-

 

 

 

 

 

 

 

Exhibit 1. Drawing the ADRCs Sample Stratified by Region and by Rural versus Urban 

Status
 

APPENDIX A. OUTCOME EVALUATION SURVEY METHODOLOGY
 

ADDITIONAL DISCUSSION
 

Region Total 

ADRCs Rural Urban Primary ADRCs 

Backup 

ADRCs 

I: CT, MA, ME, NH, RI, VT, DC, 30 12 18 2 2 

II: NY, NJ 74 28 46 2 2 

III: DE, MD, PA, VA, WV 108 41 67 2 2 

IV: AL, FL, GA, KY, MS, NC, SC, TN 85 31 54 2 2 

V: IL, IN, MI, OH, WI 75 23 52 2 2 

VI: LA, OK, TX 39 8 31 2 2 

VII: IA, KS, MO, NE 6 2 4 2 2 

VIII: CO, MT, UT, WY, ND, SD 30 9 21 2 2 

IX: CA, NV, AZ, HI 22 2 22 2 2 

X: AK, ID, OR, WA 17 3 14 2 2 

Single, Statewide ADRCs: AR, MN, NM 3 -- -- 3 --

Total 489 157 329 23 20 

Exhibit 2. AAAs with Service Areas that do not Overlap with ADRC Service Areas, by
 

Region
 

Region AAAs With Non Overlapping Service 

Areas Rural Urban 

I: CT, MA, ME, NH, RI, VT, DC, 0 0 0 

II: NY, NJ 5 3 2 

III: DE, MD, PA, VA, WV 1 0 1 

IV: AL, FL, GA, KY, MS, NC, SC, 

TN 17 10 7 

V: IL, IN, MI, MN, OH, WI 4 2 2 

VI: AR, LA, OK, NM, TX 12 2 10 

VII: IA, KS, MO, NE 32 20 12 

VIII: CO, MT, UT, WY, ND, SD 14 6 8 

IX: CA, NV, AZ, HI 28 5 23 

X: AK, ID, OR, WA 21 8 13 

Total 134 56 78 

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Exhibit 3. Drawing the AAA Sample Stratified by Region and by Rural versus Urban 

Status.
 

Region 

AAAs with Non 

Overlapping Service 

Areas 

Rural Urban Primary 

AAAs* 

Backup 

AAAs* 

I, II, & III: CT, MA, ME, NH, RI, VT, 

NY, NJ, DC, DE, MD, PA, VA, WV 6 3 3 6 --

IV: AL, FL, GA, KY, MS, NC, SC, 

TN 17 10 7 2 8 

V: IL, IN, MI, MN, OH, WI 4 2 2 2 2 

VI: AR, LA, OK, NM, TX 12 2 10 2 2 

VII: IA, KS, MO, NE 32 20 12 2 2 

VIII: CO, MT, UT, WY, ND, SD 14 6 8 2 2 

IX: CA, NV, AZ, HI 28 5 23 2 2 

X: AK, ID, OR, WA 21 8 13 2 2 

Total 134 56 78 20 20 

*For each region, two AAAs each, one from the rural stratum and one from the urban stratum; the exception is 

Regions I – III, where the three urban and the three rural AAAs were selected into the sample with certainty and 

backup AAAs were drawn from Region IV. 

Exhibit 4. Agencies that Discontinued Participation in the Study 

Site Name State Date site 

dropped out Reason for dropping out 

ADRC Urban 

Larimer County ARCH Colorado 6/18/13 Limited number of staff, and current workload 

including two major projects 

Area 10 Area Agency on 

Aging Indiana 7/30/13 Changes in capacity 

ADRC Rural 

Orleans County New York 6/20/13 Insufficient staffing 

Bristol Bay Native 

Association (BBNA) 

ADRC 

Alaska Mid-June 

Site is not near a FedEx pick-up and could 

therefore not send the data forms back via 

regular pre-paid mail and inconsistent internet 

access 

Kenai Peninsula ILC: An 

ADRC Alaska Mid-June Too remote with very low client rates 

ADRC Certainty 

The Resource Center Wyoming Early August Insufficient staffing 

AAA Rural 

Southeastern Illinois Area 

Agency on Aging Illinois Early August Insufficient staffing 

South Central Nebraska 

Area Agency on Aging Nebraska 7/31/13 Staffing reductions 

Exhibit 5. Agencies that Participated in the Study
 

Site Name State Region 

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Site Name State Region 

ADRC Urban 

Community Choices: North Central Region Connecticut I 

Essex County ADRC New Jersey II 

West Virginia Aging and Disability Resource Center –

Fairmont Site West Virginia III 

Area IV Agency on Aging and Community Action Programs Indiana V 

Ability Resources Oklahoma VI 

LifeLong Links ADRC Heritage AAA Iowa VII 

Mesa County ARCH Colorado VIII 

Area V – Southeast Idaho Area Agency on Aging Idaho X 

NorthWest Senior & Disability Services Oregon X 

ADRC Rural 

ServiceLink Resource Center of Coos County New Hampshire I 

Appalachian Agency for Senior Citizens Virginia III 

Generations Indiana V 

Concho Valley ADRC Texas VI 

Kiamichi Economic Development District of Oklahoma AAA Oklahoma VI 

Northwest Missouri Area Agency on Aging Missouri VII 

Area VI Montana VIII 

San Juan Basin ADRC Colorado VIII 

Nevada County California IX 

ADRC Certainty 

Senior Linkage Line, Disability Linkage Line Minnesota V 

Choices in Living Resource Center Arizona VI 

AAA Urban 

Cape Fear Council of Governments North Carolina IV 

WPCOG Area Agency on Aging North Carolina IV 

Area Agency on Aging of the Heart of Texas Texas VI 

Area Agency on Aging of the Permian Basin Texas VI 

Aging Partners AAA Nebraska VII 

Southwest 8 Senior Services, Inc. Iowa VII 

AAA Rural 

Albermarle Commission Area Agency on Aging North Carolina IV 

Isothermal Planning & Development Commission North Carolina IV 

Northeast Mississippi Area Agency on Aging Mississippi IV 

Area Agency on Aging of Deep East Texas Texas VI 

Area Agency on Aging of Texoma Texas VI 

Northeast Nebraska Area Agency on Aging Nebraska VII 

Area IX Area Agency on Aging Montana VIII 

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APPENDIX B: OUTCOME EVALUTION ACL LETTERS OF SUPPORT
 

Dear [DIRECTOR NAME]; 

We would like to thank you for agreeing to participate in the evaluation of long-term service and support 

(LTSS) programs. Please recall that the Administration for Community Living (ACL) has contracted with 

IMPAQ International, LLC and Abt Associates Inc. to evaluate LTSS programs funded by the agency. The 

overall purpose of the evaluation is to gather information to help ACL better understand how to best support the 

delivery of LTSS, and we greatly appreciate your help in screening and recruiting clients. 

The study is well underway with the evaluation team gathering rich data from clients recruited from agencies 

like yours. We are contacting you at this time to ask if any questions have come up for you or your staff during 

the client screening and recruitment process, and to encourage you to forward client information to the 

evaluation team at the end of each week. To reach our target sample size and ensure nationally 

representativeness, it is vitally important that all sites that agreed to participate begin the recruitment process 

and forward data to the team on a weekly basis. 

If you have any questions about your participation in this evaluation, please email Susan Jenkins, the ACL 

Project Officer, at Susan.Jenkins@ACL.HHS.GOV. 

Thank you in advance for your help, 

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Dear [DIRECTOR NAME]; 

We would like to thank you for participating in the evaluation of long-term service and support (LTSS) 

programs that is being conducted by the Administration for Community Living (ACL) to evaluate LTSS 

programs funded by the agency. The overall purpose of the evaluation is to gather information to help ACL 

better understand how to best support the delivery of LTSS, and we greatly appreciate your help in screening 

and recruiting clients. 

The study is well underway with the evaluation team of IMPAQ International and Abt Associates gathering rich 

data from your clients. We are contacting you at this time to remind you and encourage you to continue to help 

the research team reach their target sample size and ensure national representativeness by actively recruiting 

clients. It is vitally important that all sites that agreed to participate continue the recruitment process and 

forward data to the team on a weekly basis. 

If you have any questions about your participation in this evaluation, please email Susan Jenkins, the ACL 

Project Officer, at Susan.Jenkins@ACL.HHS.GOV. 

Thank you in advance for your help, 

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APPENDIX C. PROCESS EVALUATION LOCAL ADRC AND AAA SURVEY
 

QUESTIONNAIRE
 

PROCESS EVALUATION: LOCAL-LEVEL WEB-BASED SURVEY 

INSTRUCTIONS TO WEB SURVEY PROGRAMMER: PREPOPULATE (PP) INFORMATION IN [ ] BASED ON SITE DIRECTOR TYPE 

(DT) OR ID NUMBER (ID). THESE PROPOPULATED DATA WILL BE USED THROUGHOUT THE SURVEY TO ORIENT THE 

RESPONDENT BASED ON TYPE OF SITE. EACH SITE WILL ALSO RECEIVE A UNIQUE ID NUMBER WITH THE NAME OF THE 

SITE. 

[ID Number - ID] 

	 Name of Site 

[Director Type - DT] 

 ADRC (Local-level)
 

 AAA (Local-level)
 

Section A. Baseline Characteristics 

[FOR LOCAL-LEVEL ADRC DIRECTORS]: The first set of questions focus on characteristics of your organization PRIOR to 

receiving an ADRC grant and the influence on your organization of the Administration on Aging (AoA) and/or CMS 

grant(s) (i.e., AoA Title IV grants, AoA title II grants, CMS Real Choice System Change grants, CMS Person-centered 

hospital discharge planning grants, Patient Protection and Affordable Care Act funds). 

[FOR LOCAL-LEVEL AAA DIRECTORS]: We are interested in how your organization has changed over time, therefore, the 

first set of questions deals with the characteristics of your organization approximately 7 years ago (i.e., in 2004-2005). 

1.	 Has your organization realized an improvement in ability to provide integrated, comprehensive access to longterm care services and supports (e.g., provide one-stop or streamlined benefits access, increase awareness of 

LTSS options, provide assistance to consumers such as counseling regarding LTSS choices or transitions from 

institutions back into the community)? [if DT = ADRC since the start of the ADRC grant; if DT=AAA over the past 7 

years] 

 Yes 

 No [skip to question 3]
 

2.	 Which have had the most positive impact on your organization's ability to provide integrated, comprehensive 

access to long-term care services and supports (e.g., provide one-stop or streamlined benefits access, increase 

awareness of LTSS options, provide assistance to consumers such as counseling regarding LTSS choices or 

transitions from institutions back into the community)? (Select up to two) 

	 Partnerships developed/expanded 

	 Staffing changes 

	 Shared data 

	 Focus on providing person-centered, self-directed services 

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	 Other, please specify 

3.	 Which of the following best describes the reason your site became an ADRC? 

 To better integrate service provision systems 

 To develop or strengthen agency/organizational partnerships 

 To improve data or IT infrastructure 

 To improve marketing or awareness efforts related to Long Term Care Services and Supports (LTSS) 

 To expand services to additional populations 

 To expand services to additional geographic locations 

 Other, please specify
 

4.	 [FOR AAA DIRECTORS ONLY]: Is your site interested in becoming an ADRC or becoming part of an ADRC in the 

future?
 

 Yes; If yes, what is your current stage or status in becoming an ADRC? (Open Response)
 

	 No; If no, please explain why you do not plan to become an ADRC? (Open Response) 

	 Other, please specify 

5.	 Please indicate the extent to which Federal (AoA/CMS) grants have enabled your ADRC to realize any of the 

following outcomes͙ (Select all that apply) 

Very much Somewhat Very little 

͙ increase the skills of existing staff o o o 

͙ recruit or attract more experienced staff o o o 

͙ increase/expand populations served o o o 

͙ increase the number of consumers served o o o 

͙ increase the number of partnerships o o o 

͙increase range of services offered o o o 

͙make other changes (please specify) o o o 

6.	 How has the ADRC grant(s) affected the resources or resource allocation at your organization or within your 

state? [IF THERE IS MORE THAN ONE ADRC IN THE STATE CHECK THE BOX IF THE ITEM IS TRUE OF AT LEAST ONE 

ADRC] (Check all that apply) 

At the site or local level At the State level 

Helped us leverage other funds  

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At the site or local level At the State level 

Improved staff training opportunities  

Increased service efficiency  

Contributed to the development of a 

statewide database of LTSS services and/or 

consumers 

 

Promoted the development of standard 

operating procedures 

 

Increased the level of coordination 

between organizations serving older 

individuals and individuals with disabilities 

 

Improved awareness/marketing 

campaigns/activities 

 

Section B. Populations Served 

This second set of questions asks about the populations in your service area as well as consumers that your organization 

serves. For questions about consumers, please focus on those who received services designed to enhance individual 

choice and support informed decision-making among consumers. This includes empowering individuals to effectively 

navigate their health and other long-term support options (e.g., Information, referral and awareness services; 

Consumer-focused decision support; Assistance with planning for future LTSS Needs; Streamlined eligibility 

determination for public programs; Person-centered transition support from institutional setting to community settings; 

and Independent living skills.) Please answer these questions to the best of your knowledge. In questions asking for 

percentages, please provide estimates if your organization does not collect the requested data. 

NOTE: The data will be used to group like organizations together to allow for more complex data analyses. These data 

will not be used to evaluate the efforts of your specific organization. 

For the following items, please indicate the demographic composition of your service area. (This question applies to the 

community that [insert ID] serves) 

7.	 Latino/Hispanic Origin
 

 Yes %
 

 No % 

Race 

 Caucasian/White % 

 Black or African American % 

 American Indian or Alaska Native % 

 Asian	 % 

 Nation Hawaiian or Other Pacific Islander % 

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8.	 If you have one or more significant racial/ethnic sub-populations in your service area please list it 

here:___________________
 

9.	 What percentage of your service area is living at or below the poverty line?
 

 At or below the poverty line %
 

 Not sure, but a significant population lives under the poverty line
 

 Not sure, but the population is small or negligible
 

10. What percentage of your service area is uninsured/does not have health insurance coverage?
 

 Uninsured %
 

 Not sure, but a significant population is uninsured
 

 Not sure, but the population is small or negligible
 

12. Within the last 12 months, has a community LTSS needs assessment been conducted?
 

 Yes 

 No, but we did complete a community needs assessment within the past three years 

 No, a community needs assessment was not completed within the past three years 

13. This next set of questions is designed to gather information about the conditions in your service area. 

[BLANK RESPONSE BOXES WILL BE POPULATED BY DROP-DOWN BOXES SHOWING OPTIONS EXPLAINED ABOVE ͚PRIOR' 

AND ͚CURRENTLY' COLUMNS΁ 

Community Needs 

Barriers to receiving Long Term Supports and Service services 

To what extent is each of the following a barrier for individuals seeking Long Term Supports and Service 

services both prior to receiving an ADRC grant [approximately 7 years ago or if you do not have 

information that goes back that far, as far back as you do have information] and currently? 

Please use dropdown menus to 

select: not a barrier, sometimes 

a barrier, often a barrier 

Prior Currently 

Lack of Long Term Supports and Services-Needed services are not 

offered 

Lack of available Long Term Supports and Service slots-(e.g., There 

are long waitlists) 

Poor service quality 

Lack of health insurance 

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Community Needs 

Barriers to receiving Long Term Supports and Service services 

To what extent is each of the following a barrier for individuals seeking Long Term Supports and Service 

services both prior to receiving an ADRC grant [approximately 7 years ago or if you do not have 

information that goes back that far, as far back as you do have information] and currently? 

Please use dropdown menus to 

select: not a barrier, sometimes 

a barrier, often a barrier 

Prior Currently 

Providers not accepting consumers with Medicaid 

Barriers based on consumer disabilities 

Language barriers 

Cultural barriers 

Religious barriers 

Sexual orientation barriers 

People needing services do not have a permanent address 

Consumers lack transportation 

Stigma, discrimination and prejudice against older adults 

Stigma, discrimination and prejudice against persons with disabilities 

Providers have high staff turnover 

Providers lack appropriately trained staff 

Service provider hours/locations are hard to access 

Other Please specify: 

[BLANK RESPONSE BOXES WILL BE POPULATED BY DROP-DOWN BOXES SHOWING OPTIONS EXPLAINED ABOVE ͚PRIOR' 

AND ͚CURRENTLY' COLUMNS΁ 

Service Availability/Choice 

Please indicate the Current 

availability of the 

following services within 

your service area 

For the following services, to what 

extent is there provider choice? 

Service has (no; limited; adequate) 

provider choice 

Prior Currently 

Safe and affordable housing 

options 

Adequate 

availability/Available but 

inadequate to meet 

need/Not available 

Peer support services/groups Adequate 

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Service Availability/Choice 

Please indicate the Current 

availability of the 

following services within 

your service area 

For the following services, to what 

extent is there provider choice? 

Service has (no; limited; adequate) 

provider choice 

Prior Currently 

availability/Available but 

inadequate to meet 

need/Not available 

HCBS Medicaid Waiver Programs Adequate 

availability/Available but 

inadequate to meet 

need/Not available 

Caregiver Support (i.e. respite 

programs, support groups, or 

counseling) 

Adequate 

availability/Available but 

inadequate to meet 

need/Not available 

Nutrition Programs Adequate 

availability/Available but 

inadequate to meet 

need/Not available 

Employment services Adequate 

availability/Available but 

inadequate to meet 

need/Not available 

Education services Adequate 

availability/Available but 

inadequate to meet 

need/Not available 

Opportunities to develop advanced 

directives 

Adequate 

availability/Available but 

inadequate to meet 

need/Not available 

Transportation services Adequate 

availability/Available but 

inadequate to meet 

need/Not available 

Opportunities for 

socialization/recreation 

Adequate 

availability/Available but 

inadequate to meet 

need/Not available 

Mental health services Adequate 

availability/Available but 

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Service Availability/Choice 

Please indicate the Current 

availability of the 

following services within 

your service area 

For the following services, to what 

extent is there provider choice? 

Service has (no; limited; adequate) 

provider choice 

Prior Currently 

inadequate to meet 

need/Not available 

Ombudsman services Adequate 

availability/Available but 

inadequate to meet 

need/Not available 

Health prevention and screening 

services 

Adequate 

availability/Available but 

inadequate to meet 

need/Not available 

Services for emergent cases/Crisis 

intervention 

Adequate 

availability/Available but 

inadequate to meet 

need/Not available 

Transition programs (from 

hospitals, nursing homes etc.) 

Adequate 

availability/Available but 

inadequate to meet 

need/Not available 

Nursing home (institutional) 

diversion programs 

Adequate 

availability/Available but 

inadequate to meet 

need/Not available 

Nursing home/residential beds Adequate 

availability/Available but 

inadequate to meet 

need/Not available 

Income assistance Adequate 

availability/Available but 

inadequate to meet 

need/Not available 

Energy assistance Adequate 

availability/Available but 

inadequate to meet 

need/Not available 

Personal care services Adequate 

availability/Available but 

inadequate to meet 

Page 12 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Service Availability/Choice 

Please indicate the Current 

availability of the 

following services within 

your service area 

For the following services, to what 

extent is there provider choice? 

Service has (no; limited; adequate) 

provider choice 

Prior Currently 

need/Not available 

Medicaid waivers Adequate 

availability/Available but 

inadequate to meet 

need/Not available 

Independent Living services (e.g., 

skills training, peer support) 

Adequate 

availability/Available but 

inadequate to meet 

need/Not available 

Other, please specify Adequate 

availability/Available but 

inadequate to meet 

need/Not available 

14. How many consumers of each type were served in the most recent 6 month period (October 2011-March 2012) 

NOTE: This question is specific to the consumers who access [insert ID] services such as I&R/I&A, benefits or 

options counseling, Information and referral services, services to support transitions from residential or 

institutional facilities to the community. 

Characteristics Currently 

Consumers 

under 60 

Consumers 

over 60 

Older Adults (60+) __ 

Individuals with Disabilities 

Physical disabilities 

Cognitive impairment 

Intellectual disabilities 

Developmental disabilities 

Mental Illness 

Multiple disabilities 

Caregivers 

Informal/family caregiver 

Paid Caregiver 

Page 13 
 

 

 

 

 

 

 

 

 

 

 

 

 

Characteristics Currently 

Health & Human Service Professional (e.g., physician, 

hospital discharge planner, nursing home staff) 

Special Subpopulations 

Traumatic Brain Injury (TBI) 

Emergent/Emergency Cases 

Low income 

Limited English proficiency 

Is the [insert ID] making any special efforts to target a 

particular population not listed above? If yes, please specify. 

