, Independence, and Longevity Aging and Disability 

Resource Center (ADRC) 

The Tennessee Aging and Disability Resource Center (ADRC) grant project was first awarded to 

TCAD in 2005 to develop pilot models of comprehensive, single point of entry Aging and Disability 

Resource Centers. Subsequently, additional grants were awarded to enable all nine (9) AAADs to 

become fully-functioning ADRCs. The AAADs serve as the single point of entry for all Older 

Americans Act funded programs as well as the CHOICES program (Medicaid Waiver). A website, 

www.tnaaad.org was also developed to provide internet access to information about all aging and 

disability resources in Tennessee. 

OAA Title VI Services for Native Americans 

Tennessee does not have an officially recognized Indian Tribal Organization and does not receive 

funding from the Older Americans Act for Grants for Services for Native Americans. 

OAA Title VII Elder Rights Protection 

Elder Rights 

TCAD advocates for the protection of older Tennesseans from physical and emotional abuse, 

theft, negative stereotyping, and discrimination. The Tennessee Vulnerable Adult Coalition was 

established in 2008, to bring the state’s public and private agencies together to promote the 

Tennessee – State Plan on Aging 2014 - 2018 124
8 

collaboration necessary to prevent abuse, neglect, and exploitation of vulnerable adults. 

Long Term Care Ombudsman

The state and the nine (9) District Long Term Care Ombudsman staff are advocates for adults age 

60 and over residing in nursing homes, residential homes for the aged and assisted care living 

facilities. The Ombudsman Program is available to help qualified residents of long-term care 

facilities when residents and their families cannot resolve their problems through consultation 

with the facility staff or governmental agencies involved. Trained Volunteer Ombudsman 

Representatives are a component of this program. Public education is also provided. 

Options for Community Living Program (Options): State-funded Home and Community Based Long 

Term Care Services 

Since 2000, the SUA has received state funds for home and community based long term care services for 

adults age 60 and over and adults with physical disabilities who do not qualify for Medicaid long term 

care services. The Options Program provides homemaker, personal care, and home-delivered meals. 

Public Guardianship for the Elderly Program 

The Public Guardianship for the Elderly Program is designed to assist adults age 60 and over who are 

unable to manage their own affairs and have no family member, friend, bank, or corporation willing or 

able to act on their behalf. Public Guardians (Conservators) assist clients in obtaining the basic 

necessities of life including making decisions regarding their finances or needed medical care. Legal 

proceedings (court order) are required prior to service delivery. 

State Health Insurance Assistance Program (SHIP) 

SHIP provides free and objective information, counseling and assistance to consumers, their adult 

children, caregivers, health care providers and other advocates about Medicare and all other related health 

insurance. An important aspect of the program is to provide information and assistance with enrollment 

in Medicare Part D and target outreach to low-income Medicare beneficiaries eligible for the Medicare 

Part D Low-Income Subsidy and Medicare Savings Programs and Duals with mental disabilities or 

illness. The Centers for Medicare and Medicaid Services (CMS) funds the nationwide program. The 

statewide Tennessee SHIP operates through a small, but highly trained, paid and volunteer staff and 

through partnerships to provide this service. In addition to counseling, program staff and volunteers 

perform community education and outreach on Medicare and current related issues. 

OTHER GRANTS, PROJECTS & STATEWIDE PROGRAMS 

Innovation Grant to Better Serve People with Alzheimer’s Disease and Related Disorders 

Activities through this grant provide Alzheimer’s disease and related dementia (ADRD) 

training/education for primary care and family physicians, emergency room personnel, hospital case 

managers for discharge planning, first responders, and persons with ADRD and family members in two 

(2) Tennessee regions. Counseling and support services are also provided for persons with ADRD, their 

family members, and caregivers. 

Senior Medicare Patrol: Empowering Seniors to Prevent Healthcare Fraud 

Senior Medicare Patrol (SMP) is a nationwide program designed to help combat fraud, waste, and abuse 

in the Medicare and Medicaid programs and is funded by the Administration on Community Living. In 

Tennessee – State Plan on Aging 2014 - 2018 125
9 

Tennessee, the program is administered by the Upper Cumberland AAAD and provides statewide 

coverage through the participation of all nine (9) AAADs. Retired professionals across the state are 

recruited and trained to serve as volunteer community experts, educating Medicare and Medicaid 

beneficiaries on how to better monitor what is paid on their behalf and report discrepancies. SMP 

programs work cooperatively with SHIP programs described above, including but not limited to, joint 

training and utilization of statewide volunteers. 

Community Based Care Transitions Program 

Current ADRC funding supported five (5) local ADRC/AAADs in developing care transitions programs 

in their regions. The funding supported meetings with local hospitals and Qsource and trainings in 

evidence based models such as Coleman’s Care Transition Intervention. Four (4) of the AAADs applied 

for the 3026 funding under the Affordable Care Act. One (1) AAAD has received funding for their 

project and is in the process of implementation. One (1) AAAD is poised to apply should funding 

become available. Several projects moved forward without grant funding to implement components of a 

community based care transitions program. All five (5) of the ADRC/AAADs have continued to meet 

and discuss how to address the issues around hospital readmissions regardless of funding. 

Older Americans Policy Academy 

TCAD partnered with the Department of Mental Health and Substance Abuse Services and TennCare 

(State Medicaid Agency) to participate in a Policy Academy. As a result, a plan was developed to address 

the awareness of mental health, suicide prevention, prescription abuse, Alzheimer’s, and depression in the 

aging and the baby boomer population. The first event will be a conference to be held in June 2013. The 

Policy Academy will also work to enhance substance abuse and mental health screening capabilities for 

the aging population and increase intervention services with those identified as needing counseling and 

treatment options. 

Discretionary Grants 

 TCAD discretionary grants received during the implementation of the previous State Plan on Aging 

2009-2013 have ended. These grants include the Alzheimer’s Evidence Based, Care Transition 

Intervention Grant, Chronic Disease Self Management Program, Lifespan Respite Grant, Medicare 

Enrollment Assistance Program (MIPPA) and the Aging and Disability Resource Center Grant. TCAD is 

poised to apply for future grant opportunities as they become available. 

Tennessee – State Plan on Aging 2014 - 2018 126
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Chapter 3 

 Statewide Needs Assessment 

Overview 

During February and March 2013, the Tennessee Commission on Aging and Disability (TCAD) 

conducted a Listening Tour including a statewide comprehensive needs assessment in each of the nine (9) 

regions served by the Area Agencies on Aging and Disability (AAAD). The Listening Tour was 

designed: 

to hear from community members about challenges facing the aging population and adults with 

disabilities; 

to gather suggestions from community members about how everyone together might address these 

challenges; 

to allow attendees the opportunity to complete the needs assessment; and 

to provide input on what can be done to make aging and disability programs and services more 

accessible, efficient, and effective. 

Attendees included adults age 60 and over, adults with disabilities, baby boomers, senior center personnel 

and volunteers, AAAD staff, Aging Network members, for profit and non-profit providers and 

organizations, and local/regional officials. 

The comprehensive needs assessment consisted of results of the surveys, the small focus groups, the 

stakeholders’ meetings, review of literature of the differences between the current senior population and 

baby boomers and a review of the previous data provided by the State Plan 2009-2013. In addition, data 

were gathered from two (2) meetings held in Nashville: 

1) Stakeholders’ meeting held January 23, 2013 and 2) the quarterly meeting of the Commission held 

February 5, 2013. 

Survey Findings 

Utilizing the data from the comprehensive needs assessment, the challenges that face TCAD and other 

state departments and agencies serving adults age 60 and over and adults with disabilities were identified 

and the Tennessee State Plan on Aging 2014-2018 was developed. The State Plan 2014-2018 provides 

policy-makers, service providers, and the general population with appropriate data about trends and 

implications for the current population as well as the impact of the increase in the aging population due to 

the aging baby boomer population. 

The survey focused on the current aging and disability issues, issues faced by baby boomers as they age, 

and the programs and services that are currently working in the community. 

Identify the aging and disability issues that are most important to you.

What are the hard things that “baby boomers” face? How should the State of Tennessee help?

What is currently working well in your community? (like agencies that help, neighbors who help 

each other, van service, senior centers, meal sites, food pantries, healthcare clinics, nursing home 

sidewalks, police presence, grocery stores that deliver) 

The major findings are included in this section. A copy of the questionnaire is included in the 

Appendices. 

Aging and Disability Issues: Each participant completing this survey question could identify one (1) 

or more of 38 issues listed on the survey as being most important. Space was also provided to include 

other issues that were not on the list. 

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The total number of questionnaires completed was 555 with 812 individuals attending the Listening Tour 

meetings, a 68 percent response completion rate. The top ten items that received 60 percent or above are 

as follows: 

Response # of

responses

%

1. Affordable dental care, hearing care and eye exams and glasses 388 69.9

2. Not having enough insurance or money to pay for doctors or medicine 386 69.9

3. Being able to get help when needed quickly and without hassle 385 69.4

4. Transportation for people who don’t drive cars 384 69.2

5. Learning new things 384 69.2

6. Being able to get accessible transportation 382 68.8

7. Keeping healthy through exercise and eating healthy foods 376 67.7

8. Getting care at home instead of in a nursing home 366 65.9

9. Respite services 340 61.2

10. Training for aid workers who help older adults and people with disabilities 333 60.0

The two (2) least important issues were as follows: 

Response # of

responses

%

1. Help with drinking too much alcohol or taking drugs 88 16.0

2. Being able to get accurate information from a website and being able to 

apply for services on line

139 25.0

Impact of Baby Boomers: A major issue impacting Tennessee’s aging system will be the aging baby 

boomer generation. Baby boomers are defined as individuals who were born between 1947 and 1964. 

Currently, an estimated 75 million individuals are identified as baby boomers. In 2011, the first baby 

boomer reached the age of 65 and an estimated 10,000 individuals reach the age of 65 every day. The 

baby boomers represent a very diverse population with the peak of the boomer generation occurring 

between 1952 and 1957 with their formative years occurring during the 1960’s. (“What’s a Boomer?” 

Baby Boomer Headquarters (bbh.com). 

According to “10 Ways Baby Boomers Will Reinvent Retirement”, US News and World Report, February 

16, 2010, “[t]he baby boomers redefined each state of life as they passed through it. This generation also 

will retire in a way that is distinct from their parents and will set the standard for generations to come.” 

Currently in Tennessee, the 65 & over population represents 13 percent of Tennessee’s population. In the 

next 15 years, an additional 1,245,064 individuals or 20 percent of Tennessee’s current population will 

reach the age of 65, representing a 65percent increase. 

In response to the survey question What are the hard things that “baby boomers” face?, most of the 

respondents indicated that the current lack of accessible and affordable services and programs and the 

lack of funding will only increase as the retired population increases and lives longer than their parents. 

The primary concerns faced by baby boomers are identified by category. Examples of the responses are 

included for clarification. 

Retirement: can’t afford to retire; having enough money to retire; retirement benefits; saving for 

retirement; part-time job to supplement retirement 

Health Insurance: high cost of medical care; able to afford insurance; availability of insurance 

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Economic Concerns: insecurity about the economy and/or shrinking economy; lack of assets; loss of 

savings from a bad economy; increasing cost of gas, utilities, food; hard to live on Social Security; 

fewer resources for middle income families; rising cost of living will outpace retirement benefits; 

reduced/fixed income; rising costs and declining income 

Social Security, Medicare, Medicaid: will they be there?; future of Social Security and the possibility 

of insolvency, raising the age eligibility requirements 

Caregiving: caring for aging parents while working; raising a family while caring for aging parents; 

shortage of caregivers; increase in Alzheimer’s and dementia

Maintaining Health: staying active physically and mentally; need more education and 

programs/facilities; health promotion; senior center hours not accessible for working adults age 60 

and over; just now beginning to provide programs for baby boomers 

Transportation: affordable, accessible, and safe transportation; more city and rural transportation; 

more choices in transportation 

Healthcare: mentally challenged have limited resources; availability of health care; paying for 

medications; veterans exposed to Agent Orange; services for aging in place; services for the disabled 

and for low income; services for people living in rural counties, services are already lacking; not 

enough home and community based services; adult day care 

Technology: automated everything; quickening pace; keeping up/computer skills 

Housing: affordable, accessible, safe; affordable/available home repairs; livable and walkable 

communities; decreasing options for housing; investment friendly housing; housing to match abilities 

All of these differences will significantly impact the aging services and programs to be designed in the 

next few years. In response to the second part of the question How should the State of Tennessee help?, 

several responses reflect the lack of answers to this question: so many retiring at the same time, money 

and provisions will run out; so many – government can’t take care; and don’t know.

What Works in the Community: The survey question “What is currently working well in your 

community?” asked participants to identify what programs and/or services they thought were working. 

Some of the programs and services identified may not be statewide. One (1) participant had the following 

statement: “The services that are available are great, but so few can access.” 

The programs and services that are currently working included: meals (meal/nutrition sites, meals on 

wheels, mobile meals), van services, senior centers, grocery and pharmacies that deliver, Second Harvest 

Food Bank, food pantries, Elder Watch; Senior Citizen Awareness Network (SCAN), local church 

assistance, Project Live, Office on Aging, Alzheimer’s Tennessee, United Way, Community Gardens, 

Area Agency on Aging and Disability (AAAD), police involvement with Seniors and Law Enforcement 

Together (S.A.L.T.) and the S.A.L.T. conference, networking, sidewalks, home and community based 

services, law enforcement and sheriff’s office, Loaves and Fishes, dental care three (3) days a week, 

Room in the Inn, Human Resource Agencies (HRA), SHIP, Senior Companion Program, Helping Hands, 

Ombudsman, Habitat for Humanity, legal aid services, homemaker services, Public Guardianship for the 

Elderly, CHOICES and Options, healthcare clinic, aquatics available, commodity distribution, Silver 

Sneakers, Matter of Balance, Cancer Society’s Road to Recovery, and physical fitness programs. 

Small Group Focus Sessions 

The Small Group Focus Sessions were asked to expand upon the aging and disability issues facing 

Tennessee and to identify the factors impacting those issues. Since the sessions were open-ended, the 

responses from the multiple groups were overlapping and provided examples to re-enforce the identified 

issues: 

Not enough programs and services and lack of funding 

Tennessee – State Plan on Aging 2014 - 2018 129
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More affordable, accessible, and flexible transportation 

Tracking services provided by churches, the community, etc. 

Need for more education and training programs 

Lack of health insurance or money 

Financial assistance for food, heating, medications, utilities, etc. 

Limited computer skills and/or internet access 

Limited assisted living, retirement communities, especially in rural areas 

Solicitation calls, frauds and scammers 

More accessible services and user-friendly information 

Affordable, accessible, and safe housing and home repairs 

Lack of financial resources for dentures, hearing aids, glasses for adults age 60 and over and adults 

with disabilities 

Waiting lists for services and programs 

Depression and loneliness 

Lack of in-home services – home and community based services 

Poor attitude toward adults age 60 and over 

High cost of medications 

Too many places to call for services and/or programs and how to qualify for services 

Decrease in people paying into system, benefits, and workers in the field 

Coordination of services 

Elder Abuse 

Caregiving 

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Chapter 4 

 Challenges

The State of Tennessee will be facing many challenges in addressing the aging and disability populations 

according to the multiple data sources used to develop the Tennessee State Plan on Aging 2014-2018. 

The long-term challenge will be the ability to keep up with the increasing demand for programs and 

services with stagnant or decreased funding. With the baby boomers reaching retirement age and the 

“frail elderly” aged 85 and older becoming the fastest growing segment of the aging population, TCAD’s 

ability to keep up with the demand for services is compromised. Primary challenges are: 

TCAD’s infrastructure must be ready to support the increase in the programs and services that will be 

needed by the growing population of adults age 60 and over and adults with disabilities; 

aging and disability programs, services, and funding are currently beyond maximum capacity while 

the growth of the baby boomer population has not yet achieved maximum demand; 

current discretionary grant funding has ended or is ending September 30, 2013, for Alzheimer’s 

Evidence Based, Alzheimer’s Innovation Grant, Care Transition Intervention Grant, Chronic Disease 

Self Management Program, Medicare Enrollment Assistance, and Lifespan Respite Grant and the 

future of discretionary grant funding is unclear, however, TCAD will be poised to apply should 

further grant opportunities become available; and 

the need for a more integrated system of services and programs to meet the needs of the growing 

aging and disability population will require that current partnerships become more inclusive of the 

public and private sector and strengthened through cooperation and coordination. 

Fiscal Challenges 

The major long-term challenge facing Tennessee is funding. Beginning July 1, 2013 – June 30, 2014, as 

the result of sequestration, federally funded programs must cut their budget by five percent; thus, 

impacting the amount of money available for aging services. Preliminary analysis of the sequestration 

shows that the nutrition program will receive the greatest impact with approximately $855,229 cut in 

funding resulting in the elimination of 149,500 (congregate and home-delivered) meals affecting 1,050 

consumers. Additional program cuts include 27,242 hours of supportive service affecting 401 consumers 

and $127,018 from the caregiver support program impacting approximately 64 consumers. The State 

Health Insurance Assistance Program was also cut by $45,175 which will mean a reduction in available 

staff to provide Medicare counseling and outreach. 

Other challenges currently facing the State of Tennessee include state budget reversions impacting home 

and community based services such as home delivered meals, personal care and homemaker services. In 

Tennessee, state revenue is dependent upon sales tax collection. The Governor has decided to pursue a 

third option regarding the expansion of Medicaid through the Affordable Care Act, known as the Tennessee 

Plan, and at this time, we are unsure whether or not the federal government will accept this plan, and therefore, 

uncertain of how the plan could impact programs and services. 

Federal funding requires matching funds from the state and securing a match may be difficult if aging and 

disability are not prioritized. In addition, 17 state agencies have some responsibility and funding for 

providing aging and disability services in addition to TCAD. According to the needs assessment, 

participants in the Listening Tour found it difficult to get help when needed quickly and without hassle 

and identified it as a priority. 

Another fiscal challenge identified by participants in the survey was not having enough insurance or 

money to pay for doctors or medicine. The U.S. Department of Labor reports that “fewer than half of 

Americans have calculated how much they need to save for retirement; in 2010, 30 percent of private 

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industry workers with access to a defined contribution such as a 401(K) plan did not participate; and the 

average American spends 20 years in retirement.”

Capacity of Programs and Services 

Waiting List: The current capacity of TCAD and state departments and agencies to provide programs and 

services is inadequate to address the immediate needs of the aging population resulting in waiting lists for 

all programs and services. Statewide, the Options Program currently has a waiting list of 9,000 

individuals seeking these services in order to remain in their home. Publicizing a toll free number and 

services and then being told there is a waiting list is frustrating for both the person seeking help and the 

provider trying to help. 

Support Services: The need for support services will continue to increase as the aging population 

increases. 

Transportation: Transportation continues to be a challenge, especially in rural areas. More 

affordable, accessible, and flexible transportation services are needed to meet the needs of the aging 

and disability population. Adults age 60 and over are outliving their ability to drive safely by an 

average of seven (7) to 10 years. 

Meals: A waiting list exists for home delivered meals. Cost effective alternatives must be 

implemented in order to serve more individuals as well as the need for additional funding. 

Housing: Affordable and accessible housing becomes a problem when the house is no longer able to 

accommodate a person who has become disabled or may have stairs the person can no longer 

navigate, the house may no longer be in a safe environment, and/or have access to services such as 

grocery stores if driving is no longer an option. 

Senior Centers: Senior Centers serve as local community focal points for information on aging 

services and aging activities in at least one location in each of Tennessee’s 95 counties offering group 

and individual services that promote healthy lifestyles, providing learning opportunities, and 

providing social interaction and volunteer opportunities. Although senior centers were an example of 

what is currently working well in the community, the senior centers are seeking funding to continue 

their services and programs. 

Caregiving: The need for caregiving and respite services are increasing and there is a concern about 

the shortage of caregivers as baby boomers age. Family and informal caregivers are providing care 

for many of Tennessee’s adults age 60 and over, adults with disabilities and grandchildren. This 

unpaid caregiving is saving the state considerable resources, but also impacts the emotional wellbeing, health, employment, income, and financial security of the caregiver. According to an article in 

the New York Daily News (March 18, 2012) written by Heidi Evans, one (1) in three (3) seniors over 

the age of 65 now die with Alzheimer’s. “Cost of care of Alzheimer’s patients was $200 billion last 

year and could reach $1.2 trillion by 2050, with costs to Medicare and Medicaid increasing more than 

500 percent.”

Baby Boomers 

The aging baby boomer population will strain the capacity of the state to provide aging and disability 

programs and services. Baby boomers will be living longer than previous generations, have greater need 

for services, and will impact the system for a longer period of time. The baby boomer generation is also 

referred to as the “sandwich” generation as they are caught between caring for elderly parents and raising 

their children and grandchildren. The baby boomers may not only impact the quantity of the programs 

and services, but the kinds of programs and services that are delivered and how those programs and 

services are delivered. 

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Learning New Things 

Those responding to the surveys identified “learning new things" as important. “Most retired baby 

boomers today go directly from full-time work to full-time retirement, according to a 2011 AARP 

survey... The worst thing retirees can do - especially those accustomed to decades of long, stressful days 

- is stop challenging their brains with new tasks and experiences. Dr. Anne Fabiny, chief of geriatrics at 

the Cambridge Health Alliance, said retirees should be changing paths, not speed.” (Staying engaged: 

Learning new things, staying engaged are keys to a sound body and mine by Nancy Reardon Stewart, The 

Boston Globe, May 20, 2012) Senior Centers are one source for “learning new things”; however, senior 

centers may have to provide more variety in services and programs to attract baby boomers. 

Adults with Disabilities 

As with the population of adults age 60 and over, adults with disabilities living independently in a 

neighborhood/community rather than in an institution will be a challenge. They will need safe housing in 

livable communities with accessible transportation. Self-determination must be the cornerstone of all 

programs and services for the aging and disabled populations. Wheelchair accessible vans must be 

available. Communities must have sidewalks so that adults with disabilities can move around 

independently - wheelchairs cannot navigate in gravel on the side of the road. Help is needed for persons 

with visual impairments such as the need for large format telephones. Home modifications such as higher 

commodes will allow adults with disabilities to live independently. Training volunteers to work with 

adults with disabilities is a necessity. Public buildings and stores must be accessible in order for adults 

with disabilities to be able to meet their needs for living independently. 

The results of the data also indicate that gaps exist in the system for adults with disabilities. Current state 

funding administered by TCAD is limited to older adults and adults over the age of 18 who have physical 

disabilities. Other state agencies provide services for adults with intellectual and developmental 

disabilities, behavioral health issues and employment issues. Little collaboration among the state 

agencies has existed in the past. However, strides are being made through efforts such as: 1) the Policy 

Academy sponsored by the Substance Abuse and Mental Health Services Administration and the 

Administration on Community Living; 2) the Transportation Committee sponsored by the State 

Legislature; 3) the “Yellow Dot” initiative sponsored by the Tennessee Department of Transportation; 4) 

the Council on Injury Prevention sponsored by the Health Department, 5) cross-training with the 

Tennessee Department of Intellectual and Developmental Disabilities, and 6) the Tennessee Vulnerable 

Adult Coalition sponsored by TCAD and the Department of Human Services—Adult Protective Services. 

Tracking In-Kind Funding and Volunteer Services 

Many of the programs and services provided for adults age 60 and over and adults with disabilities in 

Tennessee would not exist without the assistance of volunteers, such as transportation, food delivery, 

senior center activities, and caregiving. Another need is being able to use State and Federal funding to 

leverage additional funds to meet the needs of adults age 60 and over and adults with disabilities. 

Currently, there is no consistent statewide system to track the in-kind services or leveraged programs, 

such as transportation or food pantries provided by community organizations or churches. Unpaid 

caregiving is saving the state considerable resources. 

Additional Challenges identified by the data include staying healthy in mind and body; depression and 

mental health; elder abuse; and alcohol and drug abuse. 

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Chapter 5 

 Planning for the Future 

Goals, Objectives, Strategies, Performance Measures 

As the baby boomer generation ages, the increase in numbers of adults age 65 and over will require a 

State Plan that utilizes all available resources, including both people and money, in the most efficient and 

effective manner. A plan that will require solutions that: 

“think outside the box”, 

provide a greater diversity of services and programs to meet the needs of all populations, 

develop and implement approaches to address both immediate needs of current retirees and the needs 

of future retirees, 

create easier access to services and programs, and 

streamline the current programs and services 

However, this is only the starting point for TCAD. 

TCAD will continue to engage policy-makers in decision-making processes that elevate the needs of 

adults age 60 and over and adults with disabilities to the forefront while recognizing the strengths and 

contributions of this population. TCAD will also continue to seek state and federal funding aimed at 

addressing the need for home and community based services. Despite budget concerns and other issues, 

TCAD will strive to maintain quality services, programs, and staff. 

The goals, objectives, strategies, and performance measures have been developed for the Tennessee State 

Plan on Aging 2014-2018 utilizing the following: Statewide Listening Tour and the Needs Assessment 

conducted in February-March 2013; Stakeholders’ Meeting (January 25, 2013); Commission Meeting 

(February 5, 2013); TCAD’s 2011 Strategic Plan (developed by the Commission Members), the 

Governor’s Conference on Aging (September 1, 2011), The Lewin Group’s Aging and Disability 

Resource Center Fully Functioning Assessment June 2012, and the Public Hearing to be held May 7, 

2013. 

The following are the goals, objectives, strategies and performance measures for the Tennessee State 

Plan on Aging 2014-2018: (Please note that * denotes that the item comes from the Commission 

Strategic Plan; ** denotes that the item comes from the Governor’s Summit on Aging; and *** denotes 

The Lewin Group’s assessment of Tennessee’s ADRC under State Status areas: Area for Growth and 

Partially Meeting Criteria) 

Goal 1: Ensure that current SUA programs and services for adults over the age of 60 and 

adults with disabilities are cost effective and meet best practices 

Objective 1: Evaluate and modify, as needed, the internal structure of the State Unit on Aging (SUA) 

to ensure effective and efficient management and monitoring of programs and services 

and of state and federal funding 

Strategies 

1. Identify the competencies, knowledge, and skills needed for each SUA position in accordance with 

the current State Plan on Aging to align employee performance with agency mission using the 

Tennessee Department of Human Resources SMART (specific, measurable, achievable, relevant, and 

timely) tool 

2. Redesign and implement staffing patterns and job plans to match the new competencies, knowledge, 

Tennessee – State Plan on Aging 2014 - 2018 134
18 

and skills required for each position 

3. Review and revise the Program and Policy Manual to describe both programmatic and fiscal 

requirements for operation and to ensure a greater understanding of those requirements 

4. Review and revise, as needed, monitoring tools for each program to be used by the SUA and AAADs 

that corresponds to the Program and Policy Manual revisions and contract requirements 

5. Review and revise the contract scope of service for each program and service provided by the SUA 

based on the revised policies and procedures for that program 

6. Ensure that the data systems for tracking programs and services are in place and providing accurate 

data and the data can be used to identify trends or patterns in program service utilization in order to 

modify or make adjustments in planning/operation 

7. Rewrite, submit, and implement the quality assurance plan annually according to state guidelines 

(Policy 22 Monitoring Plan/Title VI Civil Rights Plan) as required by the State of Tennessee 

Objective 2: Evaluate and modify, as needed, the state and federally funded home and community 

based (HCBS) programs to maximize the number of people served with the funding 

Strategies 

1. Evaluate the number of persons served in each district compared to the funding provided through the 

intrastate funding formula using data currently provided by the SAMS database 

2. Evaluate the trends in frequency and amount of services needed and provided compared to Activities 

of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) of the consumers 

utilizing data currently provided by the SAMS database 

3. Evaluate the waiting list and determine if there are ways in which to redesign the HCBS delivery 

system to be able to serve more people 

4. Evaluate the HCBS to determine cost effectiveness of the current funding and determine how much 

additional funding would be needed to further reduce the waiting list 

5. Create a usable continuum of care that would incorporate three funding sources (Title III-B, Title IIIE, and State HCBS) to provide needed and appropriate services and programs to the individual based 

on the number of ADLs, IDLs, and family supports identified for each individual to ensure cost 

effectiveness and reduce the waiting list 

6. Increase the availability of self-directed care in all nine (9) AAAD regions based on the current 

policies and procedures to ensure that all consumers have choices for HCBS services 

7. Provide training on person-centered concepts and self-determination (Example: Boston University 

on-line training through the ADRC) 

8. Ensure that the individual receiving HCBS and family members, if available, are personally involved 

in the development of the Plan of Care so that the Plan of Care is person-centered and self-determined 

9. Review and revise, if needed, the contract scope of service based on the revised policies and 

procedures and the best practices for HCBS 

10. Work with the AAADs and the service provider network to identify training needs for in-home 

workers and develop guidelines for the training 

Objective 3: Evaluate and modify, as needed, the Family Caregiver Program to ensure that the 

program is managed in the most cost effective manner and maximizes the number of 

people served with the funding 

Strategies 

1. Evaluate the number of persons served in each district compared to the funding provided through the 

intrastate funding formula utilizing data currently provided by the SAMS database

2. Evaluate the Family Caregiver program delivery system and re-design the program to focus 

Tennessee – State Plan on Aging 2014 - 2018 135
19 

specifically on respite and redirect funding to respite to serve more caregivers and reduce the waiting 

list 

3. Partner with the AAADs and the Tennessee Respite Coalition (TRC) to ensure that the Family 

Caregiver program focuses on the needs of the caregivers by providing respite and by providing other 

support services on an as needed basis such as training, education, and supplies 

4. Determine the amount of additional funding that would be needed to further reduce the waiting list 

after identifying and implementing cost effective measures to the current funding 

5. Revise, if needed, the contract scope of service based on the revised policies and procedures for the 

Family Caregiver program 

Objective 4: Evaluate and modify, as needed, the Nutrition program to ensure that the program is 

managed in the most cost efficient manner to maximize the number of people served with 

the funding, to provide nutritious meals that are tasty and attractive according to customer 

satisfaction, and to provide supportive services to prevent, delay, or manage chronic 

health conditions 

Strategies 

1. *Determine the actual costs of current congregate and home-delivered meals in each district and 

evaluate the cost effectiveness 

2. Identify the most cost effective methods of reducing the costs of meals without jeopardizing nutrition 

and attractiveness 

3. Evaluate methods of providing nutritious meals that could reduce costs such as the use of statewide 

vendors; use of volunteers; unit cost reimbursement; cook chill; and/or vouchers and incorporate 

these cost saving measures, if feasible 

4. Provide nutrition counseling and education to individuals that have elevated risk factors for 

nutritional problems as determined by the Independent Living Assessment (ILA) 

5. Partner with faith-based organizations to enhance their food programs, such as meal programs, food 

pantries, gleaning, and commodities 

6. Provide education on the value of community gardens, the healthy benefits, the importance of eating 

fresh fruits and vegetables, and the resources available in the community to help 

7. Initiate changes that will reduce costs, enable more customers to be served, and reduce the waiting list 

through the development of appropriate policies, procedures, and contracts 

8. *Partner with all entities providing access to food and nutritious meals to evaluate the current state of 

the delivery system and design ways to improve the system 

9. *Develop an accessible and easy-to-understand curriculum based upon evidence-based information 

for statewide use by dietitians to provide a greater focus on nutrition education 

Objective 5: Identify and implement strategies to ensure that the Ombudsman program is more 

effective and efficient in advocating for all patients in all long-term care facilities 

Strategies 

1. Ensure that the data from the Ombudsmanager database is accurately recorded and in a timely manner 

2. Ensure that the database is used to evaluate and improve the program 

3. Ensure that all Ombudsman federal and state reports are submitted annually as required 

4. Evaluate how to distribute funding for the Ombudsman program more efficiently and effectively 

taking into consideration the location of the long-term care beds 

5. Increase monitoring and technical assistance for District Ombudsman programs to ensure that 

programs are meeting the goals and guidelines 

6. Develop a Volunteer Ombudsman Representative (VOR) manual and training materials 

Tennessee – State Plan on Aging 2014 - 2018 136
20 

7. Conduct volunteer on-line and face-to-face training in each district annually led by the State Longterm Care Ombudsman 

8. Continue to stay updated on the emerging Ombudsman issues such as the role of the Ombudsman 

program in the Managed Long Term Care Support Services 

9. Implement the peer program in each district (Pennsylvania’s Empowered Expert Residents) that 

provides training for a cadre of residents to serve as advocates 

10. Revise, if needed, the contract scope of service based on the revised policies and procedures for the 

Ombudsman program 

Objective 6: Increase awareness and access to information regarding the prevention of abuse, neglect, 

and exploitation 

Strategies 

1. Pursue greater collaboration among Legal Assistance Providers through training and quarterly 

meetings to identify issues and solutions 

2. Promote the use of the statewide www.onlinetnjustice.org , www.legalinfotn.org and hotline 888-

aLEGALz for attorney consultations and self-help 

3. Seek additional funding sources to strengthen the legal assistance program such as the “Model 

Approaches to Statewide Legal Assistance Systems” grant opportunity

4. Develop curricula on the prevention of financial exploitation to be delivered by SUA staff and legal 

assistance providers 

Objective 7: Support and enhance multi-disciplinary responses to abuse, neglect, and exploitation of 

adults over age 60 and adults with disabilities by involving Adult Protective Services 

(APS), Ombudsman, legal assistance, law enforcement, healthcare professionals, and 

financial institutions 

Strategies 

1. Identify the best practices for increasing public awareness about elder rights and addressing elder 

abuse prevention, such as the Year of Elder Abuse Prevention (YEAP) Toolkit provided by the AoA 

2. Partner with Tennessee Vulnerable Adult Coalition to implement initiatives that utilize the identified 

best practices and maintain the social networking site for the purpose of disseminating elder abuse 

prevention information 

3. Enhance the partnership with APS to build awareness of APS services and how citizens should 

contact APS for needed services 

Objective 8: Identify and implement strategies to ensure that the Guardianship program is more 

effective and efficient in serving clients who cannot make their own financial and 

healthcare decisions and have no one else to assist them 

Strategies 

1. Ensure that the client data in the SAMS database is accurately recorded and in a timely manner 

2. Ensure that the client data is used to evaluate and improve the program 

3. Review the current Guardianship funding formula and modify, as necessary, to ensure that the 

funding is distributed consistently and cost effectively 

4. Update and modify, as needed, the volunteer manual 

Tennessee – State Plan on Aging 2014 - 2018 137
21 

5. Conduct volunteer recruitment, training, and retention activities in each region to ensure that each 

client has friendly visitations and someone to quickly identify any issues or problems that need to be 

reported to the Guardian 

6. Review and implement best practices for the public guardianship program, for setting and collecting 

fees for services, and for developing statewide program standards in partnership with Conservatorship 

Association of Tennessee (CAT) in order to ensure a cost effective and efficient program 

7. Conduct training for guardians twice a year 

8. Advocate for alternatives to public guardianship such as mediation, advance directives, and training 

family guardians 

9. Review and revise, as needed, the policies and procedure governing the Guardianship Program 

Objective 9: Evaluate and modify, as needed, the Senior Center program and provide support to senior 

centers that are striving to meet the needs of the current population and to embrace the 

needs of the emerging baby boomer population 

Strategies

1. Identify best practices for Senior Centers and conduct training and technical assistance for senior 

center directors and staff 

2. Create incentives for Senior Centers that develop and implement programming geared for meeting the 

needs of the baby boomers, such as computers and competitive mini-grants 

3. Assist Senior Centers with fundraising activities to support best practice programming 

4. Assist Senior Centers with diversifying funding and developing programs and services that are selfsufficient and/or profitable 

5. Provide technical assistance and training to assist senior centers in becoming AIRS certified 

6. Provide technical assistance to the senior center board of directors and center directors to enable 

Level 3 and Level 4 senior centers to apply for and achieve accreditation 

Objective 10: Review emergency preparedness plans submitted by the AAADs and senior centers to 

ensure that plans meet best practices as determined by the Tennessee Emergency 

Management Agency (TEMA). 

Strategies 

1. Continue to provide staff as “Emergency Services Coordinator” to participate in TEMA training, 

certification, and plans 

2. Annually, review emergency preparedness plans of the AAADs and senior centers 

3. Provide regional training on emergency preparedness for agencies and individuals 

4. Monitor to ensure that the AAADs have completed the on-line FEMA emergency preparedness 

training 

Objective 11: Review and modify, as needed, all SUA’s fiscal policies and procedures to ensure that all 

budgeting, accounting, contracting and reporting follow state and federal guidelines and 

that all reports are accurate, submitted on-time, and in accordance with accepted 

procedures 

Strategies 

1. Provide technical assistance to the AAADs in regard to fiscal management, budgeting, and quarterly 

reporting 

2. Review AAAD expenditures quarterly and compare to number of consumers served as reported in 

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SAMS to determine if programs and services are on target with performance goals to meet contract 

requirements 

3. Determine the amount of additional funding needed to serve people on the waiting lists based on 

fiscal and programmatic data provided by the management and program staff of SUA 

4. Determine budgets for all SUA programs and grant applications with the assistance of management 

and program staff 

5. Conduct fiscal and programmatic monitoring of all contracts to determine contract compliance and 

ensure that all state and federal guidelines are met 

Outcomes and Performance Measures for Goal 1 

1. By, 2014, align employee performance with agency mission by using the SMART Formula Planning 

Tool to determine competencies, knowledge, and skills for each SUA positions as evidenced by TN 

Department of Human Resources approval of Performance Plans and all new Job Classifications 

2. By 2015, implement uniform customer satisfaction survey statewide for each funded program as 

evidenced by Program Instruction issued to AAADs for each funded program 

3. By 2015, complete evaluation and modification of all SUA programs as evidenced by the issuance of 

a Program Instruction to the AAADs of the Revised Program and Policy Manual 

4. Ensure that current funding is serving the appropriate number of consumers as evidenced by FY15 

AAAD contract scope of service outlining performance measures based unit cost 

5. By 2018, increase by five (5) percent the number of people served from the waiting list as evidenced 

by comparing the number of people served from the waiting list in FY13 

6. By 2018, ensure that there is a five (5) percent increase in the specified number of individuals that 

will be served home-delivered and/or congregate meals by each AAAD as based on a identified cost 

per unit in the Contract Scope of Service and as evidenced by data recorded in SAMS 

7. Annually, increase by five (5) the number of Ombudsman volunteers in four (4) targeted rural areas 

as evidenced by the OmbudsManager data 

8. By 2018, three (3) communities per region will implement community gardens 

9. By 2018, 50 percent of senior centers will have a minimum of two (2) AIRS certified staff 

10. By 2018, increase by 10 percent the number of respite hours provided in each region as by comparing 

the FFY14 to FFY18 data reported in the State Program Report 

11. By 2018, five (5) senior centers will achieve accreditation 

12. By 2018, increase by 10 percent the number of consumers in each region who choose to participate in 

nutritional counseling as compared to FFY14 to FFY18 State Program Report 

Goal 2: *Diversify funding and partnerships to sustain effective services and programs to 

meet current needs and to expand and/or implement additional services and 

programs to meet the emerging needs of the baby boomer population 

Objective 1: Continue to identify and pursue sources of funding, including grant and foundation 

opportunities 

Strategies 

1. Research new and/or alternative sources of funding and non-traditional funding 

2. Determine the feasibility of developing grant and foundation applications with potential grant 

partners such as Alzheimer’s Tennessee, Senior Centers, Mental Health America, and Area Agencies 

on Aging and Disability 

3. *Seek grant applications for evidence-based, proven practices to serve adults over 60 and adults with 

disabilities 

4. *Partner with corporations, universities, and foundations as potential funding sources 

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5. Continue to partner with State departments such as, but not limited to, the Department of Health and 

the Department of Mental Health and Substance Abuse Services to seek joint federal and state 

funding to serve adults over 60 and adults with disabilities 

6. **Utilize public, private, and non-profit resources to leverage funding to provide needed evidencebased, proven services and programs for adults over 60 and adults with disabilities 

7. Track funding for programs and services that have been leveraged by State and Federal funds 

 

Objective 2: Maintain and grow relationships with partners and stakeholders including key state 

agencies, statewide organizations, universities, and private and non-profit entities with 

statewide influence 

Strategies 

1. Create a forum to review resources, determine where costs can be saved and funding can be 

redirected to unmet needs, and identify where there is duplication of services or potential for 

duplication 

2. Partner with universities to develop innovative programming regarding healthy aging issues and 

training of aging network staff 

3. Partner with Council on Aging, Alzheimer's Tennessee, Mental Health America, Alzheimer's 

Association and other non-profits that serve as subject matter experts 

4. Promote advocacy for adults over 60 and adults with disabilities by providing information and 

education to legislators, policy-makers, and community organizations 

5. *Partner with corporations, universities, and foundations to strengthen the ability to reach baby 

boomers through information and education about services and healthy aging; to utilize subject matter 

expertise; to increase volunteerism; and to raise awareness about how these partners will be impacted 

by the aging population 

 

Objective 3: *Build infrastructure and capacity both at the state level and at the area agency level to 

include marketing; grant writing and grants management expertise; and other payment 

options and capabilities such as private pay and cost-share 

Strategies 

1. Develop and implement marketing strategies that are best practices geared to reach the baby boomer 

population 

2. Redirect staffing at the state and area agency levels to include competencies in facilitation, grant 

writing, and grants management 

3. *Revise policies and procedures to include private pay and cost-share payment options to underwrite 

the cost of services and programs 

4. Provide staff training and technical assistance on the development of payment options such as private 

pay and cost-share 

Outcomes and Performance Measures for Goal 2 

1. By 2016, add five (5) new partners assisting in obtaining funding for programs and services for adults 

60 and over and adults with disabilities 

2. Annually, add 4 new applications annually for funding (federal, state, foundation, etc.) 

3. By 2018, all regions will have private pay option as evidenced by the implementation of private pay 

option in three (3) districts per year 

4. Annually, increase by one (1) percent statewide the number of consumers who contribute through 

cost share as evidenced by the SAMS database 

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Goal 3: Build the capacity of programs and services to serve more adults 60 and over and 

adults with disabilities by identifying strategies that can be cost-effective, 

implemented incrementally, and integrated into the current programs and services 

Objective 1: Partner with Alzheimer's Tennessee, Alzheimer's Associations, Mental Health America, 

Area Agencies, the Aging Network, and other aging service providers to coordinate 

planning, public awareness, and program development efforts to address the increase in 

Alzheimer’s Disease and Related Dementia (ADRD) with the increase in the number of 

aging baby boomers 

Strategies 

1. Review the 10-year Alzheimer's State Plan submitted to the Governor in 2009; identify the 

components that have been implemented; and identify goals and objectives that can be addressed in 

the next four (4) years 

2. Seek funding to implement the goals, objectives, and recommendations of the updated Alzheimer’s 

State Plan 

3. *Support families of individuals with ADRD by sustaining current services and developing additional 

services 

4. *Provide and grow dementia capable training and professional development opportunities for 

healthcare professionals, first responders, and physicians about ADRD 

5. Provide a “no wrong door” access to ADRD services by coordination and cross-training with the 

ADRC/AAADs, Alzheimer's Association, Alzheimer's Tennessee, Mental Health America, and 

Tennessee Respite Coalition 

6. Increase respite care for families of individuals with Alzheimer's Disease using current funding and 

new funding 

7. Re-direct SUA staffing to include responsibilities for liaison and coordination with ADRD partners 

Objective 2: Implement evidence-based programming that promotes healthy aging and disease 

prevention 

Strategies 

1. Ensure that current federal Administration for Community Living (ACL) funding for health 

promotion and disease prevention targets evidence-based programs such as, but not limited to, 

Chronic Disease Self-Management, Arthritis Self-Management, Silver Sneakers, Tai Chi, and Matter 

of Balance (fall prevention) 

2. Partner with the Department of Health to ensure that all seniors have access to the Chronic Disease 

Self-Management Program 

3. Work with the Department of Mental Health and Substance Abuse Services to implement evidencebased prevention and intervention programs to address depression and use of alcohol and drugs in the 

aging population 

4. *Pursue funding (federal, foundation, public and private sectors) to implement evidence-based 

practices for healthy aging and disease prevention 

5. *Designate, when possible, traditional state and federal funding toward effective evidence-based 

practices that address, but not limited to, health promotion and disease prevention, medication 

management, volunteer coordination, and senior center programs 

Tennessee – State Plan on Aging 2014 - 2018 141
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Objective 3: Enhance transportation services that are easier to access for adults age 60 and over and 

adults with disabilities 

Strategies 

1. Review and map current transportation services available to adults 60 and over and adults with 

disabilities 

2. Identify best practice models in other states and move to implement best practices statewide 

including, but not limited to, the Independent Transportation Network (ITN) 

3. Identify the current and emerging needs for transportation using data available from the State 

Listening Tours, Area Agencies, ITN, and other sources 

4. *Convene partners and transportation leaders to explore issues and opportunities to develop 

innovative partnerships for the purpose of planning that are user friendly, affordable, and accessible 

5. Identify gaps in current transportation services and develop a plan to address mobility needs of adults 

60 and over and adults with disabilities including door-to-door and door-through-door (assisted 

transportation or escort) accessibility 

6. Seek grant opportunities and transportation funding 

7. Provide planning and grant development technical assistance to urban and rural communities that are 

pursuing grant opportunities for transportation funding and interface with the National Center for 

Senior Transportation 

8. Advocate for “livable communities” and “aging in place” initiatives

9. Advocate for increased capacity to serve adults 60 and over that helps them stay independent and stay 

connected such as, but not limited to, accessible transportation to senior centers, nutrition sites, 

grocery stores, pharmacy, hairdresser, and shopping 

10. Partner with companies that have an interest in reaching aging customers to develop transportation 

services to their stores 

11. *Actively participate in the legislative appointed Transportation Coordination Committee (Public 

Law #198), to which SUA was appointed by the Governor 

Objective 4: Identify and maintain professional volunteer program coordinators at the SUA and each 

of the nine (9) AAADs to implement a volunteer program targeting baby boomers to 

meet the growing needs of the aging population 

Strategies 

1. Review and revise, as needed, volunteer program recruitment, training, and retention plans for each of 

the following programs: Ombudsman, Guardianship, Legal Assistance, State Health Insurance 

Assistance Program (SHIP), Nutrition, and Transportation 

2. Develop policy and procedures for the professional volunteer program coordinator including job 

description and qualifications 

3. *Designate existing federal funding for the purpose of developing a volunteer infrastructure with a 

volunteer program coordinator in each of the AAADs and at the SUA 

4. Reach out to the faith-based organizations to encourage program development and community 

activity and volunteerism regarding services to adults over the age of 60 and adults with disabilities 

5. Develop a toolkit for the recruitment, training, and retention of volunteers geared toward faith-based 

organizations for the purpose of facilitating easier access to information and education and 

participating in community service projects 

6. Provide cross training on specific volunteer roles for each program such as, but not limited to, 

caregiver, guardianship, elder rights, etc. that utilize volunteers and encourage volunteers to move 

from one program to another 

7. Grow volunteers to become program leaders so that a program might become self-sustaining 

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8. Identify organizations (government and non-government) that serve the aging and disability 

populations and form collaborations/partnerships to address specific issues impacting this population, 

such as, but not limited to, affordable and accessible dental care, eye examinations and glasses, and 

hearing tests and hearing aids/devices 

Objective 5: Develop and implement a Healthy Aging Plan for Tennessee “Baby Boomers”

Strategies 

1. Organize a task force with prospective partners such as, but not limited to, universities, state agencies, 

healthcare providers and professionals in the healthcare field, such as physicians and nurses, to 

discuss strategies for healthy aging for baby boomers 

2. Provide recommendations for a Healthy Aging Plan for Tennesseans 

3. Develop a Healthy Aging Plan for Tennesseans based on the recommendations 

Objective 6: Promote healthy aging through the Healthy Aging Guide for Tennesseans

Strategies 

1. Design and publish a Healthy Aging Guide that includes easy to read and understand strategies that 

can be implemented to assist people to stay active in mind and body 

2. Develop and implement a plan for distribution of the Guide specifically targeting baby boomers 

3. Implement information and education programs that encourage healthy lifestyle behaviors 

4. Identify and emphasize the opportunities for exercise currently available such as Silver Sneakers, 

dance classes, and Tai Chi. 

5. Provide information and education on programs and services to enhance economic security 

6. Identify and educate about the opportunities for community involvement and the importance of 

socialization for staying healthy 

7. Include activities that require new or different ways of thinking to encourage an active mind 

8. Educate about the importance of a healthy diet and provide some examples of meals that are tasty and 

inexpensive to prepare 

9. Provide information and education on fiscal planning for retirement and adequate health insurance 

10. Provide a list of contacts for information should the contacts be needed at some future date 

Outcomes and Performance Measures for Goal 3 

1. By 2019, increase by 20 percent statewide the number of volunteers providing programs and services 

to adults 60 and over and adults with disabilities 

2. By 2016, publish and distribute statewide the Healthy Aging Guide for Tennesseans

3. By 2018, add one (1) new transportation initiative in each district 

4. By 2018, implement one (1) recommendation each year from the 10-year Alzheimer’s State Plan 

Goal 4: Ensure that the Area Agencies on Aging and Disability serving as the Aging and 

Disability Resource Centers in Tennessee provide easily accessible, user-friendly 

access to programs, services, and resources regardless of payment type so that 

individuals can get help quickly and without hassle 

Objective 1: Ensure that the ADRC/AAAD meets the fully-functioning criteria and standards set by 

the Administration on Community Living 

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Strategies

1. Gather and verify that the data for all functions of the ADRC are entered correctly into the State 

Reporting Tool (SRT) and reports all of the data available 

2. Ensure that the current tracking and case management system meets the needs of the ADRC for data 

collection 

3. ***Continue to actively market the ADRC to all Tennesseans needing assistance regardless of 

method of payment for services (marked as Area for Growth in the June 2012 assessment of 

Tennessee ADRCs) 

4. Review the data to make certain that all adults 60 and over and adults with disabilities are being 

served and being referred to the appropriate programs and/or services 

5. Review the consumer satisfaction surveys to determine what issues, if any, are impacting the 

functions of the ADRC 

6. Ensure that the ADRC meets the policies, procedures, and standards for the delivery of a 

comprehensive, fully functioning ADRC 

7. Identify and implement ways for reducing the waiting lists for services and programs that are 

provided through the ADRCs and the AAADs 

8. Ensure that the ADRCs have access to telephone technology to make “soft” transfers

9. Provide aging and disability training issues for all staff, including the AAAD, SUA, Department of 

Intellectual and Developmental Disabilities, and Department of Mental Health and Substance Abuse 

Services 

10. ***Implement strategies to address the Lewin Group’s Tennessee ADRC Fully Functioning 

Assessment June 2012 criteria that the assessment indicates the criteria are Partially Meeting Criteria 

and/or Area for Growth 

Objective 2: Market the ADRC as the single point of entry/first stop for Information and Referral/ 

Assistance on aging and disability issues 

Strategies 

1. Ensure that all ADRC personnel who provide Information and Referral/Assistance have Alliance for 

Information and Referral Systems (AIRS) certification 

2. Ensure that the ADRC implements standardized processes for referrals and promotes consistency in 

how services are delivered and received for the Information and Referral/Assistance service 

3. ***Conduct follow-up on ADRC contacts receiving the Information & Referral and Assistance 

services to collect identifying information on the appropriateness of the referrals; the information met 

the individual’s need; the individual was able to make the necessary connections and if not, why not; 

and determine if further assistance is needed 

4. Provide education, information, and cross-training statewide about the “no wrong door” access to 

programs and services for adults 60 and over and adults with disabilities available through the Aging 

and Disability Resource Center (ADRC) 

5. ***Cross train staff so that all agencies can be of service to adults 60 and over and adults with 

disabilities regardless of the service for which the individual is applying 

6. Update resource database regularly to ensure accuracy of listings 

7. Ensure that inquiry calls are answered within 48 hours 

Objective 3: Provide objective one-on-one counseling, information, distribution, and assistance to 

people with Medicare, potential Medicare consumers, their families, and other advocates 

through the State Health Insurance Assistance Program (SHIP) and provide public 

education 

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Strategies

 

1. Maintain a cadre of trained SHIP counselors and volunteers in each district 

2. Disseminate information about Medicare and related insurance benefits that help to maintain healthy 

aging 

3. Design and implement community outreach to individuals eligible for Medicare Part D Low-Income 

Subsidy, Medicare Savings Programs, and other benefits 

4. Assist beneficiaries with finding affordable prescription drugs and working to assist Duals with 

mental illness and/or disability with prescription drug availability on an annual basis and access to 

drugs not covered under Medicare Part D 

5. Ensure that all SHIP staff and volunteers receive annual training to update the information needed to 

provide accurate and effective counseling services 

Objective 4: Ensure that the ADRC Options Counseling program meets the national standards based 

on the AoA national draft of Options Counseling standards 

Strategies 

1. Ensure a “no wrong door” approach to implementing the ADRC Options Counseling Program 

2. Develop policy and procedures that incorporate the national standards 

3. ***Incorporate cross-training, particularly focused on working with special populations and cultural 

competencies, to ensure consistency and quality in services delivery by the ADRC 

4. ***Ensure that all ADRCs use common Options Counseling tools to provide consistency, promote 

team approaches to delivery of Options Counseling, facilitate data sharing, and improve the quality 

and measurement of quality of services 

5. ***Ensure that all ADRC personnel meet expectations for staff education, training, and experience 

for a base level of knowledge for all Options Counselors 

6. ***Continue to conduct follow-up contacts with individuals receiving Options Counseling to 

determine if the individual was able to follow through on the steps outlined in the action plan, what 

decisions he/she made, identify barriers experienced when implementing the action plan, and 

determine if further assistance is required and if the Options Counseling was helpful 

7. ***Collaborate with the State’s Medicaid office to implement an effective data sharing system that 

will serve to meet federal requirements for a fully functional ADRC with streamlined access to 

services 

8. Determine the status and the success of the implementation of the online training program developed 

around the Options Counseling Standards 

9. ***Ensure that consumers, partners, and stakeholders are actively involved in the ADRC through, but 

not limited to, advisory boards, formal and informal partnerships, and consumer surveys 

10. Partnership with other State Departments and Agencies serving the aging and disability population to 

ensure a collaborative approach to ADRC sustainability 

Objective 5: Collaborate with local hospitals and other healthcare organizations to implement the care 

transitions concept focused on reducing hospital readmissions 

Strategies 

1. Review the current Care Transitions programs currently in operation to determine their effectiveness 

and identify lessons learned 

2. Support a collaborative partnership among the ADRC/AAADs, hospital and healthcare facilities, 

community partners, and Qsource to implement the Care Transitions program in each region 

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29 

3. Ensure that an evaluation component is included in the implementation of Care Transition program 

Objective 6: Partner with Memphis VA Medical Center; Mountain Home VAMC in Johnson City; 

Tennessee Valley Healthcare System in Nashville and Murfreesboro; ADRC/AAADs, 

and Public Partnership, LLC (PPL) to implement the Tennessee Veterans’ Directed 

Home and Community Based Services 

Strategies 

1. Implement a contract with each VAMC partner to provide the VD-HCBS 

2. Review and revise, as needed, The Tennessee Veterans Directed Home and Community Based 

Services Program Guidelines and the Tennessee Veteran Directed Home and Community Based 

Services Consumer Handbook to make certain that the documents meet the needs of each VAMC 

3. Review protocol for linking veterans with needed long term support services and making mutual 

referrals from each VAMC to the ADRC/AAAD 

4. Ensure that staff at the ADRC/AAADs will serve as the Support Brokers and that PPL will serve as 

the fiscal intermediary 

5. Ensure that veterans will be able to make their own decisions about who will provide their in-home 

services if they choose 

Outcomes and Performance Measures for Goal 4 

1. By 2016, implement VD-HCBS in the three (3) VAMCs 

2. By 2018, implement the care transition concept in three (3) ADRC/AAADs 

3. By 2018, implement the National Standards for the Options Counseling Program in all nine (9) 

districts 

Goal 5: Collaborate with state agencies to develop a seamless system of accessible services 

and programs for adults 60 and over and adults with disabilities 

Objective 1: *Map the current service system and the state agencies providing aging services 

Strategies 

1. Identify the state agency and programs and services that are currently being provided to the target 

population 

2. Identify gaps in and/or barriers to the needed programs and/or services 

3. Evaluate the success and cost effectiveness of current services 

4. Identify the emerging programs and services that will be needed to meet the needs of baby boomers 

Objective 2: Establish a seamless system of accessing and delivering services and programs that 

reduces and prevents fragmentation and curtails duplication of cost and services 

Strategies 

1. Enhance cooperation, coordination, and communication among state agencies that provide aging 

services to address the concerns of the aging and disabled population and identify possible strategies 

to address those concerns 

2. Develop a system to share data on programs and services to avoid duplication 

3. *Establish standards of services that reflect care with compassion 

4. *Establish a collaborative network and structure to create ease of accessibility to services, including, 

Tennessee – State Plan on Aging 2014 - 2018 146
30 

but not limited to, State Agencies and Governmental entities with common aging and disability 

issues, the Aging Network, and other partners 

5. *Develop an infrastructure to include a broader pool of services providers and organizations in the 

greater aging network 

6. Integrate and coordinate services and funding sources to ensure timely and appropriate services as 

needed 

7. Provide a comprehensive continuum of services and programs that include medical, behavioral, and 

social services 

8. Provide information and education on the “no wrong door” and “first stop” approaches to programs 

and services and the function of the Aging and Disability Resource Center 

9. Meet with state agencies 

Outcomes and Performance Measures for Goal 5 

1. By 2015, complete the mapping of services and programs as evidenced by the publication of the 

services map on the TCAD website and updated annually 

2. Annually, TCAD will document meetings with a minimum of nine (9) state agencies to ensure better 

coordination of programs and services for the aging and disability population 

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Attachment B 

Information Requirements 

Section 305(a)(2)(E) 

The mechanisms for assuring that preference will be given to providing services to older 

individuals with the greatest economic need and older individuals with greatest social need (with 

particular attention to low-income older individuals, including low-income minority older 

individuals, older individuals with limited English proficiency, and older individuals residing in 

rural areas) include: 

1. The Intrastate Funding Formula is weighted to address the population age 60 and over; 

low-income elderly; low income minority elderly; elderly living in rural areas, and the 

population age 80 and above. 

2. The State Unit on Aging is in compliance with Title VI (Civil Rights) and submits a Title 

VI Implementation Plan to the Tennessee Commission on Human Rights annually for 

approval. The plan includes how outreach and services are provided and monitored in 

each district annually. 

3. The Area Plans include a section on “Targeting” low-income, rural and minority 

populations. 

4. Monitoring activities include the evaluation of persons served who are low-income, rural, 

and/or minority. 

Section 306(a)(17) 

The mechanisms for assuring that each Area Plan will include information detailing how the 

Area Agency will coordinate activities and develop long-range emergency preparedness plans 

with local and State emergency response agencies, relief organizations, local and State 

governments and other institutions that have responsibility for disaster relief service delivery 

include: 

1. The Tennessee Emergency Management Agency (TEMA) requires that all state agencies 

have a Department Operational Guide (DOG) and a Continuity of Operation Plan 

(COOP). TEMA requires that each state agency designate an Emergency Services 

Coordinator (ESC) who serves as the staff who has the authority to coordinate emergency 

services under the auspices of the agency. TEMA also requires that the ESC has 

completed the TEMA certification training. 

2. The SUA has a certified ESC and an alternate. 

3. The SUA has a DOG and a COOP (emergency preparedness plans). 

4. All Area Plans contain a section on Emergency Preparedness. 

5. Each AAADs and senior center is required to have an Emergency Preparedness Plan that 

is reviewed by the State ESC. 

Tennessee – State Plan on Aging 2014 - 2018 160
Section 307(a)(2) 

1. The SUA develops the budget categories for the budgets contained in each Area Agency 

Plan. The budget categories include: 

a. Planning and Administration 

b. III-B Supportive Services (including information and assistance, senior centers, 

legal services, ombudsman, transportation, in-home services; adult day care) 

c. IIIC-1 Congregate Meals 

d. IIIC-2 Home Delivered Meals 

e. IIID- Preventive Health 

f. IIIE-Family Caregiver 

g. VII-Ombudsman; Elder Abuse 

h. Options HCBS (state funds) 

i. Other 

2. Area Plan budgets are approved by the Fiscal Director as part of the annual Area Plan 

approval process. 

Section 307(a)(3) 

In regard to services for older individuals residing in rural areas, 15% of the Intrastate Funding 

Formula is weighted for rural elderly. 15% of the total funds projected for FY2014 and the next 3 

years that is targeted for the rural elderly would be $3,187,590 (OAA total $21,250,600). 

Section 307(a)(10) 

The Intrastate Funding Formula is weighted and takes the needs of older individuals living in 

rural areas into consideration. The weights are as follows: population over age 60 is 35%; low 

income elderly is 30%; low income minority elderly is 10%; elderly living in rural areas is 15%; 

and population age 80 and over is 10%. According to the Social Assessment Management 

Software (SAMS) database records, 96,043 individuals received AoA registered services, nonregistered services, and family caregiver services in FY2012 . Of those individuals served 

46,220 resided in rural areas (48%). 

Section 307(a)(14) 

The number of low-income minority older individuals in Tennessee is 20,132 and 2.1 % of all 

people living in Tennessee do not speak English. As described above in Section 305(a)(2)(E), 

the Title VI Implementation Plan describes outreach to low-income minority older individuals 

and individuals with limited English proficiency. The State has a contract with Avaza Language 

Services Corporation for translation services. The translation service is available at all AAADs. 

Posters are displayed prominently at the SUA and AAADs that list the 23 languages that can be 

translated by the service along with directions on how staff can access the services. 

Tennessee – State Plan on Aging 2014 - 2018 161
Section 307(a)(21) 

There is no identified Native American tribe or reservation in Tennessee. According to the 

Native American Indian Association of Tennessee, there are 10,000 Native American residents 

in Tennessee. The Association states that “there has been no state or federal recognition of the 

Indian population and no services directed to them.”

Section 307(a)(29) 

As described above in Section 306(a)(17), the SUA has an emergency preparedness plan called 

the Departmental Operational Guide and a Continuity of Operation Plan as required by the 

Tennessee Emergency Management Agency.

Section 307(a)(30) 

As described above in Section 306(a)(17), the SUA follows the lead of the Tennessee 

Emergency Management Agency (TEMA) which requires all State Departments to have a 

Departmental Operational Guide and a Continuity of Operation Plan. The State Department of 

Health is required to have the plans and the coordinating entity is TEMA.

Section 705(a)(7) 

As described in Attachment F, a statewide needs assessment was conducted in 2013 that 

incorporated listening tours in all nine regions of the State. Participants included citizens, the 

aging network, and stakeholders. The information was analyzed and the top ten needs were 

identified. The goals and objectives of the State Plan target the needs identified. A public 

hearing was held on the State Plan in which the identified needs and goals and objectives were 

discussed. Area Agencies are required to hold public hearings prior to the submission of the 4-

year area plan and in each year if there are significant changes. 

The Area Plan format includes goals and objectives for the Elder Rights program, Ombudsman, 

and Legal Assistance. 

The SUA developed and routinely up-dates its Program and Policy Manual in which all 

programs administered by the SUA are outlined and policies issued, including fiscal policies and 

procedures. From time to time, as policies need to be revised, workgroups are comprised of 

SUA staff and Area Agency staff to make recommendations. Program Instructions are issued to 

the Area Agencies and contractors when changes take place. 

Tennessee – State Plan on Aging 2014 - 2018 162
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AREA PLAN on AGING and DISABILITY

For Progress toward a Comprehensive, Coordinated Service System 

for Older Persons and Adults with Disabilities

Designated Area Agency on Aging and Disability 

for the 

Planning and Service Area 

in TENNESSEE for 

July 1, 2010 – June 30, 2014 

Tennessee – State Plan on Aging 2014 - 2018 209
TABLE of CONTENTS

Older Americans Act 

Section 306 AREA PLANS

Each area agency on aging designated under section 305(a)(2)(A) shall, in order to be approved 

by the State agency, prepare and develop an area plan for a planning and service area for a two-, 

three-, or four-year period determined by the State agency, with such annual adjustments as may 

be necessary. Each such plan shall be based upon a uniform format for area plans within the State 

prepared in accordance with section 307(a)(1). 

Section 307 STATE PLANS 

(a) Except as provided in the succeeding sentence and section 309(a), each State, in order to be 

eligible for grants from its allotment under this title for any fiscal year, shall submit to the 

Assistant Secretary a State plan.... 

(a)(1) The plan shall—

(A) require each area agency on aging designated under section 305(a)(2)(A) to develop and 

submit to the State agency for approval, in accordance with a uniform format developed by the 

State agency, an area plan meeting the requirements of section 306; and (B) be based on such area 

plans. 

Link to OAA: http://www.aoa.gov/AoAroot/AoA_Programs/OAA/oaa_full.asp 

Submittal Page 

Part A: Area Profile 

Part B: Area Service Plan 

Part C: Status Report and Goals, Objectives & Strategies 

Part D: Staffing and Organization 

Part E: Documentation 

Part F: Area Plan Public Hearings and Waivers 

Part G: Financial Plan 

Tennessee – State Plan on Aging 2014 - 2018 210
SUBMITTAL PAGE 

( ) 4-Year Plan for July 1, 2010 – June 30, 2014 

( ) Plan Update for _____________ 

( ) Amendment (Date): _____________

This Area Plan for Programs on Aging and Disability is hereby submitted for the 

__________________________________ planning and service area. The 

_____________________________________ Area Agency on Aging and Disability 

assumes full responsibility for implementation of this plan in accordance with all 

requirements of the Older Americans Act and Regulations; laws and rules of the State of 

Tennessee; and policies and procedures of the Tennessee Commission on Aging and 

Disability. 

This plan includes all information, goals and objectives, and assurances required under 

the Tennessee Area Plan on Aging format, and it is, to my best knowledge, complete and 

correct. 

 Signature: _______________________________ Date: _________ 

 Area Agency Director 

The Area Agency Advisory Council has participated in the development and final review 

of the Area Plan. Comments of the Advisory Council are included in Part F of the Plan. 

Signature: _______________________________ Date: _________ 

 Chair, Area Agency Advisory Council 

The Board of Directors of the sponsoring agency has reviewed this plan and Submittal 

Page. It is understood that we are approving all sections of the Plan A-G. We are 

satisfied that the plan is complete, correct, and appropriately developed for our planning 

and service area. 

 Signature: ______________________________ Date: _________ 

 Director, Grantee Agency 

 Signature: ______________________________ Date: _________ 

 Chair, Grantee Agency Board 

Tennessee – State Plan on Aging 2014 - 2018 211
Part A: AREA PROFILE 

Older Americans Act

Section 305(a) ORGANIZATION

(1) the State shall, in accordance with regulations of the Assistant Secretary, designate a State 

agency as the sole State agency to—

(E) divide the State into distinct planning and service areas...in accordance with guidelines issued 

by the Assistant Secretary, after considering the geographical distribution of older individuals in 

the State, the incidence of the need for supportive services, nutrition services, multipurpose senior 

centers, and legal assistance, the distribution of older individuals who have greatest economic 

need...residing in such areas, the distribution of older individuals who have greatest social 

need...residing in such areas, the distribution of older individuals who are Indians residing in 

such areas, the distribution of resources available to provide such services or centers, the 

boundaries of existing areas within the State which were drawn for the planning or administration 

of supportive services programs, the location of units of general purpose local government within 

the State, and any other relevant factors.... 

Section 306(a) AREA PLAN

(3)(A) designate, where feasible, a focal point for comprehensive service delivery in each 

community, giving special consideration to designating multipurpose senior centers (including 

multipurpose senior centers operated by organizations referred to in paragraph (6)(C)) as such 

focal point....

Exhibit Number Title of Exhibit 

 

 A-1 Designated Planning and Service Area 

 A-2 Area Profile 

A-3 2000 Census Data 

A-4 Focal Points 

A-5 Methods Used to Determine Service Needs 

A-6 Summary of Service Needs 

Tennessee – State Plan on Aging 2014 - 2018 212
 Exhibit A-1 

PSA: ( ) Original, Dated: 

Plan Period: ( ) Update, Dated: 

Designated Planning and Service Area 

Area Agency: 

Physical Address: 

Mailing Address (if different): 

All Phone #s and Fax #: 

E-mail Address: 

Website: 

Director: 

In Operation Since: 

Mission: 

Tennessee – State Plan on Aging 2014 - 2018 213
 Exhibit A-2 

PSA: ( ) Original, Dated: 

Plan Period: ( ) Update, Dated: 

Area Profile 

1. Identification of counties within the planning and service area. 

2. Identification of counties designated as rural in the planning and service area. 

3. Identification of counties/communities designated as urban in the planning and 

statistical area. 

4. Describe significant differences among counties/communities in the planning and 

service area. 

Tennessee – State Plan on Aging 2014 - 2018 214
Delete this blank page and insert PSA Census Data. Change exhibit # to Exhibit A-3. 

 

Tennessee – State Plan on Aging 2014 - 2018 215
Exhibit A-4 

PSA: ( ) Original, Dated: 

Plan Period: ( ) Update, Dated: 

Focal Points

1. For the purpose of assuring access to information and services for older persons, the 

area agency shall work with elected community officials in the planning and service 

area to designate one or more focal points on aging in each community, as 

appropriate. Define “community” for the purposes of focal point designation. 

2. List community focal points within the Planning and Service Area. 

Tennessee – State Plan on Aging 2014 - 2018 216
 Exhibit A-5 

PSA: ( ) Original, Dated: 

Plan Period: ( ) Update, Dated: 

Methods Used to Determine Service Needs

1. Describe below how the Area Agency assessed the needs of older persons and adults 

with disabilities residing in the planning and service area. 

2. Which home and community based services have all slots filled and how many 

individuals are on wait lists as of October 1, 2009? 

Tennessee – State Plan on Aging 2014 - 2018 217
Exhibit A-6 

PSA: ( ) Original, Dated: 

Plan Period: ( ) Update, Dated: 

Service Needs

1. Based on the information reported in Exhibit A-5, Methods Used to Determine 

Service Needs, list the prevalent service needs of older persons and adults with 

disabilities in the planning and service area. 

2. Based on the list of needs identified in question #1, briefly describe how the Area 

Agency will address the top 5 identified needs? This is an overview, details are more 

specific in Part C of this plan in the Goals, Objectives and Strategies section. 

3. List the top 5 needs for the Grand Division that includes the planning and service 

area identified in the 2009 Statewide Needs Assessment. 

4. Based on the list of needs in question #3, briefly describe how the Area Agency will 

address the top 5 needs identified. Do not repeat if the service was already addressed 

in question #2. This is an overview, details are more specific in Part C of this plan in 

the Goals, Objectives and Strategies section. 

Tennessee – State Plan on Aging 2014 - 2018 218
Part B: AREA SERVICE PLAN 

Older Americans Act 

Section 306 AREA PLANS

(a) Each area agency on aging designated under section 305(a)(2)(A) shall, in order to be 

approved by the State agency, prepare and develop an area plan for a planning and service area.... 

Each such plan shall—

(a)(1) provide, through a comprehensive and coordinated system, for supportive services, 

nutrition services, and, where appropriate, for the establishment, maintenance, or construction of 

multipurpose senior centers, within the planning and service area covered by the plan, 

(a)(7) provide that the area agency on aging shall, consistent with this section, facilitate the areawide development and implementation of a comprehensive, coordinated system for providing 

long-term care in home and community-based settings, in a manner responsive to the needs and 

preferences of older individuals and their family caregivers 

Exhibit Number Title of Exhibit 

 

 B-1 System of Aging and Disability Services 

B-2 Service Delivery in the Planning and Service Area 

B-3 AAAD Budget Summary 

Tennessee – State Plan on Aging 2014 - 2018 219
 Exhibit B-1 

PSA: ( ) Original, Dated: 

Plan Period: ( ) Update, Dated: 

Statewide Aging and Disability Programs 

Introduction 

The Area Agency uses funding from a number of programs to provide a comprehensive 

array of services for older persons and other adults with disabilities in the planning and 

service area (PSA). The following is a brief description of the public funding sources and 

a summary of how many individuals were served in each program. 

Older Americans Act 

Older Americans Act (OAA) funds provide, in addition to a comprehensive array of 

services, the administrative infrastructure to deliver all OAA programs. As the designated 

state unit on aging, the Tennessee Commission on Aging and Disability (TCAD) receives 

an annual allotment under Title III of the Older Americans Act as amended, from the 

Administration on Aging (AoA) in the U.S. Department of Health and Human Services. 

TCAD allocates OAA funds to nine Area Agencies on Aging and Disability (AAADs) 

based on an approved intrastate funding formula. The AAADs plan, develop, and 

implement a system of services for older persons age 60 and over in their respective 

Planning and Service Areas (PSA). OAA funds support home and community based 

programs and services such as information and assistance, case management, nutrition 

services, in-home services, multipurpose senior centers, health promotion, transportation, 

legal services, Long Term Care Ombudsman Program, and the National Family 

Caregiver Support Program. 

Using Older Americans Act funding the Area Agency served approximately: 

Persons Served 2009 2010* 2011* 2012* 2013*

Personal Care

Homemaker

Nutrition Services

Case Management

Transportation

Legal Assistance

Information & 

Assistance

Family Caregiver

Ombudsman

Units of Service

Personal Care

Homemaker

Nutrition Services

Case Management

Tennessee – State Plan on Aging 2014 - 2018 220
Transportation

Legal Assistance

Information & 

Assistance

Family Caregiver

Ombudsman

 * 2010-2013 data will be completed in future Area Plan Updates. 

Options for Community Living 

On July 1, 2000, the Tennessee Commission on Aging and Disability received $5 million 

in state funds to support information and referral and to initiate a home and community 

based long term care services program for older persons and other adults with disabilities 

who do not qualify for Medicaid long term care services. The Options Program provides 

homemaker, personal care and home-delivered meals. Other services may be available on 

a case-by-case basis as funds allow. 

Using Options for Community Living funding the Area Agency served approximately: 

2009 2010 2011 2012 2013

Persons Served

Units of Service

Statewide Medicaid Home and Community Based Waiver Services 

for Elderly and Disabled (Waiver) 

Tennessee is in the process of implementing the Long Term Care Community Choices 

Act of 2008. The State Medicaid Agency, the Bureau of TennCare, is converting from a 

1915(c) Statewide Home and Community Based Medicaid Waiver for Elderly and 

Disabled to a 1115 Waiver. The planned start date for the transition is expected to begin 

in 2010 and phased in over an eighteen month period. The State’s nine Area Agencies on 

Aging and Disability will act as the single points of entry for the CHOICES Program. 

The Statewide Home and Community Based Services Waiver is intended to provide a 

community-based, cost-effective alternative to institutional nursing facility care for 

eligible individuals. The program is administered by the Tennessee Department of 

Finance and Administration, Bureau of TennCare. This Medicaid Waiver program 

provides a variety of home and community-based services to low-income older persons 

and adults with disabilities who are frail, functionally impaired, and at-risk of nursing 

home placement. Funding for this program comes from the U.S. Department of Health 

and Human Services, Centers for Medicare and Medicaid. 

Using Waiver funding the Area Agency served approximately: 

2009 2010 2011 2012 2013

Persons Served

Units of Service

Tennessee – State Plan on Aging 2014 - 2018 221
State Health Insurance Assistance Program (SHIP) 

SHIP is funded by the Centers for Medicare and Medicaid in the U.S. Department of 

Health and Human Services. The SHIP program is mandated by Congress to provide free 

and objective information, counseling and assistance to consumers, their adult children, 

caregivers, health care providers and other advocates about Medicare and all other related 

health insurance. Currently, an important aspect of the program is to provide information 

and assistance with enrollment in Medicare Part D and target outreach to low-income 

Medicare beneficiaries eligible for the Medicare Part D Low-Income Subsidy and 

Medicare Savings Programs. The Centers for Medicare and Medicaid Services (CMS) 

funds the nationwide program. The statewide Tennessee SHIP operates through a small, 

but highly trained, paid and volunteer staff. In addition to counseling, program staff 

performs community education and outreach on Medicare and current related issues. 

Using SHIP funding the Area Agency served approximately: 

2009 2010 2011 2012 2013

Individuals 

Provided SHIP

Counseling

Public Guardianship for the Elderly Program 

The Public Guardian Program is a state funded program designed to assist persons 60 

years of age and older who are unable to manage their own affairs and have no family 

member, friend, bank or corporation willing or able to act on their behalf. Public 

Guardians (Conservators) assist clients in obtaining the basic necessities of life including 

making decisions regarding their finances or needed medical care. Legal proceedings 

(court order) are required prior to service delivery. The Tennessee legislature established 

a volunteer component to expand the guardianship program in 1996. 

Using Public Guardianship funding the Area Agency served approximately: 

2009 2010 2011 2012 2013

Persons Served

Other State Appropriations 

The State of Tennessee also appropriates funds to distribute among the area agencies to 

support multipurpose senior citizen centers, home delivered meals and homemaker 

services. An intrastate funding formula is used to distribute the funds to each area agency. 

The funding formula is based on a number of factors such as the number of counties in 

the planning and service area, the proportion of elderly persons and proportion of low 

income elderly persons residing in the area. 