Other (Please specify) 

Other (Please specify) 

14a. Since the start of the ADRC grant, the number of clients under 60 served by [insert ID] has: 

 Significantly increased 

 Significantly decreased 

 Stayed the same 

14b. [FOR AAA DIRECTORS ONLY]: Over the past 7 years, the number of clients under 60 served by [insert ID] has: 

 Significantly increased 

 Significantly decreased 

 Stayed the same 

15a. Since the start of the ADRC grant, the number of consumers over 60 served by [insert ID] has: 

 Significantly increased 

 Significantly decreased 

 Stayed the same 

15b. [FOR AAA DIRECTORS ONLY]: Over the past 7 years the number of consumers over 60 served by [insert ID] has: 

 Significantly increased 

 Significantly decreased 

 Stayed the same 

Page 14 
 

 

 

 

 

 

 

 

 

 

16a. Since the start of the ADRC grant, the number of consumers with physical disabilities served by [insert ID] has: 

 Significantly increased 

 Significantly decreased 

 Stayed the same 

16b. [FOR AAA DIRECTORS ONLY]: Over the past 7 years, the number of consumers with physical disabilities served 

by [insert ID] has: 

 Significantly increased 

 Significantly decreased 

 Stayed the same 

17a. Since the start of the ADRC grant, the number of consumers with mental/emotional disabilities served by 

[insert ID] has: 

 Significantly increased 

 Significantly decreased 

 Stayed the same 

17b. [FOR AAA DIRECTORS ONLY]: Over the past 7 years, the number of consumers with mental/emotional 

disabilities served by [insert ID] has: 

 Significantly increased 

 Significantly decreased 

 Stayed the same 

18a. Since the start of the ADRC grant, the number of consumers with multiple disabilities served by [insert ID] has: 

 Significantly increased 

 Significantly decreased 

 Stayed the same 

18b. [FOR AAA DIRECTORS ONLY]: Over the last 7 years, the number of consumers with multiple disabilities served 

by [insert ID] has: 

 Significantly increased 

 Significantly decreased 

 Stayed the same 

Page 15 
 

 

 

 

 

”

Η ”

 

 

 

19a. Since the start of the ADRC grant, the number of caregivers served by [insert ID] has:
 

 Significantly increased
 

 Significantly decreased
 

 Stayed the same
 

19b. [FOR AAA DIRECTORS ONLY]: Over the past 7 years, the number of caregivers served by [insert ID] has: 

 Significantly increased 

 Significantly decreased 

 Stayed the same 

Section C. Service Provision 

These questions are about the services provided by your organization/network 

20. How frequently do consumers ask about the following͍ For each, indicate “frequently,” “sometimes,” 

Ηinfrequently”, or “never.” Advanced directives 

Topic 

Frequency of consumer inquiry: 

There will be a drop down menu in each cell with 

the options: “frequently,” “sometimes, 

infrequently”, or “never. 

Advanced directives 

Advocacy 

Caregiver support 

Respite services 

Chronic health conditions 

Education 

Employment 

Energy assistance 

Home modification 

Affordable housing 

Income assistance 

Medicaid eligibility and services 

Medicare eligibility and services 

Mental/behavioral health services 

Nutrition services 

Ombudsman/abuse or neglect issues 

Independent living services 

Personal care/attendant care services 

Preventative health services 

Recreation opportunities 

Services for emergent care/crisis intervention 

Support groups 

Page 16 
 

”

Η ”

 

 

 

 

 

 

 

 

Topic 

Frequency of consumer inquiry: 

There will be a drop down menu in each cell with 

the options: “frequently,” “sometimes, 

infrequently”, or “never. 

Transition services 

Transportation 

Other, please specify 

21. Does [insert ID] engage in advocacy activities for older adults?
 

 Yes
 

 No 

22. Does [insert ID] engage in advocacy activities for persons with disabilities?
 

 Yes
 

 No 

23a. Is diversion form nursing homes or other institutional residential facilities an outcome sought to be achieved? 

Specific goal͙ 

 Yes
 

 No [Skip to question 24]
 

23b. How is [insert ID] measuring and tracking this?
 

 Staff track using a standard electronic system
 

 Staff track using a standard hardcopy/paper system
 

 An external group (e.g., an evaluator, auditor) tracks using a standard system
 

 Staff track using an informal system
 

 Other, please specify
 

CARE COORDINATION/TRANSITION ASSISTANCE PROGRAMS 

24. Does your organization provide transition services to consumers discharged from an acute care setting? 

 Yes 

 No [If no skip to question 30] 

25. Care Coordination/Transition Assistance 

[insert ID] Clients Provided Care Coordination/Transition Assistance 

No. individuals assisted with transition from hospital ONLY through formal 

Page 17 
 

 

 

 

 

 

care transitions program (evidence-based CT intervention or innovative 

model) 

Number of participants carried over from last reporting period (started 

program in last reporting period and continued with the intervention into 

this reporting period) 

Number of participants whose cases were closed during this period (i.e., 

participants whose transition services were ended either bacause of a 

readmission or new admission to a care facility or because the transition 

period ended) 

# of participants that readmitted within 30 days of discharge 

# of participants that readmitted within 30 days and re-entered the care 

transition program 

26. What is the number of individuals who were assisted with transition from hospital through formal care 

transitions intervention in this [INSERT ID] program service area this reporting period by participating hospital?
 

 Name of Hospital 1
 

 No. of Individuals for Hospital 1
 

 Name of Hospital 2
 

 No. of Individuals for Hospital 2
 

 Name of Hospital 3
 

 No. of Individuals for Hospital 3
 

27. What is the number of individuals who were assisted with transition from hospital through formal care 

transitions intervention across all participating hospitals in this [INSERT ID] program service area this reporting
 

period by age group?
 

 Aged 60 and Over
 

 Under Age 60
 

 Age Unknown
 

28. What is the number of individuals who were assisted with transition from hospital through formal care transitions 

intervention across all participating hospitals in this [INSERT ID] program service area this reporting period by 

health insurance source? 

_____Medicare
 

_____Medicaid
 

_____Dual-Eligible
 

_____ No insurance
 

_____Private insurance
 

_____Veterans Administration Services
 

_____Other Unknown
 

Page 18 
 

 

 

 

 

 

 

29. What is the number of individuals who were assisted with transition from hospital through formal care transitions 

intervention across all participating hospitals in this [INSERT ID] program service area in this reporting period who 

were referred to one or more health/prevention programs? 

_____Chronic Disease Self Management Program
 

_____Diabetes Self Management Program
 

_____Exercise Program
 

_____Mental Health and Substance Misuse
 

_____Falls Management and Prevention
 

 ͅ ͅ ͅ ͅ ͅAlzheimer's Programs 

_____Medication Management
 

_____Home Injury/Risk Screenings
 

_____Other
 

30a.What is the number of individuals who were assisted with transition from hospital through formal care transitions 

intervention across all participating hospitals in this [INSERT ID] program service area in this reporting period that were 

referred to one or more of the following long term services or supports? 

_____ Additional Options Counseling
 

_____ Home delivered meals
 

_____Nutrition services or nutrition counseling
 

_____ Care giver support
 

_____Personal care/homemaker/choremaker services
 

_____Transportation
 

31a. Do you have a marketing plan?
 

 Yes, our marketing plan is operational
 

 Yes, we have a plan but it is not yet operational 

 No, we do not have a plan at this time
 

31b. Does [insert ID] utilize a standard operating procedure to assess consumer need?
 

 Always 

 Sometimes
 

 Never
 

32. Is the consumer assessment tool and/or basic consumer needs assessment process common across partner 

organizations?
 

 Yes, common across all partners
 

 Yes, common across some partners 

 No, each partner organization uses their own assessment tool/process 

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OPTIONS COUNSELING OR OTHER ONE ON ONE COUNSELING 

33. Does your organization/network provide “Options Counseling” or other one-on-one counseling designed to 

support consumers' ability to make informed decisions about their long-term care?
 

 Yes
 

 No [If no skip to question 36]
 

34. Referrals to Public and Private Services this Reporting Period 

Referrals to Public and Private Services this Reporting Period 

What is the number of [insert ID] clients referred to or given an application for a 

public program, including Older Americans Act; Medicare; Medicaid; Food Stamps; 

TANF; Social Security (SSI or SSDI); LI-HEAP; VDHCBS; Other State-funded and countyfunded programs for Medicaid; Other? 

What is the number of [insert ID] clients referred to some other type of service (nonpublic services, resources or program)? 

What is the number of [insert ID] clients that were not referred to any type of service? 

What is the number of [insert ID] Unknown Clients (remainder of all Clients)? 

Total 

[FOR SITES WITH OPTIONS COUNSELING OR OTHER ONE ON ONE COUNSELING ONLY] 

35. Clients Provided Options Counseling this Reporting Period 

[insert ID] Clients Provided Options Counseling By Age 

[insert ID] Clients Aged 60 and 

Over 

[insert ID] Clients Under Age 60 

[insert ID] Clients Age Unknown 

Total 

[insert ID] Clients Provided Options Counseling by Method 

In person 

By phone 

Page 20 
 

 

 

 

 

 

Electronic Communication (e.g. 

email or website chat) 

Total 

[insert ID] Clients Provided Options Counseling by Setting 

[insert ID] 

Hospital 

Nursing facility/Institution 

At the client's community residence 

Other 

Total 

Client Feedback About Options Counseling 

What is the number of [insert ID] 

Clients who report that options 

counseling enabled them to make 

well informed decisions about their 

long term support services? 

What is the number of [insert ID] 

Clients surveyed this reporting 

period? 

36. Does [insert ID] or network have a standardized tool or process to provide options counseling?
 

 Yes
 

 No
 

 Don't know
	

 Not applicable
 

PUBLIC PROGRAMS 

37. Average Monthly Public LTSS Program Enrollment in WHOLE [INSERT ID] SERVICE AREA 

This set of questions is asking about all current enrollment levels in these programs in the [INSERT ID] service area. 

Enrollment fluctuates from month to month, so please calculate the average enrollment per month during the reporting 

period. 

Page 21 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

Average Monthly Public LTSS Program Enrollment in WHOLE [INSERT ID] SERVICE AREA 

What is the average number of individuals enrolled in Medicaid HCBS 

Waivers in [INSERT ID] Service Area each month (should include [INSERT 

ID] Clients and might include Non-[INSERT ID] Clients)? 

What is the average number of individuals enrolled in Medicaid residing in 

institutions in [INSERT ID] Service Area each month (should include [INSERT 

ID] Clients and might include Non-[INSERT ID] Clients)? 

What is the average number of individuals enrolled in other public LTSS 

programs in [INSERT ID] Service Area each month (should include [INSERT 

ID] Clients and might include Non-[INSERT ID] Clients)? Please list LTSS 

programs and HCBS waivers (e.g. aged and disabled, MR/DD) that 

individuals are enrolled in. 

[FOR SITES THAT REFER CLIENTS TO PUBLIC PROGRAMS ONLY]: 

38. Total New Enrollment among [INSERT ID] CLIENTS ONLY in Public LTSS Programs 

This set of questions is asking about the absolute number of [INSERT ID] clients who were newly enrolled into these 

programs during the last six months. 

Total New Enrollment among [INSERT ID] CLIENTS ONLY in Public LTSS Programs 

What is the number of [INSERT ID] Clients who are newly enrolled into a 

Medicaid HCBS Waiver this reporting period (including individuals enrolled 

by [INSERT ID] staff and individuals referred for assessment/application by 

[INSERT ID] staff)? 

What is the number of [INSERT ID] Clients who are newly enrolled into 

Medicaid institutional services this reporting period (including individuals 

enrolled by [INSERT ID] staff and individuals referred for 

assessment/application by [INSERT ID] staff)? 

What is the average number of individuals enrolled in other public LTSS 

programs in [INSERT ID] Service Area each month (should include [INSERT 

ID] Clients and might include Non-[INSERT ID] Clients)? Please list LTSS 

programs and HCBS waivers (e.g. aged and disabled, MR/DD) that 

individuals are enrolled in. 

Page 22 
 

 

 

 

 

 

 

39. For data collected on consumers, are staff required to follow the Alliance of Information and Referral Systems 

(AIRS) standards1

? 

 Yes with all consumers 

 Yes, with specific groups of consumers ʹPlease specify:
 

 Never
 

40. Does [insert ID] have a database/MIS that does any of the following (Select all that apply)?: 

 Track consumer requests for information and referrals 

 Track referrals made to consumers 

 Maintain records on individual consumers 

 Maintain a list of services/service providers 

 Links to other databases (e.g., Medicaid waiver tracking systems, Money Follows the Person tracking 

system). If yes, specify: _______________ 

 Other, please specify
 

 We do not have an electronic records/tracking system [skip to question 41]
 

41. Do operational partners have access to data they need for their operations such as data about your 

consumers/services? If yes, for what purpose? (review client information, input client demographic information, 

input referrals, input service utilization information, review client service utilization, obtain summary reports on 

clients and/or services) 

 Yes (specify _____________________________________) 

 No, but there are plans to develop that capacity 

 No, and there are no current plans to do this 

42. Do service providers have access to data about our consumers? If yes, for what purpose? (see above)
 

 Yes (Specify___________________________________)
 

 No, but there are plans to develop that capacity
 

 No, and there are no current plans to do this
 

42a. Do staff follow up with consumers after their initial contact with your organization?
 

 Always
 

 Sometimes-Under what circumstances: ___________________
 

 Never [skip to question 45]
 

42b. How many times does staff follow up with consumers after their initial contact with your organization? 

1 Standard 13: Inquirer Data Collection 

Page 23 
 

 

 

 

 

 

 

 Once
 

 Multiple times
 

42c. What is the approximate timing of the first follow up with consumers after their initial contact with your 

organization? 

	 One to weeks after service 

	 Three weeks after service 

	 One to two months after service 

	 Three to five months after service 

	 Six months after service 

	 One year or longer after service 

42d. What is the approximate timing of the last follow up with consumers after their initial contact with your 

organization? 

	 One week after service 

	 Two weeks after service 

	 Three weeks after service 

	 One to two months after service 

	 Three to five months after service 

	 Six months after service 

	 One year or longer after service 

43. When consumers are referred to other agencies or organizations, are those providers contacted as part of the 

follow up procedure?
 

 Always
 

	 Sometimes-Under what circumstances:____________________ 

	 Never 

44.	 Approximately what percentage of consumers who are referred to other organizations receive a “warm 

transfer” (e.g., Simultaneous transfer of a telephone call and its associated data from one agent to another 

agent or supervisor)? ______% 

45. Does your organization routinely collect quantitative performance data about its services and consumers? 

 Yes 

 No [skip to question 49] 

46. Indicate any of the ways that your organization uses performance data: [check all that apply] 

Page 24 
 

 

 

 

 

 To justify funding requests 

 To improve consumer service 

 To administer service provider contracts 

 To provide information to stakeholders (governing board, advocacy organizations, local government, 

etc.)
 

 For program planning
 

 Do not use performance data
 

47. On which topics, if any, would you like to receive additional assistance from the technical assistance provider? 

(Open Response) 

Eligibility Screening Module: Initial Screening of ADRC Clients 

48. When a client contacts the ADRC about long-term services and supports (LTSS), do ADRC staff administer a 

screening questionnaire to make a preliminary determination of eligibility and need for publicly-funded LTSS? 

 Yes 

 No 

 Other, please describe ________________ 

49a. If yes, to which of the following populations is the eligibility screening instrument administered ? Check all 

that apply. 

 Aged 65 and older 

 Physical disability 

 Intellectual Disability/Developmental Disability 

 Brain injury 

 HIV/AIDS 

 Medically fragile 

 Autism 

 Mental illness 

 Other (specify _________) 

49b. What kind of information is collected? Check all that apply. 

 Demographic information (i.e., age, gender, ethnicity, marital status) 

 Living arrangements 

 Caregivers 

 Health status 

 Activities of daily living (ADL) 

 Instrumental activities of daily living(IADL) 

 Cognitive functions 

 Troublesome behaviors 

 LTSS currently received 

 Income 

Page 25 
 

 

 

 

 

 

 Assets 

 Other, please list __________________ 

Eligibility Screening Module: Financial Eligibility Determination 

50. How do clients in your state/site complete and file applications for financial eligibility for Medicaid or publiclyfunded LTSS? Check all that apply. 

 Applications are accessed on-line, printed, completed by hand, and returned to a state or county office. 

 Applications are accessed on-line, completed on-line, printed, and returned to a state or county office. 

 Applications are accessed on-line, completed on-line, and submitted to the state or county 

electronically. 

 Paper copy applications are obtained at various locations including _____ [INSERT LOCATIONS], 

completed by hand, and returned either in person or by mail to a state or county office. 

 Other ______________________ 

51. In what ways do ADRC staff assist clients with financial eligibility applications for Medicaid LTSS Programs? Check 

all that apply.
 

 We do not assist clients with financial eligibility applications
 

 Advise the client where s/he can obtain an application
 

 Assist the client in completing the application
 

 Assist the client in collecting the required financial documentation
 

 Check on the status of the client's application
	

 Notify the client when the application has been approved/disapproved
 

 Manage appeals by clients whose applications were not approved
 

 Other ____________________________
 

52. In what ways do ADRC staff assist clients with financial eligibility applications for publicly-funded LTSS* other 

than Medicaid LTSS? Check all that apply. 

 We do not assist clients with financial eligibility applications 

 Advise the client where s/he can obtain an application 

 Assist the client in completing the application 

 Assist the client in collecting the required financial documentation 

 Check on the status of the client's application 

 Notify the client when the application has been approved/disapproved 

 Manage appeals by clients whose applications were not approved 

 Other ____________________________ 

 *Please describe the publicly funded LTSS services in your state. This includes LTSS programs funded 

solely by state or county _________________________ 

53. Does your state/site permit presumptive financial eligibility in order to expedite the provision of LTSS to clients 

while their financial eligibility applications are being processed?
 

 Yes
 

 No
 

 In Progress
 

Eligibility Screening Module: Functional Assessment 

Page 26 
 

54. Does your state/site use a universal, comprehensive assessment instrument for functional (level of care) 

eligibility determinations for LTSS? 

 Yes
 

 No
 

 No, but in development
 

55a. If yes, what best describes the kind of instrument your state/site is using? Check one. 

 A custom-designed instrument developed by state staff
 

 A custom-designed instrument developed by a vendor specifically for our state
 

 An instrument developed by a vendor that is also used by other states 

 Other, please list: ____________________
 

55b. What best describes the process for how the assessor completes the instrument? Check all that apply. 

 The assessor completes a paper form while interviewing the client; there is no electronic data entry. 

 The assessor completes a paper form while interviewing the client and later inputs the data on an 

electronic form at the office. 

 The assessor completes an electronic form while interviewing the client, which is later downloaded into 

an electronic database. 

 The assessor completes a web-based form while interviewing the client and the client's data is entered 

“real time” into an electronic database. 

 Our state/site uses multiple processes, including ________ [SELECT FROM A-D ABOVE] 

55c.Do you work with consumers to develop a care plan? 

 Yes, with all consumers
 

 Yes under certain circumstances (Please specify________)
 

 No, that is not part of this service
 

55d.For which of the following populations is the functional assessment used? Check all that apply. 

 Aged 65 and older
 

 Physical disability
 

 ID/DD
 

 Brain injury
 

 HIV/AIDS
 

 Medically fragile
 

 Autism
 

 Mental illness
 

56. The Affordable Care Act requires states to implement Health Insurance Exchanges effective January 1, 2014. 

States are required to provide a single electronic portal for “real time” financial eligibility determinations for 

Medicaid and Qualified Health Plans offered through the Exchange. 

56a. Is your organization involved in planning for your state's Exchange͍ 

Page 27 
 

 

____________________________________________________ 

____________________________________________________ 

 

 Yes
 

 No [skip to question57]
 

 Not Sure.
 

If Yes, please describe your organization's role role:  ͅ ͅ ͅ ͅ ͅ ͅ ͅ ͅ ͅ ͅ ͅ ͅ ͅ ͅ ͅ ͅ ͅ ͅ ͅ ͅ ͅ ͅ ͅ ͅ ͅ ͅ ͅ ͅ ͅ ͅ ͅ ͅ ͅ ͅ 

56b.Is your state/site examining ways to align functional eligibility determination for publicly-funded LTSS with 

Medicaid financial eligibility determination carried out through the Exchange website? 

 Yes
 

 No
 

 Not Sure.
 

If Yes, please describe: _______________________________________________________ 

57. Are any of your organization's functions reimbursed under Federal financial participation (FFP) or Federal 

medical assistance percentage (FMAP)? If so please specify the functions.
 

 No, none of our functions are reimbursed under FFP or FMAP
 

 Yes, the following functions are reimbursed under FFP
 

	 Yes, the following functions are reimbursed under FMAP 

Section D. Organizational Characteristics 

These questions are about your organization budget, partnerships, and structure. 