Using State Appropriations the Area Agency served approximately: 

Persons Served 2009 2010 2011 2012 2013

Senior Centers

Meals

Homemaker Services

Tennessee – State Plan on Aging 2014 - 2018 222
Units of Service

Senior Centers

Meals

Homemaker Services

Tennessee – State Plan on Aging 2014 - 2018 223
Exhibit B-2 

PSA: ( ) Original, Dated: 

Plan Period: ( ) Update, Dated: 

Service Delivery in the Planning and Service Area 

1. Describe how the following ACCESS SERVICES and related activities are 

coordinated and/or delivered in the planning and service area. 

Information and Assistance:

Single Point of Entry: 

Website and Resource Directory Development: 

Marketing the Area Agency: 

Outreach: 

Transportation 

Other: 

2. Describe how the following HOME & COMMUNITY BASED SERVICES and 

related activities are coordinated and/or delivered in the planning and service area. 

Service Coordination/Case Management: 

Service Provider Network Support: 

Family Caregiver Support: 

Homemaker: 

Personal Care: 

Respite: 

Chores/Home Modifications: 

Personal Emergency Response Systems: 

Assistive Technology: 

Pest Control: 

Tennessee – State Plan on Aging 2014 - 2018 224
Adult Day Care:

*Other:

3. Describe how the following DISEASE PREVENTION and HEALTH PROMOTION 

services and related activities are coordinated and/or delivered in the planning and 

service area.

Health Promotion:

Health Education: 

Medication Management: 

*Other: 

4. Describe how ELDER RIGHTS services and related activities are coordinated and/or 

delivered in the planning and service area. 

Long Term Care Ombudsman: 

Legal Assistance: 

Public Guardian for the Elderly: 

Elder Abuse Awareness: 

*Other: 

5. Describe how NUTRITION SERVICES are coordinated and/or delivered in the 

planning and service area. 

6. Describe how SENIOR CENTER activities are coordinated and/or delivered in the 

planning and service area. 

7. Describe how SHIP, SMP and MIPPA services are coordinated and/or delivered in the 

planning and service area. 

Tennessee – State Plan on Aging 2014 - 2018 225
8. Describe how Older Americans Act funding for coordination is used within the 

planning and service area. 

9. Describe how the Area Agency coordinates with other public, non-profit or private 

partners to meet the service needs of older persons or adults with disabilities within 

the planning and service area. Include a summary of emergency/disaster preparedness 

coordination activities.

10. Describe other coordination activities related to advocacy or public education to meet 

the needs of older persons or adults with disabilities in the planning and service area. 

11. Describe how the Area Agency provides volunteer opportunities or coordinates with 

volunteer organizations to meet the service needs of older persons or adults with 

disabilities within the planning and service area. 

12. Describe any grant activities or pilot projects being conducted in the planning and 

service area to meet the needs of older persons, adults with disabilities and their 

caregivers. 

13. How are consumers or their caregivers contributing to the cost of the services they 

receive—donations, cost-share and sponsored services. 

14. *Other 

Tennessee – State Plan on Aging 2014 - 2018 226
Exhibit B-3 

PSA: ( ) Original, Dated: 

Plan Period: ( ) Update, Dated: 

AAAD Budget Summary 

Operating Budget for FY 2011* 

A: Total Resources to Be Used for Area Agency Administration: 

Federal/State

Funds

Minimum

Match

Other

Resources

Total 

Budget

OLDER AMERICANS ACT 

Area Plan Administration 

Coordination/Service 

Development

STATE FUNDS

Options for Community Living

MEDICAID

Elderly & Disabled Waiver

LOCAL FUNDS

TOTAL

B: Total Resources to Be Used For Service Delivery: 

Federal/State

Funds

Minimum

Match

Other

Resources

Total 

Budget

OLDER AMERICANS ACT 

Title IIIB Supportive Services

Title IIIC1 Nutrition Services

Title IIIC2 Nutrition Services

Title IIID Disease Prevention & 

Health Promotion

Title IIID Medication 

Management

Title IIIE Family Caregiver

Title VII Elder Rights

STATE FUNDS

Senior Centers

Nutrition (Home Delivered)

Homemaker

Guardianship 

Title III Match

Options for Community Living 

OTHER

Elderly & Disabled Waiver

NSIP

SHIP

TOTAL

*Allocations are estimates. Funding allocations for FY 2011 have not yet been approved by the 

State Legislature. 

Tennessee – State Plan on Aging 2014 - 2018 227
Part C: GOALS, OBJECTIVES AND STRATEGIES

Older Americans Act 

Section 306 AREA PLANS

(a)(4)(A)(i)(I) provide assurances that the area agency on aging will—

(aa) set specific objectives, consistent with State policy, for providing services to older 

individuals with greatest economic need, older individuals with greatest social need, and older 

individuals at risk for institutional placement; 

(bb) include specific objectives for providing services to low-income minority older individuals, 

older individuals with limited English proficiency, and older individuals residing in rural areas; 

and

(II) include proposed methods to achieve the objectives described in items (aa) and (bb) of 

subclause (I)

(a)(4)(B) provide assurances that the area agency on aging will use outreach efforts that will—

(i) identify individuals eligible for assistance under this Act, with special emphasis on—

(I) older individuals residing in rural areas; 

(II) older individuals with greatest economic need (with particular attention to low-income 

minority individuals and older individuals residing in rural areas); 

(III) older individuals with greatest social need (with particular attention to low-income minority 

individuals and older individuals residing in rural areas); 

(IV) older individuals with severe disabilities; 

(V) older individuals with limited English proficiency;

(VI) older individuals with Alzheimer’s disease and related disorders with neurological and 

organic brain dysfunction (and the caretakers of such individuals); and 

(VII) older individuals at risk for institutional placement

Exhibit Number Title of Exhibit 

 

 C-1 Annual Status Report and Highlights 

C-2 Access Services 

C-3 Home and Community Based Services 

C-4 Health Promotion and Disease Prevention 

 C-5 Elder Rights 

C-6 Management Practices 

C-7 Targeting Status Report 

C-8 Targeting Plan 

Tennessee – State Plan on Aging 2014 - 2018 228
Exhibit C-1

PSA: ( ) Original, Dated: 

Plan Period: ( ) Update, Dated: 

 

Annual Status Report and Highlights 

For each of the goals listed in the FY 2010 Area Plan Update (July 1, 2009 – June 30, 

2010), provide a status update that reflects the progress and accomplishments toward 

meeting the goals. Briefly describe any other agency highlights. 

Goal 1: Access Services 

Goal 2: Community Services / Health Promotion 

Goal 3: Home and Community Based, Long-Term Care 

Goal 4: Elder Rights 

Goal 5: Management Practices 

Other AAAD Highlights: 

Tennessee – State Plan on Aging 2014 - 2018 229
Exhibit C-2 

PSA: ( ) Original, Dated: 

Plan Period: ( ) Update, Dated: 

Access Services 

AoA Goal: Empower older people, their families, and other consumers to make informed 

decisions about, and to be able to easily access, existing health and long-term care 

options. 

TCAD Goal: Increase the number of individuals who access aging and disability services 

and benefits through a comprehensive, reliable, unbiased and easily accessible 

information, counseling and referral system. 

AAAD GOAL 

MEASURABLE Objective: 

Strategy 

Strategy 

Performance Measure: Method for Measurement. 

Tennessee – State Plan on Aging 2014 - 2018 230
Exhibit C-3

PSA: ( ) Original, Dated: 

Plan Period: ( ) Update, Dated: 

 Home and Community Based Services 

AoA Goal: Enable seniors to remain in their own homes with high quality of life for as 

long as possible through the provision of home and community-based services, including 

supports for family caregivers. 

TCAD Goal: Assist older individuals and adults with disabilities who are at risk of 

losing their independence the choice of remaining in their homes or communities thus 

delaying institutionalization in long term care facilities. 

AAAD GOAL

MEASURABLE Objective:

Strategy 

 

Strategy 

 

Performance Measure: Method for Measurement. 

Tennessee – State Plan on Aging 2014 - 2018 231
Exhibit C-4 

PSA: ( ) Original, Dated: 

Plan Period: ( ) Update, Dated: 

Health Promotion and Disease Prevention 

AoA Goal: Empower older people to stay active and healthy through Older Americans 

Act services and the new prevention benefits under Medicare. 

TCAD Goal: Provide community services and benefits counseling for older individuals 

that promote healthy aging through a variety of preventive services and enrollment in 

Medicare and other insurance options. 

AAAD GOAL

MEASURABLE Objective:

Strategy 

Strategy 

Performance Measure: Method for Measurement. 

Tennessee – State Plan on Aging 2014 - 2018 232
Exhibit C-5 

PSA: ( ) Original, Dated: 

Plan Period: ( ) Update, Dated: 

 

Elder Rights 

AoA Goal: Ensure the rights of older people and prevent their abuse, neglect and 

exploitation. 

TCAD Goal: Develop, strengthen, and enhance elder rights services in the state that 

prevent elder abuse, neglect, and exploitation. 

AAAD GOAL

MEASURABLE Objective:

Strategy 

 

Strategy 

Performance Measure: Method for Measurement. 

Tennessee – State Plan on Aging 2014 - 2018 233
Exhibit C-6 

PSA: ( ) Original, Dated: 

Plan Period: ( ) Update, Dated: 

Management Practices

AoA Goal: Maintain effective and responsive management. 

TCAD Goal: Utilize practices that promote effective and responsible management of 

financial and human resources.

AAAD GOAL

 MEASUREABLE Objective: 

Strategy 

Strategy 

Performance Measure: Method for Measurement. 

Tennessee – State Plan on Aging 2014 - 2018 234
 Exhibit C-7

PSA: ( ) Original, Dated: 

Plan Period: ( ) Update, Dated: 

Targeting Status Report

Report on activities during the preceding year. 

1. PSA Demographics and Individuals Served in Older Americans Act programs: 

a. Number of low-income minority older individuals in the 

planning and service area (use 2000 Census population data)

b. Number of older individuals residing in rural areas in the 

planning and service area (use 2000 Census population data)

c. Number of older individuals who speak English less than very 

well (use 2000 Census population data)

d. Number of low-income minority older individuals served (use 

State Reporting Tool data)

e. Number of individuals residing in rural areas served (use State

Reporting Tool data)

2. Provide information on the extent to which the Area Agency met its Targeting 

objectives for all programs in the FY 2009 Area Plan Update. 

2009*

OBJECTIVE

ACTUAL

ACCOMPLISHMENT

* Last complete 12-month period. 

Tennessee – State Plan on Aging 2014 - 2018 235
Exhibit C-8 

PSA: ( ) Original, Dated: 

Plan Period: ( ) Update, Dated: 

Targeting Plan

1. Civil Rights Act of 1964, Title VI Targeting Activities 

a. Describe how the Area Agency plans and coordinates activities to disseminate 

information about services and programs to minority populations in the planning and 

service area? 

b. How is diversity reflected in all aspects of area planning—programming, participants, 

personnel, service providers, governing/advisory entities?

c. What documentation or process is used by the Area Agency to document activities 

focused on increasing the representation and/or participation of minority populations 

in programs and services? 

2. Older Americans Act Required Targeting Activities

Set specific objectives, consistent with State policy, for providing services to older 

individuals with greatest economic need, older individuals with greatest social need, and 

older individuals at risk for institutional placement; including specific objectives for 

providing services to low-income minority older individuals, older individuals with 

limited English proficiency, and older individuals residing in rural areas; and propose 

methods to achieve the objectives. 

NOTE: Objectives and Tasks/Activities should cover Older Americans Act programs and 

may cover all statewide programs such as Single Point of Entry Marketing or SHIP. 

OBJECTIVE TASK / ACTIVITY AREA AGENCY STAFF

RESPONSIBLE

Tennessee – State Plan on Aging 2014 - 2018 236
Part D: STAFFING AND ORGANIZATION

TCAD Policies and Procedures 

5-4-.03 AAAD STAFFING REQUIREMENTS

(1) The AAAD must develop and implement a staffing plan consistent with federal and state 

requirements which sets forth the number and type of personnel employed and the timetable for 

hiring staff to carry out the functions of the AAAD. The AAAD is responsible for: 

(a) recruiting and employing adequate numbers of staff members to develop and administer the 

area plan, and 

(b) carrying out the functions and responsibilities prescribed by the OAA and other state and 

federally funded programs addressing the needs of older persons and other adults with 

disabilities, and its accompanying regulations and these policies. 

(8) The AAAD shall submit in the area plan a Training and Staff Development Plan for staff and 

service providers. The plan should include conferences, meetings and in-service training 

organized for staff or service providers....

Older Americans Act Regulations 

Section 1321.55 Organization and staffing of the area agency. 

(b) The area agency, once designated, is responsible for providing for adequate and qualified staff 

to perform all of the functions prescribed in this part.

Older Americans Act 

Section 306 AREA PLANS

(a)(6)(c)(iii) make use of trained volunteers in providing direct services delivered to older 

individuals and individuals with disabilities needing such services....

Exhibit Number Title of Exhibit 

D-1 Staff Resources 

D-2 Training and Staff Development Plan 

D-3 Advisory Council 

Tennessee – State Plan on Aging 2014 - 2018 237
Exhibit D-1 

PSA: ( ) Original, Dated: 

PLAN PERIOD: ( ) Update, Dated: 

AAAD STAFFING 

TABLE 1. 

Staff Positions & 

Name of AAAD

Staff Person & 

Job Title

Minimum Full-Time

Equivalent (FTE)

& Responsibilities

Required

Qualifications

AAAD Staff FTEs 

& Qualifications

Older Americans Act

Director 1 FTE

Oversight of AAAD 

operation; Planning and 

development of Area

Plan; Management and 

operation of all

program and fiscal

aspects

Master’s Degree and five 

years experience in 

supervision or

management in field of 

gerontology, aging 

programs or related field 

of social work. 

Bachelor’s Degree in a 

related field and seven 

years of related 

experience may be 

substituted for the 

Master’s Degree

Financial Specialist 1 FTE

Fiscal functions of 

AAAD; Financial 

accounting; Budgeting; 

Technical assistance to 

service providers and 

Financial monitoring

B.S. Degree in 

Accounting or related 

degree in an area of

financial management 

and minimum of 2 years 

experience requiring 

financial expertise

Quality Assurance 1 FTE

Provide technical

assistance to service 

providers; Develop 

district Q&A Plan; 

Monitoring service 

providers, Approve 

Plans of Correction

RN, BSN or Bachelor’s 

Degree in social work, 

gerontology, psychology, 

sociology, counseling or 

related field. 

Program Specialist/

Coordinator, 

Assistant Director

.05 – 1 FTE

Duties as assigned by 

Director

Bachelor’s Degree in 

social work or related 

field and minimum of 2 

years experience in Social 

Service Program

implementation

Tennessee – State Plan on Aging 2014 - 2018 238
Management 

Information 

Specialist

1 FTE

Manage databases; 

Compile reports;

Maintain resource 

directory; SRT; 

Analyze data

Proven familiarity with 

software and hardware 

installation and 

customization; Ability to 

provide help desk support 

on hardware, software, 

communications; Ability 

to develop and conduct 

training; Oral and written 

skills; Working 

knowledge of software 

packages; Programming 

experience; BS Degree, 

preferably in Computer 

Science, or other

computer-related field 

with data-base experience, 

hardware experience, 

and/or 5 year’s relative 

experience

Family Caregiver 

Coordinator

A designated 

coordinator, full-time 

or part-time as deemed 

necessary

Disseminate caregiver 

information; Organize 

support groups; 

Maintain records; 

Compile reports;

Oversee caregiver 

needs assessments;

Arrange for caregiver 

services; Assist with 

Area Agency functions 

as assigned by the 

AAAD Director

Bachelor’s Degree in 

social work or related 

field, or RN

Support Staff Full-time or part-time 

as deemed necessary

Assist AAAD program 

staff (Letters, faxes, 

documents, telephone, 

meeting coordinator, 

etc.)

Computer skills; Verbal 

and written skills; Ability 

to organize files; 

Correspondence; Faxing; 

Minimum of High School 

Education with emphasis 

in business, preferably 

post secondary clerical 

skills training

Other Staff

Adequate numbers of

staff, qualified by 

Full-time or part-time 

as deemed necessary

Qualifications will be 

developed in keeping with 

Tennessee – State Plan on Aging 2014 - 2018 239
education and 

experience, assigned 

for the development

and administration of 

the plan and to 

conduct other 

required AAAD

functions

Based on the needs of

the individual AAAD 

planning and service

area

responsibilities assigned 

to the position

SHIP 

SHIP Coordinator 1 dedicated FTE

Cooperate with CMS 

requests to recruit/train 

volunteers; Maintain 

current knowledge of

Medicare and Medicaid 

and other health

insurance; Telephone

counseling to 

beneficiaries; Compile 

reports; 

Communication skills; 

Work with media;

computer skills

Preferably a Bachelor’s 

Degree and 2 years 

experience in advocacy or 

information and 

assistance. A high school 

education and 4 years 

experience in advocacy or 

information and assistance 

may be substituted. 

Guardianship for the Elderly

Guardian 1 dedicated FTE

Manage Guardianship 

Program 

See the Guardianship for 

the Elderly Chapter in this 

Policy Manual

Statewide HCBS Waiver for the Elderly and Disabled

Waiver Manager 1 FTE

Financial & Program

Oversight; Marketing; 

Policies and Procedures

Compliance; Data 

Analysis of 

Performance;

Reporting; 

Contact for Case

Management Provider; 

Recruitment/Relations; 

Grievances/Appeals; 

Staff supervision as 

assigned by AAAD

Director

Preferably Master’s 

Degree in Social Work or 

a Registered Nurse 

(subject to Waiver 

requirements). Minimum 

of 2 years in management 

or supervision, preferably 

working with older adults 

and/or adults with 

disabilities.

Tennessee – State Plan on Aging 2014 - 2018 240
Information &

Assistance Specialist

1 – 2 FTE 

As deemed necessary

Telephone Information 

Assistance and 

Referral;

Comprehensive 

telephone screening; 

Assist with 

appointments for inhome assessment visits; 

Assistance with case 

file development

AIRS Certified 

Information and Referral 

Specialist – Aging, 

according to AIRS 

Standards within 2 years 

of employment; 

Written/Verbal 

communications skills; 

Minimum of completion 

of grade 12, preferred at 

least 2 years college and 

minimum of 2 years 

employment in field of

social work.

Pre-Enrollment 

Specialist

2 – 4 FTE

As deemed necessary

Arrange and complete 

in-home assessments;

Develop PAE; Develop 

initial Plan of Care; 

Compile information to 

submit to DHS for

financial eligibility; 

Coordinate getting

physician’s orders; 

Submit paperwork to 

TCAD for enrollment

Preferably a Master’s 

Degree in Social Work, 

Psychology, Sociology, or

a related field from an 

accredited college or 

university and one year of 

supervised social services 

experience, with 

experience in geriatrics or 

service planning and 

delivery for the disabled. 

Bachelor’s Degree in 

Social Work, Psychology, 

Sociology, or other field 

related to social work with 

2 years of supervised work 

experience in a social 

services program, with 

experience in geriatric or 

service planning and 

delivery for the disabled 

preferred. The Bachelor’s 

level Social Worker must 

work under the 

supervision of a Social 

Worker with a Master’s 

Degree or an RN. 

Waiver QA 1 FTE

Provider Recruitment; 

Training / Provider 

Meetings; Problem 

solving w/consumers 

and providers; 

Complaint Resolution; 

Missed Visits / Trends / 

QI; Plan of Correction; 

Bachelor’s Degree in 

social services or related 

field or nursing degree 

(RN or LPN)

Tennessee – State Plan on Aging 2014 - 2018 241
HIPAA 

Responsibilities

Data Entry 0.5 – 1 FTE

As deemed necessary

Waiver Client Data / 

Care Plan entered in 

SAMS 2000; Invoice /

Billing Data entered in 

SAMS 2000; Develop 

and Run Rosters for 

Providers

Computer Skills;

Minimum of High School

education, preferably postsecondary training

Assistant Fiscal Staff 0.5-1 FTE

As deemed necessary

Assist AAAD Financial 

Specialist with duties as 

assigned; Assist with 

Billing; TCAD contact 

for denials of payment; 

Provider Relations; 

Reconcile Care Plans to 

Provider Invoices;

Provide financial 

monitoring

Minimum of high school 

education and 2 years 

training or experience in 

the field of Accounting

Support Staff 1 – 2.5 FTE

As deemed necessary

Assist waiver staff with 

duties as assigned

Computer skills; Verbal 

and written 

communication skills; 

Ability to organize files; 

Correspondence; Faxing; 

Minimum of high school 

education with emphasis 

in business, preferably 

post secondary clerical 

skills training

OPTIONS for Community Living

I&A Specialist 1 dedicated FTE

Disseminate 

information and make 

referrals; Telephone 

screening; Telephone

counseling; Enter data 

into Beacon/SAMS 

database

AIRS Certified 

Information and Referral 

Specialist – Aging, 

according to AIRS 

Standards Written/Verbal 

communications skills. 

Minimum of completion 

of grade 12, prefer at least 

2 years college and 

minimum of 2 years 

employment in field of

social work.

Tennessee – State Plan on Aging 2014 - 2018 242
Service Coordinator 1 FTE

Plus additional FTEs as 

deemed necessary by

caseload

In-home assessments;

Development and

management of Care 

Plans; Referral and 

arrange services;

Re-assessment

BS Degree in social work, 

psychology, gerontology, 

sociology, counseling, 

nursing, or equivalent 

degree; or Licensed 

Practical Nurse/Registered 

Nurse or BS Degree with 

minimum of 2 years 

experience working with 

older persons and/or adults 

with disabilities; or 

Minimum of completion 

of 2 years of accredited 

college or university and 2 

years experience in the 

field of social work or 

related field 

TABLE 2. 

Name Age 60+? Female? Minority? Disability?

Total

Supervision 

The director of the Area Agency on Aging and Disability is directly supervised by: 

_________________________ 

Tennessee – State Plan on Aging 2014 - 2018 243
 Exhibit D-2 

PSA: ( ) Original, Dated: 

Plan Period: ( ) Update, Dated: 

Training and Staff Development Plan

Title & Subject of

Training

Category & Number of Persons to 

be Trained

Estimated

Date of

Training

AAAD

Staff

Providers or 

Partners

Volunteers

Tennessee – State Plan on Aging 2014 - 2018 244
Exhibit D-3 

PSA: ( ) Original, Dated: 

Plan Period: ( ) Update, Dated: 

Advisory Council

Ask for copy of bylaws—see P&P manual 5-4-.04. 

A. MEMBERSHIP and REPRESENTATION 

Composition of Council: Choose among the following options to specify which category 

each Advisory Council member represents on the table below. 

a. Age 60+ (50% Older persons) 

b. Minority age 60+ 

c. Minority age <60 

d. Resides in a Rural Area 

e. Family Caregiver 

f. Advocate for Older Persons 

g. Service Provider for Older Persons 

h. Advocate for Individuals with Disabilities 

i. Service Provider for Individuals with Disabilities 

j. Business Community 

k. Local Elected Official 

l. Provider of Veterans’ Health Care

m. General Public (County Representative) 

n. Has a Disability 

Members Represents

Tennessee – State Plan on Aging 2014 - 2018 245
B. SCHEDULE OF ADVIORY COUNCIL MEETINGS 

Give Dates and Times of Scheduled Meetings 

C. OFFICERS & OFFICE 

Name of Officer Office Date Term Expires 

D. ADVISORY COUNSIL BYLAWS

 Attach Bylaws that show date of last review. 

Tennessee – State Plan on Aging 2014 - 2018 246
Part E: DOCUMENTATION

Exhibit Number Title of Exhibit 

E-1 OAA Assurances of Compliance 

E-2 Availability of Documents 

E-3 Civil Rights Act Compliance 

Tennessee – State Plan on Aging 2014 - 2018 247
 Exhibit E-1 

PSA: ( ) Original, Dated: 

PLAN PERIOD: ( ) Update, Dated: 

Older Americans Act (2006) Assurances of Compliance 

Section. 306. AREA PLANS 

(a) Each area agency on aging designated under section 305(a)(2)(A) shall, in order to be 

approved by the State agency, prepare and develop an area plan for a planning and service 

area for a two-, three-, or four-year period determined by the State agency, with such annual 

adjustments as may be necessary. Each such plan shall be based upon a uniform format for 

area plans within the State prepared in accordance with section 307(a)(1). Each such plan 

shall—

(1) provide, through a comprehensive and coordinated system, for supportive services, 

nutrition services, and, where appropriate, for the establishment, maintenance, or 

construction of multipurpose senior centers, within the planning and service area covered 

by the plan, including determining the extent of need for supportive services, nutrition 

services, and multipurpose senior centers in such area (taking into consideration, among 

other things, the number of older individuals with low incomes residing in such area, the 

number of older individuals who have greatest economic need with particular attention to 

low-income older individuals, including low-income minority older individuals, older 

individuals with limited English proficiency, and older individuals residing in rural areas)

residing in such area, the number of older individuals who have greatest social need (with 

particular attention to low-income older individuals, including low-income minority older 

individuals, older individuals with limited English proficiency, and older individuals 

residing in rural areas) residing in such area, the number of older individuals at risk for 

institutional placement residing in such area, and the number of older individuals who are 

Indians residing in such area, and the efforts of voluntary organizations in the 

community, evaluating the effectiveness of the use of resources in meeting such need, 

and entering into agreements with providers of supportive services, nutrition services, or 

multipurpose senior centers in such area, for the provision of such services or centers to 

meet such need; 

(2) provide assurances that an adequate proportion, as required under section 307(a)(2), 

of the amount allotted for part B to the planning and service area will be expended for the 

delivery of each of the following categories of services—

(A) services associated with access to services (transportation, health services 

including mental health services) outreach, information and assistance, (which may 

include information and assistance to consumers on availability of services under part 

B and how to receive benefits under and participate in publicly supported programs 

for which the consumer may be eligible) and case management services); 

(B) in-home services, including supportive services for families of older individuals 

who are victims of Alzheimer’s disease and related disorders with neurological and 

organic brain dysfunction; and 

(C) legal assistance; and assurances that the area agency on aging will report 

annually to the State agency in detail the amount of funds expended for each such 

category during the fiscal year most recently concluded; 

(3) (A) designate, where feasible, a focal point for comprehensive service delivery in 

each community, giving special consideration to designating multipurpose senior centers 

Tennessee – State Plan on Aging 2014 - 2018 248
(including multipurpose senior centers operated by organizations referred to in paragraph 

(6)(C)) as such focal point; and

(B) specify, in grants, contracts, and agreements implementing the plan, the identity 

of each focal point so designated; 

(4) (A) (i) (I) provide assurances that the area agency on aging will—

(aa) set specific objectives, consistent with State policy, for providing 

services to older individuals with greatest economic need, older 

individuals with greatest social need, and older individuals at risk for 

institutional placement; 

(bb) include specific objectives for providing services to low-income 

minority older individuals, older individuals with limited English 

proficiency, and older individuals residing in rural areas; and 

(II) include proposed methods to achieve the objectives described in items 

(aa) and (bb) of subclause (I);

(ii) provide assurances that the area agency on aging will include in each 

agreement made with a provider of any service under this title, a requirement 

 that such provider will—

(I) specify how the provider intends to satisfy the service needs of lowincome minority individuals, older individuals with limited English 

proficiency, and older individuals residing in rural areas in the area served by 

the provider; 

(II) to the maximum extent feasible, provide services to low-income minority 

individuals, older individuals with limited English proficiency, and older

individuals residing in rural areas in accordance with their need for such 

services; and 

(III) meet specific objectives established by the area agency on aging, for 

providing services to low-income minority individuals, older individuals with 

limited English proficiency, and older individuals residing in rural areas 

within the planning and service area; and 

(iii) with respect to the fiscal year preceding the fiscal year for which such plan is 

prepared—

(I) identify the number of low-income minority older individuals in the 

planning and service area; 

(II) describe the methods used to satisfy the service needs of such minority 

older individuals; and 

(III) provide information on the extent to which the area agency on aging met 

the objectives described in 

clause (i); 

(B) provide assurances that the area agency on aging will use outreach efforts that 

will—

(i) identify individuals eligible for assistance under this Act, with special 

emphasis on—

(I) older individuals residing in rural areas; 

(II) older individuals with greatest economic need (with particular attention to 

low-income minority individuals and older individuals residing in rural 

areas); 

(III) older individuals with greatest social need (with particular attention to 

low-income minority individuals and older individuals residing in rural 

areas); 

Tennessee – State Plan on Aging 2014 - 2018 249
(IV) older individuals with severe disabilities; 

(V) older individuals with limited English proficiency; 

(VI) older individuals with Alzheimer’s disease and related disorders with 

neurological and organic brain dysfunction (and the caretakers of such 

individuals); and 

(VII) older individuals at risk for institutional placement; and

(ii) inform the older individuals referred to in sub-clauses (I) through (VII) of 

clause (i), and the caretakers of such individuals, of the availability of such 

assistance; and 

(C) contain an assurance that the area agency on aging will ensure that each activity 

undertaken by the agency, including planning, advocacy, and systems development, 

will include a focus on the needs of low-income minority older individuals and older 

individuals residing in rural areas; 

(5) provide assurances that the area agency on aging will coordinate planning, 

identification, assessment of needs, and provision of services for older individuals with 

disabilities, with particular attention to individuals with severe disabilities, and 

individuals at risk for institutional placement with agencies that develop or provide 

services for individuals with disabilities; 

(6) provide that the area agency on aging will—

(A) take into account in connection with matters of general policy arising in the 

development and administration of the area plan, the views of recipients of services 

under such plan; 

(B) serve as the advocate and focal point for older individuals within the community 

by (in cooperation with agencies, organizations, and individuals participating in 

activities under the plan) monitoring, evaluating, and commenting upon all policies, 

programs, hearings, levies, and community actions which will affect older 

individuals; 

(C) (i) where possible, enter into arrangements with organizations providing day care 

services for children, assistance to older individuals caring for relatives who are 

children, and respite for families, so as to provide opportunities for older individuals 

to aid or assist on a voluntary basis in the delivery of such services to children, adults, 

and families; 

(ii) if possible regarding the provision of services under this title, enter into 

arrangements and coordinate with organizations that have a proven record of 

providing services to older individuals, that- 

(I) were officially designated as community action agencies or community 

action programs under section 210 of the Economic Opportunity Act of 1964 

(42 U.S.C. 2790) for fiscal year 1981, and did not lose the designation as a 

result of failure to comply with such Act; or 

(II) came into existence during fiscal year 1982 as direct successors in interest 

to such community action agencies or community action programs; and that 

meet the requirements under section 676B of the Community Services Block 

Grant Act; and 

(iii) make use of trained volunteers in providing direct services delivered to older 

individuals and individuals with disabilities needing such services and, if 

possible, work in coordination with organizations that have experience in 

providing training, placement, and stipends for volunteers or participants (such as 

organizations carrying out Federal service programs administered by the 

Tennessee – State Plan on Aging 2014 - 2018 250
Corporation for National and Community Service), in community service 

settings; 

(D) establish an advisory council consisting of older individuals (including minority 

individuals and older individuals residing in rural areas) who are participants or who 

are eligible to participate in programs assisted under this Act, family caregivers of 

such individuals, representatives of older individuals, service providers, 

representatives of the business community, local elected officials, providers of 

veterans’ health care (if appropriate), and the general public, to advise continuously 

the area agency on aging on all matters relating to the development of the area plan, 

the administration of the plan and operations conducted under the plan; 

(E) establish effective and efficient procedures for coordination of—

(i) entities conducting programs that receive assistance under this Act within the 

planning and service area served by the agency; and 

(ii) entities conducting other Federal programs for older individuals at the local 

level, with particular emphasis on entities conducting programs described in 

section 203(b), within the area; 

(F) in coordination with the State agency and with the State agency responsible for 

mental health services, increase public awareness of mental health disorders, remove 

barriers to diagnosis and treatment, and coordinate mental health services (including 

mental health screenings) provided with funds expended by the area agency on aging 

with mental health services provided by community health centers and by other 

public agencies and nonprofit private organizations; (G) if there is a significant 

population of older individuals who are Indians in the planning and service area of 

the area agency on aging, the area agency on aging shall conduct outreach activities 

to identify such individuals in such area and shall inform such individuals of the 

availability of assistance under this Act; 

(7) provide that the area agency on aging shall, consistent with this section, facilitate the 

area-wide development and implementation of a comprehensive, coordinated system for 

providing long-term care in home and community-based settings, in a manner responsive 

to the needs and preferences of older individuals and their family caregivers, by—

(A) collaborating, coordinating activities, and consulting with other local public and 

private agencies and organizations responsible for administering programs, benefits, 

and services related to providing long-term care; 

(B) conducting analyses and making recommendations with respect to strategies for 

modifying the local system of long-term care to better—

(i) respond to the needs and preferences of older individuals and family 

caregivers; 

(ii) facilitate the provision, by service providers, of long-term care in home and 

community-based settings; and 

(iii) target services to older individuals at risk for institutional placement, to 

permit such individuals to remain in home and community-based settings; 

(C) implementing, through the agency or service providers, evidence-based programs 

to assist older individuals and their family caregivers in learning about and making 

behavioral changes intended to reduce the risk of injury, disease, and disability 

among older individuals; and 

(D) providing for the availability and distribution (through public education 

campaigns, Aging and Disability Resource Centers, the area agency on aging itself, 

and other appropriate means) of information relating to—

(i) the need to plan in advance for long-term care; and 

Tennessee – State Plan on Aging 2014 - 2018 251
(ii) the full range of available public and private long-term care (including 

integrated long-term care) programs, options, service providers, and resources; 

 (8) provide that case management services provided under this title through the area 

agency on aging will—

(A) not duplicate case management services provided through other Federal and State 

programs; 

(B) be coordinated with services described in subparagraph (A); and 

(C) be provided by a public agency or a nonprofit private agency that—

(i) gives each older individual seeking services under this title a list of agencies 

that provide similar services within the jurisdiction of the area agency on aging; 

(ii) gives each individual described in clause (i) a statement specifying that the 

individual has a right to make an independent choice of service providers and 

documents receipt by such individual of such statement; 

(iii) has case managers acting as agents for the individuals receiving the services 

and not as promoters for the agency providing such services; or 

(iv) is located in a rural area and obtains a waiver of the requirements described 

in clauses (i) through (iii); 

(9) provide assurances that the area agency on aging, in carrying out the State LongTerm Care Ombudsman program under section 307(a)(9), will expend not less than the 

total amount of funds appropriated under this Act and expended by the agency in fiscal 

year 2000 in carrying out such a program under this title; 

(10) provide a grievance procedure for older individuals who are dissatisfied with or 

denied services under this title; 

(11) provide information and assurances concerning services to older individuals who 

are Native Americans (referred to in this paragraph as ‘‘older Native Americans’’), 

including—

(A) information concerning whether there is a significant population of older Native 

Americans in the planning and service area and if so, an assurance that the area 

agency on aging will pursue activities, including outreach, to increase access of those 

older Native Americans to programs and benefits provided under this title; 

(B) an assurance that the area agency on aging will, to the maximum extent 

practicable, coordinate the services the agency provides under this title with services 

provided under title VI; and 

(C) an assurance that the area agency on aging will make services under the area 

plan available, to the same extent as such services are available to older individuals 

within the planning and service area, to older Native Americans; and 

(12) provide that the area agency on aging will establish procedures for coordination of 

services with entities conducting other Federal or federally assisted programs for older 

individuals at the local level, with particular emphasis on entities conducting programs 

described in section 203(b) within the planning and service area. 

(13) provide assurances that the area agency on aging will—

(A) maintain the integrity and public purpose of services provided, and service 

providers, under this title in all contractual and commercial relationships; 

(B) disclose to the Assistant Secretary and the State agency—

(i) the identity of each nongovernmental entity with which such agency has a 

contract or commercial relationship relating to providing any service to older 

individuals; and 

(ii) the nature of such contract or such relationship; 

Tennessee – State Plan on Aging 2014 - 2018 252
(C) demonstrate that a loss or diminution in the quantity or quality of the services 

provided, or to be provided, under this title by such agency has not resulted and will 

not result from such contract or such relationship; 

(D) demonstrate that the quantity or quality of the services to be provided under this 

title by such agency will be enhanced as a result of such contract or such relationship; 

and 

(E) on the request of the Assistant Secretary or the State, for the purpose of 

monitoring compliance with this Act (including conducting an audit), disclose all 

sources and expenditures of funds such agency receives or expends to provide 

services to older individuals; 

(14) provide assurances that preference in receiving services under this title will not be 

given by the area agency on aging to particular older individuals as a result of a contract 

or commercial relationship that is not carried out to implement this title; 

(15) provide assurances that funds received under this title will be used—

(A) to provide benefits and services to older individuals, giving priority to older 

individuals identified in paragraph (4)(A)(i); and 

(B) in compliance with the assurances specified in paragraph (13) and the limitations 

specified in section 212; 

(16) provide, to the extent feasible, for the furnishing of services under this Act, 

consistent with self-directed care; and 

(17) include information detailing how the area agency on aging will coordinate 

activities, and develop long-range emergency preparedness plans, with local and State 

emergency response agencies, relief organizations, local and State governments, and any 

other institutions that have responsibility for disaster relief service delivery. 

(b) (1) An area agency on aging may include in the area plan an assessment of how prepared 

the area agency on aging and service providers in the planning and service area are for any 

anticipated change in the number of older individuals during the 10-year period following the 

fiscal year for which the plan is submitted. 

(2) Such assessment may include—

(A) the projected change in the number of older individuals in the planning and 

service area; 

(B) an analysis of how such change may affect such individuals, including 

individuals with low incomes, individuals with greatest economic need, minority 

older individuals, older individuals residing in rural areas, and older individuals with 

limited English proficiency; 

(C) an analysis of how the programs, policies, and services provided by such area 

agency can be improved, and how resource levels can be adjusted to meet the needs 

of the changing population of older individuals in the planning and service area; and 

(D) an analysis of how the change in the number of individuals age 85 and older in 

the planning and service area is expected to affect the need for supportive services. 

(3) An area agency on aging, in cooperation with government officials, State agencies, 

tribal organizations, or local entities, may make recommendations to government officials 

in the planning and service area and the State, on actions determined by the area agency 

to build the capacity in the planning and service 

area to meet the needs of older individuals for—

(A) health and human services; 

(B) land use; 

(C) housing;

(D) transportation; 

Tennessee – State Plan on Aging 2014 - 2018 253
(E) public safety; 

(F) workforce and economic development; 

(G) recreation; 

(H) education; 

(I) civic engagement; 

(J) emergency preparedness; and 

(K) any other service as determined by such agency. 

 (c) Each State, in approving area agency on aging plans under this section, shall waive the 

requirement described in paragraph (2) of subsection (a) for any category of services 

described in such paragraph if the area agency on aging demonstrates to the State agency that 

services being furnished for such category in the area are sufficient to meet the need for such 

services in such area and had conducted a timely public hearing upon request. 

(d) (1) Subject to regulations prescribed by the Assistant Secretary, an area agency on aging 

designated under section 305(a)(2)(A) or, in areas of a State where no such agency has 

been designated, the State agency, may enter into agreement with agencies administering 

programs under the Rehabilitation Act of 1973, and titles XIX and XX of the Social 

Security Act for the purpose of developing and implementing plans for meeting the 

common need for transportation services of individuals receiving benefits under such 

Acts and older individuals participating in programs authorized by this title. 

(2) In accordance with an agreement entered into under paragraph (1), funds appropriated 

under this title may be used to purchase transportation services for 

older individuals and may be pooled with funds made available for the provision of 

transportation services under the Rehabilitation Act of 1973, and titles XIX and XX of 

the Social Security Act. 

(e) An area agency on aging may not require any provider of legal assistance under this title 

to reveal any information that is protected by the attorney-client privilege. 

(f) (1) If the head of a State agency finds that an area agency on aging has failed to comply 

with Federal or State laws, including the area plan requirements of this section, 

regulations, or policies, the State may withhold a portion of the funds to the area agency 

on aging available under this title. 

(2) (A) The head of a State agency shall not make a final determination withholding 

funds under paragraph (1) without first affording the area agency on aging due process in 

accordance with procedures established by the State agency. 

(B) At a minimum, such procedures shall include procedures for—

(i) providing notice of an action to withhold funds; 

(ii) providing documentation of the need for such action; and 

(iii) at the request of the area agency on aging, conducting a public hearing 

concerning the action. 

(3) (A) If a State agency withholds the funds, the State agency may use the funds 

withheld to directly administer programs under this title in the planning and service area 

served by the area agency on aging for a period not to exceed 180 days, except as 

provided in subparagraph (B). 

(B) If the State agency determines that the area agency on aging has not taken 

corrective action, or if the State agency does not approve the corrective action, during 

the 180-day period described in subparagraph (A), the State agency may extend the 

period for not more than 90 days. 

Tennessee – State Plan on Aging 2014 - 2018 254
Section. 374. MAINTENANCE OF EFFORT 

Funds made available under this subpart shall supplement, and not supplant, any Federal, 

State, or local funds expended by a State or unit of general purpose local government 

(including an area agency on aging) to provide services described in section 373. 

Certification by Authorized Agency Official 

(Insert name of AAAD) hereby gives full assurance that every effort will be made to comply 

with the regulations of the Older Americans Act. 

SIGNATURES 

____________________________________________ Date__________________ 

AAAD Director 

____________________________________________ Date __________________ 

Grantee Agency Director 

 

Tennessee – State Plan on Aging 2014 - 2018 255
Exhibit E-2 

PSA: ( ) Original, Dated: 

Plan Period: ( ) Update, Dated: 

Availability of Documents

(Insert name of AAAD) hereby gives full assurance that the following documents are 

current and maintained in the administrative office of the AAAD and will be filed in such 

a manner as to ensure ready access for inspection by TCAD or its designees at any time. 

The AAAD further understands that these documents are subject to review during quality 

assurance visits by TCAD. 

1. Current policy making board member roster, including officers 

2. Applicable current licenses 

3. AAAD Advisory Council By-Laws and membership list 

4. AAAD staffing plan 

a. position descriptions (signed by staff member) 

b. staff resumes and performance evaluations 

c. documentation that staff meet the educational and experience requirements 

of the position and that appropriate background checks have been completed 

d. equal opportunity hiring policies and practices 

5. Personnel Policy Manual of grantee agency 

6. Financial procedures manual in accordance with TCAD policies 

7. Program procedures manual 

8. Interagency agreements, if applicable 

9. Insurance verification (general professional liability such as errors and omissions, 

officers and directors, etc.) 

10. Bonding verification 

11. Affirmative Action Plan 

12. Civil Rights Compliance Plan 

13. Conflict of Interest policy 

14. Grievance Procedure and designated staff member 

Tennessee – State Plan on Aging 2014 - 2018 256
15. Documentation of public forums conducted in the development of the area plan, 

including attendance records and feedback from providers, consumer, and 

caregivers 

16. Americans with Disabilities Act (ADA) policies, ADA Existing Facility Checklist 

and report on barrier removal 

17. Documentation of match commitments for cash, voluntary contributions and 

building space, as applicable 

18. Financial Reports or if applicable copy of audited copy of Financial Report of 

service providers 

19. Emergency Preparedness/Disaster Plan

20. Drug-Free Workplace policies 

21. Confidentiality and HIPAA policies 

22. Individual background information for newly hired employees and volunteers 

who provide direct care for, have direct contact with, or have direct responsibility 

for the safety and care of older persons and adults with disabilities in their homes. 

Certification by Authorized Agency Official 

I hereby certify that the documents identified above currently exist and are properly 

maintained in the administrative office of the Area Agency on Aging and Disability. 

Assurance is given that TCAD or its designee will be given immediate access to these 

documents, upon request. 

SIGNATURES 

____________________________________________ Date__________________ 

AAAD Director 

____________________________________________ Date __________________ 

Grantee Agency Director 

Tennessee – State Plan on Aging 2014 - 2018 257
Exhibit E-3 

PSA: ( ) Original, Dated: 

Plan Period: ( ) Update, Dated: 

Title VI of the Civil Rights Act of 1964 Compliance 

The____________________________Area Agency on Aging and Disability reaffirms its 

policies to afford all individuals the opportunity to participate in federal financially 

assisted programs and adopts the following provision: 

“No person in the United States, shall, on the grounds of race, color, 

or national origin, be excluded from participation in, be denied the 

benefits of, or be subjected to discrimination under any program or 

activity receiving federal financial assistance.”

This policy applies to all services and programs operated by, or through contracts or 

subcontracts from the _____________________ Area Agency on Aging and Disability. 

Prohibited practices include: 

1. Denying any individual any services such as: congregate meals, in-home services, 

and information and assistance; opportunity to serve as a volunteer, advisor, or 

member of a policy board, positions of leadership, or other benefit for which he/she is 

otherwise qualified. 

2. Providing any individual with any service, or other benefit, which is different or is 

provided in a different manner from that which is provided to others under the 

program, such as the selection of menu items, the mode of style of service, or the 

manner of conveyance in transportation. 

3. Subjecting any individual to segregated or separate treatment in any manner related to 

that individuals receipt of service, including congregate meals in separate sites or 

facilities, senior center services in separate sites or facilities, or employment services 

in separate sites or facilities. 

4. Restricting an individual in any way in the enjoyment of services, facilities or any 

other advantage, privilege, or other benefit provided to others under the program. 

5. Adopting methods of administration which would limit participation by any group of 

recipients or subject them to discrimination, including submitting bids for services 

and receiving contracts or subcontracts; and personnel practices such as hiring, firing, 

and granting raises. 

6. Addressing an individual in a manner that denotes inferiority because or race, color, 

or national origin. 

Tennessee – State Plan on Aging 2014 - 2018 258
The________________________________Area Agency on Aging and Disability shall 

appoint a Title VI coordinator to ensure that the Area Agency on Aging and Disability 

and all service providers comply with the provision of Title VI. Whenever a planning or 

advisory body, such as a board or a committee is an integral part of the Area Agency on 

Aging and Disability or service provider program, the Area Agency on Aging and 

Disability will take such steps as are necessary to ensure that minorities are notified of 

the existence of such bodies and are provided equal opportunity to participate as 

members. Where members of a board or committee are appointed by the area agency or 

service provider agency, minorities shall be represented at least in proportion to their 

presence in the general population of the service area. 

SIGNATURES 

____________________________________________ Date__________________ 

AAAD Director 

____________________________________________ Date __________________ 

Grantee Agency Director 

Tennessee – State Plan on Aging 2014 - 2018 259
Part F: PUBLIC HEARINGS ON AREA PLAN & WAIVERS

Older Americans Act 

Section 306 AREA PLANS

(a)(6)(D) establish an advisory council consisting of older individuals (including minority 

individuals and older individuals residing in rural areas) who are participants or who are eligible 

to participate in programs assisted under this Act, family caregivers of such individuals,

representatives of older individuals, service providers, representatives of the business 

community, local elected officials, providers of veterans’ health care (if appropriate), and the 

general public, to advise continuously the area agency on aging on all matters relating to the 

development of the area plan, the administration of the plan and operations conducted under the 

plan

(c) Each State, in approving area agency on aging plans under this section, shall waive the 

requirement described in paragraph (2) of subsection (a) for any category of services described in 

such paragraph if the area agency on aging demonstrates to the State agency that services being 

furnished for such category in the area are sufficient to meet the need for such services in such 

area and had conducted a timely public hearing upon request. 

Exhibit Number Title of Exhibit 

F-1 Public Hearing on Area Plan on Aging 

F-2 Advisory Council Participation in the Area Plan Process 

F-3 Requests for Waivers – Optional

F-3.1 Direct Provision of Service 

F-3.2 Required Minimum Services 

F-3.3 Provision of Priority Services 

F-3.4 Nutrition Site 

F-3.5 State Rule, Regulation, or Policy Requirement 

F-3.6 Cost Share Requirement 

Attachment 1 Supporting Documentation for Public Hearing and Advisory 

Council Participation 

Tennessee – State Plan on Aging 2014 - 2018 260
Exhibit F-1 

PSA: ( ) Original, Dated: 

Plan Period: ( ) Update, Dated: 

Public Hearings on Area Plan

A. PUBLIC HEARING INFORMATION 

Date(s) of Public Hearing

Time(s) when hearing was 

held

Place(s) where hearing was 

held

Was Place Accessible?

Type of Notice(s) or

Announcement(s) 

Date(s) of Notices or

Announcements (attach 

copy)

B. ATTENDANCE* 

County # of Advisory 

Council Members 

from County

Total from

County**

Total # Advisory Council

Members in column 2

Total Attendance*

* Do not include AAAD staff in Public Hearing attendance 

** Include Advisory Council Members in column 3 so that the Total Attendance reflects 

everyone in attendance. 

C. AGENDA & ANNOUNCEMENTS 

Attach a copy of the agenda. See P&P manual for required agenda topics. Attach one 

example of each type of notice sent out and describe who notices were sent to. If the 

AAAD is requesting a waiver for any reason, the agenda and announcement must 

include a statement that a waiver is being requested. 

D. DESCRIPTION 

Include any other information about the Public Hearing. Mention any extenuating 

circumstances that affected attendance (weather, high proportion of sickness, etc.).

Tennessee – State Plan on Aging 2014 - 2018 261
E. SUMMARY of PUBLIC COMMENTS 

 Opportunity must be provided for comments on goals, budgets, and waivers. 

F. SUMMARY of CHANGES 

List changes made in the plan as a result of comments made at public hearing(s). 

Tennessee – State Plan on Aging 2014 - 2018 262
Exhibit F-2 

PSA: ( ) Original, Dated: 

Plan Period: ( ) Update, Dated: 

Advisory Council Participation in the Area Plan Process

Describe how the Area Agency Advisory Council was involved in the development of the 

area plan. 

1. Date(s) when the Area Plan was reviewed by the Advisory Council. 

2. Attach an agenda of the Area Plan review meeting or describe the review process. 

3. List of Advisory Council members in attendance at the review meeting or who were 

actively involved in the review process. 

4. Provide a summary of comments made by advisory council members about the 

completed plan.

5. Summary of Changes. List changes made in the plan as a result of comments made at 

Advisory Council review. 

Tennessee – State Plan on Aging 2014 - 2018 263
Exhibit F-3.1 

PSA: ( ) Original, Dated: 

Plan Period: ( ) Update, Dated: 

Request for Waiver for FY ____ 

DIRECT PROVISION OF SERVICE 

1. AAAD: __________________________________________________________ 

2. Direct Service to be Provided by AAAD: (Please use a separate waiver request form 

for each service to be provided directly. 

3. List all agencies in PSA now providing this service and the extent that each is 

providing service (funding level and area served). 

 

a.

 b. 

c.

4. Based on your responses in item 3, explain how the AAAD determined that the 

current level of service available is inadequate to meet the need. 

5. Explain how this service is directly related to the AAAD’s administrative function.

6. If service of comparable quality can be provided more economically by the AAAD, 

please document by providing an analysis which includes: 

a. costs comparison; 

 b. quality comparison; 

c. method by which the analysis was conducted. 

7. Explain the AAAD plan to phase out the direct provision of this service an to assure 

adequate service provision through a contracted provider agency in the PSA. 

Tennessee – State Plan on Aging 2014 - 2018 264
8. Attachments: At the end of Request for Waiver(s) attach the following items. 

a. List all agencies, providers, and individuals that received personal notice of public 

hearings (attach copy of letter sent). 

b. List all publications which carried public notice of public hearings and indicate 

circulation of each. (Attach a copy of notice). 

c. Record of public hearings. The record shall detail all written and oral testimony 

regarding the Area Agency on Aging and Disability’s intention to request the 

waiver specified above. 

SIGNATURES 

_________________________________ _________________ 

AAAD Director Date 

_________________________________ _________________

Chief Administrative Officer of Grantee Agency Date 

 

_________________________________ _________________

Advisory Council Chairperson Date 

Tennessee – State Plan on Aging 2014 - 2018 265
Exhibit F-3.2 

PSA: ( ) Original, Dated: 

Plan Period: ( ) Update, Dated: 

Request for Waiver for FY ____ 

REQUIRED MINIMUM EXPENDITURES FOR PRIORITY SERVICE

1. AAAD: __________________________________________ 

2. Service Category: ________________________________________ 

3. Required Minimum Percentage for this Service: ______% 

4. Required minimum expenditure for this priority service using the required minimum 

percentage: $ _________________ 

5. Actual expenditure of Title III (federal funds only) for this service during the past 

fiscal year: $ _________________ 

6. Expenditure amount requested under this waiver $ _________________ 

7. Justify the request for waiver by explaining the: 

a. Projected impact on other services, using documented facts and figures (attach 

documentation); 

b. Projected impact on this service, using documented fact and figures (attach 

documentation), and

c. Projected impact on level of service need and availability throughout the PSA. 

8. Outline AAAD plan for achieving the required minimum funding level by the next 

fiscal year. 

9. Attachments: At the end of Request for Waiver(s) attach the following items. 

a. List all agencies, providers, and individuals that received personal notice of 

public hearings (attach copy of letter sent). 

Tennessee – State Plan on Aging 2014 - 2018 266
b. List all publications which carried public notice of public hearings and 

indicate circulation of each (attach a copy of notice). 

c. Record of public hearings. The record shall detail all written and oral 

testimony regarding the Area Agency on Aging and Disability’s intention to 

request the waiver specified above. 

SIGNATURES 

_________________________________ _________________ 

AAAD Director Date 

_________________________________ _________________

Chief Administrative Officer of Grantee Agency Date 

 

_________________________________ _________________

Advisory Council Chairperson Date 

Tennessee – State Plan on Aging 2014 - 2018 267
Exhibit F-3.3 

PSA: ( ) Original, Dated: 

Plan Period: ( ) Update, Dated: 

Request for Waiver for FY ____ 

PROVISION OF PRIORITY SERVICE 

1. AAAD: _____________________________ 

2. Priority Service to be Waived: ___________________________________ 

3. List all agencies in PSA now providing this service and the extent that each is 

providing service (funding level and area served). 

a.

b. 

c.

4. Explain how the need for this service by targeted population is being met throughout 

the PSA, and how the AAAD evaluated the ability of current provider agencies to 

meet that need. 

5. Attachments: At the end of Request for Waiver(s) attach the following items. 

a. List all agencies, providers, and individuals that received personal notice of 

public hearings (attach copy of letter sent). 

b. List all publications which carried public notice of public hearings and 

indicate circulation of each. (Attach a copy of notice). 

c. Record of public hearings. The record shall detail all written and oral 

testimony regarding the Area Agency on Aging and Disability’s intention to 

request the waiver specified above. 

SIGNATURES 

________________________________ __________________ 

AAAD Director Date 

Tennessee – State Plan on Aging 2014 - 2018 268
________________________________ __________________

Chief Administrative Officer of Grantee Agency Date 

 

________________________________ __________________

Advisory Council Chairperson Date 

Tennessee – State Plan on Aging 2014 - 2018 269
Exhibit F-3.4 

PSA: ( ) Original, Dated: 

Plan Period: ( ) Update, Dated: 

Request for Waiver for FY ____ 

NUTRITION SITE 

AREA AGENCY: COUNTY: 

NAME AND ADDRESS OF 

NUTRITION SITE: 

 

 

1. Average Number of Congregate Meals Served 

 Daily During Last Quarterly Reporting Period 

2. Average Number of Home-Delivered Meals Sent 

 Daily from Site (Last Quarterly Reporting Period) 

3. Explain why the nutrition site’s combined average of congregate and home-delivered 

meals is below 20. 

4. Provide documentation of outreach and publicity activities undertaken to promote 

nutrition site attendance. Include in the documentation when the activity was 

conducted, who conducted the activity, and the number of potentially eligible persons 

contacted. 

5. List all costs involved in keeping the site open, e.g. site manager’s salary, rent, 

utilities, and insurance. 

6. Discuss possibility of merging site with another nutrition site. How close is the 

nearest site? Do participants have their own transportation to the site or are they 

transported by other provider agencies? 

Attach additional pages as necessary. 

Tennessee – State Plan on Aging 2014 - 2018 270
SIGNATURES 

 ________________ 

Area Agency Director Date

________________________________ __________________

Chief Administrative Officer of Grantee Agency Date 

 

________________________________ __________________

Advisory Council Chairperson Date 

Tennessee – State Plan on Aging 2014 - 2018 271
Exhibit F-3.5 

PSA: ( ) Original, Dated: 

Plan Period: ( ) Update, Dated: 

Request for Waiver for FY ____ 

STATE RULE, REGULATION OR POLICY REQUIREMENT 

1. AAAD: ____________________________ 

2. State Rule, Regulation and/or Policy for which waiver is requested: 

3. Reference Location and Number of Specific Rule, Regulation or Policy: 

4. Give full justification for this waiver request by documenting all efforts of the AAAD 

to meet the requirement and specific barriers to meeting the requirements. 

5. Outline steps the AAAD will take to meet the requirements, giving specific dates of 

accomplishment for each step. 

SIGNATURES: 

____________________________________ _______________ 

AAAD Director Date 

____________________________________ _______________ 

Chief Administrative Officer of Grantee Agency Date 

 

___________________________________ _______________ 

Advisory Council Chairperson Date 

Tennessee – State Plan on Aging 2014 - 2018 272
Exhibit F-3.6 

PSA: ( ) Original, Dated: 

Plan Period: ( ) Update, Dated: 

Request for Waiver FY ______ 

COST SHARE REQUIREMENT 

1. List Service(s) for which cost share waiver is requested. 

2. Check below the basis for waiver request. 

___ a. A significant proportion of persons receiving the Older Americans Act 

services listed above have incomes below 200% of the Federal Benefit 

Rate. 

___ b. Cost sharing would be an unreasonable administrative or financial burden 

on the area agency. 

3. Justify the request for waiver based on the proportion of low-income individuals 

participating in services affected by cost share. 

4. Justify the request for waiver explaining the negative impact of cost share on area 

agency administration or financial responsibilities. 

5. Attachments: At the end of Request for Waiver(s) attach the following items: 

a. List all agencies, providers, and individuals that received personal notice of 

public hearings (attach copy of letter sent). 

b. List all publications which carried public notice of public hearings and 

indicate circulation of each. (Attach a copy of notice.) 

c. Record of public hearings. The record shall detail all written and oral 

testimony regarding the area agency’s intention to request the waiver specified 

above. 

SIGNATURES 

________________________________________ _______________

AAAD Director Date 

Tennessee – State Plan on Aging 2014 - 2018 273
________________________________________ _______________

Chief Administrative Officer of Grantee Agency Date 

________________________________________ _______________

Advisory Council Chairperson Date 

Tennessee – State Plan on Aging 2014 - 2018 274
ATTACHMENTS

1. Public Hearing Documents 

2. 

Tennessee – State Plan on Aging 2014 - 2018 275
Part G: FINANCIAL PLAN

Older Americans Act 

(NOTE: This summary does not include ALL financial or allotment references in the OAA)

Section 306 AREA PLANS

(a)(2) provide assurances that an adequate proportion, as required under section 307(a)(2), of the 

amount allotted for part B to the planning and service area will be expended for the delivery of 

each of the following categories of services—

(A) services associated with access to services (transportation, health services (including mental 

health services) outreach, information and assistance, (which may include information and 

assistance to consumers on availability of services under part B and how to receive benefits under 

and participate in publicly supported programs for which the consumer may be eligible) and case

management services); 

(B) in-home services, including supportive services for families of older individuals who are 

victims of Alzheimer’s disease and related disorders with neurological and organic brain 

dysfunction; and 

(C) legal assistance; and assurances that the area agency on aging will report annually to the State 

agency in detail the amount of funds expended for each such category during the fiscal year most 

recently concluded

Section 315 CONSUMER CONTRIBUTIONS 

(a)(5) (Cost Sharing) REQUIREMENTS.—If a State permits the cost sharing described in 

paragraph (1), such State shall require each area agency on aging in the State to ensure that each 

service provider involved, and the area agency on aging, will—

(a)(5)(B) establish appropriate procedures to safeguard and account for cost share payments; 

(a)(5)(C) use each collected cost share payment to expand the service for which such payment 

was given; 

(b)(4) (Voluntary Contributions) REQUIRED ACTS.—The area agency on aging shall ensure 

that each service provider will—

(A) provide each recipient with an opportunity to voluntarily contribute to the cost of the service; 

(B) clearly inform each recipient that there is no obligation to contribute and that the contribution 

is purely voluntary; 

(C) protect the privacy and confidentiality of each recipient with respect to the recipient’s 

contribution or lack of contribution; 

(D) establish appropriate procedures to safeguard and account for all contributions; and 

(E) use all collected contributions to expand the service for which the contributions were given 

and to supplement (not supplant) funds received under this Act.

Section. 721. PREVENTION OF ELDER ABUSE, NEGLECT, AND EXPLOITATION

(a) ESTABLISHMENT.—In order to be eligible to receive an allotment under section 703 from 

funds appropriated under section 702 and made available to carry out this chapter, a State agency 

shall, in accordance with this section, and in consultation with area agencies on aging, develop 

and enhance programs to address elder abuse, neglect, and exploitation. 

Exhibit Number Title of Exhibit 

G-1 Financial Report File 

Tennessee – State Plan on Aging 2014 - 2018 276
Tennessee – State Plan on Aging 2014 - 2018 277
TCAD Disaster Operations Guide

DISASTER OPERATIONS GUIDE 

Tennessee Commission on Aging and Disability 

EMERGENCY SUPPORT FUNCTIONS 

ESF 5: INFORMATION and PLANNING 

Purpose 

The purpose of the Tennessee Emergency Management Agency (TEMA) Emergency 

Support Function (ESF) 5, is to gather and analyze information to determine the extent of 

an emergency and implement Tennessee’s Emergency Preparedness Plan for the Aging 

Services Network. 

Concept of Operations 

Tennessee has nine designated planning and service areas known as Area Agencies on 

Aging and Disability. Each Area Agency will gather information and report the extent of 

the emergency to the (TCAD) Emergency Services Coordinator (ESC). The ESC will 

relay information to TEMA. 

Mission 

The mission of TCAD is to identify and describe the availability of resources and 

services that can be accessed in an emergency and the location of persons over the age of 

60 and those individuals age 18 and older with a disability. 

ESF 5 Responsibilities

a. TCAD provides an ESC to the State Emergency Operations Center (SEOC).

b. The ESC shall comply with requirements of the ESF. 

ESF 6: HUMAN SERVICES 

Purpose 

The purpose of this ESF 6 is to provide emergency shelter in senior centers, with the 

senior center director acting as coordinator for their center, their participants, and their 

contractors, in cooperation with TEMA, county mayors, Red Cross and other disaster 

agencies to the extent needed and within the limits of available resources. Focus of the 

assistance will be directed toward the elderly and persons age 18 or older with a 

disability. 

Tennessee – State Plan on Aging 2014 - 2018 278
TCAD Disaster Operations Guide

Concept of Operations 

The Tennessee Commission on Aging and Disability (TCAD) will utilize there resources 

across the state to assist with ESF 6 duties in a disaster. 

ESF 6 services which may be employed, depending on the need, include the following: 

a. Temporary shelter in Senior Centers 

b. Helping with mass feedings 

c. Helping with evacuation 

d. Use of facilities as temporary morgues 

e. Counseling and Advocacy 

f. Information and Referral 

g. Legal Services 

h. Senior Volunteers 

i. Transportation 

j. Special Needs Transportation 

k. Centralized nutrition sites 

l. Home–delivered meals 

m. Homemaker services 

ESF 8: HEALTH 

 

Purpose 

The purpose of this Emergency Support Function 8 is to provide supplemental

homemaker services and information and referral services to regional and local areas. 

Concept of Operations 

In the event of an emergency which requires the involvement of TCAD, the ESC 

coordinator and the Area Agency Directors will act as coordinator in the area where the 

emergency occurs. The Senior Center Director will act as coordinator for their center, 

their participants, and their contractors, in cooperation with TEMA, County Mayors, Red 

Cross and other disaster agencies to the extent needed and within the limits of available 

resources. The Tennessee Emergency Preparedness Plan for the Aging Services Network 

will be implemented. 

ESF 8 Mission 

a. The TCAD ESC will respond to the SEOC. 

b. Area Agencies on Aging and Disability and Senior centers where the disaster 

occurs will report to TCAD ESC. 

c. The TCAD ESC will support the mission of the State of Tennessee. 

Note: Additional TCAD emergency management information may be found in the 

Tennessee Commission on Aging and Disability Continuity of Operations Plan (COOP) 

and Chapter 13 of the TCAD Policies and Procedures Manual. 

Tennessee – State Plan on Aging 2014 - 2018 279
Tennessee Commission on Aging and Disability 

CONTINUITY of OPERATIONS PLAN (COOP) 

CONCEPT OF OPERATIONS 

I. Objectives and Specifics 

The objective of this plan is to ensure that a viable capability exists to continue essential 

agency functions across a wide range of potential emergencies, specifically when the 

primary facility is either threatened or inaccessible. The specifics of this objective 

include: 

A. Protecting essential facilities, equipment, records, and other assets; 

B. Reducing disruptions to operations; 

C. Identifying and designating principals and support staff to be relocated; 

D. Facilitating decision-making for execution of the Plan and the subsequent conduct 

of operations; and 

E. Achieving a timely and orderly recovery from the emergency and resumption of 

full service to all older Tennesseans. 

II. Planning Considerations and Assumptions 

In accordance with Federal guidance and emergency management principles, a viable 

COOP capability must: 

A. Be maintained at a high-level of readiness; 

B. Be capable of implementation both with and without warning; 

C. Be operational no later than three hours after notification; and 

D. Maintain sustained operations in an alternate facility for up to 30 days, if 

necessary. 

Tennessee’s elder population is rapidly increasing and placing greater demands on the 

network of social service agencies. Following a disaster, the burden placed on the aging 

network becomes larger as older adults who ordinarily are self-sufficient, turn to local 

agencies for assistance and guidance. 

The function of state, regional, and local agencies in disaster preparedness, response, 

recovery, and mitigation procedures is to address and meet the needs of older citizens 

through the coordination of mutual assistance. Cooperation and coordination in the aging 

network ensures all agencies will provide effective disaster relief services. The 

Continuity of Operations Plan encompasses agency responsibilities in the event of a 

disaster, natural or manmade, and its impact on older persons. During times of disaster 

emergency preparedness procedures will take precedence over normal duties. 

Tennessee – State Plan on Aging 2014 - 2018 280
Tennessee COOP 2

The COOP will be reviewed and updated annually reflecting the changes in department 

and emergency management procedures. 

Planning Considerations 

In the event a major or catastrophic event, natural or manmade, such as earth quakes, 

tornadoes, floods, civil disturbances, contractual disputes, epidemics, massive migrations, 

fires, nuclear power plant accidents, train derailments, terrorism, bio-terrorism and 

hazardous materials have occurred: 

A. The first 72 hours are the most critical for all Mass Care functions; 

B. The Commission directs the Area Agencies on Aging to implement their 

Continuity of Operations Plan and, in turn, the AAAD directs the Local Service 

Providers to implement their Plans; 

C. The ESC or alternate completes the call-down procedures to the Area Agencies on 

Aging and Disability and/or Local Service Providers in the potential impacted 

area; 

D. Area Agencies on Aging and Disability and Local Service Providers will call 

down or home visit all at risk, in-home, community based, older consumers in the 

potential impacted area; 

E. Area Agency on Aging and Disability and Local Service Provider personnel will 

ensure the services to their consumers will not be interrupted and will assist, if 

possible, at special needs shelters; and 

F. Ensure delivery of shelf stable meals for consumers who remain in their homes. 

Assumptions 

This plan will be implemented when emergency conditions are apparent. This will allow 

response and recovery actions to be implemented quickly and efficiently. In the event of 

a major or catastrophic event, natural or manmade, the State Emergency Operations 

Center will be fully activated and the following will occur: 

A. The Governor issues an Executive Order declaring a state of emergency. This 

order will direct Tennessee Emergency Management (TEMA) to implement 

Tennessee’s Comprehensive Emergency Management Plan and, if necessary, the 

Continuity of Operations Plan; 

B. The Governor requests activation of the Federal Response Plan. The Federal 

Emergency Management Agency (FEMA) coordinates and deploys federal 

resources to the State Emergency Operations Center; and 

C. The Governor requests federal disaster assistance to supplement state and local 

emergency resources. 

Agency’s Capacity and Response Capability 

A. Area Agencies and Local Service Providers have existing memorandums of 

agreement with neighboring counterparts to assist with providing services in the 

event they are overwhelmed; 

B. There are a number of identified service provider personnel who are available for 

shelter management training; 

Tennessee – State Plan on Aging 2014 - 2018 281
Tennessee COOP 3

C. Service provider personnel to assist with staffing of special needs shelters, if 

possible; 

D. Area Agency on Aging and Disability Trained staff throughout the state available 

to staff Human Needs Assessment Teams, Community Relations teams and 

Disaster Recovery Centers; 

E. Currently there are a number of volunteers throughout the state who can assist in 

recovery efforts on behalf of older Tennesseans disaster victims from the 

following programs: Adult Day Care, Advisory Council/Board membership, 

Clerical/administrative, Companionship, Congregate Meals, Consumer 

Education/counseling, Counseling, Education, TNVOCAD, Friendly visitation, 

Fundraising, Health promotion, Home delivered meals, Homemaker, Home 

repair/chore, Information and referral, Intergenerational, Legal assistance, 

Telephone reassurance, Transportation, TRA, Red Cross, Salvation Army, 211 

(the 211 helpline system has the capability to accept calls for older Tennesseans 

who may need assistance). 

Computer Network Systems Capability 

A. Servers are backed fully on a daily basis. 

B. The latest weekly copy of the full backup is stored offsite servers can be restored 

by using the full backup. 

C. Restoration of operating environment would consist of simply reloading backups 

and restarting. If any equipment is destroyed, the equipment can be replaced, 

reloaded with backups and restarted. 

D. Periodic testing has ensured the process works properly. 

III. COOP Execution 

Emergencies, or potential emergencies, may affect the ability of TCAD to perform its 

mission essential functions from the Headquarters. The following could mandate the 

activation of the TCAD Plan. 

A. TCAD headquarters is closed to normal business activities as a result of an event 

(whether or not originating in the Headquarters office) or credible threats of 

action would preclude access or use of the office and the surrounding area. 

B. The area is closed to normal business activities as a result of a widespread utility 

failure, natural disaster, significant hazardous material incident, civil disturbance, 

or terrorist or military attack(s). Under this scenario there could be uncertainty 

regarding whether additional events such as a secondary explosion or cascading 

utility failure could occur and TCAD will have to activate this plan. 

In an event so severe that normal operations are interrupted, or if such an incident 

appears imminent and it would be prudent to evacuate the area as a precaution, the 

Emergency Service Coordinator Officer in consultation with the Executive Director 

will activate the TCAD COOP Plan. TCAD will be composed of selected essential staff 

members who possess the knowledge, skills and abilities to perform TCAD mission 

essential functions. This group will conduct operations remotely from the alternate 

Tennessee – State Plan on Aging 2014 - 2018 282
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facility and will be responsible for continuing mission essential functions of TCAD for a 

period up to 30 days pending regaining access to the Agency’s office.

The alternate facility will be a designated fixed site or a leased facility that will 

accommodate the Relocation Group. If the headquarters office is inaccessible the 

alternate facility will be utilized. 

When the headquarters office is again ready for occupancy, the performance of the 

mission essential functions will be transitioned back to the headquarters office. 

Such incidents could occur with or without warning and during duty or non-duty hours. 

Whatever the incident or threat, the TCAD COOP Plan will be executed in response to a 

full-range of disasters and emergencies, to include natural disasters, terrorist threats and 

incidents, and technological disruptions and failures. 

It is expected that, in most cases, the Emergency Service Coordinator will receive a 

warning of at least a few hours prior to an incident. Under these circumstances, the 

process of activation would normally enable the partial, limited, or full activation of The 

TCAD COOP Plan with a complete and orderly alert, notification of all personnel, Area 

Agencies on Aging and Disability and Local Service Providers. 

When an emergency occurs without warning, the process becomes less routine, and 

potentially more serious and difficult. The ability to execute the TCAD COOP Plan 

following an incident that occurs with little or no warning will depend on the severity of 

the incident’s impact on the physical facilities and whether personnel are present in the 

TCAD office or in the surrounding area. 

Positive personnel accountability throughout all phases of emergencies, to include the 

COOP, is of utmost concern, especially if the emergency occurs without warning, during 

duty hours. TCAD Evacuation Plans should include accountability of personnel. 

IV. Emergency Procedures 

When an emergency occurs within Tennessee affecting the health and safety of 

Tennessee’s older persons, the Agency will enact the following procedures as support 

agency to the State’s Comprehensive Emergency Management Plan and assists the 

impacted local AAAD. Each office within the Agency may be called upon to assist at the 

Agency, County Emergency Operations Center and in the field. A key component is the 

call down procedures to the Local Service Providers at risk in a disaster or emergency. 

If the emergency is a tornado, notices of various levels are announced by the National 

Weather Service or additional information and/or actions are taken by the State 

Emergency Operations Center, the following describes the flow of action to be taken by 

Agency staff members. The Tennessee Emergency Management Agency (TEMA) 

monitors all state activities in the state 24 hours, 7 days a week. All Emergency Services 

Coordinators and alternates are on call 24 hours, 7 days a week. 

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If the emergency is a terrorism or bio-terrorism attack, there will possibly not be a 

warning prior to the attack. In this case the TEMA will go immediately to full activation. 

TEMA will be the lead agency in the case of an Earthquake, tornado, nuclear emergency, 

terrorism or bio-terrorism attack. 

When an emergency is anticipated: 

A. The (TEMA), State Emergency Operations Center, and State Emergency 

Response Team are activated. 

B. The Aging Emergency Services Coordinator receives notification via pager 

System or other medium (cell phone, home phone and e-mail). 

C. At each level of activation, the ESC notifies Tennessee Commission on Aging 

and Disability’s Executive Director, who then informs the Area Agency on Aging 

and Disability Emergency Coordinating Officers. 

D. In the event of headquarters having to relocate to an alternate facility, the 

relocation group will be activated. 

E. In the event of the Area Agency on Aging and Disability having to relocate to an 

alternate facility, the Agency’s relocations group will be activated.

F. Depending on the level of activation at the State Emergency Operations Center, 

the following may be required: 

Level 3 Activation: Primarily informational; State Emergency Operations Center 

and ESC monitors situation. Division of Emergency Management makes 

notifications to key personnel in selected Emergency Support Functions via 

conference calls, pages, E-mails and phone calls. 

Level 2 Activation: Partial activation; State Emergency Operations Center and all 

Emergency Support Functions are activated. The State Emergency Response 

Team members are requested to report to SEOC. Emergency Services 

Coordinator and/or Alternate Emergency Service Coordinator Officer will report 

to State Emergency Operations Center, as needed. 

a. Formal message documentation begins. 

b. The Emergency Service Coordinator begins call downs to Area Agency on 

Aging and Disability Emergency Coordinating Officers, who in turn will 

begin call downs to the Local Service Provider Emergency Coordinating 

Officer in potentially affected areas and updates on a regular basis. 

c. The ESC, Alternate ESC will notify and update, TCAD headquarters, in 

order for them to notify field staff in potential impacted areas. 

Level 1 Activation: Full activation; State Emergency Operations Center is 

operating 24 hours a day, 7 days a week. In the event of a major or catastrophic 

event, terrorist attack or bio-terrorism, the State Emergency Operations Center 

will immediately be activated at this level. The following will occur: 

a. Response and recovery efforts begin. 

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Tennessee COOP 6

b. Federal Emergency Management Agency (Federal Emergency Response 

Team) involvement is anticipated. 

c. Selected ESC staff members will report, if requested, to State Emergency 

Operations Center and provide staffing as long as needed. 

d. Normal Disaster Preparedness and Operations daily activities will cease 

during any emergency or disaster event. 

e. The TCAD Emergency Service Coordinator or Alternate Emergency 

Services Coordinator completes or notifies a designee within the 

department to complete the Department’s Preparation to Implement 

Emergency Relief Measures Once approved by the Executive Director, 

Assistant Director or designated the following occurs: 

1. Area Agency on Aging Emergency Services Coordinators contacts 

Local Service Providers. 

2. Local Service Providers implement their COOP Plan and call 

down to clients as required. 

3. After call downs have been completed, Local Service Providers 

call Area Agency on Aging Emergency Coordinating Officers with 

results of call downs of operational activities. 

4. Area Agency on Aging Emergency Coordinating Officers contact 

the Department’s Emergency Coordinating Officer with results of 

call downs and operational activities. 

5. If the event occurs during business hours, staff will begin Agency 

shutdown and evacuation procedures. Special instructions will be 

given as required. 

6. If the event occurs outside of business hours, staff will be given 

instructions by their supervisor if and when they should report to 

the Agency to implement shutdown procedures. Staff should call 

the agency’s main phone number and/or their voice mail for any 

messages regarding the closing and reopening of headquarters. 

Staff should also monitor local media for latest updates. 

7. In the event of a terrorist or bio-terrorism attack in the Nashville 

Tennessee area and has impacted the headquarters office and 

causes the immediate evacuation of headquarters, the Department 

will immediately activate its COOP Plan to relocate to an alternate 

site, if indicated. 

Post-Disaster Response/Recovery 

A. Area Agencies on Aging and Disability and Local Service Providers will call 

down or home visit all at risk, in-home, community based, older Tennessee clients 

in the potential impacted area; 

B. Area Agency on Aging and Disability and Local Service Provider personnel will 

ensure the services to their clients will not be interrupted and will assist, if 

possible, at special needs shelters; and 

C. Ensure delivery of shelf stable meals for clients who remain in their homes. 

Tennessee – State Plan on Aging 2014 - 2018 285
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V. Area Agency on Aging and Disability Office Roles – Key Staff 

The Area Agency on Aging and Disability provides staffing of the County Emergency 

Operations Center, as needed. 

 

Note: Normal Disaster Preparedness and Operations daily activities will cease 

during any emergency or disaster event. 

Area Agency on Aging and Disability or Local Service Provider’s office may be advised 

to remain at or return home pending further instructions. A COOP activation will not, in 

most circumstances, result in a change of duty location affecting pay and benefits. 

RESPONSIBILITIES OF KEY TCAD STAFF 

A. Executive Director or Back-up to Emergency Services Coordinator shall: 

1. Be fully aware of all the responsibilities of the ESC. 

2. Be well versed in the Area Agency's Emergency’s Plan.

3. Coordinating Component’s Disaster Preparedness and Recovery Plans.

4. Keep Executive Director and/Commission members informed about Area 

Agency Disaster Preparedness and Recovery Plans. 

5. Notify TCAD Executive Director of Agency's plans at time of impending 

disaster. 

6. Execute responsibilities of Emergency Service Coordinator. 

7. Ensure that the Area Agency property insurance is adequate and up-todate. 

8. Facilitate release of funds, on a yearly basis, for any needed emergency 

and recovery purchases/supplies. 

B. MIS Director shall: 

1. Establish procedures for the shut-down of system server. 

2. Ensure that the designated staff is trained in all procedures. 

3. Maintain and convey to the ESC any MIS emergency preparation and 

planning decisions reached by AAAD.

4. Protect all Area Plan documents and files. 

5. Assist the ESC with the call-down of service providers. 

C. Fiscal Staff shall: 

1. Plan for all disk and hard copy back-up of fiscal operations, such as, fiscal 

records, accounting program data, and provider reports SAMS and Beacon 

reports, and monthly data and spreadsheets. 

2. Prioritize which records, ledgers, etc. must be packed and/or removed 

from the premises. Maintain hard copy list of the same, to become an 

attachment to this plan. 

3. Color code financial records to be packed/protected. 

4. Protect provider contract records and documents. 

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D. Support Staff shall: 

1. By June 1 of each year, check all boxes of recovery supplies to ensure 

contents are in working order and not outdated. Maintain an inventory of 

these supplies. 

2. Procure any needed/replacement supplies by June 1 of each year, once the 

list has been approved by the ESC and the Chief Fiscal Officer. 

E. Executive Assistant shall: 

1. Review and update on a yearly basis, the list of all Commission 

documents/files to be safeguarded in the event of an emergency/disaster. 

2. Protect all TCAD contracts. 

3. Assist the ESC in updating the staff Telephone Tree. 

4. Produce the Disaster I.D. Badges. 

F. Floor Wardens shall: 

Pack/protect file cabinets that include special program and special event 

materials, documents, contracts and computer disks. 

G. Director of Human Resources (with the assistance of ESC) shall: 

1. Include disaster preparation materials in each new staff person’s

orientation packet. 

2. Require each staff person, to fill out the TCAD Agency Personal/Family 

Disaster Preparedness Plan”. Update each plan yearly.

3. Develop a Telephone Tree, Utilize Experience Corps and ESC for disaster 

education outreach, prior to and during the Tornado Season. 

4. Utilize Red Cross, RSVP and TNVOAD volunteers to assist with support 

after a disaster. 

5. Staff members will compile a list of volunteers willing to assist in shelters, 

centers, etc. 

VI. Alternate Facilities 

The determination of an alternate facility will be based on the incident or threat. If TCAD 

headquarters only is inaccessible and there is no threat. 

VII. Mission Essential Functions 

It is important to establish priorities to ensure that the relocated staff can complete TCAD 

mission essential functions. All divisions and sections shall ensure that their essential 

functions can continue or resume as rapidly and efficiently as possible during relocation. 

Any function not considered essential will be deferred. 

VIII. Delineation of Mission Essential Functions 

It is important to establish priorities prior to an emergency to ensure that the relocated 

staff can complete TCAD mission essential functions. All Division/section heads shall 

ensure that their essential functions can continue or resume as rapidly and efficiently as 

possible during an emergency relocation. Any task not deemed essential must be deferred 

until additional personnel and resources become available essential functions. 

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Tennessee COOP 9

IX. Overview of Disasters

This section provides a brief overview of common disasters anticipated and conditions 

expected during a disaster, natural or manmade, such as floods, tornadoes, civil 

disturbances, contractual disputes, epidemics, massive migrations, fires, nuclear power 

plant accidents, train derailments, terrorism, bio-terrorism and hazardous materials. In the 

event of a disaster, the local county office of emergency management will determine if 

evacuation is necessary and how to proceed with the evacuation. 

Catastrophic disasters will require massive state and federal assistance, including 

immediate military involvement; major disasters will exceed local capabilities and 

require a broad range of state and federal assistance; and minor disasters will be within 

the response capabilities of local government and result in only a minimal need for state 

and federal assistance. Catastrophic or major terrorism and/or bio-terrorism attacks 

will require massive state and federal assistance, including immediate military 

involvement because of the nature of these attacks. 

1. Catastrophic Emergency Conditions 

The capabilities of state and political subdivisions to provide prompt and effective 

relief and recovery measures are overwhelmed by a catastrophic event; 

transportation is damaged and local transportation services are disrupted. There may 

be damage to commercial telecommunications and communication for government 

response and recovery will be impaired. Homes, public buildings, other facilities 

and equipment are destroyed or severely damaged. 

Debris makes streets and highways impassable. The movement of emergency relief 

supplies and resources are impeded. Public utilities are damaged. Many state, 

regional, and local emergency personnel are victims of the disaster, prohibiting 

them from performing emergency duties. Fires in urban and rural areas should be 

anticipated. 

After a disaster, numerous victims may be left homeless, injured and require social 

service assistance. Many victims will be in life-threatening situations requiring 

immediate rescue and medical care. There will be a shortage of supplies necessary 

for emergency survival. Hospitals, nursing homes, pharmacies and other 

health/medical facilities will be severely damaged or destroyed. Medical and health 

care facilities in operation will be overwhelmed with victims requiring medical 

attention and medical supplies and equipment will be in short supply. 

Damage to facilities, which generate, produce, use, store or dispose of hazardous 

materials could result in the release of such materials into the environment. Food 

processing and distribution capabilities will be severely damaged or destroyed. 

There will be prolonged disruption of energy sources and electric power failure. 

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2. Types of Disasters 

a. Tornados: Tornadoes are nature’s most violent storms. Spawned from 

powerful thunderstorms, tornadoes can cause fatalities and devastate a 

neighborhood in seconds. A tornado appears as a rotating, funnel-shaped cloud 

that extends from a thunderstorm to the ground with whirling winds that can 

reach 300 miles per hour. Damage paths can be in excess of one mile. 

b. Tornado Watch: Tornadoes are possible. Remain alert for approaching 

storms. Watch the sky and stay tuned to NOAA Weather Radio, commercial 

radio, or television for information. 

c. Tornado Warnings: A tornado has been sighted or indicated by weather 

radar. Take shelter immediately. 

d. Flooding: Floods are one of the most common hazards in the United States. 

Flood effects can be local, impacting a neighborhood or community, or very 

large, affecting entire river basins and multiple states. 

However, all floods are not alike. Some floods develop slowly, sometimes over 

a period of days. But flash floods can develop quickly, sometimes in just a few 

minutes and without any visible signs of rain. Flash floods often have a 

dangerous wall of roaring water that carries rocks, mud, and other debris and 

can sweep away most things in its path. Overland flooding occurs outside a 

defined river or stream, such as when a levee is breached, but still can be 

destructive. Flooding can also occur when a dam breaks, producing effects 

similar to flash floods. 

Be aware of flood hazards no matter where you live, but especially if you live in 

a low-lying area, near water or downstream from a dam. Even very small 

streams, gullies, creeks, culverts, dry streambeds, or low-lying ground that 

appears harmless in dry weather can flood. Every state is at risk from this 

hazard. 

e. Terrorism and/or Bio-Terrorism Attacks: Terrorism or bio-terrorism 

attacks may occur without warning and can impact elders and services delivered 

to them. 

f. Other Disasters: There are other disasters that may occur that are not 

weather related. Incidents such as train derailments, plane or major interstate car 

crashes, civil disturbances, contractual disputes, epidemics, massive migrations, 

fires, nuclear power plant accidents, and hazardous materials can impact elders 

and services delivered to them. 

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X. Warning Conditions

Upon receiving notification that a disaster has occurred or is about to occur, the Area 

Agency on Aging will respond in accordance with the Continuity of Operations Plan. 

Activation Phase: 

A. The notification procedure is facilitated for the aging network in the following 

manner: 

1. State level notification comes from the Division of Emergency Management 

to via ESC pager. The Emergency Services Coordinator and Alternate 

Emergency Service Coordinator are available by pager. The Emergency 

Services Coordinator (ESC) pager number is 1-800-841-7243. 

2. Regional level notification, depending on the nature and type of disaster, 

may come from TCAD to the Area Agency on Aging or from the Lead and 

Local Service Provider to the Area Agency on Aging, who in turn notifies 

TCAD. Local Service Providers may, in some instances, be the first to 

notify the aging network if the disaster originates in their county. 

Evacuation orders are issued at the local level by county emergency 

management requiring local coordination between the Area Agencies on 

Aging, Local Services and County Emergency Management. 

3. If evacuation becomes necessary, the State ESC Officer will assist with any 

coordination that may be needed between counties or regions for the 

evaluation and registration process at shelters. 

B. The alert phase requires two plans: 

1. During normal working hours; and 

2. After hours, weekends and holidays. Both plans include the following: 

 

a. The Emergency Service Coordinating Officer and Alternate 

Emergency Service Coordinating Officer maintain current listings of 

home addresses, home telephone numbers, work numbers, cell phone 

numbers, and pager numbers of key Area Agency on Aging staff. 

b. The Emergency Service Coordinating Officer or Alternate 

Emergency Service Coordinating Officer alerts TEMA and TCAD’S 

Executive Director on disaster status and begins preparation for 

potential mobilization. 

c. The Emergency Service Coordinating Officer or Alternate 

Emergency Service Coordinating Officer, in consultation with upper 

management, makes assessments as to the safety of the Agency’s 

facilities, equipment and records. 

d. The Emergency Service Coordinating Officer in consultation with 

the AAAD Director will notify the Agency Relocation Group to 

activate and start preparation for relocation in an event so severe that 

normal operations are interrupted, or if such an incident appears 

Tennessee – State Plan on Aging 2014 - 2018 290
Tennessee COOP 12

imminent and it would be prudent to evacuate the area as a 

precaution. 

C. Upon receiving a memorandum for Preparation to Implement Emergency Relief 

Measures and/or the Implementation of Emergency Relief Measures, the Area 

Agency on Aging notifies the Local Service Providers of the actions to be taken 

in the event of a disaster. 

XI. TCAD on Aging Support Activities 

TCAD, will work with the local County Emergency Management Office in order to 

provide support under the appropriate Emergency Support Functions (ESFs). The ESF 

concept groups agencies, based on common functions and activities, in a coordinated 

approach for responding to disasters. The Area Agency provides support under the same 

ESFs that TCAD is named under in the state recovery plan. These are ESF 5 (Information 

and Planning), 6 (Human Services), 8 (Health). 

XII. Direction and Control 

TCAD will pre-delegate authorities for making policy determinations and decisions. All 

such pre-delegations will specify what the authority covers, what limits may be placed 

upon exercising it, which (by title) will have the authority, and under what circumstances. 

This list will be an attachment. The Relocation Group Members are: 

Division/Office Position Title:

XIII. Hours of Operation for Alternate Facility 

TCAD will operate Monday through Friday, 8:00 am to 5:00 pm. In the event of the need 

for 24-hour, 7-day coverage of Helpline and the Technical Assistance for Volunteers line 

at the alternate facility, a schedule will be established for this purpose. 

XV. Alert and Notification 

In case the area is affected by the event, the COOP Plan will be activated. Upper 

management will notify department staff members of the potential emergency. 

1. If the event occurs during business hours, staff will begin Agency shutdown and 

evacuation procedures. Special instructions will be given as required. 

2. If the event occurs outside of business hours, staff will be given instructions by 

their supervisor if and when they should report to the Agency to implement 

Shutdown procedures (Attachment I – Telephone Tree). 

Staff should call the agency’s main phone number and/or check their voice mail for any 

messages regarding the closing and reopening of headquarters. Staff should also monitor 

local media for latest updates. In the event of a terrorist or bio-terrorism attack in the 

Nashville TN area and has impacted The Agency’s office and causes the immediate 

evacuation of the TCAD office the Agency will immediately activate its COOP Plan to 

relocate to an alternate site, if indicated. 

Tennessee – State Plan on Aging 2014 - 2018 291
Tennessee COOP 13

Attachment 1

PHONE TREE for Managers and Supervisors

NAME HOME PHONE 

NUMBER and/or CELL

HOME E-MAIL 

ADDRESS

Tennessee – State Plan on Aging 2014 - 2018 292
Attachment C 

Intrastate Funding Formula Requirements 

Tennessee – State Plan on Aging 2014 - 2018 293
Intrastate Funding Formula 

Y=(.35*(%60))+(.3*(%LI))+(.1*(%LIM))+.15*(%RUR))+.1*(%80)) 

Factors Weights 

Population Age 60 and Over 35%

Low Income Elderly 30%

Low Income Minority Elderly 10%

Elderly Living in Rural Areas 15%

Population Age 80 and Above 10%

How changes in the 2010 census affected the funds distributed to the nine districts: 

First Tennessee: +$20,900 

East Tennessee: +$81,800 

Southeast Tennessee: +$15,500 

Upper Cumberland: +$89,100 

Greater Nashville: -$105,500 

South Central Tennessee: -$106,600 

Northwest Tennessee: -$159,200 

Southwest Tennessee: +$116,400 

Memphis/Delta: +$47,600 

Tennessee – State Plan on Aging 2014 - 2018 294
RULES

OF

TENNESSEE COMMISSION ON AGING AND DISABILITY 

CHAPTER 0030-1-10

FINANCIAL MANAGEMENT STANDARDS AND PROCEDURES 

TABLE OF CONTENTS 

0030-1-10-.01 Intrastate Funding Formula 

0030-1-10-.01 INTRASTATE FUNDING FORMULA. 

(1) Federal funds received under Title III of the Older Americans Act shall be allocated to each of the nine 

area agencies on aging using the following formula: 

(a) Ten percent of the Title III funds for area agencies is designated for administration of area 

agencies on aging. From this amount each area agency is allocated an identical base sub-grant 

of $100,000 plus a pro rata share of the remaining funds. The pro rata share shall be equal to 

the percentage which reflects a given area agency’s portion of total state funds allocated to all 

area agencies by the state agency for nutrition services and senior centers in the state fiscal year 

immediately preceding the distribution of funds. 

(b) Ninety percent of the Title III funds for area agencies is allocated for services. This amount 

shall be distributed as follows: 

1. Thirty-five percent of the services allocation shall be distributed among the area agencies 

in proportion to each planning and service area’s share of the total number of elderly

persons (aged 60 and over) in the state. 

2. Thirty percent of the services allocation shall be distributed among the area agencies in 

proportion to each planning and service area’s share of the total number of elderly

persons with income below 100% of the poverty level established by the Office of 

Management and Budget. 

3. Ten percent of the services allocation shall be distributed among the area agencies inproportion 

to each planning and service area’s share of the total number of minority elderly persons with 

income at or below 100% of the poverty level established by the Office of Management and 

Budget. 

4. Fifteen percent of the services allocation shall be distributed among the area agencies in 

proportion to each planning and service area’s share of the total number of elderly living 

in rural areas (as defined by the Census Bureau). 

5. Ten percent of the services allocation shall be distributed among the area agencies in 

proportion to each planning and service area’s share of the total number of elderly

persons who are age 80 and above. 

(c) The Commission shall review and update the Title III formula as often as a new State Plan is 

submitted to the Administration on Aging. 

(d) The source of data for all formula factors listed in sub-paragraph (1)(b) above shall be the most 

recent decennial federal census of population. 

October, 2006 (Revised)

Tennessee – State Plan on Aging 2014 - 2018 295
Attachment D 

State of Tennessee Policy of Non-Discrimination 

Tennessee – State Plan on Aging 2014 - 2018 296
STATE OF TENNESSEE 

POLICY OF NON-DISCRIMINATION 

Pursuant to the State of Tennessee’s policy of non-discrimination, the Tennessee Commission on 

Aging and Disability does not discriminate on the basis of race, sex, religion, color, national or 

ethnic origin, age, disability, or military service in its policies, or in the admission or access to, or 

treatment or employment in, its programs, services, or activities. 

Equal Employment Opportunity/Affirmative Action inquiries or complaints should be directed to 

the Tennessee Commission on Aging and Disability EEO/AA Officer, Nashville, Tennessee 

37243-0860, 615-741-2056. ADA inquiries or complaints should be directed to the Tennessee 

Commission on Aging and Disability ADA Coordinator at the same location. 

Assistance for those with speech, hearing and visual impairments is available through the 

Tennessee Relay Center at 1-800-848-0299. 

Tennessee Commission on Aging and Disability 

161 Rosa Parks Blvd. 

3

rd Floor 

Nashville, TN 37243 

(615)741-2056 telephone 

(615)741-3309 facsimile 

www.tn.gov/comaging

Tennessee – State Plan on Aging 2014 - 2018 297
Attachment E 

Demographic Data

Tennessee – State Plan on Aging 2014 - 2018 298
Demographics 

According to the 2010 Census, Tennessee’s population, 60 and over, increased 29.9% from the 

2000 Census, from 942,620 to 1,224,186. At the same time the population 85 and over increased 

22%, from 81,465 to 99,917. In the ensuing years since the 2000 census, while the total 

population of older Tennesseans (60+) has increased, the population has also shifted away from 

some of the more rural areas and toward metropolitan and micropolitani

areas of the state. 

According to the Office of Management and Budget, a micropolitan statistical area contains an 

urban core of at least 10,000, but less than 50,000, population. 

The funding formula requires that federal funds be distributed based on the proportion 

(percentage) of the age 60 and over population represented by each district, for 35% of the funds. 

Low income (income below 100% of poverty level) elderly comprise a 30% portion of the 

formula. Ten percent of the services portion of the formula is based on the percentage of low 

income minority elderly persons. Ten percent is based on all low income elderly persons, and 

15% is based on the proportion of elderly living in rural areas. Ten percent of the services 

allocation is based on the proportion in each planning area represented by frail elderly (80+). 

The factors and weighting of the formula are based in the requirements of the Older American’s 

Act. The goal of the formula is to target vulnerable populations while at the same time, providing 

needed services for those who are 60 and over. 

Tennessee – State Plan on Aging 2014 - 2018 299
PSA Persons 60+

2000

Percent 60+

2000

Persons60+

2010

Percent 60+

2010

First Tennessee 95,130 10.10% 121,679 9.940%

East Tennessee 189,775 20.15% 255,617 20.811%

Southeast 101,585 10.78% 132,460 10.820%

Upper

Cumberland

61,520 6.35% 81,974 6.69%

Greater 

Nashville

191,515 20.33% 264,717 21.624%

South Central 70,920 7.53% 89,883 7.234%

Northwest 52,920 5.62% 59,189 4.839%

Southwest 43,805 4.65% 53,244 4.349%

Aging 

Commission 134,875 14.32% 165,423 13.513%

Totals 942,045 100% 1,224,186 100%

Tennessee – State Plan on Aging 2014 - 2018 300
 

PSA Persons Age 60+

2010 Census

UT Data Center

Low Income 

Minority

65 +

American

Community Survey 

UT Data Center

Low Income 65+

American

Community Survey

UT Data Center

Estimated Rural

TN. Dept. of Health,

Bureau of Health

Statistics

Persons Age 80+

2010 Census

UT Data Center

Number Percent Number Percent Number Percent Number Percent Number Percent

FIRST 121,679 9.940% 376 1.868% 10,289 11.017% 35,220 10.838% 21,520 10.157%

EAST

255,617 20.881% 1,211 6.015% 17,365 18.594% 70,400 21.664% 43,864 20.703%

SE

132,460 10.820% 1,999 9.929% 9,371 10.034% 32,510 10.004% 23,612 11.144%

UC

81,974 6.696% 191 0.949% 7,970 8.534% 40,470 12.454% 13,473 6.359%

GNRC

264,717 21.624% 4,064 20.187% 15,716 16.828% 42,620 13.115% 44,080 20.805%

SC

89,883 7.342% 767 3.810% 6,942 7.433% 42,050 12.940% 15,659 7.391%

NW

59,189 4.835% 922 4.580% 5,816 6.228% 26,870 8.269% 11,099 5.239%

SW

53,244 4.349% 1,661 8.251% 6,328 6.776% 21,930 6.749% 9,576 4.520

ACMS

165,423 13.513% 8,941 44.411% 13,594 14.556% 12,890 3.967% 28,988 13.682%

TOTALS 1,224,186 100% 20,132 100.00% 93,391 100.00% 324,960 100% 211,871 100.00%

Tennessee – State Plan on Aging 2014 - 2018 301
Attachment F 

Statewide Comprehensive Needs Assessment 

Data and Analysis 

Regional Needs Assessment Reports 

Tennessee – State Plan on Aging 2014 - 2018 302
Needs Assessment

Content 

Introduction 

Purpose and Scope 

Impact of Baby Boomers 

Needs Assessment 

Aging and Disability Issues 

 Impact of Baby Boomers 

 What Works in the Community 

 Small Focus Groups 

 Conclusion 

 Copies of the Survey Instruments 

Stakeholders’ Meeting

TCAD Commission Meeting 

Regional Reports for the Area Agency on Aging and Disability 

First Tennessee Area Agency on Aging and Disability 

East Tennessee Area Agency on Aging and Disability 

Southeast Tennessee Area Agency on Aging and Disability 

South Central Tennessee Area Agency on Aging and Disability 

Upper Cumberland Area Agency on Aging and Disability 

Greater Nashville Area Agency on Aging and Disability 

Southwest Area Agency on Aging and Disability 

Northwest Area Agency on Aging and Disability 

Aging Council of the Mid-South Area Agency on Aging and Disability 

Tennessee – State Plan on Aging 2014 - 2018 303
Introduction 

During February and March 2013, the Tennessee Commission on Aging and Disability (TCAD) 

conducted a Listening Tour across the Tennessee in each of the nine (9) regions served by the 

Area Agencies on Aging and Disability (AAAD). The Listening Tour was conducted 

to allow community members to discuss the challenges facing the aging and disability 

population; 

to gather suggestions about addressing these challenges; and 

to provide input on what can be done to make programs and services more accessible, 

efficient, and effective. 

At each of the sites, attendees participated in the needs assessment by completing a survey 

focusing on: 

current aging and disability issues; 

issues faced by “baby boomers” as they age; and 

programs and services that are currently working in the community. 

Attendees also participated in small focus groups. Additional input was provided from three (3) 

meetings held in Nashville: 1) Stakeholders’ meeting held January 23, 2013; 2) the quarterly 

meeting of the Commission held February 5, 2013; and 3) public hearing held May, 2013. 

The comprehensive needs assessment consisted of results of the surveys, the small focus groups, 

the stakeholders’ meetings, review of literature regarding the differences between the current 

senior population and baby boomers, and a review of the previous data provided by the State 

Plan 2009-2013. The needs assessment was designed to aid in the development of the 

Tennessee State Plan on Aging 2014-2018 and to give policy makers pertinent information 

about trends and themes expected to evolve with the increasing aging population, especially in 

regard to emerging growth of the baby boomer population. 

Purpose and Scope 

The Listening Tour and needs assessment was designed to aid in the development of the 

Tennessee State Plan on Aging 2014-2018, but it was also intended to provide community 

members the opportunity to provide input about their needs, to identify emerging needs as the 

baby boomer population ages, and to ensure that programs and services are efficient and 

effective to meet current and future needs. The needs assessment was used to identify the 

current and future challenges that will be faced in providing services and programs to the aging 

population. From the identified challenges, the goals, objective, strategies and performance 

measures were developed. 

Tennessee Commission on Aging and Disability (TCAD) is celebrating its 50th anniversary. 

TCAD is taking the opportunity to use the data gathered from the needs assessment to review 

and assess its internal structure to ensure that the programs and services are cost effective and 

meet best practices. This effort will include identifying the competencies, knowledge, and skills 

needed for each position and to implement staffing patterns and job plans to match those 

Tennessee – State Plan on Aging 2014 - 2018 304
competencies, knowledge, and skills. Such a review might also include revisions to the Program 

and Policy Manual, monitoring tools, contract scope of service, and the data collection system. 

Impact of Baby Boomers 

The single largest factor impacting Tennessee’s aging programs and services will be the growth 

of the aging population of “baby boomers”. Baby boomers are defined as individuals who were 

born between 1947 and 1964. Currently, an estimated 75 million individuals are identified as 

baby boomers. In 2011, the first baby boomer reached the age of 65 and an estimated 10,000 

individuals reach the age of 65 every day. The 2010 Census for Tennessee reports that the 65 & 

over population represents 13.7% of Tennessee’s population as compared to the national rate of 

13.3%. In the next 15 years, an additional 1,245,064 individuals or 20% of Tennessee’s current 

population will reach the age of 65, representing a 65% increase. 

According to “10 Ways Baby Boomers Will Reinvent Retirement”, US News and World Report, 

February 16, 2010, “ baby boomers redefined each state of life as they passed through it.” 

Baby boomers: 

are living longer therefore retirement will last longer than their parents. 

will have to control their retirement funds by managing their investments. 

will continue to work as they need the income, the mental stimulation, and/or socialization. 

don’t see retirement as a withdrawal from activity, but a new adventure.

are the sandwich generation as they may be taking care of elderly parents, paying college 

tuition for the children, and/or taking care of their grandchildren. 

will have lower social security benefits. 

may retire with debt owing money on their mortgage, credit cards, and even college debt. 

As baby boomers age and live longer, the sheer number of aging individuals will impact all 

systems, such as, but not limited to, health care; health and fitness; nutrition; mobility/ 

transportation; income, investments, and financial security; housing and community/ 

neighborhood development; socialization opportunities; work force; leisure and volunteer 

activities; mental health, people with disabilities, and family responsibilities/caregiving. 

“Baby boomers are healthier in some important ways. They are much less likely to smoke, 

have emphysema, or get heart attacks.” (Aging Poorly: Another Act of Baby Boomer 

Rebellion Rob Stein, NPR, February 4, 2013) However, diabetes, high blood pressure and 

obesity are increasing. The number of individuals with disabilities is increasing. 

Disability Statistics: Online Resource for U.S. Disability Statistics reports that an estimated 

36.8% of persons age 65 and over reported a disability. This includes non-institutionalized, 

males and females of all races regardless of ethnicity with all educational levels. For 

Tennessee, it is 40.8%. 

“There are currently 7,162 allopathic and osteopathic certified geriatricians in the US — one 

geriatrician for every 2,620 Americans 75 or older. Due to the projected increase in the 

number of older Americans, this ratio is expected to drop to one geriatrician for every 3,798 

Tennessee – State Plan on Aging 2014 - 2018 305
older Americans in 2030.     There are far fewer geriatric psychiatrists. Currently there are 

1,751 - one for every 10,865 older Americans. That ratio is projected to decrease by 2030 to 

one geropsychiatrist for every 12,557 Americans 75 and older.” (The American Geriatrics 

Society, Advocacy Public Policy) 

“Persons aged 65 years and older comprise only 13 percent of the population, yet account for 

more than one-third of total outpatient spending on prescription medications in the US.” 

(National Institute on Drug Abuse (NIDA) Research Report Series: Prescription Drugs: 

Abuse and Addiction, October 2011)

“The major sources of income as reported by older persons in 2010 were Social Security 

(reported by 86% of older persons), income from assets (reported by 52%), private pensions 

(reported by 27%), government employee pensions (reported by 15%), and earnings 

(reported by 26%).” (The Administration on Aging, A Profile of Older Americans: 2012) 

According to the article The Ripple Effect of Baby Boomer Retirement by Dave Bernard, 

usnews.com August 3, 2012, baby boomers will not only challenge the health care system, 

but will also impact the nature of the work force, the amount of money going to charities, the 

nature of investments, and exercise and recreation. 

“The baby boom in American was neither planned nor anticipated. It brought challenges and 

new ideas to many parts of our culture. It also brought problems. Fortunately, members of the 

baby boom generation will be around and working in order to be part of the solution.” (The 

Administration on Aging, A Profile of Older Americans: 2012) 

Needs Assessment 

The Listening Tour was held at the following locations in each of the nine (9) regions served by 

the Area Agencies on Aging and Disability in the following order: 

Area Agency Date Location

Northwest February 12, 2013 Senior Center, Union City

Southwest February 13, 2013 Southwest AAAD, Jackson

Aging Commission of the February 14, 2013 Pink Palace, Memphis

Tennessee – State Plan on Aging 2014 - 2018 306
Mid-South AAAD

South Central February 19, 2013 Henry Horton State Park, Chapel Hill

Upper Cumberland February 21, 2013 Life Church, Cookeville

Greater Nashville Regional 

Council

February 26, 2013 Ajax Turner Senior Center, Clarksville

Southeast Tennessee February 28, 2013 Jewish Cultural Center, Chattanooga

First Tennessee March 6, 2013 Memorial Park Community Senior Center, 

Johnson City

East Tennessee March 7, 2013 John T. O’Connor Senior Citizen’s Center, 

Knoxville

Attendees represented adults age 60 and over, adults with disabilities, baby boomers under the 

age of 60, service providers, healthcare organizations, insurance providers, AAAD staff, TCAD 

staff, senior center staff, Veterans Affairs (VA), AARP, American Cancer Society, mental health 

facilities, area newspapers, businesses, housing authorities, offices on aging, churches and 

ministries, University of Tennessee Extension services, and public officials. 

The survey focused on the current aging and disability issues, issues faced by “baby boomers” as 

they age, and the programs and services that are currently working in the community. 

Identify the aging and disability issues that are most important to you. 

What are the hard things that “baby boomers” face? How should the State of Tennessee 

help? 

What is currently working well in your community? (like agencies that help, neighbors 

who help each other, van service, senior center, meal sites, food pantry, healthcare clinic, 

nursing home sidewalks, police presence, grocery stores that deliver) 

The major findings are included in this section. 

The total number of questionnaires completed statewide was 555 with 812 individuals attending 

the Listening Tour meetings, a 68% response completion rate. The following identifies the 

number of individuals who attended the Listening Tour at each site and the number of 

questionnaires completed. 

Area Agencies on 

Aging and Disability

# 

attending

#

responding

% 

responding

Northwest 152 99 65%

Southwest 59 37 63%

Aging Council of the Mid-South 100 56 56%

South Central 32 23 72%

Upper Cumberland 103 81 80%

Greater Nashville 74 47 64%

Southeast 55 32 60%

First Tennessee 86 66 77%

East Tennessee 151 114 67%

Total 812 555 68.3%

Tennessee – State Plan on Aging 2014 - 2018 307
Aging and Disability Issues 

Each participant completing this survey question could identify 1 or more of 38 issues listed on 

the survey as being most important. Space was also provided to include other issues that were 

not on the list. 

Issues # of 

responses

%

1. Affordable dental care, hearing care and eye exams and glasses 388 69.9

2. Not having enough insurance or money to pay for doctors or medicine 386 69.5

3. Being able to get help when needed quickly and without hassle 385 69.4

4. Transportation for people who don’t drive cars 384 69.2

5. Learning new things 384 69.2

6. Being able to get accessible transportation 382 68.8

7. Keeping healthy through exercise and eating healthy food 376 67.7

8. Getting care at home instead of in a nursing home 366 65.9

9. Respite services 340 61.3

10. Training for aid workers who help older adults and people with disabilities 333 60.0

11. Housing that people on a pension or Social Security can pay for 326 58.7

12. Learning how to live with a serious condition like heart disease, cancer 

arthritis

321 57.8

13. Learning about how to take care of yourself so that you don’t get sick and 

tired

303 54.6

14. Protect people from abuse 302 54.4

15. Teaching volunteers to work with older adults and people with disabilities 298 53.7

16. Meals that are healthy and prevent hunger 289 52.0

17. Houses that are easy to get around in if you’re on a walker or in a 

wheelchair

276 49.7

18. Knowing where to call for help and getting help without a big runaround 273 49.2

19. Help with memory loss 273 49.2

20. Learning about how to care for someone at home 271 48.8

21. Reasons people have to go into nursing homes 263 47.4

22. Teaching doctors, nurses, and other healthcare works to know the special 

needs of old adults and people with disabilities

260 46.8

23. Teaching police, firemen, emergency workers to know the special needs of 

older adults and people with disabilities

248 44.7

24. Meeting people and Making new friends 237 42.7

25. Being able to choose the workers who come into your home 233 42.0

26. Neighborhoods that are easy and safe to walk in 231 41.6

27. Making decision about health insurance, Medicare, and 0planning for the 

future without depending upon the government

230 41.4

28. Understanding how Medicare works 220 39.6

29. Easting out with friends 220 39.6

30. Learning how to prevent falls 218 39.3

Tennessee – State Plan on Aging 2014 - 2018 308
31. Help with chores like lawn mowing and leaf raking 207 37.3

32. Places to volunteer 206 37.1

33. Reasons people have to go back to the hospital 200 36.0

34. Help with feeling sad or lonely 186 33.5

35. Neighborhoods that have grocery stores close by 178 32.1

36. Help with taking too much medicine 175 31.5

37. Being able to get accurate information from a website and being able to 

apply for services on-line

139 25.0

38. Help with drinking too much alcohol or taking drugs 89 16.0

All attendees were provided an opportunity to identify other aging and disability issues that were 

not identified in the above list of 38 items by listing their issues under the topic Other. Their 

responses to Other are contained in the AAAD Regional Reports. 

Impact of Baby Boomers 

A major issue impacting Tennessee’s aging system will be the aging “baby boomer” generation. 

In response to the survey question What are the hard things that “baby boomers” face?, most 

of the respondents indicated that the current lack of accessible and affordable services and 

programs and the lack of funding will only increase as the retired population increases and lives 

longer than their parents. 

The primary concerns faced by baby boomers are identified by category. Examples of the 

responses are included for clarification. 

Retirement: can’t afford to retire; having enough money to retire; retirement benefits; saving 

for retirement; part-time job to supplement retirement 

Health Insurance: high cost of medical care; able to afford insurance; availability of 

insurance 

Economic Concerns: insecurity about the economy and/or shrinking economy; lack of assets; 

loss of saving from a bad economy; increasing costs of gas, utilities, food; hard to live on 

Social Security; fewer resources for middle income families; rising cost of living will 

outpace retirement benefits; reduced/fixed income; rising costs and declining income 

Social Security, Medicare, Medicaid: will they be there?; future of Social Security and the 

possibility of insolvency, raising the age eligibility requirements 

Caregiving: caring for aging parents while working; raising a family while caring for aging 

parents; shortage of caregivers; increase in Alzheimer’s and dementia

Maintaining Health: staying active physically and mentally; need more education and 

programs/facilities; health promotion; senior center hours not accessible for working adults 

age 60 and over; just now beginning to provide programs for baby boomers 

Transportation: affordable, accessible, and safe transportation; more city and rural 

transportation; more choices in transportation 

Healthcare: mentally challenged have limited resources; availability of health care; paying 

for medications; veterans exposed to Agent Orange; services for aging in place; services for 

the disabled and for low income; services for people living in rural counties, services are 

already lacking; not enough home and community based services; adult day care 

Tennessee – State Plan on Aging 2014 - 2018 309
Technology: automated everything; quickening pace; keeping up/computer skills 

Housing: affordable, accessible, safe; affordable/available home repairs; livable and walkable 

communities; decreasing options for housing; investment friendly housing; housing to match 

abilities 

All of these differences will significantly impact the aging services and programs to be designed 

in the next few years. In response to the second part of the question How should the State of 

Tennessee help?, several responses reflect the lack of answers to this question: so many retiring 

at the same time, money and provision will run out; so many – gov’t can’t take care; and don’t 

know. 

What Works in the Community

The survey question “What is currently working well in your community? asked participants to 

identify what programs and/or services they thought were working. Some of the programs and 

services identified may not be statewide. One participant had the following statement: “The 

services that are available are great, but so few can access.” 

The programs and services that are currently working included: meals (meal/nutrition sites, 

meals on wheels, mobile meals), van services, senior centers, grocery and pharmacies that 

deliver, Second Harvest Food Bank, food pantries, Elder Watch; Senior Citizen Awareness 

Network (SCAN), local church assistance, Project Live, Office on Aging, Alzheimer’s 

Tennessee, United Way, Community Gardens, Area Agency on Aging and Disability (AAAD), 

police involvement with Seniors and Law Enforcement Together (S.A.L.T.) and the S.A.L.T. 

conference, networking, sidewalks, home and community based services, law enforcement and 

sheriff’s office, Loaves and Fishes, dental care 3 days a week, Room in the Inn, Human Resource 

Agencies (HRA), SHIP, Senior Companion Program, Helping Hands, Ombudsman, Habitat for 

Humanity, legal aid services, homemaker services, Public Guardianship for the Elderly, 

CHOICES and Options, healthcare clinic, aquatics available, commodity distribution, Silver 

Sneakers, Matter of Balance, Cancer Society’s Road to Recovery, and physical fitness programs. 

Small Focus Group 

The Small Group Focus Sessions were asked to expand upon the aging and disability issues 

facing Tennessee and to identify the factors impacting those issues. Since the sessions were 

open-ended, the responses from the multiple groups were overlapping and provided examples to 

re-enforce the identified issues: 

Not enough programs and services and lack of funding 

More affordable, accessible, and flexible transportation 

Tracking services provided by churches, the community, etc. 

Need for more education and training programs 

Lack of health insurance or money 

Financial assistance for food, heating, medications, utilities, etc. 

Limited computer skills and/or internet access 

Tennessee – State Plan on Aging 2014 - 2018 310
Limited assisted living, retirement communities, especially in rural areas 

Solicitation calls, frauds and scammers 

More accessible services and user-friendly information 

Affordable, accessible, and safe housing and home repairs 

Lack of financial resources for dentures, hearing aids, glasses for adults age 60 and over and 

adults with disabilities 

Waiting lists for services and programs 

Depression and loneliness

Lack of in-home services – home and community-based services 

Poor attitude toward adults age 60 and over 

High cost of medications 

Too many places to call for services and/or programs and how to qualify for services 

Decrease in people paying into system, benefits, and workers in the field 

Coordination of services

Elder abuse

Caregiving

Conclusion 

The AARP survey seems to support the survey findings of this needs assessment. Baby boomers 

are concerned for financial security and improving their health. Aging in place is important to 

baby boomers. They do not plan to move like their parents. 

Utilizing the data from the comprehensive needs assessment, the challenges that face TCAD and 

other state departments and agencies serving adults age 60 and over and adults with disabilities 

were identified and the Tennessee State Plan on Aging 2014-2018 was developed. The State 

Plan 2014-2018 provides policy makers, service providers, and the general population with 

appropriate data about trends and implications for the current population as well as the impact of 

the increase in the aging population due to the aging “baby boomer” population.

Tennessee – State Plan on Aging 2014 - 2018 311
Tennessee Commission on Aging and Disability 

Listening Tour 

2013 

I. What are the hard things that “baby boomers” face? How should the 

State of Tennessee help? 

1. ______________________________________________________

______________________________________________________ 

2. ______________________________________________________ 

______________________________________________________ 

3. ______________________________________________________

______________________________________________________ 

4. ______________________________________________________

______________________________________________________ 

Tennessee – State Plan on Aging 2014 - 2018 312
Tennessee Commission on Aging and Disability 

Listening Tour 

2013 

II. Here are seven (7) aging and disability issues. 

Under each, there is a list.

Mark the ones on the list that you think are most important. 

Staying Healthy While Aging 

o Keeping healthy through exercise and eating healthy foods 

o Affordable dental care, hearing care, and eye exams and glasses 

o Learning how to prevent falls 

o Meals that are healthy and prevent hunger 

o Learning how to live with a serious condition like heart disease, 

cancer, arthritis 

Health and Wellness 

o Reasons people have to go into nursing homes (like falling down, 

breaking bones, medicine errors, lack of transportation, lack of 

healthy meals, lack of services in the home) 

o Reasons people have to go back to the hospital (like not taking 

medication, not having someone to make meals, not asking the doctor 

questions) 

o Not having enough insurance or money to pay for doctors or medicine 

o Getting care at home instead of in a nursing home 

o Knowing where to call for help and getting help without a big 

runaround 

o Understanding how Medicare works 

o Making decisions about health insurance, Medicare, and planning for 

the future without depending upon the government 

o Help with feeling sad or lonely (like depression) 

o Help with drinking too much alcohol or taking drugs 

o Help with taking too much medicine (like prescription drugs, pain 

killers, tranquilizers) 

o Help with memory loss (like dementia, Alzheimer’s Disease)

o Protect people from abuse (like being hit, yelled at, forced to do things 

you don’t want to do, others using your money)

Tennessee – State Plan on Aging 2014 - 2018 313
Tennessee Commission on Aging and Disability 

Listening Tour 

 2013 

Continue choosing important issues 

Caregiving (taking care of loved one at home) 

o Respite services (like getting someone else to look after loved one 

so you can have a short break and take care of errands) 

o Learning about how to care for someone at home 

o Learning about how to take care of yourself so that you don’t get 

sick and tired 

Independence and Getting Services Easily 

o Being able to get help when needed quickly and without hassle 

(like being able to call and get the help you need without a 

runaround) 

o Being able to get accurate information from a website and being 

able to apply for services on-line 

o Being able to choose the workers who come into your home 

o Being able to get accessible transportation (like rides that are there 

to pick you up when you need it; rides that can help people who 

use walkers or wheelchairs) 

Housing, Neighborhoods, and Safe Communities 

o Help with chores like lawn mowing and leaf raking 

o Housing that people on a pension or Social Security can pay for 

o Neighborhoods that are easy and safe to walk in (like sidewalks, 

low crime) 

o Neighborhoods that have grocery stores close by 

o Transportation for people who don’t drive cars

o Houses that are easy to get around in if you’re on a walker or in a 

wheelchair 

Tennessee – State Plan on Aging 2014 - 2018 314
Tennessee Commission on Aging and Disability 

Listening Tour 

 2013 

Continue choosing important issues 

 Staying Connected and Involved in the Community 

o Places to volunteer 

o Learning new things (like ideas, skills, hobbies)

o Meeting people and making new friends 

o Eating out with friends (like affordable, tasty, nutritious meals shared with 

friends) 

 Working with Older Adults and People with Disabilities 

o Training for paid workers who help older adults and people with disabilities 

(like staff who go into homes, or who work in nursing homes) 

o Teaching police, firemen, emergency workers to know the special needs of 

older adults and people with disabilities 

o Teaching doctors, nurses, and other healthcare workers to know the special 

needs of older adults and people with disabilities 

o Teaching volunteers to work with older adults and people with disabilities 

(like recruiting volunteers, training volunteers, and helping them do their 

best)

Other (Is there something else that you think is important?) 

___________________________________________________________ 

_____________________________________________________________________

_____________________________________________________________________

_______________________________________ 

This survey may also be taken on-line at www.tn.gov/comaging/ or by mailing this form to the 

following address: TCAD, 161 Rosa L. Parks Blvd., Nashville, TN 37243. (Survey available 

until March 14, 2013.) 

Tennessee – State Plan on Aging 2014 - 2018 315
Tennessee Commission on Aging and Disability 

Listening Tour 

 2013 

III. What is currently working well in your community? 

(like agencies that help, neighbors who help each other, van service, 

senior center, meal sites, food pantry, healthcare clinic, nursing home, 

sidewalks, police presence, grocery stores that deliver) 

___________________________________________________________

___________________________________________________________

___________________________________________________________

___________________________________________________________

___________________________________________________________

___________________________________________________________

___________________________________________________________

___________________________________________________________ 

Tennessee – State Plan on Aging 2014 - 2018 316
Needs Assessment 

Stakeholder Meeting 

Nashville Public Library 

Nashville, TN 

January 23, 2013 

Number of Attendees: 56 

Tennessee – State Plan on Aging 2014 - 2018 317
Statewide Needs Assessment Key Stakeholders’ Meeting

January 23, 2013 

Attendees 

Lynette Porter Council on Developmental Disabilities 

Nancy Carr Retired Citizen 

Renee Bouchillon Department of Human Services/Adult Protective Services 

Holly Williams Upper Cumberland Area Agency on Aging and Disability 

Lanelle Godsey Upper Cumberland Area Agency on Aging and Disability 

Patty Ray Upper Cumberland Area Agency on Aging and Disability 

Elaine Graf Aging Commission of the Mid-South 

Jesse Samples TN Health Care Association 

Maribeth Farringer Council on Aging (Middle Tennessee) 

Norma Powell Greater Nashville Regional Council 

Cathy White Greater Nashville Regional Council 

Shani Abell The Arc of TN 

Wanda Simmons Southwest Area Agency on Aging and Disability 

Tom Cheetham TN Department of Intellectual and Developmental Disabilities 

Kathy Whitaker First Tennessee Area Agency on Aging and Disability 

Robin Rochelle South Central Area Agency on Aging and Disability 

Dottie Lyvers East Tennessee Area Agency on Aging and Disability 

Joe Evans South Central Area Agency on Aging and Disability 

Lisa Wright Blue Cross Blue Shield 

Simi Atolagbe TN Department of Labor 

Andrew Sandler Abe’s Garden

Vickie Trice TN Department of Insurance 

Carol Westlake TN Disability Coalition 

Valerie H. King TN Commission on Aging and Disability 

Lucy Utt TN Commission on Aging and Disability 

Janet Lamb TN Commission on Aging and Disability 

Jeanne Caudill TN Commission on Aging and Disability 

Cathy Taylor Belmont University 

Carol Wilson Metro Social Services 

Beverly Patnaik Lipscomb University 

Sherry Cummings University of Tennessee School of Social Work 

Dora Ivey Aging Commission of the Mid-South 

Tom Starling Mental Health America 

Carole Moore-Slater TN Disability Pathfinders/Vanderbilt Kennedy Center 

Aaron Bradley East Tennessee Area Agency on Aging and Disability 

Steve Witt Southeast Tennessee Area Agency on Aging and Disability 

Tommy Preston Southeast Tennessee Area Agency on Aging and Disability 

Julie Jones Northwest Tennessee Area Agency on Aging and Disability 

Susan Hill Northwest Tennessee Area Agency on Aging and Disability 

Barbara Acuna Blue Cross Blue Shield 

Adrienne Newman Fifty Forward 

Janice Wade-Whitehead Alzheimer’s Tennessee

Tennessee – State Plan on Aging 2014 - 2018 318
Libby Cain TN Department of Commerce and Insurance 

Michelle Morse Jernigan TennCare 

LaVerdia McCullough TN Commission on Aging and Disability 

Shannon Jones TN Commission on Aging and Disability 

Carlie Cruse Senator Corker’s Office

Beth Zeitlin Abe’s Garden

Harriet Karro The Gift Initiative 

Angela Jefferson, Ph.D. Vanderbilt Memory and Alzheimer’s Center

Consuelo Wilkins Vanderbilt University-Meharry College 

Ruth Garrett Vanderbilt University-Meharry College 

Julian Sanborn Fifty Forward 

Robert Dittus Vanderbilt 

Rachel Henderson Lakeshore Estates 

Bonne Fertig Citizen 

Anna Lea Cothron Vanderbilt University 

Stephanie Mayers Vanderbilt University 

Tennessee – State Plan on Aging 2014 - 2018 319
Stakeholder Meeting

Nashville Public Library 

January 23, 2013 

A Stakeholders’ Meeting was held in Nashville on January 23, 2013 as the kick-off to the 

statewide Listening Tour regional meetings. The purpose of the meeting was to provide an 

overview of the Listening Tour agenda and the development of the State Plan on Aging for 2014-

2018 in order to receive the federal funding, and have stakeholders participate in potential 

surveys to be used for the needs assessment and provide feedback. Attendees at each of regional 

meetings will be asked to complete the surveys for the needs assessment required for the State 

Plan. Stakeholders were also asked to encourage people to attend the Listening Tour in the Area 

Agency on Aging and Disability Regions. 

The stakeholders’ meeting consisted of an open discussion of the impact of the aging population 

on Tennessee’s fiscal resources, programs, and services; the results of the surveys completed by 

attendees and feedback comments on the surveys; and concluding comments. 

Fifty-six (56) individuals were in attendance at the meeting. Attendees including representatives 

from the Council on Developmental Disabilities, Area Agencies on Aging and Disability, 

Council on Aging, Tennessee Healthcare Association, ARC of Tennessee, Tennessee 

Department of Developmental and Intellectual Disabilities, Blue Cross/Blue Shield of 

Tennessee, Tennessee Department of Commerce and Labor, Abe’s Garden, Tennessee Disability 

Coalition, Belmont University, Metro Social Services, Lipscomb University, University of 

Tennessee-Knoxville, Mental Health of America, Tennesse Pathfinders/Vanderbilt 

University/Kennedy Center, Fifty-Forward, Alzheimer’s Tennessee, TennCare, Senator Corker’s 

Office, The Gift Initiative, Vanderbilt Memory Center, Tennessee Department of HealthDivision of Family Health and Wellness, Merry Hospital, and Lake Shore Estates. 

The survey questions completed at the stakeholders’ meeting included the following: 

Overall, what are the four (4) most pressing challenges facing the State of Tennessee in 

order to provide aging and disability services? 

The growing “baby boomer” population appears to have different wants and needs than 

the current aging population being served. Overall, what are the four (4) most pressing 

challenges facing the State of Tennessee in providing services to this “baby boomer” 

population? 

What works?

From your area of expertise, what are the best practices, programs or services on which 

the State should focus? What would help Tennessee move forward to better serve our 

elders and people with disabilities? 

Tennessee – State Plan on Aging 2014 - 2018 320
Challenges 

With the emerging baby boomer population, this question was designed to identify the 

challenges that Tennessee will be facing in the near future. The responses for Question #1 were 

divided into major categories for easier review; however, some of the responses may be 

overlapping. 

Challenges facing Tennessee as the baby boomers age include providing healthcare (programs 

and services), building awareness of and access to information, resources and technology; 

addressing economic issues; coordinating, collaborating, and building partnerships; and 

addressing support services, including transportation, housing, nutrition and meals, caregiving, 

and advocacy. Repetitive responses, such as “transportation” or “funding”, are included only 

once in this report. 

Overall, what are the four (4) most pressing challenges facing the State of Tennessee in 

order to provide aging and disability services? 

Healthcare/Programs and Services 

Home Health services 

Desire to live in their home as long as possible 

Mental services/support for those with Alzheimer’s/memory loss diseases

Identifying people in need 

Finding the right person or agency to assist the consumer 

Preparing for baby boomers – not enough services 

The aging baby boomers will be a large group needing multiple services. (from a volunteer) 

In-Home services 

Fragmentation of services (need aging department) 

Catching up to other states in service delivery options (promoting choice) 

Early identification of memory loss in older adults in the community 

Home health services for elders with cognitive impairment who need assistance with daily 

activities 

Services for the Alzheimer’s community

Single point of entry and return

To include people with intellectual and development disabilities in existing services 

Service providers recommending appropriate resources and helping with connections 

Consistency of contact person at a given agency 

In-home services 

Healthcare (affordable & effective) including end of life care - Dementia related . . . . 

Healthy Aging

Inconsistencies in assessments across the State 

Evaluating programs to assess efficacy 

Finding the target population 

Identifying their real vs. perceived needs 

Developing programs to meet needs 

Tennessee – State Plan on Aging 2014 - 2018 321
Skilled providers 

Trained gerontology professionals/staff 

Providers in general 

Access to care 

Rural areas need access to services in a timely way 

Access in rural areas (funding) 

Easier access to in-home services 

Changes in TNCare criteria for CHOICES 

Affordable healthcare 

Shorten waiting lists for services – being able to get more people off waiting lists 

Increase in number of seniors for several more years (boomers) 

Growth of Alzheimer’s population - increase in dementia 

Home and Community Based Services waiting list is causing many folks to be forced into 

facility LTC settings at more expense to government and taxpayers and it’s not where 

consumers want to be 

Increase in ultra-elderly (85+) and having complex needs 

No emergency services available 

Aging mentally ill

The rapidly aging general population which will increase demands for services 

Systems are too complicated to navigate for individuals and families 

Availability of services (waiting lists) 

Awareness, Information, Education and Technology

Awareness of programs and services available 

Many have no internet access 

Updating databases is time consuming and not always undated creating services no long 

available info that is not useful. Those same agencies could work together to share 

information about community services needed by county creating more comprehensive data. 

Tennessee, for too long, prefers to work in silo’s or individually. This also creates 

duplication and wastes valuable state and federal dollars. We can do better. 

Lack of awareness from the consumer’s level, of AAA services

Raising public awareness of the challenges and opportunities presented by an aging 

population 

Getting folks who need resource the knowledge that it exists 

Health literacy

Same as “boomers” – knowledge of available services in order to make informed choices 

Educating seniors about fraud and ways to avoid being financially taken advantage of 

Help educate seniors about medication & to be aware of all the meds they are taking. So 

many are taking meds that should not be taken together 

One stop shop/”first call”/well publicized statewide

Education of primary care providers and staff for early identification and treatment 

Economic Issues 

Static funding while need for services grows 

Tennessee – State Plan on Aging 2014 - 2018 322
Health care affordability on fixed incomes 

More flexibility with funds (OAA) - OAA funding - flexibility between OAA programs 

Finding funding for persons who are uninsured 

Rising medical costs, low Medicare payments to physicians; medical subsidies 

Funding to provide or subsidize cost of HCBS 

Lack of funds available to provide services 

Funding has not grown with population 

Instability of Medicare and Social Security 

Budget/resources 

Will the State be prepared at the appropriate time regarding budgets? (from a volunteer) 

Funding for in-home care 

Competition with other populations in need for funding 

Threats to federal/state funding for services 

Possibly money/resources 

Need waivers or expansions (funding) 

Rigidity of current funding streams 

Need funding to encourage innovation 

Affordability of services 

Money 

Funding, Funding, Funding, Funding 

Fiscal Pressures as the demand increases so funding decreases 

Lack of State funding

Sufficient funding

Financial assistance for heat, prescription drugs, basic needs 

Funding for in-home assistance services 

Senior Centers provide a variety of social, educational & health related activities, but they are 

very limited to what programs they can provide due to very little funding and inability to 

expand with the growing population. 

Affordable health care 

Limited resources

Income stability/economic self-sufficiency 

Economic/employment needs

Medicare/coverage

Reliable medical benefits/medication 

Resources available for Baby Boomer 

Adequate Medicare coverage 

Not enough resources for the # of people in need 

Planning for growth of aging population 

Aging issues as a priority 

Coordination, Collaboration & Partnerships 

Effectively engaging faith communities in helping support of older adults and those with 

disabilities 

Partnering with stakeholders to fill gaps in service 

Tennessee – State Plan on Aging 2014 - 2018 323
Coordination of services across departments/funding sources 

Centralized networking system (Tennessee) 

Coordination among key sectors – i.e., health, AoA programs, mental health, substance abuse 

Lack of coordination between State departments and private sector 

Better coordination of community resource information and referral to specific services is 

needed between disability, mental health, and aging agencies. 

Removing “silos” to maximize efficiency – resources/service delivery 

State giving State agencies the support necessary to do work (not shrinking workspace) 

Lack of leadership 

No comprehensive aging plan in TN 

Care coordination

Will all agencies connected with State be prepared? (from a volunteer) 

Are agencies, volunteers, and the State planning now? (from a volunteer) 

Infrastructure needs to be in place in order for 21st century solutions be addressed 

Support Services: 

Transportation 

Public transportation for seniors 

Lack of public transportation for senior 

Transportation that meets the (needs?) 

Transportation especially in rural area 

Transportation/access to services must be available 

Transportation that is senior-friendly and disability-friendly while also being affordable 

Funding for rural transportation 

Meals

Congregate meals have a cap and the program is having to turn people away who really 

need a meal

Meals program

Caregiver

Caregiver Support

Support services for caregivers 

(Alzheimer’s) caregiver stress

Workforce/caregiver development training - needs to be exercised 

Lack of natural support system 

Nutrition 

Meals

Food

Nutrition (especially in Memphis) 

Hunger – home delivered meals/congregate meals 

Housing 

Affordable housing

Housing options 

Aging in place 

Tennessee – State Plan on Aging 2014 - 2018 324
Advocacy

Legislative advocacy 

True advocacy for seniors 

External advocacy services 

Other 

Pattern of doing same old same old 

Impact of Baby Boomers 

For the Needs Assessment, it was important to get input from the stakeholders as to the impact of 

the baby boomers on their programs and services to the aging and disability population. Baby 

boomers are defined as individuals who were born between 1947 and 1964. Currently, an 

estimated 75 million individuals are identified as baby boomers with an estimated 10,000 

individual reaching the age of 65 every day. In Tennessee, the 65 & over population represents 

13% of Tennessee’s population (2010 Census). In the next 15 years, an additional 1,245,064 

individuals or 20% of Tennessee’s current population will reach the age of 65, representing a 

65% increase. 

The results of Question #2 have been divided into major categories concerning the challenges 

facing Tennessee as the baby boomers age. The categories are Awareness/Access to Information 

and Resources/Technology; Healthcare; Economic Issues; Housing; Need for Continued 

Employment and/or Postponing Retirement; Maintaining Health and Self-Sufficiency; 

Caregiving and Family Dynamics; Transportation; Meals; Expectations of Baby Boomers; Elder 

Care; and Other. The comments provided by the attendees are included in each category. 

Repetitive statements, such as “healthcare” or “funding”, are included only once in this report.

The growing “baby boomer” population appears to have different wants and needs than 

the current aging population being served. Overall, what are the four (4) most pressing 

challenges facing the State of Tennessee in providing services to this “baby boomer” 

population? 

Awareness/Access to Information and Resources/Technology

Communicating relevant programs in aging – many seniors do not know about the services 

that are available to them or how you get these services 

Knowledge – starting early on – relating to navigating system/Social Security/Medicare 

Address those without internet access 

Systematic way to communicate services available for baby boomers and their parents 

Make the public aware thru media – internet, etc. of these responses so the children of the 

aged are more aware of resources and information 

Technology

Digital (web) resource banks/ Info 

Boomers utilize computers more – need to have everything web base 

Become more web-based for a “computer-savvy generation 

Navigating a complicated system 

Tennessee – State Plan on Aging 2014 - 2018 325
Education on what services are available in order to make informed choices 

Technology/innovative skills 

Information via website and mobile app 

Comprehensive Resource Database 

Where to find information about services – no wrong door approach 

One stop shop – first place to call 

Health literacy

Developing more social media sites to help them access services 

Healthcare 

The obesity epidemic and associated chronic illness 

Resources that are available when I need them 

Programs that have as proven outcome (best practices) 

Personal assistant/in-home assistance 

Find out what services they want and how they want them delivered

Provide ways for boomers to participate in the delivery of services 

Use volunteers more

Affordable home and community based services for aging in place 

Access to healthcare 

Demands for clinical services – locals services related to memory lost and dementia are 

going to exceed capacity 

In-home care availability 

Waiting lists and CAPS on most services – no APS $ 

LTC – long term care, nursing home and skilled care – not enough preparation being taken 

now for when we are older 

Additional health care providers and caregivers are needed 

Control over healthcare

Change in marketing strategy (do not call them “seniors” or “older adults”)

Need assistance but may miss eligibility criteria 

Educating service providers of changing needs 

Lack of mental health service 

Enjoyment in all areas of their care 

Build their own plan of care

Finding what their needs and wants are – such as new programs 

HIV, AIDS, and LGBT issues in long term care 

Lack of knowledge of their needs/wants 

Substance abuse issues (carried over from the 1960’s)

Affordable health care 

Alzheimer’s

Chronic illnesses – diabetes, high blood pressure, etc. 

Mental health support/suicide prevention 

Increasing prevalence of Alzheimer’s disease with aging “baby boomers”

Planning for themselves (LTC) and how best to plan for and access services for an older 

family member 

Tennessee – State Plan on Aging 2014 - 2018 326
Baby boomers will need more self-directed programs 

Home Health Care

Economic Issues

Funding

Income stability/economic self-sufficiency 

Serving more people with existing dollars 

Need a statewide system for regulated pay private services 

No emergency services – housing, financial assistance 

Put needs in budget far in advance 

Working with agencies and volunteers on budget items 

Demand/Need 

Financial Issues – do I have enough to retire? 

The # of people that fall into this category in Tennessee is huge. 

Finding insurance coverage 

Funding to transform senior centers into “booming” centers

Financial instability during retirement years due to social security’s insecurity

Have some resources, but state may not have the infrastructure of services 

Money

Funding to provide new programs

$ 

We need incentives to encourage more geriatric case managements and geriatric 

professionals 

Boomers have longer life expectancies and limited resources 

Impact of Obamacare

# in population

Health Insurance coverage 

Medical resources/benefits 

Lack of affordable health care insurance 

Handling the growth of aging population with services without an increase in funding 

Housing (living arrangements and facilities)

Affordable assisted living

Housing 

Aging in Place

Access to affordable housing and housing that meets ADA 

Living arrangements 

Independent living

Desire to age in place

Residences that are not existing/assisted living center 

Changing legislation to accommodate changing residential settings that don’t look like 

traditional assisted living or SNF 

Tennessee – State Plan on Aging 2014 - 2018 327
Need for Continued Employment and/or Postponing Retirement 

Employment 

Volunteer and/or employment

Employment opportunities/training opportunities 

Still working, decreases volunteers 

Currently, a large percentage is still employed so we will encounter bigger challenges in 

years to come. Due to so many still being employed, it increase challenges of recruiting 

volunteers 

Having to work longer to be able to retire 

Workforce opportunities 

This group will work longer by necessity 

Need for income beyond SS benefits – employment 

Lots of boomers still work and need flexibility 

Lack of employment or forced into early retirement without adequate financial planning 

Enough money to retire 

Many are still having to work 

Maintaining Health and Self-Sufficiency 

Opportunities for productive aging 

More active – difficult to reach 

Transforming senior center 

They not only wasn’t to remain at home, they want to remain active. They want and need 

preventative services and activities to stay as active as they want as long as they can 

Healthy aging

Desire to be active physically and intellectually – meeting needs through programming 

Health reliability

Redesigning to suit different lifestyles, i.e. they don’t want to eat a congregate meal then 

head home 

Emphasis on healthy aging and need to promote fitness. Drawn by resort style amenities 

Exercise programs for prevention 

Developing programs at local focus points that will draw baby boomers and keep them active 

Caregiving and Family Dynamics 

Caregiving responsibilities 

Care/service coordination 

Caregiver support services 

Trustworthy assistance for those with no children 

Caregiving issues

Raising children or grandchildren later in life 

Maybe caring for parents and grandchildren 

Less enjoyment from their adult children – children live long assistance from their parents 

Respite/in-home services for caregivers 

Tennessee – State Plan on Aging 2014 - 2018 328
Capitalize on the group’s talents – understanding the parameters around which we can tap 

them to help support older adults in need 

Being caretakers of “old Old parents” and opening their homes to adult kids

Support services for their caregivers 

Adult daycare/senior center/programs 

Boomers are sandwiched as caregivers to young and older relatives 

Transportation 

Transportation service low or no cost 

Improved public transportation

Public transportation for seniors 

Provision of an effective and consumer friendly transportation system 

Rural and urban transportation

Mobility options

Simplify and streamline transportation support and service 

Meals 

Lack of nutrition resources (both food and education) 

Revamp service delivery – congregate meals probably won’t work for booms

Expectations of Baby Boomers 

They want choices, options which are often unavailable 

They want to be heard, honor their preferences when possible which often not the case 

They tend to be more interested in health care, wellness or prevention – not enough resources 

spent on preventative health care 

Changing the name (aging) – the brand name needs to change

Boomers want quick efficient service 

Boomers typically have researched what service they want and know the details of the 

services needed 

Expectation of more services than previous generations 

They don’t identify themselves as “old folks”

Elder Care 

No identified agencies to protect seniors from scams/frauds 

Lack of neutral advocacy services 

Planning for aging (advance directives) 

Other: 

I don’t know enough about the validity of the statement (”The growing “baby boomer” 

population . . . .) to give an answer 

Changing direction from the old way 

Making sure there are open communications at all levels and all parties involve 

Innovation

Tennessee – State Plan on Aging 2014 - 2018 329
What Works

The purpose of this question was to begin to identify some positive, proven practices that could 

be replicated and/or improved to address the issues and concerns of adults age 60 and over and 

adults with disabilities. Stakeholders are in an excellent position to provide this important data 

in order to build a better system of healthcare services and programs in Tennessee. This is 

especially important as the baby boomers age and require programs and services to meet the 

changing expectations and needs of this population. 

The responses to this question are categorized by what is currently working; the focus areas 

identified by attendees that are categorized into programs and services; staff training; 

coordination, collaboration, and partnerships; information, education, and resources; support 

services; and funding, and ideas that would help move Tennessee forward. Repetitive responses, 

such as “transportation” or “funding”, are included only once in this report.

What works? 

From your area of expertise, what are the best practices, programs, or services on which 

the State should focus? 

What would help Tennessee move forward to better serve our elders and people with 

disabilities? 

What works 

The State has a great delivery system for services in place, but the available services are full. 

SHIP is an excellent, much needed service for seniors 

Healthcare Mission orientation of Saint Thomas Health 

Palliative and end of live care by Alive Hospice (community based) 

Meals i.e. with Senior Citizens, Inc. 

Returning calls within 48 hours

Working with related agencies and volunteers 

Encouragement of volunteerism by seniors and with seniors 

Focal points in the community

Options, HCBS, & SHIP

Communication

Best practices – building on existing resources – don’t reinvent the wheel – i.e. Pathfinder –

partner with it and build on it 

Emergency Assistance Program in our district provides a unique way to meet health and/or 

safety needs of an elderly or disabled adult that would not otherwise be provided due to lack 

of funding or a program directive. 

Focus Areas 

Programs and Services 

Guardianship services are needed for those with disabilities under the age of 60 years. 

SIVAP – food stamp program – needs adjusting to provide more benefits to seniors 

More services available to people under 60 who have disabilities 

Tennessee – State Plan on Aging 2014 - 2018 330
There are more and more people under 60 who need help, but the options program is very 

limited in their funds 

HCBS for those not sick enough or poor enough to need CHOICES 

In-home assessment regarding needs 

SHIP and SMP are two programs that will continue to be the first “go to” programs for 

health care benefits and fraud/abuse information and assistance 

Continue to expand SHIP area 

Care management

One-stop shop for services

States should focus on home and community based services and further development of a 

single point of entry 

Seniors Centers have a great bricks and mortar presence, but need to be redesigned for 

greater appeal to ages 60+ 

AAADs are pivotal to community services 

Emphasis on prevention of unhealthy behaviors 

Self directed service models 

One stop shop/First call!/single toll free # 

Public guardianship services for under 60 

Medical outreach (SHIP & SMP) *with boomers this becomes more detailed and 

involved, more choices 

Public Guardianship services for those under 60 

State should focus more on programs that are meeting the family from a holistic approach 

(housing, transportation, food, relative caregiver, respite care, etc.) 

Support programs for those with Alzheimer’s disease and memory loss

More services to support driving evaluations for seniors 

Continuum of care

Health promotion and healthy aging programs 

Inter-generational programs 

Aging in place options

Have smaller focus areas to target specific issues in a community 

Better quality home and community based services that meet the needs of current old 

adults and boomers 

Peer counseling programs at senior centers to provide opportunity for seniors to share 

stressors 

Aging specific substance abuse programs – CBT, MI 

Depression treatment – psychosocial interventions as well as pharmacological. CBT, 

Interpersonal Psychotherapy 

Self direction (consumer direction) 

Adult Day Care programs/activities 

Integration with people of varying needs 

Programs that reflect activities participated in during other phases of adult life (not 

children’s programs)

Single Point of Entry and Return 

Tennessee – State Plan on Aging 2014 - 2018 331
Staff Training 

Adequately trained/educated service providers 

Cross training of all staff at all levels of A&D network to ensure quality, uniform 

customer service 

Elevate volunteer programs to professional status, treat them like every other program –

dedicated staff, standards, competency expectations, etc. 

Fortifying and educating lay and professional caregivers 

Trainings for workers – i.e. cooking, transferring, mental health, etc. 

Educational programs to train professionals re: agency services and resources –

physicians, social workers, etc. 

Coordination, Collaboration and Partnerships 

Program coordination/access 

Coordination under a Department of Aging 

Having a centralized network of services available statewide and local for senior and 

baby boomers 

Improved care coordination 

Partnerships with other government depts./non-profits/for-profits 

Identify neighborhood leaders 

Creative partnership to share funding burden for increasing needs 

Having like providers meet to share issues and concerns (i.e. senior center directors meet 

with each other regularly) 

Continue State being more focused and involved with agencies and volunteers 

Improved coordination of transit and home care providers 

Information, Education and Resources 

Regarding adults with disabilities, under 60 years of age, work more collaboratively with 

Vanderbilt Kennedy Center for disability specific information and agency resources 

With Health Care Reform, individuals will seek knowledge . . . need resources 

Utilization of senior centers for providing information/education/outreach 

Health literacy

Large scale public service announcement campaign for memory loss, screening and 

education about symptoms (i.e., memory loss is not normal) 

Additional resources to assist elders and people with disabilities in navigating the ever 

increasing complexities of our long-term care health system 

More information, easier flowing website - *consider creating a “meta” website of 

services by AAAD regions and then create collaborations – don’t have duplication of 

services

Navigating systems: “How to . . . .” manual

Comprehensive Resource list statewide 

Better mental health resources & trainings 

Information on services available – needs to be local and up-to-date

Support Services 

Transportation vouchers/volunteer based transit 

Tennessee – State Plan on Aging 2014 - 2018 332
More accessible transportation services 

Prepare better meals more in line with baby boomers wants such as salads, etc. 

Provide more transportation and make easier access 

Transportation

Nutrition/food 

Residential based housing alternatives 

Residential setting

Better more reliable transportation services 

Providing more resources for nutrition so more seniors can receive meals 

Caregiver support services (senior daycare services, etc.) 

One on one consultations about care giving techniques and how to delay/prevent 

institutionalization 

Funding 

Moving forward, the State needs to develop a private pay system for those able to pay for 

services. 

Be sure to budget supports needs 

Senior Center Funding for best practices 

Helping seniors meet medical costs so they can receive medical care and medications 

Improved access and funding to care 

But, it’s going to take some type of funding stream to be able to move forward in 

addressing issues of a growing population 

What would help Tennessee move forward to better serve our elders and people with 

disabilities? 

TN should develop a statewide Policy on Aging services for the next 10 years. 

Provide examples from other areas of good programs for transportation, healthy aging, etc. 

Re-evaluate old solutions

Agencies need to be more pro-active, more visual, more hands on. We need to identify 

people in need and know who to connect them to for assistance. Agencies need to network 

more and have contacts so when calls come in we know where to send the caller. 

An inclusive system that provides a wide array of services for those in poverty and those who 

can pay. This a regulated coordinated approach – everyone can request an assessment and 

can choose from a variety of services and receive them either free, reduced rate (gov’t. 

subsidies) and for private pay. 

What should elderly be concern regarding global warming 

Tennessee – State Plan on Aging 2014 - 2018 333
Needs Assessment

Stakeholders Meeting 

Comments from Attendees 

January 23, 2013 

Resources available to develop the Needs Assessment and State Plan 

1. Use local information and information from Information and Assistance 

2. Use Kennedy Resource Center data that’s already been compiled (and other agencies’ 

needs assessment data) 

3. 211 may have needs assessment information 

4. Blended experience is important—we want to hear from our constituents 

5. Get in with mainstream media, public hearing 

6. Identify segments of the community that don’t get touched

7. Tell them what you are going to do with the information they give you 

8. What about Walgreens and Walmart as locations for gathering information? Kroger has 

senior discount day every Wednesday. 

9. Non-profit hospitals are doing a mandated needs assessment. Perhaps get that data. 

Tennessee Hospital Association may be helpful. 

10. “Community Café” style meetings seem to work (round tables, neighborhoods, in the 

evening, provide meal, provide transportation, location is important, get someone in the 

community to be your champion/team leader, get interns to make calls) 

11. Use United Way needs assessment data 

12. The people (attendees) need to get something out of it (health screening, information) 

13. Get non-traditional people involved (not in our network) like police, firemen 

14. Get seniors in churches involved; put it in bulletins, in Electric Company bills 

15. Ask researchers in Tennessee like at the universities such as Vanderbilt, University of 

Tennessee-Knoxville, Tennessee State University, Middle Tennessee State University, and 

Tennessee – State Plan on Aging 2014 - 2018 334
other pubic higher education institutions 

16. Time of day is a challenge. Mid-afternoon meeting may be hard for those who work. 

Think beyond to the “sandwich generation.”

17. What about Facebook and Twitter? 

18. Ask special interest groups to only bring 1-3 designated members of their constituency so 

that the results don’t get skewed

19. Let them know the “quality” of the people listening to their concerns 

20. Provide food and door prizes or gift packets, gift cards 

21. Ask key employers to allow their Human Resource Manager or other employees to take off 

work to attend and provide feedback from the retiree or family caregiver perspective 

22. Let participants know that they are helping to craft the State Plan on Aging 

23. Let participants know that decision makers will be in attendance – invite local and state 

elected officials to be there 

24. What about virtual participation? 

25. What about being able to watch the proceedings? Teleconference? Give input? Document 

it? 

26. What about an Aging Cabinet? 

27. Grassroots connections seem to be working, but there is less connection among the state 

offices and between the state offices and the grassroots 

Verbal feedback on regional meeting survey: 

Add Alzheimer’s Disease/memory loss

Add disability issues 

Make sure terms are clear (like access, medical training) 

Make the language plain 

Add employment for older adults or adults with disabilities 

Break into 2 half hour sessions so that participants can experience 2 different topics 

Tennessee – State Plan on Aging 2014 - 2018 335
Let participants know that they will be moving around 

Write down what participants say 

Make it clear in the introduction that you want a broad range of ideas 

If you split into groups, make sure that the participants go to two different groups/topics 

Ask them to share opinion, then make sure they get feedback—thank you or a copy of what 

they said 

Written feedback on regional meeting survey: 

Add senior/adult with disability employment support (to supplement social security income) 

Add budgeting help—ongoing support to best manage money 

Add screening for LIS, MSP, Medicaid, SSI, LIHEAP, telephone bill, SNAP 

Use term “older adult” rather than elderly

Separate mental health and health. 

Mental health should include Alzheimer’s Disease, Depression, alcohol misuse, prescription 

drug misuse, severe mental illness 

Define terms/give examples 

Be careful/sensitive with language 

Suggest looking at health literacy information—commonly used terms 

Circled many terms that should have easier to understand language: chronic disease; 

geriatric; first responders; Medicare/Medicaid—what’s the difference; elderly; elder rights; 

respite; accessible; social engagement; congregate; livable and senior-friendly communities; 

walkable communities; non-driver; guardianship; universally designed housing; home and 

community based services; self-directed care; user-friendly 

Make the font bigger

Tennessee – State Plan on Aging 2014 - 2018 336
Needs Assessment 

Commission Meeting

Tennessee Commission on Aging and Disability 

Doubletree Hotel, Downtown 

Nashville, TN 

February 5, 2013 

Number of Commission Members Present: 15 

Tennessee – State Plan on Aging 2014 - 2018 337
Tennessee Commission on Aging and Disability 

Quarterly Commission Meeting 

February 5, 2013 

At the quarterly meeting, Commission members were asked for their input or reaction to the 

Needs Assessment being done for the 4-year State Plan on Aging as required by the 

Administration on Aging (AoA). The AoA Program Instruction was distributed and reviewed. 

The State Plan must address the AoA core programs, discretionary grant initiatives, and 

document input from stakeholders and citizens. The Needs Assessment will be conducted in 

conjunction with the Regional Listening Tours to be held in February-March. Commission 

members provided feedback and competed the surveys to be used for the Listening Tour 

meetings. 

Comments from Commission members included the following: 

Communication: 

Contact Chamber of Commerce and get list of non-profits (and faith based) and businesses in 

aging community 

Special dates – make it “newsworthy”

More than one date

Senior watch the news

Personally target people who need to be there 

E-mail, Facebook, Twitter – more and more seniors are on internet 

Tell them what you are going to ask ahead of time (preparation time) 

How do we get them to come? 

Using technology to get information – not everyone needs to come 

Use survey wording – get away from term “needs assessment”

1-3:30 bad time of day for those who are working; 6-8 in some of the larger cities too 

Door prizes? 

What about locations? – left to the AAADs to find good, accessible location 

Go where people are

Wellness complex – attract seniors – probably willing to sponsor 

Jim Shulman discussed Process of Meeting: 

Is it better for moderators to move or people to move? 

Be specific on the questions – do concerns and solutions – Baby Boomers have solutions 

Are you going to have big note cards? If there is an opportunity to write, then they might 

take advantage of it. 

However you choose to circle back, it’s important for you to let them know that they were 

heard and there will be follow-up. 

Commission members present completed the three (3) surveys that were distributed at the 

Stakeholders Meeting on January 23, 2013. Each question is identified and the Commission 

Tennessee – State Plan on Aging 2014 - 2018 338
members’ responses to each question are listed. The responses have been grouped under each 

survey question. 