58.	 For the current Fiscal Year, what is the approximate amount of funding from each of the following sources? (In 

$ amounts) 

Check if you 

have received 

funding in prior 

Fiscal Years 

Amount of 

funding 

during the 

current Fiscal 

Year 

Funding source 

 Administration on Aging Title IV ADRC Grant 

 Administration of Aging Title II Grant 

 CMS Real Choice Systems Change Grants 

 CMS Person-Centered Hospital Discharge Planning Grant 

 Patient protection and Affordable Care Act Grant 

 Veteran's Administration 

Page 28 
 

 

 

 

Check if you 

have received 

funding in prior 

Fiscal Years 

Amount of 

funding 

during the 

current Fiscal 

Year 

Funding source 

 Money Follows the Person Demonstration 

 State Transformation Grant 

 Alzheimer's Disease Demonstration Grant 

 Evidence-Based Disease Prevention Grant 

 Program of All-Inclusive Care for the Elderly (PACE) 

 Medicare Improvement for Patients and Providers Act (MIPPA) 

 Respite Care Act funds 

 Rehabilitation Services Administration (RSA) 

 Substance Abuse and Mental Health Services Administration 

(SAMHSA) - Mental Health Transformation Grant 

 Agency for Health Care Research and Policy - Chronic Disease 

Self-Management Grant 

 Administration for Children and Families, Office of Community 

Services - Low Income Home Energy Assistance Program 

(LIHEAP) 

 Health Resources and Services Administration HIV/AIDS 

Bureau - Ryan White Fund 

 State Unit on Aging 

 State General Revenue 

 County of local government 

 Private entities/grants - Hospitals or other businesses 

 Medicaid for Direct Services (state and federal) 

 Medicaid for Federal Financial Participation 

 Care Transitions Income 

 Consumer Fees or Cost Sharing 

 Charitable Donations 

 Other, please specify 

 Total Budget for FY 2013 

59. What best characterizes the operation of your agency? 

Page 29 
 

 

 

	 Single-point of entry: one agency maintains a knowledgebase on LTSS options and assists consumers 

in making decisions about the best and most feasible options for LTSS 

	 No wrong door: multiple agencies are knowledgeable about LTSS options and cooperate to assist 

consumers regardless of which agency the consumer first contacts. 

60. Do you identify your structure as any of the following: 

 Independent, non-profit 

 Part of city government 

 Part of county government 

 Part of COG or RPDA
 

 Other. Specify: _____________
 

61.	 [ADRCs only] What organizations comprise the core operating organizations? [BLANK RESPONSE BOXES WILL BE 

POPULATED BY DROP-DOWN BOXES SHOWING YES/NO] 

Organization 

Core Operating Organization? 

(Yes/No) 

AAA 

State Unit on Aging 

Veterans Organization 

Alzheimer's Association 

Other Aging Services Organization 

Centers for Independent Living 

Vocational Rehabilitation Departments 

Other Disability Services Organization 

Community Mental Health 

County or Regional Council of Governments 

County Government Office or Agency 

Local Housing Authority 

State or Local Medicaid Agency 

211 

Other Human Services of Social Service Provider (please 

specify) 

Page 30 
62. [FOR EACH OF THE CORE OPERATING ORGANIZATIONS]: Please describe your relationship with other core 

operating organizations at your site and the functionality of the site in meeting the objective of improving and 

streamlining access to information, assistance, and long-term services and supports for older adults, persons 

with disabilities, and their families. Would you describe the current status as having a solid working relationship? 

Please provide as much detail as possible. _____________________________________________ 

Page 31 
 

 - 

 

 

 

 

 

 

 

 

 

 

 

63. With which organizations do [insert ID] have a partnership? What is the strength of the relationship, as well as the type of partnership agreement and 

shared resources? [BLANK RESPONSE BOXES WILL BE POPULATED BY DROP-DOWN BOXES SHOWING OPTIONS EXPLAINED IN EACH COLUMN] 

Partner 

(Check all 

the apply) 

Functionality 

of 

Partnership 

(1=Weak 

functionality; 

2=Moderately 

functional/ 

functional in 

some areas; 

3=Highly 

functional) 

Partnership 

Agreement 

Select from the 

following list: 

ͻFunding 

relationship 

ͻFormal MOU 

ͻContract 

ͻCooperative 

ͻInformal 

working 

relationship 

ͻ Other, please 

specify 

Shared Resources 

Select from the following list: 

 Co-located staff 

 Shared monetary resource 

 Information sharing 

 Joint training 

 Joint sponsorship of 

programs 

 Shared non-monetary 

 resources (i.e. office space) 

 Shared data 

 No shared resources 

State Departments (with cabinet level 

secretaries): 

Health 

Human Services 

Aging 

Other (specify): 

State Agencies (located within state 

departments): 

Aging 

Developmental Disabilities 

Acquired or Late-Onset Disabilities 

Mental Health 

Medicaid 

Housing 

Page 32 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Partner 

(Check all 

the apply) 

Functionality 

of 

Partnership 

(1=Weak 

functionality; 

2=Moderately 

functional/ 

functional in 

some areas; 

3=Highly 

functional) 

Partnership 

Agreement 

Select from the 

following list: 

ͻFunding 

relationship 

ͻFormal MOU 

ͻContract 

ͻCooperative 

ͻInformal 

working 

relationship 

ͻ Other, please 

specify 

Shared Resources 

Select from the following list: 

 Co-located staff 

 Shared monetary resource 

 Information sharing 

 Joint training 

 Joint sponsorship of 

programs 

 Shared non-monetary 

 resources (i.e. office space) 

 Shared data 

 No shared resources 

Education 

Other (specify): 

Local Government Agencies 

Area Agency on Aging 

County Health Department 

County Medicaid office 

County Department on Aging 

County Department on Disability 

County Housing Office 

Library 

Other (specify): 

Federal Agencies: 

Local Veterans Administration 

Local Indian Health Service 

Other (specify): 

Organizations Providing Direct Services: 

211 or other call center 

Page 33 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Partner 

(Check all 

the apply) 

Functionality 

of 

Partnership 

(1=Weak 

functionality; 

2=Moderately 

functional/ 

functional in 

some areas; 

3=Highly 

functional) 

Partnership 

Agreement 

Select from the 

following list: 

ͻFunding 

relationship 

ͻFormal MOU 

ͻContract 

ͻCooperative 

ͻInformal 

working 

relationship 

ͻ Other, please 

specify 

Shared Resources 

Select from the following list: 

 Co-located staff 

 Shared monetary resource 

 Information sharing 

 Joint training 

 Joint sponsorship of 

programs 

 Shared non-monetary 

 resources (i.e. office space) 

 Shared data 

 No shared resources 

Community Health Clinic 

Community Mental Health Clinic 

Deaf Service Center 

Hospital/Medical Center 

School for the Blind 

School for the Deaf 

The ARC 

United Way 

Vocational/Rehabilitation Services 

Other (specify): 

Advocacy/Referral Organizations: 

AIDS Coalition 

Alzheimer's Association 

American Council of the Blind 

Autism Society state/regional chapter 

Brain Injury Association state/regional chapter 

Centers for Independent Living 

Page 34 
 

 

 

 

 

 

 

 

 

Partner 

(Check all 

the apply) 

Functionality 

of 

Partnership 

(1=Weak 

functionality; 

2=Moderately 

functional/ 

functional in 

some areas; 

3=Highly 

functional) 

Partnership 

Agreement 

Select from the 

following list: 

ͻFunding 

relationship 

ͻFormal MOU 

ͻContract 

ͻCooperative 

ͻInformal 

working 

relationship 

ͻ Other, please 

specify 

Shared Resources 

Select from the following list: 

 Co-located staff 

 Shared monetary resource 

 Information sharing 

 Joint training 

 Joint sponsorship of 

programs 

 Shared non-monetary 

 resources (i.e. office space) 

 Shared data 

 No shared resources 

Easter Seals 

Epilepsy Foundation state/regional chapter 

National Association of Mental Illness 

state/regional chapter 

National Autism Association state/regional 

chapter 

National Multiple Sclerosis Society 

state/regional chapter 

State Association for the Deaf 

United Cerebral Palsy 

Other (specify): 

Page 35 
 

 

 

 

 

 

 

 

 

 

64. Approximately how many FTEs (Full-time equivalents) perform each of the following functions? 

	 I&R/I&A 

	 Options counseling/counseling to provide in-depth person centered decision support 

	 Benefits counseling/eligibility determination 

	 Care transition services 

	 Crisis intervention services 

	 Independent Living services 

	 Advocacy services 

	 Providing administrative or other support for the above functions 

65. How many front line staff are Alliance of Information and Referral Systems (AIRS) certified? 

	 Number of AIRS certified staff 

	 Total number of front line staff 

66. Is your organization paid on a fee-for-service or per-unit basis for performing any of the following services for a 

client? (Please check all that apply)
 

 Information/referral
 

 Options counseling
 

 Screening
 

 Assessment
 

 Application assistance
 

 Transition support
 

 Other, please specify
 

67. [if any of the boxes are checked in previous question] What is the source of the fee-for-service or per-unit 

payments?
 

 Medicare
 

 Medicaid waiver
 

 Medicaid state plan
 

 Medicaid managed care organization
 

 State-funded program other than Medicaid
 

 Private health plan
 

 Provider
 

 Other, please specify
 

Section E. LTSS Environment 

68.	 Since this [insert ID] started serving consumers, has there been an impact on the LTSS or Home and CommunityBased (HCBS) system in your community? 

	 There has been an increase in the number of LTSS providers. 

	 There has been a decrease in the number of LTSS providers. 

	 There has been an increase in the quality of LTSS services. 

	 There has been a decrease in the quality of LTTS services. 

Page 36 
____________________ 

69. Please add any final thoughts about [insert ID] and either its operations and/or its results (Open response). 

Page 37
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

APPENDIX D. PROCESS EVALUATION STATE ADRC SURVEY QUESTIONNAIRE
 

PROCESS EVALUATION Ͷ STATE-LEVEL WEB-BASED SURVEY 

INSTRUCTIONS TO WEB SURVEY PROGRAMMER: PREPOPULATE (PP) INFORMATION IN [ ] BASED ON SITE DIRECTOR TYPE 

(DT) OR ID NUMBER (ID). THESE PREPOPULATED DATA WILL BE USED THROUGHOUT THE SURVEY TO ORIENT THE 

RESPONDENT BASED ON NAME OF SITE. EACH SITE WILL ALSO RECEIVE A UNIQUE ID NUMBER WITH THE NAME OF THE 

SITE. 

[ID Number - ID] 

	 Name of State-level Site 

[Director Type - DT] 

	 ADRC (State-level) 

Section A. Baseline Characteristics 

The first set of questions focus on characteristics of your aging and disability network PRIOR to receiving an ADRC grant 

and the influence on your aging and disability network. . 

1.	 Click here to review federal funding received by your state since [ENTER YEAR OF RECEIPT OF ADRC GRANT] for 

the development of ADRCs. On a scale of 1 to 5, how would you rate your state's progress since ΀YEAR΁ in 

improving access to the following services, with 1 being “Poor” and 5 being “Excellent͍” 

Poor Excellent 

1 2 3 4 5 

Information, referral, and 

awareness of LTSS options 

Options counseling and 

assistance 

Streamlined eligibility 

determination for public 

programs 

Person-centered transition 

support 

2.	 States used federal grant funding in a variety of ways to develop their aging and disability networks. On a scale 

of 1 to 5, indicate the importance of each of the following in improving access to LTSS in your state since YEAR, 

with 1 being “not important at all” and 5 being “very important.” 

Not important 

at all 

Very 

important 

1 2 3 4 5 

Development of 

new partnerships 

Page 38 
 

 

 

 

 

 

 

 

 

Not important 

at all 

Very 

important 

Staffing 

Advisory council 

Development of 

shared data 

systems 

Web-based 

information and 

referral 

Other 

3.	 When your state applied for its first ADRC grant in YEAR, what were your goals for the project? Check all that 

apply. 

 To better integrate the delivery of LTSS for the aging and disability populations 

 To develop or strengthen agency/organizational partnerships 

 To improve data or IT infrastructure 

 To improve marketing or awareness efforts related to Long Term Care Services and Supports (LTSS) 

 To expand services to additional populations 

 To expand services to additional geographic locations 

 Other, please specify _____________________
 

4.	 Please indicate how your State initially selected local sites to receive ADRC funds. 

 Selected sites that were already integrated to help them maintain or expand their efforts 

 Selected sites that were partially integrated to support further integration 

 Selected sites that were fragmented to encourage integration 

 Selected AAAs already in operation 

 Selected organizations that were currently serving the aging community (e.g., senior centers) 

 Selected sites that were currently serving the disability community (e.g., CILS) 

 Selected county offices because existing infrastructure was available 

 Other, please specify
 

Indicate the extent to which the grants your state received for ADRC development contributed to the following: 

Page 39 
 

 

 

 

Very much Somewhat Very little 

͙ increase the skills of existing staff o o o 

͙ recruit or attract more experienced staff o o o 

͙ increase/expand populations served o o o 

͙ increase the number of consumers served o o o 

͙ increase the number of partnerships o o o 

͙increase range of services offered o o o 

͙make other changes (please specify) o o o 

5.	 How has the ADRC grant(s) affected the resources or resource allocation at your organization/network or within 

your state? If there is more than one ADRC in your state, select the box if the item is true for at least one ADRC. 

(Select all that apply) 

At the Site or Local Level At the State Level 

Helped us leverage other funds (including 

reimbursement for specific functions) 

 

Improved staff training opportunities  

Increased service efficiency  

Contributed to the development of a 

statewide database of Long Term Supports 

and Service and/or consumers 

 

Promoted the development of standard 

operating procedures 

 

Increased the level of coordination 

between organizations serving older 

individuals and individuals with disabilities 

 

Improved awareness/marketing 

campaigns/activities 

 

6.	 Within the last 12 months, has the state conducted a community long-term service and support needs 

assessment?
 

 Yes , we assessed the needs in all [ADRC communities in our State
 

	 Yes, we assessed the needs in some of the [ADRC or communities in our State 

	 No, but we did complete a community needs assessment, for at least some of the [ADRC or 

communities in our State within the past three years 

	 No, a community needs assessment was not completed within the past three years 

Page 40 
 

This next set of questions is designed to gather information about the conditions in the service network for your state. 

Please think about the status of your state as a whole. 

7. Community Needs 

Barriers to receiving Long Term Supports and Service services 

What barriers do individuals in your state encounter in accessing LTSS? For each barrier listed below, 

indicate the extent to which this was a barrier in YEAR when the state first began developing its ADRC 

network and the extent to which it is currently a barrier. 

Use drop-down menu to select 

“not a barrier,” “sometimes a 

barrier,” or “often a barrier” 

YEAR 2012 

Non-availability of needed services and supports 

Limits on Medicaid HCBS waiver enrollment 

Limits on enrollment in state-only funded LTSS 

Quality of available LTSS 

Lack of health insurance 

Providers not accepting consumers with Medicaid 

Lack of accommodations for consumers with disabilities 

Language barriers 

Cultural barriers 

Religious barriers 

Sexual orientation barriers 

People needing services do not have a permanent address 

Consumers lack transportation 

Stigma, discrimination and prejudice against older adults 

Stigma, discrimination and prejudice against persons with disabilities 

Providers have high staff turnover 

Providers lack appropriately trained staff 

Service provider hours/locations are hard to access 

Other, Please specify: 

Page 41 
 

 

 

8. Service Availability/Choice 

Please indicate the Current 

availability of the 

following services within 

your service area 

For the following services, to what 

extent is there provider choice? 

Service has (no; limited; adequate) 

provider choice 

Prior to first 

ADRC grant Currently 

Safe and affordable housing 

options 

Adequate availability/Available 

but inadequate to meet 

need/Not available 

No/Limited/Adequate No/Limited/Adequate 

Peer support services/groups Adequate availability/Available 

but inadequate to meet 

need/Not available 

No/Limited/Adequate No/Limited/Adequate 

HCBS Medicaid Waiver Programs Adequate availability/Available 

but inadequate to meet 

need/Not available 

No/Limited/Adequate No/Limited/Adequate 

Caregiver Support (i.e. respite 

programs, support groups, or 

counseling) 

Adequate availability/Available 

but inadequate to meet 

need/Not available 

No/Limited/Adequate No/Limited/Adequate 

Nutrition Programs Adequate availability/Available 

but inadequate to meet 

need/Not available 

No/Limited/Adequate No/Limited/Adequate 

Employment services Adequate availability/Available 

but inadequate to meet 

need/Not available 

No/Limited/Adequate No/Limited/Adequate 

Education services Adequate availability/Available 

but inadequate to meet 

need/Not available 

No/Limited/Adequate No/Limited/Adequate 

Legal services Adequate availability/Available 

but inadequate to meet 

need/Not available 

No/Limited/Adequate No/Limited/Adequate 

Transportation services Adequate availability/Available 

but inadequate to meet 

need/Not available 

No/Limited/Adequate No/Limited/Adequate 

Socialization/recreation programs Adequate availability/Available 

but inadequate to meet 

need/Not available 

No/Limited/Adequate No/Limited/Adequate 

Mental/behavioral health services Adequate availability/Available 

but inadequate to meet 

need/Not available 

No/Limited/Adequate No/Limited/Adequate 

Ombudsman services Adequate availability/Available 

but inadequate to meet 

need/Not available 

No/Limited/Adequate No/Limited/Adequate 

Health prevention and screening 

services 

Adequate availability/Available 

but inadequate to meet 

need/Not available 

No/Limited/Adequate No/Limited/Adequate 

Emergency services/crisis 

intervention 

Adequate availability/Available 

but inadequate to meet 

need/Not available 

No/Limited/Adequate No/Limited/Adequate 

Page 42 
 

 8. Service Availability/Choice 

Please indicate the Current 

availability of the 

following services within 

your service area 

For the following services, to what 

extent is there provider choice? 

Service has (no; limited; adequate) 

provider choice 

Prior to first 

ADRC grant Currently 

Nursing home transition programs Adequate availability/Available 

but inadequate to meet 

need/Not available 

No/Limited/Adequate No/Limited/Adequate 

Hospital transition programs 

Nursing home (institutional) 

diversion programs 

Adequate availability/Available 

but inadequate to meet 

need/Not available 

No/Limited/Adequate No/Limited/Adequate 

Nursing home services Adequate availability/Available 

but inadequate to meet 

need/Not available 

No/Limited/Adequate No/Limited/Adequate 

Assisted living services 

Shared living programs 

Adult day care 

Consumer-directed LTSS 

Income assistance Adequate availability/Available 

but inadequate to meet 

need/Not available 

No/Limited/Adequate No/Limited/Adequate 

Energy assistance Adequate availability/Available 

but inadequate to meet 

need/Not available 

No/Limited/Adequate No/Limited/Adequate 

Personal care/attendant services Adequate availability/Available 

but inadequate to meet 

need/Not available 

No/Limited/Adequate No/Limited/Adequate 

Medicaid HCBS waiver programs Adequate availability/Available 

but inadequate to meet 

need/Not available 

No/Limited/Adequate No/Limited/Adequate 

Independent Living supports (e.g., 

skills training, vocational programs, 

peer support) 

Adequate availability/Available 

but inadequate to meet 

need/Not available 

No/Limited/Adequate No/Limited/Adequate 

Other, please specify Adequate availability/Available 

but inadequate to meet 

need/Not available 

No/Limited/Adequate No/Limited/Adequate 

Section B. Organizational Characteristics 

These questions are about your organization or network budget, partnerships, and structure. 