Overall, what are the four (4) most pressing challenges facing the State of Tennessee in 

order to provide aging and disability services. 

Actions to reduce obesity across all ages – to reduce diabetes, blood pressure issues and 

health costs

Promote “visiting nurse” type programs and use of clinics

Long waiting lists for various seniors 

Options program

Providing adequate healthcare-higher risk of chronic health conditions 

Legislation surrounding long term care 

Expanding and improving the services to include unmet needs for veterans, healthcare 

(Alzheimer’s), caregivers

Having choice – an array of services for varied needs and lifestyles 

Need a comprehensive network for information 

Lack of knowledge of what already exists 

Awareness by families/individuals of all services/issues (not just those with financial need) 

Deeper and broader community awareness 

Providing better information of available services to families in crisis, hospitals, religious 

organizations, etc. 

A more educated and informed General Assembly 

No one seems to have a knowledge of all the available resources; free, for private pay or 

sliding scale 

Outreach – getting the word out 

Economy – limited resources to meet demands across the spectrum 

Funding opportunities/need to be increase and expanded 

Lack of allocation of funding for seniors for individuals with other developmental disabilities 

State funding for the “extra loads” on programs & services

Successfully obtaining non-government to supplement government funding 

Selling the idea that aging and disabled persons should pay (if they can) for their services. 

Even partial payment (sliding scale) would enhance quality without additional paid staff. 

Need a state-level commission or what other organizations are doing to provide services for 

50+ 

Need to identify gaps and move collectively to fill them 

Shared vision and commitment

Combined resources of ALL involved 

Fragmented Medicare/Medicaid delivery system and lack of coordination across benefits 

Caregiving (that allows aging in place) information 

Lack of community-based residential alternatives for people who cannot live alone 

Expand options or other support to promote community living (reduce institutionalization) 

Needed housing (different levels of care) 

Rebalancing initiatives that promote community living 

Community outreach for education and alternative funding - corporation – grants - churches 

Tennessee – State Plan on Aging 2014 - 2018 339
Community outreach for partnering and volunteers 

Finding ways to enlist the aging and disabled community to be a part of the solution 

Impact of Baby Boomers: The growing “baby boomer” population appears to have 

different wants and needs than the current aging population being served. Overall, what 

are the four (4) most pressing challenges facing the State of Tennessee in providing services 

to this “baby boomer” population?

Communication their way!

Information that is reliable and easy to access 

Keeping up with technology 

A strong network of information on what is currently available 

Community awareness of services 

Long waiting list

Support aging services and providers 

LTC Assistance In-home and ACLF (how to fund so more affordable) 

The Sheer numbers!

Adequate Medicare coverage/health insurance to meet LTC needs and maintenance of 

chronic diseases 

Broader options for all economic levels - $0 to full pay 

Expansion of services 

Funding for “quality” services

Medical services

Making certain that private companies fully fund retirement plans (define benefits) or 

provide some matching funds to motivate defined contribution plans 

Development of a variety of housing options to meet needs of vulnerable individuals with 

multiple issues 

More innovative long-term living options (new designs/ community) 

More focus on community design for future 

Ageless communities

Long term care facilities 

Jobs

Prolonging time before employment 

Belonging (participate/staying active) 

How to channel the energy of healthy “baby boomers” seniors to the joy of helping others. 

Caregiving challenges 

Knowledge of and support for caregiving 

Hunger

Hunger – growing need not only for prepared food 

Resistance to label of “aging”

Legal support/advanced directives/wills 

Integrated services (not management of individual pieces but combine services – food, 

household, transportation, shopping 

Promote educational development (at all levels) to assure adequate labor force participation 

Tennessee – State Plan on Aging 2014 - 2018 340
What works? 

Home meal delivery 

Transportation

Health insurance (SHIP) 

Integrated care delivery systems especially for dual eligibles 

Sliding scale fee for service enables service providers to provide more services with limited 

funds. Consumers value what they pay for – don’t try to have more services than they need

From my personal observations – I believe that the Options program works. I am a big 

advocate of elderly and disabled individuals living within their homes for as long as 

possible!! 

Case Management – Re: hunger – innovative food pantries 

From your area of expertise, what are the best practices, programs, or services on which 

the State should focus? 

What would help Tennessee move forward to better serve our elders and people with 

disabilities? 

Focus on existing programs – transportation (rural areas), housing, hunger 

Telemedicine

More outreach program 

Need expanded waivers 

Innovative partnerships for community gardens (hunger) 

Coordination of efforts and information 

Mobile Food Banks/commodity sharing 

Caregiving support – Ombudsman Program 

Additional transportation (public/rural) 

Housing

Mobility options 

Hunger

Ageless communities

Nutrition – across all ages to reduce chronic illnesses (diabetes, blood pressure, etc.) 

Structured housing settings/funding for such programs 

Grant – sharing/collaborations 

Reward/assist programs which seek funding from foundations, corporations, United Way, 

local governments, etc. 

General funding to develop needed new programs 

Stronger funded caregiver programs 

I hate to say it – but more money – not likely 

Need a state level working group to address current programs and needs and/of plan for 

moving forward 

Tennessee – State Plan on Aging 2014 - 2018 341
Needs Assessment

First Tennessee Area Agency on Aging and Disability 

Memorial Park Community Center Senior Center, Johnson City 

March 6, 2013 

Tennessee – State Plan on Aging 2014 - 2018 342
First Tennessee AAAD 

Memorial Park Community Center Senior Center, Johnson City, TN 

March 6, 2013 

What are the hard things that “baby boomers” face? How should the state of TN help?

(Number of Questionnaires containing 1 or more responses - 51) 

This open-ended questionnaire was designed to elicit qualitative data from the attendees about 

how they thought aging would impact baby boomers. However, many attendees also identified 

issues that currently exist. Attendees were able to respond to the questions in any manner that 

included short, one-word answers, such as transportation, to very involved responses. In order to 

provide some order to the responses, major topic areas have been identified. In addition, some 

topics might include sub-topics for the purpose of reading the report more easily. Repetitive 

responses are included only once. 

1. Easier Access to Services Without Hassle (including information and assistance; 

communication; and technology) 

Aging education

Technology – education, education, education 

Access to information on “Aging with Choices” that is easy to understand and 

navigate 

Not knowing what all is available for them and how to find out 

More available information for meals, transportation, doctor appointments 

Getting information and assistance on services that can keep them safe and secure at 

home 

Community meetings that can openly inform individuals of providers as well as 

benefits that may help them as they are needed 

2. Healthcare (including in-home services; Home and Community Based Services; long 

term care; chronic disease; Alzheimer’s disease and related dementia)

Lack of affordable, accessible alternative healthcare 

Since coming to TN 31⁄2 years ago – no one has been coming to my door offering the 

HELP – everyone has been looking for something: a donation, use my phone, sign up 

for something. Need door-to-door asking if they can HELP seniors 

More doctors that will visit home bound patients 

Finding assistance when different family members live out of the area (state) 

Identify quality and recognized service providers 

Better services for seniors – should not have to choose between food and treatment 

Less family to help them 

Medical knowledge

Shortage of any present programs 

Help with meds, more discounts for lower income people taking multiple meds 

Monthly set up of medications. There are no options once home health leaves 

Qualifying for state benefits and learning various Options that they may have 

Less of functioning ability – lack of mobility 

Tennessee – State Plan on Aging 2014 - 2018 343
Receiving help at home

In home care vs. nursing home, being able to stay home longer with in home care –

homemaker services 

Education > home care

Long-term care facilities; medical and dental care 

Health care, dental, vision, hearing 

Dealing with chronic illness or other health related issue 

Dementia – Alzheimer’s – help caregiver with funding to keep in home 

Isolation from their very/very busy children/grandchildren 

3. Fiscal Concerns (including health insurance; Medicare/Medicaid; employment; 

retirement; social security; cost of living) 

Affordable healthcare/insurance 

Health insurance access before Medicare eligibility 

Affordable health insurance exchange 

Medicare – will it be there?? – more out of pocket 

Prescription coverage that is affordable and accessible 

Medicare cuts – higher costs 

Cash prices for doctor services are the most expensive way to pay. Allow payers who 

can’t afford insurance to pay Medicare reimbursement rates for services

Good insurance too costly 

Limited resources to stay healthy and well – doesn’t cover all needed items (hearing 

aids), expensive medications 

Unfair employment; little/no retirement 

Employment opportunities

Working longer – help with training for jobs after retirement 

Not enough work

Help get jobs for the elderly that still want to work 

Social security becoming insolvent 

Rising costs of living – groceries, home and care insurance 

Securing money for retirement 

Retiring as they originally planned 

Folks having to put off retirement due to insurance/financial reasons 

Part-time employment in retirement 

Give help on retirement and how to apply – which insurance best suits retiree 

4. Support Services (including transportation, meals/nutrition; elder abuse services; senior 

centers)

a. Transportation 

Transportation to and from doctor’s appointments and etc., especially as 

driving abilities decline 

Transportation issues – need more public transportation options for seniors 

who need service to and from home/living facility to and from doctor’s 

offices, etc. 

Tennessee – State Plan on Aging 2014 - 2018 344
Transportation for elderly parents to doctor appointments and other necessities 

Transportation – better bus service without having to pay – this is hard for 

seniors on a limited income to do 

Provide more bus routes in community

Transportation issues – no able to drive – to/for shopping and doctor 

appointment - learning how to transport, and various provisions that are in 

place for needy individuals 

Government resources have waiting lists 

b. Meals/Nutrition 

Meals and nutritional guidance for elderly parents (also spouses) 

c. Elder Abuse 

d. Senior Center 

Having senior centers to go to if you do not have family – friendships are built 

in senior centers

Support senior centers and activities 

Have more senior facilities in rural area 

5. Staying Healthy While Aging (including exercise, eating healthy foods, socialization, 

chronic disease, staying connected and involved in the community, volunteer 

opportunities) 

Fun things to do in the general public 

Maintaining/extending quality of life through various activities in the community 

Living longer – help with health education & preventative lifestyles 

Socialization, more Adult Day Care – senior organizations, for which they can 

socialize for their well being 

Physical activities that promote good mental and physical health 

Programs that are geared to fitness and maintaining health, balance, sound mind 

Access to social services

6. Adults with Disabilities 

Disability housing 

Transportation for disabled

7. Caregiving 

Caregiving for elder parents and children 

Elder care – transitions from caring for older parents to caring for self 

Caring for elderly parents while trying to work and maintain a household 

Caring for their parents and themselves – financial difficulty 

Caregivers that live out of state 

Good training for their caregivers 

8. Housing, Neighborhoods, and Safe Communities (including home repairs and utilities) 

Tennessee – State Plan on Aging 2014 - 2018 345
Being a part of a community when they are often isolated or shut-in due to physical 

conditions 

Senior housing – more senior living spaces 

Affordable housing

Maintaining a sense of independence in their homes 

9. Funding/Resources 

10. Other: 

Holding onto our traditional values and habits in face of ID theft, rudeness, 

narcissism by younger generations 

More municipal support for senior services (Johnson City) 

Assist elderly in renewing driver’s license on line to they can avoid the long wait and 

hassle of the DMV office 

Assist elderly in paying property taxes (same reason as above) 

No facilities for meeting with friends 

Tennessee – State Plan on Aging 2014 - 2018 346
First Tennessee Area Agency on Aging and Disability 

Memorial Park Community Center Senior Center, Johnson City, TN 

March 6, 2013 

Question: Here are seven (7) aging and disability issues. 

 Under each, there is a list. 

Mark the ones on the list that you think are most important. 

Number of Questionnaires completed: 66 

Response # of 

responses

%

1. Getting care at home instead of in a nursing home 49 74.2

2. Meeting people and making new friends 47 71.2

3. Keeping healthy through exercise and eating healthy foods

4. Not having enough insurance or money to pay for doctors or medicine

5. Transportation for people who don’t drive cars

46 69.7

6. Respite services 45 68.2

7. Affordable dental care, hearing care and eye exams and glasses

8. Being able to get help when needed quickly and without hassle

9. Being able to get accessible transportation

44 66.7

10. Housing that people on a pension or Social Security can pay for 42 63.6

11. Learning about how to take care of yourself so that you don’t get sick 

 and tired

39 59.1

12. Training for aid workers who help older adults and people with

 disabilities

38 57.6

13. Knowing where to call for help and getting help without a big runaround 37 56.1

14. Learning about how to care for someone at home 35 53.0

15. Learning how to live with a serious condition like heart disease, cancer, 

 arthritis

34 51.5

16. Learning new things 33 50.0

17. Meals that are healthy and prevent hunger 31 47.0

18. Reasons people have to go into nursing homes

19. Protect people from abuse

20. Teaching doctors, nurses, and other healthcare workers to know the 

 special needs of older adults and people with disabilities

30 45.5

21. Houses that are easy to get around in if you’re on a walker or in a 

 wheelchair

29 43.9

22. Neighborhoods that are easy and safe to walk in 28 42.4

23. Reasons people have to go back to the hospital

24. Help with memory loss

25. Teaching volunteers to work with older adults and people with 

 disabilities

27 40.9

Tennessee – State Plan on Aging 2014 - 2018 347
26. Teaching police, Firemen, emergency workers to know the special 

 needs of older adults and people with disabilities

26 39.3

27. Understanding how Medicare works 24 36.4

28. Making decisions about health insurance, Medicare, and planning for 

 the future without depending upon the government

29. Being able to choose the workers who come into your home

23 34.8

30. Learning how to prevent falls

31. Eating out with friends

21 31.8

32. Places to volunteer 19 28.8

33. Help with chores like lawn mowing and leaf raking 17 25.8

34. Help with feeling sad or lonely

35. Help with taking too much medicine

16 24.2

36. Neighborhoods that have grocery stores close by 15 22.7

37. Being able to get accurate information from a website and being able to

 apply for services on-line

14 21.2

38. Help with drinking too much alcohol or taking drugs 10 15.2

Other: 

Free internet for low income seniors

Better ambulance service in rural areas

Improved medical access in rural areas

More doctors in rural counties/areas

Ambulance services in rural areas – faster response times – more stations or contracts to let services cross 

county line to pick up patients

Free internet for seniors (for low income seniors)

More ambulance services in rural areas

More physicians in rural counties

There are too many homebound needy people who are not eligible for current HBS, but they desperately 

need help!

Assisting elderly with making the best decisions on housing, insurance, etc.

Help for those that have no where to go or no one to care for them after being released from the hospital. 

There is a huge gap and those people need help.

Accessible food pantries

More involvement with government “pushing” issues with elderly concerns

Communal homes: like small care centers, i.e. 2 workers to 8 residents – these are all great - like a foster 

care, but the client stays in place and staff has 8-10 hour shifts

Provide pet care to people aging in place to frail or insufficient $ for pet care

public forums for information

Community endeavors to encourage participation

Make insurance companies actually consort with care providers on in home care before they make arbitrary 

changes

Tennessee – State Plan on Aging 2014 - 2018 348
An easier path to getting employees in the home care industry put on the elder abuse list

Being able to apply for services via phone

People go into a nursing home due to lack of money

People go back into the hospital because doctors do not ask questions

Making it easier for seniors to sign up for programs that can provide services for them

I have some unusual health challenges like multiple chemical sensitivities celiac. Makes going to public 

places very difficult (perfume)

Meeting people that are not totally unavailable due to grandchild duties

Eating healthy foods especially in restaurants

Getting affordable care at home

Feeling sad and lonely, especially if family lives elsewhere

Need more small support groups for taking care of yourself

High grocery taxes – high gas taxes

Teaching self-management skills to seniors and caregivers

Understanding how seniors are going to be affected by Obama care

The above issues and lists are hard to find one or two important issues. All are good and all should be 

addressed masking it hard to accomplish much.

Tennessee – State Plan on Aging 2014 - 2018 349
First Tennessee Area Agency on Aging and Disability 

Memorial Park Community Center Senior Center, Johnson City, TN 

March 6, 2013 

Question: What is currently working well in your community? 

(like agencies that help, neighbors who help each other, van service, senior center, 

meal sites, food pantry, healthcare clinic, nursing home, sidewalks, police 

presence, grocery stores that deliver) 

(Number of Questionnaires containing 1 or more responses - 47) 

This open-ended questionnaire was designed to allow attendees to identify the community 

programs and services that have worked for them and in their community. Evidence based 

and/or proven practices were not a consideration in the design of the questionnaire and no 

checklist was provided. The above items in parentheses were provided as examples. Attendees 

were asked to write in the programs and services that were working well in their community. 

The responses are individual and specific to the region served by the Area Agency on Aging and 

Disability. The number of attendees who indicated that the program is working well in the 

community is provided in parentheses (). 

All of the above – need more community forums for soon to be seniors or caregivers of 

seniors

These are all very good services – we need more of them and need to have more in 

home visits and more watchful eyes

Agencies that help

Neighbors who help each other

Van service (2)

Van service (to Wal-Mart)

KATS transportation (2)

Para transit

Transit

Bus service

Transportation

Net trans

Transport from FTHRA

Senior Center (10)

Wellness, provide activities of interest to seniors

Johnson City Senior Center

As Director of a Senior Center, our goal is to reach out to the aging population with 

services and activities of interest to seniors. We have grown so much in the past 

year with membership because of baby boomers and word of mouth about out 

programming. A new center is in our future within the year allowing for more 

opportunities.

Tennessee – State Plan on Aging 2014 - 2018 350
Meal sites (3)

Salvation Army (meal sites)

Need more

Meals on wheels (7)

Regional meals on wheels – calls come in almost daily for assistance – needs are

growing

Meal assistance (delivery and preparations)

Schwann’s home food delivery (but they are expensive)

Food pantry (4)

Healthcare clinic

Nursing home (2)

Sidewalks

Police presence (2)

Police involvement with SALT/SALT conference

Grocery stores that deliver

Volunteer grocery delivery

Adult Protective Services

Assisted living

Aide and Assistance

First Tennessee Area Agency on Aging and Disability (FTAAAD) – handling all 

services of help in community (4)

Human Resource Center at the JC Mall sponsored by MHSA

Good Samaritan ministries

Downtown Clinic

Keystone Dental Clinic

Second Harvest (3)

Senior adult church meetings

Adult Day Care services

There is still a need for these service organizations to coordinate their services because 

there are people falling through the cracks that are hungry, hurting, etc. and with small 

children that are not being cared for appropriately

Church members who volunteer to go to peoples’ homes and help

Active senior groups - advocacy

Great health care

Alzheimer’s services

United Way

Community Gardens

Shepherd Center (drivers for doctors’ appointments, medical equipment for loan)

A new website launched by Aging with Choices, Council of the United Way of Greater 

Kingsport

Senior Connectkpt.org – an easy-to-use portal that links seniors, their families/ 

caregivers, and concerned community members with information on local providers 

and resources

Tennessee – State Plan on Aging 2014 - 2018 351
Unknown

Home health and hospice services

Education to seniors and their families about different services available

First Tennessee Human Resource Agency (FTHRA) – the broad based agency that 

serves the community, always a standard for help and information (2)

The First Tennessee Human Resource Agency is offering a lot of assistance to the 

elderly and disabled in the community but there is always room for more 

help/funding

Clinics and volunteer agencies and program

In home care organizations that provide assistance with personal care, house keeping 

and errands. Services also provide companionship and foster meaningful relationships 

that will enhance quality of life.

Networking of agencies providing services in most cases

Jonesborough Public Safety/Jonesborough Senior Center

Gentiva

Amedysis

Volunteers 

Community mental health

Home health hospice

Non-clinical in home care

Support groups that provide respite

Homemaker services

ETSU and church volunteers

Slater Center

Choices program

In home services

Kiwanis Towers of Kingsport

Contact ministries

Net-Vac

I think that the networks are in place, affordability is the issue.

Options other than nursing facilities are cheaper and would be, in most cases, more 

beneficial

Tennessee – State Plan on Aging 2014 - 2018 352
First Tennessee Area Agency on Aging and Disability 

Memorial Park Community Center Senior Center, Johnson City 

March 6, 2013 

Small Focus Group Responses 

Tennessee – State Plan on Aging 2014 - 2018 353
First Tennessee AAAD 

Memorial Park Community Center Senior Center, Johnson City 

March 6, 2013 

Facilitator Notes for Small Focus Group 1 

Keeping healthy for Baby Boomers

Not having enough insurance or money – being harassed by hospital – (Don’t know how to get 

help) Programs and getting word out at senior centers

Knowing where to call for help – call senior center – and getting help without a big 

runaround - timely manner, get frustrated

Feeling sad or lonely not discussed or diagnosed

Volunteers

Staying busy keeps you young 

Stepping out one door into another door

Protect people from abuse – seniors are afraid, embarrassed, or in denial

It’s ok to ask for help

Parrish Nurse outreach can help you learn about taking care of someone at home

Education about available groups for learning to take care of yourself

Senior Connect – education and advertising on services

Net Trans is beneficial – in wheelchair hard to get anyone to take you

Will need more housing due to baby boomers

Feeling safe (drugs, theft)

Baby boomers better off than those in 80-90’s now

Getting out – making new friends helps depression

Teaching and training for all who work with the elderly

Resistant doctors – not referring them to home health, hospice, etc.

Senior centers bringing services to them

Exercise – increased at centers

Facilitator Notes for Small Focus Group 2 

Transportation: doctors, grocery store – NET Trans - evening transportation – social events

Maze of resources available – how confusing it can be to find the right resource

Confusion of consumers on how to use the resources that are available (schedule 

transportation, cancel van rides, etc.)

Handicap accessible/safe housing at affordable rates

Meeting basic needs first (food, shelter, etc.) then adding

Loneliness of elders/seniors – can lead to depression

Mental health issues that go untreated or unknown: cost of treatment, transportation to get 

there, patients don’t want to be over medicated

Communication issues – no internet access or even cell phone services in many of our rural 

areas

Prescription drugs: costs even with insurance – food, medication, or shelter; people may not 

be aware of or have too much pride to ask for assistance that is available

Senior Employment training

Economic problems for seniors – if only income is Social Security – affording housing (rent, 

Tennessee – State Plan on Aging 2014 - 2018 354
upkeep on house if own house, etc.), utilities, insurance, etc.

Meals/Nutrition

Adequate, fresh locally grown food

Not just getting food to live on but that’s healthy

Education on healthy food choices and having healthy options available

Deliveries from grocery stores – available in some metro areas but not our area

Maintaining house if own home

Lawn care – may be some church groups, but it’s not well- known and people wouldn’t

Know who to contact

Even if can afford it – finding someone who is reliable and honest and safe to trust

Safety – medications – being over-medicated and being able to follow instructions

Education for Doctors

What to look for – how seniors respond to meds

Only have one gerontologist in area that we’re aware of

Recruit gerontologist and gerontology nurses for area

Women who take sleep aids 65% more likely to fall

Resistance of some seniors to participate in “Senior” activities or go to Senior Centers

Don’t want to consider themselves old

Do education programs at places that reach beyond senior centers

Multi-generational community centers and events

Retirement homes – consumers who refuse to go into a nursing home, assisted living, etc., 

even those who need to be there for safety – who won’t even address the issue – fears about 

going there to die, etc.

Caregiver issues

Not enough support for caregivers – not enough services to get them breaks and rest

 to care for themselves

The services that are available for caregivers often aren’t aware that they are there 

or don’t take advantage

Caregivers who live elsewhere and trying to get help for senior – where to go, what’s

available in the area, etc.

People who need help but don’t know where to begin

Our area markets itself as a retirement destination/communities – as that population increases 

their families/support system is elsewhere and they are not aware of resources that are 

available and caregivers are dealing with issues from other states, etc.

Sitters or personal care companions who can be there all day – difficult to find trustworthy

people and afford cost

More financial assistance as to in-home care

More adult day cares

Dental and vision care

Both of those affect the overall health and improve quality of life – if have poor 

dental care or poor teeth, can’t eat healthy, etc.

Very limited resources in area for those services

Hearing – if you have poor hearing, it isolates seniors even if gets out/isn’t homebound

Home safety

Unsafe homes – hoarders, burn trash close to home, other house hazards – electric,

Tennessee – State Plan on Aging 2014 - 2018 355
 heating - wood stoves, kerosene heaters, heating with cooking stoves

Large numbers of pets they can’t care for

Limited resources not always used wisely – heating with cooking oven instead of 

 other heating sources

Can’t afford home repairs

Silver sneakers – good program

Hospital readmissions

No advocate from family for the discharge plan and make sure patient complies 

 (meds, meals, therapy, etc.)

Need social support in hospital and on discharge

Patients being discharged too early

APS - being pushed to close cases earlier

Goes back to money pressures

Self-neglect – ss that most often in their APS cases that they provide services to

No longer have capacity to care for themselves, take care of finances, cook well/

 eat healthy etc.

Suicide or threat of suicide – seen an increase in clients threatening suicide

On-line services

Computer training, adding more services that people can find about online 

 (baby boomers)

Some services have increases – have personal contact, but many service applications

 could be started online

Do see many clients who are functionally illiterate – filling out paperwork

Choosing caregiver

Compensating family members as caregivers – much too complicated under CHOICES

Choice between staying home with parent or working – other family members 

 who can’t/won’t help

If do send in professional caregiver thru service sometime the senior has conflict with

 caregiver or (vise versa) really like him/her and becomes upset if worker has to change

Family dynamics can create problems with caregiving or adds complications to 

 delivering services

Available services for developmentally disabled

DIDDs there to provide services but waiting list for community services make services

basically unavailable unless the person is in crisis - no real preventive services – family

fights to keep person out of institution – depending on behaviors can be difficult to get 

professional caregivers in the home

Facilitator Notes for Small Focus Group 3 

Other - Budget cuts – will make increase in seniors that are homeless – some can’t even get 

out of wheelchair on their own

Staying Health While Aging – need affordable dental – old enough to retire – not old enough 

for Medicare – service not available to them or can’t afford

Tennessee – State Plan on Aging 2014 - 2018 356
Hearing problems – cause change in personality and many other problems – won’t participate 

in activities – creates isolation

Possible solutions

ETSU cleaning and exams – dental/still need dentures, extractions, etc.

RAM – available but older adults may be intimated by that

places offering glasses and hearing aids didn’t have takers

need to make people more aware of where services are

dental was long waiting list for extractions

work with Senior Center or FTHRA to take van

Need to get info out to rural areas – some people don’t go to Center - Think about what you 

can do for people where they are

Learning how to manage chronic health problems

causing rise in health care – cost if not controlled

Alzheimer’s recognition needed

Barrier – not wanting to know

Solution: educate, educate, educate

Health and Wellness – government wants to cut down on money being spent but aren’t

 offering services to supplement need

Barrier: lack of funding for support services and medical skilled care – can’t get into facilities

more funding needed for HCBS and supports

new PAE requirements are too difficult to get approval

need to look at requirements for LTC in TN 

no money for prevention – role of MCO – goal NP to go into home and do assessment 

-identify needs – and get help – growing and a real plus

need to access care

Health and Wellness

Need to better get the word out on where to call for help such as AAAD

Tap in church – establish info and resources – offer classes – assessments

Understanding Medicare, especially as relates to VA

Being charged for Part B even if they don’t need it

Not aware of SHIP or certified counselors

Getting care at home vs. nursing home

Other:

Would love to have NP office in every HUD facility in each area

Once they qualify for HUD – never get kicked out base on income (ex. large money 

was inherited)

Medication management – huge problem – increase due to hospitalization – changes in 

meds memory problems

Use emergency room care due to lack of transportation or not knowing if emergency 

vs. management or not

APS needs to be better able to take action – APS needs more funding

Tennessee – State Plan on Aging 2014 - 2018 357
Caregiving – must take care of caregiver to take care of person

Need education – Alzheimer’s, how to provide care (physically), and how to managehow to manage equipment – offer counseling

*Offer more respite - *not much to offer – can’t afford private pay

Need more in home respite – funding ADC and a place without a waiting list

Independence and getting services easily

Takes too much time to get help

Need real person to answer the phone – not an automated machine

Facebook and twitter needed for baby boomers and social networks caregivers

New site called Senior Connect.com

*Ask each provider to put a link on it

Like big red button to talk

Need agency that provides grocery shopping

Barrier - handling money – would grocery store set up account, including contact # of person 

brining them

Contact Jr. League, HS, ETSU for volunteers tapping into service hours

Housing, neighborhoods

Neighborhood watch – needed but can’t get it worked out – suggest group walks, walking 

buddies

Transportation

Transportation – huge need – not always transporting people, but also bring things to people

Barrier – liability, cost of gas

Staying Connected

Volunteer ideas: 

Dorcas group at church - collect materials – for baby blankets to foreign country

Watauga Square now hosts to volunteer group and resident take part

Working with Older Adults

Dementia training is offered to EMS, police, etc., but not mandatory – often they don’t

participate

Need to get word out

Need to offer specialty training for top medical conditions

Other

Relax HIPAA law with caregivers, social workers, etc. – can’t share very important

things with health workers because HIPAA prevents it – prevents proper care

Difficult to plan ahead but don’t know what you will need – sort of like state planning but we 

need aging planning

What to expect as we age

Get long term care insurance before it’s needed

Re-evaluate/redistribute funding from prison to LTC

Tennessee – State Plan on Aging 2014 - 2018 358
Facilitator Notes for Small Focus Group 4 

Rick – training for CHOICES – managers – client – dementia

Incontinent – horrible – took two weeks

VA morning 7 X week – evening

Case managers do not consult with sitter service

TN – geriatric – 50’s stroke patient – did not meet criteria for CHOICES – AOL

Kim – MSHA – their case management – providing Health Pro – case managers – no thorough 

enough so patients care going home ill-equipped and are returning to the hospital – cannot 

financially afford care – raising children/grandchildren

Ed Jeffries – increased calls from folks whom cannot afford basic living expenses – economics 

is playing a huge part in problems

Case Managers CHOICES – problems

Need Case Managers – Medicare – early onset dementia

Safety – denied twice

AAA ER Plan – emergency plan – T. Sutphin

Daughter – 27 hours – CHOICES cuts – Lobby – Obama Care

Case Managers – caseload – AAAD 

1 hr. 1 week bath

3 hrs.

Who will make the call – on schedule

Marilyn Turner -

Payment –

Rick 60,000

Regular meetings

Kim – Fink – caseloads – client chooses

6 different providers

MCOs

Terrie – lack of medical management – not utilized

1 hot meal

APS – can no longer

Baker’s act

CHOICES – case managers – caseload size ?

Case managers change client’s schedules without notifying providers

Need training across the board for case managers – someone needs to monitor case managers 

more as they do not always make the proper med. Needs

Increase in calls from folks not able to meet basic living expenses

Loss of payment to providers of home health when changed from waiver to CHOICES

CHOICES not meeting needs of clients when they are no

Facilitator Notes for Small Focus Group 5 

Housing: lack of affordable homes for those that do not already own their own home

Healthy food:

cannot afford fresh or nutritious food – all frozen and processed – just fills their belly but 

does not provide “good” nutrition

not getting the food that they need – may cause many of the health problems – if the could 

Tennessee – State Plan on Aging 2014 - 2018 359
get the fresh fruit and grains they need – this may cut down on disease and medication use

Someone to check on them and provide socialization

Individuals are getting sent out of state so they can get help paying for assisted living and 

nursing homes. TN is not providing this to these individuals so they must leave the State. 

We are dependent upon other states for . . . 

Respite hours being available for those families that need it

The cost of hospital care is outrageous and there is not regulation on what the hospital charges 

you. There are not choices for people and hospitals are not up-front

Help dealing with hospitals and insurance companies. Who will help them appeal if the 

insurance company doesn’t cover a cost or “bargain” over the billed price

Safe and affordable housing: multiple floors + no steps + can they get out if there is a fire? 

How is their mobility?

How long they wait when they use the transportation that is available. They may spend hours 

just traveling to their destination or waiting to be picked up

They need “door to door” rather than “curb to curb” with transportation

Assisted transportation: if you are bed bound you have to use the ambulance to go to the 

doctor so many end up going to the emergency room to avoid a huge fee since Medicare does 

not cover that

More meals on wheels delivery

More volunteers recruited, church involvement to help more people – if more churches were 

involved then there would be more help available to the community. The State should 

collaborate with these churches to initiate programs – informal support systems

The FTAAAD is really good about spreading information.

The government pays everything for those individuals with kids, but they neglect the elderly.

Community gardens to give access to more fresh nutrition to the elderly. We could utilize 

high schools for 4-H programs to grow gardens to feed the elderly.

They have to choose between medications and food.

Advocacy for individuals who seek help. No where to look for help and not give up.

Problems getting approved for CHOICES – people who need help are not getting it. They are 

scared of appealing and it is a hard process in an already difficulty time. Scared of the money 

that could be owed in the end.

Not enough funding for all the people and problems

Knowing where to go if you can’t get help getting the medication prescribed if insurance 

won’t pay. Who will help appeal?

More cohesive system for tracking what medications an individual is on so there are no drug 

interactions

Facilitator Notes for Small Focus Group 6 

Activities for seniors in afternoons

Workshops/information for children of older persons that are in the evening, due to them 

working during the day

More residential housing for seniors

Residential hospice centers in this area

Help with being placed in the community after leaving a nursing home/retirement 

center/assisted living center

Tennessee – State Plan on Aging 2014 - 2018 360
Better training of works caring for the elderly in the hospital

More help for grandparents caring for their grandchildren

Immediate access to what is available when help I needed. Where to go?

How to get the word out about services that are available to reach the most people.

Healthy eating – senior centers not serving unhealthy foods (cookies, etc.)

Limited resources for Baby Boomers due to financial instability

Not able to pay for needed medications

Older persons understanding what to do when being discharged from the hospital (new 

medications, --?-- with PCP)

More knowledge of home health on part of doctors and other healthcare providers – home 

health and resource

Resource in community to train people on how to care for an older person

Local agencies getting together to discuss resources that are available in the area

Medicare waste/too many not needed tests

More accessibility for services

Educating individuals on how to plan for the future

Less dependency on family for assistance

More training on how to deal with individuals with mental health issues

More awareness of mental health issues

Senior centers holding forums on mental health

After hour forums for working individuals

Facilitator Notes for Small Focus Group 7 

Lack of planning – disaster plans – no one wants to talk about what would happen if disaster 

strikes

Resources for Seniors: - how to find them

How to find out what is available for seniors and disabled – make easier to find

Main desk # is not on brochures

Complaints about not getting through to area agency

Website is not correct with updated events

APS – needs to do something –

They call ahead of time to schedule appointment for visit but defeats the purpose of the

visit

Frustration about APS not doing anything

Providers are not informed about issues with consumers re: drugs, theft, mental health issues –

several agencies have been in the home – see situation but provider of services is not notified –

This is problem with CHOICES and Options referrals.

*No cooperation with MCO’s to providers of services – communication was much better when 

program was waiver with FTAAAD

FTAAAD website is difficult to find things, especially for seniors – needs to be more senior

friendly

Have everyday places such grocery stores about services

Target adult children about what services are available

Vision care and dental care

Pet care – vet bills, pet food – seniors cannot afford vet bills and pet food – big problem for 

Tennessee – State Plan on Aging 2014 - 2018 361
seniors if someone has to go to senior housing and can’t take their pet with them – pets 

enhance quality of life for seniors – flip side is that seniors have say “25(?)” cats and are 

unable to take care of them and caregivers spent most of their time taking care of the pets 

instead of the senior

Abuse of services in the system – providers see people that are getting services that do not 

need services – both in CHOICES and Options programs

Food Pantry: Angel food ministries – co-op food initiatives

Having someone to help with the shopping

Transportation is limited – no escort – all that is offered is drop-off and pick-up service

*Elder Abuse Registry – this needs to change: can’t put a caregiver on the elder abuse registry 

– only medical professionals are the only people that can be place on registry

Affordable housing: people are taking advantage of the system and then the people that need 

affordable housing cannot get in – need checks and balances

Fall risks: make homes that are more accessible – washer and dryers need to be moved 

upstairs, loose carpet and they trip and fall, electrical not up to code

Difficult to get minor home modification contractors approved – use people that are in their 

50’s and that are hand and could do home repairs – employ them

Pest control is big issues – bed bugs and fleas – no money to help with these issues

Substance abuse

Getting paid by MCO’s to the providers is a big problem

Overseeing services check on participants

Facilitator Notes for Small Focus Group 8 

Staying healthy

Free programs – like healthy lifestyles

Free health fairs

Education is #

Age specific education

Health and Wellness

Can’t take help @ home

Can’t get the type of care they need at home

Fear of bringing someone in your home – fear of uncertainty

Dementia related forgetfulness – can’t remember to take meds

Open up Medicaid/Medicare/assisted living beds so that increases bed for those individuals

30-day not admit

Better placement from the hospital upon discharge

Reassessment during transitional care

Other

Medicare: Insurance companies are the client, not the individual

Get more churches on board – come together

Abuse – don’t be afraid to make a referral. Fear of making APS referral

Having advocates in the community

Empower home delivered meal for safety checks

Tennessee – State Plan on Aging 2014 - 2018 362
Empower parish nurses

Community centers

There was a time when you knew your neighbor. Go back to community to check on each 

other. > public service – building comes inside/out

respite care – too often funds are cut

home delivered meals should not be cut

*Respite – families afraid that someone is stealing – afraid of being sued

How do seniors get info – should doctors?

Future is in technology:

Healthcare

Information on insurance

Being able to use all technology

*Have the State do something like the SeniorConnectkgt.com – like generation on line

*Social Security want to schedule computer lab on how to use SS line

Technology – seniors want and demand info – knowledge is power

Transportation: 

bus lines – continue good working relationship with public transportation 

how to get seniors to/from doctors – services for dialysis

put some transportation back on the providers, maybe healthcare provider or hospitals 

could do transportation bus 

*clinics to pay or contract with a facility to transport patients like car dealerships

empower seniors for this

Training for seniors to enter the work place so they can enter the workplace – partner with 

businesses to train seniors on computers through senior centers – corporate business 

partnership with senior centers to train seniors to enter specific jobs

Neighborhood – get volunteers to help with home improvement

Disability – no place for programs for the disabled under age 50 to do social activities – open 

up community centers to younger than 50 - *possible grants for activities for disabled under 50

Facilitator Notes for Small Focus Group 9 

People don’t have a lot of information, no contacts, don’t know the different companies, don’t

know the AAAD (these are industry people talking) AAAD need signage, need more 

community presentations

People totally shut-in – don’t know, but people ask us as care agency (the ones who go in and

do housekeeping and bathing)

People complain that they call 6 places and get no answers 

Example: called 12 places to get help for father

If people are at home, they can’t call and ask for help so they are “googling”

Regardless of which company they choose to call, they need information, need to be reanswered

Question why there are a whole lot of programs to help people who have families (who can

and should be helping); and then there are really needy people who can’t get on the program

(and those are the people who seem to have the least # of hours of service)

Sometimes there are not enough home visits to see how people are doing – they are declining

and case managers don’t know it (again, this is the perception of the service agency about the

Tennessee – State Plan on Aging 2014 - 2018 363
case managers who decide how many hours of service someone receives)

It’s our responsibility to call care coordinator if person is getting progressively worse

People are falling through the cracks with care coordinators

ET/Upper East – more of a retirement destination, mobile socially, torn family = need for more

services

Too many clients per MCO care coordinator

Companies need to keep calling up the line to TennCare

Some people need someone to help pay bills (help them write checks)

We’re the in-house agency so we are who the people ask (the clients are not calling their case

managers)

Worried about PAE being done on Alzheimer’s patients in nursing home and nursing home

turning them out because no longer meet new criteria – nursing home sending them to

Salvation Army

Example – man lived in nursing home for 3 years and nursing home discharged; another 

example is when an equipment company left the lift they were delivering in the garage. The 

equipment was not set up or the family trained on how to use it.

Some of the legislators should make some home visit with us

Safety issues – skipping steps when nursing home discharges to home – not making home

visits – houses not safe (discharges and care coordinator not making home visits)

Prior to discharge, they need to make sure everything is set up

For a lot of Baby Boomers, they’ve lost resources and retirement isn’t going to go as they

expected - need some kind of intervention – need employment opportunities for seniors

Older people serving as respite workers – seems like a good fit

Dental issues

More educated seniors seem to be taking care of themselves better

Wellness messages – people seem to understand it now. If we don’t do wellness – the cost 

will be even more

Not enough $ for insurance – not enough $ for Medicare – eat rather than buy medicine

The length of time a person is in a chronic condition is bad

Income requirements – assessing that for government programs

Seeing a lot of depression but not as much substance abuse

Very lonely people

Over medication? Not as much – now those on oxycodone, etc. are referred to pain clinic

What do families need the most? Emergency respite, some families just need someone to sit 

with patient awhile – they have a few hours to take a hot bath and a nap

Families need help with lifting (back pain)

Transportation – Johnson City has Para-Transit - $4 each way – not affordable – 24 hours in

advance – no easy – transit won’t come get you when appointment is over (waiting) – if you 

can ride bus for 50 cents why can’t you ride para-transit for 50 cents.

People need an advocate. People have had fraud calls over the phone.

Dementia/depression rampant – and patient refuses to go to doctor (lay on couch, hasn’t left 

house in 2 years) (mental health issue, but refuses to get help)

Good senior housing here, but there are waiting lists

Need laundry facilities in senior housing facilities

Programs may be available in community, but the people don’t know how to access it

Tennessee – State Plan on Aging 2014 - 2018 364
Needs Assessment 

East Tennessee Area Agency on Aging and Disability 

John T. O’Connor Senior Citizen’s Center, Knoxville, TN

March 7, 2013

Number of Attendees: 151 

Tennessee – State Plan on Aging 2014 - 2018 365
East Tennessee AAAD 

John T. O’Connor Senior Citizen’s Center, Knoxville, TN

March 7, 2013 

What are the hard things that “baby boomers” face? How should the state of TN help?

(Number of Questionnaires containing 1 or more responses - 120) 

This open-ended questionnaire was designed to elicit qualitative data from the attendees about 

how they thought aging would impact baby boomers. However, many attendees also identified 

issues that currently exist. Attendees were able to respond to the questions in any manner that 

included short, one-word answers, such as transportation, to very involved responses. In order to 

provide some order to the responses, major topic areas have been identified. In addition, some 

topics might include sub-topics for the purpose of reading the report more easily. Repetitive 

responses are included only once. 

1. Easier Access to Services Without Hassle (including information and assistance; 

communication; and technology) 

Better education about services available for seniors 

Medical information/education – requirement and qualifications for 

assistance/education in medical insurance, medical equipment, and medicine 

Technology – more training – the problem is businesses, doctors’ offices, and any 

healthcare or government facility assuming everyone is up-to-date on technology 

Information – making available and easy to access information available and 

pertinent to “BB” 

Awareness – insure that “BB’s” are made aware of all the services available

Centralized and up-to-date information about what resources are available for the 

elderly 

Need for accurate and easily available information for services - understanding 

resources in the community 

Adapting to changing technology – TN provide classes and workshops to learn skills 

Central place for help in obtaining all these things – directories, websites, phone #s 

Difficulty of finding answers to problems 

Finding information and access to resources for seniors and disabled 

One stop shop to access all services 

Knowledge of assistive technology to help them or parents live more independently 

within their own home 

Figuring out how to access programs and services 

Good outreach/identification of service 

Need for intergenerational education 

Having sufficient information to plan our own retirement 

Falls – need more education and exercise programs, specifically designed to prevent 

falls 

Providing a system that will help to keep the 50+ informed in regard to services and 

programs available 

Tennessee – State Plan on Aging 2014 - 2018 366
Knowing what services are available to them – advertise the AAAD more – advertise 

“211” more

More volunteer to answer questions 

2. Healthcare (including in-home services; Home and Community Based Services; long 

term care; chronic disease; Alzheimer’s disease and related dementia)

Help establish program to help members who don’t qualify for Choices-pre hospice 

PAE 

Healthcare – increasing costs of medication and healthcare - cost of medical/Rx care 

Medical monitoring in home – telemedicine 

Being taken care of at end of life 

Healthcare – assist financially with free clinics/provide free care 

Medical doctors over medicating

Medication issues - *TN – monitor $ aspects and pharmaceutical co. 

Affordable medications cost

Health care issues since they are getting older. The State of TN could make it easier 

for people to get insurance if they are not of age to get Medicare 

Affordable medications

VA Veterans – Agent Orange 

Fund programs that allow for home health care – make mental health assistance more 

available to seniors 

Lack of Adult Day Homes for obese, brain injury, etc. who can’t access nursing home 

care 

Not enough doctors to handle # of retirees; increase # of clinics and NP, PE 

Paying for medicines – extend GI 1 & 2 programs – expand 

Dealing with aging and knowing what health problems they may have 

Affordable and accessible healthcare services 

Maintain independence – support organizations to promote this 

How to deal with the medical community and how to connect with professionals that 

are in tune with aging issues 

Low income services (sliding fee scale) – already need more transportation, mobile 

meals, homemaker

Mental health services including medical care and case management and assistance 

for those unable to care for themselves 

Services when and how they are needed – flexibility 

Lack of mobility

Loss of independence due to health and disability – promote and fund in home 

affordable services, including home-delivered meals 

Accepting disabling conditions as they occur to themselves 

If the become deaf, the will need a strobe light or vibrating smoke detector – cost 

$200 

Lack of supportive services, cooking, cleaning, transportation 

Medication management - prescription drug abuse - *bring in programs like “Home 

Meds” management system

Help with ADLs – Choices program – additional enrollment 

Tennessee – State Plan on Aging 2014 - 2018 367
Lack of affordable case management to facilitate elders’ health needs and 

transitioning needs 

Services for elderly who want to live at home as long as possible 

Case management

More access and monies for programs 

Make sure ach caseworker is aware of social programs such as Adult Day Care in 

their community and promote above home care 

Promote village concept – one club services in Knox County 

Cost of prescriptions and health care – help with training for SHIP counselors 

Assistance with prescriptions if over income for the extra help – help with doctors’ 

co-pays dental and vision 

Medical expenses – State provide assistance with costs of medications, dental care/ 

Medicaid expansion, respite 

More baby boomers will be faced with more health issues. Continuing support for 

senior centers and finding new free programs for baby boomers to live a healthy 

lifestyle is needed. 

Need for help with med administration and transportation 

Health concerns – coverage of routine health screenings and community education 

Finding in-home care that they care afford – extend $ to Options, NFCG programs 

Paying for assisted living and other alternative care. The State should expand its 

programs, etc. Home health and homemaker services (Choices, Options) 

May need assistance with ADL’s but not ready for a nursing home 

In home service to keep seniors out of nursing home and in their own homes as long 

as possible 

More in home services for seniors and disabled – create more funding 

Services (home-based) that are easier to acquire and/or afford?

Long term care – ease in application, quick response, affordable services 

Sharing nursing home facilities with younger residents – separate them 

Assistance with assisted living. It takes too long for the Choices process 

Paying for long term care; stable subsidized alternatives to nursing homes 

Possibility of having to live in nursing home 

More “in home” services – less focus on dollars to nursing homes 

Vouchers to help pay for a doctor visit co pay or a copy on denture, glasses, or 

hearing aid fitting - programs to help with dental, vision and hearing aids 

Health care is getting more expensive – very little access to much needed dental care 

and dentures - Assistance with dentures (dental care) and vision care and purchase of 

glasses 

Dental coverage/work – more dental clinics/encouraging more foundation or 

donations from dentists (RAM clinics especially) 

State partnerships with pharmaceutical companies to decrease drug costs for those 

with chronic conditions 

Living longer with chronic conditions – funding for programs that educate and teach 

people how to self-manage their health 

Assistance program to help manage medication (daily) Alzheimer’s, dementia 

without Choices or family PAE 

Tennessee – State Plan on Aging 2014 - 2018 368
Dementia – care facilities for behavior 

Need Alzheimer’s support group that’s accessible by bus and in daytime for 

Knoxville area 

One-stop centers for services – make access easy by either funding or better networks 

Continued difficulty transitioning from care settings – hospital – NF – home 

Poor quality of nursing homes – insufficient staffing, not enough facilities appropriate 

for Alzheimer’s patients with behavioral issues or violent patients – creates problem 

keeping loved ones close enough to visit 

3. Fiscal Concerns (including health insurance; Medicare/Medicaid; employment; 

retirement; social security; cost of living) 

Health insurance that is affordable and available - include dentures, glasses 

Rising cost and declining income

Being prepared financially before retirement 

Limit on government funded programs 

Affordable services for the boomers in the middle-earning bracket 

Less money to live on. I’m not sure this is the State of Tennessee problem.

Access to health care – make sure all groups can get insurance (affordable) 

Outliving resources

Feeling confident in the future of Medicare, Health care, financial issues *More truth 

and less politics 

The future of our economy - *positive feedback from Washington with our 

representatives local and State 

Lack of opportunities for economic development – increase service funding for 

national service programs (i.e.: senior companion program) 

Medical care – regulate amounts doctors and hospitals can charge seniors, especially 

ones who can’t afford insurance

Assistance with paying for medication and basic needs, voting, assistive technology, 

more in-home doctor visits 

Having (feeling the need) to expend otherwise “nest egg” funds for their adult 

children’s needs rather than for themselves

Declining health and cost of health care 

Pay for medications as income is getting smaller - cost of medication 

Living on a fixed budget - surviving on a limited income – provide reasonable 

resources 

Distribute the dollars and cents equally and not just to a certain area of the city. 

Senior live all over Knoxville and dollars designated for seniors should be blind. 

Educating and assisting early preparation and financial info 

Increasing health costs 

Poor economy (loss of retirement funds meaning greater reliance on Social Security) 

More job training and self improvement classes for seniors 

Having a source of income big enough to live off of – income to meet needs 

Living longer, not financially prepared 

Medication plans and insurance plans that are affordable and have good coverage 

Tennessee – State Plan on Aging 2014 - 2018 369
Medicare Choices are very challenging. The cost is very expensive - Medicare 

seminars to explain best plans - understanding Medicare – made simple - Medicare 

questions and concerns about what insurance will cover - more assistance for ongoing 

Medicare issues 

Cost of medical care and medications even with insurance is still very high 

Insurance coverage – open Medicaid categories 

Insurance coverage and how it could meet the needs of the individual 

Hire more people to work strictly with Medicare on a daily basis, not just Senior 

Center Directors or OOA Directors who are already overwhelmed with other senior 

problems 

Paying for in-home care and nursing home care 

Doctors who will take Medicare patients - drug costs – expand Medicaid 

What medical expenses and coverage will be – assist with low cost solutions 

How to navigate health insurance issues, specifically prescription drug plans 

Social Security and Medicare benefits – adjustment to these programs – TN programs 

to educate and explain 

Health care coverage for those with low income 

Affordable supplemental insurance for this age group 

What kind of insurance will there be for them and will it take care of their need 

Insurance – better screening services for government assistance to weed out truly 

ineligible individuals

Medicare – will it be there for baby boomers? - possible lack of Social Security, 

Medicare, Medicaid

Affordability of healthcare coverage – I am not sure how the state can help without 

possibly hurting another program or tax increases. 

Jobs – helping seniors get jobs – availability – job market 

Age discrimination in the work place and in employment 

Having to work longer 

Social Security – possibility that SS may not be available - I’m 60. Will I have Social 

Security by the time I retire? 

Navigating through Social Security system – when developmentally challenged 

Fewer people paying into Social Security and other government programs. There are 

lots of baby boomers to support.

Cost of living increases - will income be enough to stay in their family home 

Out living funds for retirement -– lack of sufficient funds for retirement – TN provide 

budgeting fair, etc./education 

Training – adjusting to retirement through volunteer or other services in order that 

transition is less stressful 

Having to continue to work pass the retirement age of 65 due to finances are not 

available to continue to pay for their expenses of daily living 

Uncertainty of their retirement income 

Having sufficient funds to meet their retirement needs. The State should drop its tax 

policies on investments. 

Low retirement income realized afterward – increase funding for employment for 

programs for seniors 

Tennessee – State Plan on Aging 2014 - 2018 370
Strong aging-in-place policies/legislation to keep people out of nursing homes 

(ex: Alabama’s Geriatric Rehabilitation Services)

Being prepared financially before retirement - preparing financially for their own 

retirement years - *education on how to finance retirement 

Adjusting to retirement – end of regular career – TN programs to help promote parttime work

Earlier retirement age/inadequate pensions 

Not being able to retire as early as they had hoped due to a challenging economy 

Enough retirement centers (facilities for living when can no longer live at 

home)/facilities for us as we age and need those services/facilities. 

Less retirement funds due to Social Security issues, failed pensions, etc. – recruit 

industry and business to Tennessee for more job opportunities for everyone 

Adequate income after retirement – offer tax breaks or rebates to low income 

individuals 

4. Support Services (including transportation, meals/nutrition; elder abuse services; senior 

centers)

a. Transportation 

Accessible, affordable, timely, senior-friendly, adequate, easy to use, and 

dependable transportation - cannot afford current service/not enough services 

Transportation for more rural areas - establish more in city and rural 

transportation - need more rural/handicap transit services that are affordable 

Being able to get affordable transportation to healthcare and shopping 

Transportation – cost/availability - *TN – grants and funding for mass transit 

Lots of seniors in my county do not have transportation 

Transportation - $ for assisted transportation – hand-to-hand 

More vans and/or small vehicles for transportation to appointments, grocery 

shopping, etc. on a more timely schedule than 3 days in advance 

Transportation to and from appointment/diapers and ensure no longer covered 

by insurance 

More transportation options - more choices - the State should work on 

expanding transportation options. 

More funding to agencies providing transportation 

Transportation for errands or appointments, etc. (vouchers?) - TN provide free 

busses, transportation, etc. 

Transportation for shopping doctor appointments, therapy – volunteers willing 

to help with errands – picking up prescriptions 

Transportation that provides an offset to isolation – from errands, from 

physicians, from senior centers, etc. 

TN can help by exploring/funding initiatives for coordinated, well-advertised, 

user-friendly options in all communities (urban, suburban, and rural) to allow 

us all to remain in our homes of choice 

Need bus service for a large area 

Increase services with ETHRA/CAC – not just limited to MD visits 

Lack of transportation that meets the needs of all 

Tennessee – State Plan on Aging 2014 - 2018 371
Transportation, assisted and unassisted 

Develop and fund more transportation options 

More transportation options/more affordable options (Greeneville, Erwin and 

Elizabethton have not transportation but Net Trans) 

Lower costs/more transportation (Greeneville, Erwin, Elizabethton should 

have their own transportation) 

As baby boomers get older their health condition are preventing them from 

driving. Having more transportation services will help. 

Adequate transportation for those that are not longer able to drive 

Volunteers who can transport 

b. Meals/Nutrition 

Meals – food and nutrition management, preparation, funding, volunteers, 

good tasting, nutritional meals, home delivered and congregate – food in 

general – assistance in obtaining 

Nutrition – nutrition education available to seniors including: mobile meals 

options and requirements, food pantries, nutrition in connection with physical, 

mental, emotional well-being - more options and affordable 

Food resources - *TN – expand subsidized food banks/pantries 

Securing food – low income

Food security – delivery options for homebound seniors – food pantries 

More funding for senior meals 

Lack of nutritious meals for seniors – increase funding for meals on wheels 

How to provide food for themselves – fund more meals for homebound 

persons and food stamps 

Having access to proper nutritional resources: education and actual food 

promote healthy living and healthy eating statewide

c. Elder Abuse 

Protection/education about Elder Abuse and fraud 

Open to financial exploitation and physical abuse as they age – more freedom 

for Adult Protective Services 

Laws changed or made to better help vulnerable seniors 

Crimes, scams against seniors - * news reports to alert of new scams 

Help defending against abuse – physical and financial 

Avoiding financial exploitation – tougher penalties for criminals 

*Dire situation – huge lack of APS assistance 

Family members – exploitation by family members is an issue. Make eligible 

services available to elderly to screen for proper living arrangements and 

supportive circles 

Increased likelihood of being scammed by unscrupulous vendors 

d. Senior Center 

Senior center funding

Baby Boomers are active. I see the need for more funding for senior centers. 

Tennessee – State Plan on Aging 2014 - 2018 372
5. Staying Healthy While Aging (including exercise, eating healthy foods, socialization, 

chronic disease, staying connected and involved in the community, volunteer) 

Staying healthy, offer more educational programs and facilities - eliminate taxes on 

groceries 

Staying well – funding health promotion – screenings/physicals/mammograms 

Staying healthy to stay out of institutional care - intense health care support, fitness, 

diet, affordable/free 

More preventive health services – exercises at senior centers 

Limits on ability to socialize/”shut-ins”

Isolation once a spouse dies - being alone – daily or weekly call checks – encourage 

volunteers - *reaching out to rural areas (forgotten area) - *trust issues 

Loneliness, no family members - lack of family – friends support- families not close 

by

Under-diagnosed/treated depression, lack of socialization/physical & mental 

stimulation, complicated by care in the home only. Malnutrition often occurs not 

from lack of food but lack of motivation to eat! 

Depression, feelings of nothing to do/live for 

6. Adults with Disabilities

Mentally challenged have very limited resources for help with ADL’s, hygiene, PAE 

Access to assistive technology to keep people with disabilities living independently - 

access to transportation – fund programs for assistive technology 

Affordable housing – handicapped accessible 

Increased accessible parking for seniors and people with disabilities. TN can help by 

passing statewide legislation requiring 2-3 times the number of accessible spaces 

provided by the American with Disabilities Act (ADA). Spaces should be close to 

accessible entrances to facilities and for those over the ADA-required number, the 

could be marked in a way to provide accessible parking restricted to use by seniors 

and people with disabilities that don’t use wheelchairs

Look @ our public (state, county, city-owned) facilities and programs and increase 

physical and programmatic access to people with disabilities. Accessible 

opportunities are available to all people, even if they don’t have a disability but 

inaccessible opportunities exclude us – it will take money to make changes to 

buildings, but will drastically increase our (TN’s) ability to welcome seniors and 

people with disabilities to our State so they can retire here, remain here, and keep 

their money here!!! 

Minimally-accessible (i.e., visitable) housing options in all parts of TN. TN can help 

by supporting proactive, creative ideas/initiative such as the one the City of Knoxville 

promotes (Statewide program was begun by TN Council on Developmental 

Disabilities and has proven hugely successful!) 

Assist DIDDS with accelerating waiting lists – ensure full utilization of Choices 

Taxi services – accessible for wheelchairs and service dogs 

Tennessee – State Plan on Aging 2014 - 2018 373
7. Caregiving

Family support 

Trying to juggle caring for aging parents and their own families/obligations 

Raise the limit in assisted technologies to help families and caregivers. That would 

take a financial burden off of them while providing better home care. 

At-home care programs – family care pay programs: paying family caregivers 

Enough caregivers/younger folks to take care of us - lack of people to take care of 

them 

Teaching caregiver to learn how to give care at home 

Help with caregiving of older parents – respite services 

Being caught between kids in college and aging parents 

How to effectively take care of aging parents while working 

Having several generations in the home – raising grandchildren, taking care of 

parents 

Taking care of aging parents, still work, and remain sane – finding help for/with them 

Grandparents caring for grandchildren – social services @ school level 

Grown children in distant communities 

Caregiving older parents/spouses – *education and support for family caregivers 

Helping adult children who return home, often with children - *education/resources to 

help with children of grandchildren 

Caring for parents – in my case – from 850 miles away as primary caregiver 

Support/relief for caregivers – education – support through AAADs 

Children returning home – stay out of it 

Caregiving services (affordable) for those wishing to remain in their homes 

Support for caregivers/more respite programs and support groups, more trained aides 

and family members - more caregiver support and training in the community 

Many Baby Boomers are caring for older parents and are in need of respite. Would 

love to see funding for Adult Day Care so that caregivers can have the peace of mind 

Shortage of available care takers in facilities and homes due to large # becoming 

elderly/disabled – more training and staff are needed to provide adequate care. 

Quality trained caregivers 

Lack of family near by to assist with issues 

8. Housing, Neighborhoods, and Safe Communities (including home repairs and utilities) 

Lack of federal funding – limit on availability of facilities = nursing home and 

assisted living

Living with family members 

Decent affordable housing in neighborhoods they desire to be 

Baby boomers are living longer. More affordable assisted living facilities with the 

best care 

Affordable and accessible housing - *TN – provide more senior housing - community 

resources - safe housing - care options – availability 

Safely staying in their home as long as possible - having the resources to safely 

remain in their homes

Tennessee – State Plan on Aging 2014 - 2018 374
Safe, affordable subsidized housing with case management support - safe housing that 

is non-invasive and affordable 

Designated housing complexes for SENIORS ONLY!!! - more housing that meet the 

needs of our age group – housing for seniors/no one under 60 

Finding an affordable retirement option such as assisted living 

Housing problems because they may not be able to afford mortgage or rent and not 

eligible for low-income housing. Need vouchers for assisted living care that can be 

used like Section 8. 

Having somewhere to live

Housing when we are unable to remain at home but not ready for the nursing home 

Housing information for this group that is safe, affordable, clean and run by people 

who care about older Americans 

Assisted living 

Lack of affordable housing 

Not enough affordable assisted living facilities or other alternatives to nursing homes 

Senior and disabled housing 

Assisted living facilities that are affordable and close to grocery store, physicians 

– assistance with rent

People need help staying in their homes, safely. There are many technology 

devices/systems that can help. More assistance needs to be given to cover these 

items. Compared to the cost of facilities, the could result in a huge savings for the 

State – reduced hospital stays, better medication compliance, and reduced cost of 

care.

Attempting to stay in their homes as long as possible – and avoid institutionalization. 

The State could work on expanding the definition of ACHs (Adult Care Homes) so 

more can be established across TN 

Enabling all seniors to remain in their home safely, regardless of income or resources 

- help with getting people in stable homes where they can remain 

Strong aging-in-place policies/legislation to keep people out of nursing homes 

(ex: Alabama’s Geriatric Rehabilitation Services)

Assistance with house repairs - house maintenance expenses without income to 

support – lawn care assistance 

Home repairs, roof repairs, etc. - home modifications- $ for home modifications –

building ramps, widening doors, moving laundry facilities 

Utilities assistance for low income 

9. Funding/Resources 

10. Other: 

Laws concerning parenthood 

Help @HM

Longevity or good health until end of life 

The need to still be heard and be a voice in society 

More of us of mentoring, elder internships or placement in corporate setting and 

service 

Tennessee – State Plan on Aging 2014 - 2018 375
Society – in rural communities where exploitation of “entitlement” programs/funds is 

occurring, the hardship this creates trickles over to the elderly population. Suggest 

reform in government assistance 

Lifetime of unhealthy lifestyles choices 

Tennessee – State Plan on Aging 2014 - 2018 376
East Tennessee Area Agency on Aging and Disability 

John T. O’Connor Senior Citizen’s Center, Knoxville

March 7, 2013 

Question: Here are seven (7) aging and disability issues. 

 Under each, there is a list. 

Mark the ones on the list that you think are most important. 

Number of Questionnaires completed: 114 

Response # of 

responses

%

1. Being able to get accessible transportation 88 77.2

2. Affordable dental care, hearing care and eye exams and glasses

3. Transportation for people who don’t drive cars

82 71.9

4. Being able to get help when needed quickly and without hassle 81 71.1

5. Housing that people on a pension or Social Security can pay for 78 68.4

6. Not having enough insurance or money to pay for doctors or medicine 76 66.7

7. Teaching volunteers to work with older adults and people with 

 disabilities

71 62.3

8. Protect people from abuse 69 60.5

9. Getting care at home instead of in a nursing home

10. Meeting people and making new friends

67 58.8

11. Meals that are healthy and prevent hunger 66 57.9

12. Keeping healthy through exercise and eating healthy foods 64 56.1

13. Knowing where to call for help and getting help without a big runaround

14. Training for aid workers who help older adults and people with 

 disabilities

62 54.4

15. Respite services 60 52.6

16. Teaching doctors, nurses, and other healthcare workers to know the 

 special needs of older adults and people with disabilities

58 50.9

17. Help with memory loss 57 50.0

18. Learning new things

19. Teaching police, Firemen, emergency workers to know the special 

 needs of older adults and people with disabilities

55 48.2

20. Reasons people have to go into nursing homes 53 46.5

21. Learning about how to care for someone at home 52 45.6

22. Learning how to live with a serious condition like heart disease, cancer, 

 arthritis

23. Understanding how Medicare works

51 44.7

24. Learning about how to take care of yourself so that you don’t get sick

 and tired

48 42.1

Tennessee – State Plan on Aging 2014 - 2018 377
25. Houses that are easy to get around in if you’re on a walker or in a 

 wheelchair

47 41.2

26. Making decisions about health insurance, Medicare, and planning for 

 the future without depending upon the government

27. Neighborhoods that are easy and safe to walk in

45 39.5

28. Places to volunteer 42 36.8

29. Reasons people have to go back to the hospital

30. Being able to choose the workers who come into your home

41 36.0

31. Help with chores like lawn mowing and leaf raking 39 34.2

32. Help with feeling sad or lonely 38 33.3

33. Eating out with friends 37 32.5

34. Learning how to prevent falls 35 30.7

35. Help with taking too much medicine 32 28.0

36. Neighborhoods that have grocery stores close by 30 26.3

37. Being able to get accurate information from a website and being able to

 apply for services on-line

25 21.9

38. Help with drinking too much alcohol or taking drugs 13 11.4

Other: 

Government assistance eligibility reform

Stretch TennCare dollars and reduce abuse of in-home caregivers being used for housekeeping for other 

family members by transitioning those who can receive service to an adult day care ($10 per hour instead 

of $22 per hour)

Also don’t forget disabled adults 18-55

Those feeling sad or lonely need socialization – care in adult day care instead of home

Learning how to live with dementia/Alzheimer’s

Being able to get accessible transportation for every day services also, not just healthcare

Assign one paid worker per county to do only Medicare – enrollment, problems, advice, etc.

Lessen the restrictions on fundraisers such as bingo or quilt raffles to help senior centers stay open

Meeting people and making new friends for socialization

Planned senior communities

Trolleys for getting to senior center and stores and other community activities

Adult day care

Support services for those caring for others

One call center

Senior communities

Have developers plan for access if the individual is on a walker or in a wheelchair

Transportation is huge – rural communities have no resources

Increased funding for Options/National Family Caregiver –

 -many people cannot get enough service time

 -HUGE waiting list (currently 450 on options & 100 on caregivers – up to a 3 year wait –

 many die before getting help 

Most do not have access to internet

Tennessee – State Plan on Aging 2014 - 2018 378
All are important

Outreach services for mental health crisis

Other rep. payee programs

Assistive technology

I could have checked every item. They are all important.

Increased national service opportunities for low income seniors

More adult day care is seriously needed. Assistance for paying for day-care services. Senior need for 

more low cost or free transportation

Transportation, transportation, and transportation all in rural counties is needed

Government and city officials need to be more accessible to homebound seniors – maybe be more involved 

in meal delivery

More nursing home access (and ALLF access) – expanded TennCare to pay for care. Lighten up PAE 

restrictions/requirements

Being sent to ER from ill equipped assist living facilities

Need more “house call” providers, geriatric physician’s assistants and nurse practitioners

Better networking between existing services. Streamlining of information systems, referral networks

When a caregiver tries to stop person who is abusing illegal substances

Housing for developmental, behavioral persons who are low income and unable to live independently

In home non-medical assistance for individuals who fall between not qualified for Choices with medical 

conditions, but not yet ready for Hospice

Assistive technology in Options and coordinate with TennCare provide newer, more expensive devices 

than $900 in Choices

Mental health – keeping mentally active

Emotional health (family relationships –maybe feeling of worthlessness and dependency on family 

members)

Hearing care is so important to elderly

Family caregiver support groups can help individual with knowing where to call without run around

“Powerful tools for caregivers” is excellent education program

Denture coverage

Adult day care

Lack of housing that allows for “aging in place”

Grocery stores close by and ones that deliver

Being able to contact APS after house – follow through out the process from visit to court action

Trolley in Sevier Co. to serve Senior Center

More support for home-delivered meals – eliminate the waiting list

People who need APS but not being served

Shorten time for disability insurance

Adult day care as an option

Support services for caregiver

One call clubs

Need assisted transportation

Planned senior center in area that is easy and safe to walk in

As OOA, I think it would be great to have a qualified person, trained to only do insurance in my county once 

a month – paid worker

Tennessee – State Plan on Aging 2014 - 2018 379
More funding for in home care

Tennessee is a growing state. As our urban areas grow – many of the federal programs whose funding is 

tied to urban area’s population are not keeping up. In fact, Congress is cutting funding. This example is 

true for transportation funding. The Knoxville urban area grew by 33% over the last 10 years, but transit 

funding did not keep up. Many citizens in rural areas like Blount, Loudon, Anderson are losing transit 

services.

Feeling safe in their home or apartment

Providing housing for persons who do not need nursing home care, but still needs to have care and can not 

afford to be in assisted living

Teaching attitudes toward the elderly that are cheerful and accepting

Educational programs for caregivers of elderly family members

Printed info versus on-line/PDF’s. Our area doesn’t have full availability of internet access

More staff and more ability from our local APS offices

The State should give each county seed money to help with volunteer programs begun by each county –

not just the region

Transportation, volunteer assisted transportation, Knox CAC

Funding for all in home services

There are waiting lists for all services

Mobile meals has a waiting list, this service is crucial to seniors

More services in rural counties

Safety checks on seniors more often and protection from scams/predators

Staying or getting involved with church life

Affordable transportation (preferably free)

Free opportunities for healthy life style and socialization

Provide persons to assist in home care

Affordable dementia housing

Emergency housing for special situations

Low cost – reliable transportation

Need more coordinated transportation services

Meals for under 60 population

Guardianship for those in need and with no one

Protection from exploitation when they can’t protect self

Mental illness: supportive housing, intervention when they don’t realize

Tennessee – State Plan on Aging 2014 - 2018 380
East Tennessee Area Agency on Aging and Disability 

John T. O’Connor Senior Citizen’s Center, Knoxville, TN

March 7, 2013 

Question: What is currently working well in your community? 

(like agencies that help, neighbors who help each other, van service, senior center, 

meal sites, food pantry, healthcare clinic, nursing home, sidewalks, police 

presence, grocery stores that deliver) 

(Number of Questionnaires containing 1 or more responses - 94) 

This open-ended questionnaire was designed to allow attendees to identify the community 

programs and services that have worked for them and in their community. Evidence based 

and/or proven practices were not a consideration in the design of the questionnaire and no 

checklist was provided. The above items in parentheses were provided as examples. Attendees 

were asked to write in the programs and services that were working well in their community. 

The responses are individual and specific to the region served by the Area Agency on Aging and 

Disability. The number of attendees who indicated that the program is working well in the 

community is provided in parentheses (). 

Second Harvest Food bank (3)

Van service (3)

East Tennessee Human Resource Agency (ETHRA) transportation (1)

ETHRA transportation service is a wonderful benefit.

CAC transportation, agency cooperation and help

Volunteer assisted transportation

Net Trans – transportation available but could be improved

Senior center (25)

Our senior centers work well with all other agencies in our community. We are

lacking grocery store deliveries. We have access to ETHRA van service which 

works well.

Senior directors are very helpful in providing a central resource for senior services 

and other community sponsored agencies

*There is not a shortage of senior centers in the area.

Knoxville – Knox County senior centers (especially O’Connor)

Senior center is great 

O’Connor and Strang Senior Centers

Senior Centers are a big help to older persons in the community. They provide 

companionship and also a healthy meal at lunch time.

This region is blessed with senior centers in our communities that strive to involve 

people in activities that benefit their health.

We have excellent city and county senior centers as well as SCAN (Senior Citizen 

Awareness Network) police department

 

Tennessee – State Plan on Aging 2014 - 2018 381
Meal sites (4) 

Senior nutrition program works very well in our area (Cocke, Grainger, Hamblen, 

Jefferson, Monroe, Sevier); however, more funds are needed and volunteers needed 

for the services

congregate meals

Providing meals to low income residents

Congregate mobile meals

Meals on wheels/mobile meals (19)

Mobile meals for seniors – needs to funded. Nutrition is a basic need. Knox 

County has a waiting list. Food pantries provide for the same basic need. A safety 

net.

Meals on wheels is vital service.

We have mobile meals, FISH deliveries and KARM which deals with meals

We have an active meals on wheels and congregate meal programs. There are 

several churches that have food pantry sites.

Meals on wheels and senior centers are very useful, but more people need to know 

about them and be able to utilize them.

Neighbors who help each other (3)

The Area Agency on Aging and Disability coordinates many programs and services 

available and works hard to make sure people know what is available for them.

Food pantry(9)

Food pantry currently service 400 families per month

Honestly, I don’t know any that are working effectively. All are short staffed and 

inadequately funded.

Healthcare clinic (Helping Hands)

Nursing home (2)

Adequate nursing home availability (need more affordable assisted living facilities)

Nursing home advocacy – need more volunteers

Sidewalks

Police presence

Knox County Sheriff’s Office (Project S.C.A.N.) – Senior Citizens Awareness 

Network. Volunteers that go out and check the well being of the senior community. 

We currently check on 240 recipients. Also make referrals to other agencies as 

needed. Eyes and ears of elderly community.

Grocery stores that deliver

Food City – grocery store that pull orders

Pharmacy/drug store that delivers (4)

Pharmacies that provide financial assistance with Rx through grants, foundations 

(need more pharmacies that do help with med costs.

Volunteers (3)

Elder Watch

Douglas Cherokee Economic Authority

Tennessee – State Plan on Aging 2014 - 2018 382
Local churches – assisting residents with home mods/doctor appointments, etc.

Office on Aging programs

Excellent Office on Aging programs – transportation services, mobile meals, senior 

centers. Unfortunately, there are insufficient funds which create waiting lists for 

important programs like mobile meals, transportation services, legal assistance for 

the elderly.

Office on Aging – Senior Services Directory

CAC – Office on Aging/Case Management – Project LIVE

Office on Aging programs

Office on Aging (including mobile meals)

CAC services – Office on Aging

Office on Aging – some food banks – outreach/community outreach events, 

volunteers

Office on Aging is a good concept as it strives to create a way to help seniors.

The Knox County Office on Aging provides many contacts and resources in 

relation to question packets I & II. Recently my neighborhood they have 

reconstructed all sidewalks so they are wheelchair accessible, which has assisted in 

many “neighbors” getting outside and around the neighborhood with ease.

Office on Aging – Chearie Phillips has an individual doing (homebound) calling 

from Anderson County; OOA

Project Live – case management for low income seniors

Free in home services for seniors through senior companion program

Church assistance

Options for Community Living, NRCS, Choices, Operation Backyard, The Love 

Kitchen, CAC

Operation Backyard, Moms Meals, MRDD

Senior citizens home assistance service

Food City, Belew, MAC’s pharmacy

Smokey Mountain Hospice

CAC transportation/Senior Companion Program

O’Connor Center

Choices and Options programs

Volunteers, local agencies, churches which supply clothing, food and meals, free dental 

clinics, Sheriff’s Office having volunteers who call on elderly and disabled individuals

Legal assistance for the elderly is a great service, but needs for funding so they can 

serve more people.

TennCare to pay for nursing home, ALF, and at-home care is a vital service, but needs 

to cover more people and not be as restrictive.

Meal delivery, church groups assisting homebound with tasks, commodity distribution, 

fuel assistance, central services agency, home health services

Volunteer groups such as local churches

*Elder Watch has been very successful in East TN.

KCDC

Alzheimer’s Tennessee

Tennessee – State Plan on Aging 2014 - 2018 383
TennCare Choices

Professional networking and resource groups

Senior services – non-profit/church/United Way collaboration

Blount Co. Community Action Agency

Blount Memorial Senior Care Services

Blount Co. Public Library – senior programs and presentations regarding services and 

information

Choices, ETHRA transportation

CADES church sponsored daycare for disabled seniors – needs duplication – makeup 

of Farragut community means fewer services

Partnerships with other agencies

Case management offered to connect seniors to community services

Low income health clinic for indigent care

Ecumenical partnerships and agencies (such as Compassion Coalition, church 

volunteer groups, etc.

Case managers in KCDC housing to provide support

All of the above are present on a limited basis. A lot of the senior population do not 

know of services they can access

Choices Home Care, SCAN, Garbage pick up, rural Metro

Community Action Connect programs

Large volunteer base, extra programs, volunteer assisted transportation

Knox County Office on Aging Programs, CAC Transit, Volunteer Assisted 

Transportation (VAT), RSVP, Senior Companion program, etc.

Ladies of Charity – food pantry and thrift store; KARM – rescue mission; Volunteer 

Ministry Center; Interfaith Health Clinic

Central point of entry

Knox Office on Aging, particularly transportation programs; AMOS (affordable 

medical options); Senior Citizens information and referral service, and mobile meals

FISH Hospitality, KASM, VMC, Salvation Army and other food programs

Good Samaritan, Family Promise and other disrupted family support

ETAAAD, ETHRA vans, Knox CAA mobile meals, KCDC housing

We are fortunate in Knoxville to have a Disability Resource Center, a Mayor’s Council 

on Disability Issues, an active Council on Aging, a great Office on Aging and public 

transportation. Other counties are not as fortunate to have these organizations and 

services.