Page 43 
 

 

 

 

9. For the current Fiscal Year, what is the approximate amount of funding from each of the following sources? (In 

$ amounts) 

Check if you 

have received 

funding in prior 

Fiscal Years 

Amount of 

funding 

during the 

current Fiscal 

Year 

Funding source 

 Administration on Aging Title IV ADRC Grant 

 Administration of Aging Title II Grant 

 CMS Real Choice Systems Change Grants 

 CMS Person-Centered Hospital Discharge Planning Grant 

 Patient protection and Affordable Care Act Grant 

 Veteran's Administration 

 Money Follows the Person Demonstration 

 State Transformation Grant 

 Alzheimer's Disease Demonstration Grant 

 Evidence-Based Disease Prevention Grant 

 Program of All-Inclusive Care for the Elderly (PACE) 

 Medicare Improvement for Patients and Providers Act (MIPPA) 

 Respite Care Act funds 

 Rehabilitation Services Administration (RSA) 

 Substance Abuse and Mental Health Services Administration 

(SAMHSA) - Mental Health Transformation Grant 

 Agency for Health Care Research and Policy - Chronic Disease 

Self-Management Grant 

 Administration for Children and Families, Office of Community 

Services - Low Income Home Energy Assistance Program 

(LIHEAP) 

 Health Resources and Services Administration HIV/AIDS 

Bureau - Ryan White Fund 

 State Unit on Aging 

 State General Revenue 

 County of local government 

 Private entities/grants - Hospitals or other businesses 

Page 44 
Check if you 

have received 

funding in prior 

Fiscal Years 

Amount of 

funding 

during the 

current Fiscal 

Year 

Funding source 

 Medicaid for Direct Services (state and federal) 

 Medicaid for Federal Financial Participation 

 Care Transitions Income 

 Consumer Fees or Cost Sharing 

 Charitable Donations 

 Other, please specify 

Total Budget for FY 2013 

Page 45 
 

 -

 

10. With which organizations do [insert ID] have a partnership? What is the strength of the relationship, as well as the type of partnership agreement and 

shared resources? [BLANK RESPONSE BOXES WILL BE POPULATED BY DROP-DOWN BOXES SHOWING OPTIONS EXPLAINED IN EACH COLUMN] 

Partner 

(Check 

all the 

apply) 

Functionality 

of Partnership 

(1=Weak 

functionality; 

2=Moderately 

functional/ 

functional in 

some areas; 

3=Highly 

functional) 

Partnership 

Agreement 

Select from 

the following 

list: 

ͻFunding 

relationship 

ͻFormal 

MOU 

ͻContract 

ͻCooperative 

ͻInformal 

working 

relationship 

ͻ Other, 

please 

specify 

Shared 

Resources 

Select from the 

following list: 

 Co-located staff 

 Shared monetary 

resource 

 Information sharing 

 Joint training 

 Joint sponsorship of 

programs 

 Shared nonmonetary 

 resources (i.e. office 

space) 

 Shared data 

 No shared resources 

State Departments (with cabinet 

level secretaries): 

Health 

Human Services 

Aging 

Other (specify): 

State Agencies (located within state 

departments): 

Aging 

Developmental Disabilities 

Acquired or Late-Onset Disabilities 

Mental Health 

Page 46 
 

 

 

 

Partner 

(Check 

all the 

apply) 

Functionality 

of Partnership 

(1=Weak 

functionality; 

2=Moderately 

functional/ 

functional in 

some areas; 

3=Highly 

functional) 

Partnership 

Agreement 

Select from 

the following 

list: 

ͻFunding 

relationship 

ͻFormal 

MOU 

ͻContract 

ͻCooperative 

ͻInformal 

working 

relationship 

ͻ Other, 

please 

specify 

Shared 

Resources 

Select from the 

following list: 

 Co-located staff 

 Shared monetary 

resource 

 Information sharing 

 Joint training 

 Joint sponsorship of 

programs 

 Shared nonmonetary 

 resources (i.e. office 

space) 

 Shared data 

 No shared resources 

Medicaid 

Housing 

Education 

Other (specify): 

Local Government Agencies 

Area Agency on Aging 

County Health Department 

County Medicaid office 

County Department on Aging 

County Department on Disability 

County Housing Office 

Library 

Other (specify): 

Federal Agencies: 

Local Veterans Administration 

Local Indian Health Service 

Page 47 
Partner 

(Check 

all the 

apply) 

Functionality 

of Partnership 

(1=Weak 

functionality; 

2=Moderately 

functional/ 

functional in 

some areas; 

3=Highly 

functional) 

Partnership 

Agreement 

Select from 

the following 

list: 

ͻFunding 

relationship 

ͻFormal 

MOU 

ͻContract 

ͻCooperative 

ͻInformal 

working 

relationship 

ͻ Other, 

please 

specify 

Shared 

Resources 

Select from the 

following list: 

 Co-located staff 

 Shared monetary 

resource 

 Information sharing 

 Joint training 

 Joint sponsorship of 

programs 

 Shared nonmonetary 

 resources (i.e. office 

space) 

 Shared data 

 No shared resources 

Other (specify): 

Organizations Providing Direct 

Services: 

211 or other call center 

Community Health Clinic 

Community Mental Health Clinic 

Deaf Service Center 

Hospital/Medical Center 

School for the Blind 

School for the Deaf 

The ARC 

United Way 

Vocational/Rehabilitation Services 

Other (specify): 

Advocacy/Referral Organizations: 

AIDS Coalition 

Alzheimer's Association 

Page 48 
Partner 

(Check 

all the 

apply) 

Functionality 

of Partnership 

(1=Weak 

functionality; 

2=Moderately 

functional/ 

functional in 

some areas; 

3=Highly 

functional) 

Partnership 

Agreement 

Select from 

the following 

list: 

ͻFunding 

relationship 

ͻFormal 

MOU 

ͻContract 

ͻCooperative 

ͻInformal 

working 

relationship 

ͻ Other, 

please 

specify 

Shared 

Resources 

Select from the 

following list: 

 Co-located staff 

 Shared monetary 

resource 

 Information sharing 

 Joint training 

 Joint sponsorship of 

programs 

 Shared nonmonetary 

 resources (i.e. office 

space) 

 Shared data 

 No shared resources 

American Council of the Blind 

Autism Society state/regional chapter 

Brain Injury Association 

state/regional chapter 

Centers for Independent Living 

Easter Seals 

Epilepsy Foundation state/regional 

chapter 

National Association of Mental Illness 

state/regional chapter 

National Autism Association 

state/regional chapter 

National Multiple Sclerosis Society 

state/regional chapter 

State Association for the Deaf 

United Cerebral Palsy 

Other (specify): 

Page 49 
 

 

 

_________ 

 

 

 

 

____________________________ 

11. Approximately, how many FTEs (Full-time equivalents) at the state level perform each of the following 

functions? 

 Information & Referral /Information & Assistance (I&R/I&A) 

 Options counseling/counseling to provide in-depth person centered decision support 

 Benefits counseling/eligibility determination 

 Care transition services 

 Crisis intervention services 

 Independent Living services 

 Advocacy services 

 Providing administrative or other support for the above functions 

12. At the State level, how many FTE (Full-time equivalents) are dedicated to working with the ADRC(s) in your 

State? 

13. Is your organization paid on a fee-for-service or per-unit basis for performing any of the following services for a 

client? (Please check all that apply)
 

 Information/referral
 

 Options counseling
 

 Screening
 

 Assessment
 

 Application assistance
 

 Transition support
 

 Other, please specify
 

14. [if any of the boxes are checked in previous question] What is the source of the fee-for-service or per-unit 

payments?
 

 Medicare
 

 Medicaid waiver
 

 Medicaid state plan
 

 Medicaid managed care organization
 

 State-funded program other than Medicaid
 

 Private health plan
 

 Provider
 

 Other, please specify
 

Section D. Long-Term Service and Support Environment 

15. Please add any final thoughts about [insert ID] and either its operations and/or its results (Open response) 

Page 50 
 - - - - 

 

 

 

 

 

 

 

 

 

 

 

APPENDIX E. PROCESS EVALUATION STATE/TERRITORY RESPONSE RATES 

100% 99% 75% 74% 50% 49% 25% 24% 1% 0% Not expected to submit 

Alabama California Michigan Florida None Guam Mississippi 

Alaska Colorado Montana New York Missouri 

Arizona Hawaii Nevada Oklahoma Nebraska 

Arkansas Maryland North Carolina Northern Mariana Islands 

Connecticut Massachusetts Oregon Wyoming 

Delaware New Jersey 

District of Columbia Pennsylvania 

Georgia Tennessee 

Idaho Vermont 

Illinois Virginia 

Indiana West Virginia 

Iowa Wisconsin 

Kansas 

Kentucky 

Louisiana 

Maine 

Minnesota 

New Hampshire 

New Mexico 

North Dakota 

Ohio 

Rhode Island 

South Carolina 

South Dakota 

Texas 

Utah 

Washington 

Page 51 
 

- -

’

- -

 

 

APPENDIX F. PROCESS EVALUATION LOCAL ADRC SURVEY RESPONSE 

TABLES
 

Section A. Baseline Characteristics
 

1. Has your organization realized an improvement in ability to provide integrated, comprehensive access to 

long term care services and supports (e.g., provide one stop or streamlined benefits access, increase awareness 

of LTSS options, provide assistance to consumers such as counseling regarding LTSS choices or transitions 

from institutions back into the community) since the start of the ADRC grant? 

Frequency Percentage 

Yes 450 95.34 

No 19 4.03 

No response 3 0.64 

Total 472 100 

2. Which have had the most positive impact on your organization s ability to provide integrated, 

comprehensive access to long term care services and supports (e.g., provide one stop or streamlined benefits 

access, increase awareness of LTSS options, provide assistance to consumers such as counseling regarding 

LTSS choices or transitions from institutions back into the community)? (Select up to two) 

Frequency Percentage 

Partnerships developed/expanded 370 78.39 

Staffing changes 112 23.73 

Shared data 86 18.22 

Focus on providing person-centered, self-directed services 213 45.13 

Other, specify* 24 5.08 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

3. Which of the following best describes the reason your site became an ADRC? 

Frequency Percentage 

To better integrate service provision systems 161 34.11 

To develop or strengthen agency/organizational partnerships 142 30.08 

To improve data or IT infrastructure 7 1.48 

To improve marketing and awareness efforts to LTSS 41 8.69 

To expand services to additional populations 84 17.80 

To expand services to additional geographic locations 4 0.85 

Other, specify* 0 0.00 

No response 33 6.99 

Total 472 100 

Page 52 
 

 

 

 

 

 

 

 

 

5. Please indicate the extent to which Federal (AoA/CMS) grants have enabled your ADRC to realize any of the 

following outcomes. (Select all that apply) 

Very much Somewhat Very little No response Total 

Freq. % Freq. % Freq. % Freq. % Freq. % 

Increase the skills of 

existing staff 

229 48.52 183 38.77 41 8.69 19 4.08 472 100 

Recruit or attract more 

experienced staff 

60 12.71 150 31.78 221 46.82 41 8.69 472 100 

Increase/expand 

populations served 

191 40.47 196 41.53 62 13.14 23 4.87 472 100 

Increase the number of 

consumers served 

200 42.37 191 40.47 58 12.29 23 4.87 472 100 

Increase the number of 

partnerships 

248 52.54 159 33.69 40 8.47 25 5.30 472 100 

Increase the number of 

services offered 

147 31.14 192 40.68 106 22.46 27 5.72 472 100 

Make other changes 

(specify)* 

44 9.32 48 10.17 64 13.56 316 66.95 472 100 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

6. How has the ADRC grant(s) affected the resources or resource allocation at your organization or within your state? 

[If there is more than one ADRC in the state, check the box if the item is true of at least one ADRC] (Check all that 

apply) 

At Site or Local Level At the State Level 

Frequency Percentage* Frequency Percentage* 

Helped us leverage other funds 178 37.71 127 26.91 

Improved staff training opportunities 346 73.31 117 24.79 

Increased service efficiency 304 64.41 79 16.74 

Contributed to the development of a statewide database of 

LTSS and/or consumers 

170 36.02 153 32.42 

Promoted the development of standard operating 

procedures 

268 56.78 144 30.51 

Increased the level of coordination between organizations 

serving older individuals with disabilities 

380 80.51 117 24.79 

Improved awareness/marketing campaigns/activities 330 69.92 112 23.73 

*Percentages do not add up to 100% as respondents could select more than one option. 

Page 53 
Section B. Populations Served
 

7. For the following items, please indicate the demographic composition of your 

service area. (This question applies to the community that [LOCAL ADRC] serves.) 

Latino/Hispanic Origin 

Frequency Percentage 

0% 3 0.63 

>0-5% 229 48.52 

6-10% 66 13.98 

11-20% 47 9.96 

>20% 40 8.47 

No response 87 18.43 

Total 472 100 

Min (%) 0.00 

Max (%) 100 

Mean (%) 9.39 

Median (%) 4.30 

Mode (%) 1.00 

Page 54 
 

 

 

 

 

7. For the following items, please indicate the demographic composition of your service area. (This question applies to the community that [LOCAL 

ADRC] serves.) 

Caucasian/White Black or African American American Indian or 

Alaska Native 

Asian Nation Hawaiian or 

Other Pacific Islander 

Frequency Percentage Frequency Percentage Frequency Percentage Frequency Percentage Frequency Percentage 

0% 1 0.21 2 0.42 3 0.64 2 0.42 30 6.36 

>0-5% 2 0.42 211 44.70 320 67.80 340 72.03 196 41.53 

6-10% 1 0.21 62 13.14 9 1.91 19 4.03 3 0.64 

11-20% 4 0.85 52 11.02 5 1.06 5 1.06 2 0.42 

21-50% 43 9.11 59 12.50 0 0.00 3 0.64 0 0.00 

51-75% 88 18.64 9 1.91 1 0.21 3 0.64 0 0.00 

76-100% 285 60.38 3 0.64 0 0.00 0 0.00 0 0.00 

No response 48 10.17 74 15.68 134 28.39 100 21.19 241 51.06 

Total 472 100 472 100 470 100 472 100 472 100 

Min (%) 0.00 0.00 0.00 0.00 0.00 

Max (%) 99.90 92.00 70.70 63.90 17.00 

Mean (%) 78.75 10.92 1.38 2.72 0.60 

Median (%) 86.30 5.00 0.40 1.20 0.10 

Mode (%) 97.00 1.00 1.00 1.00 0.10 

Page 55 
 

 

 

 

9. What percent of your service area is living at or below the poverty line? 

Frequency Percentage 

At or below the poverty line (those who specified a percentage) 280 59.32 

Not sure, but a significant population lives under the poverty 

line 

147 31.14 

Not sure, but the population is small or negligible 18 3.81 

No response 27 5.72 

Total 472 100 

9a. What percent of your service area is living at or below the poverty 

line? 

Frequency Percentage 

0% 0 0.00 

>0-10% 83 29.64 

11-25% 159 56.79 

26-50% 12 4.29 

51-100% 20 7.14 

No response 6 2.14 

Total 280 100 

Min (%) 1.70 

Max (%) 95.00 

Mean (%) 16.71 

Median (%) 13.00 

Mode (%) 12.00 

10. What percent of your service area is uninsured/does not have health insurance coverage? 

Frequency Percentage 

Uninsured (those who specified a percentage) 115 24.36 

Not sure, but a significant population is uninsured 227 48.09 

Not sure, but the population is small or negligible 92 19.49 

No response 38 8.05 

Total 472 100 

Page 56 
 

10a. What percent of your service area is uninsured /does not have health 

insurance coverage? 

Frequency Percentage 

0% 2 1.70 

>0-10% 31 26.96 

11-25% 63 54.78 

26-50% 10 8.69 

51-100% 0 0.00 

No response 9 7.83 

Total 115 100 

Min (%) 0.00 

Max (%) 45.00 

Mean (%) 15.39 

Median (%) 13.65 

Mode (%) 9.00 

12. Within the last 12 months, has a community LTSS needs assessment been conducted? 

Frequency Percentage 

Yes 155 32.84 

No, but we did complete a community needs assessment within 

the past three years 

141 29.87 

No, a community needs assessment was not completed within the 

past three years 

149 31.57 

No response 27 5.72 

Total 472 100 

Page 57 
 

 

 

 

 

 

 

 

 

13. To what extent is each of the following a barrier for individuals seeking Long Term Supports and Services both prior to receiving an ADRC grant and 

currently? 

Prior Currently 

Not a barrier Sometimes a 

barrier 

Often a 

barrier 

No response Not a barrier Sometimes a 

barrier 

Often a 

barrier 

No response 

Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

Lack of LTSS-needed 

services are not offered 

49 10.38 238 50.42 157 33.26 28 5.93 68 14.41 284 60.17 91 19.28 29 6.14 

Lack of available LTSS slots 

(i.e., long waiting lists) 

53 11.23 149 31.57 240 50.85 30 6.36 72 15.25 183 38.77 190 40.25 28 5.93 

Poor service quality 227 48.09 185 39.19 27 5.72 33 6.99 254 53.81 181 38.35 6 1.27 31 6.57 

Lack of health insurance 40 8.47 255 54.03 142 30.08 35 7.42 50 10.59 290 61.44 101 21.40 31 6.57 

Providers not accepting 

consumers with Medicaid 

93 19.70 256 54.24 89 18.86 34 7.20 90 19.07 264 55.93 86 18.22 32 6.78 

Barriers based on consumer 

disabilities 

80 16.95 260 55.08 94 19.92 38 8.05 104 22.03 290 61.44 42 8.90 36 7.63 

Language barriers 140 29.66 252 53.39 50 10.59 30 6.36 172 36.44 254 53.81 19 4.03 27 5.72 

Cultural barriers 149 31.57 253 53.60 33 6.99 37 7.84 174 36.86 251 53.18 14 2.97 33 6.99 

Religious barriers 332 70.34 98 20.76 4 0.85 38 8.05 340 72.03 96 20.34 3 0.64 33 6.99 

Sexual orientation barriers 271 57.42 134 28.39 26 5.51 41 8.69 289 61.23 132 27.97 13 2.75 38 8.05 

People needing services do 

not have a permanent 

address 

124 26.27 276 58.47 40 8.47 32 6.78 126 26.69 294 62.29 23 4.87 29 6.14 

Consumers lack 

transportation 

8 1.69 128 27.12 307 65.04 29 6.14 14 2.97 187 39.62 245 51.91 26 5.51 

Stigma, discrimination and 

prejudice against older 

adults 

218 46.19 188 39.83 27 5.72 39 8.26 240 50.85 184 38.98 13 2.75 35 7.42 

Stigma, discrimination and 

prejudice against persons 

with disabilities 

141 29.87 235 49.79 63 13.35 33 6.99 171 36.23 249 52.75 24 5.08 28 5.93 

Providers have high staff 

turnover 

73 15.47 250 52.97 115 24.36 34 7.20 75 15.89 270 57.20 97 20.55 30 6.36 

Providers lack appropriate 

trained staff 

83 17.58 279 59.11 75 15.89 35 7.42 109 23.09 281 59.53 50 10.59 32 6.78 

Service provider 147 31.14 235 49.79 56 11.86 34 7.20 171 36.23 248 52.54 22 4.66 31 6.57 

Page 58 
 

 

 

 

 

 

13. To what extent is each of the following a barrier for individuals seeking Long Term Supports and Services both prior to receiving an ADRC grant and 

currently? 

Prior Currently 

Not a barrier Sometimes a 

barrier 

Often a 

barrier 

No response Not a barrier Sometimes a 

barrier 

Often a 

barrier 

No response 

Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

hours/locations are hard to 

access 

Other, please specify* 6 1.27 8 1.69 11 2.33 447 94.70 4 0.85 8 1.69 10 2.12 450 95.34 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

13. Please indicate the current availability of the following services within your service area. 

Adequate availability Available but inadequate 

to meet the need 

Not available No response 

Frequency Percentage Frequency Percentage Frequency Percentage Frequency Percentage 

Safe and affordable housing options 60 12.71 377 79.87 19 4.03 16 3.39 

Peer support services/groups 183 38.77 247 52.33 16 3.39 26 5.51 

HCBS Medicaid Waiver Programs 198 41.95 230 48.73 14 2.97 30 6.36 

Caregiver Support (i.e. respite program, 

support groups, or counseling) 

166 35.02 277 58.69 3 0.64 26 5.51 

Nutrition Programs 237 50.21 208 44.07 1 0.21 26 5.51 

Employment Services 147 31.14 286 60.59 11 2.33 28 5.93 

Education services 242 51.27 176 37.29 16 3.39 38 8.05 

Opportunities to develop advanced 

directives 

293 62.08 134 28.39 9 1.9 36 7.63 

Transportation services 37 7.84 407 86.23 7 1.48 21 4.45 

Opportunities for socialization/recreation 224 47.46 217 45.97 3 0.64 28 5.93 

Mental health services 76 16.10 368 77.97 7 1.48 21 4.45 

Ombudsman services 329 69.70 114 24.15 3 0.64 26 5.51 

Health prevention and screening services 218 46.19 221 46.82 6 1.27 27 5.72 

Emergency services/crisis intervention 118 25.00 315 66.74 11 2.33 28 5.93 

Transition programs (from hospitals, 

nursing homes etc.) 

105 22.25 285 60.38 50 10.59 32 6.78 

Page 59 
 

 

 

13. Please indicate the current availability of the following services within your service area. 

Adequate availability Available but inadequate 

to meet the need 

Not available No response 

Frequency Percentage Frequency Percentage Frequency Percentage Frequency Percentage 

Nursing home (institutional) diversion 

program 

153 32.42 265 56.14 23 4.87 31 6.57 

Nursing home/residential beds 283 59.96 153 32.42 7 1.48 29 6.14 

Income Assistance 62 13.14 350 74.15 30 6.36 30 6.36 

Energy assistance 97 20.55 345 73.09 3 0.64 27 5.72 

Personal Care services 178 37.71 267 56.57 2 0.42 25 5.30 

Medicaid waivers 172 36.44 268 56.78 5 1.06 27 5.72 

Independent living services (e.g., skills 

training, peer support) 

154 32.63 270 57.20 17 3.60 31 6.57 

Other, please specify* 3 0.64 8 1.69 5 1.06 456 96.61 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

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13. For these services, to what extent is there provider choice both prior to receiving an ADRC grant and currently? 