Getting information out to the elderly community

Home health care/transportation

Serenity House – hospice care; dental care; Helping Hands – medical clinic

ALPS, ETHRA – transportation, volunteers, Senior Connect, home health

ALPS Adult Day Care; Hospitals senior network; Helping Hands clinic; ETHRA

Transportation services; Neighborhood Watch; networking

Tennessee – State Plan on Aging 2014 - 2018 384
Senior center – has activities – information – exercise – transportation – 2 nursing 

homes – volunteers are good – churches and centralized services @ Central Services –

2 free health clinics – police active with Elder Watch

CAC – case management project/services/mobile meals/transportation; food 

pantries/churches assist well

Partnerships with State, Federal, local and private funding to provide in-home services, 

meals, food pantries, learning, exercise, and socialization; FISH pantry

What’s not working: We attack each problem in isolation from all the other problems –

dividing people by diagnosis – not addressing all the issues and how they interact with 

each other.

Knox County CAC; Options through ETHRA; Choices/TennCare; food pantries 

throughout Knoxville; KARM

ETHRA transportation; great senior centers

The small community of Lake City has a wonderful lady running the congregate meal 

site. She uses her talents of hospitality to bring this community together in a 

celebration type environment daily. If all of the congregate meal sites we would never 

have to worry about attendance at the sites. She uses her personality and passion to 

enlist volunteers to transport folks who need it. These volunteers included several 

public servants. The Lake City police officers are great helpers as well.

Volunteer assisted transportation; O’Connor Senior Center; Disability Resource 

Center; CAC; Office on Aging

Choices

Knoxville’s Project Live program which assists low income homebound seniors by 

providing free in-home case management to link vulnerable seniors to community

resources and volunteers to assist with home repairs, housekeeping services

CAC, Choices Program, Love Kitchen

ETHRA; MLB Building; Elder Watch

Lots of volunteers to assist with programs

Volunteer assisted transportation; CAC Transit; One Call Club; Daily Living Center –

Adult Day Program free for low income

CAC but need more and quick availability

Congregate and home delivered meals, sliding scale services; pharmacies that allow 

fixed income consumers to make payments on their meds as they are able

More police presence in East Knoxville; Rights For Caregivers; shorter waiting periods 

for minor home repairs for seniors

Collaboration with disability and seniors groups; existence of CODI “Mayor’s Council 

on Disability Issues” that advises city on disability (and senior) issues; commitment to 

visitable housing; team effort toward transportation options that work for seniors and 

people with disabilities; person with a disability is in charge of disability issues, policy, 

etc. @ City of Knoxville

Having a relationship (partnership) with CSBG funding to provide senior services

Innovative nutrition partnerships with local hospital, assisted living facilities

Tennessee – State Plan on Aging 2014 - 2018 385
Roane county is beginning a clearinghouse starting with 8 local churches beginning 

with utility and crisis services. This may be widened to include these senior issues.

Loudon Co. has a very successful clearinghouse through Love, inc.

Neighborhood Service Center (LIHEAP)

ETAAAD – good source of information

AAA; home delivered meals; SHIP; service centers; fuel assistance through CSBE; VA 

Hospital

AAAD; SHIP/SMP; home-delivered meals; VA

ETAAAD; SHIP; SMP; fuel assistance through CSBG; neighborhood service centers; 

adult day care centers; VS’s; Mooney’s West Towne Pharmacy and Princeton 

Pharmacy deliver

Churches with food panties and clothes closets; also provide monthly senior adult 

activities

Tennessee – State Plan on Aging 2014 - 2018 386
East Tennessee Area Agency on Aging and Disability 

John T. O’Connor Senior Citizen’s Center, Knoxville, TN

March 7, 2013 

Small Focus Group Responses 

Tennessee – State Plan on Aging 2014 - 2018 387
East Tennessee Area Agency on Aging and Disability 

John T. O’Connor Senior Citizen’s Center, Knoxville, TN

March 7, 2013 

Facilitator Notes for Small Focus Group 1 

Options program is frozen – 2 year wait list.

State is hoping people will just die and let them off the hook.

New TennCare PAE requirements are far too restrictive.

People with mental problems don’t know how to find help.

CHOICES is denying people who need care desperately.

People are actually dying from lack of care.

Hospitals are sending people home when they are in desperate need of continuing medical 

care.

Hospitals are limited as to what they can do. They have to send them home – CHOICES does 

in-home assessment and says, “they don’t qualify for care”.

There needs to be programs in place to see that all elderly in need have help at home, adequate 

meals, medication help.

Big gap between CHOICES and Hospice that needs to be filled. There are non-medical help 

services that will go in for $10/hr. but may elderly cannot even afford that.

We all see people starving to death – literally – from lack of food.

Need more hot meal programs. People starving. Family members are often not helpful. 

People tend to eat undercooked food, rotten, expired good when they are mentally challenged.

In some counties a route can be 90 miles/day. Lack of volunteers because they have to donate 

their own gas as well as time. In rural counties, the volunteers don’t even have enough money 

for the gas.

Transportation is a big issue. 

People can’t sit and wait for van for medical appointments.

Issues with no one to help people on and off vans or to help them get inside medical 

offices.

Demand is so great, transport so many people, that they often sit and wait for hours to be

picked up and sometimes never get picked up.

Facilitator Notes for Small Focus Group 2 

More volunteers

More education for volunteers

Centralized volunteer line for all counties for people to connect to volunteer opportunities

Limitations of Adult Protective Services law for older adults who live alone and have no 

support system:

APS say “not in imminent danger” so can’t help

APS be more aggressive

Socialization and other programs that don’t require money to participate

Transportation – free for those who can’t afford

education to public on opportunity (getting the word out)

for those not eligible for publicly-funded programs

Affordable medical care for those not on TennCare, etc.

Tennessee – State Plan on Aging 2014 - 2018 388
Home repairs – more funds for (currently only wait lists)

Affordable assisted living

Quality and affordable and decent residential housing

Affordable services for middle-income (those just over limit for publicly-funded programs)

Neighborhood watch for older adults who live alone

Education for businesses and back tellers

Way to connect churches to get volunteers to assist older adults

Have programs that benefit all counties, especially rural

SCAN program or outreach program in each county

For CHOICES members transitioning out of SNF – vital to have socialization and 

transportation to keep engaged

More funds for works in assisted living, SNF, APS – better salary

Dental care indigent – more dentists offering free or low cost dental

Get churches engaged in watching our seniors

More regulation for gov’t., county, etc. – seniors need a break for access to services, 

transportation

Advocate (volunteer based) for those going to doctor, in hospital, etc. (for those who don’t 

have anybody) – have government have advocates in each area (vase # of advocates on 

population of seniors in area)

Emergency housing for individuals coming out of hospitals

Support for individuals transition out of hospitals (to reduce hospital readmissions)

Facilitator Notes for Small Focus Group 3 

Caregiving and taking care of loved ones at home. Not know what resources are out there for 

families and caregivers. Navigating care and services

Transportation issues because the pick-up/drop-times. Waiting on the ETHRA buses. Run out 

of oxygen, while waiting on buses

Being able to get accessible transportation

Education current generation about NH, assisted living and/or care @ home for their family 

members

Affordable dental, hearing care, eye exams and glasses

Learning healthy foods and amount exercise that is really needed to sustain brain health

Making sure all materials are printed for the home-bound people

Making sure the resources are very easy to access, especially to those who are not out in the 

community

Food stamp amounts for elderly people

Not enough adequate housing. Why not use some of the homes that are taken by the State of 

CHOICES or NH care and put seniors or disabled clients into them so that they have “safe” 

places to live

Getting information out to home-bound clients

Facilitator Notes for Small Focus Group 4 

Lack of affordable hearing and dental services

More SNAP benefits for our seniors - $16.00 is the average benefit

Affordable, accessible, senor friendly transportation (through organized church groups, grant 

Tennessee – State Plan on Aging 2014 - 2018 389
funding) (liability issues?)

Additional adult day care facilities. Partnerships with churches and financial/stipend 

assistance

Respite care

Looking at the senior nutrition program, looking at a way that eligible seniors pay a portion of 

their meal. Seniors will have more a stake in the program and feel better that they are 

contributing.

More flexibility with Senior Nutrition Congregate meal sites. Partnerships with local 

restaurants, hospitals as voucher system, etc.

Part D Medicare very difficult for our seniors to understand. More educational opportunities 

by trained, paid staff into the community. Needs dedicated staff in the communities

Medication management, higher incidents of hospital re-admissions. Providing funding for 

telehealth when released form hospital and beyond

More funding through CHOICES for in-home monitoring systems (PERS, TeleHealth, 

emergency buttons, bed sensors, bp monitors, etc.)

Addressing the high occurrence of depression in the elderly, leading to suicide in some cases, 

and poor quality of life

Need for more affordable, reliable creditable minor home repair for seniors. Also help with 

lawn mowing, leaf blowing, raking and garbage pick-up. Vouchers for garbage pick up

Area Agencies across the State to unify OOAs, SCs, Nutrition programs by assisting with 

fundraising, advertising that benefits each county in the specific region’

Utilize community colleges for volunteers

Facilitator Notes for Small Focus Group 5 

Aging in Place after coming to DC to work – Baby Boomer resources eaten up in economy 

decline

Moved away from family ties and ties don’t bind as in the past

Churches and traditional network has faded away as a result of the mobility of the BB 

generation as traditional aspect of supports faded away

Who’s going to take up the slack

Thinning the herd – where is the parachute/net

Reaping repercussions of longer life

Younger retirees not wanting to see yourself as senior or attend senior centers/resources

Senior discounts are “embarrassing”

See the handwriting on the wall – forced to look for resources which increase demand for

service providers

Not building group of friends/network to help one another

Has become exclusive “book group” that is dying away/shrinking

Volunteerism

Peace corp generation

Special volunteer opportunities in focused health (cancer group)

Gov’t. is not best resource - people are

XY generation not so willing to give $/small wonder to give (don’t waste my time)

Insurance issues

Different set of values around volunteerism

Tennessee – State Plan on Aging 2014 - 2018 390
Get different generation in perspective – same priorities but different perspective of solving

We’re in for it for the next 5 years.

We’re not prepared for the next 5 years

Decreasing people paying into the system

Decreasing benefits

Decreasing in new workers in aging field

Stigma

Invisible generation/put away in nursing home

Aging marginalized

Life expectancy has increased and definition of old has change

Concept of retirement

Family experience with multi-generation has changed

Sandwich generation overwhelmed

Baby Boomers may change definition of aging

Baby Boomer had small families

Information though available but not user friendly

Young old more tech savvy, but older old

Perception of being on Medicare/Medicaid –

Intelligent folks struggle with understanding the process

Preventive services more critical of Betty Crocker generation

Is chronic disease increasing because of transplants?

Other states (Florida) offer increasing senior benefits

No emissions control = increase health issues in the valley

Worried about who is going to take care when desire to be independent

Children “take over” when parents decrease health

Don’t understand legal issues

People with no children have decreasing choices

Communication styles different among generation

U.S. Cellular training program

Safety issues without computer

Senior network for profession is ineffective and would benefit from a data base/clearinghouse

Frustration level of sorting out resources and give up

Income issues for meeting needs

Inpatient is prevalent

Trust issues and avg. people don’t always know right questions to ask

Long distance care is a totally different world

Navigating health resources state to state issues

Transportation/driving a care must be monitored and a strong willed independent person is a 

challenge

Get the white coat involved

Topography is not conducive to independence

Crosswalks are unsafe

Tele-medicine may be on the horizon

May need to provide bridge to make connection

If no need for face-to-face exam, tech may decrease office visits

Tennessee – State Plan on Aging 2014 - 2018 391
Primary care docs are over schedule and don’t have time to assess

Flash drive must be updated

HIPPA is limiting and goes way beyond common sense

Document/fear and liability oriented

Crisis reaction and crisis management

TN has good POA on line but legal issues still hard

Get out the power of attorney (documents available)

Making sure accurate information is promoted

How can you be sure you have accurate information?

What supersedes will? POA, bank account vs. financial POA

Auto immune disease increasing due to stress of BB, sandwich between 2 generations and 

fixers

Caregiver mentality

Facilitator Notes for Small Focus Group 6 

More funding for in-home care for aging and disabled people, make eligibility less stringent

Affordable health care – people can’t afford their medicines or insurance –

supplement the physicians to take Medicare

Medicare rules need to be adapted to Real Life Situation – elderly and disable are

 discharged too soon and when they need to be readmitted hospital keeps them in ER so

 they won’t get fined

More funding for mobile meals – they all have waiting lists

More respite services for caregivers

More accessible transportation – frail elderly or disabled people need an attendant to escort 

them in and out of care and in and out of doctor’s office – vans leave them too long – aren’t 

very easy for frail people

Facilitator Notes for Small Focus Group 7 

Affordable housing: Case manager - There is an increase of seniors without family support,

housing that we currently have right now. There is a mix of seniors and under 60, senior

housing is not safe (more senior housing). Same i.e., nursing homes – younger generation

mixed in with seniors

@ Home care: Family members who want or who are caring for a family member. But family 

member can’t afford to quit job and care for senior (need program that can help family stay @ 

home to care for senior)

Energy Help: Seniors living in older homes that in turn has abnormally high energy bills -

$400 and up bills with incomes $600 to $1,000 per month

Foster Care: foster care for seniors – group homes for seniors – adopting a senior (good 

ideas!)

Community churches: partnering with local agencies to help care for seniors in church 

communities, with home visits, assurance calling

Nutrition: not enough of food! Even seniors that get mobile meals, too many seniors are doing 

without food. Seniors not able to get the food – no way to food banks – need a program that 

gives food to seniors that are not able to get to a food bank or other food distribution

Back Packs for Seniors!!: Maybe piggy back with senior nutrition to deliver easy open foods, 

Tennessee – State Plan on Aging 2014 - 2018 392
micro meals, etc. – work with the senior nutrition programs in each county – partner up with 

food banks, second harvest, churches, agencies – deliver pack once per week

Transportation: affordable, easy access, money for transportation – hand on hand 

transportation – assisted transportation – transportation can also prevent depression, can 

promote health nutrition

Mental health: more in home mental health care, more mental health – prevent depression –

how can we prevent

Loneliness of Seniors: more contact for seniors

Most Important! - Transportation, Extended Nutrition

Facilitator Notes for Small Focus Group 8 

Sign language instruction

Staying Healthy while Aging

Mobile meals – healthy and tasty, specialized meals

Affordable dental, hearing, eye exams and glasses and medical care

Health and Wellness

More D/C assistance

Decreased availability of housing

Availability of funding for meds

Independence

Outlive driving abilities about 8 years

Cut D/T without tx

$ for tx divided more evenly

Access when and where

Funding and coordination of services

Caregiving

Pre-planning for recoup from surgery or illness – meals, meds - transportation to and from 

appointments

Personal responsibility – for care

Education on condition and providing programs at various sites

Independence and Getting Services Easily

More networking between agencies and thinking outside the box – possibly sacrificing 

agencies’ individual programs for a better outcome

Housing, Neighborhoods, Safe Communities

ID agencies in each community to recruit providers for services – maintain referral list with 

central group

Staying Connected and Involved

*Senior centers – branch out into areas that target local community needs and adding programs 

Tennessee – State Plan on Aging 2014 - 2018 393
that will meet a real need – set up satellite offices

Working with Older Adults and People with Disabilities

Add education regarding aging and respect

Abuse issues – especially drug abuse

Teaching police, etc. to know special needs and those with disabilities

Facilitator Notes for Small Focus Group 9 

More truth and less politics

Unsure about the future – need “plain talk” to understand changes in Medicare and/or health 

care or any issues affecting elderly

CHOICES 

Affordable housing issues – someone who would need assisted living but cannot afford

it. The person that is in the “gap” needs help. 

Not enough options for disabled people who cannot afford to refurbish their hone to 

make it accessible and needs to more into an accessible apartment/room

Working people in a gap between TennCare need financial help

Need housing opportunity to share duties to help the disable. There are some places, but very 

few in this area

Program that would allow someone to monitor those who need monitoring – maybe all live in 

the same house

Transportation mileage that is unaffordable for those who need transportation

Agencies need to work together to help people in need – especially in small rural counties

Since the inception of CHOICES there has not been a raise to the provider and the gas prices, 

etc. have continued to increase

CHOICES is a big savings to the State by keeping the elderly out of nursing homes

Seniors are being scammed more often

Seniors need to be checked on more often. Visits needed from dependable persons

Need help to find a doctor or other healthcare – Doctors are not taking Medicare/primary care 

and some doctors are dropping TennCare

Clients need to be able to go to dentist and get other care, but they need insurance before they 

are accepted.

Transportation from this area to Johnson City is an all day trip with transfers of vans and the 

cost increases for each county line crossed

FISH and KARM is visible in our area and have volunteers to help

Good dental health is needed for seniors who cannot afford it,

Need accessible and affordable transportations in rural counties – everywhere – need to partner 

with disability agencies and senior citizens agencies

Needy people who are disabled need to be able to be transported. Volunteer Assisted 

Transportation in Knoxville is good, but service needs to be in all counties

Some disabled need equipment donated or affordable for their vehicle. Sometimes they need 

to find a provider to do maintenance also.

Compassion Coalition – over 2,000 to 7,000 churches – group of churches that help with needs 

of people in the community (i.e., elderly man needs roof on home in Anderson Co. – church in 

Anderson county does project) (i.e.; disabled needs a lift for vehicle - $500

Mobile meals program – there is a waiting list in our area. Need additional funds to provide 

Tennessee – State Plan on Aging 2014 - 2018 394
more meals

Need to develop a foster care program for the elderly

Lack of education and knowledge of programs is common with the elderly

Better integration of services that cross county lines – elderly and disabled

Need additional guardians for those who do not have anyone to be a guardian, especially in 

rural counties

Facilitator Notes for Small Focus Group 10 

Some co-pays should be required if customer can pay – sliding fees too

More services should be available in outlying counties

More in-home services – in-home services should include meal preparation

Services for elderly homeless

Need congregate meals on weekends too

Bedbug and other pests in complexes

Housing options for those who don’t qualify for Medicaid – from Medicare standpoint, more

affordable assisted living

Partner with church groups like Family Promise to meet needs in community – increase efforts 

of Circle of Support and FISH program – good models for nutrition and even housing

Boost volunteer – assisted transportation particularly in rural areas

Transportation in general, especially wheelchair accessible

Need care settings – adult care homes for hard to place patients, traumatic brain injury, mental 

illness, and obese patients

Assistive technology and adaptive equipment

Mental illness – more training for police, etc. – better treatment – more long term counseling 

and medication stabilization – more services/case management in home to reduce 

hospitalization of chronically mentally ill (like PACT with Helen Ross McNabb) (“do more on 

front end to prevent crises” like hospitalization, jails, homelessness)

More defined ADA parking enforcement – more “cut out” in sidewalks for wheelchairs

More ramps, etc. to promote handicap accessibility

Facilitator Notes for Small Focus Group 11 

Elderly outlive everyone who can help them, then it’s a crisis. Example: person with disability 

(DD) and parent dies. Families not preparing but also resources are limited. Need system that 

builds resources. These resources are overwhelmed. Some how reach out to elderly family 

member and help them make a plan for the adult child with disability (education and resources 

needed) – all disabilities need this – MH/DD/etc. Need to navigate easier through the system 

we already have

Help to navigate through the system – forms; unable to read/hard for those who are trying to 

live independently

Barriers to helping people

Outlying counties – issue is transportation for folks that don’t have family or friends to help

especially to go to Dr.

Need housing in rural counties - affordable

By the time they pay basics, there is little money left for housing like assisted living

People live in less than desirable living situations, don’t want to go to nursing home, challenge 

Tennessee – State Plan on Aging 2014 - 2018 395
to get them safe housing

When person wants to go home from nursing home, some don’t have a home to go to and the

nursing home has only 30 days to find a place – Discharge to shelter

Real issue with people discharged from nursing home to community but no “in between” place

Harder to get approved medically for Medicaid

Some people need to be in nursing homes – also need supportive homes for vulnerable 

mentally ill, etc

As a caregiver, what are my rights as the person who take care of younger sister who has 

dementia, stroke, drug, alcohol use – I have no help. The sister refuses to get any help. I’m 

afraid to leave home. What are the resources to help me?

Homes for aged/assisted living qualify, but just barely and people are living in less than 

desirable situation, they need somebody to watch over them – home is clean, well lit, cares 

about them as a resident – needs things to do – go to park

Need for more training for people who run homes for aged

To eat healthy, it costs $, so they are going for convenient and cheap. People have a hard time

standing up to cook.

Even staff who work in the field have a hard time keeping up with all the resources (Resource 

Directory very helpful.)

Need to have more places that people could call up and get help. It’s all word of mouth.

By word of mouth, information about what faith-based organizations are doing – need for 

coordination and info – need more coordination

Need help with people who need to move

Needed help for someone who lived in Nashville, didn’t know how to get help for someone in 

another town

Hard to get information on services. Time is limited for staff people, get the run around – 

wasted time (hassle and run around)

More finances for aging in place

More networking of the agencies

More affordable housing

More transportation in rural counties

Just because you’re older, you may not be disabled, and you need employment (3-4 hours per 

day)

Need affordable dental care

Issues discussed on the larger group (Jim Shulman facilitating)

People are being let out of hospital in as cab and no help at home (no transitions)

HUD Housing – seniors feel unsafe because of the younger people using drugs – need 

complexes for just seniors. This also happens in nursing homes.

APS – hands are tied – waste of our time to call them – we need to know what they are 

allowed to do or not (they can only help if “imminent danger”)

Need better oversight of MCOs – in response when families have issues

More funding for CHOICES and Options

Tennessee – State Plan on Aging 2014 - 2018 396
Facilitator Notes for Small Focus Group 12 

Needs of Seniors:

Awareness of day care agencies that are available

Takes as long to get senior approved for CHOICES

Too many seniors falling through cracks because they are above monetary guidelines

Transportation is often a problem for seniors in rural counties. Senior Center attendance 

would thrive - Upper East TN has voucher system for free transportation to senior centers

Research volunteers to help with all programs

ATTAC is providing computers – State surplus is trying to distribute used computers

Caregiver training before the need arises

Brain games – competition between senior centers from county to county and resulting in a

statewide contest. 3 championship teams competing in the final contest in Nashville, possibly 

at Belmont.

Facilitator Notes for Small Focus Group 13 

Increase in the # of home meals needed – funding cuts probable to affect

Title 3 programs funding – cuts expected but current funding is already insufficient

Transportation

Homemakers

Sr. Companions

Dental and hearing needs – education of benefits and services available

Proper assessment of need

NF care – activity

Ratio of care providers to residents in NF

Take more action & put more funding toward HCBS

Mental health needs continue increasing for elderly and disabled with little or not resources 

available

Depression affecting physical well being

Need a holistic approach

Rural areas affected by lack of resources

Lack of knowledge about Medicare/Medicaid/insurance

Opening up lines of communication about planning for LTC (families)

Proactive action become common practice

Elder Abuse = APS (need improvements in process outcome)

Organize resources

Housing, housing, housing!

Facilitator Notes for Small Focus Group 14 

Transportation, especially assisted

Transportation for low income seniors

Road condition issues

Funding for dental/eye/hearing

Increase OCL in-home services

Eliminated donut hole – penalties

More stipend opportunities

Tennessee – State Plan on Aging 2014 - 2018 397
Resources to get meds to seniors

Dual diagnosis Alz./MR issues – how to get the resources

Increase respite care

Better hospital discharge coordination

Way to get resources

Increase APS resources

Home repair services – develop community resource responses – UAW/old Dominion 

Trucking

More for mobile meals

Develop partnerships with colleges, schools – intergenerational

Raise awareness of aging issues for medical community, police, etc.

Medication management assistance – in-home (reminders)

Case management in home for seniors

Utilities assistance for seniors – help with insulation, caulking

Affordable assisted living

Affordable health insurance (subsidies, other)

Awareness (aging) training for volunteers, anyone working with seniors

Solutions for elderly homeless

Facilitator Notes for Small Focus Group 15 

Staying Healthy While Aging – NEED:

Healthy food, help preparing food, enough food (so does not need to worry about getting next 

meal)

Education to prevent falls since one fall can begin the demise of a senior adult (cited 40% of 

hospitalizations are from hip fractures and that most will never regain their independence)

More education about how to stay safe (Senior Safety Task Force, Sheriff’s Department, Knox 

County – promotes prevention – exercise, home safety, medication management and good 

vision)

More opportunities to participate in “Stay Active and Independent for Life” (SAIL, CDCfunded) program 

Brain fitness programs

Health and Wellness – NEED:

Greater focus on socialization to prevent depression and resultant physical decline

Much easier process for making application for Social Security and Medicare (current system 

is too complicated for older persons; many inadvertent mistakes are made and seniors suffer 

consequences)

More access to programs like Senior Companions (participant said she works through Knox 

CAC in a stipend Senior Companion role, feels she makes a positive difference for the 

consumers she serves)

Education and support for older persons when they are discharged from hospitals with a “bag 

of medications” and don’t know what to do with them when they get home because they are 

weak, confused and still sick (said hospitals, doctors, pharmacies need to pay more attention to 

the issues that ensue when elderly patients don’t take their meds as prescribed post-discharge; 

noted penalties to hospitals for readmissions under the new health care law as motivation for 

Tennessee – State Plan on Aging 2014 - 2018 398
change; suggested a chart be sent home with patient to clearly show meds and schedule for 

taking them - hospitals/doctors/pharmacies would use same chart)

Teach seniors to ask questions about their medications (of their doctors and pharmacists)

Teach older adults the importance of throwing old/outdated medications away (cited her 

parents were born during The Depression and refuse to throw anything away)

Teach older adults about the dangers of taking tranquilizers and pain medications on an 

ongoing basis and restrict doctors from prescribing them for long-term use (said when her 

parents were younger tranquilizers and pain meds were frequently prescribed and that parents 

expect pills to be “like magic”)

Fewer medications for older adults (said sister changed to new doctor who reduced the number 

of meds she was taking and that she feels much better, is more active, etc.)

Advocates for older persons to interface with doctors and pharmacies around medication 

management

“HomeMeds” program (developed in Tarrant County, TX; evidence-based; reduces medication 

errors through patient support; suggested could use AmeriCorps workers to implement)

Focus medication management efforts on homebound seniors and adults with disabilities

Develop training for persons who work with seniors and adults with disabilities to learn how to 

motivate them to focus on what they can do, instead of what they cannot

Educate older adults about the dangers of smoking and offer more opportunities for smoking 

cessation learning (said sees many older caregivers who still smoke and make the statement 

that smoking is the only bad thing they do)

More focus on brain fitness

Caregiving – NEED:

Education on being a caregiver, as well as being a care recipient (said most adults will be 

either a giver or getter of care at some point; AARP is focusing on caregiving this year)

Much more help/support for caregivers (husband/wife team have non-profit that trains 

caregivers – individuals and providers – offering free, evidence-based education to unpaid 

caregivers; cited stat that indicates persons caring for loved one with dementia often die first; 

655,000+ caregivers in TN suffer from depression and financial distress)

Mental health support (60% of caregivers have moderate to severe depression, are raising 

grandchildren in addition to caring for spouse or parent)

Financial support to caregivers who must retire early or give up jobs to provide care (average 

hourly rate lost by caregivers is $25)

Utilize AARP NC model for education and facilitated support groups for caregivers

Independence and Getting Services Easily – NEED:

Understanding that as we get older, we will probably not be able to do what we always did 

(e.g., repair the roof) and that being less able is okay; said the belief that we should maintain 

all of our physical abilities causes depression (suggested educating on appropriate aging and 

slowing down some)

Housing, Neighborhoods and Safe Communities – NEED:

Neighborhoods for seniors and older adults that foster ”loosely-knit support” among residents 

(stated his father lives in a retirement community where he has observed that fellow residents 

care about and for each other on an informal basis)

Tennessee – State Plan on Aging 2014 - 2018 399
Protection from grandchildren and adult children stealing and selling/using narcotics 

prescribed for a legitimate issue for the older adult (mentioned medication collection and 

disposal programs)

More transportation access (said no public transportation available in Blount County)

Help getting groceries (shopping, getting them home and into the house and put away) 

Staying Connected and Involved in the Community – NEED:

To live in communities, rather than alone

To have opportunities to develop new friendships as spouses and friends die

Help to be able to go places (assisted transportation options)

More income to be able to afford to participate in activities (movies, church, senior centers, 

etc.)

Working with Older Adults and People with Disabilities – NEED:

Teach those who work with seniors to develop substantive relationships with their clients (said 

good program, “Emotional Isolation and How to Deal with It,” teaches that superficial 

relationships do not bolster the sense of self-worth for older persons, but have a devaluing 

effect on them; said it is possible to maintain healthy boundaries and still have meaningful 

relationships)

Teach health care providers to address elderly patients appropriately, rather than addressing 

questions or discussion to the adult children who accompany the older person to appointments 

(said with “Silver Tsunami,” health care system will be overwhelmed and Boomers will not 

tolerate being ignored)

Other

This group was comprised of a county AARP representative, a Second Harvest employee, a 

Health Department Injury Prevention Coordinator, an Alzheimer’s Tennessee representative, a 

Senior Companions worker, a BCBST representative, a librarian and a couple who operates a 

non-profit to train consumers and providers about caregiving. Most group members were 

engaged in the conversation, had ideas for improving existing service access and delivery and 

expressed interest in learning the outcomes of the statewide needs’ assessment initiative.

Tennessee – State Plan on Aging 2014 - 2018 400
Needs Assessment 

Upper Cumberland Area Agency on Aging and Disability 

Life Church, Cookeville 

February 21, 2013 

Number of Attendees: 103 

Tennessee – State Plan on Aging 2014 - 2018 401
Upper Cumberland Area Agency on Aging and Disability 

Life Way Church, Cookeville 

February 21, 2013 

What are the hard things that “baby boomers” face? How should the state of TN help?

(Number of Questionnaires containing 1 or more responses - 33) 

This open-ended questionnaire was designed to elicit qualitative data from the attendees about 

how they thought aging would impact baby boomers. However, many attendees also identified 

issues that currently exist. Attendees were able to respond to the questions in any manner that 

included short, one-word answers, such as transportation, to very involved responses. In order to 

provide some order to the responses, major topic areas have been identified. In addition, some 

topics might include sub-topics for the purpose of reading the report more easily. Repetitive 

responses are included only once. 

1. Easier Access to Services Without Hassle (including information and assistance; 

communication; and technology) 

Better access to services

Create a better means to access services – the processes should be more accessible 

and easier to understand 

The need for increased computer skills to gain services 

Learn more about hospice and what they do 

Not knowing what assistance is available 

Finding relevant information covering insurance, housing, etc. 

Everything appears to be going to self-service due to computers 

Making baby boomers be informed about health 

Cancer awareness 

Computer issues and phone issues – training 

Getting info pertinent for insurance (SHIP) 

Need a “master list” of available services – in church offices 

Easily understood information about services offered via the State. Getting such to 

non-email recipients 

Some baby comers don’t know what their choices are out there, I think after a certain 

---DOB should send information out – do they know they can help 

Caregiver information and support awareness – advertise/website 

2. Healthcare (including in-home services; Home and Community Based Services; long 

term care; chronic disease; Alzheimer’s disease and related dementia)

Affordable health care and medication cost 

Being able to stay at home when ill or hurt 

Increase day care would decrease the need for institutional care 

Money for medicines and being able to live on fixed income 

Medical care – we need standardized care for standardized costs and readily available 

Provide more benefits and services, meals 

Many are grieving – fund counselors for every other week or more 

Tennessee – State Plan on Aging 2014 - 2018 402
Affordable health care with healthy lifestyles 

Large number of baby boomers that will soon be entering the health care system 

If medicine funds will be available for all, the people that will be needing it. 

Available community resource that aren’t affordable

Not being able, medically, to make their own decision. Have support groups to let 

them know its OK. 

Medication Assistance – “donut hole issues!”

They need the help of SHIP and their volunteers. The State can help by not cutting 

funding. 

Offering programs for individuals who are not in poverty 

Some programs that are designed to help are income/asset based – too much income 

TennCare – replace it with a more user friendly programs 

Not being able to care for myself 

More service for them – more info for the services 

Affordable prescriptions for them 

Aging – age 65 and onward – “Quality of life” for physical, emotional and overall 

wellbeing – be able to afford care for themselves as they move in life from 

independence to dependence 

More real, direct help and service at grassroots level where needed 

-Cost of medical supplies 

Medical care – TennCare 

Health disabilities

Needed assistance that is unavailable 

Health/mobility issues and how to pay for services. Carefully screen these people to 

provide appropriate/available services 

More assistance for in-home care 

Access to needed home and community based services such as home delivered meals, 

homemaker, personal care services 

Assistance in-home with activities such as cooking and cleaning 

Giving up their independence – having to have someone come in and help them do 

daily activities in their home 

In-home caregiver assistance to ensure their safety 

Loss of abilities – provide caregivers 

Long waiting to receive in home care – should be as quicker process 

Option for low income elderly to live in affordable assisted living – or stay at home 

with caregiving at affordable levels or provided by TennCare

Getting long term care 

More option 2 approval on Choices program 

Cost effective alternatives to LTC facilities and other LTC services 

Free dental and hearing exams and help with treatment - eyeglass assistance– free 

testing at centers. Need for regular dental and vision testing and payment of these 

services 

Chronic illness – COPD, diabetes – many disabled at a young age

Care of dementia residents 

Tennessee – State Plan on Aging 2014 - 2018 403
Increase dementia-related disease and shortage of providers and funds 

3. Fiscal Concerns (including health insurance; Medicare/Medicaid; employment; 

retirement; social security; cost of living) 

Being stuck in the middle of having too much money, but not enough to pay for 

needed services 

Need more assistance/tax cuts for middle age, middle-income people 

Financial concerns from living longer 

So many that need help that the gov’t will not be able to take care of

National debt 

Putting in place a plan for loved ones to that they are not a burden on their loved ones 

Not enough income

Collapse of value of investments 

Assistance with banking, business

If we bankrupt State, all seniors and other citizens will suffer more. 

Excessive amount of individuals applying for assistance 

Fewer pension plans 

Affording health care – insurance becoming so expensive –raising deductibles in 

order to afford insurance and then avoiding care due to falling in the deductible range 

and insurance won’t cover

Due to housing loans being difficult to obtain – renting/lease expenses are high –

really taking advantage of those that may not be able to get a lesser expensive home 

loan 

Need more crackdown on insurance companies – raising premiums even if client in 

good health – need insurance options 

Planning for their care and future needs affording health care/insurance cost – spend 

down

Health coverage – not sure 

Paying for healthcare and paying for the cost of insurance 

Affordable insurance supplements 

Insurance costing too much – provide cheaper insurance 

Not being educated on Medicare/Medicaid – have training/meetings/more 

documentation how what it pays for and how it is paid 

Medicare – too many plans/info 

High costs of prescription drugs and medical services (insurance costs) 

With Medicare related issues as that continues to be more complex 

Fraudulent Medicare providers; lack of Medicare-accepting physicians 

Access to employment

Transcending to possible part-time employment 

Finding meaningful thought provoking employment after retirement 

Work because to many will have to work past retirement age 

New technology in jobs –training 

Insolvent Social Security in 2025 

Tennessee – State Plan on Aging 2014 - 2018 404
Social Security stability – lobby government representatives to limit social security 

disability, and place social security funds separate from general funds to preserve this 

program for seniors (for which the program was originally intended). 

Social Security being available 

Increased cost of living. Increasing costs of medicines, healthcare, long term care. 

Aggressive promotion is needed to advise adults as early as possible to save for 

retirement and their senior years. 

Rising cost of living and continued cuts in healthcare cuts – re-evaluate the increasing 

cost of living

Cost of living increases outpace retirement benefits

Enough money to get through the retirement years 

They can’t afford to retire

No or limited part-time work available 

There are so many that will hit retirement age at the same time – money and provision 

will run out 

Planning for retirement and long term care when needed 

Financially preparing for the aging years, i.e. having financial nest egg that provides 

for their health and welfare 

Lack of retirement planning and knowledge of healthcare laws and services available 

4. Support Services (including transportation, meals/nutrition; elder abuse services; senior 

centers)

a. Transportation 

Affordable and accessible transportation 

Money for more services 

Transportation for evening and weekend events – increase u-carts routes and 

hours - step risers on vans 

Resources for transportation, non-covered services in the home 

Adequate, accessible transportation for both medical and non-medical 

assistance 

Transportation for elderly that is timely and easy to obtain 

Recognizable rail transportation service 

U-carts or other etc. or having better way to get to appointments, shopping, 

picking, exams 

b. Meals/Nutrition 

Adequate healthy foods 

Lunch every day

Commodities delivered to the Senior Centers 

Stipend to deliver meals

Provide food from Second Harvest or other food distribution 

Nutrition 

Food programs could deliver bulk food monthly to those who can’t travel to 

food pantries 

Grocery delivery 

Tennessee – State Plan on Aging 2014 - 2018 405
Ability to get food – prep and/or pay for these. Services provided for persons 

as needed by person accountable when able 

c. Elder Abuse 

Protecting elders from financial exploitation 

Free legal advice available for many daily life issues, not simply wills, deeds, 

etc. 

d. Senior Center 

Staying active – support financially our senior centers so programs can be 

provided 

Senior centers will need to change to adapt to baby boomers. The State could 

help with a marketing campaign. 

5. Staying Healthy While Aging (including exercise, eating healthy foods, socialization, 

chronic disease, staying connected and involved in the community, volunteer 

opportunities) 

Staying healthy and in shape 

Keeping healthy and exercise programs 

Isolation/lonely – promote community/provide companionship 

6. Adults with Disabilities 

Develop training programs to help those with disabilities and adding adults gain new 

skills 

7. Caregiving 

Multi-family care responsibility – children in home longer (can’t afford to live out on 

their own) and parents – they need assist with care from all levels – housing –ADLs –

financially

Must take care of both parents and grand-children while still working 

Maintaining employment – caring for parents 

Balancing care of parents and care of children 

Baby boomers are now facing the task of taking care of the elderly parents while 

taking care of their children and grandchildren. They need support with finding 

resources and community

Sitter services/respite – state approved funded attendant services 

Taking care of aging parents 

Loss of abilities – provide caregivers 

8. Housing, Neighborhoods, and Safe Communities (including home repairs and utilities) 

Able to find affordable housing

Suitable housing for individual’s physical/mental needs

Broader options available for home loans – subsidized loan options, etc. 

Not enough assisted living places 

Community involvement, seminars

Tennessee – State Plan on Aging 2014 - 2018 406
Assistance with staying connected to their community, i.e. volunteering, meeting new 

friends, staying busy with their idle time 

Affordable assisted living – offset costs 

Home - property less due to rising costs associated with increased taxes 

Advocate for 202 housing (HUD)

Staying in home – money for more services 

Aging in place – need more options for care in the home, continuous care, retirement 

Living longer . . . assist with finding appropriate housing for persons in needs. Still 

give people some responsibility when able.

Ramps – member have to be on a waiting list and usually is up to 2 years waiting list 

More help for members to get help on furniture or help around the house to fix floors 

or actually have good, they may have Choices and have good stand, and still have to 

pay bills and meds and can’t get or pay for their house to fix the Big Safety problems 

on their home

Supplemental payments for electricity for low income 

9. Funding/Resources 

Conservatorship funding for adults 50 and up – mental health services – none 

available

Money

10. Other:

Maintaining employment while taking care of patients 

Undo new PAE guidelines

The turmoil without our gov’t. – don’t make it worse with absurd laws and 

threatening legislation 

Government should stay out of doing welfare – welfare belongs in the hands of the 

churches!

Churches must step up!!

Help/learning to make decision with declining “smarts” – classes and resources 

State of TN should not do more than facilitate help 

Tennessee – State Plan on Aging 2014 - 2018 407
Upper Cumberland Area Agency on Aging and Disability 

Life Way Church, Cookeville 

February 21, 2013 

Question: Here are seven (7) aging and disability issues. 

 Under each, there is a list. 

Mark the ones on the list that you think are most important. 

Number of Questionnaires completed: 81 

Response # of 

responses

%

1. Not having enough insurance or money to pay for doctors

 or medicine

2. Being able to get accessible transportation

59 72.8

3. Getting care at home instead of in a nursing home 57 70.3

4. Affordable dental care, hearing care and eye exams and

 glasses

56 69.1

5. Respite services

6. Being able to get help when needed quickly and without

 hassle

7. Training for aid workers who help older adults and people

 with disabilities

55 67.9

8. Transportation for people who don’t drive cars 53 65.4

9. Housing that people on a pension or Social Security can

 pay for

52 64.2

10. Keeping healthy through exercise and eating healthy foods 51 63.0

11. Teaching volunteers to work with older adults and people with

 disabilities

48 59.3

12. Meals that are healthy and prevent hunger

13. Learning how to live with a serious condition like heart disease, cancer, 

 arthritis

47 58.0

14. Meeting people and making new friends 44 54.3

15. Knowing where to call for help and getting help without a big runaround

16. Houses that are easy to get around in if you’re on a walker or in a 

 wheelchair

41 50.6

17. Help with memory loss 40 49.4

18. Protect people from abuse

19. Learning about how to care for someone at home

39 48.1

20. Making decisions about health insurance, Medicare, and planning for 

 the future without depending upon the government

37 45.7

Tennessee – State Plan on Aging 2014 - 2018 408
21. Reasons people have to go into nursing homes

22. Learning about how to take care of yourself so that you don’t get sick

 and tired

23. Learning new things

36 44.4

24. Understanding how Medicare works 35 43.2

25. Teaching doctors, nurses, and other healthcare workers to know the 

 special needs of older adults and people with disabilities

33 40.7

26. Being able to choose the workers who come into your home 32 39.5

27. Teaching police, Firemen, emergency workers to know the special 

 needs of older adults and people with disabilities

31 38.3

28. Help with taking too much medicine

29. Eating out with friends

30 37.0

30. Learning how to prevent falls 29 35.8

31. Help with chores like lawn mowing and leaf raking 27 33.3

32. Reasons people have to go back to the hospital

33. Neighborhoods that are easy and safe to walk in

34. Places to volunteer

26 32.1

35. Help with feeling sad or lonely 24 29.6

36. Being able to get accurate information from a website and being able to 

 apply for services on-line

20 24.7

37. Neighborhoods that have grocery stores close by 17 21.0

38. Help with drinking too much alcohol or taking drugs 12 14.8

Other: 

Meaningful activities, spiritual and otherwise

Some medical personnel available periodically to answer question and address concerns when people 

cannot afford or cannot get to a doctor

Create yellow dot program (AARP) or the Vial of Life on house

Understand how Medicaid works

Having the member get money that are on a fixed income to help the aide with enans.(?) Members that 

don’t have a care, we should have a special transportation for members that are on these services.

Providers should have more info on all the options there is out there. A lot providers don’t have enough 

one their snap card to last the whole month.

Being able to get accessible transportation - Members bend the aide ride and have problems with meals for 

diabetic and bathroom breaks for UI and can’t go so they go in their depends.

Need more options for transportation

Houses that are easy to get around in if you’re on a walker or in a wheelchair - Member have problems 

trying or not having money to make ramps or insurance won’t pay.

Family support, Community support

Education concerning legal information such as living will, healthcare, POA, etc.

Public education (e.g. TV spot ads) on respect and helping elderly

Understanding how Medicare works – no one knows!!

Help with taking too much medicine – most seniors take too many meds because Dr’s. keep prescribing to 

Tennessee – State Plan on Aging 2014 - 2018 409
avoid liability

Being able to get accessible transportation – UCART tries

To get better meals at the Overton Co. Senior Center instead of warm over from Gainesboro. Get it from 

nursing home.

Suggest workshop for physicians and staff to learn about programs offered

Classes offered to families educating them on the value of the seniors in their family

More funding for help!! State and federal

Home delivered meals program

I’m a nurse director of CHOICES for NOTO – my patients are my #1 thing to keep them safe in home. 

Transportation I think is the worse thing with this program.

Employment opportunities for people with disabilities or older adults; job coaching; life skills training; 

teaching business about hiring these individuals.

Greater emphasis from UCDD & TCAD for services for people with disabilities (seems there is a greater 

emphasis on the aging population)

People in nursing homes are often not receiving adequate care by physicians, routine checkups, etc. I 

think that people in nursing homes should be visited by doctors and receive routine exams to ensure their 

healthcare needs are met.

Workers that are available that can assist in the home with the elderly

Money for more services – 370+ on home delivered meal waiting list – needs to be reduced

Tennessee – State Plan on Aging 2014 - 2018 410
Upper Cumberland Area Agency on Aging and Disability 

Life Way Church, Cookeville 

February 21, 2012 

Question: What is currently working well in your community? 

(like agencies that help, neighbors who help each other, van service, senior center, 

meal sites, food pantry, healthcare clinic, nursing home, sidewalks, police 

presence, grocery stores that deliver) 

(Number of Questionnaires containing 1 or more responses - 66) 

This open-ended questionnaire was designed to allow attendees to identify the community 

programs and services that have worked for them and in their community. Evidence based 

and/or proven practices were not a consideration in the design of the questionnaire and no 

checklist was provided. The above items in parentheses were provided as examples. Attendees 

were asked to write in the programs and services that were working well in their community. 

The responses are individual and specific to the region served by the Area Agency on Aging and 

Disability. The number of attendees who indicated that the program is working well in the 

community is provided in parentheses (). 

Food pantry (7)

Senior center and Welchland Baptist – food pantry

Police presence (5)

Several opportunities for volunteers – library, nursing home

Upper Cumberland Development District (UCDD) (4)

Upper Cumberland Human Resource Agency (UCHRA) (7)

UCHRA/White Co.,

Area Agency on Aging and Disability (AAAD) (4)

Meal sites (4)

Congregate meals (5)

Home delivered meals (3)

Meals on wheels (6)

UCHRA nutrition

Senior meals

Meals delivered – great need since less are qualifying for nursing homes – but very

difficult to get access to – long waiting lists

Commodities

Home delivered meals from nursing home

Churches (2)

Church in area that distributes food

Life Church helps the DAV and many others

Several of our patients receive assistance from churches in the form of food items, 

financial services, and home health care

Churches: Help Hands

Unaware of any grocery stores that deliver

CRMC (Cumberland Regional Medical Center)

Tennessee – State Plan on Aging 2014 - 2018 411
 

Community agencies that help

Agencies that help

Neighbors who help each other

Family members and friend, neighbors that are always willing to go that extra mile

Grocery store that delivers/Clay County

Need more groceries that could deliver

Floyds Grocery/Sparta

Transportation/Public transportation (7)

Transportation for senior and persons with disabilities

Public transportation = is about the best but they still have work that can be done

Van services/UCHRA van (8)

U-carts (6)

No personal experience (yet) but I think UCHRA transportation might be

Alzheimer’s TN Regional Office Services:

Alzheimer’s TN for support/direction

Rescue Mission

Pharmacy

There are pharmacies that will deliver

Pharmacy delivers

There are a few pharmacies in the area that deliver meds

Senior centers (18)

Allgood Senior Center is great resource site

Seniors centers offer opportunity to make new friends & stay socially active

Senior center only thing working in community

Services provided by area senior centers

Senior center and healthcare clinic in Baxter

Senior center – Putnam – YES – Maxine Frazier

Need funding for UCADD and for senior centers/please provide additional funding

Senior citizen center/Sparta 

Senior centers with meals

Senior centers are good in some places, but others are too “clicky”

Senior center is helping a lot, they need more info for the seniors. More info on the 

food pantry so more seniors know what’s out there. A lot of seniors don’t know 

what they can get.

Nursing home (2)

Nursing homes present but are much harder to meet LTC criteria

Geri-Psych Units readily available but none to deal with alcohol and detox except Ten 

Brook Tennessee at CRMC but that is more adult structured

There are a lot of providers in our area but the problems are hard to get around. We 

need more funding Respite care with dealing with Alzheimer’s, etc.

Have health agencies able to offer help to seniors wanting to stay independent and at 

home

Tennessee – State Plan on Aging 2014 - 2018 412
SMP/SHIP

SHIP is very helpful (Meghan Moore)

Public awareness has increased in recent years. Doctors, nurses have a better 

understand of people’s needs. Food Pantries in area have become increasingly 

important as the costs of food increase and government payments stay the same

Cleaning project started by Clare Farless at UCDD/AAAD

Volunteerism:

Ministerial programs that provide volunteer assistance

Volunteer programs from churches

Service providers – non-medical and medical

Senior expos

Community support

Help program

Options and CHOICES Programs (2)

Screening for Choices LTC

Choices program – YES

Options – NOT – waiting list

Emergency – 911 services

Life line – YES – but $ for some

Health department

SHIP & Choices

Adult day care

Senior companion program

I work with State of TN Services for Blind & Visually Impaired. We show people that 

are physically able, but have vision impairment to be more independent in doings 

things around their home by showing alternative way or assistive devices.

Senior center; food pantry – multiple options throughout the community; day 

habilitation programs; vocational rehab (could be enhanced but is a valuable resource); 

networking opportunities for agencies/providers to collaborate; employment options 

like Goodwill (need more opportunities)

Second harvest food bank

Local agencies working together to provide assistance – donate money and fund local 

programs

Helping hands

Elder Abuse agency – need more; delivery services

Home and community based services

Community center

We have no delivery grocery in Tansi; no sidewalks in Tansi, little police; we have 

good neighbors; Crossville has 2 good senior centers/Tansi has none of the other 

services. We need van service, meal sites, food pantry, healthcare clinic, nursing 

home, SIDEWALKS, delivery grocery.

Cookeville Housing Authority – Elderly housing is clean & safe

NHC Nursing Home – great staff & director

Public Conservator Office very helpful & professional

CRMC Rehab Facility is great – CRMC ER – NOT great

Tennessee – State Plan on Aging 2014 - 2018 413
Ombudsman Marie Ferran – smart and cooperative

Apartments for elderly

Networking amongst healthcare providers, State, county and gov’t. agencies; DHSAPS; senior centers and local health department; homecare services (various); nursing

home care (need more dementia/Alzheimer’s units)

The White Co. Senior Citizen Center – excellent job!; unaware of a grocery store that 

delivers in White Co.; police presence could be more prevalent

Habitat for Humanity; LBJC; Food pantry at White Co. Agricultural Center

CRUC – low income housing

Tennessee – State Plan on Aging 2014 - 2018 414
Upper Cumberland Area Agency on Aging and Disability 

Life Church, Cookeville 

February 21, 2013 

Small Focus Group Responses 

Tennessee – State Plan on Aging 2014 - 2018 415
Upper Cumberland Area Agency on Aging and Disability 

Life Church, Cookeville 

February 21, 2013 

Facilitator Notes for Small Focus Group 1 

Staying Health While Aging

Keeping healthy through exercise & eating healthy foods – more funding for meals as many 

don’t have food

Affordable dental care, hearing care and eye exams and glasses – insurance should cover

Learning how to prevent falls – continue prevention education

Include cognitive impairments, treatment for mental illness at home treatment

Health and Wellness

Reasons people have to go into nursing homes – spouse may not be able to care for person at 

home – early prevention could prevent nursing home need

Reasons people have to go back to the hospital – Proactive Discharge Planning and good 

referral sources 

Not have enough insurance or money – affordable insurance Medicaid expansion needed

Getting care at home – expand Choices $ for more services – Choices not enough currently

Understanding how Medicare works – education, education (SHIP)

Making decisions about health insurance, Medicare, and planning for the future – limited 

resources – income still a problem

Help with feeling said or lonely – more mental health oversight – need better insurance

coverage

Help with drinking too much alcohol or taking drugs – will become a bigger problem in future 

– need to be more proactive now

Help with taking too much medicine – electronic system for MD’s would help prevent or catch

Help with memory loss – more respite care/adult day care

Protect people from abuse – should be very high on the list – see lots of these problems more

and more – regionalize abuse hot line – direct access to case workers

Caregiving

Respite services – need increased hours

Learning about how to take care of yourself – caregivers must have breaks as they will wear 

down quickly and most are not also caring for grandchildren

Independence and Getting Services Easily

Being able to get help when needed quickly and without hassle – increased funding so people 

can answer live

Being able to get accurate information from a website and being able to apply for services online – Baby Boomers will use computers so this could be useful

Being able to choose the workers who come into your home – people like to have people in 

their home they know

Being able to get accessible transportation – work on transportation that can meet all needs, 

mot has restrictions (wheelchairs, etc.)

Tennessee – State Plan on Aging 2014 - 2018 416
Housing, Neighborhoods, and Safe Communities

Help with chores – more community outreach (Churches, etc.)

Neighborhoods that are easy and safe to walk in – more HUD/202 developments – more

affordable

Neighborhoods with grocery stores close by – Dollar store concept with delivery services

Staying Connected and Involved in the Community

Places to volunteer – not lack of places but volunteers

Learning new things – are plenty out there just encourage them to participate

Meeting people and making new friends – making senior centers more safe

Working with Older Adults and People with Disabilities

Training for paid workers – continue training

Teaching police, firemen, emergency workers – could save problems – use something like 

yellow dot program

Other

Working with underserved groups that may not feel comfortable talk to their family, etc.

Facilitator Notes for Small Focus Group 2 

Food for hungry seniors is a big need. Not just dropping some frozen food at the door. People 

need a warm meal that is already prepared. So often those who can’t make it to a meal at the 

nutrition site, also feed isolated.

I think it is a shame that people are on the waiting list for 2 years to get home delivered meals. 

Before we try to fix anything else we need to make sure that seniors aren’t starving or having 

their health compromised by poor nutrition.

There is a need to coordinate all the food providers in the area so we are able to tell where the 

needs are greatest. There are churches and civic groups that provide meals or are willing to 

provide meals if the effort is coordinated so that there is no duplication or leaving people out 

of the loop. 

Meals need to move closer to the people so that they are hot when delivered, and cost is 

reduced.

Baby Boomers are going to want a lot more choices in meals.

Overton County, poor county, the wait is 3-4 months for a home delivered meal, but the wait is 

forever 3-4 months, no one ever seems to get off the list and onto the meals.

Lack of a place and opportunity to exercise. Tied to isolation, transportation motivation.

Not a lot of resources that are known of for older folks who are feeling depressed as the losses 

begin to pile up, decrease in sight, loss of significant other all at once or one day at a time with 

dementia, loss of mobility, Mental Health as treatment and prevention.

Emotional health needs a lot of attention. Often people are willing to help out by raking leaves 

and changing light bulbs, what might be needed is a kind ear to listen.

All of it seems to tie together, emotional health, nutrition, exercise and a place to be connected 

to others.

Caregivers, especially for Alzheimer’s and other dementias need a lot of support either through 

Tennessee – State Plan on Aging 2014 - 2018 417
respite or information and education or both.

There are speakers and health fairs but what is needed is something like the diabetes support 

groups for other chronic issues.

Often it is hard to get people to ask for help, example caregivers feel like they need to do it 

themselves, don’t want to admit that they need help.

There is a need for a trained group of volunteers that are screened and trained to do small 

things around the house , but mainly to check on and listen to people.

U-cards ( U- carts?), uchra transportation is terrible, pick folks up early drop them off at home 

very late with a medical apt in the middle. Some felt all the time and coordination was being 

used on TennCare pts. Need access to affordable transportation without long waits. 

Someone needs to monitor how transportation is done, too many ways to take advantage of 

vulnerable seniors.

Need to make the homes safer, help clear clutter, repair flooring and wiring.

Need more and better coverage for eyeglasses and dental.

Suggested coordinating with VR, who runs workshops to train staff, to train and background 

check personal care and homemaker workers.

What is working:

The SHIP program great, non-biased information at no cost to the consumer. 

*Legal Assistance is not working. 

Facilitator Notes for Small Focus Group 3

Meals are not good – “feed them to dog”

Specialty meals are same one (HRA)

nutritional risk assessment not being completed on all clients – Choices (AoA)

Should be transportation just for Choices

12 hour van ride – transportation

Need more education about what services available

More Options hours

More training for the elderly about issues that affect them

Employment opportunities for seniors who needs

Train how to hire those with disabilities and elderly people

Enhanced training for those with disabilities

Medications 4 or 500 dollars

Education of doctors about programs

Too many meds being prescribed

Not enough doctors who understand disabilities

First responders need to be more educated in elderly and disabled

More network opportunities

More outreach to doctors and hospitals

Teeth – dental

Eye glasses

Home care equipment

More home modifications

More outreach to dentists to figure out how to better get dental work done for seniors 

Tennessee – State Plan on Aging 2014 - 2018 418
Partner with DHS

Dinged up halls due to wheel chairs in Senior Housing , Seniors being charged 4-5 hundred 

dollars for damage.

Training on how to use equipment

Training on individuals on abuse

Facilitator Notes for Small Focus Group 4 

Staying Healthy While Aging – NEED:

Increase funds to reduce long waiting list for home-delivered meals

Increase access to food (great need for food in this region)

Help with cost of food

Commodities dropped off at senior centers in every county (rather than consumers, many of 

whom lack transportation, having to go to another location to get them)

Increase congregate meals to five per week from current four

Reinstate hospital discharge priority status for home-delivered meals (persons just discharged 

from inpatient hospital settings no longer eligible for meals)

Encourage health plans to provide more comprehensive availability of Silver Sneakers 

Program (some said would like to participate, but would have to travel a distance to do so)

Educate about benefits of eating properly and exercising regularly (15 of 20 senior centers 

have exercise equipment)

Increase funds for transportation vouchers (region supplies vouchers to consumers to use for 

any type of ride they wish, but supplies are limited, funds will run out and voucher program 

may end)

Teach seniors how to use, care for (clean) and change batteries in hearing aids (schedule 

regular sessions at senior centers for this and other similar activities)

Get information on services out to more consumers (many are unaware of what's available)

Health and Wellness – NEED: 

As above,

Increase funds to reduce long waiting list for home-delivered meals

Increase access to food (great need for food in this region)

Help with cost of food

Commodities dropped off at senior centers in every county (rather than consumers, many of 

whom lack transportation, having to go to another location to get them)

Increase congregate meals from four per week to five

Reinstate hospital discharge priority status for home-delivered meals (persons just discharged 

from inpatient hospital settings no longer eligible for meals)

Encourage health plans to provide more Silver Sneakers Program (at present, only four UC 

counties have the program; consumer said would like to participate, but would have to travel a 

distance to do so)

Educate about benefits of eating properly and exercising regularly (15 of 20 senior centers 

have exercise equipment)

Increase funds for transportation vouchers (region supplies vouchers to consumers to use for 

any type of ride they wish, but supplies are limited, funds will run out and voucher program 

may end)

Tennessee – State Plan on Aging 2014 - 2018 419
Teach seniors how to use, care for (clean) and change batteries in hearing aids (schedule 

regular sessions at senior centers for this and other similar activities)

Develop collaboration between dental, vision and hearing care providers in each county 

wherein each practice takes a turn giving free care on an annual schedule (some dental 

practices in area already offer periodic free care days; good PR for providers and for meeting 

needs of consumers; TCAD and AAADs would maintain online calendar of these events and 

work to inform public about them)

Help with cost of utilities

More education and information on health issues (White County Senior Center offers a 

monthly program “Breakfast with the Doctor” where doctor comes in to speak)

Help/tools to identify depression in seniors (one center director said it is hard to tell when a 

senior is feeling down because they usually perk up when with others)

More holistic approach to seniors' issues, like Choices MCO takes (MCO staff present 

indicated their program observes for mental health and substance abuse issues and refers 

people for help)

Better transportation system for getting consumers to Nashville for specialized medical care 

(long days, bumpy rides, uncomfortable conditions not good for sick people trying to get well)

Access to chore services (one senior center offers these to consumers – separately from 

Options Program)

Access to SHIP staff for more seniors (senior center director commented SHIP is very helpful 

to consumers)

Caregiving – NEED:

Volunteer programs like Senior Companions to provide support to consumer and caregivers 

(could serve to slow decline and forestall need for greater level of care; UCDD staff member 

said people who are sick, but not sick enough for Choices, decline when they are no longer 

being able to drive, become isolated and depressed – Senior Companions would keep this 

group able longer)

Better matching of caregivers to care recipients (Choices)

Independence and Getting Services Easily – NEED:

Transportation designated for seniors (Choices consumers take priority on vans)NOT SURE 

HOW THIS FITS WITH FREE RIDES VIA VOUCHERS, BUT SOMEONE SAID IT: Keep 

cost to ride down (currently $1/ride in Putnam County; has schedule of fees based on distance, 

e.g., to/from Nashville and other out of county locations) 

Maintain funding for HRA Transportation Voucher Program (provides no charge, door to door 

rides; consumer must call 24-48 hours in advance to reserve, but county coordinators work to 

accommodate persons who do not call to reserve within required time frame)

Getting information about services out in non-computer-based formats (most older adults do 

not use computers)

Housing, Neighborhoods and Safe Communities – NEED:

Modifications of older houses to be accessible for ambulances

Senior housing facilities unsafe (younger residents using and selling drugs, being rowdy)

Affordable residential facilities where persons with mental illnesses (depression, schizophrenia 

and others) could live and receive supervision for taking their meds as prescribed; those whose 

Tennessee – State Plan on Aging 2014 - 2018 420
illnesses would be controlled could then become reliable workers (this population is 

underserved, there will be more among Boomers)

Staying Connected and Involved in the Community – NEED:

Identify ways to motivate seniors to volunteer (senior center director stated it is very hard to

get seniors to volunteer)

Develop programs to help retirees cope with sudden loss of identity (when they are no longer

participating in the work world where most had more responsibility than they have once they 

retire - UC staff member and MCO representatives – big issue)

Develop volunteer programs geared toward Boomers and seniors (model after local hospital

where over 100 volunteers are very active, raising $50,000/year for the hospital's pet therapy 

program; volunteers are provided free meals while volunteering)

Working with Older Adults and People with Disabilities – NEED:

Help persons with mental illnesses become reliable workers by creating residential 

environments where they may live and have the help of supervision to take their medications 

as prescribed.

Other

This group was composed of a hospital social worker, three MCO representatives, an UC staff

member, three senior center directors and one consumer. 

Noteworthy comments from different members of the group were, as follows: 

A local National Guard group periodically provides medical and dental treatment at no or 

low-cost; it was suggested that TCAD could partner with the National Guard at the state

level to make this service available statewide.

An old Cookeville family of dentists (the Johns family) holds an annual event where free 

dental

services are provided. 

Bethesda Health Care sends a nurse to one senior center on a monthly basis to provide a

different health-oriented presentation each month.

Suggestion that a senior center do a pilot project where high school students help seniors make 

and tend a community garden and/or teach seniors computer skills and seniors teach the 

students a skill like knitting or canning. THIS MAY BE IN PLACE NOW, NOT SURE.

Facilitator Notes for Small Focus Group 5 

Staying Health While Aging

To expand on last bullet (Learning how to live with a serious condition like heart disease, 

cancer, arthritis) – education about their condition

Health and Wellness

Medical Resource Director and one location for all entities to contact for updating this 

directory. Also, in other areas such as respite.

Consider county site offices for AAAD

Tennessee – State Plan on Aging 2014 - 2018 421
Caregiving

Flexibility within the employment industry to allow caregivers to care for loved ones

Certification process for staff to stay with care recipients; could be available on YouTube

Independence and Getting Services Easily

The requirement of 72 hours for reservations

Training on how to use internet and other computer-based technology

Horsing, Neighborhoods, and Safe Communities

Livable communities – bring stakeholders together

Resources for home meds such as wheelchair ramps

Staying Connected

Senior centers and ADCs are not utilized enough

To build on 2nd bullet (Learning new things) – learning computer/internet skills

Employment opportunities

Intergenerational activities

Working with Older Adults and People with Disabilities

Training on utilizing public transportation

Training curriculum for staff that is held in the home with caregivers present. Each situation is 

unique and varies home to home

Other

Elder law is so valuable and needed by everyone

Facilitator Notes for Small Focus Group 6 

Staying Healthy While Aging

Exercise – seniors will not exercise for 1 hour – helping by breaking it up (senior centers)

Overton County meals coming from Jackson Co. Meals are cold and need re-heating. Should 

use local providers. Re-heating is ruining the food.

Need affordable clinics to help with dental, hearing; more money into health departments; 

maybe they can help with these services; preventative services very important – need access

Health and Wellness

Most people want to stay home, but caregivers do not have respite and they burn out – leads to 

burnout and abuse- respite funding is needed

Not a lot of people getting enrolled in group 2 TennCare; this is cheaper than group 1; why is 

this group so limited?

Need low-income assisted living based on income; we are hurting our middle class and 

making them low income

Socialization is very important

Widows are lonely, depression

Dementia patients falling through cracks; not ready for NH but can’t stay at home safely

Tennessee – State Plan on Aging 2014 - 2018 422
Like the vial of life program, but things change – how to keep seniors updating the 

information. Where is best place to keep information for easy access.

Caregiving

Respite funding

Need more $ - one day a month is not enough

Training for caregivers in the home – utilize home health

Some are forced to be caregivers

How do we know that caregivers are not hurting

Worry about retaliation to senior if report abuse

APS only get snapshots – they need more funding

Independence and Getting Services Easily

Respite

Caregiver training

Need assistance for short term help. People who are recovering from surgeries (HDM, HMK, 

PCS)

There is a waiting list need more funding

Need sitters they need training

Seniors are afraid to let people in home Getting worse every day

Transportation: not enough for non-medical trips – takes so long that peoples’ food spoils –

heard people had to wait 4 hours at the Drs. Office after her appointment

ER transportation for seniors – rural counties

More money for Options

Do needs assessment at senior centers couple of times a year – then link to services

Need assistance with yard work

Need a “pot of money” for volunteers – risk involved – they need to reimburse for some things 

(gas)

Easy access to county resources that everyone can use

Housing, Neighborhoods and Safe Communities

Trailers and low income apartments – drug use

Not enough housing for middle income seniors – would love for there to be assisted living 

facilities based on income

Lots of door-to-door crimes in the counties – need education for seniors

Need more weather alerts – Van Buren does not have any alert system for severe weather

Staying Connected and Involved in the Community

Need more transportation so they can get out – transportation has changed over the years –

seniors are getting pushed out by medical trips and younger people using

More vans with ramps, etc. What about a volunteer helping people one and off – some people 

need a little assistance on and off van, but could navigate fine in town

Wait time

Tennessee – State Plan on Aging 2014 - 2018 423
Working with Older Adults and People with Disabilities

Police, fire department, mail man, hair dresser: educate them so they can keep their eyes open 

for problems

Wellness checks by police department

Churches could also do wellness checks

Some people go for days without contact

Keep information in purse, etc. with medical, etc.

Teach about living wills

Facilitator Notes for Small Focus Group 7

Emphasis Health

How much do you have to make? To get help? Make a little, too much to qualify 

Health & Exercise

Amount you make affects the kind of help you can get

Living with serious conditions –

Taking care of husband with Alzheimer’s but I also have a serious condition

Getting divorce so spouse can get care – shouldn’t have come to that

Facing fact that help might not be available for Baby Boomers

Glasses/dentist – some can’t afford the insurance

Do without food to pay for medicine

Church has pantry – feed 200+ per week (gone up from 150) ( city)

Cancer – unhealthy things that get put in food

Food and Drug Admin. & Dept. of Ag have been bought off

Another persons says – well, we are living longer

Concerned about sugar, corn syrup, additives, etc. – known carcinogens

Cost of prescriptions monopoly on it, not going generic/issue with pharmaceutical company

Issue with doctors and pharmaceuticals/making huge profits

Doctors give too much medicine that Medicare won’t pay for

People become disabled and in home doctor never referred – perhaps doctor’s office doesn’t 

know how to refer

Need more education of doctor’s office about services

People who are newly disabled should be told of all the services that are available

Issues with substance abuse/medication abuse but they may not know they need help

Frustrating when you want to help people, but it may take months to them help (waiting list, 

estate recovery)

Thoughts of losing her little house, legacy, estate recovery

Thought of losing everything is biggest fear

Perhaps we need legal advocates for elderly

Stress and worry that you might lose your home

Churches helping caregivers – need more advertising of help/website available

DHS care workers should help people find services (like when the frail go in to recertify for 

food stamps – they should be more helpful)

Social worker’s job should be to tell people what’s available

Church staff should be observing and socials director should be referring – need training for

Tennessee – State Plan on Aging 2014 - 2018 424
church staff and volunteers

Newspaper ads/facebook with information

The State of Tennessee has no business doing this for people, we are bankrupting the gov. –

State should make sure that churches and charities that are taking in money and not helping 

people

If churches are not providing services, then they should lose their tax exemption

Churches need to do more community outreach and put sign out

Need to make better choices of how government money is spent

Prosecution of fraud

Gov. does a lot of good and there is a lot of shenanigans – we are taking notice

Balance budget

Training of caregiver – for at home caregiving

People don’t know what’s available

Need a list of services

We use SHIP, but many people have never heard of SHIP

Transportation – frustrating – 3 days in advance, what if something happens and need to go next 

day

What about U-Cart – works well if in advance

Need transportation to banks, etc.

U-Cart seems to work

State should make a list of the needs in the community & contact churches and let churches step 

and provide the service (like chores, etc.)

Perception is that neighborhoods are fairly safe

Some bootlegging in public housing

U-Cart will take you to grocery store

Courses to audit in community colleges – computer literate – senior centers

Need programs to get “life alerts” – some people need this, but doesn’t have a land line

No transportation from outside city to congregate meal site

Congregate meals seem to be OK

Good word to postal service – fell at mailbox – letter carrier got him up

U-Cart has someone to ride with you if you need help

Background checks/certification need to be made for all who work with elderly & disabled

Need professional training

Need to be well-monitored (like child day care centers)

Need to be careful of abuse of elderly and disabled – it’s rampant

Choices – family members get paid – ripping off patient – State doesn’t govern this enough

Need to drop in on family in nursing homes because staff is not taking good care

Nursing homes are understaffed

Senior Expos – need to get people there – get churches to help

Tennessee – State Plan on Aging 2014 - 2018 425
Needs Assessment 

Greater Nashville Agency on Aging and Disability 

Ajax Turner Senior Center, Clarksville 

February 26, 2013 

Number of Attendees: 74 

Tennessee – State Plan on Aging 2014 - 2018 426
Greater Nashville Area Agency on Aging and Disability 

Ajax Turner Senior Center, Clarksville, TN 

February 26, 2013 

What are the hard things that “baby boomers” face? How should the state of TN help?

(Number of Questionnaires containing 1 or more responses – 41) 

This open-ended questionnaire was designed to elicit qualitative data from the attendees about 

how they thought aging would impact baby boomers. However, many attendees also identified 

issues that currently exist. Attendees were able to respond to the questions in any manner that 

included short, one-word answers, such as transportation, to very involved responses. In order to 

provide some order to the responses, major topic areas have been identified. In addition, some 

topics might include sub-topics for the purpose of reading the report more easily. Repetitive 

responses are included only once. 

1. Easier Access to Services Without Hassle (including information and assistance; 

communication; and technology) 

Understanding modern technology – e.g. Email, etc. 

Low income and public assistance info available in terms one can understand 

How to get emergency assistance if necessary (especial those living alone) 

Better information on what programs are out there for seniors 

Caring for grandchildren – understanding school system and technology 

Asking for help rather than going it alone or guessing what to do 

The ability to get services right away, instead of always going to the hospital first 

Be able to help when needed 

Do they understand resources available whether disability or retirement 

2. Healthcare (including in-home services; Home and Community Based Services; long 

term care; chronic disease; Alzheimer’s disease and related dementia)

Support groups/senior education 

Interpreters for non-English speakers 

Doctor – general 

Afford medical care 

Better help with drugs and doctors 

Help for the low income

Health workshops and support groups in evening or weekends 

Medicine help

Continue to have available resources that are in close areas 

Health care after retirement, education, nutrition 

Fall prevention

Housing upkeep – house keeping – clean-up 

Middle class people need to be eligible for some type on in-home care

Alzheimer’s

Drug and alcohol abuse 

Have to get off of drugs and alcohol 

Tennessee – State Plan on Aging 2014 - 2018 427
3. Fiscal Concerns (including health insurance; Medicare/Medicaid; employment; 

retirement; social security; cost of living) 

Rising gas and food prices 

Increased cost of prescription drugs 

Still working but need help illnesses and insurance 

Health care and insurance 

Medicare insurance –promote TN SHIP 

Long-term care insurance/facilities 

Doctor and hospitals not taking certain insurance 

Insurance not covering hearing aids completely or as needed 

Insurance covering in home care as needed 

Cuts in Medicare

Lack of assets/savings

Understanding disability and Medicare

Help with city and county taxes

Employment with accommodation 

Better wages

Competitive edge in workplace

More and better jobs 

Raising limits for Social Security

Working longer ? retirement – health care after retirement 

Do they have enough to retire on? 

Thinking about retirement (have more TN and radio ads) 

Work longer because the retirement age has been raised 

Adequate finances past work retirement – help with more advise, continued 

 promotion of savings plans and public education on “what I can do now”

4. Support Services (including transportation, meals/nutrition; elder abuse services; senior 

centers)

a. Transportation 

Access to safe, reliable transportation 

Provide transportation and make this info known 

Right to drive 

Mobility issues (bus, stores, homes, etc.) 

b. Meals/Nutrition 

Access to adequate and appropriate food 

Meal services - food assistance 

Food – store having carts 

Improve on the type of meals that are served to seniors at the centers 

Some seniors cannot cook for themselves – some go without on weekends 

because centers are closed. One good meal, per day at affordable prices – buy 

Tennessee – State Plan on Aging 2014 - 2018 428
meal tickets like the school kids do.

c. Elder Abuse 

Avoiding misdirection by commercial vendors (i.e. Reverse Mortgage) and 

scammers – help – continued public education

d. Senior Center 

By funding these interested in 50+ senior center 

The Senior” Centers are just now providing programs for the Baby Boomers

Some are still working – center hours are not helpful 

More weekend programs or evening programs 

Extended centers for seniors 

Place to socialize on evening and weekends/more hours at Senior 

Center/utilize volunteers for opening on weekends 

Better facilities for the senior centers 

Senior Centers in Tennessee are not able to meet the needs of Baby Boomers 

as they currently are operating. Baby Boomers demand or expect more than 

playing Bingo, cards, etc. Senior Centers need more money from the State of 

Tennessee to expand their space, programs, and fill needs of Baby Boomers. 

More needs to be done to get “seniors” who think they are young maybe too 

young to be seniors. They are old and I’m not old. Recommend we put the 

word community in the name of all Tennessee Senior Centers. The Ajax 

senior center does a great job for seniors but are about to run out of money. 

The State should look at the way senior centers are funded. Some States use a 

different method of funding. We seem to be caught up in the sixties (60’s)

– wake up before we have to close doors – 400 Baby Boomers every minute –

Wow! 1946-1964 the We Generation – Right. 

5. Staying Healthy While Aging (including exercise, eating healthy foods, socialization, 

chronic disease, staying connected and involved in the community, volunteer) 

Have places to go

Getting up when being seated 

Promote things they are interested in, such as diet, exercise, and staying healthy. 

Playing their type of music at the dances 

6. Adults with Disabilities Ramps in public places 

Dealing with disabilities and reduction in income 

Wheelchair accessibility in housing – lower sinks in homes, etc. 

7. Caregiving 

Taking care of parents and grandchildren 

Raising family – help more if they help themselves 

8. Housing, Neighborhoods, and Safe Communities (including home repairs and utilities) 

Affordable housing

Tennessee – State Plan on Aging 2014 - 2018 429
Housing for their abilities

There is no low rent housing except in slum area 

2/3’s of the people at age 65 only have Social Security to live on which is fine if they 

can find cheap rent 

More police protection

Stay home as long as possible

9. Funding/Resources 

Fundraisers 

Funding for all of these: reduction in health care – price increases in all areas –

funding for all college schooling from childhood 

More resources for rural counties 

10. Other: 

No fireworks in city

Want term limits for politicians 

Clothes 

Myrtle Colman 

Info for VA benefits, arthritis, cancer, and heart attack

Tennessee – State Plan on Aging 2014 - 2018 430
Greater Nashville Area Agency on Aging and Disability 

Ajax Turner Senior Center, Clarksville, TN 

February 26, 2013 

Question: Here are seven (7) aging and disability issues. 

 Under each, there is a list. 

Mark the ones on the list that you think are most important. 

Number of Questionnaires completed: 47 

Response # of 

responses

%

1. Not having enough insurance or money to pay for doctors or medicine 40 85.1

2. Affordable dental care, hearing care and eye exams and glasses 37 78.7

3. Keeping healthy through exercise and eating healthy foods

4. Being able to get accessible transportation

35 74.5

5. Transportation for people who don’t drive cars 33 70.2

6. Housing that people on a pension or Social Security can pay for 32 68.1

7. Learning how to live with a serious condition like heart disease, cancer,

 arthritis

31 65.9

8. Houses that are easy to get around in if you’re on a walker or in a 

 wheelchair

30 63.8

9. Respite services 29 61.7

10. Making decisions about health insurance, Medicare, and planning for 

 the future without depending upon the government

11. Learning about how to take care of yourself so that you don’t get sick 

 and tired

12. Being able to get help when needed quickly and without hassle

28 59.6

13. Help with memory loss

14. Protect people from abuse

15. Meeting people and making new friends

27 57.4

16. Getting care at home instead of in a nursing home

17. Teaching police, Firemen, emergency workers to know the special 

 needs of older adults and people with disabilities

26 55.3

18. Being able to choose the workers who come into your home

19. Teaching doctors, nurses, and other healthcare workers to know the 

 special needs of older adults and people with disabilities

25 53.2

20. Learning how to prevent falls

21. Meals that are healthy and prevent hunger

23 48.9

22. Reasons people have to go into nursing homes

23. Training for aid workers who help older adults and people with

 disabilities

22 46.8

24. Neighborhoods that have grocery stores close by

25. Learning new things

21 44.7

Tennessee – State Plan on Aging 2014 - 2018 431
26. Learning about how to care for someone at home

27. Teaching volunteers to work with older adults and people with 

 disabilities

20 42.3

28. Neighborhoods that are easy and safe to walk in

29. Places to volunteer

18 38.3

30. Reasons people have to go back to the hospital

31. Knowing where to call for help and getting help without a big runaround

32. Understanding how Medicare works

17 36.2

33. Help with feeling sad or lonely

34. Help with chores like lawn mowing and leaf raking

16 34.0

35. Help with taking too much medicine

36. Eating out with friends

14 29.8

37. Being able to get accurate information from a website and being able 

 to apply for services on-line

13 27.7

38. Help with drinking too much alcohol or taking drugs 12 25.5

Other: 

Not have enough insurance or money to pay for dentists. Dental car is an important issue. Everyone 

seems concerned about health in seniors and healthy eating. Having affordable dental care is a huge 

issue. If a person cannot consume healthy foods because they do not have the teeth to chew; this is the 

first step to unhealthy eating which is the next step to failing health.

If there is a special list for geriatrics, I have not seen it. There is a very big difference in regular M.D.’s and 

General M.D.’s

Grocery stores close by that provide highest quality of food.

Clarksville is void of sidewalks – put unemployed to work putting in sidewalks in neighborhoods. Paid for 

by city and county tax funds

Most take care of dental care, hearing care and eye exams and glasses themselves

Learn to prevent fall – just got to be careful

Most don’t have enough $ to pay for doctors or medicine – insurance is high

Hate the thought of going to a nursing home

In some cases don’t know where to call for help

Most who are on Medicare understand it

Too many dependent on the government – too expensive

Don’t know if people need help with taking too much medicine – I take it if prescribed

Protect from abuse in nursing homes

Respite services, especially for those who don’t have enough $

Accessible transportation is a problem for people who can’t see

Help with chores – generally have to pay for it yourself

Would love to volunteer, but that’s hard when blind

Not enough places to meet real friends

Tennessee – State Plan on Aging 2014 - 2018 432
Most important are learning how to live with a serious condition, not having enough insurance or money, 

and being able to get help when needed

Respecting seniors and utilizing their skills

Sidewalks in TN

We try to fulfill all of the above through our senior center here in Clarksville. I have read the newsletters 

from the surround counties and they do not offer as many of the above programs.

Knowing where to get the information to get help when needed

Accessible and affordable transportation

Finding housing for those with disabilities and live on SSA alone

Programs which help disabled and seniors find employment with accommodations

Affordable low cost housing for seniors

Housing that people on a pension or Social Security can pay for that are safe

Tennessee – State Plan on Aging 2014 - 2018 433
Greater Nashville Area Agency on Aging and Disability 

Ajax Turner Senior Center 

February 26, 2012 

Question: What is currently working well in your community? 

(like agencies that help, neighbors who help each other, van service, senior center, 

meal sites, food pantry, healthcare clinic, nursing home, sidewalks, police 

presence, grocery stores that deliver) 

(Number of Questionnaires containing 1 or more responses - 34) 

This open-ended questionnaire was designed to allow attendees to identify the community 

programs and services that have worked for them and in their community. Evidence based 

and/or proven practices were not a consideration in the design of the questionnaire and no 

checklist was provided. The above items in parentheses were provided as examples. Attendees 

were asked to write in the programs and services that were working well in their community. 

The responses are individual and specific to the region served by the Area Agency on Aging and 

Disability. The number of attendees who indicated that the program is working well in the 

community is provided in parentheses (). 

Agencies that help (1)

Neighbors who help each other (2)

Van services (7)

Senior center (15)

With more money from gov.

Things to do – like trips – I’m stuck – this is the only place I go

Need more funding

Ajax Center is great

Ajax Center

Meal sites (6)

Food pantry (2)

Healthcare clinic (5)

Nursing home (3)

Signature HC Erin

Sidewalks (2)

There are no sidewalks in the subdivision I live in. It would be great to 

have them.

Police presence (5)

Grocery stores that deliver (2)

Meals on wheels (4)

Not sure at this point – new to the situation

Manna Cafe

Council on Aging

Greater Nashville Regional Council (GNRC)

United way

The people, neighbors in the community

Tennessee – State Plan on Aging 2014 - 2018 434
Good emergency response system

Good lighting in public areas

Loaves and Fishes (2)

There is a clinic the Baptist Church on Madison Street that provides dental care 

and has a Dr. 3 days a week

Room at the Inn that the churches sponsor during cold weather (a place to eat, 

socialize, take a bath and spend the night for the homeless)

Transportation:

Transportation for elders

Bus route

Need of van service outside city limits

No transportation

There is increased awareness of places offering assistance to seniors.

Need more senior housing at affordable prices

Second Harvest

Everybody working with the senior citizens

Working for the seniors

Hand in hand together

Still being able to work, drive self, having close knit family members, all of the 

above

The Mayor’s city and county

I do believe we have a good working establishment of the above agencies. I

feel there is a serious downfall in the publication. The agencies work well for 

the people who know them. As, “The Montgomery Sr. Center – the best kept 

secret in Clarksville.” We are improving. Now open on Sat. and Fri. night for 

other than dancing. Knitting, crochet, ceramics, etc.

People being able to get services in their home, but need more than 2 hours a 

day sometimes.

Tennessee – State Plan on Aging 2014 - 2018 435
Greater Nashville Agency on Aging and Disability 

Ajax Turner Senior Center, Clarksville 

February 26, 2013 

Small Focus Group Responses 

Tennessee – State Plan on Aging 2014 - 2018 436
Greater Nashville Area Agency on Aging and Disability 

Ajax Turner Senior Center, Clarksville 

February 26, 2013 

Facilitator Notes for Small Focus Group 1 

There is a lack of resources in rural counties (Houston and Stewart). Seniors have to come 

into Clarksville for services and sometimes transportation is an issue. 

What does a person going into retirement or past 65 do next? There should be an avenue or 

county seat or somewhere where someone can go talk with someone face to face about what 

do they do next. They should be able to explain about what steps does a senior citizen need to 

take to get the help they need. A suggestion would be to develop a packet for retirees and 

persons over the age of 65 that would include this information as well as information about 

affordable health insurance.

Health Insurance – People have no idea of what is available and they are overpaying for things 

they don’t need. 

Education to seniors on how to live comfortably with the income they have. Education from 

utility companies about what they provide to senior citizens in the way of help especially for 

those with limited income.

Transportation is sad. Needs to be more accessible. You have to call and get on their schedule

and it doesn’t always work with the appointments you have. They limit where you can go. 

The wait time after you appointment is done is too long, it takes the transportation people too 

long to come back and pick you up.

Nutrition, the quality of the food is not good. They want to know who evaluates the food. 

Sometimes the food taste like sandpaper and the meat is unrecognizable. 

It is hard to find transportation when needed. She would like to come to the senior center but 

has asked and they always say they don’t provide transportation from her retirement 

community to the senior center. She want to be involved in the activities and being around 

other people but unless she can drive which her children don’t want her too or she can get her 

children to bring her and they have to work she is not able to get to the center.

She mentioned that she works at a senior center and they have transportation that is designated 

for the seniors who are members of the center but the transportation is often taken away for 

other uses. She is at the Senior Center at Ashland City. She says seniors are often turned 

away for rides or has to be picked up by 12:30 which doesn’t allow them to enjoy the day. 

Transportation is a big issue.

The quality of food at congregate meal sites is bad. The meals are not well balanced. 

Sometimes the meals have all this starch and no green foods. The food is overcooked to the 

point you can’t tell what it is and loses its nutritional value. 

There is not enough senior housing for low income seniors.

Baby Boomers – What happens to people who are not a retirement age but they have lost their 

jobs? There are people who have lost their jobs at 50 years old and they are unable to get 

employment but don’t have the money to not work. Workforce protection is needed. 

Eligibility for meals on wheels. Some seniors have too much money to get a meal through 

meals on wheels but can’t afford to pay for them.

The frozen meals are sent to seniors who live in rural counties but when they get the frozen 

meal they are still going hungry because of health reasons they are not able to physically get 

up and prepare the frozen meal.

Tennessee – State Plan on Aging 2014 - 2018 437
More places are needed for seniors especially boomers who have addiction issues. There is 

not anywhere for them to go for help.

Transportation is sometimes available to go to the doctors at a cost but not able to financially 

pay to get to the transportation to take to them to the doctors and not on Medicaid for them to 

pay the cost. 

Advocacy for seniors in nursing facilities is needed. Seniors are not aware of the ombudsman. 

State Internal Advocate for seniors without any political boundaries and not appointed by 

governor or legislatures. 

Something should be done about when places such as doctors’ offices give seniors packets of 

papers to fill out and people need assistance. Also too many things have to be done online and 

seniors don’t have access to internet.

Rights/Access – No matter what income you have when you are sick you should be able to get

help.

More doctors and specialist in rural counties.

Facilitator Notes for Small Focus Group 2 

Training for police officers in dealing with seniors or adults on meds or disabilities

More senior housing

Can’t eat the food they serve here

They are smarter

Going to need more services – Baby boomers caught between generations needing help - now 

they are aging to need more services

Most siblings don’t share genetics – a lot of difference in health of people

Medical – complicated – too many doctors – do they talk to each other – learn how to talk to 

doctors

Lack of training for Baby Boomers

Insurance companies – hard to understand

Meds – you have to get meds through your insurance – drug plans hard to understand

Solicitation from insurance – scammers

Don’t answer phone calls

Live independently – some need to know about Veterans benefits

Programs – are there programs out there for people

There is a screening for Option program

Transportation – Mid-Cumberland HRA. $4 a day for dialysis curb to curb not door to door 

He is in a wheelchair – needs assistance

You can’t call – the week – 2 weeks in advance

Scooter limited to Walmart and Kroger

Does the Senior Center give out this information

Affordable – lifts. Tennessee Mobility finding private funding sources

Gaps between funding sources and agencies

YMCA – does some transportation

Need has to be demonstrated – of mobility

Disabilities and obesity are increasing - Disabled baby boomers

People losing mobility between the ages 40-60

Tennessee – State Plan on Aging 2014 - 2018 438
How can we solve the problem – immediately – Kroger needs to be made available

Need – home modifications and repairs

Insurance – Part B – need more and fresher information on premiums

Employment is a need for healthy people - need jobs to supplement their income

Jobs not there – age

There is a lot of wasted money government

Facilitator Notes for Small Focus Group 3 

Bill at the table ID 3 different senior center participants that took wrong meds in the last 2 

weeks from their senior center that have been hospitalized

Senior Center takes eyeglasses from members who have passed and recycle them for current 

members because eye exams and glasses are too expensive. I gave them name of Lion’s Club 

contact as potential partner.

3 expressed worry about workers coming into their homes – wanted choice

Safety issues – yes, both Jerry and Bill expressed decrease in their neighborhoods; 

Worked: increased lighting, better sidewalks, closer grocery stores that are accessible

*Connectedness – “That’s why we all come here” – Bill and all nodded heads – last 4 years 

without wife – huge issue here

Began expressing their worries about worries that Center will close . . . I turned it around to 

“help think of some new ides to fund raise” – Zumba bands, cooking classes, dances

Facilitator Notes for Small Focus Group 4 

Reasons for not going into a nursing home – depressing and don’t like going there

Reasons people go back to the hospitals – concerned won’t have help

Not having enough insurance – not for people @ my table

Knowing where to call – don’t know, need help

Understanding Medicare – confusing – need help

Making decisions about health insurance, etc. – not sure who to trust – afraid someone will

hurt us

Help with memory loss – big problem

Abuse – not a problem for my group, but could be

Respite services – definitely for some activities

Need help learning about how to care for someone at home

Big need learning about how to take care of yourself

Big problem being able to get help quickly and without hassle

Don’t use computer

Didn’t know you could choose workers

Accessible transportation very limited – takes too much getting it when needed

Not sure that housing on a pension or Social Security is available

Too many neighborhoods are not easy and safe – small or some big

Don’t have grocery stores close to senior citizens 

Houses that easy to get around in – It’s very hard. Don’t know where to go. It is a problem.

Places to volunteer – don’t know of any

Don’t know where to go to learn new thing

Meeting people – just started @ senior center and go to church

Tennessee – State Plan on Aging 2014 - 2018 439
Eating out with friends – can’t afford to – don’t know where to go

Training for paid workers – needed but not knowing its accessibility

Teaching policeman, firemen, etc. – needed but not a priority

Teaching doctors, nurses, etc. – don’t know how to fix or what to do

Teaching volunteers – very needed

VA benefits help. Benches @ business to sit on waiting for bus. Worried about falling in tub, 

etc. Accessibility to info (brochures) about heart attack, stroke, and arthritis. Affordable 

housing. Sidewalk problems.

Facilitator Notes for Small Focus Group 5 

For the first part of the discussion, a senior center employee reviewed all of the programs that 

the senior center offered that are good

Matter of Balance and nutrition – it would help to follow up once a month

Tai chi is starting. This will be a full class

Tuesday line dance is exercise

Water Aerobics is on base. Have transportation to it. If want, van can do it and take it on 

post (they can go to water aerobics in the van)

Fall prevention – Master your body exercise with sister. Fell after class and credits class 

for survival. Broke back and knew how to get up. There is a waiting list for this class.

Have discount lunch based on income. 61 people on the discounted lunch list where they pay 

$1-$3. Full price is $4 that anyone can buy.

One person at the table has $140/month income. Said if did not have children would be under 

a bridge.

Ladies have a problem with income. The average of the senior center is 78 and going up to 80. 

That age women did not work. Also a lot of farmers and they don’t have income.

Won’t find men asking for help because men won’t tell that they are down and out. One man 

comes and gets bread.

Address food issues with Food Bingo. Prized include peanut butter, popcorn, coffee, cereal, 

green beans. 15-20 play each day.

Congestive heart failure support group

Living with chronic disease support group

Support group for the blind

Alzheimer’s

They have the only adult day care. Have 19 on the list. Five that come every day from 7-6. It 

is income based, but they have to be continent. The program is maxed out but there is a bigger 

need for either here or a nursing home.

Exercise classes

The reason people go to the nursing home is falls. Once go to a nursing home never see them 

after. Lack of services in home. Nursing home. Caregiving a hardship on one person. 

Couldn’t take husband to the car. Took all three to help.

She’d got down on the floor and couldn’t get her up. Got down where they couldn’t get her.

Put John in the nursing home and could not pick her up. Need an on call organization to pick 

up people. Pick up the phone (ambulance) would charge $600. Sheriff and fire department 

call. Some simple thing. People in the neighborhood are all in the same age group or working.

Mature medical. No insurance on dental for 55-65

Tennessee – State Plan on Aging 2014 - 2018 440
Need affordable dental care. Depend on people to take care of self and spend money on other 

things. Son gave $400. Priority in need.

Hearing care. People need hearing aids. Cannot afford them. Send people to the Lions 

donation to see if there are any glasses that work.

Mostly homeless. Four or five come in every day. Class on Alzheimer’s. Most staff alert 

regarding dementia.

Participants transition to adult day care.

So many in age group do not have computer. Do not want to. Most government sites have 

more problems or government sites are confusing even with technical skills. People are 

impatient. Arrogant. All of them top list Social Security. For more paper and more paper. 

Then how dare you ask a question 

Medicaid waiver. Got to sign property

Accessible transportation:

Montgomery County has the Lift. Call the Lift 24 hours in advance. Only within city 

limits. Outside call 72 hours and lucky if them come. Some one couldn’t get 

transportation because of service animal.

72 hours – not reliable – Selective about who can pick. Couldn’t find place. Depends

Some drivers hateful to consumers. Have had people sit and wait. Can’t handle – things 

no accessible transportation outside of city limits

Two vans not active. Have to buy gas. Cannot buy gas

Cannot afford gas. If city would furnish gas, could serve more.

Senior housing: 

Do not have enough

Apartment complex

Reserved one building. Assisted living. Have cooking facility to have to buzz door. Had 

to sign in and out.

More secured senior living facilities. Independent and assisted living. South Central 

village. Fieldstone – have to be a millionaire to live there

153,000 military and dependents – lost of military – VA hospital – Veteran home – half senior 

community is retired military

BB retirees attracted here. Loosen rules to make money – Casino night – want to break 

50/50

People struggle to make most subsidize housing. Lincoln homes made

Summit Heights based on income. People have to lock equipment

Dental and medicine. No one can eat good food if do not have good teeth. Medicare needs 

Part Something for dental

Facilitator Notes for Small Focus Group 6 

Opening Comments for attendees

TCAD – no one had heard of TCAD

Is there anyone who knows how to teach police to treat seniors?

Linda – survivor of traumatic brain injury – uneven gate – policemen with years of service are 

nice – new ones not so much (may think the person is an alcoholic)

Need more senior housing in Clarksville

Tennessee – State Plan on Aging 2014 - 2018 441
Issues

Teach policemen – train them to treat seniors correctly

Do not take medicine properly - Linda talking about her experiences

Mary Ann – hospital setting – people react quickly – deaf in left ear - Young people think 

every one is like themselves, the don’t understand – might take lessons

Staying Health While Aging

*Learn how to prevention falls – balance class – helps people who have had strokes, etc. 

Footwear, hand rails, objects in the way

Medicine

Respite care - Linda’s husband works 4:30 p.m. – 1:00 a.m. Her husband prepares her

medicine

*Affordable dental care is a problem.

Hearing aids – insurance will not pay for it – receive hearing aid through United Way (half the 

price

Health and Wellness

Not having enough insurance or money to pay for doctors or medicine

Laverdia talked about addition (over medicate, alcohol, smoke) – one person said she stopped 

drinking

Need homemaking services (clean house) 

Laverdia asked about abuse (no one admitted to being abused)

Feeling sad or lonely – depression – no one admitted to being depressed, sad or lonely (not a 

problem

*communication for seniors – everyone needs a buddy system in case they get sick, fall or 

need help – last to know if the person is OK – if single, person may need more help

Life alert/medical alert

*Boomers don’t stop.

Caregiving (taking care of love one at home)

*Respite services are needed. 

Caregiving is such that people cannot retire. Seniors keep working in order to pay for 

caregiving services. People want to go in TennCare because they don’t want to lose their 

home

*Employers need family care as a benefit. Sandwich generation (children taking care of their 

parents, children, and grandchildren

Independence and Getting Services Easily

Choose your own caregiver

*Transportation 

The need to be independent

Question – how does the State handle a situation when a senior person does not need to be 

driving. Car Fit

Tennessee – State Plan on Aging 2014 - 2018 442
Housing, Neighborhoods and Safe Communities

Safe neighborhoods, housing

Wheelchair – accessible

*Older houses are not wheelchair accessible

Staying Connected and Involved in the Community

50 Forward senior centers

recommended a membership at the YMCA (Laverdia)

Working with Older Adults and People with Disabilities

*They would be willing to help older adults and people with disability

Facilitator Notes for Small Focus Group 7 

Staying Healthy While Aging – NEED:

Transportation to support staying in society and maintaining well-being (this was of great 

concern to this group; one 81 year old lady said she is not supposed to drive at night, but says a 

prayer first, then drives on Friday nights in order to go to the center’s dance – said won’t miss 

one) 

Restore the $5 evening meal that was stopped for the Friday night dances due to funding cuts 

(group said some seniors have stated they depended on that meal and that dance night 

participation has dropped since the meal is no longer available)

Better engage the over 3,000 members of the Ajax Turner Center to raise more funds

Affordable dental, vision and hearing care (some thought Medicare would cover, did not 

realize it would not)

Create programs to help persons whose incomes and savings are above eligibility for getting 

help so that more people can participate (suggested sliding fee scale based on income) 

Offer more accessible opportunities for socialization 

More donations of food to center (said no food pantry at center, but churches, Loaves & 

Fishes, Manna do provide food to those in need; also, that Ft. Campbell, Walmart, Publix and 

Kroger’s donates bread and some other food items to the center daily for the lunch meal –

everyone in group said the food was good and they appreciated it)

Reviews/repetition of Matter of Balance training they received several years ago (one lady 

shared technique she had learned in that training, says she tells everyone she meets who is 

older – when arising from a sitting position, move slowly and stand in place for 4 – 5 seconds 

before trying to walk)

Health and Wellness – NEED:

More income to pay co-pays for medicines, doctor visits and tests

Nursing home care without spouse losing “everything,” including the house 

Information on what’s available to help (didn’t know about services, programs, etc.)

Visitors or companions to check on persons who live alone or who spend days by themselves

Meds that are easy to tell apart (many same approximate size, shape and color; confusing)

Independence (if lose this, get depressed, downward spiral)

Education about free “Wellness Checks” performed by Clarksville’s 911 Service for older 

Tennessee – State Plan on Aging 2014 - 2018 443
adults who may be questioning whether or not to go to the ER for an issue or feel they need 

something like their blood pressure checked (several consumers in the group said they use the 

service whenever they need it)

Communities to develop programs for people to take care of one another in times of need 

(mentioned training)

Caregiving – NEED:

Money to pay for home modifications to make caring for someone at home more manageable

More respite care (one man repeated several times how much the two hours/day of respite he 

received when his wife was terminally ill meant to him; knowing that she was well-cared for 

while he was out gave him great relief)

More volunteers, as in neighbors and friends, to help family member provide care to loved one 

at home (several said they had provided long-term volunteer help to neighbors and good 

friends who were working hard to keep someone at home; one woman said she cared for both 

of her neighbors until their deaths and now there is no one left to help her should she need 

help)

Independence and Getting Services Easily – NEED:

Transportation to doctor and other health care appointments, to shop and just to get out (said 

important to have contact with other humans)

Assisted transportation so frail individuals and those with disabilities are able to go out

Programs to help prevent depression (social groups, activities, healthy diet)

Sheltered areas at all bus stops (weather – rain, wind, snow, ice, heat – real threats for older 

adults and people with disabilities)

More bus stops in neighborhoods comprised mostly of older persons

Better coordination between doctors’ offices and transportation providers (cited incidents 

where transportation is late, so consumer is late for doctor appointments and when consumer 

arrives s/he is told it’s too late and will have to make another appointment)

Housing, Neighborhoods and Safe Communities – NEED:

More sidewalks in neighborhoods (one lady said the City of Clarksville promised her 

sidewalks when she built her house in 1965 and there are none yet)

Sidewalks in, especially, areas surrounding stores like WalMart where people in wheelchairs 

could go safely to shop for food and other items (cited woman in motorized wheelchair they 

see going down the side of a busy highway – if there was a sidewalk, she could make the trip 

in relative safety)

Bus stops covered to protect the elderly and adults with disabilities from the weather, 

especially extreme heat and cold, wind, rain, snow (group mentioned risk of dehydration, 

hypothermia for older adults)

More senior-friendly police presence (most said feel “fairly safe,” but some talked about 

incidents where police were not as helpful as they might have been)

Affordable/subsidized senior housing (said have only two assisted living facilities in town –

one based on income – one couple and a single woman said they would move to a facility if 

cost wasn’t so high)

Tennessee – State Plan on Aging 2014 - 2018 444
Staying Connected and Involved in the Community – NEED:

More funding for senior center (to avoid participants feeling shortchanged when there are 

budget cuts and to attract more participants)

Charge a fee to those who are able to pay to attend senior center (help with costs, maybe add 

new programs)

Program to support and acknowledge neighbors, friends and relatives as they work to help 

elderly persons and adults with disabilities (to increase commitment to the “work”)

Working with Older Adults and People with Disabilities – NEED:

There were no comments on this topic.

Other

This group was comprised of six older adult consumers, all of whom are active at the senior 

center (all Clarksville residents) and two TCAD staff members. Group members seemed wellbonded with one another and protective about others who did not have the ability or resources 

they had and how those persons manage their day to day lives. None of the group’s members 

had a physical disability.

Facilitator Notes for Small Focus Group 8 

Need to teach people how to eat (fruits and veg) – it’s gotten sky high – can’t afford to eat 

healthy

Move – do something – even if it’s not exercise - boredom = inactivity

Sometimes you have to drive to get somewhere to exercise – transportation has a lot to do with 

it – cost has a lot to do with it

Discount to ride the bus – this is good- $30 for 30 rides, but what if you don’t have $30

Lift rides aren’t available on Sundays – Rides aren’t available at the time you need it 

(example: 1 and 1/2 hours early to get to church on Friday night and then they come back 

before program is over)

Living in city is better than in county when it comes to getting transportation

Depend on friends for rides

Chronic conditions – classes; but it’s up to the person to change (buddy system is also good)

Medicare booklet very complicated to understand – can also go on-line, but hard to understand

Low income – AFDC – act like it’s their money – sometime make $20 too much

Don’t take into consideration all you have to pay out of Social Security

The way benefits are calculated seems wrong – worker said “You don’t look like you need it.” 

(talking about TennCare) (even before I touched a paper)

About food stamps “Prove it” . . . . . in terms of who is on it

Some people sell food stamps – need to drug test all who are on it (example: got a phone call 

from someone selling food stamps - $50 for $100 worth)

People who put Medicare together don’t understand how it works!

Confusing about Health Springs and still have to pay for some things

How do you help someone from losing their memory? “I don’t have Alzheimer’s, I have halfheimer’s”

Affordable Housing – only have one in Clarksville – run by 7th Day Adventist – we need more 

senior housing – need for medium income people- need independent living housing

Tennessee – State Plan on Aging 2014 - 2018 445
Friends and neighbors help with respite for caregivers

Family members need to learn how to take care of loved ones

Important to get out of each other’s hair

People don’t help handicapped – like sidewalks for wheelchairs

Affordable dental – available at church, but it’s at night – need more affordable dental care

Where do you go for help? – phone book, internet, ads, friends

(need to ask staff, not volunteer on phone

Need to set people up to volunteer

Work 20 hours and get minimum wage – good program

Chores – depend on family – need volunteers to help – perhaps could pay organization a little 

and volunteer could do it – would help people stay independent

Clarksville is void of sidewalks – unsafe - no one walks – no one knows neighbors

(It’s OK in particular neighborhoods)

Need to make neighborhoods safer (drugs . . .) not safe to walk – never see kids outside

because of it 9 near homeless shelter – and they ask people for cigarettes, etc.

With all the money going overseas, keep it at home and help us

Making information that seniors should have easy to understand

Tennessee – State Plan on Aging 2014 - 2018 446
Needs Assessment 

South Central Area Agency on Aging and Disability 

Henry Horton State Park, Chapel Hill 

February 19, 2013 

Number of Attendees: 32 

Tennessee – State Plan on Aging 2014 - 2018 447
South Central AAAD 

Henry Horton State Park, Chapel Hill, TN 

February 19, 2013 

What are the hard things that “baby boomers” face? How should the state of TN help?

(Number of Questionnaires containing 1 or more responses - 22) 

This open-ended questionnaire was designed to elicit qualitative data from the attendees about 

how they thought aging would impact baby boomers. However, many attendees also identified 

issues that currently exist. Attendees were able to respond to the questions in any manner that 

included short, one-word answers, such as transportation, to very involved responses. In order to 

provide some order to the responses, major topic areas have been identified. In addition, some 

topics might include sub-topics for the purpose of reading the report more easily. Repetitive 

responses are included only once. 

1. Easier Access to Services Without Hassle (including information and assistance; 

communication; and technology) 

Place to get information and assistance 

Factual information on issues such as Medicare, nursing homes, assisted living, 

Social Security 

Awareness of help available 

Awareness of help with insurance 

Awareness of help available – educate about assistance for help available 

2. Healthcare (including in-home services; Home and Community Based Services; long 

term care; chronic disease; Alzheimer’s disease and related dementia)

Affordable adult day care programs are needed 

Healthcare – in facilities and at home – what is out there for them? 

Less waiting list like options

Cost of healthcare

Not enough money to purchase medication 

Health problems and aging

Preventing falls

Health benefits 

Programs – offer light housekeeping for the people who don’t funding for Choices or 

Options

Medical issues – hearing, vision, dental (not covered by Medicare) – is there any way 

to help with these items? 

Healthcare – affordable care that covers dental, optical, and hearing for those unable 

to afford 

Lonely – miss friends/family 

Stress

3. Fiscal Concerns (including health insurance; Medicare/Medicaid; employment; 

retirement; social security; cost of living) 

Tennessee – State Plan on Aging 2014 - 2018 448
Saving of money instead of spending 

Fewer resources for middle income families 

Lack of funds/wellness 

Rise in overall living expenses on fixed incomes 

Gas prices on a fixed income 

Baby Boomers – fresh start on credit history 

Health insurance cost and availability – more competition in State market 

Fraud and financial abuse 

Health insurance – for those unable to pay – something like TennCare 

Rising medical costs, insurance premiums 

Medicare deductibles

No insurance or can’t afford it

Workforce – more jobs

Employment/security and availability 

Training 

Part time jobs – occupy time 

Many will need to work past retirement age to be able to maintain an acceptable 

lifestyle or to keep insurance. 

They need continued supports to help them stay active in the workforce in the way of 

training or accommodations as they age. 

Social Security cuts 

Social Security – will the age for retirement change from 62 to 65 

Rising cost of living – with threat of the limited resource of Medicare being taken 

away 

Cost of living out weighs the average retirement costs 

Enough money to retire 

Retirement benefits – being able to work for a company long enough to get retirement 

4. Support Services (including transportation, meals/nutrition; elder abuse services; senior 

centers)

a. Transportation 

Transportation issues – can’t see or hear! You need dependable transportation 

systems that work 

Availability of transportation services if there is a change – make it affordable 

Transportation – assist with planning to provide transportation for those they 

need transportation to get to important appts. That affect their healthcare 

Offer rides to Dr’s. /hospital at low or reasonable rates

Gas prices 

Transportation – programs – for things like stores/outings 

b. Meals/Nutrition 

Meals – offer meals at Senior Centers and to home bound for reasonable 

prices 

 

Tennessee – State Plan on Aging 2014 - 2018 449
c. Elder Abuse 

Work on legislation to protect seniors who have assigned Power of Attorney 

d. Senior Center 

5. Staying Healthy While Aging (including exercise, eating healthy foods, socialization, 

chronic disease, staying connected and involved in the community, volunteer 

opportunities) 

Volunteer opportunities to maintain sense of worth 

Social Activities – trips to library, movies, senior centers, shopping 

6. Adults with Disabilities 

7. Caregiving 

Caring for elderly parents and spouses 

Sitter – programs – that are affordable 

8. Housing, Neighborhoods, and Safe Communities (including home repairs and utilities) 

Affordable safe housing – make good neighborhoods available and investment 

friendly for housing 

Housing (affordable) for the Baby Boomers who don’t have retirement

Housing – community – that resemble retirement community – that are affordable 

9. Funding/Resources 

Community resources

10. Other: 

Tennessee – State Plan on Aging 2014 - 2018 450
South Central Area Agency on Aging and Disability 

Henry Horton State Park, Chapel Hill 

February 19, 2013 

Question: Here are seven (7) aging and disability issues. 

 Under each, there is a list. 

Mark the ones on the list that you think are most important. 

Number of Questionnaires completed: 23 

Response # of 

responses

%

1. Being able to get accessible transportation 19 82.6

2. Protect people from abuse

3. Transportation for people who don’t drive cars

17 73.9

4. Getting care at home instead of in a nursing home 16 69.6

5. Keeping healthy through exercise and eating healthy foods

6. Respite services

7. Housing that people on a pension or Social Security can pay for

8. Teaching volunteers to work with older adults and people with

 disabilities

15 65.2

9. Affordable dental care, hearing care and eye exams and glasses

10. Meals that are healthy and prevent hunger

11. Not having enough insurance or money to pay for doctors or medicine

12. Learning about how to care for someone at home

13. Being able to get help when needed quickly and without hassle

14. Training for aid workers who help older adults and people with 

 disabilities

14 60.9

15. Learning how to prevent falls

16. Learning new things

17. Meeting people and making new friends

13 56.5

18. Learning how to live with a serious condition like heart disease, cancer,

 arthritis

19. Making decisions about health insurance, Medicare, and planning for

 the future without depending upon the government

20. Learning about how to take care of yourself so that you don’t get sick

 and tired

12 52.2

21. Houses that are easy to get around in if you’re on a walker or in a

 wheelchair

11 47.8

22. Reasons people have to go back to the hospital

23. Knowing where to call for help and getting help without a big runaround

24. Understanding how Medicare works

25. Neighborhoods that are easy and safe to walk in

26. Eating out with friends

10 43.5

Tennessee – State Plan on Aging 2014 - 2018 451
27. Reasons people have to go into nursing homes

28. Help with feeling sad or lonely

29. Help with memory loss

30. Being able to choose the workers who come into your home

31. Places to volunteer

9 39.1

32. Teaching police, Firemen, emergency workers to know the special

 needs of older adults and people with disabilities

8 34.8

33. Being able to get accurate information from a website and being able to 

 apply for services on-line

34. Neighborhoods that have grocery stores close by

7 30.4

35. Help with taking too much medicine

36. Help with chores like lawn mowing and leaf raking

6 26.1

37. Teaching doctors, nurses, and other healthcare workers to know the 

 special needs of older adults and people with disabilities

5 21.7

38. Help with drinking too much alcohol or taking drugs 3 13.0

Other: 

Handicapped Public Restrooms need to be improved for enough room for the motorized wheel chairs

Showing these people love!

Change some of the menus

Tennessee – State Plan on Aging 2014 - 2018 452
South Central Area Agency on Aging and Disability 

Meeting at the Henry Horton State Park, Chapel Hill 

February 19, 2013 

Question: What is currently working well in your community? 

(like agencies that help, neighbors who help each other, van service, senior center, 

meal sites, food pantry, healthcare clinic, nursing home, sidewalks, police 

presence, grocery stores that deliver) 

(Number of Questionnaires containing 1 or more responses - 14) 

This open-ended questionnaire was designed to allow attendees to identify the community 

programs and services that have worked for them and in their community. Evidence based 

and/or proven practices were not a consideration in the design of the questionnaire and no 

checklist was provided. The above items in parentheses were provided as examples. Attendees 

were asked to write in the programs and services that were working well in their community. 

The responses are individual and specific to the region served by the Area Agency on Aging and 

Disability. The number of attendees who indicated that the program is working well in the 

community is provided in parentheses (). 

Meal sites (2)

Congregate needs additional funding

Nutrition (congregate and home delivered)

Meals on wheels (2)

More meals on wheels

Senior center (5)

Meals and activities

Senior centers are a great place to obtain information and get services, but only 

reaching a small number of the elderly and disabled population

Van services (2)

Legal aid services

Churches that help with odd jobs for seniors

Nursing home

To some degree, transportation, but as a whole

Not sure – some are not publicly advertised

Police presence

Meals for the elderly

Homemaker services

Affordable housing in some counties

Health fairs (2)

Food banks

Churches

Mifa – companion program

CHOICES

AARP sponsored bringing medical canisters to collect old medications

Nursing homes

Tennessee – State Plan on Aging 2014 - 2018 453
 

Visiting with the sick

Homemaker services

Volunteerism

Food pantry - At the churches

Facility for mentally challenged has gone up in price until it is not affordable/was 

$25.00 daily now - $65.00 daily

Vita

Tennessee – State Plan on Aging 2014 - 2018 454
South Central Area Agency on Aging and Disability 

Henry Horton State Park, Chapel Hill 

February 19, 2013 

Small Focus Group Responses 

Tennessee – State Plan on Aging 2014 - 2018 455
 South Central Area Agency on Aging and Disability 

Henry Horton State Park, Chapel Hill 

February 19, 2013 

Facilitator Notes for Small Focus Group 1

Staying Healthy While Aging

Exercise and eating healthy - diet and exercise (do what doctor says)

Concerned about poverty level and concerned about diet (fats and carbs)

is healthy food available?

seniors get fewer food stamps ($16 not enough)

Physical fitness in senior centers important, but need more equipment to attract seniors

Difficulty accessing services – more and more people (despicable state)

understanding mail

people on their own with no one to help

families less likely to help financially

*Seniors are having trouble accessing services because they don’t know how (example –

accessing social security – system has gotten too sophisticated

Need for social workers to help them navigate system

Ones that call us don’t know about other services they could get

Families don’t always get information from facilities (like hospitals)

Senior centers could be place where people could ask resources

HRA has offices in all counties

Some people don’t know that senior center is a place to get information

Fraud and financial abuse of seniors (children taking checks and bills not getting paid)

Even people working in agencies don’t know about how Social Security works – need for 

education

SHIP works to help understand Medicare

People who really need that help may not be the people who read the paper, etc. to know that 

help is available

Need publicity of what’s available

We advertise, do health fairs, and people don’t take advantage

Need billboards, PSA’s, radio PSA’s

How open are providers (like pharmacies, doctors) to helping to publicize

How would you see a carrier, like BCBS, helping with message?

Best is give I&A # (toll free #)

BCBS – we could do more to customize out message by region

Health and Wellness

Care at home instead of institutionalized

Seniors worried about losing home

Many physicians affiliated with nursing homes to they don’t want to tell patient that home care 

is a choice (conflict of interest)

Seeing more mental health issues – depression, bi-polar perhaps not addressed when younger, 

or not taking medication (not counting Alzheimer’s and dementia

Tennessee – State Plan on Aging 2014 - 2018 456
More Alzheimer’s and dementia

More people aging well yet others are not (perhaps life style)

Still concerned about people in poverty “just don’t know” how to do things

Seeing more substance abuse among elderly – street value of medications and selling half of 

meds

Substance abuse rampant in elderly

Public information needs to be on Facebook and Twitter

Need to change image of senior centers as more than quilting/cards/recreation

Senior centers – word of mouth that you can get help there

Tricky to talk to seniors so that are not stigmatized by going to senior center or place for help

Caregiving

Computer illiterate issue, phones untouched

There are programs in place for low income and high income can go to assisted living or hire 

someone in; problem is middle income because their families are working. Need adult daycare 

while families work.

Independence and Getting Services Easily

Need more adult day programs. Need to be covered by insurance

Had to get adult care started because of licensure requirements

Rural counties – logistics for adult day care is a problem – driving long ways, etc.

If a nursing home could have adult day care – but recruitment is problem

Transportation – Maury Co. Senior Center looking at purchasing van because undependable 

transportation from rural transportation. Looking at buying rides from church vans – thinking 

outside the box

Issue with liability of using church vans, etc. – this is the key to figuring out

Issue with Medicaid medical trips taking priority for rides

Easier to buy a ride than buy vans

Runaround – calling many places to get help

If everyone is being taken care of in-home, how do you keep them from being lonely and sad? 

Need a visitation program. Perhaps “Health Occupation” in high schools to check on them, 

special time, adopt them

Affordable and Safe housing – hard to get both at the same time

Chores – like cleaning gutters Example: churches doing odd jobs around the house needs to 

get formalized volunteer programs

How to find those people who are isolated

Break up families causes elderly to have to help raise grandchildren

Need coordination of intergenerational help – identification of an organization to spear head –

one organization to pull it all together

Working with Older Adults and People with Disabilities

Need teaching volunteers to work with people with disabilities

Tennessee – State Plan on Aging 2014 - 2018 457
Need training for nursing home personnel

All providers need to do training out in the community (also a good way to do marketing)

When people retire, educate prior to retirement and also have volunteer opportunities 

Issue with reaching out/marketing and then there’s a waiting list

Really frustrating to publicize toll free # and services and then having to say there is a waiting 

list

Need marketing professional to help us to find people

Facilitator Notes for Small Focus Group 2 

Transportation is limited other than going to the doctor’s office. Seniors would like to be able 

to get the Senior Centers and to shops but the local transportation never has space to take them 

to those places.

The senior centers have cut back on congregate meals. One site went from having 35 meals to 

12 meals. They charge a $1.25 for members and $7 for non-members. Some seniors have

stop getting a meal so that others who they feel need a meal more can get a meal.

Seniors would like education provided to families on Alzheimer’s disease. This education is 

rarely if ever available in their community. They would like education on the disease process. 

Work with churches about providing resources such as the Aging and Caring book provided 

through Council on Aging of Greater Nashville. If the churches have the information then 

they can share with seniors in their church.

Renaming the senior centers. Offer a contest to see who can come with the most creative 

name for a senior center. They feel maybe the name is outdated. 

Transportation of Seniors who are not on TennCare is an issue, not necessarily transport to the 

dr or other medical appointments, but going to the store for example.

Ahead of time scheduling has increased from one day to some times 3 or 4 days to call ahead 

to schedule an appointment to be picked up. Passengers pay 1$ one way within the city limits 

and 2$ each way for destination in the county limits. Passengers have noticed a drop in 

service sing the agency s started providing transportation for TennCare.

Murray county meal site has cut back to 12 meals per day. Say they can’t afford to do more???

Alzheimer’s Disease is an issue for baby boomers on two fronts, one taking care of aging 

parents or a spouse with dementia and two worrying about dementia for themselves in later 

years.

Participants agreed that they need more information about all aspects of aging, healthy aging, 

Alzheimer’s, not getting ripped off by home repair or insurance sales agents, what services are 

out there.

One participant spoke about the book that fifty forward put together for caregivers as a part of 

the Innovative Alzheimer’s grant.

There is a need to know a lot of stuff about aging and resources and what to expect and where 

to turn for in depth information .

Need more resources on mental health/depression as people age.

Caregivers need more support and help

Facilitator Notes for Small Focus Group 3 

Staying Healthy While Aging – NEED:

More meals served at senior centers (number of recipients recently reduced due to funding

cuts, so fewer seniors are able to receive meals – big problem, consumers say has created 

Tennessee – State Plan on Aging 2014 - 2018 458
concern about future access to meals at senior centers) 

Help for persons with visual impairments to manage at home (someone to manage meds, write

checks, provide some personal care, shop)

Dependable transportation for people who use wheelchairs in Centerville (Hickman County)

Make lifestyle changes to eat right and exercise both body and brain regularly (said can walk

at senior center, but need more help to make real changes)

More food access for unemployed Boomers

Build and maintain an active lifestyle

Access to health care

Education and information on available services

Health and Wellness – NEED:

Transportation to be able to go anywhere (some can't get to doctor, pharmacy, grocery

store, senior center)

Use transportation money more efficiently by stopping current practice of “zig-zagging" from

the North to South side of town and back picking people up or traveling with one person on

board”)

Door-to-Door transportation

Not to be dropped off in the middle of the street by van (one consumer reported this, said 

confusing and dangerous to stand in the middle of a busy street with vehicles moving in front 

and behind older person)

Dependable transportation for people who use wheelchairs in Centerville (Hickman County)

Improved transportation for Columbia (“SC DOT;” consumers said provider often late, so that

they miss programs at the senior center – supposed to be there by 8, but get there at 10, eat 

lunch at 11 and then van comes to take them home at noon – discouraging)

More “free” transportation “like Marshall County offers” (per Ms. Vernell – may be free to

her because she taught school there for 32 years and knows the drivers)

Sidewalks (Centerville, wheelchair cannot navigate gravel on side of road; if had paved

sidewalks, consumer could go independently to grocery store one block away from home)

Wheelchair accessible public bathrooms (while ADA requires compliance, many restaurants

and other businesses' public bathrooms do not accommodate wheelchairs, walkers, etc. - big 

problem)

Increase funding for senior centers for activities and programs, meals and transportation (food

pantry operated by one center often runs out of food and cannot help consumers before the 

consumers' next check comes)

Access to health care in the home (a doctor in Centerville makes house calls, but only to 

patients he has recently seen – suggested nurse practitioners could do this)

Behavioral health services (to help seniors who are isolated, depressed, etc.)

Caregiving – NEED:

Training for informal caregivers (neighbors, friends, family members) for helping older people 

who live alone and need some help (example, one man helps blind neighbor put eyedrops into 

her eyes x4/day and he and his wife prepare and deliver all of her meals to her – would do 

more, but feels he would need training in some areas)

Tennessee – State Plan on Aging 2014 - 2018 459
Independence and Getting Services Easily – NEED:

Transportation to be able to go anywhere (“just get out,” some can't get to doctor, pharmacy,

grocery store, senior center)

Dependable transportation for people who use wheelchairs in Centerville 

Improved transportation for Columbia (said provider often late, so that they miss programs at 

the senior center – supposed to be there by 8, but get there at 10, eat lunch at 11 and then it's 

time to go home at noon - discouraging)

Sidewalks (Centerville, wheelchair cannot navigate gravel on side of road; if had paved 

sidewalks, could go independently to grocery store one block away)

Transportation to be able to go anywhere (some can't get to doctor, pharmacy, grocery store,

senior center)

Dependable transportation for people who use wheelchairs in Centerville 

Improved transportation for Columbia (said provider often late, so that they miss programs at 

the senior center – supposed to be there by 8, but get there at 10, eat lunch at 11 and then it's 

time to go home at noon - discouraging)

Help for persons with visual impairments/who are blind to manage at home (someone to 

manage meds, write checks, provide some personal care, shop)

Large format telephones for persons with visual impairments

Someone to walk with persons who are unsteady on their feet, whose balance is a little off or

whose meds affect vision (consumers reluctant to walk alone for these reasons)

Housing, Neighborhoods and Safe Communities – NEED:

Sidewalks, but, also, someone to walk with persons who are unsteady on their feet, whose 

balance is a little off or whose meds affect vision (consumers reluctant to walk alone for these

reasons)

Higher commodes for older people and for those with disabilities

Large format telephones for people with visual impairments

Program to make contact with people who do not show up for regular activities or 

appointments to make sure they are okay (said they informally watch over each other, but 

know there are older adults and people with disabilities who live alone and have no one to 

check on them)

Transportation that does not require older adults to stand outside for long periods of time,

especially in unsafe neighborhoods or business districts

Grass cutting (so house does not look abandoned)

Staying Connected and Involved in the Community – NEED:

More transportation options that are readily available so people can go where they need and 

want to go (to avoid isolation and greater dependence on others)

Working with Older Adults and People with Disabilities – NEED:

There were no comments on this topic.

Other

This group included three MCO case managers, a Franklin County Mayor's assistant, six 

consumers (a woman who uses a wheelchair and her husband, plus four elderly women) and a 

Tennessee – State Plan on Aging 2014 - 2018 460
senior center director. 

An innovative practice used by the senior center director is participation in the “Pet Pals”

program where donations of cat and dog food are made to seniors to allow them to use their

limited dollars on food, medicines, etc. 

Tennessee – State Plan on Aging 2014 - 2018 461
Needs Assessment 

Southeast Area Agency on Aging and Disability 

Jewish Cultural Center, Chattanooga 

February 28, 2013 

Number of Attendees: 55 

Tennessee – State Plan on Aging 2014 - 2018 462
Southeast Area Agency on Aging and Disability 

Jewish Cultural Center, Chattanooga, TN 

February 28, 2013 

What are the hard things that “baby boomers” face? How should the state of TN help?

(Number of Questionnaires containing 1 or more responses - 33) 

This open-ended questionnaire was designed to elicit qualitative data from the attendees about 

how they thought aging would impact baby boomers. However, many attendees also identified 

issues that currently exist. Attendees were able to respond to the questions in any manner that 

included short, one-word answers, such as transportation, to very involved responses. In order to 

provide some order to the responses, major topic areas have been identified. In addition, some 

topics might include sub-topics for the purpose of reading the report more easily. Repetitive 

responses are included only once. 

1. Easier Access to Services Without Hassle (including information and assistance; 

communication; and technology) 

Information – have information available to them on what might be resources for 

them 

Keeping up with technology – training sessions 

Lacking awareness of communication access 

Making sure the programs are made known in homes, church, the senior centers and 

the YMCA and such 

Don’t know what’s available to them. Inform them more by taking more time to 

explain in detail to them. 

2. Healthcare (including in-home services; Home and Community Based Services; long 

term care; chronic disease; Alzheimer’s disease and related dementia)

More slots available for assistance 

Education on how to cope with aging, depression, how to prevent falls 

Not enough services or money available 

Some are as agile and able to move about as others or have the appropriate resources 

or family members to assist 

Develop trusting relations with service providers 

Simple health service – easy access – locations – low cost 

Nursing home care for elderly and those with disabilities 

Nursing home or retirement homes – HH or late deafened – need exposure of 

resources available to be captions, etc. 

Inadequate funds for health care 

Main concern because of the changes 

Palliative care options

Affordable and practical health care that’s accessible and beneficial – better choices 

in healthcare systems 

Help with medication costs

More home and community based services 

Tennessee – State Plan on Aging 2014 - 2018 463
Getting home care instead of a nursing home even if it means paying a family 

member 

Cost share programs to help supplement cost for home care 

Knowing and understanding homemaker services and how to obtain Homecare, 

chores, outside work 

Long term care for middle-income parents and for self 

Basic needs taken care of to assist ADL’s – dental care – glasses 

No funds available to help late deafened adults with assistive devices and ASL 

classes 

Affordable dental care

Help managing chronic conditions like CHF, COPD, etc. 

Dementia care for those who need long term care (nursing homes) 

Being alone – medically 

3. Fiscal Concerns (including health insurance; Medicare/Medicaid; employment; 

retirement; social security; cost of living) 

Adult child living with aging senior parent earring limited income – prevent parents 

from receiving benefit for home repair grant – reconsider not counting or having that 

family income included their income 

Gas prices – set cap on gas prices/low income families 

Grocery, utilities, and phone services – create lower price scales for low income 

families

Less benefits in other areas 

Financial guidance – need someone to teach and/or handle finances to prevent others 

from taking money 

Health insurance – Medicare/Medicaid 

Inflation; create jobs to supplement Social Security 

Rising property tax – give tax break by setting the bar lower 

Being able to afford health insurance 

Insurance coverage

Understanding insurance and assistance with obtaining insurance 

Financial fear – job loss – job bank for seniors still able to work 

Social security benefits, increase in medical care, and increase of long term care 

Social Security retirement – do more to protect Social Security 

Lack of Medicare and/or SSA when we retire 

Difficulty with saving for retirement due to rising gas and grocery prices 

The anger over the theft of their retirement funds by corporations to whom these 

funds were entrusted. 

Retirement and employment - part-time employment options 

Having enough money to retire 

Building or rebuilding retirement plans that are sound investments – offer retirement 

planning at no to low cost 

4. Support Services (including transportation, meals/nutrition; elder abuse services; senior 

centers)

Tennessee – State Plan on Aging 2014 - 2018 464
a. Transportation 

Transportation for the “old, old” who need “door to door” transportation 

alternatives (destination on demand too) as opposed to group, curbside 

transportation 

Transportation – provide funding for the less fortunate in order to keep their 

independence 

Safe, reliable transportation 

Transportation – public transportation – transports in groups – having to arrive 

too early for appointments and having to set and wait for public transportation 

to take them home 

Better transportation public/private 

Let PSSA transport 

b. Meals/Nutrition 

Elderly couple cannot receive meals on wheels in Tiftonia – why? 

Food, prescriptions, delivery to homes at a reasonable price 

Need home cooked meals – don’t like frozen meals – caretaker cook for them 

c. Elder Abuse 

Bricks/mortar emergency shelter for elder abuse victims who need to be 

separated from their caregiving perpetrators

d. Senior Center 

5. Staying Healthy While Aging (including exercise, eating healthy foods, socialization, 

chronic disease, staying connected and involved in the community, volunteer 

opportunities) 

Help with providing means for activities to exercise and healthy nutrition 

Keeping lines of communication with relative and friends – create community centers 

that assist with reconnecting individuals 

Not losing identify or self-worth as aging occurs – behavioral services that focuses on 

self-esteem 

Keeping healthy through exercise and healthy foods 

Isolated socially 

Prices for admission to events are too high for those on limited incomes 

6. Adults with Disabilities 

Mobility for access to buildings and venues 

7. Caregiving 

Some are faced with caring for elderly parents and need assistance themselves 

Employee retention for providers who provide services and lack of good caregivers 

The Baby Boomer generation now have children that they are currently taking care of 

Being caregivers 

Tennessee – State Plan on Aging 2014 - 2018 465
8. Housing, Neighborhoods, and Safe Communities (including home repairs and utilities) 

Livable communities with mixed use zoning, high density housing, sidewalks, 

sidewalk setbacks and grid-system roadways 

Affordable housing and affordable repairs 

Being able to maintain – upkeep of a home (home repairs) 

No affordable housing either independent or assisted 

Affordable assisted living rather than nursing home placement 

Program to help them stay in their homes longer 

Affordable assisted living/in home care for middle income individual 

Safety in home – being able to stay in your own home 

Housing assistance – emergency housing solutions 

Shared housing 

Aging in place – provide services that will allow them to do just that 

Help stay in homes! 

9. Funding/Resources 

10. Other: 

State: coordination of services and volunteers – reverse adoption: adoption/foster 

elders 

Better education, better paying job, removal of gang problems, and health education 

Ongoing advocate 

There are more single parents coming from that age group 

Funeral assistance/planning 

Tennessee – State Plan on Aging 2014 - 2018 466
Southeast Area Agency on Aging and Disability 

Jewish Cultural Center, Chattanooga, TN 

February 28, 2013 

Question: Here are seven (7) aging and disability issues. 

 Under each, there is a list. 

Mark the ones on the list that you think are most important. 

Number of Questionnaires completed: 32

Response # of 

responses

%

1. Affordable dental care, hearing care and eye exams and glasses

2. Learning how to live with a serious condition like heart disease, cancer,

 arthritis

3. Learning about how to take care of yourself so that you don’t get sick 

 and tired

26 81.3

4. Getting care at home instead of in a nursing home

5. Being able to get accessible transportation

6. Transportation for people who don’t drive cars

25 78.1

7. Not having enough insurance or money to pay for doctors or medicine

8. Being able to get help when needed quickly and without hassle

24 75.0

9. Protect people from abuse 23 72.9

10. Respite services

11. Training for aid workers who help older adults and people with 

 disabilities

22 68.8

12. Keeping healthy through exercise and eating healthy foods

13. Meals that are healthy and prevent hunger

14. Teaching doctors, nurses, and other healthcare workers to know the 

 special needs of older adults and people with disabilities

21 65.6

15. Understanding how Medicare works

16. Help with memory loss

17. Housing that people on a pension or Social Security can pay for

18. Houses that are easy to get around in if you’re on a walker or in a 

 wheelchair

20 62.5

19. Meeting people and making new friends 19 59.4

20. Reasons people have to go into nursing homes

21. Neighborhoods that are easy and safe to walk in

22. Teaching volunteers to work with older adults and people with 

 disabilities

18 56.3

23. Learning how to prevent falls

24. Learning about how to care for someone at home

25. Neighborhoods that have grocery stores close by

17 53.1

Tennessee – State Plan on Aging 2014 - 2018 467
26. Places to volunteer

27. Learning new things

16 50.0

28. Reasons people have to go back to the hospital

29. Teaching police, Firemen, emergency workers to know the special 

 needs of older adults and people with disabilities

15 46.9

30. Knowing where to call for help and getting help without a big runaround

31. Making decisions about health insurance, Medicare, and planning for 

 the future without depending upon the government

32. Help with feeling sad or lonely

33. Help with chores like lawn mowing and leaf raking

14 43.8

34. Being able to choose the workers who come into your home

35. Eating out with friends

13 40.6

36. Help with taking too much medicine 12 37.5

37. Help with drinking too much alcohol or taking drugs

38. Being able to get accurate information from a website and being able to 

 apply for services on-line

8 25.0

Other: 

Building trust relationship with client/caregivers and other family

Just love them!

Help with food, housing and health care needs.

Retirement funds cannot keep up with inflation

Help for car for Alzheimer’s patients that are not ready for nursing home

Tennessee – State Plan on Aging 2014 - 2018 468
Southeast Area Agency on Aging and Disability 

Jewish Cultural Center, Chattanooga, TN 

February 28, 2012 

Question: What is currently working well in your community? 

(like agencies that help, neighbors who help each other, van service, senior center, 

meal sites, food pantry, healthcare clinic, nursing home, sidewalks, police 

presence, grocery stores that deliver) 

(Number of Questionnaires containing 1 or more responses - 22) 

This open-ended questionnaire was designed to allow attendees to identify the community 

programs and services that have worked for them and in their community. Evidence based 

and/or proven practices were not a consideration in the design of the questionnaire and no 

checklist was provided. The above items in parentheses were provided as examples. Attendees 

were asked to write in the programs and services that were working well in their community. 

The responses are individual and specific to the region served by the Area Agency on Aging and 

Disability. The number of attendees who indicated that the program is working well in the 

community is provided in parentheses (). 

Neighbors who help each other

Van service

SETHRA bus

Transportation/public (3)

Senior center (5)

Meal sites (3)

Food services

Food pantry (3)

Healthcare clinic

Nursing home

Sidewalks

Sidewalks have been placed – good

Police presence (3)

Probably would like more police presence

Law enforcement

Grocery stores that deliver (and Pharmacy) (2)

Cook’s grocery

Meals on wheels (4)

Health Department (3)

Human services (food stamps)

The Partnership

All work well

Tennessee – State Plan on Aging 2014 - 2018 469
Partnership Elderly Services (2)

Samaritan Center

Hamilton Human Services

Southeast Tennessee Human Resource Agency (SETHRA) (2)

Housing authority

Jewish Federation/services (2)

Area Agency on Aging and Disability (2)

Alzheimer’s Association

Community services

Networking to have someone to check on elders that live alone

Homemaking

Diversity of residential housing options and alternative

Networking of aging service provider/agencies

Chattanooga “can do” attitude

Willingness/determination to solve aging issue problems

Attracting retirees to region

Availability of adult day centers

Having senior centers where meals are available

Senior nutrition centers

Home and community based services

Suggestion: wrapped care – think of as neighborhood school model – most working 

because its not multi-faceted – think specialist instead of generalist

The agencies are too under funded to really do more than help people subsist. If older 

and disabled people are helped to thrive they can contribute much to the community. 

Too many are homeless or nearly so.

Tennessee – State Plan on Aging 2014 - 2018 470
Southeast Area Agency on Aging and Disability 

Jewish Cultural Center, Chattanooga 

February 28, 2013 

Small Focus Group Responses 

Tennessee – State Plan on Aging 2014 - 2018 471
Southeast Area Agency on Aging and Disability 

Jewish Cultural Center, Chattanooga 

February 28, 2013 

Facilitator Notes for Small Focus Group 1

Transportation/Assisted Transportation

One speaker has elderly parents in West Tennessee (Brownsville) but lives in Chattanooga 

herself. Things like trips to the doctor cannot be taken for granted. A sibling is closer, but she 

has difficulty physically helping the parents into and out of the car—they both do. They share

the responsibility and try to help one another, but the commute back and forth from 

Chattanooga is also challenging, tiring, and problematic. 

*And I contributed to this topic myself, noting that my mother is the only one of three children 

in the state close enough to provide immediate care to my grandparents, and immediate is still 

a relative term in that she travels roughly three hours each way between Murfreesboro and 

Paris, Tennessee. She typically takes a weekend “shift,” which means additional 

arrangements—more trips—have to be made for things like appointments with doctors, which 

are often in places like Nashville or Memphis.

Even when public transportation is available, it’s often accompanied by extended delays—

typically forced waits when a group of patients is taken together and some complete their visits 

earlier than others. 

There are people willing to help or looking at alternatives to existing transportation programs, 

but it’s cost prohibitive, particularly with commercial insurance in mind, and there is concern 

for liability. In the case of volunteers willing to waive reimbursement, there is also perhaps 

some confusion over what is and isn’t legal, or what is and isn’t possible. *There is crossover 

here with a feeling shared later that existing rules and regulations often prevent or hamper 

solutions to problems.

Who (or what) authority regulates transportation? Where would one ask for approval to try 

new things? Clarification is needed as to who can legally do what. Is the issue one of the

exchange (or not) of money alone?

SETHRA was mentioned as a source of assistance with transportation needs. (There is a 

website at www.sethra.us which I identified after the fact.)

Several people agreed that it’s better sometimes to forge ahead, asking forgiveness rather than 

permission when in conflict with a regulation.

Healthcare and Medical Needs

There needs to be recognition for the need for “familiar faces.” There is a rotation of care

providers that is upsetting to the elderly, who respond much better to care when they receive it 

regularly from the same people.

Tennessee – State Plan on Aging 2014 - 2018 472
Rather than addressing problems separately, health care needs to be addressed in a way that 

looks at the entirety of a person. In other words, there is a need for a role in which a care 

provider examines and analyzes a person’s holistic needs: what they’re eating, what medicines 

they’re taking, their injuries, their diseases, their transportation requirements. Rather than 

identifying and treating a single need or ailment, the need is for an entity who will look 

inclusively and who will examine the ways in which many factors contribute to an individual 

patient’s quality of life.

Nursing homes should be a last resort, a medical necessity

What will be the impact of the Affordable Healthcare Act on Tennesseans?

Access to Services (Communicating Resources)

He messages need to speak to the average person. What good is a directory if a senior never 

opens it? Older Adults . . . the Resource Guide was the example on hand. The point was not 

that the guide is without value, just that it doesn’t reach everyone and, more importantly, it’s 

not necessarily accessible to everyone—even people who can get their hands on it. The belief 

stated was that there has to be a alternate delivery method for the information, particularly in 

communities where there may not even be a senior center. *TV was highlighted. “Older people 

watch TV.”

It’s heard regularly and too often: “I didn’t know that service was available!”

There is a need to better utilize relationships with associations and organizations to spread 

information. Contact needs to be made with administrators and directors, and a strong effort 

must be made to “engage them in the vision.”

The path to answers, to reliable and easily accessed sources of information, remains 

convoluted. It’s too often still too difficult for seniors to get the information they need, and 

they give up.

Housing

Why not provide shared homes for compatible people—people with similar conditions or 

circumstances—who can live together and help each other? The state would provide the house, 

the physical structure, and the people living in it would help care for each other. This could 

also address homelessness and social isolation. It’s an idea in common with integrated 

community services.

Title 3: “CHORE” was referenced. How can assistance for home maintenance be provided 

while fighting to keep seniors in those same homes—their homes? Where is the funding? And 

there is a need for a resource: a list of trusted sources of both work and for legitimate 

donations. It’s not just an issue of yard care, although that’s a major problem, but also 

structural repairs such as roofing, flooring, plumbing, etc. This has not been addressed in an 

organized way, and seniors (and their support) need help in locating reliable and trustworthy, 

as well as affordable or free, sources of labor.

Could estate recovery be modified to allow for reclamation of empty or abandoned homes for 

use as shared or group homes?

Everything Else: Statements I Wasn’t Sure How to Categorize

CHOICES and OPTIONS are limited in their ability to intervene and assist. *Made in 

reference to transportation, but I took the meaning as also a generalization of their overall

capacity for affecting change.

Tennessee – State Plan on Aging 2014 - 2018 473
More hours are needed—more money for at-home care (CHOICES).

Partnerships was brought up more than once as a resource, with the VOCA, VOCARE, and 

SARAH programs each invoked by name as possible providers of solutions to various 

problems. Each program deals with its own target issues, as well as separate age groups.

There was an assertion that more collaboration and coordination of resources, like churches 

and faith based groups, was needed. “They’re ready to help but . . . they’re scattered and 

without direction.” And in some cases they only give to coordinated organizations. The 

sentiment was that they are an underutilized and untapped resource.

“Stop penalizing people for doing the right thing.” Medicare restrictions on taking a loved one, 

someone receiving institutional care or living in a facility, home for the weekend was offered 

as an example. The sentiment among more than one person is that the federal government, as 

well as state agencies, create roadblocks to practical, good-hearted, well-intentioned solutions 

at times.

Tennessee does not pay/reimburse family members who provide care to other family members. 

This can contribute to a number of problems, not least of which is creating the conditions for a 

cycle of dependency when caregivers must leave the workforce to provide care, with the result 

that they then eventually need financial help themselves.

More needs to be done to address the exploitation of finances by family and “friends.” Victims 

of theft or misappropriation need more attention, someone—a counselor—who can work with 

them over an extended period of time to address both the exploitation and the associated fears. 

(Fear of abandonment, for example, by reporting the crime.) 

Facilitator Notes for Small Focus Group 2 

Funding – needs are great than funds

Aging population – want to stay home

Information for those that need more programs – to help stay at home

Assistance with errands

Chronic disease self management needed

Huge gaps in dental care

Meals that are healthy needed – can’t make nutritional meals

Medication management

People go back to hospital – being able to afford cost of medication

More family involvement, training, etc.

Need people to visit with people who are feeling said and lonely

Isolation – need ways to bridge gap from those who don’t have access to information/services

Problem: reaching home bound

Need home modifications to stay at home but can’t afford

Need for more community/social/religious organizations to do more

Definitely more education on Alzheimer’s and how to deal with people who suffer with 

disease

Gap in services between people with cognitive disability vs. physical disability

Current provider is providing non-reimbursed services – how long ban agencies due this and

survive?

Tennessee – State Plan on Aging 2014 - 2018 474
Help with chores – living in homes that are in poor shape – in need of repairs/can’t afford

Transportation

If major life changes, like moving – assistance with doing so

Being a victim of exploitation

Depressing that people/elderly are living in poor conditions

Education on health condition – in relation to behaviors (eating, smoking)

Places to volunteer – giving them purpose

Family needs to be more involved

Training for paid workers, especially with Alzheimer’s, and training especially to deal with 

frequent illness

Pest control is a huge need

They want to feel loved

Need for federal assistance/food stamps

Caregiver education/training

Volunteer programs – use high schoolers to assist seniors

Education of caregivers on dementia/Alzheimer’s

Basic needs should be considered based on person and not program

If someone is on meals and needs a lifeline, should be covered

Access to assistive devices

Streamlining application process for most services

Need for more case management services and assist seniors with accessing services

Transportation – huge problem – seniors driving power wheelchairs on main road due to lack 

of transportation especially rural/outlying counties

Funding is issue but knowledge is half battle of that

All the points on this sheet are important

Facilitator Notes for Small Focus Group 3 

Affordable living for middle-income families, persons – too much $ for TennCare – not 

enough to maintain living at home with HCBS

After hours care – adult evening care

Need to promote phone #s 1+A – SHIP

People who need the information don’t know who to call

Caregivers of Alzheimer’s are s isolated – info needs to be on TV

Dental care a big issue – without it other body systems

For eye glasses not covered in some supplement policies

Consumers need to have input in how TennCare designs its programs

Caregivers need respite – time to run errands go to the grocery store

Need to begin to engage in developing livable communities and homes so folks don’t have to 

drive everywhere

MCO’s for TennCare – need to do better assessments – they don’t even consider the caregiver

More community awareness of the problems

Wait list on meals – inexcusable

Need to involve more Senior Center and churches in disease prevention healthy life choices

With more boomers staying in the work force – healthy living courses could be taught there

Expand relative caregiver program (grandparents caring for grandkids)

Tennessee – State Plan on Aging 2014 - 2018 475
Do away with automated phone message and answering – also language is an issue for some 

consumer lines - Ex. VA help line: “If you are considering suicide, call --- --- ---.”!

Need to do a better job of end of life/palliative care – more services more education

Need to change dr. culture so they are more compassionate and listen

EMS needs training in dementia

Not knowing enough to make the right decisions

Why is insurance getting higher?

Older people have financial fear – will they have enough?

More and better MH services - seniors are depressed/lonely/isolated have a lot of loss to deal 

with

What works: Those in the field know about services/resource – everybody else should

Facilitator Notes for Small Focus Group 4 

Ombudsman program – need help with volunteers 

Need support of State; need more funding; getting Baby Boomers in nursing home; BB’s have 

a different mind set – more meetings, advocating for rights – they want to be heard – want 

socialization – not satisfied with just setting by the nurses station

Alzheimer’s – Baby Boomers are caregivers and their expectations are more demanding –

glaring problem is that they expect Medicare/Medicaid to pay, but it doesn’t

sometimes those who have funds, don’t have enough

opposite ends of the spectrum – either have $ or no $

need cost-share program that is less restrictive than the current

Tighten up on eligibility requirement and people who are very ill aren’t able to get on Choices 

or in home service -- there is a group of people who can’t get services at home and get sicker 

and sicker and end up in nursing home

General lack of funding for any program you can name, don’t know remedy

Social Security income less that $1,000 a month and if need to go into assisted living, it’s 

more then income

also regular rent is more than SS income

have to decide between loneliness and eating

Nothing to help people who become deaf in old age – where can you get free devices; what if 

you don’t know computer skills

Baby Boomers – factory workers; rock music – loss of hearing and no funds to help these 

people thrive in the community (just subsisting not thriving and contributing to community)

People would volunteer and contribute if they didn’t have to worry about subsistence

Need to look at innovative ways to use funding (no one wants increase in taxes). We have

some good programs that need to be expanded – would like to see more of a mind set where

community takes care of community

Example: teaching about elder care/dementia care; physician’s awareness about the lives of 

patients (example – medicine bottles)

There are some simple things that could be done to help (we all need to fix it; awareness; 

mindset)

People don’t want to think about elderly until absolutely have to

Do more PSA’s about safety issues/elder issues (solutions that won’t burden to the system)

Americans have moved away from intergenerational living and more people living alone

Tennessee – State Plan on Aging 2014 - 2018 476
Problem moving out to suburbs and not conducive to community living – no sidewalks, easy

access; transportation (need better planning for urban living

Multi-cultural/diverse community make-up needed

Example: Walmart comes in 12 miles out and small accessible downtown area died –

Walmart parking lots/dangerous to navigate

Do more with less (funding) is ok concept until you can’t do it

How do we creatively solve problems

Volunteers – how do we recruit effective volunteers and train them? Teaching young people 

to care about aging.

Hard to get volunteers out of families who are working 2 jobs; at some point, you have 

to have more resources

Cultural Awareness of Aging (Agism exists)

Use of media to raise awareness

Transportation – Hunger – Healthcare/Medication – Housing

Communication for disabilities – hearing – lack of awareness of culture – need more 

interpreters – people they have to deal with on a regular basis and no communication 

(example: where deaf person had no interpreters; no schooling, etc.)

Issue about awareness of all disability issues (deafness, diabetes, etc.) – needs to start in the

schools

Need experiential learning

Shelter – victims of abuse – no bricks and mortar place for them to go when abuser is taken off 

to jail – shelters not accessible

700+ homeless in Chattanooga

Concerned about transportation – church has community service program

Partnership has program for women over 60; network between non-profits and gov. – for

women who don’t have family support – hiring a case manager – education is the key

Faith-based organization also lost $ during recession so they have fewer resources

Education of faith-based organization

Need for adult day care centers – co-located with senior centers (need new names for it)

Policy change – make cost effective changes

Like a “hub”

Somewhere people can mingle

Also attractive

 Help to families and sandwich generation/concept change – resources to families

 Intergeneration/accessible, etc.

 Make it easy

 Incentive

Deaf couple were not able to get meals on wheels in Tiftonia (Hamilton Cty.)

If I retire to take care of mother in her home, she would lose benefits because too much 

income (if both are in same house), but my retirement wouldn’t be enough (rules aren’t 

logical)

Facilitator Notes for Small Focus Group 5

The number 1 issue from the group centered on healthcare, home care, the bureaucracy, 

Tennessee – State Plan on Aging 2014 - 2018 477
accessible housing, and senior transportation.

Concerns were raised about the fact that people don’t know who to call and where to got to get 

their questions answered

Discussion the focused on the lack of case management services in Tennessee and the fact that 

there is really no follow up after initial help is provided by agencies. No one is out there 

checking on folks; no one is out there.

Right now, people use referrals or education to figure out how to manage and operate within 

the system. Need for more PSA’s to let people know about what services are available.

On senior transportation, discussion focused on para-transit in Chattanooga (door-to-door service) and 

SETHRA. Catholic Charities also does work in the senior transportation area in the Chattanooga area.

On senior housing, one of the group participants commented on the concept of Purpose-built 

Communities which is being led by former Mayor of Atlanta, Shirley Franklin.

Tennessee – State Plan on Aging 2014 - 2018 478
Needs Assessment 

Southwest Area Agency on Aging and Disability 

Southwest Tennessee Development District, Jackson 

February 13, 2013 

Number of Attendees: 59 

Tennessee – State Plan on Aging 2014 - 2018 479
Southwest Area Agency on Aging and Disability 

Southwest Tennessee Development District 

February 13, 2013 

What are the hard things that “baby boomers” face? How should the state of TN help? 

(Number of Questionnaires containing 1 or more responses – 29) 

This open-ended questionnaire was designed to elicit qualitative data from the attendees about 

how they thought aging would impact baby boomers. However, many attendees also identified 

issues that currently exist. Attendees were able to respond to the questions in any manner that 

included short, one-word answers, such as transportation, to very involved responses. In order to 

provide some order to the responses, major topic areas have been identified. In addition, some 

topics might include sub-topics for the purpose of reading the report more easily. Repetitive 

responses are included only once. 

1. Easier Access to Services Without Hassle (including information and assistance; 

communication; and technology) 

Computer on-line applications – designate folks @ AAAD to help 

Knowing what resources are available and how to access those 

Home base for low-income who do not have access to computers 

Provide assistance with understanding and completing forms 

Educate public on viable options for in-home care 

2. Healthcare (including in-home services; Home and Community Based Services; long 

term care; chronic disease; Alzheimer’s disease and related dementia)

Uncertainty of the future of healthcare as a result of legislative action 

Affordable and available healthcare 

Rising health care costs 

Cancer patients need lodging resources as well to help them complete their treatment. 

Across the state these are the largest reasons cancer patients call the American Cancer 

Society 

Security of healthcare 

Baby boomers face medical issues 

Physicians that understand the elderly 

Friendly OHS workers 

Greater needs – fewer services; greater need for more services 

Help with housekeeping, bills, personal care when not ready for Choices – provide 

more funding for services under Title III and options

People in prison get all their meals and healthcare taken care of but the nursing homes 

have to pay to get services. When aging adults go to nursing homes, don’t take 

everything they got. 

Dental and eye benefits

Mental health issues – provide more education for seniors on mental health (other 

than Alzheimer’s)

Tennessee – State Plan on Aging 2014 - 2018 480
3. Fiscal Concerns (including health insurance; Medicare/Medicaid; employment; 

retirement; social security; cost of living) 

The high cost of healthcare and insurance 

Affordable and available health insurance 

Rising cost of living 

Continuing decline of our purchasing power – inflation - $15 increase in SSA benefits 

& $7 loss of food stamp assistance (2 yrs. in a row) 

Finance – assist & provide programs on savings 

The price of health insurance, even if it is possible to get it 

Different “levels” of Medicaid and TennCare and No One who can explain what or 

why

Explain insurance and what insurance pays for better 

Security of Medicare and Social Security 

Tax relief for buying a long-term care insurance 

Have funds for retirement when they reach retirement age 

Not certain of retirement/SS benefits after paying in for entire working life – 40+ 

years

Not prepared for retirement financially/less money to live on 

4. Support Services (including transportation, meals/nutrition; elder abuse services; senior 

centers)

a. Transportation

Inability to drive distances to doctors (financial/physical & dependable 

transportation) 

Cancer patients are having transportation issues that are causing them not to 

complete their treatment - we need help in funding more transportation 

resources for cancer patients 

Provide affordable & reliable transportation 

b. Meals/Nutrition 

Cost of food which continues to rise

Keep providing good healthy meals 

5. Staying Healthy While Aging (including exercise, eating healthy foods, socialization, 

chronic disease, staying connected and involved in the community, volunteer) 

Continue games etc. to keep minds active 

Elderly – isolation 

6. Adults with Disabilities

7. Caregiving 

Advancing age while still care taking either parents or disabled children 

Raising grandchildren 

Taking care of parents – children and grandchildren 

Tennessee – State Plan on Aging 2014 - 2018 481
Who will take care of them as they get older? 

Caregiver program 

Being able to take care aging 

8. Housing, Neighborhoods, and Safe Communities (including home repairs and utilities) 

Affordable independent living facilities 

Financial assistance with home repair and maintenance (& other emergency 

assistance) 

Payment for overvalued homes – government lending institutions 

Senior housing – aging in place for independent assisted and memory care patients on 

one campus

9. Funding/Resources 

Make more resources available in health care 

Food stamp funding

Keep funding centers 

10. Other: 

Education of their children – teaching more on how important education is 

Reasons that minorities are left still at an educational disadvantage

The Great Recession that seems to have no end 

Tennessee – State Plan on Aging 2014 - 2018 482
Southwest Area Agency on Aging and Disability 

Southwest Tennessee Development District 

February 13, 2013 

Question: Here are seven (7) aging and disability issues. 

 Under each, there is a list. 

Mark the ones on the list that you think are most important. 

Number of Questionnaires completed: 37 

Response # of 

responses

%

1. Being able to get help when needed quickly and without

 hassle

26 70.3

2. Keeping healthy through exercise and eating healthy

3. Affordable dental care, hearing care and eye exams and 

 glasses

25 67.6

4. Learning about how to take care of yourself so that you don’t get sick

 and tired

5. Getting care at home instead of in a nursing home

24 64.9

6. Not having enough insurance or money to pay for doctors 

 or medicine

23 62.2

7. Learning new things 21 56.8

8.. Learning how to live with a serious condition like heart disease, cancer,

 arthritis

9. Respite services

10. Being able to get accessible transportation

11. Training for aid workers who help older adults and people with

 disabilities

20 54.1

12. Transportation for people who don’t drive cars 19 51.4

13. Housing that people on a pension or Social Security can pay for 18 48.6

14. Teaching police, Firemen, emergency workers to know the special 

 needs of older adults and people with disabilities

15. Meals that are healthy and prevent hunger

17 45.9

16. Being able to choose the workers who come into your home

17. Knowing where to call for help and getting help without a big runaround

16 43.2

18. Learning about how to care for someone at home

19. Understanding how Medicare works

20. Help with memory loss

15 40.5

21. Teaching volunteers to work with older adults and people with

 disabilities

22. Help with chores like lawn mowing and leaf raking

23. Reasons people have to go into nursing homes

14 37.8

Tennessee – State Plan on Aging 2014 - 2018 483
24. Eating out with friends 

25. Neighborhoods that are easy and safe to walk in

26. Learning how to prevent falls

13 35.1

27. Teaching doctors, nurses, and other healthcare workers to know the 

 special needs of older adults and people with disabilities

28. Houses that are easy to get around in if you’re on a walker or in a

 wheelchair

29. Protect people from abuse

12 32.4

30. Help with feeling sad or lonely 11 29.7

31. Places to volunteer

32. Meeting people and making new friends

9 24.3

33. Being able to get accurate information from a website and being able

 to apply for services on-line

34. Neighborhoods that have grocery stores close by

35. Making decisions about health insurance, Medicare, and planning for

 the future without depending upon the government

36. Help with taking too much medicine

8 21.6

37. Reasons people have to go back to the hospital 7 18.9

38. Help with drinking too much alcohol or taking drugs 4 10.8

Other: 

Hospital admissions are getting too complicated for some seniors.