Prior Currently 

No Limited Adequate No response No Limited Adequate No response 

Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

Safe and affordable housing 

options 

26 5.51 360 76.27 47 9.96 39 8.26 18 3.81 355 75.21 71 15.04 28 5.93 

Peer support services/groups 45 9.53 285 60.38 94 19.92 48 10.17 22 4.66 269 56.99 143 30.30 38 8.05 

HCBS Medicaid Waiver 

Programs 

39 8.26 248 52.54 130 27.54 55 11.65 25 5.30 210 44.49 193 40.89 44 9.32 

Caregiver Support (i.e. 

respite program, support 

groups, or counseling) 

31 6.57 287 60.81 105 22.25 49 10.38 5 1.06 268 56.78 164 34.75 35 7.42 

Nutrition Programs 34 7.20 212 44.92 179 37.92 47 9.96 26 5.51 216 45.76 193 40.89 37 7.84 

Employment Services 30 6.36 287 60.81 102 21.61 53 11.23 23 4.87 297 62.92 110 23.31 42 8.90 

Education services 20 4.24 218 46.19 177 37.50 57 12.08 14 2.97 204 43.22 206 43.64 48 10.17 

Opportunities to develop 

advanced directives 

27 5.72 220 46.61 170 36.02 55 11.65 11 2.33 150 31.78 266 56.36 45 9.53 

Transportation services 45 9.53 357 75.64 28 5.93 42 8.90 33 6.99 372 78.81 36 7.63 31 6.57 

Opportunities for 

socialization/recreation 

13 2.75 249 52.75 159 33.69 51 10.81 4 0.85 232 49.15 196 41.53 40 8.47 

Mental health services 29 6.14 346 73.31 54 11.44 43 9.11 18 3.81 354 75.00 69 14.62 32 6.78 

Ombudsman services 41 8.69 158 33.47 223 47.25 50 10.59 36 7.63 149 31.57 248 52.54 39 8.26 

Health prevention and 

screening services 

21 4.45 294 62.29 102 21.61 55 11.65 7 1.48 230 48.73 193 40.89 42 8.90 

Emergency services/crisis 

intervention 

42 8.90 316 66.95 65 13.77 49 10.38 28 5.93 331 70.13 76 16.10 37 7.84 

Transition programs (from 

hospitals, nursing homes 

etc.) 

170 36.02 217 45.97 35 7.42 50 10.59 57 12.08 286 60.59 89 18.86 40 8.47 

Nursing home (institutional) 

diversion program 

119 25.21 235 49.79 70 14.83 48 10.17 29 6.14 277 58.69 128 27.12 38 8.05 

Nursing home/residential 

beds 

14 2.97 178 37.71 229 48.52 51 10.81 6 1.27 162 34.32 259 54.87 45 9.53 

Income Assistance 36 7.63 336 71.19 49 10.38 51 10.81 36 7.63 348 73.73 48 10.17 40 8.47 

Energy assistance 24 5.08 320 67.80 78 16.53 50 10.59 21 4.45 329 69.70 86 18.22 36 7.63 

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13. For these services, to what extent is there provider choice both prior to receiving an ADRC grant and currently? 

Prior Currently 

No Limited Adequate No response No Limited Adequate No response 

Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

Personal Care services 13 2.75 284 60.17 131 27.75 44 9.32 6 1.27 252 53.39 178 37.71 36 7.63 

Medicaid waivers 31 6.57 273 57.84 122 25.85 46 9.75 17 3.60 256 54.24 165 34.96 34 7.20 

Independent living services 

(e.g., skills training, peer 

support) 

47 9.96 289 61.23 84 17.80 52 11.02 27 5.72 282 59.75 118 25.00 45 9.53 

Other, please specify* 5 1.06 9 1.91 2 0.42 456 96.61 6 1.27 9 1.91 3 0.64 454 96.19 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

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14. How many consumers of each type were served in the most recent 6 month period (October 

2012 March 2013)? Note: This question is specific to the consumers who access [LOCAL 

ADRC] services such as I&R/I&A, benefits or options counseling, information and referral 

services, services to support transitions from residential or institutional facilities to the 

community. 

Total Number of Older Adults (60+) 

Frequency Percentage 

0 0 0.00 

>0-100 25 5.30 

101-500 58 12.29 

501-1000 65 13.77 

1001-2500 105 22.25 

2501-5000 59 12.50 

5001-10,000 39 8.26 

>10,000 35 7.42 

No response 86 18.22 

Total 472 100 

Min 15 

Max 58,388 

Mean 3,961 

Median 1,444 

Mode 517 

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14. How many consumers of each type were served in the most recent 6 months period (October 2012 March 2013)? This question is specific to the 

consumers who access [LOCAL ADRC] services such as I&R/I&A, benefits or options counseling, information and referral services, services to 

support transitions from residential or institutional facilities to the community. 

Consumers Under 60 

0 >0-25 26-50 51-100 101-200 >200 No response Range Mean Median Mode # % # % # % # % # % # % # % Min Max 

Individuals with Disabilities 

Physical Disabilities 5 1.06 72 15.25 30 6.36 34 7.20 34 7.20 68 14.41 229 48.52 0 3,004 248 71 2 

Cognitive 

Impairment 15 3.18 82 17.37 8 1.69 9 1.91 8 1.69 9 1.91 341 72.25 0 1,347 59 9 1 

Intellectual 

Disabilities 17 3.60 69 14.62 4 0.85 6 1.27 3 0.64 4 0.85 369 78.18 0 1,200 49 8 1 

Developmental 

Disabilities 15 3.18 92 19.49 4 0.85 16 3.39 7 1.48 10 2.12 328 69.49 0 1,234 73 8 2 

Mental Illness 7 1.48 112 23.73 25 5.30 21 4.45 16 3.39 15 3.18 276 58.47 0 1,166 66 19 1 

Multiple Disabilities 8 1.69 80 16.95 25 5.30 11 2.33 14 2.97 29 6.14 305 64.62 0 14,188 236 25 1 

Caregivers 

Informal/family 

caregiver 7 1.48 45 9.53 24 5.08 28 5.93 27 5.72 31 6.57 310 65.68 0 2,216 163 64 2 

Paid Caregiver 13 2.75 27 5.72 9 1.91 6 1.27 3 0.64 3 0.64 411 87.08 0 1,362 75 22 1 

Health and Human 

Services 

Professional 

11 2.33 44 9.32 17 3.60 14 2.97 9 1.91 21 4.45 356 75.42 0 2,265 132 34 2 

Special Subpopulations 

Traumatic Brain 

Injury (TBI) 16 3.39 85 18.01 6 1.27 3 0.64 0 0.00 0 0.00 362 76.69 0 96 9 3 1 

Emergent/ 

Emergency Cases 16 3.39 30 6.36 4 0.85 1 0.21 2 0.42 0 0.00 419 88.77 0 150 19 6 2 

Low income 7 1.48 18 3.81 14 2.97 15 3.18 21 4.45 40 8.47 357 75.64 0 5,053 384 135 50 

Limited English 

proficiency 14 2.97 38 8.05 2 0.42 4 0.85 5 1.06 4 0.85 405 85.81 0 1,234 75 9 3 

Is the LOCAL 

ADRC making any 

special efforts to 

target a particular 

population not 

listed above? If yes, 

please specify* 

0 0.00 11 2.33 0 0.00 3 0.64 1 0.21 7 1.48 450 95.34 2 1,1013 203 40 2 

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14. How many consumers of each type were served in the most recent 6 months period (October 2012 March 2013)? This question is specific to the 

consumers who access [LOCAL ADRC] services such as I&R/I&A, benefits or options counseling, information and referral services, services to 

support transitions from residential or institutional facilities to the community. 

Consumers Under 60 

0 >0-25 26-50 51-100 101-200 >200 No response Range Mean Median Mode # % # % # % # % # % # % # % Min Max 

Other, specify* 0 0.00 16 3.39 1 0.21 4 0.85 2 0.42 8 1.69 441 93.43 2 2,119 224 24 2 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

14. How many consumers of each type were served in the most recent 6 months period (October 2012 March 2013)? This question is specific to the 

consumers who access LOCAL AAA services such as I&R/I&A, benefits or options counseling, Information and referral services, services to support 

transitions from residential or institutional facilities to the community. 

Consumers 60 and over (Currently) 

0 >0-25 26-50 51-100 101-200 >200 No response Range Mean Median Mode # % # % # % # % # % # % # % Min Max 

Individuals with Disabilities 

Physical 

Disabilities 4 0.85 21 4.45 27 5.72 38 8.05 45 9.53 123 26.06 214 45.34 0 27,567 793 190 0 

Cognitive 

Impairment 9 1.91 62 13.14 22 4.66 24 5.08 15 3.18 38 8.05 302 63.98 0 3,467 155 42 0 

Intellectual 

Disabilities 18 3.81 67 14.19 5 1.06 4 0.85 4 0.85 8 1.69 366 77.54 0 589 41 4 0 

Developmental 

Disabilities 17 3.60 79 16.74 10 2.12 8 1.69 5 1.06 4 0.85 349 73.94 0 3,543 59 6 0 

Mental Illness 6 1.27 99 20.97 28 5.93 35 7.42 19 4.03 18 3.81 267 56.57 0 979 70 22 1 

Multiple 

Disabilities 7 1.48 51 10.81 27 5.72 30 6.36 27 5.72 43 9.11 287 60.81 0 7,949 422 65 0 

Caregivers 

Informal/ 

Family 

Caregiver 

5 1.06 28 5.93 22 4.66 29 6.14 29 6.14 90 19.07 269 56.99 0 9,678 428 152 0, 200 

Paid Caregiver 11 2.33 29 6.14 6 1.27 10 2.12 5 1.06 10 2.12 401 84.96 0 5,311 199 20 0 

Health and 

Human Services 

Professional 

11 2.33 36 7.63 20 4.24 15 3.18 17 3.60 43 9.11 330 69.92 0 9,293 340 65.50 0 

Special Subpopulations 

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14. How many consumers of each type were served in the most recent 6 months period (October 2012 March 2013)? This question is specific to the 

consumers who access LOCAL AAA services such as I&R/I&A, benefits or options counseling, Information and referral services, services to support 

transitions from residential or institutional facilities to the community. 

Consumers 60 and over (Currently) 

0 >0-25 26-50 51-100 101-200 >200 No response Range Mean Median Mode # % # % # % # % # % # % # % Min Max 

Traumatic Brain 

Injury (TBI) 17 3.60 81 17.16 6 1.27 2 0.42 1 0.21 0 0.00 365 77.33 0 125 8 2 1 

Emergent/ 

Emergency 

Cases 

16 3.39 29 6.14 11 2.33 4 0.85 3 0.64 4 0.85 405 85.81 0 1,226 52 10 0 

Low income 7 1.48 6 1.27 9 1.91 10 2.12 19 4.03 94 19.92 327 69.28 0 9,896 936 342 0 

Limited English 

proficiency 8 1.69 44 9.32 9 1.91 4 0.85 3 0.64 14 2.97 390 82.63 0 3,148 179 10 0 

Is the LOCAL 

ADRC making 

any special 

efforts to target 

a particular 

population not 

listed above? If 

yes, please 

specify* 

0 0.00 6 1.27 2 0.42 3 0.64 5 1.06 7 1.48 449 95.13 2 3,141 402 101 2 

Other, please 

specify* 0 0.00 3 0.64 1 0.21 1 0.21 3 0.64 5 1.06 459 97.25 6 1,250 235 140 8 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

Page 66 
 

14a. Since the start of the ADRC grant, the number of clients under 60 served by [LOCAL ADRC] 

has : 

Frequency Percentage 

Significantly increased 305 64.62 

Significantly decreased 2 0.42 

Stayed the same 128 27.12 

No response 37 7.84 

Total 472 100 

15a. Since the start of the ADRC grant, the number of consumers 60 and over served by [LOCAL 

ADRC] has : 

Frequency Percentage 

Significantly increased 286 60.59 

Significantly decreased 4 0.85 

Stayed the same 145 30.72 

No response 37 7.84 

Total 472 100 

16a. Since the start of the ADRC grant, the number of consumers with physical disabilities served by 

[LOCAL ADRC] has: 

Frequency Percentage 

Significantly increased 289 61.23 

Significantly decreased 0 0.00 

Stayed the same 137 29.03 

No response 46 9.75 

Total 472 100 

17a. Since the start of the ADRC grant, the number of consumers with mental/emotional disabilities 

served by [LOCAL ADRC] has: 

Frequency Percentage 

Significantly increased 246 52.12 

Significantly decreased 1 0.21 

Stayed the same 179 37.92 

No response 46 9.75 

Total 472 100 

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18a. Since the start of the ADRC grant, the number of consumers with multiple disabilities served by 

[LOCAL ADRC] has: 

Frequency Percentage 

Significantly increased 276 58.47 

Significantly decreased 2 0.42 

Stayed the same 145 30.72 

No response 49 10.38 

Total 472 100 

19a. Since the start of the ADRC grant, the number of caregivers served by [LOCAL ADRC] has: 

Frequency Percentage 

Significantly increased 275 58.26 

Significantly decreased 5 1.06 

Stayed the same 143 30.30 

No response 49 10.38 

Total 472 100 

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Section C. Service Provision
 

20. How frequently do consumers ask about the following? 

Frequently Sometimes Infrequently Never No Response 

Freq. % Freq. % Freq. % Freq. % Freq. % 

Advanced directives 62 13.14 204 43.22 141 29.87 17 3.60 48 10.17 

Advocacy 187 39.62 164 34.75 68 14.41 7 1.48 46 9.75 

Caregiver support 315 66.74 97 20.55 10 2.12 3 0.64 47 9.96 

Respite services 290 61.44 118 25.00 17 3.60 1 0.21 46 9.75 

Chronic health conditions 173 36.65 196 41.53 48 10.17 8 1.69 47 9.96 

Education 36 7.63 152 32.20 203 43.01 35 7.42 46 9.75 

Employment 73 15.47 174 36.86 159 33.69 18 3.81 48 10.17 

Energy assistance 313 66.31 93 19.70 16 3.39 2 0.42 48 10.17 

Home modification 207 43.86 190 40.25 26 5.51 1 0.21 48 10.17 

Affordable housing 329 69.70 80 16.95 12 2.54 2 0.42 49 10.38 

Income Assistance 325 68.86 77 16.31 16 3.39 4 0.85 50 10.59 

Medicaid eligibility and services 375 79.45 43 9.11 5 1.06 0 0.00 49 10.38 

Medicare eligibility and services 350 74.15 60 12.71 12 2.54 0 0.00 50 10.59 

Mental/behavioral health services 106 22.46 240 50.85 74 15.68 5 1.06 47 9.96 

Nutrition services 289 61.23 108 22.88 25 5.30 4 0.85 46 9.75 

Ombudsman/abuse or neglect issues 121 25.64 226 47.88 76 16.10 2 0.42 47 9.96 

Independent living services 187 39.62 179 37.92 52 11.02 4 0.85 50 10.59 

Personal care/attendant care services 335 70.97 77 16.31 11 2.33 0 0.00 49 10.38 

Preventative health services 36 7.63 249 52.75 129 27.33 12 2.54 46 9.75 

Recreation opportunities 55 11.65 167 35.38 174 36.86 19 4.03 57 12.08 

Services for emergent care/crisis 

intervention 

100 21.19 203 43.01 109 23.09 7 1.48 53 11.23 

Support groups 76 16.10 251 53.18 91 19.28 6 1.27 48 10.17 

Transition services 111 23.52 225 47.67 79 16.74 5 1.06 52 11.02 

Transportation 388 82.20 29 6.14 6 1.27 0 0.00 49 10.38 

Other, specify* 40 8.47 14 2.97 2 0.42 24 5.08 392 83.05 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

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21. Does local ADRC engage in advocacy for older adults? 

Frequency Percentage 

Yes 449 95.13 

No 10 2.12 

No Response 13 2.75 

Total 472 100 

22. Do local ADRC engage in advocacy activities for persons with 

disabilities? 

Frequency Percentage 

Yes 435 92.16 

No 24 5.08 

No Response 13 2.75 

Total 573 100 

23a. Is diversion from nursing homes or other institutional residential 

facilities an outcome sought to be achieved? 

Frequency Percentage 

Yes 427 90.47 

No 27 5.72 

No Response 18 3.81 

Total 472 100 

23b. How is [Local ADRC] measuring and tracking this? 

Frequency Percentage 

Staff track using standard electronic system 212 44.92 

Staff track using hardcopy/paper system 35 7.42 

An external group (e.g., an evaluator, auditor) 

tracks using a standard system 

31 6.57 

Staff track using an informal system 75 15.89 

No Response 119 25.21 

Other, please specify* 0 0.00 

Total 472 100 

*Free text responses accompanying this question are available in the appendix with supplemental 

questions. 

Page 70 
24. Does your organization provide transition services to consumers discharged 

from an acute care setting? 

Frequency Percentage 

Yes 176 37.29 

No 270 57.20 

No Response 26 5.51 

Total 472 100 

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25. [Local ADRC] Clients provided Care Coordination/Transition Assistance 

0 >0-100 101-200 201-300 301-400 >400 No Response Range Mean Median Mode 

# % # % # % # % # % # % # % Min Max 

Number of individuals assisted with transition 

from hospital ONLY through formal care 

transition programs (evidence-based CT 

intervention or innovative model) 

4 0.85 72 15.25 16 3.39 8 1.69 6 1.27 14 2.97 352 74.58 0 2908 221.91 57.5 8,9 

Number of participants carried over from last 

6 months (October 2012-March 2013) period 

(started program within last 6 months and 

continued with the intervention) 

8 1.69 58 12.29 7 1.48 0 0.00 1 0.21 3 0.64 395 83.69 0 551 61.62 23 4,12 

Number of participants whose cases were 

closed during last 6 months (October 2012-

March 2013) (i.e., participants whose 

transition services were ended either because of 

a readmission or new admission to a care 

facility or because the transition period ended) 

3 0.64 72 15.25 10 2.12 4 0.85 3 0.64 9 1.91 371 78.60 0 3214 158.23 25 1 

Number of participants that readmitted within 

30 days of discharge 

6 1.27 76 16.10 4 0.85 1 0.21 0 0.00 1 0.21 384 81.36 0 640 28.74 3.5 2 

Number of participants that re-admitted within 

30 days and re-entered the care transition 

program 

10 2.12 29 6.14 1 0.21 0 0.00 0 0.00 2 4.76 430 91.10 0 640 45.97 2 1 

26. What is the number of the individuals who were assisted with transition from hospital through formal care transitions intervention program this local ADRC program service area 

in the past 6 months (October 2012 March 2013) by participating hospital? 

0 >0-200 201-400 401-600 601-800 No Response Range Mean Median Mode 

# % # % # % # % # % # % Min Max 

No. of Individuals for Hospital 1 3 0.64 85 18.01 3 0.64 6 1.27 1 0.21 374 79.24 0 748 73.97 27 2 

No. of Individuals for Hospital 2 3 0.64 52 11.02 4 0.85 1 0.21 1 0.21 411 87.08 0 640 63.97 16 2 

No. of Individuals for Hospital 3 3 0.64 24 5.08 2 0.42 1 0.21 1 0.21 441 93.43 0 630 85.21 20 3,5 

27. What is the number of the individuals who were assisted with transition from hospital through formal care transitions intervention on across all 

participating hospitals in this local ADRC program service area this reporting period by age group? 

0 >0-250 251-500 501-750 751-1000 >1000 No Response Range Mean Median Mode # % # % # % # % # % # % # % Min Max 

Aged 60 and Over 4 0.85 89 18.86 7 1.48 2 0.42 2 0.42 4 0.85 364 77.12 0 2583 160.06 38 3,8 

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Under Age 60 6 1.27 47 9.96 3 0.64 0 0.00 0 0.00 0 0.00 416 88.14 0 305 43.46 19 1 

Age unknown 7 1.48 10 2.12 1 0.21 0 0.00 1 0.21 0 0.00 453 95.97 0 851 141.58 45 9 

28. What is the number of the individuals who were assisted with transition from the hospital through formal care transitions intervention program across all 

participating hospitals in this local ADRC program service area in the past 6 months (October 2012 March 2013) by health insurance group? 

0 >0-100 101-200 201-300 301-400 >400 No Response Range Mean Median Mode # % # % # % # % # % # % # % Min Max 

Medicare 4 0.85 58 12.29 10 2.12 4 0.85 2 0.42 9 1.91 385 81.57 0 2908 191.37 37 9 

Medicaid 5 1.06 28 5.93 1 0.21 0 0.00 0 0.00 1 0.21 437 92.58 0 418 28.53 9 2 

Dual-Eligible 4 0.85 38 8.05 3 0.64 1 0.21 0 0.00 0 0.00 426 90.25 0 240 26.36 6 1 

No- insurance 6 1.27 11 2.33 1 0.21 0 0.00 0 0.00 0 0.00 454 96.19 0 114 16 5 1,2,4 

Private insurance 5 1.06 14 2.97 0 0.00 0 0.00 0 0.00 0 0.00 453 95.97 0 35 7.71 5 2,3,4 

Veterans Administration on 

Services 5 1.06 7 1.48 0 0.00 0 0.00 0 0.00 0 0.00 460 97.46 0 10 2.86 2 1 

Other unknown 4 0.85 7 1.48 0 0.00 2 0.42 0 0.00 0 0.00 459 97.25 0 269 58.33 4 1,2 

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29. What is the number of the individuals who were assisted with transitioning from hospital through formal care transition intervention program across all participating 

hospitals in this local ADRC program service area in last 6 months (October 2012 March 2013) who were referred to one or more health/prevention programs? 

0 >0-25 26-50 51-75 76-100 >100 No response Range Mean Median Mode # % # % # % # % # % # % # % Min Max 

Chronic Disease Self-Management 

Program 5 1.06 26 5.51 5 1.06 0 0.00 1 0.21 1 0.21 434 91.95 0 170 18.42 6 1 

Diabetes Self-Management Program 5 1.06 15 3.18 0 0.00 1 0.21 0 0.00 0 0.00 451 95.55 0 70 10.06 4 1,3 

Exercise Program 6 1.27 12 2.54 0 0.00 0 0.00 1 0.21 0 0.00 453 95.97 0 90 10.92 2 6 

Mental Health and Substance Misuse 4 0.85 24 5.08 1 0.21 0 0.00 0 0.00 0 0.00 443 93.86 0 50 7.92 4 1 

Falls Management and Prevention 6 1.27 16 3.39 2 0.42 1 0.21 1 0.21 2 0.42 444 94.07 0 608 51.00 10 5, 10 

Alzheimer’s program 5 1.06 18 3.81 1 0.21 0 0.00 0 0.00 2 0.42 446 94.49 0 166 19.05 3 1,2 

Medication Management 4 0.85 28 5.93 3 0.64 3 0.64 3 0.64 0 0.00 431 91.31 0 1273 71.76 10 1,2 

Home injury/ Risk Screenings 5 1.06 13 2.75 1 0.21 0 0.00 0 0.00 1 0.21 452 95.76 0 608 47.00 2 1 

Other 3 0.64 10 2.12 2 0.42 0 0.00 1 0.21 3 0.64 453 95.97 0 438 69.75 12 2 

30a. What is the number of individuals who were assisted with transitioning from hospital through formal care transitions intervention program across all participating 

hospitals in this local ADRC program service area in last 6 months (October 2012 March 2013) that were referred to one or more of the following long term services and 

supports? 

0 >0-25 26-50 51-75 76-100 >100 No response Range Mean Median Mode # % # % # % # % # % # % # % Min Max 

Additional Options Counseling 14 2.97 39 8.26 7 1.48 1 0.21 3 0.64 3 0.64 405 85.81 0 1018 45.87 10 2 

Home Delivered meals 13 2.75 55 11.65 12 2.51 1 0.21 1 0.21 6 1.27 384 81.36 0 300 26.93 7 2 

Nutrition services or nutrition 

counseling 14 2.97 29 6.14 2 0.42 2 0.42 0 0.00 3 0.64 422 89.41 0 637 37.42 6 1 

Care giver support 13 2.75 51 10.81 3 0.64 0 0.00 1 0.21 3 0.64 401 84.96 0 382 25.60 7 7 

Personal care/homemaker/chore 

maker services 13 2.75 53 11.23 12 2.54 2 0.42 1 0.21 6 1.27 385 81.57 0 881 48.07 9 1 

Transportation 14 2.97 50 10.59 8 1.69 2 0.42 1 0.21 3 0.64 394 83.47 0 255 23.89 5 1 

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31a. Do you have a marketing plan? 

Frequency Percentage 

Yes, our marketing plan is operational 247 52.33 

Yes, we have a plan but it is not operational yet 57 12.08 

No, we don’t have a plan at this time 121 25.64 

No Response 47 9.96 

Total 472 100 

31b. Does [Local ADRC] utilize a standard operating procedure to assess consumer 

need? 

Frequency Percentage 

Always 314 66.53 

Sometimes 96 20.34 

Never 19 4.03 

No Response 43 9.11 

Total 472 100 

32. Is the consumer assessment tool and/or basic consumer needs assessment process common across partner 

organization? 

Frequency Percentage 

Yes, common across all partners 109 23.09 

Yes, common across some partners 118 25.00 

No, each partner organization uses their own assessment 

tool/process 

207 43.86 

No Response 38 8.05 

Total 472 100 

33. Does your organization/network provide “Options Counseling” or other one on one counseling 

designed to support consumers’ ability to make informed decisions about their long term care? 

Frequency Percentage 

Yes 361* 76.48* 

No 89 18.86 

No Response 22* 4.66* 

Total 472 100 

*Only those who responded “Yes” to Question 33 should have been directed to Questions 34 and 35. However, the 

figures in Questions 34 and 35indicate that the skip pattern did not work as intended. Therefore, Question 33 responses 

for “Yes” and “No Response” categories were updated based on the extra information available from Questions 34 and

35. 

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34. Referrals to Public and Private Services this Reporting Period 

0 >0-1000 1001-2000 2001-3000 3001-4000 >4000 No response Range Mean Median Mode 

# % # % # % # % # % # % # % Min Max 

What is the number of Local ADRC 

clients referred to or given an 

application for a public program, 

including Older Americans Act; 

Medicare; Medicaid; Food Stamps; 

TANF; Social Security (SSI or SSDI); 

LI-HEAP; VDHCBS; Other Statefunded and county-funded programs 

for Medicaid; Other? 

3 0.64 163 34.53 41 8.69 29 6.14 11 2.33 27 5.72 198 41.95 0 30864 1788.03 719 500 

What is the number of Local ADRC 

clients referred to some other type of 

service (non-public services, resources 

or program)? 

7 1.48 190 40.25 31 6.57 12 2.54 3 0.64 13 2.75 216 45.76 0 15968 954.51 246 10 

What is the number of Local ADRC 

clients that were not referred to any 

type of service? 

22 4.66 130 27.54 14 2.97 6 1.27 2 0.42 2 0.42 295 62.50 0 5470 498.21 93 7 

What is the number of Local ADRC 

Unknown clients (remainder of all 

clients)? 

23 4.87 93 19.70 13 2.75 3 0.64 5 1.06 5 1.06 330 69.92 0 13207 781.40 154 2,20 

Total 3 0.64 86 18.22 46 9.75 28 5.93 17 3.60 54 11.44 238 50.42 0 47187 3244.51 1639 365 

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35. Clients provided Options Counseling by age during this Reporting period. 

Clients provided Options 

counseling By Age 

0 >0-1000 1001-2000 2001-3000 3001-4000 >4000 No Response Range Mean Median Mode 

# % # % # % # % # % # % # % Min Max 

Clients Aged 60 and Over 3 0.64 189 40.04 22 4.66 5 1.06 6 1.27 16 3.39 231 48.94 0 74000 1267.85 170 7 

Clients Under Aged 60 4 0.85 202 42.80 9 1.91 1 0.21 2 0.42 2 0.42 252 53.39 0 8234 297.17 58 2 

Clients Age Unknown 14 2.97 122 25.85 10 2.12 4 0.85 4 0.85 7 1.48 311 65.89 0 10192 685.56 69 1 

Total 3 0.64 184 38.98 24 5.08 13 2.75 8 1.69 27 5.72 213 45.13 0 140633 2037.47 266 37 

35. Clients provided Options Counseling by method during this Reporting period. 

Clients provided Options 

counseling By Method 

0 >0-1000 1001-2000 2001-3000 3001-4000 >4000 No Response Range Mean Median Mode 

# % # % # % # % # % # % # % Min Max 

In Person 6 1.27 185 39.19 11 2.33 6 1.27 3 0.64 2 0.42 259 54.87 0 12521 437.91 85 3 

By Phone 5 1.06 158 33.47 17 3.60 4 0.85 10 2.12 15 3.18 263 55.72 0 48935 1125.75 133 12 

Electronic Communication 

(e.g., email or website chat) 

24 5.08 85 18.01 3 0.64 0 0.00 1 0.21 1 0.21 358 75.85 0 9650 241 19 1,3,5 

Total 3 0.64 157 33.26 19 4.03 9 1.91 11 2.33 17 3.60 256 54.24 0 71106 1423.34 230 37 

35. Clients provided Options Counseling by setting during this Reporting period. 

Clients provided Options 

counseling By Setting 

0 >0-1000 1001-2000 2001-3000 3001-4000 >4000 No Response Range Mean Median Mode 

# % # % # % # % # % # % # % Min Max 

Local ADRC 7 1.48 135 28.60 15 3.18 7 1.48 7 1.48 7 1.48 294 62.29 0 9480 725.32 137 25 

Hospital 18 3.81 56 11.86 1 0.21 - - - - - - 397 84.11 0 1021 96.28 18 1 

Nursing facility/Institution 11 2.33 105 22.25 3 0.64 2 0.42 - - - - 351 74.36 0 2980 153.91 19 1 

At the client’s community residence 8 1.69 131 27.75 5 1.06 2 0.42 - - 1 0.21 325 68.86 0 6019 241.83 50 10 

Other 14 2.97 58 12.29 3 0.64 2 0.42 0 0.00 2 0.42 393 83.26 0 9565 449.23 20 3,4 

Total 4 0.85 151 31.99 20 4.24 11 2.33 6 1.27 11 2.33 269 56.99 1 55316 1135.75 196 12,37 

35. Clients provided Options Counseling during this Reporting period. 

Client Feedback about Options 

Counseling 

0 >0-200 201-400 401-600 601-800 800-1000 >1000 No Response Range Mean Median Mode 

# % # % # % # % # % # % # % # % Min Max 

What is the number of Clients who 13 2.75 82 17.37 9 1.91 7 1.48 1 0.21 1 0.21 6 1.27 353 74.79 0 7648 295.76 49 7,49 

Page 77 
 

report that options counseling 

enabled them to make well informed 

decisions about their LTSS? 

What is the number of insert id 

clients surveyed this reporting 

period? 

28 5.93 85 18.01 12 2.54 7 1.48 5 1.06 3 0.64 4 0.85 328 69.49 0 12750 318.91 65 5,13 

36. Does local ADRC or network have a standardized tool or process to provide options 

counseling? 

Frequency Percentage 

Yes 276 58.47 

No 90 19.07 

Not applicable 54 11.44 

Don’t know 10 2.12 

No Response 42 8.90 

Total 472 100 

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37. Average monthly Public LTTS Program Enrollment in WHOLE [Local ADRC] SERVICE AREA: 

This set of questions is asking about all current enrollment levels in these programs in the Local ADRC service area. 

0 >0-1000 1001-2000 2001-3000 3001-4000 >4000 No Response Range Mean Median Mode 

# % # % # % # % # % # % # % Min Max 

What is the average number of 

individuals enrolled in Medicaid 

HCBS Waivers in Local ADRC 

Service area each month? 

11 2.33 178 37.71 15 3.18 9 1.91 7 1.48 11 2.33 241 51.06 0 26655 972.80 215 15 

What is the average number of 

individuals enrolled in Medicaid 

residing in institutions in Local ADRC 

Service area each month? 

15 3.18 100 21.19 10 2.12 7 1.48 5 1.06 5 1.06 330 69.92 0 11748 912.44 343 5 

What is the average number of 

individuals enrolled in other public 

LTSS programs in Local ADRC 

Service area each month? Please list 

LTSS programs and HCBS waivers 

(e.g., aged and disabled, MR/DD) that 

individuals are enrolled in 

10 2.12 117 24.79 16 3.39 10 2.12 2 0.42 84 17.80 233 49.36 0 10411 849.02 269 20 

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38. Total new Enrollment among [Local ADRC] Clients Only in Public LTSS programs: 

This set of questions is asking about the absolute number of Local ADRC clients who were newly enrolled into these programs during the last six months. 

0 >0-200 201-400 401-600 601-800 801-1000 >1000 No Response Range Mean Median Mode 

# % # % # % # % # % # % # % # % Min Max 

What is the number of Local ADRC Clients who 

are newly enrolled into a Medicaid HCBS Waiver 

this reporting period (including individuals enrolled 

by Local ADRC staff and individuals referred for 

assessment/application by Local ADRC staff)? 

11 2.33 138 29.24 20 4.24 6 1.27 3 0.64 4 0.85 5 1.06 285 60.38 0 2930 169.70 62 23 

What is the number of Local ADRC Clients who 

are newly enrolled into Medicaid institutional 

services this reporting period (including individuals 

enrolled by Local ADRC staff and individuals 

referred for assessment/application by Local ADRC 

staff)? 

16 3.39 58 12.29 7 1.48 5 1.06 0 0.00 3 064 8 1.69 375 79.45 0 5096 373.80 49 1,5 

What is the average number of individuals enrolled 

in other public LTSS programs in Local ADRC 

service area each month? Please list LTSS 

programs and HCBS waivers (e.g., aged and 

disabled, MR/DD) that individuals are enrolled in. 

14 2.97 74 15.68 13 2.75 5 1.06 0 0.00 1 0.21 15 3.18 350 74.15 0 3988 369.92 75.5 2 

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39. For data collected on consumers, is staff required to follow the Alliance of Information and 

Referral Systems (AIR) standards? 

Frequency Percentage 

Yes, with all consumers 208 44.07 

Yes, with specific groups of consumers- Please specify 0 0.00 

Never 129 27.33 

No Response 135 28.60 

Total 472 100 

40. Does [Local ADRC] have a database /MIS that does any of the following? (Select all that apply) 

Frequency Percentage* 

Track consumer requests for information and referrals 357 75.64 

Track referrals made to consumers 295 62.50 

Maintain records on individual consumers 369 78.18 

Maintain a list of services/service providers 344 72.88 

Links to other databases (e.g., Medicaid waiver tracking 

systems, Money Follows the Person tracking system). If yes, 

specify. 

68 14.41 

Other, specify** 54 11.44 

*Percentages do not add up to 100% as respondents could select more than one option.
 

**Free text responses accompanying this question are available in the appendix with supplemental questions.
 

41. Do operational partners have access to data they need for their operations such as data about your 

consumers/services? If yes, for what purposes? (review client information, input client demographic 

information, input referrals, input service utilization information, review client service utilization , 

obtain summary reports on clients and/or services) 

Frequency Percentage 

Yes 107 22.67 

No, but there are plans to develop 

that capacity 

135 28.60 

No, and there are no current plans 

to do this 

182 38.56 

No response 48 10.17 

Total 472 100 

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 - 

 

 

 

 

42. Do service providers have access to data about our consumers? If yes, for what purposes (review client 

information, input client demographic information, input referrals, input service utilization information, 

review client service utilization , obtain summary reports on clients and/or services) 

Frequency Percentage 

Yes 114 24.15 

No, but there are plans to develop that capacity 111 23.52 

No, and there are no current plans to do this 214 45.34 

No Response 33 6.99 

Total 472 100 

42a. Do staff follow up with consumers after their initial contact with your organization? 

Frequency Percentage 

Always 424* 89.83* 

Sometimes – Under what Circumstances 0 0 

Never 1 0.21 

No Response 48* 10.17* 

Total 472 100 

*These numbers are updated based on extra information available from the questions 42b, 42c and 42d. 

42b. How many times does staff follow up with consumers after their initial contact with your 

organization? 

Frequency Percentage 

Once 113 23.94 

Multiple times 305 64.62 

No Response 54 11.44 

Total 472 100 

42c. What is the approximate timing of the first follow up with consumers after their initial contact with 

your organization? 

Frequency Percentage 

One to two weeks after service 337 71.60 

Three weeks after service 31 6.57 

One to two months after service 32 6.78 

Three to five months after service 6 1.27 

Six months after service 4 0.85 

One year or longer after service 1 0.21 

No Response 61 12.92 

Total 472 100 

42d. What is the approximate timing of the last follow up with consumers after their initial contact with 

your organization? 

Frequency Percentage 

One week after the service 79 16.74 

Two weeks after the service 67 14.19 

Three weeks after service 35 7.42 

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42d. What is the approximate timing of the last follow up with consumers after their initial contact with 

your organization? 

Frequency Percentage 

One to two months after service 121 25.64 

Three to five months after service 27 5.72 

Six months after service 33 6.99 

One year or longer after service 34 7.20 

No Response 76 16.10 

Total 472 100 

43. When consumers are referred to other agencies or organizations, are those providers contacted as a part of 

the follow up procedure? 

Frequency Percentage 

Always 53 11.23 

Sometimes – Under what circumstances 0 0.00 

Never 58 12.29 

No Response 361 76.48 

Total 472 100 

44. Approximately what percentage of consumers who are referred to other 

organizations receive a “warm transfer” (e.g., Simultaneous transfer of a telephone 

call and its associated data from one agent to another agent or supervisor)? _____% 

Frequency Percentage 

0% 3 0.64 

>0-20% 130 27.54 

21-40% 38 8.05 

41-60% 34 7.20 

61-80%% 24 5.08 

81-100% 46 9.75 

No response 197 41.74 

Total 472 100 

Min (%) 0 

Max (%) 100 

Mean (%) 37.58 

Median (%) 25.00 

Mode (%) 10.00 

45. Does your organization routinely collect quantitative performance data about its services 

and consumers? 

Frequency Percentage 

Yes 365* 77.33* 

No 74 15.68 

No Response 33* 6.99* 

Total 472 100 

*These numbers are updated based on the extra information available from question 46. 

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-

 

 

 

 

 

 

 

 

46. Indicate any of the ways that your organization uses performance data. (Check all that apply) 

Frequency Percentage* 

To justify funding requests 289 61.23 

To improve consumer service 352 74.58 

To administer service provider contracts 207 43.86 

To provide information on stakeholders (governing board, 

advocacy organizations, local government, etc.) 

338 71.61 

For program planning 331 70.13 

Do not use performance data 5 1.06 

*Percentages do not add up to 100% as respondents could select more than one option. 

48. When a client contacts the ADRC about LTSS, do ADRC staff administer a screening 

questionnaire to make a preliminary determination of eligibility and need for public funded LTSS? 

Frequency Percentage 

Yes 360* 76.27* 

No 81 17.16 

Other, specify** 0 0.00 

No Response 31* 6.57* 

Total 472 100 

*These numbers were updated using the extra information available from Questions 49a and 49b. See note under Question 

33 for more information about how numbers were updated in a table when skip patterns did not work as intended. 

**Free text responses accompanying this question are available in the appendix with supplemental questions. 

49a. If yes, to which of the following populations is the eligibility screening instrument 

administered? 

Frequency Percentage* 

Aged 65 and older 337 71.40 

Physical Disability 317 67.16 

Intellectual Disability/Development Disability 228 48.31 

Brain Injury 231 48.94 

HIV/AIDS 171 36.23 

Medical fragile 255 54.03 

Autism 153 32.42 

Mental Illness 209 44.28 

Other, specify** 66 13.98 

*Percentages do not add up to 100% as respondents could select more than one option.
 

**Free text responses accompanying this question are available in the appendix with supplemental questions.
 

49b. What kind of information is collected? 

Frequency Percentage* 

Demographic information (i.e., age, gender, ethnicity, marital 

status) 

403 85.38 

Living Arrangements 379 80.30 

Caregivers 367 77.75 

Health Status 360 76.27 

Activities of Daily living (ADL) 332 70.34 

Page 84 
 

 

Instrumental Activities of Daily Living (ADL) 311 65.89 

Cognitive functions 302 63.98 

Troublesome Behaviors 242 51.27 

LTSS currently received 346 73.31 

Income 374 79.24 

Assets 294 62.29 

Other, specify** 47 9.96 

*Percentages do not add up to 100% as respondents could select more than one option.
 

**Free text responses accompanying this question are available in the appendix with supplemental questions.
 

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50. How do clients in your state/site complete and file applications for financial eligibility for Medicaid or publicly 

funded LTSS? Check all that apply. 

Frequency Percentage* 

Applications are accessed on-line, printed, completed by hand, and returned to 

state or county office. 

283 59.96 

Applications are accessed on-line, completed on-line, printed, and returned to 

state or county office. 

214 45.34 

Applications are accessed online, completed on-line, and submitted to the state 

or county electronically. 

234 49.58 

Paper copy applications are obtained at various locations including [insert 

locations], completed by hand, and returned either in person or by mail to a 

state or county office 

296 62.71 

Other, specify** 36 7.63 

*Percentages do not add up to 100% as respondents could select more than one option.
 

**Free text responses accompanying this question are available in the appendix with supplemental questions.
 

51. In what ways does ADRC staff assist clients with financial eligibility applications for Medicaid LTSS 

Programs? Check all that apply. 