Support for caregivers, more education.

More communication between systems of care.

Drug tests for anyone under 50 drawing SSI

Assistive Technology to help increase quality of life, independence and decrease the level of daily care

CPR – first aid certs – low cost training

CHOICES: members in McNairy and Hardeman Cos. Are highly upset about 27 AC (Attendant Care State 

Mandate) our UHC MCO is not giving us opportunity to gradually decrease those with high AC hours and it 

is causing them to request Group 1 placement!!

Huge issue: Being able to get accessible transportation – they will not help folks on and off bus (SW)

Transportation for people who don’t drive cares or whose cars can’t go distances

Not being “forced” into public housing because of financial (lack of) assistance for repairs

Teaching emergency workers, teaching doctors

Not enough services and funding

Too long of waiting list

Tennessee – State Plan on Aging 2014 - 2018 484
Southwest Area Agency on Aging and Disability 

Southwest Tennessee Development District 

February 13, 2013 

Question: What is currently working well in your community? 

(like agencies that help, neighbors who help each other, van service, senior center, 

meal sites, food pantry, healthcare clinic, nursing home, sidewalks, police 

presence, grocery stores that deliver) 

(Number of Questionnaires containing 1 or more responses - 25) 

This open-ended questionnaire was designed to allow attendees to identify the community 

programs and services that have worked for them and in their community. Evidence based 

and/or proven practices were not a consideration in the design of the questionnaire and no 

checklist was provided. The above items in parentheses were provided as examples. Attendees 

were asked to write in the programs and services that were working well in their community. 

The responses are individual and specific to the region served by the Area Agency on Aging and 

Disability. v The number of attendees who indicated that the program is working well in the 

community is provided in parentheses (). 

We have none in Scotts Hill

Senior center (13)

Scotts Hill Senior Center works well drawing senior to potluck and activity. We

pack commodities for Southwest

Senior center – provides transportation, meals, volunteer opportunities, educational 

classes and socialization

Senior center is very active

The Selmer Senior Center

Senior Center transportation program

Meal sites (3)

Commodity distribution

Nursing home (4)

Van for seniors (4)

Transportation

Southwest van (2)

Transportation is important to some of our people

Transportation program

Agencies

Agencies that help

Food pantry (3)

McNairy and Hardeman

No opinion here as I have not given much thought to this until just right now!

Grocery stores that deliver (1)

Neighbors who help each other (2)

Healthcare clinics (2)

McNairy and Hardeman

Tennessee – State Plan on Aging 2014 - 2018 485
Clinics

Police presence/McNairy and Hardeman

AARP contributing to food banks

Choices, Rx delivery

Physical fitness programs – counseling!

information and assistance programs

Most things

CHOICES program

Southwest Tennessee Development District (SWTDD) (very helpful resource)

Assisted living facilities

Church organizations

Not the weatherization assistance, nor the winter utility assistance

Don’t know what works

Disparity between disabled/elderly to get State assistance vs. irresponsible youth (or 

illegals) who get “rewarded” for fertility

Partners with Southwest Human Resource Agency (SWHRA) with meals and 

transportation

Local churches contributing to food pantry

Not sure!

Resource assistance programs

The services that are available are great, but so few people can access

Tennessee – State Plan on Aging 2014 - 2018 486
Southwest Area Agency on Aging and Disability 

Southwest Tennessee Development District, Jackson 

February 13, 2013 

Small Focus Group Responses 

Tennessee – State Plan on Aging 2014 - 2018 487
Southwest Area Agency on Aging and Disability 

Southwest Tennessee Development District, Jackson 

February 13, 2013 

Facilitator Notes for Small Focus Group 1

Nutrition

Home delivered & congregate are bad

Over/under cooked

Frozen

No seasoning

Not good

Serve a lot of greens but people on blood thinner no eat

Cooking themselves would work

Some items are raw & some could be better

Better participation when make own foods

Vouchers would work @ a restaurant

Ashamed of what meal they got today

Staying Healthy

People not afford meds

One participant passed away

Some meds not covered

Borrow $ from kids to pay for meds

No dental care is huge

Eye care needed

Keep same glasses for years

Lions Club will help w/ glasses

Resources are limited to what they can do

Young people getting all benefits

Even w/ meds @ $5 each pt. D = people take so many they can’t afford

Changes year to year

Can afford generic some but not as good

Not help if it goes to garbage

Health and Wellness

Clinics not see you without insurance

Hospital taking pay up front before service

Fed like others (minorities) getting services ¬ majority

Depression not talked about

Some ready to give up & go to NH

Because they have no support or interaction

Lonely at home

Family believes senior center is meeting all his social needs

Tennessee – State Plan on Aging 2014 - 2018 488
Senior centers being used by families as adult day care 

Using as respite

Directors worry about the people and they

worry

Financial abuse: children taking parents $

Seniors not realize or want to do anything about it

Caregiving

Most have family to do CG

Family needs a break

Not afford to have a sitter

Sons & daughters moving mom out of home that leads to depression

Best thing to do is commit a crime & go to prison to get services

Some depression starts because losing ability to drive

Depression due to decreasing health & no hope of getting better

Senior centers save lives because it gives purpose & provides interaction

Senior centers need more money

Want more arthritis exercise

Enjoy the NH coming to senior centers. They bring cakes and play games

Independence

Not get information they need

Vans miss appts. = consumer miss surgery

Families are paying individuals to provide transportation

Not like automated voice on calls for help

Housing

Yard work needed by many

Home repairs needed

Not one to come bale hay on farm = even for free

Many churches build ramps out of their benevolent fund in small community

Crime not as much of a problem

Most places accessible > can pay utilities at the bank

Utility help is available & most elderly are very conservative

Staying Connected

Everyone likes shopping – Dollar Tree, Dairy Queen

Some come to senior center because just need transport to go shopping

Most that go are independent & no need help with their shopping – only transportation

The HRA bus is too expensive

HRA only allows the passenger to have 2 bags – some shop most than that

Some want trips to Tunica to gamble

Tennessee – State Plan on Aging 2014 - 2018 489
Not much want to volunteer

Would like to volunteer at NH if there was enough people

Really like to go out to eat but about $6-$& is the limit

Enjoy going at night – if back by dark (4-6 p.m.)

Socialization is the biggest draw of the center

Not like speaker because can’t hear

Working w/ Older Adults

Companies change in-home workers & that unsets the elder

Most elders cannot afford $15/hr.

If personal care doctor doesn’t listen to concerns, elder is changing doctor

Many problems getting diabetic shoes – doctors think they are scams

These shoes cost $300 to $500 - Medicaid is supposed to provide 1 pair a year

Biggest Need

1. yard work

2. medications & insurance (can’t afford)

3. medication

4. medication

5. medication & lawn care

Facilitator Notes for Small Focus Group 2 

Staying Healthy While Aging – NEED:

Focus on preventive services for Boomers

Access to exercise facilities in rural areas (distance and lack of transportation)

Free “card” to access exercise facilities (for Boomers and seniors)

Partner with senior centers for exercise equipment/class access (Boomers)

Education about what's available (Boomers and seniors)

More marketing/networking/partnering to get info out to seniors

Resource guide in two parts – first part to address how to stay healthy; second part is 

information about types of resources and resource directory

Some way to motivate seniors to be more active (Wanda Simmons said they are getting more 

calls from children concerned about their parents' “slowing down,” or showing decreased 

interest in being active)

Affordable access to dental, hearing, vision care resources (lots of need)

More education about serious and chronic illnesses before leaving hospital and accessible 

support groups post-discharge; more involvement of families, friends; volunteer program to 

visit in home post-discharge

Food pantries designated for older persons (younger people who “don't care to find jobs”

exhaust supplies)

Health and Wellness – NEED:

In-home help, especially for those living alone (cooking, bathing, shopping, cleaning)

Help for raising grandchildren (said if raising grandchildren, often go to nursing home sooner)

Tennessee – State Plan on Aging 2014 - 2018 490
Support for taking meds correctly after hospital discharge

More income/lower cost to be able to afford doctor visits and meds

Stay at home with help, rather than go to nursing home

Less bureaucratic process when trying to get help (big response on this, said many give up)

Help to navigate Medicare (think we understand, but then find out later we didn't)

More human contact for people living alone to prevent or help with loneliness or depression 

(said see problems, but don't want to butt in, especially in small communities where everyone

knows each other)

More education on alcohol and drug abuse for older persons; more AA groups in region 

(mental health provider said there is a problem, but that families usually approach the matter 

with caution and consumer doesn't get help)

Law enforcement to stop doctors who prescribe tranquilizers for elderly so that “doctor 

shopping” options are fewer and to stop children and grandchildren from stealing their meds

More programs like Selmer's “Jesus Cares” which provides food, financial assistance and other 

help to eligible consumers of all ages – sees many seniors (UMC collaboration with churches 

in McNairy County to pool funds for buying in bulk, uses common application and tracks 

distribution to individuals to prevent consumers going from church to church.)

Doctors to tell patient and pharmacist to use generics (elderly don't know this is possible)

Help for newly discharged and often confused persons to manage meds

Avoid going back to hospital by not discharging too soon (DRG system cited as cause of early 

discharges)

Doctors dispense 2-3 day supply of meds at discharge, but should then fax prescriptions to 

pharmacy since patients are unable to go to pharmacy to have prescriptions filled

More pharmacies that deliver (if using public transportation, often unable to stop to get meds 

on way home from doctor)

Less costly meds (many delay getting refills due to cost, many cut pills in half, many don't take 

Pharmacists should always tell consumer about potential negative drug interactions (product 

inserts are done in small font and use language that most are unable to understand)

Teach consumers to be alert and informed about medication safety and to always ask questions 

of doctors and pharmacists (media campaign, booklets, pamphlets at doctors' offices, 

pharmacies, senior centers, etc.)

Caregiving – NEED:

More “Caregivers' Day Out” programs

Education on the relevant disease(s) for both caregiver and care recipient, especially regarding 

Alzheimer's; awareness of resources to help

An easy-to-read guide for caregivers (from man who cares for mother )

Expand the reach of caregiver support programs

Independence and Getting Services Easily – NEED:

More education to consumers about help to maintain independence

Acknowledgment to older persons that their independence matters

Reduce stigma felt by older persons about asking for help (they do not want to be a burden for 

Tennessee – State Plan on Aging 2014 - 2018 491
anyone)

More readily available and more affordable transportation options ($6/trip for shopping in one 

county; must call three days ahead to reserve)

Standardized appearance of transportation provider vehicles (one consumer afraid to go to big, 

dark colored car with darkly tinted windows – thought wasn't legitimate provider – turned out 

it was, but she was traumatized)

Transportation from Jackson area to Memphis for medical treatment (said this is often needed,

but unavailable)

Raise awareness among Choices recipients about transportation availability

Easier way to get benefits (less runaround, fewer barriers to getting information and making 

application)

More respectful workers at DHS, particularly (bad experiences made seniors unwilling to go 

back)

Education on advance care directives (most do not know about them)

Housing, Neighborhoods and Safe Communities – NEED:

More safe and affordable senior housing (mental health worker cited sliding fee scale 

independent living facility in McNairy County sponsored by UMC)

Senior apartments without drug deals

Staying Connected and Involved in the Community – NEED:

More attention from families

Transportation to get to senior center, places of worship, visit families and friends

Opportunities to help others, as in children, grandchildren (no transportation, cost of gas cited 

as barriers)

Working with Older Adults and People with Disabilities – NEED:

There were no comments on this topic.

Other

This group was small and included two seniors from the NW district (Carroll County) who 

were unable to attend the NW Listening Tour event, one mental health provider, two MCO 

representatives and a VA representative.

The two men from NW serve as AARP representatives for their county and are actively 

involved in helping others through their church's food pantry and whatever initiatives AARP 

asks them to work. One of the men is recently retired and provides care for his mother, as well.

Facilitator Notes for Small Focus Group 3 

Staying Healthy While Aging

Exercise is very important but not enough facilities for older folks

The lack of affordable dental care, vision blocks

Accessing info to learn how to stay healthy

Health and Wellness

Outreach in accessing

Tennessee – State Plan on Aging 2014 - 2018 492
Clear concise info on where to access help with medicine “face to face”

“Unknown” service with names not reflective of “Choices” service

Rural setting blocks much info access

Caregiving

Not enough hours available to realistically give you a rest

More family members want to taske care of loved one but don’t know how and they want 

compensation

Ruler makes it hard for family members to caregivers

Independence & Getting Service Easily

Need for workers not to rotate so that people can establish a relationship with worker

Still not receptive of technology and want a live person

Current services limit “Independence”

Staying Connected and Involved

Meeting people should be encouraged

Redefine senior center

Working with Older Adults & People with Disabilities

Not enough service

Access is limited

Not clearly defined what is available

Stop warehousing people, take closer look

Streamline service

Facilitator Notes for Small Focus Group 4 

Bethel Springs has no local services and no transportation.

Affordable care for in-home services.

Some of the “help” lines for providers are located in other counties where language maybe a 

barrier for some customers.

There was lots of conversation around DHS and attitude toward older folks. Example of eye 

rolling, rude words, etc. When clients go for help – food stamps for the first time in these lines –

then treated poorly.

DHS is confusing and compassion is missing. They need to use simple language and listen to the 

customer.

DHS and others (MCOs, transportation, doctors practice) need to learn how to better coordinate 

services.

Missouri has self-directed care, does Tennessee? No – discussed what self-directed was - & 

possibility of VA using

Baby boomers are caught in between plus they didn’t have as many children.

Need more and better support for the caregiver

Couple of suggestions grew out of this:

1. At the persons home – need a place where a list of all meds are kept & everyone knows 

where it is. Home Instead gives folks a magnetic white board 5X7 or so to put of the 

refrigerator and list drugs

Tennessee – State Plan on Aging 2014 - 2018 493
2. This led to a discussion of first responders police, for EMS to receive training in dementia

- also have to deal with mental health issues - *training is done, but not in a coordinated

 effort rural areas probably left out of the loop

3. Senior Emergency Kit – one provider gives customer a Senior Emergency Kit with they

Sign up – with a place to list meds and controls; and the need to have an emergency plan

Training – Training – Training

 Customer training for <60

 Tech Schools, Community Colleges – working with older adults

 Education about LTC insurance and advanced directives

There needs to be better outreach to seniors to let them know there is a safe, comfortable place to 

go for information.

There needs to be a hospital ombudsman – after poor and not easily understood instruction and 

sent home pt’s – which ends in a return – discussed concept of Care Transition

Also mentioned that DHS needed a separate ombudsman

Pastime aspect – Baby Boomers will not stand a lot of this

Need to channel that energy to be volunteers - advocates

Facilitator Notes for Small Focus Group 5

Staying Healthy

Preventative care is important

Keeping healthy

Dental health – glasses

Serious illness – 2 conditions (heart and arthritis)

Health and Wellness

Depression – a lot of seniors deal with depression

Abuse – spouse, children, nursing home, verbal or physical

Knowing where to get help w/o runaround

Keeping you on hold for extended periods

Feel like get runaround mostly with insurance

Insurance workers intimidate elderly & insurance can’t answer your questions (private health 

insurance)

Feel same about Medicare in some instances

Caregiving 

Learn how to take care of yourself

Accepting help from others with caregiving

Independence

Being able to depend on walker/other assistance after surgery or falls

Transportation – when you need it

Getting help without hassle

Internet doesn’t apply right now – most elderly will not use computers and don’t want one –

should be other ways for service info and applying – elderly senior just don’t use computers

Tennessee – State Plan on Aging 2014 - 2018 494
Staying Connected

Senior centers cover all things in this sector

Seniors would take a trip to Jackson to eat out every wee if center could take them

Love going, but not having to drive

Working with Older Adults and People with Disabilities

Better pay and better training for staff

Facilitator Notes for Small Focus Group 6 

There are too many places to try and find out of they are eligible – too many hoops

Also concern about too many services (through homemaker services, et.) being provided. Some 

get more than they need. We could actually save more money.

Healthy aging: Program through MAC – Jackson County – a whole program of activities

How do you get people more involved. Finding people who need to get out and get services –

churches, talk to the communities – promote interesting events

Also coordination of programs would help

A Retirement Guide – everything to do with aging – softball, sports, religion

A clearinghouse – one phone number for folks to call

Home Instead is a foundation that might be worth look into

More children calling about how to get parents involved after retirement

Lack of transportation services for individual with cancer or a cancer diagnosis – led to 

American Cancer Society’s Road to Recovery program in Madison City (to get people to their 

treatment) – Road to Recovery is a volunteer-let program – volunteers pick them up and take

them home. 459 trips in the past year – runs on American Cancer Society donations - Road to 

Recovery – calls them 24 hours in advance –

In further discussions about transportation, Madison City buses don’t go as far as the Star Center 

facility – is located in Jackson so people have to find their own way

Volunteers going into certain area has been a problem in some areas - not a problem going into 

certain areas with the program here

A provider said that he continues to have problems understanding who qualified for what 

programs including TennCare

There needs to be a “landing pad” for people looking for services

“The community is responsible for the community.”

Facilitator Notes for Small Focus Group 7

People don’t know how to get services like meals – education about programs

Can’t afford to buy food because of buying medication

Lack of resources under 60

Don’t know who to call or ask

I’ve been disabled for 15 years

Use the senior center as point of contact to ask questions

 Before went to center, asked the county mayor because call 5 different places – “circled

 around” and nobody know about helping anybody with anything, then just went to senior

 center – senior center was advocate

Tennessee – State Plan on Aging 2014 - 2018 495
Senior center has classes

Older people don’t get on-line to learn and computer sites send you around also

Caregiver for 10 years

House not wheelchair accessible

Ambulance had to carry out bodily

Agency got motorized wheelchair and ramp and that made a huge difference (thru agriculture 

dept.)

Always stayed with him (don’t know anybody in McNairy Co. that would do that)

People don’t understand the disease they have and they don’t ask questions, so they don’t try to 

do better

People don’t understand directions doctor gives them

Important to have someone with me during a doctor visit to help me listen (have it put on your 

record that doctor can talk)

Health and Wellness

Understand Medicare and TennCare - unwieldy

I have Medicare and TennCare – I get all these bills and I was told not to pay the bill – why do 

they send me a bill

Different levels –QMB– what is all that?

Waste of money for Pink Cards (TennCare)

Some doctors not taking Medicare and TennCare (some have signs up that doctor is not taking 

any more Medicare or TennCare patients

Hard for family members who have someone with dementia/Alz.

Nice to know ahead of time – information about what we face – or doctor refer to class 

(example: Hospice told me what to do for wife)

Would have liked to have someone come in so I could go to grocery or go get medicine

I took a home health aid course so I could learn to take care of husband and now neighbors call 

me

Doctor in Franklin – vehicle won’t make it – you’ve got QMB so you don’t qualify 

$150 to get ride to Franklin 

when you go to a doctor out of town and often, then you can’t afford transportation

How do they figure those benefits?

Then issue about doctor no longer being in network

Missing appointments because of transportation issues

Have to get on at 8:00 and don’t get back on to 2:00 (one van gets 6 or 7 people and everyone 

has to wait on each other – no food, can’t take meds)

Often have to go to Nashville or Memphis to get treatment – issues about child care when

Bus rides rough – pain after long ride

Wife taking husband for a ride – so she didn’t get help until he was bedridden

Have a good neighbor who helps and calls everyday to see what I need

Needed home repairs – so was told to move to public housing – house payment is less than 

public housing – can’t get help with roof (could get a low interest loan but don/t have income to 

pay

For < 60 with disabilities hard to get a little help

Agencies run out of $ (like run out of energy assistance)

State does not do a good job to telling people where to go for help

Tennessee – State Plan on Aging 2014 - 2018 496
People getting in line at 4:00 a.m. to get food

Are there checks and balances in the system – are we serving most needy?

Families with children get all the food boxes, free food and seniors (who get $44 in food stamps) 

don’t get the free food

Boxes ought to go to people who only get a little in food stamps

Volunteerism – opportunities at senior center

 Pooled volunteerism “Jesus Cares” coordinates it

Need training for people who work with seniors and adults with disabilities, but not sure State 

needs to be doing it (example: 1st responders)

More $ for senior center

 You can have I&A lines, but there is nothing better than having face-to-face at senior center

 Who is advocacy

Legalize strip poker at senior center

Facilitator Notes for Small Focus Group 8

More HDM meal sites necessary

Food stamps being cut out

TennCare HDM assessment

Need more extended hours

Need for dental, eye wear, and hearing aids

Home health 

Fire alert

Doctors need to a better job at educating their patients

Lack of services in home – not enough services 

TennCare clients getting readmitted to hospital because they are not afforded Medicare

No support results in readmission

Transportation issue for all things

Bus driver will not assist clients on and off bus

TennCare only allowed 5 prescriptions a month

Depends on county by county basis – nw/sw are different

Lack of advertisers

Too much advertisements around Medicare especially evaluating eligibilities

Mental health education outside of Alzheimer’s both on client and doctor level

Need more resources the community for chores

Errands no one to run errands

Affordable safe housing (waiting list) for senior and those with disabilities

Drs. are referring seniors to pain clinics 

aging issues

More senior centers in the community

Need for free SPR and first aid certified

Self directed programs cumbersome

ppl drug testing

Tennessee – State Plan on Aging 2014 - 2018 497
Tennessee – State Plan on Aging 2014 - 2018 498
Needs Assessment 

Northwest Area Agency on Aging and Disability

Senior Center, Union City 

February 12, 2013 

Number of Attendees: 152 

Tennessee – State Plan on Aging 2014 - 2018 499
Northwest Area Agency on Aging and Disability 

Southwest Tennessee Development District 

February 13, 2013 

What are the hard things that “baby boomers” face? How should the state of TN help? 

(Number of Questionnaires containing 1 or more responses – 91) 

This open-ended questionnaire was designed to elicit qualitative data from the attendees about 

how they thought aging would impact baby boomers. However, many attendees also identified 

issues that currently exist. Attendees were able to respond to the questions in any manner that 

included short, one-word answers, such as transportation, to very involved responses. In order to 

provide some order to the responses, major topic areas have been identified. In addition, some 

topics might include sub-topics for the purpose of reading the report more easily. Repetitive 

responses are included only once. 

1. Easier Access to Services Without Hassle (including information and assistance; 

communication; and technology) 

Technology - making it easier for them to reach their resources 

Able to get their services easier without having to push a bunch of buttons 

Having service available when needed 

2. Healthcare (including in-home services; Home and Community Based Services; long 

term care; chronic disease; Alzheimer’s disease and related dementia; loneliness; alcohol 

and drugs) 

How to stay out of nursing 

Adapting to having to leave their home for temporary services (nursing home) 

Too many trips to doctor to get to the final lab test and results – skip worthless test 

and go right to the good test/change from 3 months to one-year prescriptions 

Get the people off tenncare, free food, free everything else and help the baby boomers 

to afford meds, drs. 

Losing your home because of nursing home care 

Being able to afford services 

Fewer care providers, thus increased waiting time in clinics 

Rising health care charges 

Learn to shop more frugally – certain to need more doctors’ visits and prescription 

medicine and remember to take meds on time 

Need more agencies to provide help within the home 

Getting healthcare at home 

More needing LTC – lengthy wait list for services 

Long term places for us to be taken care of it there is not family members to take of 

me. 

Hearing aids – medication 

Stop the selling of drugs and alcoholic parents 

Tennessee – State Plan on Aging 2014 - 2018 500
3. Fiscal Concerns (including the economy, health insurance; Medicare/Medicaid; 

employment; retirement; social security; cost of living) 

Financial changes when there confronted with lost savings from bad economy and 

high cost of medical care 

Hard to live on social security - if fortunate not to have what's put aside for medical 

expenses

More money needed for services 

Rising prices in food and gas 

Save more money for their golden years 

Hope social Security and Medicare will be available for them when they become of 

age 

Helping financially with parents at same time as helping children with college 

Adjust to a lower pay check

Paying for some of our meds and that makes it hard to pay for food and bills 

Help with insurance 

Health problems and enough money to meet expenses 

Provide accurate and affordable insurance. 

Understanding insurance questions 

How to afford healthcare

Paying for medications 

Affordable long-term healthcare 

Planning and help about Medicare and legal matters 

We need health care 

Help with medical bills 

Changes in medical (Medicare) insurance due to affordable care act – repeal it 

Rise in cost of Medicare and supplemental insurance – every time a COLA is given 

cost 

of insurance goes up 

Medical benefits 

Buying food or healthcare, but not both 

Expenses for healthcare and med. Should be a consideration for financial assistance 

not 

just income and assets alone 

Medicine/Insurance 

Need to lower insurance

Getting old! Will there still be Medicare and Social security 

Supplemental insurance to cover more for low-income people 

(Insurance gap)/too young not old enough 

Insurance prices 

Help prevent insurance fraud 

Less taxes out of my check - anything to keep taxes as low as possible 

Take some young people off welfare and put them to work 

Job opportunities, programs, finding jobs, loss of jobs, no security 

Employment for elderly 

Tennessee – State Plan on Aging 2014 - 2018 501
Lack of pensions 

No paid insurance with jobs 

Keeping job

Change in social security information 

Increase in social security checks 

Baby boomers are expecting to get social security so hopefully there will be funds 

 available for them - possibility of social security not being there for them 

High cost of living

Live according to their income 

Having enough income in their later years - saving for retirement 

Plan a way of security so that they can help them self 

By financing away to let them know how to help them self 

Possible loss or decreased social security benefits/concerns re: retirement and how to 

fund it 

They are still working more retirement benefits 

Can I afford retirement? 

Estate planning

Possible loss of retirement 

No retirement in sight

The 60-65 year Old baby boomers seem to have issues finding jobs to supplement 

their 

retirement and SSI 

We should not be supporting all those on welfare that should not be on it - better 

screening

4. Support Services 

 a. Transportation 

o Transportation For Sick to Nashville and Memphis 

o Better transportation - transportation availability 

o Transportation to doctors, groceries, and center activities 

o Gas prices/ sit on congress and president to stop gas prices from jumping up –

older people are starving/no money left to buy essentials 

o Transportation in Union City – no taxi or public transportation 

b. Meals/Nutrition 

o Meals for the elderly 

o Help with food 

o Good hot nutritious meals

o Food costs - groceries 

o Help in feeding the low-income seniors more! 

o Nutrition services, more choices for meals on wheels 

o Better meal sites with choices 

o Food stamps going down and good going up

 c. Elder Abuse 

o Being victimized by telephone solicitation when the "Do not call" is ignored 

and no action taken by government to stop this practice 

Tennessee – State Plan on Aging 2014 - 2018 502
o Protecting elderly parents from opportunist 

o Protection against fraud and identify theft 

o Exploitation from others who take advantage of the elderly 

o Affordable legal assistance 

d. Senior Centers 

5. Staying Healthy While Aging (including exercise, eating healthy foods, socialization, 

chronic disease, staying connected and involved in the community, volunteer) 

Activities for grandparents that have grandkids living with them 

Maintaining a healthy profile 

Staying active physically and mentally 

Being able and try to stay independence 

Accepting that they are seniors – more positive image of 60+ 

Age appropriate activities and social events 

Staying healthy and able to work until their age requirement 

Senior trips 

Need larger buildings for senior centers 

Making friends in safe settings 

6. Adults with Disabilities

7. Caregiving 

Being caregivers for elderly parents 

More funding to aid caregivers to help keep their parents at home 

Care for aging parents – home care assistance 

Taking time to keep others and be unselfish with older adults 

Taking care of aging parents while trying to work fulltime 

Caregiver burnout 

8. Housing, Neighborhoods, and Safe Communities (including home repairs and utilities) 

Crime

Safety in the home - also personal safety education for outside home 

Low-income housing – (quality) for single seniors 

Assistance with home repairs

All utilities 

More help in order to stay in our homes

Making friends and enjoying activities at safe locations in their community 

Several seniors come to us needing help with repairs on their homes, needing air 

conditioning/heating and no $ to do so. We need programs to assist. 

9. Funding/Resources 

More funding for activities and to rent space to have activities 

Make sure resources for benefits are very accessible to the public 

Put some money in programs to help these people 

Tennessee – State Plan on Aging 2014 - 2018 503
10. Other:

"David Reynolds" Tenn. is doing, it best, to 

"Helping all of the people of the state" We thank you very much 

Tell them about God - And that he died for their sins 

I believe the State of Tennessee is going a pretty good job right now. 

Tennessee – State Plan on Aging 2014 - 2018 504
Northwest Area Agency on Aging and Disability 

Senior Center, Union City 

February 12, 2013 

Question: Here are seven (7) aging and disability issues. 

 Under each, there is a list. 

Mark the ones on the list that you think are most important. 

Number of Questionnaires completed: 99 

Response # of 

responses

%

1. Being able to get help when needed quickly and without

 hassle

80 80.8

2. Keeping healthy through exercise and eating healthy 79 79.8

3. Affordable dental care, hearing care and eye exams and 

 glasses

73 73.7

4. Transportation for people who don’t drive cars 71 71.7

5. Not having enough insurance or money to pay for doctors 

 or medicine

68 68.7

6. Learning how to live with a serious condition like heart

 disease, cancer, arthritis

7. Training for aid workers who help older adults and people

 with disabilities

67 67.7

9. Getting care at home instead of in a nursing home 66 66.7

10. Meeting people and making new friends

11. Respite services

65 65.7

12. Reasons people have to go into nursing homes 64 64.6

13. Housing that people on a pension or Social Security can 

 pay for

63 63.6

14. Teaching volunteers to work with older adults and people

 with disabilities

15. Being able to get accessible transportation

60 60.6

16. Houses that are easy to get around in if you’re on a walker

 or in a wheelchair

58 58.6

17. Help with memory loss

18. Protect people from abuse

56 56.6

19. Learning new things 55 55.6

20. Knowing where to call for help and getting help without a

 big runaround

21. Help with chores like lawn mowing and leaf raking

54 54.5

23. Learning about how to take care of yourself so that you 52 52.5

Tennessee – State Plan on Aging 2014 - 2018 505
 don’t get sick and tired

24. Understanding how Medicare works

25. Eating out with friends 50 50.5

26. Being able to choose the workers who come into your home 49 49.5

27. Making decisions about health insurance, Medicare, and planning for 

 the future without depending upon the government

48 48.5

28. Meals that are healthy and prevent hunger 48 48.5

29. Neighborhoods that are easy and safe to walk in 47 47.5

30. Learning how to prevent falls

31. Teaching police, Firemen, emergency workers to know the special

 needs of older adults and people with disabilities

32. Teaching doctors, nurses, and other healthcare workers to know the 

 special needs of older adults and people with disabilities

46 46.5

33. Places to volunteer

34. Help with taking too much medicine

44 44.4

35. Help with feeling sad or lonely

36. Neighborhoods that have grocery stores close by

40 40.4

37. Being able to get accurate information from a website and being able

 to

27 27.2

38. Help with drinking too much alcohol or taking drugs 18 18.1

Other: 

Recycling opportunities and more local sites that are available for items

Recycling opportunities – need more coordination between recycling sites and the city/county & also 

phasing out Styrofoam containers by state and local agencies

Meeting people and make new friends

All is important – everyone would like help

All of these non-medical agencies that are sent to care for seriously medically ill patients that are not 

qualified

We keep hearing volunteer, no one can afford volunteer anymore

We need a place to turn to when we hear of an individual who is in a bad way, starving, house keeping –

lists are too long when added to these list.

Teach senior computers

Strengthening federal laws to provide residents on long term care facilities a voice and better, consistent 

care.

More support for senior centers. You want to get Baby Boomers in our centers, but Baby Boomers want 

modern building, topnotch equipment and well informed instructors. These things cost money. Many thins 

in this survey can be accomplished thru senior centers with more support.

Educate children on importance of “time spent” with elder parents and proper understanding of 

medication’s usage and side effects.

In-home service is very important. It’s a service to keep the elderly at their homes and out of the nursing 

homes.

Love – Peace – Happiness – Forever – Togetherness

Tennessee – State Plan on Aging 2014 - 2018 506
Love – Peace – Honesty – Sharing – Caring – Fellowship

Checking in on more people that are on Medicaid, that are selling their meds.

Plenty more need to be helped

Tennessee – State Plan on Aging 2014 - 2018 507
Northwest Area Agency on Aging and Disability 

Senior Center, Union City, TN 

February 12, 2012 

Question: What is currently working well in your community? 

(like agencies that help, neighbors who help each other, van service, senior center, 

meal sites, food pantry, healthcare clinic, nursing home, sidewalks, police 

presence, grocery stores that deliver) 

(Number of Questionnaires containing 1 or more responses - 80) 

This open-ended questionnaire was designed to allow attendees to identify the community 

programs and services that have worked for them and in their community. Evidence based 

and/or proven practices were not a consideration in the design of the questionnaire and no 

checklist was provided. The above items in parentheses were provided as examples. Attendees 

were asked to write in the programs and services that were working well in their community. 

The responses are individual and specific to the region served by the Area Agency on Aging and 

Disability. The number of attendees who indicated that the program is working well in the 

community is provided in parentheses (). 

In my community all the things above are near my home.

All of this/All of the above (3)

All good

All of these are very important and work well in our community.

All of the above/senior centers most important

Senior Center (42)

Senior Center Milan

Thank God for our senior center

Our senior center provides a place for older adults to get together five days a week 

playing games, meals, exercise, health clinics, information, problems.

Our senior center is aware of other monies that become available for use with 

citizens through the Senior Center.

Senior center activities at Union City, Obion County

Our Senior Center is doing good, but could have more participants if transportation 

could more in getting them there.

Senior centers are a great place. They need more funding for activities.

The Dresden Senior Center is a great place. It really helped me when I was left 

alone. It was great to make new friends.

The senior center in Dresden is helpful in our little town. They offer help in giving 

information on Medicare and insurance supplements and also in delivering daily 

hot meals and frozen meals. And, several activities are provided for entertainment 

and socializing.

Center is going strong but need additional space.

Madison Senior Center

Having senior centers for us to enjoy, meeting new people and enjoying day trips

Senior Centers – older adults can go for companionship, congregate meals – just to 

Tennessee – State Plan on Aging 2014 - 2018 508
be with others and learn different things

Police Presence (20)

Sheriff’s Dept. extremely active in support (meals, etc.)

Sheriff’s department

Police are always available to help when needed

Nursing home (20)

Van service (19)

Transportation vans help individuals in our community. Also WeCare helps 

provide volunteer opportunities, clothes, furniture and other items at an affordable 

rate/price.

Northwest Transportation Service

Van service is helpful

Some time they schedule one person to be picked up by two drivers at different 

times in the a.m. Some times not enough time.

Transportation services

Local transportation (Center operated) for trips to gro. Local drs. And clinics (need 

a new van).

Living in country, I have to get my own transportation to grocery store and to drs.

The Bridge at Ridgely is a nursing facility in Lake County that now offers home 

modifications to those that prefer to stay home, but need their home to be accessible to 

them.

Waiting too long

It is sad that when you sign up that you will have to wait so long to get some help. 

Most of the time when they get to you, you are dead.

Senior meals and having places for senior to go

Meal sites (19)

Meals on wheels

United Way and all programs for meals is hurting so it would help to have sponsors 

for meals on wheels

Meals are delivered to older and sick people

Food pantry/mobile (16)

Food bank services

Neighbors who help each other (5)

Cut away sidewalks (need to be more though)

Sidewalks

T.A.R.P.

Going to grocery store

Grocery stores that deliver (4)

E W James delivers groceries

Healthcare clinic (12)

Healthmart Pharmacy (has delivery service in town)

Pharmacy from neighboring town delivers to center since we do not have a 

pharmacy.

Tennessee – State Plan on Aging 2014 - 2018 509
Programs/Rehab services for information

Good volunteers to help with activities (2)

Agencies that help (3)

We have all of the above but many of the things are for already on SSI or other services 

– many don’t know of the services or are to proud to ask for help

AARP

Church, church, church

Partnering with TN Extension Service for certified instructors for teachers on Chronic 

Disease.

In my community, van service and center for seniors are working very well. Most 

seniors don’t have transportation or family to transport them to different areas, i.e. 

supermarket, bank, post office, etc. and the Center gives seniors a place to come and 

make new friends, great old friends and to just commune and have fun.

Agencies with knowledgeable people

Our Senior Citizen Center very good, my church, my friends, my family

Food assistance through Ministerial Alliance in Benton Co.

Food assistance through partnership with First United Methodist Church and 

Second Harvest Food Bank

CHOICES program with TNCare

Food drives, commodities

Aquatics available

Service for seniors

In-home service from the local OOA

Dresden office on aging helped me with all of my problems – liked helped me with my

insurance – and keeps us active

Tennessee – State Plan on Aging 2014 - 2018 510
Northwest Area Agency on Aging and Disability 

Senior Center, Union City 

February 12, 2013 

Small Focus Group Responses 

Tennessee – State Plan on Aging 2014 - 2018 511
Northwest AAAD 

Senior Center, Union City, TN 

February 12, 2013 

Facilitator Notes for Small Focus Group 1 

Staying Healthy While Aging

What works: 

Silver sneakers *

Need more exercise equipment

Matter of Balance

Problem of attracting Baby Boomer’s to services:

Choices are more important to baby boomers

They want more choices in food and activities

One newly retired BB wanted to know why he hasn’t seen more people of his age at the 

senior center

Health eating, Healthy aging/Nutrition provider

Meals provider suggested that they are concerned with hunger and that there are meals that are 

provided by churches, pot lucks, other sponsors and they are not counted or reported for Title 

IV meals

There should be a way to count as match

Eating alone – one participant talked about eating alone – food not as tasty as it used to be and 

then eating alone on top of that. Likes congregate meals.

How do we attract younger BB to food program

Food desert - from Paris, TN – have to drive to Jackson for low fat, low carb foods

Back to BB’s and good program: they want more choices

What works:

Senior Circle: hospital-based education program – monthly lunch and an education program 

on Healthy Living and Choices

Exercise:

Enjoys walking inside with a few friends

Facilities (community centers) usually don’t have a pool and UT Martin has a pool, but it’s not 

heated

Gardening mentioned as a favorite hobby (exercise) by several

Transportation:

Mentioned several times not just to Dr. appointments, but other activities

Nutrition

Mentioned on two levels: 1) quality of food 2) some seniors going hungry

Tennessee – State Plan on Aging 2014 - 2018 512
Facilitator Notes for Small Focus Group 2 

Windows – money for repairs, heating and air conditioning – only programs are for veterans –

no general programs for seniors

Home modification programs through TennCare was suggested and Reel Foot Rural Ministries

Limited Assisted Living and Retirement communities in rural areas

High utilities and limited assistance

Statewide Community/Neighborhood watch geared toward seniors

Solicitors/callers not honoring do not call list – seniors being taken advantage of - Do Not 

Call being violated

Up Police Presence in rural areas

Requirements for someone being sent home from facility to home that is in poor condition that 

would put client and caregiver at risk

Turnaround time on getting services

Marketing of services for housing modifications and other things available

Internet not good marketing tool – most seniors don’t have access

Housing for seniors and disabled with younger disabled sometimes becomes unsafe for seniors

More affordable housing

Guidelines for housing (who qualifies) – more strict on behavior (Ex. Drug Abuse)

More information about more efficient housing (ex. Handicap accessible)

Funding for modifications

Training local departments on responding to those with disabilities

Better marketing of services available in area

More neighborhood watch in communities

Failing Life Alerts (Life Alerts for Seniors would help with safety for seniors)

Lighting and sidewalks (better to accommodate wheelchairs)

Safe places to go in bad weather (in home or community)

Educate more on Emergency Preparedness and Safety

Facilitator Notes for Small Focus Group 3 

Staying Connected

Playing rook in senior center /Luncheon events dominoes keep people connected

Doctor said keep your heart ticking-they more you do the better your emotional and physical 

health.

Seniors go to Churches and nursing homes sing and visits - positively/religiously healthy

Find friends to do the same thing you like and do it together.

Join AARP –

Go through churches to get names of homebound people, civic organizations share list of 

homebound going to their home on holidays bring gifts-inviting them to senior center

functions

Bring in new activities to senior centers- Basket weaving/knitting, quilting, exercise

More Nursing home volunteers. 

Problem: Most people who come to centers are repeats...it hard to keep new people committed 

to coming.

Barriers: People having problems getting to Senior Center for Activities - handicapped 

Tennessee – State Plan on Aging 2014 - 2018 513
accessible travel < room in the centers-Transportation schedule medical first then recreational.

Mentality of older people are changing < few changing younger mind

No resources for vehicles to take people to and from recreational activities

For seniors who are Homebound/telephone reassurance programs need to be used more

More Nursing home visits

Staying healthy – exercise/project list

Most Seniors cannot afford healthcare if they don’t have Medicare and tend to neglect their 

health

No financial resources for Dentures/Hearing Aids/Glasses

Staying active is very important to Seniors

Educating in the Centers makes a huge impact on health

Health & Wellness

Prevent repeat injuries many fall in nursing homes - do not have appropriate care when they 

come home—taking meds, dr visits, etc.

There is a Role for education in senior centers-educating them on finances, health, and other 

important things that are not discussed.

Protecting our seniors

Facilitator Notes for Small Focus Group 4 

Consumer Direction – have own workers

CPR - training 

Resources for free training

Volunteers for more help for the seniors – home maintenance - _____home repairs – air 

conditioners

Volunteers to check on them on people out of hospitals and nursing

Educating community/people for volunteer communities – registry of people willing to help

Facilitator Notes for Small Focus Group 5 

Staying Healthy While Aging – NEED:

Information on our programs and other help (don't know what's available)

Food assistance (vehicle counts toward eligibility, so most get small benefit (county is rural, so 

having car is essential – need to change rules to allow vehicle without penalty)

Heating assistance

More money for home-delivered meals to reduce long waiting list (per center director)

Transportation to be able to apply for benefits, get healthy food, see doctors, go to senior 

center, visit others, go to church, etc.

More money (get less income when retired than when working)

Somewhere nearby to walk/exercise

Someone to walk with (afraid might fall or be robbed)

Health and Wellness – NEED:

More visits and help from family (loneliness)

Medicare to cover dental care, OTC vitamins

Tennessee – State Plan on Aging 2014 - 2018 514
Medicare (better coverage of meds - high cost)

Help with cost of Medicare premiums and co-pays

COLA increases to be greater than Medicare premium increases

Transportation to get to senior center or “Y” (Silver Sneakers Program) to exercise

Help with utility bills

More services when needed, no waiting lists (“hard to get services”)

Caregiving – NEED:

“Companions” (need more than are available)

More funding for program

Independence and Getting Services Easily – NEED:

Transportation – more options, less expensive than current $5 each way, more vans, more 

volunteer drivers, help getting from house to van/van to destination, separate programs for 

TennCare clients and elderly clients – “TennCare has taken over” transportation for one person 

even if no one else is scheduled to ride (HRA will not transport just one)

“One-Stop Shop” to get “benefits” (food stamps, heating assistance, “Extra Help”) – now must

go to different place to sign up for each 

Easier access to services (“hard to get services,” want more marketing of our and other 

services and easier way to apply, help in filling out applications)

Housing, Neighborhoods and Safe Communities – NEED:

Property tax break for elderly

Homeless shelter (there is none in county)

Better help from police (police not helpful, too busy talking to each other, focused on drug 

problems, community unsafe)

Police department to protect names of those calling to report suspicious activity (people afraid 

to call because their names are broadcast on police scanners – everyone in small towns know 

each other – too risky to become known as one who alerted police)

Subsidized housing for seniors separated from subsidized housing for younger people (too 

much drug activity and other crime, seniors do not feel safe)

Staying Connected and Involved in the Community – NEED:

More funding for senior centers (center director said too many cuts to services)

Transportation to get to senior centers

More family involvement in lives (visits and other expressions of caring)

Working with Older Adults and People with Disabilities – NEED:

There were no comments on this topic.

Other

The greatest needs expressed by this group (all from Lake County Senior Center) were more, 

more affordable and more accommodating transportation options and ssafety in their

community. 

There was much frustration expressed about the lack of transportation for individuals who 

happened to be the only person needing a ride on a particular day, since the HRA 

Tennessee – State Plan on Aging 2014 - 2018 515
Transportation will not provide the service for just one person. Several cited 92 year old 

woman with cancer who is refused transportation to chemo appointments if she is the only 

person scheduled to ride.

Lots of discussion about the concern for police protection in the community due to police 

seeming to regard drug violations as very important and the needs of older adults as much less 

important. Many said they had stopped believing the police department was there to help a 

long time ago.

Facilitator Notes for Small Focus Group 6 

Caregiving

More qualified workers

More clients/more $

Caregiver training and support group

Unable to research/limited computer skills

Education the family to take care of elderly!

Educate on Alzheimer’s or dementia

Support for caregivers – someone to talk to

Adult day care – socialization – motor skills

More hours

Transportation

Lower price or discounted prices

Less hassle w/ appointments

Is not helping the community

False advertising

Scheduling difficulties

Misinformation given

Why are different districts operated differently?

More accessible services and info

Volunteering

Not enough training

Recruitment

Where are the needs?

Adopt a Grandparent Day

More ppl. Involved – not enough volunteers

Staying Healthy

Exercise class/dance class/table tennis > lots of participation

More $ for equipment/health promotion $

Ease of Info

Limited computer skills

Phonebooks – small

Referrals from community/Dr.’s to AAAD – do Dr.’s know to refer?

Tennessee – State Plan on Aging 2014 - 2018 516
Facilitator Notes for Small Focus Group 7 

Residents in home and nursing home need more education and supports for seniors to process 

medication and alcohol interaction

Too many doctor visits

Once a year instead of every three months

Long waits at office visits

Doctor visit process too long and tedious

Lack of interest in exercise program

Healthy aging what to expect

Lack of consistent transportation

More funds for transportation

Need for senior companion programs

More money for in-home services

More training for personal care services

More home delivered meals

More affordable meds

Encourage more education with sheriff’s department

More intergenerational

Easy to understand electronics

Better meds

More meds

Expand program in churches

More in home services

Respite for caregivers, especially for those with dementia

Surrogate program to help make health care decision

Options waiting list

Protection against fraud and abuse

Recycle programs into senior center and community education

$20 of food stamps for seniors/have to hire someone to take them to set – signed up – not 

worth it

Alternate exercises that are low impact

Silver sneakers have been for 5 years – make people have for socialize and exercise for all 

ages 2 times a week

More in community supports to avoid readmission

Limits on pa pain clinics – too much pain

Primary care

No med list like no call list for solicitation

Use of pill dispenser

TRA program advertise and don’t work

A lot of seniors don’t have money for insurance – insurance does not cover hearing aides/or 

glasses – can see or hear or removed

Seniors can’t afford supplemental plans in the 20192 up but premiums go up

Not understanding how insurance or socials security works – long waits at social services and 

Medicare

Social Security unapproachable

Tennessee – State Plan on Aging 2014 - 2018 517
Not talks to person re electronic voice mail to reach me

Consistency in the people who they talk to

It’s important that seniors keep healthy exercise

Need funds to hire well trained instructors

Facilitator Notes for Small Focus Group 8 

Health and Wellness

Seniors over 60 – not enough income for hearing aide, eyeglasses, can’t afford (hearing aides 

$2,000) people discounted

Runaround – when you call, it takes forever and put on hold, back with you, never get back –

people wind up getting really rich 

Money not handled at the lowest level

Concern about where $ goes - - too much at administrative level and not at local level

(pyramid on the point - - drive pyramid into ground)

Need more help – not enough

Need more help in home (ended up in nursing home)

Don’t want estate recover – families leaving themselves to death so family farm won’t be lost, 

but still want mom to have good care

On waiting list for homemaker – don’t get when you need it

Nursing – don’t have enough help – not enough staff and patients don’t get help – friends and 

family helping to feed patients

When in nursing home/rehab – nobody (staff came to help)

CSBG (Corrine Welch grant $) program – now have to go through ABS

Family caregiver – no help so I can leave (more falls/can’t cook)

End up in nursing home because they didn’t take medicine right (forget

Sometimes doctor doesn’t tell you right

Doctor’s don’t listen when medications make you feel bad or funny

Medicare? Don’t know half the time what I’m reading

High poverty rates

Care coordinators fall behind on visits and fall behind on re-certification and person ends up 

getting sicker/falling (CHOICES)

Care coordinators/not doing job/services combine/service provider doesn’t get paid

Need more home health

Need to communicate more with patients about medicines/what their supposed to be doing

Some people can’t take medicine on their own – taking wrong pill (need to use trays to put 

them in

People with memory loss – not understanding how to take medicine

Staying Healthy While Aging

Activity/exercise at senior center – need $

More classes/dietitian/diabetic classes

Recreation/not being home alone

Have to be able to afford food, etc., when they need to change diet – expensive

One store in Taylorville

Tennessee – State Plan on Aging 2014 - 2018 518
Need Dr. Oz

Chronic Disease – on diagnosis have to watch what eat/fluid intake/use less salt

New Group

Transportation

People are weak – need to have 3 or 4 chairs on as van to set on a trip to Nashville

Example: cancer patient needing new medication stranded for an hour or more at hospital -

$25 to go to Nashville (private pay)

Appointment – month ahead of time with specialty doctor; no transportation; if it’s public 

transportation, then they need to be on a schedule (false advertisement)

How do you qualify to ride on the vans? (someone answers – anyone can qualify –

supposedly)

In Crockett Co. – no problems with vans taking around the county (beauty ________)

Supportive Living – need accessible vans to wheelchairs (pulling on him) (dangerous)

It shouldn’t come to that – shouldn’t take an act of congress to get what you need in terms 

of accessible transportation

Volunteers –

want to hear volunteer ideas 

guardianship training – new to it – lots of hands on

volunteers at senior centers

recruitment of volunteers

need list of where volunteers are needed

Most can’t work computer

Surprising

Not know what’s available/not knowing what they are eligible for

Private companies – level of care – come in to do house making, but citizen needs more – like 

taking medicine

Waiting lists – needs and can’t help people

Nursing home > then home > home not livable when they get back

Central registry for volunteers who help people get home repair assistance

Tennessee – State Plan on Aging 2014 - 2018 519
Needs Assessment 

Aging Commission of the Mid-South 

Area Agency on Aging and Disability 

Pink Palace, Memphis 

February 14, 2013 

Number of Attendees: 100 

Tennessee – State Plan on Aging 2014 - 2018 520
Aging Commission of the Mid-South Area Agency on Aging and Disability 

Pink Palace, Memphis 

February 14, 2013 

What are the hard things that “baby boomers” face? How should the state of TN help?

(Number of Questionnaires containing 1 or more responses – 56) 

This open-ended questionnaire was designed to elicit qualitative data from the attendees about 

how they thought aging would impact baby boomers. However, many attendees also identified 

issues that currently exist. Attendees were able to respond to the questions in any manner that 

included short, one-word answers, such as transportation, to very involved responses. In order to 

provide some order to the responses, major topic areas have been identified. In addition, some 

topics might include sub-topics for the purpose of reading the report more easily. Repetitive 

responses are included only once. 

1. Easier Access to Services Without Hassle (including information and assistance; 

communication; and technology) 

Communicating program (we are not talking to each other)/funds available 

Help! Partner and go to McDonald’s at breakfast! Target group is there.

Not up to date with technology – provide tutoring workshops 

Give discounts – affordable internet & cable TV for those who cannot get out of the 

 house due to disability or transportation. We want to stay connected to information. 

Build awareness in general public and among key stakeholders 

Provide a list of comprehensive guidelines to agencies and service 

More public information about the TN Choices program – infomercials would help 

Use methods other than the internet to provide information 

How to function IT age 

Guidance, people need to be taught how to care for themselves, what to do, where to 

do and who to talk with 

Continue to provide training on know how, prevention 

Provide health ads 

Knowledge of programs about care services – public information – *media attention 

Clear info on services for elderly 

Knowing where to go to for assistance with love ones 

Limited knowledge base – teach the basic applications for living 

2. Healthcare (including in-home services; Home and Community Based Services; long 

term care; chronic disease; Alzheimer’s disease and related dementia; assisted living) 

Health care issues > decreasing coverage?/ co-payments – transportation to and from 

appointments 

Health issues aging with grace – make it affordable – doctors who liberally use the 

pen and pad for prescriptions 

Medical care/finance 

Independence - assistance to remain independent 

Affordable health care 

Tennessee – State Plan on Aging 2014 - 2018 521
Because there are so many baby boomers, there is a ratio where boomers out number 

providers and not enough opportunities for them all to participate in the programs. 

Some do not have family support. Provide home based services and supports that are 

not income based. 

Medicine compliance

There will be so many of them requiring services at the same time. There will be a 

need for partnerships with various agencies. 

They have a hard time paying for medication 

Health changing with the aging peers 

Need for medical clinic access to avoid ER 

Lack of adequate healthcare – where to seek healthcare 

Guidance – classes on how to function during the time of need 

By accepting the Obamacare insurance program 

Mental health for the homebound and also at senior high rises, communities and 

centers. This is also important for people with disabilities. 

The self-directed waiver should NOT include dental along with funds for the 

caregiver 

Support services for “boomers” with and without disabilities, such as CHOICES 

program 

Better communication between service providers 

Co-ordination of communication regarding care 

The need for programs to be available to assist older clients with their finances and 

personal needs 

More health clinics - More non-medical in home services 

HCBS (getting services in home – NOT nursing home) without going broke 

They would like to stay in their homes but have no one to help them with little things 

around the house. 

In-home assistance to age in place 

Lack of family support particularly as it affects how income older adults 

Lack of in-home services (homemaker services) 

Expand Medicaid (Choices – Expand Choices 3 

Confine/increase support to CHOICES program

Affordable medical and dental care 

Drug and alcohol use – free counseling services 

Access to assisted living which is now totally not subsidized – i.e. fill the “gap” 

between independent living and nursing home 

3. Fiscal Concerns (including health insurance; Medicare/Medicaid; employment; 

retirement; social security; cost of living) 

Rising health care costs 

Poor health care insurance 

Insurance concerns; make sure they have great medical insurance after retirement 

Financial concerns (decreasing income > expenses >/= income; increasing medical 

cost; Food/housing/general expenses 

Tennessee – State Plan on Aging 2014 - 2018 522
Financial stability 

Finance restrictions for State cost reduction 

Lack of financial resources – prepare financial assistance that will provide stability 

Reality of living on fixed income 

Income not meeting the demand of increasing cost 

Enough money for shelter, food, and clothing 

Getting reverse mortgage without the equity 

Paying for non-prescription drugs 

Medical bills – lower the prices 

Medication costs – not eligible for Medicare yet 

Lack of knowledge about products marketed to seniors/older adults 

Non-medical home health costs 

Drug cost

Affordable insurance/dental care/medicines 

The difference between what is Medicaid and Medicare? – give a better explanation 

on the program

Medicare/healthcare access; working towards adapting the “Obamacare” Act vs. what 

is currently being done 

People living longer – will Medicare be enough

Jobs – incentives for employers to retain aging workers 

Discrimination of the aged in jobs. 

Loss of Social Security

They are in need of an increase in SSI and SS income 

Questions about Social Security 

Guarantee of Social Security benefits

Retirement issues with issues with health and finance 

Retirement with lifestyle they are used to 

Financial security – many adults have not saved enough for retirement. State could 

provide financial planning, etc. 

Not enough in savings to support retirement 

Money – incentives to save for retirement 

How to live on retirement income 

For younger boomers – planning financially for retirement needs; appropriate 

counseling for retirees – adjusting to retirement living 

Part-time job (retirement) – raise the retirement allowance 

Inability to retire because of increasing cost of living 

Guarantee of a true retirement 

Betters opportunities to work for the ones that choose to work 

4. Support Services (including transportation, meals/nutrition; elder abuse services;) 

a. Transportation 

Help! Expand transportation coverage/vendors/availability – MATA 

vouchers, etc. 

Accessible transportation

Tennessee – State Plan on Aging 2014 - 2018 523
Public transportation when no longer able to drive – Help: more vans for 

senior centers

Options that realistically connect people in older neighborhoods with medical 

 centers where doctors offices are 

Lack of transportation services 

Transportation affordable and on schedule 

Access to transportation; having more transportation services available in a 

timely manner 

Spread out community – when mobility is limited – services too spread out 

Provide more support public transit – loss for roads 

b. Meals/Nutrition 

State partner with big chain grocery stores to deliver groceries to those who 

can no longer drive to grocery store, but who still cook their meals 

Restaurants that serve low sodium or special dietary foods – Piccadilly has 

fantastic dietary meals at affordable price. Perhaps State could partner with 

restaurant associations. 

Help with food insecurities

Healthy veg food

c. Elder Abuse 

Elder abuse from those who guide us in “wrong direction” for Commission

Elder maltreatment is a huge issue. ASPS not appropriately managed or 

responsive. Needs to be supported in same manner as children’s courts

Legal services 

d. Senior Centers 

Not having enough activities to catch their interest; ensure that the “senior 

centers” have age appropriate activities that fun and not boring

5. Staying Healthy While Aging (including exercise, eating healthy foods, socialization, 

chronic disease, staying connected and involved in the community, volunteer 

opportunities) 

Not enough senior related activities 

Getting old with nothing to do (daily) 

Community involvement driven activities 

Being left alone

6. Adults with Disabilities

More programs to do for disable people at home – more hours too 

Provide assistance in reducing the cost of public transportation for people with 

disabilities 

Transportation for all disabled

Day programs for seniors and mentally ill adults with disabilities 

Programs and services for the blind 

Tennessee – State Plan on Aging 2014 - 2018 524
The State needs to try to extend TennCare for the adult who is disabled 

Increase support for Center for Independent Living 

7. Caregiving 

Caregiver support > caregivers die before boomer; not willing/capable/available CGs 

 Help! Like with advance directives – add space for caregiver support/people/contacts 

Caregivers not supported. Work with businesses to offer caregiver support through 

worksite wellness/benefits 

Caring for aging parents and spouse while still working 

Resources to taking care of aging parents, especially when grandchildren don’t live 

near parent 

Caring for aging parents – Help: more in-home services 

I am a 70-year-old caregiver. I take care of my daughter. State of Tennessee won’t 

give me help because they say my situation is not critical. I have hypertension and I 

am diabetic. It gets very hard for me at times. I don’t have time for myself.

Caring for elderly parents and children while saving/trying to retire 

Working longer while caring for aging parents 

8. Housing, Neighborhoods, and Safe Communities (including home repairs and utilities) 

Decreasing number of options; income not sufficient to cover 

Help! Build . . . they will come 

Housing (accessible, affordable) 

Safety

Affordable living communities 

Help keep up the community with tree cutting and street repair 

Retirement communities with access to shopping, activities, no maintenance=safe 

environment 

Some of them face housing problems.

Downsizing to livable communities – ordinances that promote mixed use/size housing 

Reasonable housing

Explain the State of TN Housing Recovery Act. How will this affect their home if 

services are given. 

By allowing home owners tax exemptions once they reach 65 years. Of age 

Apply for next round of 811 housing vouchers 

Crime (drugs, guns) protection 

Existing housing stock not accessible or able to promote “aging in place” – fund 

home repair/modification efforts, use volunteers. 

9. Funding/Resources 

Few resources

There may be limited resources and the State must be ready to aid in supplying the 

short fall 

The state can help with funding & create new problems 

Funding for housing and develop start up services for elderly 

They need help in paying bills 

Tennessee – State Plan on Aging 2014 - 2018 525
Shelby County has lost funding to service seniors – increase budget 

Financial assistance 

10. Other: 

A prevailing attitude of RESPECT for elders/treatment of dignity 

Several emotional barriers – address the barriers for actual healing 

Recognizing that patience is a work in progress. As helping professionals this point 

we certainly want to convey the importance. 

Public services

Engage lower income seniors in the advocacy movement 

Engage the corporate world 

The demands of the baby boomers will demand different things than seniors today – 

 TN will needs to balance the needs of the aging. 

Need someone to advocate for them since many are unable to do it themselves 

Better coordination of services 

Not really coming to grips with getting older 

Need people focused government vs. corporate health 

Tennessee – State Plan on Aging 2014 - 2018 526
Aging Commission of the Mid-South Area Agency on Aging and Disability 

Pink Palace, Memphis 

February 14, 2013 

Question: Here are seven (7) aging and disability issues. 

 Under each, there is a list. 

Mark the ones on the list that you think are most important. 

Number of Questionnaires completed: 56 

Response # of 

responses

%

1 Transportation for people who don’t drive cars 38 67.9

2. Keeping healthy through exercise and eating healthy 37 66.1

3. Not having enough insurance or money to pay for doctors or medicine

4. Getting care at home instead of in a nursing home

5. Housing that people on a pension or Social Security can pay for

36 64.3

6. Learning new things 34 60.7

7. Learning how to live with a serious condition like heart disease, cancer,

 arthritis 

8. Being able to get help when needed quickly and without hassle

9. Training for aid workers who help older adults and people with 

 disabilities

33 58.9

10. Being able to get accessible transportation 32 57.1

11. Affordable dental care, hearing care and eye exams and glasses 31 55.3

12. Learning about how to take care of yourself so that you don’t get sick

 and tired

13. Teaching doctors, nurses, and other healthcare workers to know the 

 special needs of older adults and people with disabilities

30 53.6

14. Protect people from abuse

15. Respite services

29 51.8

16. Houses that are easy to get around in if you’re on a walker or in a

 wheelchair

28 50.0

17. Learning about how to care for someone at home 27 48.2

18. Neighborhoods that are easy and safe to walk in 26 46.2

19. Being able to choose the workers who come into your home

20. Teaching volunteers to work with older adults and people with 

 disabilities

25 44.6

21. Eating out with friends

22. Teaching police, Firemen, emergency workers to know the special 

 needs of older adults and people with disabilities

24 43.9

23. Neighborhoods that have grocery stores close by

24. Places to volunteer

25. Meeting people and making new friends

23 41.1

Tennessee – State Plan on Aging 2014 - 2018 527
26. Meals that are healthy and prevent hunger

27. Knowing where to call for help and getting help without a big runaround

28. Understanding how Medicare works

29. Help with memory loss

22 39.3

30. Learning how to prevent falls 21 37.5

31. Help with chores like lawn mowing and leaf raking 20 35.7

32. Help with feeling sad or lonely 18 32.1

33. Reasons people have to go into nursing homes

34. Being able to get accurate information from a website and being able to

 apply for services on-line

17 30.4

35. Reasons people have to go back to the hospital 16 28.6

36. Making decisions about health insurance, Medicare, and planning for the 

 future without depending upon the government

15 26.8

37. Help with taking too much medicine 13 23.2

38. Help with drinking too much alcohol or taking drugs 9 16.1

Tennessee – State Plan on Aging 2014 - 2018 528
Aging Commission of the Mid-South Area Agency on Aging and Disability 

Pink Palace, Memphis TN 

February 12, 2013 

Question: What is currently working well in your community? 

(like agencies that help, neighbors who help each other, van service, senior center, 

meal sites, food pantry, healthcare clinic, nursing home, sidewalks, police 

presence, grocery stores that deliver) 

(Number of Questionnaires containing 1 or more responses - 30) 

This open-ended questionnaire was designed to allow attendees to identify the community 

programs and services that have worked for them and in their community. Evidence based 

and/or proven practices were not a consideration in the design of the questionnaire and no 

checklist was provided. The above items in parentheses were provided as examples. Attendees 

were asked to write in the programs and services that were working well in their community. 

The responses are individual and specific to the region served by the Area Agency on Aging and 

Disability. The number of attendees who indicated that the program is working well in the 

community is provided in parentheses (). 

All of the above serve a fraction of purpose

There are services in my neighborhood who also provide van service and assist with 

grocery store delivery

Grocery stores that deliver

Meal sites (3)

Meals on wheels

MIFA – meals on wheels – congregate meals

Commodities

Senior center (6)

In my community the senior center works well. We have a place to go and learn or 

refresh what we know, like knitting, the computer, the movies and getting to be 

around people to laugh, dance and enjoy

Senior center activities and educational meetings

Great senior center facilities – under utilized, but available

Senior center activities and educational meetings

Healthcare clinic (4)

Police presence (6)

Law Enforcement Agencies provide some education

Senior crime stoppers/Senior B Safe programs

The aging commission in the Mid-South does a wonderful job at accessing the needs of 

the aging.

Van services (3)

There needs to be MUCH, MUCH more services for medical services for the disabled.

MCIL; I do not see a lot that is working well.

MIFA – ombudsman program to provide advocates for nursing home residents

Lauderdale Commission on Aging (many programs)

Tennessee – State Plan on Aging 2014 - 2018 529
Faith Based Organizations – food, meals

Deltas Human Resource Agency – food and van service

Arnold’s Drug Co. in Hale – delivers medicines

Sidewalks (2)

I don’t know of any

Neighbors who help each other (4)

A company called Top Priority Homemaker Services. This company was introduced to me 

from a good friend of mine. She is getting a home services through the Choices program. 

The other came out and met with me and after about 2 months I’ve got the service started 

for me. If not for the information from my friend, I would not have know about this 

program. Thank you.

Free community senior expo’s that have vendors who serve seniors available to 

provide education what is available to the.

Free senior expo’s to give out information

Services that are affordable to seniors – need more

Agencies that help (3)

Nursing home (2)

Public Guardianship for the Elderly

Although extremely under funded and busting at the seams, the Public Guardianship 

program provides URGENT SERVICES for person who can no longer help 

themselves. Sometimes it happens – we don’t wish it or want it to happen – but it does 

and we need to admit this need and provide for it!

Fire Department comes into our homes to install detectors

Choices waiver is great, but needs expansion to include housekeeping and maybe yard 

work for seniors and people with disabilities who can’t pay for these services.

Food pantry

We have a good pantry and get food from Memphis food bank who often runs short of 

food – they need donations.

Tennessee – State Plan on Aging 2014 - 2018 530
Aging Commission of the Mid-South 

Area Agency on Aging and Disability 

Pink Palace, Memphis 

February 14, 2013 

Small Focus Group Responses 

Tennessee – State Plan on Aging 2014 - 2018 531
Aging Commission of the Mid-South Area Agency on Aging and Disability 

Pink Palace, Memphis 

February 14, 2013 

Facilitator Notes for Small Focus Group 1 

Housing does not allow for aging in place

Heating, cooling, pest control

Waiting list

Easy assistance

Better access to services

Falling between the cracks 

Work better with physicians to sent out information

Make greater effort to stay in community

Expand community support

Transportation to go back to work

Are seniors being provided the opportunity to stay informed

Seniors and technology – how do we get senior acquainted with technology?

Elder abuse

Formula how we allocate dollars to programs

Abuse in nursing homes

Facilitator Notes for Small Focus Group 2 

There is a need for more contact with/ oversight for older people who live in facilities, nursing 

homes and have no children, family or friends who watch out for and advocate for them.

Difficulty with transportation to dr appointments with adults on disability Medicare. Medicare 

does not pay for transportation. Transportation costs are expensive and inconvenient. 

There is a big hole in services for non-elderly adults with disabilities. Options wait list goes 

on for years.

It seems like all services are cutting back.

Income restrictions on Choices, makes folks become almost destitute before they can receive 

services.

It’s a struggle to keep houses safe and livable, energy efficient, well insulated, painted not 

falling apart. 

Things that work: VA has some self directed care and also offers a foster family program for 

veterans who have no one. Families are screened before placement and are paid a foster 

family monthly fee. 

Facilitator Notes for Small Focus Group 3 

Health care in the suburbs – hard to get to – transportation

Hearing, seeing, eating

Physicians who will accept Medicare

Evidence-based programs – Matter of Balance

In-home services

Victims of fraud and scams

Long-distance caregiving – consider bringing in outside help – emotional, financial

Tennessee – State Plan on Aging 2014 - 2018 532
Transportation – huge issue

Computer information not so important

CHOICE of caregiver very important

Safe, accessible housing

How to prioritize which neighborhoods for curb cuts (?)

Home mods. – bathrooms

TN Housing Dept, - problem – won’t help renters

Facilitator Notes for Small Focus Group 4 

Staying Healthy While Aging

Learning how to live with a serious condition such as dementia/memory loss

38104, 38109, etc. needs local med. home in the community

Health and Wellness

Getting care at home instead of a nursing home – simplify, streamline & centralize approval to 

7-10 days of less

Understanding how Medicare works – Dept. of Commerce & Insurance – regulate/guidelines 

for marketing Medicare – stop (all phone) solicitation

Caregiving

More affordable options for respite services

Housing

Help with companion care for light errands

Transportation for people who don’t drive cars

1) decrease wait (from phone to action) from TennCare < 3 days to written 24 hours

2) more reliable transportation

3) more affordable transportation

4) expand geographic limits (to Drs. East)

Increase private/public partnerships to improve/develop affordable healthy habits(?) (reduces 

blight/crime)

Staying Connected and Involved in the Community

Affordable internet services (seniors, kids, grandkids’ school work, etc.)

Communication between service providers, ideally electronically

Working with Older Adults and People with Disabilities

Dementia training for all works, professionals, and volunteers who help older adults and 

people with disabilities

Other

The Alzheimer’s Association offers family caregiver training at no cost. Professional training 

for a fee.

Tennessee – State Plan on Aging 2014 - 2018 533
Facilitator Notes for Small Focus Group 5 

Issues and Possible Solutions

Health Financing:

Medicare D – existed 7 years – need more information

SHIP program – 7 workshops – for new Medicare beneficiaries – 4 in Shelby, +1 per other 

county = pilot program

140,000 in Delta AAAD area (4 county)

Medicaid – people need information

Social Security:

People need more information on SSI

Big issue of Education people – communicating

Suggest: Rural TN vs. Urban TN? Communication needed

Transportation:

Need to get elder driving skills assessed at TN-DOT. Need to be able to request the elder 

parent, etc. come in for assessment – need to be based on traffic area and on individual basis, 

for ex. on prior accident

Senior Centers:

Cuts in funding – need more funding for transportation in rural areas

Choices program:

To keep people out of nursing home

Concern for caregivers –

Need TEAM decision on nursing home admits

Facilitate Sr. Volunteering:

R.S.V.P. not currently through AAAD

Increased retirement age: 

How does it impact employers and how do they react?

Need workplace incentives (tax wise?) to retain older workers

Technology/ computers & Literacy issue – adults:

Use RSVP volunteers and Teach for America

Medical records:

Need to follow individuals and allow necessary access

Food needs

Awareness of elder abuse – need more adult protective services – only 1 in our AAAD

End of Life Care – Major Luttrell

Tennessee – State Plan on Aging 2014 - 2018 534
Facilitator Notes for Small Focus Group 6 

Staying Healthy While Aging – NEED:

Information and education about benefits of proper diet and exercise

Access to medical care and medications (undesirable transportation options and unaffordable 

for some)

Preventive health care screenings

More accommodating transportation options (some must wait 2-3 hours for buses and never 

get to medical appointments; no help for getting to/from appointments; Memphis Area Transit 

Authority charges $1.50/trip, but is unreliable)

Ramps on homes in order to be able to get out to go anywhere

Leaders to collaborate to place focus on transportation from quality of life perspective

Health and Wellness – NEED:

Transportation options that are more accommodating (long waits; may never get to 

appointments)

Lower gas costs (if own vehicle or if taking ride from friend/family and want to help pay for 

gas)

Benefits' eligibility to be less rigid, based on need, rather than on “numbers” (“Look at person 

and not at numbers.”)

Lower cost of “private insurance” (reference to Medicare Supplement Plan by consumer with 

high enough income that her Part B premium was $140/month – she didn't know why, but 

another member of the group explained the income-based fee scale to her)

Campaign to lessen distrust of government and ensure confidentiality so more people enroll in 

benefits (make information on complex topics simple, inasmuch as possible)

Campaign to increase awareness of young people about the achievements and value of older 

people (lack of respect from young people evident; treated badly at DHS and other offices)

Government to reach out to people in zip codes where low-income persons live to enroll

them in benefits (no excuse for people to miss out if government would act)

Family members to be more involved in care of elders

Restructure system to eliminate the flood of marketing mail and phone calls to people new to 

Medicare and during Open Enrollment periods (very confusing and misleading)

Insurance companies penalized for lying to consumers

Better communication between agencies/health and drug plans and government departments to 

help and protect consumers

Classes/training for all persons about to go on Medicare

Require Congress to have the same benefits as regular citizens

Distribute information about Medicare, programs and other services at places people 

commonly frequent (suggested WalMarts, McDonald's, groceries, pharmacies, places of 

worship)

Caregiving – NEED:

There were no comments on this topic.

Independence and Getting Services Easily – NEED:

Eliminate automated phone systems and have real people answer phones at agencies older 

Tennessee – State Plan on Aging 2014 - 2018 535
persons need to contact about benefits or services (very confusing, unless computer-savvy, 

can't navigate)

Foster respect for older adults and those with disabilities among young people

Transportation options that are more accommodating (long waits; may never get to 

appointments)

Lower gas costs (if own vehicle or if taking ride from friend/family and want to help pay for 

gas)

Benefits' eligibility to be less rigid, based on need, rather than on “numbers” (“Look at person 

and not at numbers.”)

Family members to help more to preserve and extend consumer's independence

Government to reach out to people in zip codes where low-income persons live to enroll them 

in benefits (no excuse for people to miss out if government would act)

Better communication between agencies/health and drug plans and government departments to 

help and protect consumers

Classes/training for all persons about to go on Medicare

Distribute information about Medicare, programs and other services at places people 

commonly frequent (suggested WalMarts, McDonald's, groceries, pharmacies, places of 

worship)

Ramps on homes (said only people who get ramps are those on Choices)

Housing, Neighborhoods and Safe Communities – NEED:

Affordable retirement communities (suggested income-based sliding fee)

Break on property taxes (woman cited $1,000 city tax, plus $900 county tax, saying she didn't 

know where she would get money to cover those)

Eliminate wheel taxes for seniors and persons with disabilities

Give seniors and those with disabilities a “fresh start” on credit

More shelters for homeless persons, especially for those who have disabilities

Staying Connected and Involved in the Community – NEED:

Transportation options more readily available than three-day advance registration, at minimal 

or no cost to consumer, and willing/able to take on necessary and elective trips

Working with Older Adults and People with Disabilities – NEED:

There were no comments on this topic.

Other

This group was comprised of three MCO representatives, one younger person with a disability 

(uses a wheelchair), two human service agency professionals and three consumers. The 

woman with a disability was largely quiet, but did echo her agreement with the needs 

identified by others in the group.

Facilitator Notes for Small Focus Group 7 

Staying Healthy

Prevention is priority to prevent other issues – if they eat right

Resources to purchase healthy foods

Access and economic means to buy food

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Should make better choices – education is needed early on with children to sustain healthier 

eating habits for long term 

Genetic factors should be considered as well – holistic perspective

More community involvement

Health and Wellness

Live in home main concern – independence in homes with some resources – some have strong 

desire to be independent

Stressed – don’t want to go in nursing home

Not have insurance, co-pays – resources

Have age restrictions Medicare

Large population not informed about Medicare

Reach limit for services – major concern

Lack of communication between doctors and hospitals - * all providers

Education at early age to save so they can prepare for future

When you recognize (not deny) symptoms for dementia/Alzheimer’s – seek assistance from 

family

Abuse happens in nursing homes

Caregiving

Self-preservation is important for caregiver

Family may abuse other family members as well

Tighter control over home care agencies – minimum for approval – which translates 

to workers – just doing a job – not really taking care of client

Independence and Getting Services Easily

#3 and #4 definitely (Being able to choose the workers who come into your home; Being able 

to get accessible transportation)

Housing, Neighbor and Self Control

Need to develop Safe communities 

Need walkable areas

Need for healthcare providers within the community

Staying Connected

Learning new things

Seniors have no where to go – senior centers are important for socialization

Working with Older Adults and People with Disabilities

Never get enough training

Continuing education for police, firemen, etc. and doctors is important 

Other

Seniors and those with disabilities need motivation and encouragement!

Nursing Homes – pretty on outside with nice amenities – but care is unacceptable – needs 

improvement, especially on 3rd shift

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Facilitator Notes for Small Focus Group 8

Increase of cost to eating healthier

Baby Boomers don’t have resources to support self in retirement

Need to learn to grow vegetables

Gardens – community gardens

Pick your own (Shelby farms)

Farmer’s Markets are expensive – need volunteer gardens for low-income

How can limited seniors access gardens? Transportation; disabilities – this might be “pie in 

the sky” – maybe need to share with others

Need delivery services – shop for seniors

Mid-America goods

There’s a meals on wheels waiting list now – need better way to reach everybody

Need more programs on TV designed for seniors and people with disabilities (make sure it’s 

not same time as their “stories”)

Older adults need socialization and others to exercise

If you don’t get out and socialize – transportation is the key

Aging in place is good and in the community is good – not enough independent senior living

facility

Need to work on an article that living in own home is not the only option – stigma against not 

living in own home

Are there other alternatives to living in original home? It could be OK.

Need to start partnering with businesses when they start talking about retirement counseling –

llo at alternative living – start figuring it out when you’re 60 – look at options

“Partnership Program” “Own Your Future” – 2008 State incentives people who plan ahead –

nothing on State website about it – Gov. Haslam needs to revisit it

Change perspective that your assets are paying for your care – it’s not that you are “losing” 

your assets or home

Estate recovery – older person going without the care they need because they want to leave it 

to kids.

Not having enough income to pay for insurance – we don’t talk about the high cost of 

medicine – everybody has to take a cut

Medicare doesn’t cover hearing or vision which is a major issue in aging

More funding for in-home services – waiting list too long – just a little help

Hardeman program (MIFA) would help people stay in homes

More funding for in-home services – Waiting list too long – just a little help

Hardeman program (MIFA) would help people stay in homes

Cities and rural areas need to be more involved & coordinated – need to work together

Cities and counties need to address transportation and make it accessible and affordable to 

older people. (It seems to work for disabled, but it’s late, etc. – hours short) Seems to work 

better for “working disabled” than it does for “older disabled”

Sidewalks seem to be more accessible than it used to, but we need to make scooter

accessibility like we did bike lanes

ACMS as focal point – it’s improved and people aren’t getting the runaround, but not all 

people know about it

Tennessee – State Plan on Aging 2014 - 2018 538
Call, intake, then find out there’s no help or waiting list – hard to give over the phone what 

they need to hear

Seniors get taken advantage of the complicated Medicare/advantage plans need better 

regulation

Safety net and focus for those who cannot make decisions on their own. This population is 

growing as fast as the aging population. Vulnerable populations

Surprising:

Automated phones a problem

Government waste in TN – why wasn’t this money spent on elderly? (UCDD, corporate 

welfare to General Motors)

Wrong to stick things in bills

Vulnerable adult population growing

Facilitator Notes for Small Focus Group 9 

Stay Healthy While Aging

Not exercising and eating healthy foods can cause illness

Affordable dental care, hearing care, and eye exams and glasses important

Learning how to prevent falls – huge problem requiring rehab can cause so many problems

Preventive care

Health and Wellness

Concern about not having enough insurance

Elderly individuals feel more comfortable at home

Concern about making health insurance decisions and planning for the future without 

government

Help with feeling sad and lonely – spouse passing, empty nest

Help with drinking too much alcohol or taking drugs – baby boomers

Protecting people from abuse

Caregiving

The table agreed all three very important – respite care, learning how to care for someone at 

home, and learning how to take care of yourself

Independence and Getting Services Easily

Being able to choose workers – personal space

Being able to get accessible transportation – proper training to transport people with walkers 

or wheelchairs

Housing, Neighborhoods, and Safe Communities

One person said all issues in this category were important

Transportation to dr. appts., errands

Life changes but house doesn’t without making renovations – wheelchair ramps

Tennessee – State Plan on Aging 2014 - 2018 539
Staying Connected and Involved in the Community

Places to volunteer

Learning new things – keeping up with technology – cell phones and computers

Eating out with friends – interaction, socialization

Working with Older Adults and People with Disabilities

Geriatric training very important (paid workers, police, firemen, emergency workers, doctors, 

nurses, healthcare workers, and volunteers) – older adults will not be intimidated to go places 

thing people will not know how to care for them if they fall

Other

Legal services – government funded free advocacy for people in nursing homes and assisted 

living

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Attachment N 

Public Hearing

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Public Hearing 

Tennessee State Plan on Aging 2014-2018

May 7, 2013 

 Fifty Forward 

Patricia Hart Building 

174 Rains Avenue 

Nashville, Tennessee 

 

Number of Attendees: 48 

Tennessee – State Plan on Aging 2014 - 2018 566
Public Hearing 

Tennessee State Plan on Aging 2014-2018 

Fifty Forward 

Nashville, Tennessee 

May 7, 2013 

Number of Attendees: 48 

Name Organization

Tracy Beard Tennessee Disability Pathfinder

William Von Schipmann Tennessee Commission on Aging and Disability volunteer

Jo Evans South Central Tennessee Area Agency on Aging and 

Disability

Dennis Temple Tennessee Department of Mental Health and Substance 

Abuse Services

Wanda Willis Tennessee Developmental Disability Coalition; Tennessee 

Commission on Aging and Disability member

Alice Kirby Tennessee Federation on Aging

Cheryl Mingle Tennessee Association of Senior Centers

Kathy Whitaker First Tennessee Area Agency on Aging and Disability

Deborah Lively Tennessee Health Care Association

Wanda Simmons Southwest Tennessee Area Agency on Aging and Disability

Patricia Miller Tennessee Commission on Aging and Disability member

Rob McRae citizen (Hamilton County

Carrie Hobbs Guiden The Arc of Tennessee

Robin Rochelle South Central Tennessee Area Agency on Aging and 

Disability

Aaron Bradley East Tennessee Area Agency on Aging and Disability

Elaine Graf Aging Commission of the Mid-South

Rachel Henderson Tennessee Health Care Association/Tennessee Center for 

Assisted Living

Tommy Preston Southeast Tennessee Area Agency on Aging and Disability

Maribeth Farringer Council on Aging

Normal Powell Greater Nashville Regional Council

Ken Kisiel Tennessee Commission on Aging and Disability Chairman

Lucy Utt Tennessee Commission on Aging and Disability staff

Ludell Coffey Tennessee Commission on Aging and Disability member

Carol Moore Slater Tennessee Disability Pathfinder

Ruth Garrett Consultant

Carol White Benton County Office on Aging/Tennessee Federation on 

Aging

Rebecca Kelly AARP

Donna DeStafano Tennessee Disability Coalition

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Dora Ivey Aging Commission of the Mid-South

Grace Smith Meharry Geriatric Center

Patty Ray Upper Cumberland Area Agency on Aging and Disability

Ryan Ellis Tennessee Commission on Aging and Disability staff

Jim Shulman Tennessee Commission on Aging and Disability staff

Diane Gramann Mental Health America of Middle Tennessee

Connie Rigsby Tennessee Association of Senior Centers

Lynne O’Neal Tennessee Department of Health/Tennessee Commission on 

Aging and Disability member

Susan Hill Northwest Tennessee Area Agency on Aging and Disability

James York Tennessee Commission on Aging and Disability member

Holly Williams Upper Cumberland Area Agency on Aging and Disability

Rose Rubin Tennessee Commission on Aging and Disability member

Joyce Paggeot Tennessee Commission on Aging and Disability member

Anna Lea Cothron Vanderbilt University

Carol Westlake Tennessee Disability Coalition

Janice Wade Alzheimer’s Tennessee

Jean Renfro Tennessee Commission on Aging and Disability staff

Cindy Warf Tennessee Commission on Aging and Disability staff

Kathy Zamata Tennessee Commission on Aging and Disability staff

Jackie Bruce Tennessee Commission on Aging and Disability staff

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Public Hearing

Tennessee State Plan on Aging 2014-2018 

May 7, 2013 

1:30 p.m. 

Introduction and Overview of the State Plan on Aging 

Kathy Zamata, Deputy Director, Tennessee Commission on Aging and Disability opened the 

Public Hearing by announcing that this is an official meeting and that the meeting is being 

recorded. Please use the microphone when making comments and begin with your name. Kathy 

introduced Jim Shulman, Director; Ryan Ellis, Cindy Warf, and Jean Renfro. Commission 

members in attendance were asked to raise their hands. Staff members from the Area Agencies 

on Aging and Disability were also asked to raise their hands. Copies of the draft State Plan and 

the funding formula were distributed. 

Kathy reported to attendees that there are two methods to provide input into the State Plan –

verbal comments and/or written comments. A form to provide written comments was 

distributed. Following Kathy’s overview of the Administration on Community Living’s Program 

Instructions, the State Plan narrative, goals and objectives, and the funding formula, the meeting 

will be open for comments. State Plan narrative and appendices will be posted on the website. 

Kathy reminded the audience that this plan was written for both the State and the Administration 

on Community Living. 

Kathy reviewed the Program Instructions that identified the required elements of the State Plan 

and then presented an overview of each chapter in the current draft of the State Plan, especially 

Chapter 2 that identified and described each of the ACL required Focus Areas (federally funded 

programs). Chapter 2 also included a description of the available State funded programs. 

Chapter 3 focused on the needs assessment and the baby boomers impact on the aging and 

disability system of services. The current system of services has 9,000 on a wait list without the 

impact of sequestration. The goals and objectives incorporated the Commission’s Strategic Plan, 

the information from the Governor’s Summit on Aging, and the Administration on Community 

who contracts with the Lewin Group’s Assessment of Tennessee’s Aging and Disability 

Resource Centers (ADRCs). 

The intrastate funding formula has not changed. The funding formula uses a weighted system. 

The Older Americans Act provides the funding and the funding is distributed to the nine (9) 

regions based on a weighed system. TCAD must make certain that the required target population 

(rural, low income, minority) receive services as specified in the Older Americans Act. 

Comments from Attendees 

Diane Gramann, Manager of Program Services for Mental Health America of Middle 

Tennessee: Is your SHIP unit going to work with the Navigators across the state to include 

the health care market information? 

Tennessee – State Plan on Aging 2014 - 2018 569
Jim Shulman, Executive Director, Tennessee Commission on Aging and Disability: That 

keeps coming up in terms of discussions that the federal government is sending down 

through SHIP to talk about it. Because of where the state is right now in terms of how this 

... we’re not exactly sure where we’re going to end up. We’ve been kind of holding that, 

trying to get a chance to talk with the Administration to figure out where we’re going to be 

or what we can do. I think that Shannon Jones has done a good job of accumulating all of 

this information and saying “they’re pushing us to do it”. But, before we... because it’s kind 

of a minefield right now within the State, we are trying to figure out what is the proper role 

for us to do? So the answer to your question? I don’t know. I know that Shannon is feeling 

pressure from the federal government to say SHIP people are supposed to do this. We’re not 

sure where we are supposed to be and we’re trying to figure that out. Then you have the 

federal government coming in with the Navigators and all of the other things. But, we’re 

hoping to figure that out, probably soon. We don’t know who will pick up the ball and move 

on this. We’re not sure if it’s going to be us. We’re willing to help.

The speaker announced that on June 10, the Mental Health American of Middle Tennessee 

will hold the First Annual Aging and Behavioral Health Symposium. This program is the 

result of the Policy Academy. It is free of charge with on-line registration. 

Kathy Zamata, Deputy Director, Tennessee Commission on Aging and Disability: The 

interesting part, I thought, the things that came out on the top 10, substance abuse was low. 

The interesting part to me was when we were sitting in listening groups and if I had a group 

of providers, it was way up. But if I had a group of seniors, it was like not an issue. So, I 

think that it has a lot to do with perspective and who actually was answering the 

questionnaire. As the baby boomer population hits us, our baby boomer drug use and alcohol 

abuse is moving on up. I think it’s going to be an issue.

Rebecca Kelly, State Director of AARP: Thanks for this. Thanks for the Listening Tours 

across the State. I’ll also say that I think that’s it’s going to take all of us ... educational 

information, but we also need to lean on the SHIP folks, providers will also need to do that 

as well. Curious, as I look at these, and actually, Aaron and I were talking earlier it looks 

like we are reorganizing the priorities. I see it here again ... in terms of how.... we can 

access information. One of the things that may be missing, but may be included, is financial 

security, in general, and jobs. Any thoughts on why those might not have shown up? Then, I 

would comment on the 5th goal, the sooner we can do that the better. It’s critical that we 

have that type of conversation. 

Jim Shulman, Executive Director, Tennessee Commission on Aging and Disability: I will 

say the #1 issue was concern on not having enough money to pay for vision, dental and 

hearing, and #2 was not having enough money, so financial security was showing up in 

different places. If it’s “I’m scared of estate planning”, or whatever, I think that’s out the re. 

It’s showing up in some specific things depending on the issues. What, I think we heard 

when we went out, was that we are very worried about money, and not having enough 

money. We hear that when we go out to visit Senior Centers, and when the SHIP people go 

out to talk about Medicare. They’re spending all of their resources down. That’s one of the 

concerns, regardless of this, they worry about, and I’m sure you all do, too, is how do you 

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protect people’s assets? How do you make sure that when you’re getting older that their 

assets are protected? One of the things that we’ve talked about, as you turn age 40 or age 50, 

or whatever, to give people advice so that they don’t ... you know when they turn 60’s and 

70’s. I’m not sure why jobs didn’t show up. I’ve heard that before, I’m not sure the reason 

for it. When we were sitting around during the talk, I don’t remember that coming up as an 

issue. 

Kathy Zamata, Deputy Director, Tennessee Commission on Aging and Disability: The only 

place I remember it was in Clarksville where they said that they wished they had part-time 

jobs. 

Dr. Ruth Garrett, Geriatrics Education Consultant, Vanderbilt University Center for Quality 

Aging: First of all, you have all done a great job and the plan is very well done. I think that 

we should give them a big hand for doing such a good job. In any other State Plan, I’ve 

looked at the Virginia State Plan and I see some solutions which are mentioned in here. One 

of them is volunteerism and I think that is a big resource to tap, and I think it should be that 

locally every Senior Center could take charge of a volunteer program. I think that’s how it 

should happen. I think you’re off to a great start. I offer the solution that ... the aging in 

place. When I looked at the Virginian plan, it first focused on aging in place, and the second 

major focus was on volunteerism and how they were able to manage. I’m wondering about 

the cutbacks on Medicare/Medicaid. I’m trying to look at the entire plan to see where we 

have to go to accomplish it; it’s very complex and it’s there in writing. It is the first time 

that it’s been there.

Maribeth Farringer, Executive Director, Council on Aging of Greater Nashville: One thing it 

talks about to me was about cross training staff, I’d love to see it go beyond that. At our 

agency, we get calls all the time from hospice and hospitals that don’t know what services 

are out there. Perhaps, once the area agencies and the Commission on Aging are trained, 

they could then train providers to get a more direct line of what services are available. 

Patty Ray, Director, Upper Cumberland Area Agency on Aging and Disability: Ok, in 

looking at the Senior Center section, it says 50% of senior centers will have a minimum of 

two AIRS certified staff, my question is will that be accomplished by a contract requirement 

or how will that be implemented? The second part of my question is AIRS certification is 

expensive, and since the AAADs already have to be AIRS certified, why would they have to 

have two AIRS certified staff in the Senior Centers? 

Dr. Ruth Garrett, Geriatrics Education Consultant, Vanderbilt University Center for Quality 

Aging: What does AIRS stand for? 

Kathy Zamata, Deputy Director, Tennessee Commission on Aging and Disability: I can’t 

remember what the acronym stands for. 

Carole Moore-Slater, Program Director, Vanderbilt Kennedy Center, Tennessee Disability 

Pathfinder, UCEDD: It stands for Alliance of Information and Referral Systems (AIRS) and 

it’s kind of the mother ship for information and referral whether its 211, area agency on 

Tennessee – State Plan on Aging 2014 - 2018 571
aging, etc. The purpose is so that people who need information and referral are kind of on 

the same page, that when you’re talking about family support groups, for example, which is a 

service, that you know what family support is. The problem with many sources in a state 

like Tennessee, there’s not many places out there so you have to be really sharp about how to 

access databases and how to find services. Because of this, I cannot see why our senior 

centers may need to be AIRS certified. It seems that training could be done without having 

to go through a national test that certifies you. You could have a training manual, and if 

you’ve got good staff who are certified then it seems that would be helpful. The other part of 

that is I’m more concerned about finding resources. I’m with the Tennessee Disability 

Pathfinders and we are an information and referral system statewide program for all ages, all 

disabilities and all nationalities. The thing that I’m more concerned about is finding 

resources because that’s my passion. I would suggest that part of that would be even more 

important than folks being certified are whether or not the information is accurate and 

current. The databases on the AAA’s websites, they know what’s going on in their 

area/districts. You need a good database, and from the disability perspective, our agency’s 

database is user friendly... we’ve helped people across the state. We’re committed to that 

particular population and I call AAADs to back us up. I am more concerned about the 

resources than I am the AIRS certification. In Tennessee, something about services because 

of the way that funding is organized in the grant, and something pops up ... if you ... you’re 

not going to find it. I trust the AAADs. 

Kathy Zamata, Deputy Director, Tennessee Commission on Aging and Disability: My 

response to the senior centers and the AIRS certification is it appears to us that many people 

go to the senior centers for information, and they go to the senior center director because 

they are the trusted person in the community. A lot of people are more likely to start there 

instead of the area agency. So when we put that in there it was a matter of trying to 

encompass the “no wrong door” concept and the people who were getting out the information 

at the senior center were certified. That’s where we were going with that and helping them 

provide ... I mean, from our state level helping them to provide training for them on that.

Carole Moore-Slater, Program Director, Vanderbilt Kennedy Center, Tennessee Disability 

Pathfinder, UCEDD: You know TNAIR has more than training ... In that organization ....

Janice Wade Whitehead, Executive Director, Alzheimer’s Tennessee, Inc.: Thank you for 

putting emphasis on Alzheimer’s. I was pleased to see the possibility of the development of 

a good healthy Tennessee plan. We get a lot of questions from folks on brain health and their 

specialties that we have developed. I would hope that cognitive health would also be 

included. What we encourage is keeping folks socially engaged. As you have been talking 

about harvesting that resource in our communities, I think it would be great to put an 

infrastructure in place. 

Connie Rigsby, President, Tennessee Association Senior Center: One of the comments that I 

wanted to make, is where you were talking about having the requirement of the certification. 

But, also the accreditation, I know that a lot of senior centers are always working toward 

that. They’ve had a hard time in getting senior centers to do this, and they still have not 

accomplished it. My encouragement in putting it in is that there needs to be some 

Tennessee – State Plan on Aging 2014 - 2018 572
encouragement for those centers to go through that process. We need to have some incentive 

to do this because we do have some directors who don’t stay longer than two years and aren’t 

thinking about the certification because two years later she’s gone. Yes, we would, as 

directors, like to be accredited centers across the state but there does need to be some 

incentive for us to do that. 

Alice Kirby, Director, Fentress County Senior Citizens Center, and President for the 

Tennessee Federation for the Aging: I want to say thank you, this has been a great day of 

learning experiences. I got to see some people, hopefully, are making very good 

acquaintances and friends today. I wanted to say that when I read on page 6 about the 

description of senior centers, you’re right on with, you know, of what you’re doing. I’m not 

questioning any of you in here. I just want you to know that senior centers are viable. I call 

Patty (Ray) because she’s my boss in the Upper Cumberland. She talks all the time about the 

partnerships with senior centers. We like to call it the grassroots of where it’s happening 

because we interact with the people every day. We see it. I reach out to the AAADs. When 

somebody calls me, the great thing about being the senior center director, you don’t have to 

know everything. You can fudge a little bit, but you can place a telephone call and call Ms. 

Patty for answers. I’ve learned a lot in the last 3 years. Please know that everything that you 

do here is for one reason and it’s for those people. Think about the impact of the decisions 

you make here today and how it’s going to filter back to the people at the senior centers. All 

of the area agency directors who I know, I want to commend you for helping your senior 

centers and being a resource for us to help us in all we do. I want to thank you for all you 

do. Please remember if you doubt how viable a senior center is, call up and give ... it’s 

about the size of this room. Come visit Jamestown. 

Jim Shulman, Executive Director, Tennessee Commission on Aging and Disability: I’ve 

been to Jamestown twice and you all have it going on; it’s a really good place to go. The last 

time I was there, you had about 100 people and you had a lot of good things to do. So this 

may be a really bad question. I haven’t been through this process before but I think that the 

plan is very, very good. Here’s my question, we’ve got a list of about 10 items that are 

concerns for seniors across the board, and then we have a lot of goals and objectives to try to 

deal with that it. I guess my question is how we make sure that we stick to our guns and we 

deal with these issues. It’s kind of a weird question, because we’re the ones doing the report, 

but, what I don’t want to do is do the report, send it to Washington, have it approved and 

then it sits on my desk for 4 years, and then we do another 4-year report. What did we do 

about the last 4-year report? Very little. The question to me is would be, ok, we’re going to 

get this report done, and it’s going to go up to Washington, and hopefully, it’s going to be 

approved. But then, how do we make sure we’re dealing with this in following our goals and 

objectives? I guess the question is do we need to meet back here? All I know is that 

transportation did not get addressed and it’s sitting there in front of everybody and we left it 

alone. So, how do we take this document and make sure that we take care of the issues and 

actually follow our goals and objectives? What I don’t want to do is to do all this work and 

it just sits there. 

Maribeth Farringer, Executive Director, Council on Aging of Greater Nashville: There were 

two things. When our agency did a Strategic Plan, we appointed one person to keep on 

Tennessee – State Plan on Aging 2014 - 2018 573
everyone else. So at the monthly board meeting, there was a monthly report on where they 

were in their strategic plan. So it never got lost because it was their job to look at that plan. 

The second thing is that we always try to be ambitious in strategic plans such as this, and it’s 

probably doubtful that everyone on the plan will get accomplished by TCAD. But if the plan 

can be widely distributed to other agencies or even businesses that could perhaps take some 

part of that, such as the Council on Aging might do or AARP could do. But, we need to go 

to our boards and say that this has been identified as a priority and need and I think that more 

could be accomplished. 

Jim Shulman, Executive Director, Tennessee Commission on Aging and Disability: 

Maribeth, I like both of those and I like the idea of forcing the issue. So the second thing 

here is the question would be... so this is the TCAD plan, but, one of the goals that we are 

trying to do is partner out and to reach out without over stepping and getting in anybody’s 

way. If we start working on goals and start pulling together teams, would you all be willing 

to serve? 

Maribeth Farringer, Executive Director, Council on Aging of Greater Nashville: Our agency 

does that. We’re not a direct service provider so we might have some responsibilities to do 

that; I realize some other agencies that are service providers might not. 

Jim Shulman, Executive Director, Tennessee Commission on Aging and Disability: We 

would rather work with everyone rather than work quietly, or separately, or against from 

everyone. We don’t want any of that. So we want to pull people in so we can go ahead and 

give you Goal #1? Depending on who’s willing, I just don’t want to see it sit on the desk and 

not do anything. I will tell you this, we’ve got a strategic plan that our Commission set up, 

we have information from the Governor’s summit that they had in 2011, and then we have 

this (Tennessee State Plan on Aging). So, we’re trying to figure out how to put everything 

together into one, so that we’re not driving ourselves crazy trying to follow three different 

plans. So we’re working on that. But, once we get that and once we get the approval back, 

hopefully, in July that this has been approved, then I think it’s our responsibility to follow 

our own plan and your responsibility, as stakeholders in this, to make sure we follow the 

plan. The only way that I can think of to do that is probably bring everybody back in 

together and give everyone some time to provide feedback. We’re also responsible so you 

all should hold us accountable. We told people when we were going through the nine city 

tour; we said we’re listening to you because what your concerns are should be our concerns. 

We have to listen to people so that we can deal with this. If everyone is willing, I think that 

we ought to try to do that. 

Dr. Ruth Garrett, Geriatrics Education Consultant, Vanderbilt University Center for Quality 

Aging: I agree with you, we are the stakeholders. But I must say that the senior center 

directors are the first contact for seniors. I’m still concerned about going to a senior center 

site and the books from the Council on Aging are still in boxes stacked up against the wall. I 

think that our senior center directors are singularly responsible for disseminating 

information. In reading through this last night, I didn’t see how information would be 

disseminated to all of us. How will those people be contacted and how will information be 

disseminated? I didn’t see that in there. Also, thank you for the AIRS explanation. Also, I 

Tennessee – State Plan on Aging 2014 - 2018 574
would like to comment on the cognitive suggestion. All the plans I have read focused first 

on physical exercise because without it.... With everything I read on the Tennessee Diabetes 

and Obesity, I think the emphasis needs to be on exercising. The World Health Organization 

mentioned it... so I think we have to get people in shape first before we can get their brain in 

shape. 

Jim Shulman, Executive Director, Tennessee Commission on Aging and Disability: Well, 

you and I have had this conversation. I think that as much as the physical part is there that 

cognitive part is there, too. 

Dr. Ruth Garrett, Geriatrics Education Consultant, Vanderbilt University Center for Quality 

Aging: It’s really important that we’re going to get too far into that without saying ... I think 

that Maribeth’s suggestion is good, people have to take responsibility. 

Jim Shulman, Executive Director, Tennessee Commission on Aging and Disability: We’re 

just going to keep fighting over that and I’m going to have Janice on my team and we’re 

going to take you on. 

Carole Moore-Slater, Program Director, Vanderbilt Kennedy Center, Tennessee Disability 

Pathfinder, UCEDD: I just wanted to ask, the meetings that we’ve had ... where the 

Commission on Aging could partner with our Commission to select one of the goals that 

they’re passionate about, that they could agree to chair that particular committee. Then all of 

the people across the state, you could get the information out asking if you have a passion 

about an objective then you have something to add to this group, then partner up with that 

committee for that particular goal. Then you are organizing people who are interested in that 

particular goal and volunteering to help out. Then those committees meet on their own and 

they can organize together whether they do it by conference call or face-to-face meetings. 

They can develop a plan of how to do that goal and that might be a way to organize the 

objectives. This is an overwhelming document with lots of different objectives. But, if there 

are people working on individual things...

Jim Shulman, Executive Director, Tennessee Commission on Aging and Disability: Sure. I 

think that’s a great idea. 

Grace Smith, Meharry Geriatric Education Center: One thing that I would love to see 

enhanced in this report is a stronger vision of what we want to see in terms of aging services 

in Tennessee. We go from having all this feedback from the seniors from around the state. 

There needs to be some guiding principles that flow through all of the objectives and goals. 

Dr. Garrett shared with me the Virginia State Plan on Aging. And very early in their plan 

they articulate some guiding principles that flow through everything; healthy aging, exercise, 

disease prevention, etc. There are guiding principles that form all of the objectives and I 

don’t see that here. I see a flow into all of the existing services that are out there and they 

should be evaluated to make sure they’re following best practices. What are we striving for? 

What can we get people excited about? Keeping senior’s mobile, keeping them healthy, 

helping them stay active. I just feel that is a piece that could be injected and is missing right 

now. 

Tennessee – State Plan on Aging 2014 - 2018 575
Jim Shulman, Executive Director, Tennessee Commission on Aging and Disability: I think 

that’s right, but, I want to add this thought, too. The question would be that we’re looking to 

the creation of the healthy aging plan, and we’re trying to pull in the right people initially, 

and then we’ll have discussions. But, there is no Healthy Aging Plan in the State of 

Tennessee. The only one that we’ve seen is the one from Virginia. If you remember, we 

called looking nationally for a state for a health aging plan and we couldn’t find one. Why 

wouldn’t you have the basic parameters of how to do this? Once you do it, which is what 

drives the state plan. I think what I’m asking is can we put it into the state plan without 

having the healthy aging plan? Or does the healthy aging plan really have to be developed 

first and then onto the next step? I’m not sure. We’re talking about really good things that 

you’re talking about, but, we haven’t sat down and actually developed that plan yet.

Kathy Zamata, Deputy Director, Tennessee Commission on Aging and Disability: I think that 

you’re right, the guiding principal thing, I understand the concept and we can do that.

Grace Smith, Meharry Geriatric Education Center: I will send that information to you 

(Kathy Zamata). 

Patricia Miller, TCAD Commission Member: There are so many things here; it would be 

nice to have a structure because we do have guiding principles. We almost need a checklist 

up on the board of what to do and should be cross checked. Then you have all of these 

mechanisms and structures in place such as a strong volunteer system. Then you take 

everything on your to do list, and then you check off those things. So you have to have a 

plan just to mobilize volunteers, for example. So there is a lot more thinking in the room that 

I’m hearing. There’s a way of getting a mental picture of all of that into play and organized 

to make sure that anytime you’re working on this piece here, it’s in line to support that piece. 

I think that’s what I’m hearing and I’m seeing a way for other organizations to kind of keep 

that in place. Then another thought I had, how are we going to get everyone involved? How 

are we going to keep on track? How are we going to make sure that we’re monitoring? 

You’ve talked about having a project manager or somebody that’s a director familiar with the 

plan. Another concept that we use in organizations is we have people actually assigned 

responsibilities to do certain things. You’ve got a team working on it. We’ve got a concept 

called a sponsor; and, what the sponsor’s role is ... a sponsor may not even be in the direct 

line of anybody working there, but, they’re the go to person if they need something, such as 

if they need counseling or advise. So when someone needs something, then the sponsor can 

then talk to whomever they need to talk with to get problems resolved. So there are all types 

of structural layers you can put into place, but, I like the ideas of developing guiding 

principles. Simply, lay that out sort of like a matrix, to keep those ideas in mind. I’m 

looking at you because of your comments, is that all what you’re thinking about?

Grace Smith, Meharry Geriatric Education Center: Yes, because I think that the guiding 

principles will flow through all of the goals, objectives and program that already exist. 

Patricia Miller, TCAD Commission Member: It’s just a way to have checks and balance.

Tennessee – State Plan on Aging 2014 - 2018 576
Dr. Ruth Garrett, Geriatrics Education Consultant, Vanderbilt University Center for Quality 

Aging: I will e-mail three slides to Kathy Zamata. 

Aaron Bradley, Director, East Tennessee Area Agency on Aging and Disability: I love the 

idea of the guiding principles because really and truly you ask yourself the question does this 

lead me towards the guiding principles or away from the guiding principles. Regardless of 

the goals and objectives, I love that concept. The other thing that I want to say, we can try to 

do 100 things well, we won’t do any of them well. My hats off to the group that pulled this 

together; it’s about as comprehensive of a state plan as I’ve ever seen. Someone said a while 

ago, it is phenomenal the work that this plan represents. I’m a proponent of lets decide on 

the top 3-4 things that we want to try to accomplish and focus all that energy on those until 

we get it done. There is no comprehensive aging support plan in the State of Tennessee and 

it’s not going to happen unless we hold hands and make it happen. Healthy aging, that’s a 

huge, huge goal in and of itself that’s part of the bigger plan and comprehensive answer to 

this. I think that is what we have to try to hold hands and have a blueprint to get it done. 

Rose Rubin, TCAD Commission Member: I want to thank Kathy and staff for all their hard 

work. I want to thank all of you for being here for your contribution. I would like to build 

on two concepts which are the vision by attributes and really targeted objectives. I would 

like to add a third leg and that is to have some timelines somewhere and attach them to 

specific objectives, such as three months, etc. You need to have timelines which is the order 

to work on achieving those. 

Patty Ray, Director, Upper Cumberland Area Agency on Aging and Disability: Kathy, may I 

make a comment? When you talk about how do we stay on task? We could use conference 

calls to focus on our shared state plan. At our quarterly review, as the AAADs and with the 

TCAD staff, they could develop an outline. 

Kathy Zamata, Deputy Director, Tennessee Commission on Aging and Disability: I want to 

thank you all so much for coming. You are all very precious. We especially want to thank 

FiftyForward for providing the location. Anything else? Thank you very much. 

Meeting concluded at 3:15 P.M. 

Tennessee – State Plan on Aging 2014 - 2018 577
State Plan on Aging

Public Hearing 

May 7, 2010 

Written Comments Submitted During the Public Hearing 

1. Carrie Hobbs Guiden, representing the Arc of Tennessee 

Please include The Arch of TN in initiatives related to transportation, 

conservatorship, abuse prevention, self-directed services, training workers to 

support adults with disabilities 

Page 11-“mentally challenged” is not person first

Page 16—need collaboration with the Department of Intellectual and 

Developmental Disabilities, as well 

An Ombudsman is needed for HCBS programs (i.e. CHOICES); there are many 

issues and few ways to advocate for people in the program 

Objective #7—need to include people with disabilities in any abuse prevention 

efforts for vulnerable populations—this population has the highest rate of abuse 

Consider using term “conservator” over “guardian” to be consistent with other 

related programs and laws around this topic 

2. Elaine Graf, representing Aging Commission of the Mid-South 

Several areas include a review and potential revision to contract scopes of 

services. Will these changes be clarified prior to Jan. 2014 to enable the ACMS 

RFP and contracts to meet the SCG timelines? 

Goal 1-Evaluate and modify internal structure of SUA. Will this goal be included 

for AAADs in the new Area Plans for FY15? 

Objective 9—Senior Centers—will there be funding to support training and the 

goal of AIRS certification for senior center staff? Accreditation? 

3. Dora Ivey, representing Aging Commission of the Mid-South 

Focus Areas and Programs--Give SHIP to AARP. Better fit as AARP has a 

bigger volunteer program. 

Statewide Needs Assessment--800+ participants is excellent #. Great job TCAD! 

Challenges—p. 22 Outcomes—“increases” are not possible with stagnant and or 

decreased funding. Maintaining is our best chance, but decreases are likely 

Goals and Objectives—page 29. We have no luck with VAMC partnerships; 

page 32 will the intrastate funding formula be reviewed in State Rule? 35% 60+; 

30 % low income elderly; 10% low income minority; 15% rural’ 10% 80+; page 

21 senior centers may not have capacity to achieve accreditation; p 21. AIRS 

certification not realistic for senior centers; p. 25 volunteer coordinator not funded 

4. Alice Kirby, representing Tennessee Federation on Aging and Fentress County Senior 

Center

Focus Areas and Programs—p. 22 #8 this is not fundable for most senior 

centers—working with the AAAD—will—would and could work closer together 

to accomplish the same result—senior centers do not have staff or funding to get 

accreditation 

Tennessee – State Plan on Aging 2014 - 2018 578
Goals and Objectives—Hey-just get it done!; You have the plan; Assign a 

dependable human to each area—get it done—They Report to?; Seniors report to 

the AAAD—we are held accountable—Set your Goals—Get it done. 

5. Ludell Coffey, representing Commission—member

I’m pleased to see private pay and cost sharing addressed. Many seniors can

afford to pay at least part of the cost. Since unity cost is impacted positively by 

increased numbers of people and unit of services/meals, etc., private pay could 

increase (dramatically) the number of people served and the amount of service 

provided. 

6. Kathy Whitaker, representing First Tennessee Area Agency on Aging and Disability 

Page 22-Performance Measures—it will be impossible to increase number of 

consumers receiving services with decreases in funding 

7. James York, representing Commission (member) 

Executive Summary—provided a realistic view of the future needs 

Focus Areas and Programs—focuses on the basic areas that govern senior needs 

Statewide Needs Assessment—the plan makes realistic use of the needs 

assessment 

Challenges—adequately addresses the future challenges facing the State of TN 

Goals and Objectives—plan does an excellent job in forming the future of TCAD 

Note: Encourage each citizen to engage in senior living activities !! 

8. Donna DeStefano 

Challenges—Learning New Things—coordinate with community arts programs—

TN Arts Commission funds many exciting programs; Community gardens—some 

exist in communities (i.e. Metro Nashville Schools have program)—need to 

coordinate with them

Goals and Objectives—Aging in Place—need to get realtors involved—as well as 

developers/builders so more accessible homes are built—lots and lots of new 

homes being built and very few are accessible for people with mobility issues; 

Respite—critical need for caregivers—good to see the focus on this as well as 

Alzheimer’s needs

9. Carole Moore Slater 

Goals and Objectives—Objective 2. Strategy 6. Update resource database 

regularly—Comments: Remove database <Services, Find organizations> on 

tnaaad.org website. This database is not user-friendly, and the organization of the 

info is dated and not useful at all. Replace this database with links to AAAD 

agencies in each developmental district—(info may not be as current but 

organization of info is better, although I have not worked directly w/AAAD 

databases in several years. On this page should be a link to TN Disability 

Pathfinder for access to this statewide database and community, disability, and 

social services agencies>is updated annually. www.familypathfinder.org 

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UTAH

COMMISSION

O N AGING

ANNUAL REPORT 2013–2014

Executive Summary 2

Statutory Purpose 3

Commission Members 4–7

Utah ADRC 8–12

ePOLST 14–15

Livability Index 16–18

Utah Demographics 19–21

Music and Memory 22–24

Medicaid and Alternatives 25–27

HHS Presentation Highlights 28–30

Management and Leadership 31–32

INSIDE THIS REPORT

Utah – State Commission on Aging Annual Report 2013-2014 617
UTAH COMMISSION ON AGING | ANNUAL REPORT

Director’s Message

No longer do we signal the warning for an 

oncoming Silver Tsunami. The aging of our Utah 

population, with dramatic peaks of retirees in 

the Baby Boomer cohort counterbalancing our 

young families, is now more predictable. We 

have had time to prepare for the aging wave in 

Utah and through coordinated efforts show signs 

that we are developing some policies to prepare 

for the surge of older, frailer people needing 

more medical and social care. Impending crisis, 

it seems, can precipitate change. This greater 

appreciation for the policy implications of aging 

in Utah shines through strains of a legislativelycoordinated planning effort during 2014. 

State Representative Rebecca Edwards called an agingfocused Utah Intergovernmental Roundtable in May 

and throughout the summer, her house colleague, Rep. 

Rebecca Chavez-Houck orchestrated a multi-agency 

presentation coinciding with the long-term planning 

agenda of the legislature’s Health and Human Services 

Interim Committee in September. Among the predictable 

gaps that were identified between needs and services was 

an unsustainable reliance on family caregivers making-do 

in providing the lion’s share for loved ones living with 

dementia and other types of chronic disease. 

Commission on Aging Chair Becky Kapp, whose primary 

hat is directing Salt Lake County Aging and Adult 

Services, pointed out the need for $350,000 in ongoing 

funding for statewide Meals on Wheels, and $250,000 to 

provide respite care at local centers for Utahns who need 

temporary relief from caregiving duties. Commission 

member and Senator Dr. Brian Shiozawa convened three 

times with leaders of the Utah Geriatrics Society, who 

impressed upon him the dire shortage of physicians, 

nurses, and nurse practitioners, who specialize in seeing 

older adult patients. Together they are discussing how to 

better prepare our healthcare workforce.

2 Utah Commission on Aging 2014 Annual Report

Utah – State Commission on Aging Annual Report 2013-2014 618
THE COMMISSION’S STATUTORY PURPOSE:

1 Increase public and government understanding of 

the current and future needs of the state’s aging 

population and how those needs may be most 

effectively and efficiently met;

2 Study, evaluate, and report on the projected 

impact that the state’s increasing aging population 

will have on, and identify and recommend 

implementation of specific policies, procedures, 

and programs to respond to the needs and impact 

of the aging population relating to government 

services, health services, social services, the 

economy, and society in general;

3 Facilitate coordination of the functions of public 

and private entities concerned with the aging 

population; and

4 Accomplish the following duties:

a. study, evaluate, and report on the status and 

effectiveness of policies, procedures, and programs 

that provide services to the aging population;

b. study and evaluate the policies, procedures, and 

programs implement-ed by other states that address 

the needs of the aging population;

c. facilitate and conduct the research and study of issues 

related to aging;

d. provide a forum for public comment on issues related 

to aging;

e. provide public information on the aging population 

and the services available to the aging population;

f. facilitate the provision of services to the aging 

population from the public and private sectors; and

g. encourage state and local governments to analyze, 

plan, and prepare for the impacts of the aging 

population on services and operations.

The Commission has focused significant 

efforts on the implementation of programs 

to help those caring for an aging loved one 

such as: 

•	 Revising the forms healthcare

providers use to document

conversations about patients’

End-of-Life care preferences

•	 Bringing personalized, iPod based

musicto nursing home residentswith

cognitive impairment

•	 Disseminating ourresearch on

proximity of age-designated housing

to community amenitiesthat enhance

livability and enable aging-in-place

•	 Hosted the Institute forHealth

Metrics and Evaluation as prospective

analysts of Utahns’ life-expectancy

•	 Analyzed Utah health information

systems’capabilitiesto hostthe

electronic Physician Ordersfor

Life-Sustaining Treatment medical

registry. 

We can and we are preparing government 

for drastic changes in our state’s makeup. 

New champions for coordinated care of the 

vulnerable elderly are emerging in this state. 

This will not be a cataclysmic flood of older 

people if we seize the opportunity to be 

prepared. Success means economic stability 

and programs to support optimal aging, not 

succumbing to an unanticipated tidal wave.

Anne Elizabeth Palmer Ed.D., M.P.A.

Executive Director

Utah Commission on Aging 2014 Annual Report 3

Utah – State Commission on Aging Annual Report 2013-2014 619
SIX ASSIGNED REPRESENTATIVES

NAME ORGANIZATION | REPRESENTING

Senator Brian Shiozawa, M.D. Utah Senate

Rep. Stewart Barlow, M.D. Utah House of Representatives

David Patton (proxy Angie Stefaniak) Executive Director, Utah Department of Health

Ann Silverberg Williamson (proxy Nels Holmgren) Executive Director, Utah Department of Human Services

Val Hale (proxy Patty Conner) Executive Director, Governor’s Office of Economic Development

Jon Pierpont (proxy Karla Aguirre) Executive Director, Utah Department of Workforce Services

1 5 VOTING MEMBERS

Approved By The Governor for a 2-year Term

Mayor Ron Bigelow West Valley City, Utah | UT League of Cities and Towns

Barry Burton Davis County | Utah Association of Counties

Michael Cupello Peace Officers Training | Public Safety Sector

Becky Kapp SL County Aging Services | UT Area Agencies on Aging

Gary Kelso Mission Health Services | Long-term Care for the Elderly

William (Bill) Knowles Public Transportation

Tracey Larsen Bank of American Fork | Financial Institutions

Alan Ormsby, J.D. AARP | Aging Advocacy Organizations

Fahina Pasi Utah Tongan Society | Ethnic Minorities

Mary Street Commerce Real Estate | Business Community

Mark Supiano, M.D. The University of Utah | Higher Education in Utah

Elizabeth (Bette) Vierra General Public

Frances Wilby Goodwill Initiatives on Aging | Charitable Organizations

Troy Wilson, J.D. Wilson Estate Elder Law | Legal Profession

Elizabeth (Bette) Vierra General Public

UTAH COMMISSION ON AGING | MEMBERS

4 Utah Commission on Aging 2014 Annual Report

Utah – State Commission on Aging Annual Report 2013-2014 620
Representative Stewart Barlow,MD

UtahHouse of Representatives

Mayor Ron Bigelow

Utah League of Cities and Towns

Barry Burton

Utah Association of Counties

Dave Gessel

Representing UtahHealth Care Providers

ValHale

ExecutiveDirector of EconomicDevelopment

NelsHolmgren

Representing UTDept. ofHuman Services

Becky Kapp, Chair

Utah Area Agencies on Aging

Gary Kelso

Long-term Care forthe Elderly

William (Bill) Knowles

Public Transportation

Utah Commission on Aging 2014 Annual Report 5

Utah – State Commission on Aging Annual Report 2013-2014 621
Tracey Larsen

Bank of American Fork

Alan Ormsby,J.D.

Advocacy Organizations-AARP

O. Fahina Tavake-Pasi

Ethnic Minorities

David Patton

ExecutiveDirector ofHealth

Jon Pierpont

ExecutiveDirector,Dept. of Workforce Services

Senator Brian Shiozawa,MD

Utah Senate

Mary Street

Business Community

Mark Supiano,MD

Higher Education in Utah

Nate Talley

Governor’s Office of EconomicDevelopment

6 Utah Commission on Aging 2014 Annual Report

Utah – State Commission on Aging Annual Report 2013-2014 622
Elizabeth (Bette ) Vierra

General Public

Fran Wilby

Charitable Organizations

Troy Wilson,J.D.

Legal Profession

Ann Silverberg Williamson

Executive Director of Human Services

Not Pictured: Michael Cupello

Public Safety Sector

Center for Alzheimer’s 

Care & Research

Center on Aging

Center for Public Policy 

& Administration

College of Medicine

College of Nursing

College of Social Work

David Eccles School of Business

Gerontology Program

Huntsman Cancer Institute

Osher Lifelong 

Learning Institute

Palliative Care Program

U of U Hospital

Utah Education Network

Dept. of Human Services

Aging and Adult Services

Div. for Services to People with Disabilities

Office of the Public Guardian

Substance Abuse & Mental Health

Dept. of Health

Bureau of Vital Records

Health Care Financing

Health Promotion

Aging & Disability Resource 

Connection (ADRC)

Attorney General’s Office

Dept. of Workforce Services

Gov. Office Economic 

Development

Lt. Governor’s Office

Municipal Planners

Salt Lake City

State of Utah (UT 2030)

Utah Dept. of Transportation

Hospice

Financial Planner

Home Health Agency

Law Firm

Long-Term Care Facility

Physician Office

Public Employees 

Health Plan (PEHP)

Personal Care Agency

Real Estate Developer

211 Information & Referral

American Association of 

Retired Persons (AARP)

Area Health Education Centers

Association of Utah 

Community Health

HealthInsight

Intermountain Health Care 

Jewish Family Services

Salt Lake Interfaith Roundtable

Urban Land Institute

Utah Legal Services

UT Health Information 

Network (UHIN)

GOVERNMENT

PRIVATE NON-PROFIT

UTAH COMMISSION ON AGING

THE UNIVERSITY O F UTAH

PRIVATE FOR-PROFIT

UCOA RELATIONSHIP CHART

Utah Commission on Aging 2014 Annual Report 7

Utah – State Commission on Aging Annual Report 2013-2014 623
Image©Alamy

Utah’s Aging and Disability 

Resource Connection has been 

working to provide a No Wrong 

Door experience for older adults 

and people with disabilities, 

needing current or future 

long-term services and supports.

A G I N G , D I S A B I L I T Y A N D V E T E R A N ’ S P R O G R A M S 

8 Utah Commission on Aging 2014 Annual Report

Utah – State Commission on Aging Annual Report 2013-2014 624
Utah Aging and Disability 

Resource Connection

In 2009 the Utah Commission on 

Aging first received Administration 

on Aging funds to create the Aging 

and Disability Connection in Utah. 

The Aging and Disability Resource 

Connection Program (ADRC) supports 

state efforts to streamline access 

to long-term services and support 

options for older adults, people with 

disabilities, and their caregivers. 

 Active Re-Entry - Center for Independent Living

 Bear River - Area Agency on Aging 

 Five County - Area Agency on Aging

 Mountainland - Area Agency on Aging

 Salt Lake County Aging and Adult Services 

Area Agency on Aging 

ADRC’ s CORE PHILOSOPHY

What is Options Counseling? 

The ADRC’s Options Counseling concept is based on personcentered planning. This one-on-one approach allows clients 

to share what they desire in their long term care needs and 

with guidance of an ADRC Options Counselor, can create a 

plan to achieve the client’s goals. It supports the broader 

system goals of rebalancing Long-Term Services and 

Supports (LTSS) and helps to prevent or delay premature 

institutionalization by offering options to help individuals 

spend resources wisely in the community. 

In 2010, the ADRC Steering Committee selected four pilot 

sites to implement the ADRC philosophy and Options 

Counseling services. Utah’s strategy was to have a balance of 

Area Agencies on Aging (AAA) and Centers for Independent 

Living (CIL) represented. 

Utah Commission on Aging 2014 Annual Report 9

Utah – State Commission on Aging Annual Report 2013-2014 625
The Utah ADRC has been fully supported by federal funds covering the ADRC Program Office, Director and Coordinator, site 

subcontracts, evaluation, training, and operational supplies. The University of Utah waived all indirect costs, providing the 

program office space without cost. The ADRC sites received between $10,000-$14,000 to function as an ADRC; trainings, 

options counseling with clients, and data reporting are provided. 

State Level Impact

ADRC initiatives have made a significant difference in our state. 

“Our agency adopted the philosophy and vision of an ADRC and changed 

our staffing and structure to address LTC options. The ADRC was the 

catalyst for these changes.”

In 2010, four pilot sites kicked off the ADRC:

•	 Ability First(CIL): Utah, Wasatch, Juab, Sanpete Counties 

•	 Active Re-Entry (CIL): Grand, San Juan Counties

•	 Bear River(AAA): Cache, Box Elder, Rich Counties

•	 Mountainland (AAA): Utah, Summit, Wasatch Counties

Three additional sites were added in the 

ensuing years:

•	 Roadsto Independence (CIL): Davis, Morgan, Weber 

Counties (April 2012)

•	 Salt Lake County Aging and Adult Services(AAA):

Salt Lake County (April 2012)

•	 Five County (AAA): Washington, Beaver, Iron, Kane, 

Garfield Counties (April 2013)

DEDICATED MEDICAID WORKER

In FY13 the Utah Commission on Aging committed 

$25,000 which allowed the ADRC to draw down a 50% 

Medicaid Federal Match to support an ADRC dedicated 

Medicaid Outreach Worker.

Strengthening Single Point of Entry

In March 2013, Josie Martinez set up her office at Salt 

Lake County Aging and Adult Services and her door was 

opened to all ADRC staff. With direct-line access, staff 

could immediately assist their clients with Medicaid 

applications, policy clarifications, waiver questions, and 

time saving troubleshooting.

MDS SECTION Q

The ADRC was instrumental in establishing procedures 

for more effective follow-up of the responses of nursing 

home residents to the Minimum Data Set Section Q (MDS 

Section Q) which asks, “Do you want to talk to someone 

about the possibility of leaving this facility and returning 

to live and receive services in the community?” This 

November a pilot project with the State Medicaid Agency 

and Active Re-Entry will be launched. Active Re-Entry will 

provide an in-person visit with Nursing Home residents 

who are interested in transitioning backing into the 

community to discuss their options.

10 Utah Commission on Aging 2014 Annual Report

Utah – State Commission on Aging Annual Report 2013-2014 626
Expanding service 

to veterans

In 2012, the Utah ADRC and the Veterans Rural Health Resource Center-Western Region sent an electronic survey to ADRC 

sites in the US to identify challenges in serving veterans in their areas. “Do you regularly assess a caller’s veteran status?”. The 

survey showed that agency staff had a lack of basic information on VA benefits and information resources about VA services 

viewed as unhelpful and/or unreliable. Staff also viewed having a personal VA contact was valuable and these agencies want 

training about VA services and benefits.

SERVING RURAL VETERANS

In March 2013, “Connecting Rural Veterans to Aging and Disability Resource Centers for Options Counseling” received funding 

from the VA Office of Rural Health with five ADRC sites to receive VA Benefits training and provide outreach to rural veterans. 

Veteran Benefits trainings have reached more than 100 staff statewide for a total of 1182 received training hours. Five 

designated veteran client options counselors have acquired over 70 hours of VA Benefits training including completion of 

a 19 module on-line VA TRIP training acquiring an exam certification, and two options counselors have passed the Veteran 

Service Officer (VSO) Accreditation exam.

The survey results led to a collaborative 

pilot project between the VA and 

Utah Aging and Disability Resource 

Connection (ADRC). 

Project Goals included:

•	 Create access pointforrural Veterans

•	 Provide optionscounselors extensive

training in VA Benefits

•	 Build relationshipswith the VA and ADRC

•	 Disseminate to ADRC programs nationwide

Deborah Crowther

Bear River Association of 

Governments

Joey Allred

Active Re-Entry, Center for 

Independent Living

Melanie Haws

Mountainland Association 

of Governments

Rachel Stoddard

Salt Lake County AAA

Stephanie Herrig

Salt Lake County AAA

Utah Commission on Aging 2014 Annual Report 11

Utah – State Commission on Aging Annual Report 2013-2014 627
APRIL 1 , 2013 – SEPTEMBER 30, 2014

ADRC Veteran Clients Served 585

Age 70+ 67%

Age 60 -70 19%

Age 59 - 2%

Deceased 12%

VETERAN DIRECTED HOME AND COMMUNITY BASED SERVICES

( V D - H C B S ) 

In June 2014, the Salt Lake City Veteran Affairs Medical Center (SLC VAMC) contracted with Mountainland Aging and Family 

Services/ADRC to begin the first VD-HCBS program in Utah. The VD-HCBS program provides Veterans the opportunity to selfdirect their long-term supports and services to enable them to avoid institutionalization and continue living independently 

at home. Veterans enrolled in VD-HCBS have the opportunity to manage their own flexible budgets, decide for themselves 

what mix of services best meet their needs, and to hire and supervise their own workers. 

Currently, Mountainland has 20 veterans participating in the program. Salt Lake County Aging and Adult Services will be the 

next ADRC site to participate in the VD-HCBS program.

“For AAAs, the vision of participant-directed services has been game 

changing. ADRC has changed the way the AAAs do business.”

TYPES O F REFERRALS MADE*

VHA Healthcare 280

Aid & Attendance 269

Pension 164

VA Nursing Home 107

Disability Compensation 85

Burial Benefits 80

VHA In-Home Services 57

Other Public Programs 228

Other Private Programs 63

*Clients referred to multiple VA Programs

12 Utah Commission on Aging 2014 Annual Report

Utah – State Commission on Aging Annual Report 2013-2014 628
ADRC’S UPCOMING YEAR

The ADRC received an additional year of funding from the Veterans Affairs 

Office of Rural Health to continue expanding the five ADRC site’s capacity 

to serve rural veterans. The Veteran Directed Home and Community Based 

Services (VD-HCBS) will continue to expand statewide providing veterans 

the opportunity to self-direct their own long term care. And the ADRC 

Program Office will continue the critical discussions to improve Utah’s 

citizens access to planning for long term services and support.

ADRC STEERING COMMITTEE MEMBERS 2014

Andy Curry Roads to Independence

Anne Smith Representative of Older Adults

Becky Kapp Salt Lake County Aging and Adult Services

Carrie Schonlaw Five County Area Agency on Aging

Chiara Cameron 2-1-1

Gary Kelso Mission Health Services

Jeremy Christensen Division of Substance Abuse and Mental Health

Les Carter Division of Services for People with Disabilities 

Michelle Benson Bear River Area Agency on Aging

Michelle Carlson HealthInsight 

Nancy Bentley Active Re-Entry Center for Independent Living

Nate Palmer Department of Workforce Services

Nels Holgrem Division of Aging and Adult Service

Sandra Curcio Ability First Center for Independent Living

Scott McBeth Mountainland Area Agency on Aging

Trecia Carpenter Utah Department of Health (State Medicaid Agency)

Non-voting member

Daniel Musto State Long Term Care Ombudsman

Staff:

Jennifer Morgan Program Director

Rhonda Hypio Program Coordinator

Evaluator:

Judith Holt Utah State University

Utah Commission on Aging 2014 Annual Report 13

Utah – State Commission on Aging Annual Report 2013-2014 629
END OF LIFE CARE Planning and recommendations

Like most states, Utah is developing a program to 

improve communications between patients with 

advanced illness, their families, and health providers – 

a means that allows frail patients to request or refuse 

certain measures such as CPR. Unlike most states, 

Utah’s will be an electronic system, rapidly accessible 

by authorized emergency medical providers. 

14 Utah Commission on Aging 2014 Annual Report

Utah – State Commission on Aging Annual Report 2013-2014 630
Mature

Endorsed

Developing

None

The Utah Commission on Aging has accepted responsibility to help 

implement the electronic Physician Order for Life Sustaining Treatment, 

or ePOLST.

Utah’s ePOLST will help to increase rapid access to POLST 

orders. These orders come from the preferences patients 

express to their primary physicians through end of life 

planning conversations.

The Utah Department of Health’s Information Technologists 

were the creators of Utah’s pilot ePOLST system. The 

private, nonprofit organization HealthInsight provided 

initial guidance and over-sight. Pilot funding came from 

the federal Beacon Community Cooperative Agreement 

Program. The aim was to show how health IT investments 

and meaningful use of electronic health records advance 

the vision of patient-centered care, while achieving better 

health and better care at lower cost.

As one of 17 Beacon Communities nationwide, coordinated 

efforts are assisting Utah’s health care organizations to 

find ways to reduce costs and improve health care using 

innovative technology and best practices in treating 

patients nearing the end of their lives.

In October, 2013, the Commission on Aging received 

funding to steer the ePOLST system from pilot to functional 

status and toward stability. With the Department of Health, 

the Commission helped stakeholders weigh key factors in 

determining where to permanently house and how to fund 

the system. The Commission was also involved in arranging 

training for healthcare professionals who will use this 

system to enter and access physician orders.

Sustainable funding for registry operations is vital to 

its long-term success, as Utah joins 43 other states in 

POLST program outreach. This engagement has enabled 

Commission members representing our public, senior 

advocacy organizations, nurses, and of course, the public, 

to contribute their expertise to a 12-month project.

Utah Commission on Aging 2014 Annual Report 15

Utah – State Commission on Aging Annual Report 2013-2014 631
NEW TRENDS IN HOUSING for Utah’s aging population

As Utahns age, three housing concerns 

consistently top the list—the ability to 

age-in-place, housing affordability, and the 

availability of housing options, with a strong 

relationship between the three. 

16 Utah Commission on Aging 2014 Annual Report

Utah – State Commission on Aging Annual Report 2013-2014 632
The Livability Index

The number of adults aging up into a 65-and-older category is growing 

rapidly, thanks in large part to the ‘baby boom’ generation. Earlier demand 

by this generation for large-lot homes in suburban style neighborhoods is 

giving way to a need for more walkable, mixed-use neighborhoods with a 

range of housing options.

The Metropolitan Research Center at the University of Utah uses several quantitative measures to determine 

neighborhood livability. Four of these measures were factored into a geographic model presented at the Center on Aging 

Research Retreat in March.

Markets

Number of Supermarkets and Farmer’s Markets within 

one half mile of census block centroids

Parks

Number of Parks and Farmer’s Markets within one half 

mile of census block centroids

Activity Density 

Resident and Job density within census blocks

Mixed Use

Diversity of job sectors within census blocks

ECONOMIC BENEFITS:

•	 Creating a range of housing

opportunitiesin proximity to jobs

saves households money.

•	 Improving neighborhood

“walkability”tendsto enhance

property values.

•	 Walkability also enhances health.

•	 Fostering a sense of place

•	 Preserving critical

environmental areas

Salt Lake City

Layton

Utah Commission on Aging 2014 Annual Report 17

Utah – State Commission on Aging Annual Report 2013-2014 633
FACILITY SIZE

LEVEL OF CARE

This brochure was presented at the 2013 Utah American Planning Association Conference.

Wasatch Front Senior Housing

A CONTINUUM O F OPTIONS

In addition to creating new policies, communities require support for breaking 

down barriers to a wider range of housing 

options. Understanding these housing 

options begins a dialog upon which to build 

inclusive, universally accessible communities. This brochure identifies, defines, and 

organizes older adult housing options.

The brochure 

cross-references 

facility size with 

levels of care.

Wasatch Cohousing Friendship Manor Highland Cove Sunrise at Holladay

18 Utah Commission on Aging 2014 Annual Report

Utah – State Commission on Aging Annual Report 2013-2014 634
UTAH’S CHANGING DEMOGRAPHICS

Image©DeseretNews

The following graphs were created 

by Mallory Bateman at the Utah 

Foundation and were presented to 

the Utah Health and Human Services 

Interim Committee in September.

Utah Commission on Aging 2014 Annual Report 19

Utah – State Commission on Aging Annual Report 2013-2014 635
76.0

67.0 65.8

54.2 53.0 52.4 47.5 46.2 47.1 46.7

14.0

13.0 15.8

14.4 15.2 17.6 24.2 26.7 31.1 33.7

1970 1980 1990 2000 2010 2020 2030 2040 2050 2060

Youth Retirement Age

DEPENDENCY RATIO

1 990 – 2050

90.0

80.0 81.6

68.5 68.2 70.0 71.7 72.9

78.2 80.4

Source: Bureau of Economic and Business Research

8.7 8.5 9

9.8

12.6 12.4

13

14.1

1990 2000 2010 2013

PERCENT OF POPULATION

65 YEARS OR OLDER

Utah US Source: US Census Bureau

MEDIAN AGE, UTAH AND U.S.

Source: 

U.S. Census 

Bureau 1990 2000 2010 2013

UT 26.3 27.1 29.2 30.2

US 32.9 35.3 37.2 37.6

UTAH DEMOGRAPHICS 2010

Source: 

U.S. Census Bureau UT US

Boomer 18.7 24.9

Gen X 20.9 21.2

Millennial 26.0 27.7

1946–1964

1965–1980

1981–1995

%

%

%

An Aging Population in Utah

PERCENT O F POPULATION

65 YEARS OR OLDER

An aging Baby-Boom generation is contributing to the 

demographic transformation in progress in Utah. The 65+ 

demographic is growing as a share of the overall population. 

And Utah’s Youth population share more closely resembles 

US numbers, so planning now for a quickly-growing demographic is increasingly important. 

DEPENDENCY RATIO | 1990–2060

The Dependency Ratio is the percentage of the population that is dependant on the working population based on working 

age. The 65+ share of the dependency ratio is projected to grow toward near-parity with the Youth share by 2060.

GENERATIONAL PROPORTIONS MEDIAN AGE

Source: BEBR analysis of Governor’s Office of Management and Budget, 2012 Projections. Note: Dependency Ratios are computed as the number of 

nonworking age persons per 100 working age (18 – 64 years old) persons in the population.

20 Utah Commission on Aging 2014 Annual Report

Utah – State Commission on Aging Annual Report 2013-2014 636
80% 60% 40% 20% 0% 20% 40% 60% 80%

0–4

5–17

18–29

30–39

40–64

65–84

85 and Over

2000 to 2010 actual

and projections for 2010 to 2030

Source: Governor's Office of Planning and Budget, 2012 Baseline Projections

2010–2030 MALE2000–2010 MALE

2010–2030

FEMALE

2000–2010

FEMALE

80% 60% 40% 20% 0% 20% 40% 60% 

0–4

5–17

18–29

30–39

40–64

65–84

85 and Over

2000 to 2010 actual

and projections for 2010 to 2030

Source: Governor's Office of Planning and Budget, 2012 Baseline Projections

2010–2030 MALE2000–2010 MALE

2010–2030

FEMALE

2000–2010

FEMALE

2010

MALE

2000

MALE

150,000 100,000 50,000 0 50,000 100,000 150,000

Under 5

10–14

5–9

15–19

20–24

25–29

30–34

35–39

40–44

45–49

50–54

55–59

60–64

65–69

70–74

75–79

80–84

85–89

UTAH POPULATION by AGE and SEX

2 000 and 2010

2010

FEMALE

2000

FEMALE

Source: U.S. Census Bureau. 2000 and 2010 Censuses. Bureau of Economic and Business Research

POPULATION CHANGE

2000–2010 actual and 

2010–2030 Projected

(Right) The demographics seeing the highest 

growth rates in Utah are the 65–85 and 85+ 

populations.

(Below) This population pyramid shows the 

overall structure of Utah’s population by age 

and the growth of those age groups in the 

decade between 2000 and 2010. The aging 

Baby Boom and ‘Echo Boom’ are shown as 

two major waves. 

UTAH POPULATION B Y AGE AND SEX

2000 and 2010

Utah Commission on Aging 2014 Annual Report 21

Utah – State Commission on Aging Annual Report 2013-2014 637
MUSIC AND MEMORY

MUSIC & MEMORYSM is a non-profit 

organization that brings personalized 

music into the lives of the elderly or 

infirm through digital music technology, 

vastly improving quality of life.

Photo Credit: BOND360

Image courtesy Michael Rossato-Bennett, 2012

22 Utah Commission on Aging 2014 Annual Report

Utah – State Commission on Aging Annual Report 2013-2014 638
“We Will Do This”

In January 2014, when Alive Inside was winning over Sundance audiences, 

at a post-screening Q&A, Deb Burcombe, Deputy Director of the Utah 

Health Care Association, stood up and announced, “I represent all of the 

nursing homes in Utah, and we will do this!” 

In a few short months (with generous guidance from 

the State of Wisconsin’s Department of Health Services, 

which has just announced expansion of their program 

to 275 nursing homes), a group of Utah leaders secured 

the funds, purchased 1,500 iPods and lined up 100 

nursing homes to initiate the Music and Memory 

program, which brings personalized, iPod-based music 

to people living with dementia.

According to Dan Cohen, Executive Director of the 

Music and Memory Foundation, based in New York, 

something extraordinary happened in Utah. Not only 

did Ms. Burcombe see the film, but so did many of 

the state’s healthcare, business, arts, and educational 

leaders. This is in no small part due to Scott Anderson’s 

leadership and generosity and that the Executive 

Producer, Geralyn Dreyfous lives here and negotiated 

the right to have the film shown throughout the state 

with Zions Bank’s philanthropic support. She worked 

with the University of Utah College of Nursing and Utah 

Commission on Aging to provide a free screening of the 

film for Careers in Aging Week in April, 2014. What 

resulted was establishment of the Music & Memory 

Coalition of Utah, spearheaded by the Commission on 

Aging. The group meets monthly to forge a unified, 

coordinated approach to implementing personalized 

music statewide. 

Skullcandy is donating headphones, Intermountain 

Homecare and Hospice is rolling out a statewide hospice 

Utah Commission on Aging 2014 Annual Report 23

Utah – State Commission on Aging Annual Report 2013-2014 639
personalized music program, Zions Bank is funding strategic 

research and the Alzheimer’s Association provided booths 

at its fall Memory Walks. The Commissioner on Aging is 

group convener, and Jewish Family Service, the state’s first to 

be M&M certified, is serving as a resource for others. Their 

goal: permeate the state’s care centers with personalized 

music and do it with one voice—one voice to gather donated 

iPods, to get students and teachers involved, to raise funds 

to build the program.

We are gratified to be a leader among 

statewide initiatives focused on improving the quality of life of elders in need 

with this inexpensive, practical and 

often powerful approach. We look forward to working with other states, regions and cities to bring the benefits of 

personalized music to those they serve.

Image courtesy Michael Rossato-Bennett, 2012

Photo Credit: BOND360

24 Utah Commission on Aging 2014 Annual Report

Utah – State Commission on Aging Annual Report 2013-2014 640
ALTERNATIVES PROGRAM AND AGING WAIVER

© PhotoAlto/Alamy

The Utah Division of Aging and Adult Services 

is tasked with overseeing the Medicaid Aging 

Waiver and Alternatives Program which are 

carried out at the local level by county based 

Area Agencies on Aging. 

Utah Commission on Aging 2014 Annual Report 25

Utah – State Commission on Aging Annual Report 2013-2014 641
Medicaid Aging Waiver and the 

Alternatives Program

The goal of the Medicaid Aging Waiver and Alternatives Program is 

to provide services for low-income, medically frail seniors that would 

otherwise be placed in a nursing home or care facilities enabling them to 

be cared for safely, independently, and cost effectively in their homes. On 

average, these individuals can be served at home for about one fifth the 

cost of nursing home placement.

MEDICAID AGING WAIVER 1915 (c)

The bulk of the funding is overseen by the Department of Healthcare Financing. The Waiver is tasked with providing services 

statewide to help older adults who are nursing home eligible remain in their homes and live as independently as possible, 

provided it is cost effective to do so.

Eligibility Requirements

•	 Be 65 years of age or older

•	 Require nursing facility level of

care approval (LOC)

•	 ADLs and IADLsscore

•	 Meet financial eligibility

requirementsfor Medicaid

Unduplicated Clients Average Annual Cost

Nursing 

Home Stay 1 $67,343 or $184 per day

499 (current enrollment) $33,604,157 

Medicaid Aging 

Waiver 1915(c) 1 $9,315 

499 $4,648,815 

$2,000

$4,000

$6,000

$8,000

$10,000

2004

2005

2006

2007

2008

2009

2010

2011

2021

2013

COST per CLIENT

UNDUPLICATED CLIENTS SERVED

and AVERAGE COST PER CLIENT

$9606

500

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

600

700

800

900

CLIENTS 506

26 Utah Commission on Aging 2014 Annual Report

Utah – State Commission on Aging Annual Report 2013-2014 642
With a current waiting list averaging around 165, an increase of ongoing 

funding of $250,000 for the Medicaid Aging Waiver Program could serve 

an additional 111 Clients throughout the state.

ALTERNATIVES PROGRAM

In 1977 the Older American Act allowed states to develop programs for Home Community Based Services/Supportive 

Services. The Alternatives Program is a state-funded, non-Medicaid assistance program. It’s goal is to provide services to 

help older adults who are not nursing home eligible, but who are at risk for facility based care, remain in their homes and as 

independent as possible.

Eligibility Requirements

•	 60 years of age or older, or

•	 18 – 59 years of agewith a disability

•	 Utilizes Activities ofDaily Living

(ADLs) and Instrumental Activities

ofDaily Living (IADLs)score

•	 Meets financial eligibility based on

the federal poverty level.

•	 Meanstested—Sliding Scale

Unduplicated Clients Average Annual Cost

Nursing 

Home Stay 1 $30,000 Cost varies 

645 (current enrollment) $19,350,000 

Alternatives 1 $5,000 

Program

645 $3,225,000 

In-Home Alternatives Expenditures FY 2004 through FY 2014

Utah Commission on Aging 2014 Annual Report 27

Utah – State Commission on Aging Annual Report 2013-2014 643
HEALTH & HUMAN SERVICES Presentation Highlights

On September 17, 2014, Utah 

Representative Rebecca Chavez-Houck 

convened a group of Aging and Adult 

Services stakeholders to present findings. 

Two major topics were nutrition and 

caregiver programs. 

28 Utah Commission on Aging 2014 Annual Report

Utah – State Commission on Aging Annual Report 2013-2014 644
1,190,514 Meals on Wheels

23,102 seniors received 9,740 seniors received

(6.5% of 60+ population in Utah) (2.7% of 60+ population in Utah) 

777,379 Congregate Meals

Utah by the numbers:

83% of seniors receiving Meals on Wheels in Utah said the meals helped them to 

continue to live at home.

Helping seniors remain in their homes saves nursing home Medicaid 

expenditures.

An estimated 112,000 volunteer hours (54.0 F.T.E.'s) valued at $2.5 million are being 

contributed each year to operate meal programs.

$350,000 in ongoing funding for 12 local Area Agencies on Aging for 

Meals-on-Wheels & senior center meals for Utah’s senior population. 

$300,000 one-time funding is in the current budget. (Without ongoing funding, 42,857 

meals will not be provided to approximately 285 seniors currently within the program.

(Add to Base Budget of Aging & Adult Services- Humans Services Department)

Legislative funding requested: $

Local

Federal

State

Sen

Con

35.2

31.1%

14.7%

Nutrition

PROVIDING THE BASIC BUILDING BLOCKS

FOR INDEPENDENT LIVING

Good nutrition is the foundation upon which 

independent living is built. Helping seniors 

remain healthy and independent by providing 

nutrition programs, both home delivered and in 

senior centers, remains the highest service priority 

for Counties and Area Agencies on Aging.

UTAH B Y THE NUMBERS

•	 1,967,893 total meals

provided in FY2013

•	 83% ofseniorsreceiving

Meals on Wheelsin Utah

said the meals helped

them to continue to live

at home.

•	 Helping seniorsremain

in their homessaves

nursing home Medicaid

expenditures.

•	 An estimated 112,000

volunteer hours(54.0 F.T.E.s)

valued at $2.5 million are

being contributed each year

to operate meal programs.

1,190,514 Meals on Wheels

23,102 seniors received 9,740 seniors received

(6.5% of 60+ population in Utah) (2.7% of 60+ population in Utah) 

777,379 Congregate Meals

Utah by the numbers:

83% of seniors receiving Meals on Wheels in Utah said the meals helped them to 

continue to live at home.

Helping seniors remain in their homes saves nursing home Medicaid 

expenditures.

An estimated 112,000 volunteer hours (54.0 F.T.E.'s) valued at $2.5 million are being 

contributed each year to operate meal programs.

$350,000 in ongoing funding for 12 local Area Agencies on Aging for 

Meals-on-Wheels & senior center meals for Utah’s senior population. 

$300,000 one-time funding is in the current budget. (Without ongoing funding, 42,857 

meals will not be provided to approximately 285 seniors currently within the program.

(Add to Base Budget of Aging & Adult Services- Humans Services Department)

Legislative funding requested: $

Local

Federal

State

Senior

Contributions

19%

35.2%

31.1%

14.7%

Senior Meal Program 

Funding Sources

LEGISLATIVE FUNDING REQUESTED:

$350,000 in ongoing funding for 12 local Area Agencies 

on Aging for Meals-on-Wheels & senior center meals for 

Utah’s senior population.

$300,000 one-time funding is in the current budget. 

(Without ongoing funding, 42857 meals will not be provided 

to approximately 285 seniors currently within the program.

Utah Commission on Aging 2014 Annual Report 29

Utah – State Commission on Aging Annual Report 2013-2014 645
382,000

Utahns

provide

care value of

$4.2

BILLION

annually

:

tor 

re 

20 HOURS/WEEK

40%

 to

70% 72%

AGE

50%

46

of caregivers have

clinically-significant 

SYMPTOMS OF DEPRESSION.

of caregivers said they

DO NOT GO TO THE DOCTO R

because they put their 

family's needs first.

of caregivers said they were

TOO TIRED TO TAKE

CARE OF THEMSELVES.

Caregiving

SUPPORTING CAREGIVERS HELPS U S ALL

Support provided to caregivers helps them continue to act in their role of 

meeting the long-term care needs of their loved ones, at home, reducing 

taxpayer expenses today and in the future.

Unpaid caregivers are meeting 

90% of long-term care needs. 

The typical caregiver is a 46-yearold female providing more than 

20 hours of care each week.

Local survey of Caregiver needs:

•	 65% had been a caregiverfor

3–10 years.

•	 53.7% listed respite care asthe

most needed service.

•	 60.3% requested education and

information on caregiving.

•	 82.5% are caring fortheirspouse

or parent.

$250,000 for 12 local Area Agencies on Aging to 

provide respite care, information, and support activities 

to caregivers.

(Add to Base Budget of Aging & Adult Services—

Human Services Department)

LEGISLATIVE FUNDING REQUESTED:

30 Utah Commission on Aging 2014 Annual Report

Utah – State Commission on Aging Annual Report 2013-2014 646
CoA Management and Leadership

ANNE ELIZABETH PALMER, ED.D., M . P. A .

Executive Director - Utah Commission on Aging

Anne Elizabeth Palmer, Ed.D., M.P.A., serves as the Executive Director of the Utah 

Commission on Aging. She is the founding director of the Osher Lifelong Learning 

Institute, which provides education to citizens age 50 and older. She was appointed 

to the Utah Commission on Aging in 2005. Needs identified through her committee 

laid the groundwork for establishing the Utah Aging & Disability Resource 

Connection. Anne completed her Doctorate in Education in 2009 at the University 

of London Institute of Education, studying international dimensions of lifelong 

learning. Her masters degree is in Public Administration, and her bachelor degree is 

from the University of California, Berkeley.

Anne Elizabeth Palmer, Ed.D, M.P.A. | Executive Director | Utah Commission on Aging

10 S. 2000 East Room 3525

Salt Lake City, Utah 84112

Office: 801-587-3058

Anne.Palmer@utah.edu | www.aging.utah.edu/programs/utah-coa/

HOLLY ABEL, B.A.

Program Coordinator - Utah Commission on Aging

The Commission on Aging welcomed Holly Abel as Administrative Program 

Coordinator in 2013. Holly has over eight years administrative experience at the 

University of Utah. She has worked previously in the departments of Biomedical 

informatics and Pharmacotherapy. Holly holds a bachelor degree in Music with 

Vocal Performance emphasis from The University of Utah School of Music. She 

coordinates the administrative needs of the Commission.

Holly Abel, B.A. | Program Coordinator | Utah Commission on Aging

30 N. 1900 E., AB193 SOM

Salt Lake City, UT 84132

Office: 801-213-4156

aging@utah.edu | www.aging.utah.edu/programs/utah-coa/

Utah Commission on Aging 2014 Annual Report 31

Utah – State Commission on Aging Annual Report 2013-2014 647
JENNIFER MORGAN, B.S.

Director - Utah Aging & Disability Resource Connection

As Director for the Utah Aging and Disability Resource Connection, Jennifer Morgan 

works closely with the seven ADRC sites for data collection, data reporting protocols, 

and on-going options counseling training. She serves on multiple community 

partner steering councils. In this past grant year she implemented an Options 

Counselor Coordinator program, organized an ADRC dedicated Medicaid Outreach 

Worker, coordinated with ADRC Program Evaluators, evaluated the readiness 

assessment for Five County AAA, and collaborated on the ADRC VA Office of Rural 

Health proposal and pilot project.

Jennifer Morgan, B.S. | Director | Utah ADRC

10 S. 2000 E., Rm 3525

SLC, UT 84112

Office: 801-585-6361 | Cell: 801-599-2016

Jen.morgan@utah.edu | www.utadrc.org

RHONDA HYPIO, B.S.

Program Coordinator - Utah Aging & Disability 

Resource Connection

Rhonda Hypio is the new Program Coordinator, working closely with the Director, 

assisting with all the daily functions at the ADRC program office. She has over 

10 years of experience working with state and federal programs, constituent 

affairs, and the aging population. Rhonda holds a Bachelor of Science in Business 

Administration, with emphasis in Information Systems and Technologies from 

Weber State University.

Rhonda Hypio, B.S. | Program Coordinator | Utah ADRC

10 S. 2000 E., Rm 3525

SLC, UT 84112

Office: 801-587-9620

Rhonda.hypio@hsc.utah.edu | www.utadrc.org

32 Utah Commission on Aging 2014 Annual Report

Utah – State Commission on Aging Annual Report 2013-2014 648
© Utah Commission on Aging | The Center on Aging

Utah – State Commission on Aging Annual Report 2013-2014 649