Frequency Percentage* 

We do not assist clients with financial eligibility applications 34 7.20 

Advise the client where s/he can obtain an application 334 70.76 

Assist the client in completing the application 323 68.43 

Assist the client in collecting the required financial documentation 257 54.45 

Check on the status of the client’s application 264 55.93 

Notify the client when the application has been approved/disapproved 106 22.46 

Manage appeals by clients whose applications were not approved 91 19.28 

Other, specify** 26 5.51 

*Percentages do not add up to 100% as respondents could select more than one option.
 

**Free text responses accompanying this question are available in the appendix with supplemental questions.
 

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1. 

52. In what ways does ADRC staff assist clients with financial eligibility applications for publicly funded 

LTSS other than Medicaid LTSS? 

Frequency Percentage* 

We do not assist clients with financial eligibility applications 48 10.17 

Advise the client where s/he can obtain an application 340 72.03 

Assist the client in completing the application 308 65.25 

Assist the client in collecting the required financial documentation 234 49.58 

Check on the status of the client’s application 215 45.55 

Notify the client when the application has been 

approved/disapproved 

93 19.70 

Manage appeals by clients whose applications were not approved 80 16.95 

Other, specify** 17 3.60 

*Percentages do not add up to 100% as respondents could select more than one option.
 

**Free text responses accompanying this question are available in the appendix with supplemental questions.
 

53. Does your state/site permit presumptive financial eligibility in order to expedite the provision 

of LTSS to clients while their financial eligibility applications are being processed? 

Frequency Percentage 

Yes 133 28.18 

No 262 55.51 

In Progress 18 3.81 

No Response 59 12.50 

Total 472 100 

Eligibility Screening Module: Functional Assessment
 

54. Does your state/site use a universal, comprehensive assessment instrument for functional 

(level of care) eligibility determinations for LTSS? 

Frequency Percentage 

Yes 352* 74.58* 

No 81 17.16 

No, but in development 37 7.84 

No Response 2* 0.42* 

Total 472 100 

*These numbers are updated based on extra information available from the questions 55a, 55b, 55c and 55d. See 

note under Question 33 for more information about how numbers were updated in a table when skip patterns did 

not work as intended. 

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55a. If yes, what best describes the kind of instrument your state/site is using? Check one. 

Frequency Percentage 

A custom – designed instrument developed by state staff 207 43.86 

A custom- designed instrument developed by a vendor specifically for our 

state 

64 13.56 

An instrument developed by a vendor that is also used by other states 23 4.87 

Other, specify* 0 0.00 

No Response 178 37.71 

Total 472 100 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

55b. What best describes the process for how the assessor completes the instrument? (Check all that apply) 

Frequency Percentage* 

The assessor completes a paper form while interviewing the client; 

there is no electronic data entry. 

56 11.86 

The assessor completes a paper form while interviewing the client 

and later inputs the data on an electronic form at the office 

222 47.03 

The assessor completes an electronic form while interviewing the 

client, which is later downloaded into electronic database. 

147 31.14 

The assessor completes a web-based form while interviewing the 

client and the client’s data is entered “real time” into an electronic 

database. 

74 15.68 

*Percentages do not add up to 100% as respondents could select more than one option. 

55c. Do you work with consumers to develop a care plan? 

Frequency Percentage 

Yes, with all consumers 106 22.46 

Yes, under certain circumstances (Please specify_____) 0 0.00 

No, that is not part of this service 148 31.36 

No Response 218 46.19 

Total 472 100 

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’

55d. For which of the following populations is the functional assessment used? Check all that apply. 

Frequency Percentage* 

Aged 65 and older 342 72.46 

Physical disability 316 66.95 

ID/DD 174 36.86 

Brain Injury 199 42.16 

HIV/AIDS 142 30.08 

Medically fragile 209 44.28 

Autism 125 26.48 

Mental Illness 157 33.26 

Other, specify** 44 9.32 

*Percentages do not add up to 100% as respondents could select more than one option.
 

**Free text responses accompanying this question are available in the appendix with supplemental questions.
 

56a. Is your organization involved in planning for your state s Exchange? 

Frequency Percentage 

Yes 78 16.53 

No 257 54.45 

Not sure 98 20.76 

No Response 39 8.26 

Total 472 100 

Page 89 
 

 

’ 

56b. Is your state/site examining ways to align functional eligibility determination for publicly 

funded LTSS with Medicaid financial eligibility determination carried out through the 

Exchange website? 

Frequency Percentage 

Yes 30 6.36 

No 30 6.36 

Not sure 82 17.37 

No Response 330 69.92 

Total 472 100 

57. Are any of your organization s functions reimbursed under Federal financial participation (FFP) or Federal 

medical assistance percentage (FMAP)? If so please specify the functions. 

Frequency Percentage 

No, none of our functions* are reimbursed under FFP or FMAP 285 60.38 

Yes, the following functions* are reimbursed under FFP. 44 9.32 

Yes, the following functions* are reimbursed under FMAP 67 14.19 

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Section D. Organization Characteristics
 

58. For the current Fiscal Year (2013), what is the approximate amount of funding from each of 

the following sources? (In $ amounts) 

Received Funding in Prior 

Fiscal Years 

Frequency Percentage* 

Administration on Aging Title IV ADRC Grant 175 37.08 

Administration of Aging Title II Grant 29 6.14 

CMS Real Choice Systems Change Grants 12 2.54 

CMS Person-Centered Hospital Discharge Planning Grant 21 4.45 

Patient protection and Affordable Care Act Grant 13 2.75 

Veteran’s Administration 36 7.63 

Money Follows the Person Demonstration 100 21.19 

State Transformation Grant 5 1.06 

Alzheimer’s Disease Demonstration Grant 36 7.63 

Evidence-Based Disease Prevention Grant 90 19.07 

Program of All-Inclusive Care for the Elderly (PACE) 5 1.06 

Medicare Improvements for Patients and Providers Act (MIPPA) 112 23.73 

Respite Care Act funds 23 4.87 

Rehabilitation Services Administration (RSA) 17 3.60 

Substance Abuse and Mental Health Services Administration 

(SAMHSA) – Mental Health Transformation Grant 

4 0.85 

Agency for Health Care Research and Policy – Chronic Disease 

Self- Management Grant 

33 6.99 

Administration for Children and Families, Office of Community 

Services – Low Income Home Energy Assistance Program 

(LIHEAP) 

27 5.72 

Health Resources and Services Administration on HIV/AIDS 

Bureau – Ryan White Fund 

3 0.64 

State Unit on Aging 206 43.64 

State General Revenue 120 25.42 

County of local Government 147 31.14 

Private entities/grants – Hospitals or other businesses 66 13.98 

Medicaid for Direct Services (State and federal) 100 21.19 

Medicaid for Federal Financial Participation 25 5.30 

Care Transitions Income 44 9.32 

Consumer Fees or Cost Sharing 103 21.82 

Charitable Donations 107 22.67 

Other, please specify** 134 28.39 

*Percentages do not add up to 100% as respondents could select more than one option.
 

**Free text responses accompanying this question are available in the appendix with supplemental questions.
 

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58. For the current Fiscal Year (2013), what is the approximate amount of funding from each of the following sources? 

Amount of Funding during the Current Fiscal Year 

$0 $>0-10,000 $10,001-

50,000 

$50,001-

100,000 

$100,001-

500,000 >$500,001 

No Response/ 

Not 

Applicable 

Range Mean Median Mode 

# % # % # % # % # % # % # % Min Max 

AoA Title IV 

ADRC Grant 

15 3.18 23 4.87 41 8.69 23 4.87 25 5.30 8 1.69 337 71.40 $0 $1,547,375 $138,310 $45,000 $40,000 

AoA Title II 

Grant 

10 2.12 1 0.21 9 1.91 2 0.42 5 1.06 9 1.91 436 92.37 $0 $5,046,488 $690,524 $229,153 No mode 

CMS Real 

Choice Systems 

Change Grants 

11 2.33 1 0.21 1 0.21 1 0.21 2 0.42 1 0.21 455 96.40 $0 $1,000,000 $258,758 $98,308 No mode 

CMS PersonCentered 

Hospital 

Discharge 

Planning Grant 

11 2.33 2 0.42 4 0.85 5 1.06 2 0.42 1 0.21 447 94.70 $0 $2,000,000 $210,814 $65,050 No mode 

PPACA Grant 11 2.33 0 0.00 6 1.27 2 0.42 1 0.21 2 0.42 450 95.34 $0 $1,000,700 $217,160 $37,422 37,422 

VA Grant 11 2.33 8 1.69 16 3.39 4 0.85 11 2.33 4 0.85 418 88.56 $0 $26,000,000 $731,420 $30,253 $12,000 

MFP Demon. 11 2.33 29 6.14 38 8.05 5 1.06 17 3.60 2 0.42 370 78.38 $0 $625,000 $64,798 $28,053 $7,500 

State 

Transformation 

Grant 

10 2.12 1 0.21 2 0.42 0 0.00 0 0.00 0 0.00 459 97.25 $0 $41,329 $26,249 $35,781 No mode 

Alzheimer’s 

Disease 

Prevention 

Grant 

10 2.12 10 2.12 13 2.75 4 0.85 2 0.42 1 0.21 432 91.53 $0 $682,645 $58,306 $23,961 $2,000 

Evidence-Based 

Disease 

Prevention 

Grant 

7 1.48 25 5.30 40 8.47 4 0.85 3 0.54 0 0.00 393 83.26 $0 $157,578 $25,274 $16,191 $7,000 

PACE 10 2.12 0 0.00 1 0.21 1 0.21 0 0.00 1 0.21 459 97.25 $0 $3,350,000 $1,138,643 $53,000 No mode 

MIPPA 10 2.12 22 4.66 16 3.39 2 0.42 1 0.21 0 0.00 421 89.19 $0 $163,000 $19,349 $9,863 No mode 

Respite Care 

Act funds 

10 2.12 1 0.21 6 1.27 6 1.27 12 2.54 0 0.00 437 92.58 $0 $408,547 $123,066 $94,350 No mode 

RSA 10 2.12 0 0.00 2 0.42 1 0.21 10 2.12 4 0.85 445 94.28 $0 $2,000,000 $404,673 $239,230 No mode 

Mental Health 

Transformation 

Grant 

10 2.12 0 0.00 1 0.21 1 0.21 0 0.00 0 0.00 460 97.46 $0 $72,733 $52,549 $52,549 No mode 

CDSMP Grant 8 1.69 7 1.48 18 3.81 2 0.42 0 0.00 0 0.00 437 92.58 $0 $93,600 $19,713 $12,799 $12,000 

LIHEAP 8 1.69 2 0.42 10 2.12 1 0.21 6 1.27 7 1.48 438 92.80 $0 $6,843,263 $770,086 $98,272 $15,000 

Ryan White 10 2.12 1 0.21 1 0.21 0 0.00 1 0.21 1 0.21 458 97.03 $0 $20,433,431 $5,164,585 $110,804 No mode 

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58. For the current Fiscal Year (2013), what is the approximate amount of funding from each of the following sources? 

Amount of Funding during the Current Fiscal Year 

$0 $>0-10,000 $10,001-

50,000 

$50,001-

100,000 

$100,001-

500,000 >$500,001 

No Response/ 

Not 

Applicable 

Range Mean Median Mode 

# % # % # % # % # % # % # % Min Max 

Fund 

State Unit on 

Aging 

2 0.42 2 0.42 46 9.75 17 3.60 44 9.32 118 25.00 243 51.48 $0 $49,386,961 $2,154,759 $564,257 $40,000 

State General 

Revenue 

3 0.64 1 0.21 11 2.33 13 2.75 45 9.53 60 12.71 339 71.82 $0 $144,759,459 $2,993,732 $438,029 $70,769 

County of local 

government 

2 0.42 10 2.12 25 5.30 18 3.81 54 11.4 

4 

42 8.90 321 68.01 $0 $77,947,927 $1,174,053 $192,215 $10,000 

Private entities/ 

grants – 

Hospitals or 

other 

businesses 

8 1.69 11 2.33 18 3.81 10 2.12 22 4.66 8 1.69 395 83.69 $0 $5,376,519 $350,269 $70,812 $4,000 

Medicaid for 

Direct Services 

(State and 

Federal) 

4 0.85 2 0.42 11 2.33 3 0.64 33 6.99 53 11.23 366 77.54 $0 $58,000,000 $2,257,882 $543,116 $300,000 

Medicaid for 

Federal 

Financial 

Participation 

8 1.69 0 0.00 2 0.42 5 1.06 7 1.48 12 2.54 438 92.80 $0 $152,498,844 $8,398,078 $378,074 $70,769 

Care 

Transitions 

Income 

9 1.91 10 2.12 19 4.03 5 1.06 8 1.69 0 0.00 421 89.19 $0 $395,592 $65,892 $25,595 $20,000 

Consumer Fees 

or Cost Sharing 

3 0.64 14 2.97 27 5.72 8 1.69 35 7.42 12 2.54 373 79.03 $0 $13,668,873 $358,462 $96,750 $40,000 

Charitable 

Donations 

4 0.85 37 7.84 29 6.14 16 3.39 24 5.08 4 0.85 358 75.85 $0 $2,463,867 $103,223 $29,762 $10,000 

Other, please 

specify 

0 0.00 10 2.12 24 5.08 18 3.81 41 8.69 66 13.98 313 66.31 $73 $45,784,809 $1,596,554 $381,755 $75,000 

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58. For the current Fiscal Year, what is the approximate amount of 

funding from each of the following sources? 

Total Budget for FY 2013 

Frequency Percentage 

$0 0 0.00 

$>0-500,000 61 12.92 

$500,001-2,000,000 58 12.29 

$2,000,001-10,000,000 99 20.97 

$10,000,001-20,000,000 32 6.78 

>$20,000,000 15 3.18 

No response 207 43.86 

Total 472 100 

Min $7,000 

Max $252,303,000 

Mean $8,314,439 

Median $2,402,675 

Mode $40,000 

59. What best characterizes the operation of your agency? 

Frequency Percentage 

Single point of entry: one agency maintains a knowledgebase on LTSS options 

and assists consumers in making decisions about the best and most feasible 

options for LTSS 

160 33.90 

No wrong door: multiple agencies are knowledgeable about LTSS options and 

cooperate to assist consumers regardless of which agency the consumer first 

contacts 

272 57.63 

No response 40 8.47 

Total 472 100 

60. Do you identify your structure as any of the following? 

Frequency Percentage 

Independent, non-profit 207 43.86 

Part of city government 6 1.27 

Part of county government 115 24.36 

Part of COG or RPDA 57 12.08 

Other, specify* 0 0.00 

No response 87 18.43 

Total 472 100 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

61. What organizations comprise the core operating organizations? 

Yes No No response 

Frequency Percentage Frequency Percentage Frequency Percentage 

AAA 381 80.72 33 6.99 58 12.29 

State Unit on Aging 219 46.40 113 23.94 140 29.66 

Veterans Organization 68 14.41 205 43.43 199 42.16 

Alzheimer’s Association 54 11.44 212 44.92 206 43.64 

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61. What organizations comprise the core operating organizations? 

Yes No No response 

Frequency Percentage Frequency Percentage Frequency Percentage 

Other Aging Services 

Organization 

135 28.60 159 33.69 178 37.71 

Centers for Independent Living 205 43.43 130 27.54 137 29.03 

Vocational Rehabilitation 

Departments 

53 11.23 214 45.34 205 43.43 

Other Disability Services 

Organizations 

136 28.81 164 34.75 172 36.44 

Community Mental Health 70 14.83 202 42.80 200 42.37 

County or Regional Council of 

Governments 

84 17.80 194 41.10 194 41.10 

County Government Office or 

Agency 

119 25.21 161 34.11 192 40.68 

Local Housing Authority 47 9.96 214 45.34 211 44.70 

State or Local Medicaid Agency 115 24.36 167 35.38 190 40.25 

211 76 16.10 195 41.31 201 42.58 

Other Human Services of Social 

Service Provider (please specify)* 

104 22.03 133 28.18 235 49.79 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

63. With which organizations do [LOCAL ADRC] have a partnership? 

State Departments (with cabinet-level secretaries) Frequency Percentage* 

Health 217 45.97 

Human Services 251 53.18 

Other (specify)** 38 8.05 

State Agencies (located within state departments) Frequency Percentage* 

Aging 374 79.24 

Developmental Disabilities 230 48.73 

Acquired or Late-Onset Disabilities 111 23.52 

Mental Health 211 44.70 

Medicaid 280 59.32 

Housing 200 42.37 

Education 117 24.79 

Other (specify)** 21 4.45 

Local Government Agencies Frequency Percentage* 

Area Agency on Aging 320 67.80 

County Health Department 263 55.72 

County Medicaid Office 257 54.45 

County Department on Aging 130 27.54 

County Department on Disability 118 25.00 

County Housing Office 164 34.75 

Library 156 33.05 

Other (specify)** 31 6.57 

Federal Agencies Frequency Percentage* 

Local Veterans Administration 294 62.29 

Local Indian Health Service 62 13.14 

Other (specify)** 12 2.54 

Page 95 
 

 

 

 

 

 

 

 

 

 

 

63. With which organizations do [LOCAL ADRC] have a partnership? 

Organizations providing Direct Services Frequency Percentage* 

211 or other call center 248 52.54 

Community Health Clinic 204 43.22 

Community Mental Health Clinic 202 42.80 

Deaf Service Center 113 23.94 

Hospital/Medical Center 299 63.35 

School for the Blind 61 12.92 

School for the Deaf 52 11.02 

The ARC 137 29.03 

United Way 243 51.48 

Vocational/Rehabilitation Services 213 45.13 

Other (specify)** 27 5.72 

Advocacy/Referral Organizations Frequency Percentage* 

AIDS Coalition 77 16.31 

Alzheimer’s Association 305 64.62 

American Council of the Blind 60 12.71 

Autism Society state/regional chapter 59 12.50 

Brain Injury Association state/regional chapter 110 23.31 

Centers for Independent Living 339 71.82 

Easter Seals 112 23.73 

Epilepsy Foundation state/regional chapter 49 10.38 

National Association of Mental Illness state/regional chapter 90 19.07 

National Autism Association state/regional chapter 38 8.05 

National Multiple Sclerosis Society state/regional chapter 67 14.19 

State Association for the Deaf 50 10.59 

United Cerebral Palsy 80 16.95 

Other (specify)** 19 4.03 

*Percentages do not add up to 100% as respondents could select more than one option.
 

**Free text responses accompanying this question are available in the appendix with supplemental questions.
 

63. What is the strength of the relationship? 

Weak 

Functionality 

Moderate 

Functionality 

High 

Functionality 

No Response/ 

Not Applicable 

State Departments 

(with cabinet-level secretaries) Freq. % Freq. % Freq. % Freq. % 

Health 38 8.05 107 22.67 67 14.19 260 55.08 

Human Services 16 3.39 101 21.40 128 27.12 227 48.09 

Other (specify)* 3 0.64 12 2.54 20 4.24 437 92.58 

State Agencies 

(located within state departments) Freq. % Freq. % Freq. % Freq. % 

Aging 5 1.06 44 9.32 312 66.10 111 23.52 

Developmental Disabilities 45 9.53 111 23.52 66 13.98 250 52.97 

Acquired or Late-Onset Disabilities 29 6.14 45 9.53 34 7.20 364 77.12 

Mental Health 55 11.65 107 22.67 44 9.32 266 56.36 

Medicaid 26 5.51 111 23.52 134 28.39 201 42.58 

Housing 42 8.90 106 22.46 44 9.32 280 59.32 

Education 40 8.47 46 9.75 23 4.87 363 76.91 

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63. What is the strength of the relationship? 

Weak 

Functionality 

Moderate 

Functionality 

High 

Functionality 

No Response/ 

Not Applicable 

Other (specify)* 2 0.42 7 1.48 10 2.12 453 95.97 

Local Government Agencies Freq. % Freq. % Freq. % Freq. % 

Area Agency on Aging 2 0.42 23 4.87 276 58.47 171 36.23 

County Health Department 43 9.11 126 26.69 86 18.22 217 45.97 

County Medicaid Office 33 6.99 110 23.31 104 22.03 225 47.67 

County Department on Aging 5 1.06 19 4.03 100 21.19 348 73.73 

County Department on Disability 15 3.18 47 9.96 52 11.02 358 75.85 

County Housing Office 29 6.14 81 17.16 46 9.75 316 66.95 

Library 42 8.90 61 12.92 45 9.53 324 68.64 

Other (specify)* 1 0.21 10 2.12 16 3.39 445 94.28 

Federal Agencies Freq. % Freq. % Freq. % Freq. % 

Local Veterans Administration 74 15.68 133 28.18 74 15.68 191 40.47 

Local Indian Health Service 23 4.87 27 5.72 12 2.54 410 86.86 

Other (specify)* 2 0.42 4 0.85 4 0.85 462 97.88 

Organizations providing Direct 

Services Freq. % Freq. % Freq. % Freq. % 

211 or other call center 34 7.20 112 23.73 88 18.64 238 50.42 

Community Health Clinic 40 8.47 104 22.03 51 10.81 277 58.69 

Community Mental Health Clinic 42 8.90 95 20.13 51 10.81 284 60.17 

Deaf Service Center 41 8.69 43 9.11 27 5.72 361 76.48 

Hospital/Medical Center 36 7.63 136 28.81 111 23.52 189 40.04 

School for the Blind 27 5.72 21 4.45 10 2.12 414 87.71 

School for the Deaf 25 5.30 16 3.39 6 1.27 425 90.04 

The ARC 45 9.53 50 10.59 35 7.42 342 72.46 

United Way 48 10.17 90 19.07 92 19.49 242 51.27 

Vocational/Rehabilitation Services 51 10.81 95 20.13 61 12.92 265 56.14 

Other (specify)* 2 0.42 7 1.48 13 2.75 450 95.34 

Advocacy/Referral Organizations Freq. % Freq. % Freq. % Freq. % 

AIDS Coalition 33 6.99 31 6.57 11 2.33 397 84.11 

Alzheimer’s Association 36 7.63 122 25.85 134 28.39 180 38.14 

American Council of the Blind 24 5.08 20 4.24 13 2.75 415 87.92 

Autism Society state/regional 

chapter 23 4.87 19 4.03 13 2.75 417 88.35 

Brain Injury Association 

state/regional chapter 32 6.78 46 9.75 29 6.14 365 77.33 

Centers for Independent Living 34 7.20 114 24.15 178 37.71 146 30.93 

Easter Seals 35 7.42 49 10.38 25 5.30 363 76.91 

Epilepsy Foundation state/regional 

chapter 26 5.51 12 2.54 8 1.69 426 90.25 

National Association of Mental 

Illness state/regional chapter 40 8.47 31 6.57 16 3.39 385 81.57 

National Autism Association 

state/regional chapter 21 4.45 8 1.69 7 1.48 436 92.37 

National Multiple Sclerosis Society 

state/regional chapter 30 6.36 25 5.30 9 1.91 408 86.44 

State Association for the Deaf 20 4.24 19 4.03 6 1.27 427 90.47 

Page 97 
 

 

 

63. What is the strength of the relationship? 

Weak 

Functionality 

Moderate 

Functionality 

High 

Functionality 

No Response/ 

Not Applicable 

United Cerebral Palsy 25 5.30 25 5.30 27 5.72 395 83.69 

Other (specify)* 0 0.00 6 1.27 12 2.54 454 96.19 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

Page 98 
 

 

 

 

 

 

 

 

 

63. What is the type of partnership agreement? 

Funding 

Relationship Formal MOU Contract Cooperative 

Informal 

Working 

Relationship 

Other No Response/ 

Not Applicable 

State Departments (with 

cabinet-level secretaries) Freq. %* Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

Health 38 8.05 30 6.36 46 9.75 60 12.71 100 21.19 2 0.42 276 58.47 

Human Services 83 17.58 54 11.44 79 16.74 77 16.31 92 19.49 5 1.06 236 50.00 

Other (specify)* 9 1.91 14 2.97 10 2.12 8 1.69 10 2.12 1 0.21 439 93.01 

State Agencies (located 

within state 

departments) 

Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

Aging 268 56.78 88 18.64 241 51.06 109 23.09 52 11.02 9 1.91 98 20.76 

Developmental 

Disabilities 19 4.03 61 12.92 22 4.66 63 13.35 112 23.73 4 0.85 259 54.87 

Acquired or Late-Onset 

Disabilities 17 3.60 22 4.66 14 2.97 27 5.72 51 10.81 4 0.85 375 79.45 

Mental Health 14 2.97 34 7.20 23 4.87 60 12.71 119 25.21 6 1.27 277 58.69 

Medicaid 107 22.67 47 9.96 73 15.47 83 17.50 94 19.92 5 1.06 196 41.53 

Housing 14 2.97 40 8.47 19 4.03 58 12.29 113 23.94 5 1.06 283 59.96 

Education 4 0.85 15 3.18 9 1.91 28 5.93 73 15.47 5 1.06 370 78.39 

Other (specify)* 6 1.27 7 1.48 7 1.48 9 1.91 6 1.27 2 0.42 450 95.34 

Local Government 

Agencies Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

Area Agency on Aging 147 31.14 113 23.94 81 17.16 101 21.40 48 10.17 52 11.02 169 35.81 

County Health 

Department 16 3.39 48 10.17 21 4.45 80 16.95 164 34.75 10 2.12 215 45.55 

County Medicaid Office 17 3.60 64 13.56 13 2.75 93 19.70 136 28.81 8 1.69 228 48.31 

County Department on 

Aging 42 8.90 46 9.75 30 6.36 45 9.53 33 6.99 17 3.60 348 73.73 

County Department on 

Disability 5 1.06 37 7.84 4 0.85 46 9.75 64 13.56 6 1.27 356 75.42 

County Housing Office 2 0.42 23 4.87 4 0.85 55 11.65 108 22.88 6 1.27 313 66.31 

Library 1 0.21 9 1.91 2 0.42 48 10.17 118 25.00 1 0.21 324 68.64 

Other (specify)* 10 2.12 18 3.81 6 1.27 15 3.18 8 1.69 1 0.21 442 93.64 

Page 99 
 

 

 

 

 

 

 

 

63. What is the type of partnership agreement? 

Funding 

Relationship Formal MOU Contract Cooperative 

Informal 

Working 

Relationship 

Other No Response/ 

Not Applicable 

Federal Agencies Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

Local Veterans 

Administration 25 5.30 38 8.05 32 6.78 89 18.86 195 41.31 6 1.27 183 38.77 

Local Indian Health 

Service 4 0.85 7 1.48 6 1.27 22 4.66 38 8.05 2 0.42 419 88.77 

Other (specify)* 2 0.42 3 0.64 1 0.21 5 1.06 6 1.27 2 0.42 461 97.67 

Organizations providing 

Direct Services Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

211 or other call center 19 4.03 70 14.83 22 4.66 64 13.56 127 26.91 11 2.33 236 50.00 

Community Health 

Clinic 10 2.12 21 4.45 13 2.75 67 14.19 143 30.30 4 0.85 276 58.47 

Community Mental 

Health Clinic 5 1.06 29 6.14 13 2.75 75 15.89 128 27.12 4 0.85 281 59.53 

Deaf Service Center 3 0.64 8 1.69 7 1.48 29 6.14 80 16.95 1 0.21 370 78.39 

Hospital/Medical Center 19 4.03 98 20.76 41 8.69 95 20.13 155 32.84 9 1.91 180 38.14 

School for the Blind 4 0.85 3 0.64 5 1.06 14 2.97 43 9.11 2 0.42 419 88.77 

School for the Deaf 2 0.42 1 0.21 2 0.42 7 1.48 32 6.78 3 0.64 432 91.53 

The ARC 3 0.64 18 3.81 9 1.91 36 7.63 90 19.07 2 0.42 342 72.46 

United Way 79 16.74 43 9.11 38 8.05 60 12.71 115 24.36 3 0.64 233 49.36 

Vocational/ 

Rehabilitation Services 17 3.60 38 8.05 17 3.60 57 12.08 134 28.39 3 0.64 268 56.78 

Other (specify)* 1 0.21 11 2.33 3 0.64 9 1.91 9 1.91 2 0.42 446 94.49 

Advocacy/Referral 

Organizations Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

AIDS Coalition 1 0.21 2 0.42 1 0.21 18 3.81 53 11.23 5 1.06 406 86.02 

Alzheimer’s Association 24 5.08 31 6.57 35 7.42 105 22.25 198 41.95 7 1.48 174 36.86 

American Council of the 

Blind 0 0.00 4 0.85 2 0.42 12 2.54 38 8.05 1 0.21 422 89.41 

Autism Society 

state/regional chapter 1 0.21 1 0.21 0 0.00 6 1.27 42 8.90 2 0.42 425 90.04 

Brain Injury Association 

state/regional chapter 3 0.64 8 1.69 5 1.06 34 7.20 85 18.01 3 0.64 365 77.33 

Page 100 
 

 

 

 

 

 

 

 

63. What is the type of partnership agreement? 

Funding 

Relationship Formal MOU Contract Cooperative 

Informal 

Working 

Relationship 

Other No Response/ 

Not Applicable 

Centers for Independent 

Living 37 7.84 158 33.47 47 9.96 92 19.49 125 26.48 12 2.54 146 30.93 

Easter Seals 5 1.06 8 1.69 15 3.18 24 5.08 73 15.47 6 1.27 367 77.75 

Epilepsy Foundation 

state/regional chapter 0 0.00 2 0.42 1 0.21 9 1.91 29 6.14 3 0.64 435 92.16 

National Association of 

Mental Illness 

state/regional chapter 

0 0.00 3 0.64 0 0.00 19 4.03 67 14.19 4 0.85 391 82.84 

National Autism 

Association 

state/regional chapter 

0 0.00 0 0.00 0 0.00 2 0.42 24 5.08 1 0.21 447 94.70 

National Multiple 

Sclerosis Society 

state/regional chapter 

0 0.00 0 0.00 4 0.85 15 3.18 47 9.96 3 0.64 414 87.71 

State Association for the 

Deaf 1 0.21 1 0.21 1 0.21 13 2.75 39 8.26 1 0.21 427 90.47 

United Cerebral Palsy 3 0.64 17 3.60 15 3.18 15 3.18 37 7.84 6 1.27 397 84.11 

Other (specify)* 3 0.64 10 2.12 2 0.42 5 1.06 7 1.48 2 0.42 453 95.97 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

Page 101 
 

 

 

 

 

 

 

 

 

63. What types of resources are shared? 

Co-located 

staff 

Shared 

monetary 

resources 

Shared 

information 

Joint 

training 

Joint 

program 

sponsorship 

Shared nonmonetary 

resources 

Shared data No shared 

resources 

No response/ 

Not 

applicable 

State Departments (with 

cabinet-level secretaries) # % # % # % # % # % # % # % # % # % 

Health 11 2.33 20 4.24 144 30.51 65 13.77 48 10.17 7 1.48 51 10.81 31 6.57 272 57.63 

Human Services 29 5.06 41 7.16 187 32.64 104 18.15 67 11.69 23 4.01 91 15.88 22 3.84 342 59.69 

Other (specify)* 5 1.06 7 1.48 23 4.87 19 4.03 7 1.48 7 1.48 11 2.33 5 1.06 439 93.01 

State Agencies (located 

within state departments) # % # % # % # % # % # % # % # % # % 

Aging 28 5.93 120 25.42 298 63.14 246 52.12 154 32.63 35 7.42 240 50.85 3 0.64 141 29.87 

Developmental 

Disabilities 13 2.75 14 2.97 157 33.26 73 15.47 37 7.84 13 2.75 47 9.96 27 5.72 270 57.20 

Acquired or Late-Onset 

Disabilities 4 0.85 10 2.12 71 15.04 30 6.36 21 4.45 7 1.48 25 5.30 16 3.39 380 80.51 

Mental Health 11 2.33 9 1.91 140 29.66 58 12.29 37 7.84 9 1.91 36 7.63 27 5.72 292 61.86 

Medicaid 17 3.60 39 8.26 192 40.68 102 21.61 39 8.26 11 2.33 112 23.73 19 4.03 227 48.09 

Housing 13 2.75 13 2.75 134 28.39 35 7.42 24 5.08 7 1.48 32 6.78 28 5.93 300 63.56 

Education 5 1.06 6 1.27 61 12.92 31 6.57 24 5.08 6 1.27 16 3.39 22 4.66 374 79.24 

Other (specify)* 6 1.27 2 0.42 16 3.39 14 2.97 3 0.64 2 0.42 4 0.85 5 1.06 450 95.34 

Local Government 

Agencies # % # % # % # % # % # % # % # % # % 

Area Agency on Aging 120 25.42 129 27.33 234 49.58 202 42.80 159 33.69 114 24.15 177 37.50 3 0.64 212 44.92 

County Health 

Department 16 3.39 15 3.18 193 40.89 80 16.95 54 11.44 12 2.54 55 11.65 18 3.81 244 51.49 

County Medicaid Office 23 4.87 11 2.33 200 42.37 84 17.80 28 5.93 12 2.54 94 19.92 15 3.18 246 52.12 

County Department on 

Aging 49 10.38 45 9.53 99 20.97 77 16.31 67 14.19 41 8.69 63 13.35 11 2.33 350 74.15 

County Department on 

Disability 15 3.18 12 2.54 95 20.13 53 11.23 24 5.08 8 1.69 30 6.36 9 1.91 359 76.06 

County Housing Office 7 1.48 3 0.64 122 25.85 37 7.84 23 4.87 6 1.27 22 4.66 17 3.60 328 69.49 

Library 3 0.64 3 0.64 104 22.03 30 6.36 33 6.99 18 3.81 15 3.18 17 3.60 332 70.34 

Other (specify)* 11 2.33 8 1.69 22 4.66 16 3.39 11 2.33 8 1.69 9 1.91 2 0.42 444 94.07 

Federal Agencies # % # % # % # % # % # % # % # % # % 

Page 102 
 

 

 

 

 

 

 

 

 

63. What types of resources are shared? 

Co-located 

staff 

Shared 

monetary 

resources 

Shared 

information 

Joint 

training 

Joint 

program 

sponsorship 

Shared nonmonetary 

resources 

Shared data No shared 

resources 

No response/ 

Not 

applicable 

Local Veterans 

Administration 15 3.18 14 2.97 215 45.55 70 14.83 51 10.81 14 2.97 49 10.38 29 6.14 205 43.43 

Local Indian Health 

Service 3 0.64 1 0.21 40 8.47 10 2.12 9 1.91 2 0.42 5 1.06 19 4.03 414 87.17 

Other (specify)* 1 0.21 3 0.64 10 2.12 4 0.85 5 1.06 1 0.21 4 0.85 2 0.42 460 97.46 

Organizations providing 

Direct Services # % # % # % # % # % # % # % # % # % 

211 or other call center 5 1.06 18 3.81 183 38.77 59 12.50 27 5.72 8 1.69 70 14.83 24 5.08 258 54.66 

Community Health Clinic 11 2.33 7 1.48 147 31.14 40 8.47 22 4.66 10 2.12 33 6.99 21 4.45 293 62.08 

Community Mental 

Health Clinic 7 1.48 7 1.48 149 31.57 50 10.59 19 4.03 10 2.12 26 5.51 20 4.24 293 62.08 

Deaf Service Center 2 0.42 4 0.85 79 16.74 22 4.66 8 1.69 5 1.06 8 1.69 20 4.24 370 78.39 

Hospital/Medical Center 33 6.99 22 4.66 232 49.15 97 20.55 83 17.58 24 5.08 95 20.13 19 4.03 202 42.80 

School for the Blind 1 0.21 3 0.64 22 6.99 10 2.12 6 1.27 3 0.64 7 1.48 21 4.45 417 88.35 

School for the Deaf 0 0.00 0 0.00 27 5.72 9 1.91 3 0.64 0 0.00 1 0.21 20 4.24 423 89.62 

The ARC 1 0.21 1 0.21 92 19.49 24 5.08 16 3.39 2 0.42 18 3.81 23 4.87 350 74.15 

United Way 2 0.42 35 7.42 156 33.05 46 9.75 44 9.32 2 0.42 43 9.11 27 5.72 271 57.42 

Vocational/Rehabilitation 

Services 5 1.06 5 1.06 160 33.90 54 11.44 26 5.51 5 1.06 31 6.57 20 4.24 287 60.81 

Other (specify)* 4 0.85 2 0.42 20 4.24 11 2.33 8 1.69 3 0.64 8 1.69 3 0.64 448 94.92 

Advocacy/Referral 

Organizations # % # % # % # % # % # % # % # % # % 

AIDS Coalition 2 0.42 0 0.00 42 8.90 10 2.12 4 0.85 0 0.00 7 1.48 25 5.30 404 85.59 

Alzheimer’s Association 10 2.12 13 2.75 227 48.09 130 27.54 94 19.92 15 3.18 51 10.81 20 4.24 197 41.74 

American Council of the 

Blind 0 0.00 0 0.00 33 6.99 10 2.12 3 0.64 0 0.00 3 0.64 20 4.24 416 88.14 

Autism Society 

state/regional chapter 0 0.00 2 0.42 29 6.14 2 0.42 1 0.21 1 0.21 0 0.00 20 4.24 422 89.41 

Brain Injury Association 

state/regional chapter 1 0.21 1 0.21 82 17.37 19 4.03 9 1.91 4 0.85 13 2.75 20 4.24 367 77.75 

Centers for Independent 

Living 40 8.47 53 11.23 274 58.05 188 39.83 99 20.97 33 6.99 123 26.06 13 2.75 163 34.53 

Page 103 
 

 

 

 

 

 

63. What types of resources are shared? 

Co-located 

staff 

Shared 

monetary 

resources 

Shared 

information 

Joint 

training 

Joint 

program 

sponsorship 

Shared nonmonetary 

resources 

Shared data No shared 

resources 

No response/ 

Not 

applicable 

Easter Seals 3 0.64 6 1.27 70 14.83 17 3.60 11 2.33 3 0.64 9 1.91 21 4.45 376 79.66 

Epilepsy Foundation 

state/regional chapter 0 0.00 0 0.00 23 4.87 4 0.85 2 0.42 1 0.21 3 0.64 21 4.45 427 90.47 

National Association of 

Mental Illness 

state/regional chapter 

0 0.00 0 0.00 59 12.50 15 3.18 8 1.69 3 0.64 4 0.85 20 4.24 390 82.63 

National Autism 

Association state/regional 

chapter 

0 0.00 0 0.00 17 3.60 2 0.42 2 0.42 0 0.00 1 0.21 21 4.45 434 91.95 

National Multiple 

Sclerosis Society 

state/regional chapter 

0 0.00 1 0.21 36 7.63 12 2.54 5 1.06 2 0.42 6 1.27 22 4.66 413 87.50 

State Association for the 

Deaf 0 0.00 0 0.00 32 6.78 8 1.69 2 0.42 0 0.00 1 0.21 17 3.60 423 89.62 

United Cerebral Palsy 1 0.21 4 0.85 49 10.38 15 3.18 8 1.69 2 0.42 16 3.39 18 3.81 102 85.17 

Other (specify)* 3 0.64 6 0.64 16 3.39 11 2.33 7 1.48 2 0.42 9 1.91 1 0.21 453 95.97 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

Page 104 
 

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64. Approximately, how many FTEs (Full time equivalents) perform each of the following functions? 

0 1 2-4 5-7 8-10 >10 No response Range Mean Median Mode # % # % # % # % # % # % # % Min Max 

Information & Referral/ 

Information & Assistance 

(I&R/I&A) 

2 0.42 82 17.37 142 30.08 65 13.7 

7 21 4.45 37 7.84 123 26.06 0 75 5 3 1 

Options counseling/ 

counseling to provide indepth person centered 

decision support 

8 1.69 113 23.94 88 18.64 45 9.53 17 3.60 37 7.84 164 34.75 0 65 5 2 1 

Benefits counseling/ 

eligibility determination 12 2.54 96 20.34 98 20.76 29 6.14 19 4.03 30 6.36 188 39.83 0 150 5 2 1 

Care transition services 22 4.66 78 16.53 54 11.44 21 4.45 5 1.06 10 2.12 282 59.75 0 40 3 2 1 

Crisis Intervention services 29 6.14 37 7.84 23 4.87 9 1.91 10 2.12 10 2.12 354 75.00 0 30 3 3 1 

Independent Living services 27 5.72 39 8.26 23 4.87 13 2.75 7 1.48 13 2.75 350 74.15 0 171 5 2 1 

Advocacy services 10 2.12 82 17.37 55 11.65 22 4.66 20 4.24 27 5.72 256 54.24 0 92 5 2 1 

Providing administrative or 

other support for the above 

functions 

8 1.69 103 21.82 117 24.79 28 5.93 13 2.75 10 2.12 191 40.47 0 91 3 2 1 

Note: Responses have been rounded to the nearest whole number. 

Page 105 
 

 

 

65. How many front line staff are Alliance of Information and Referral Systems 

(AIRS) certified? 

Number of AIRS certified 

Frequency Percentage 

0 57 12.08 

1 59 12.50 

2-4 127 26.91 

5-7 45 9.53 

8-10 16 3.39 

>10 21 4.45 

No response 147 31.14 

Total 472 100 

Min 0 

Max 32 

Mean 4.41 

Median 3 

Mode 1 

Note: Responses have been rounded to the nearest whole number. 

65. How many front line staff are Alliance of Information and Referral Systems 

(AIRS) certified? 

Total Number of Frontline Staff 

Frequency Percentage 

0 28 5.93 

1 31 6.57 

2-4 119 25.21 

5-7 69 14.62 

8-10 22 4.66 

>10 44 9.32 

No response 159 33.69 

Total 472 100 

Min 0.50 

Max 161 

Mean 7.09 

Median 4 

Mode 2 

Note: Responses have been rounded to the nearest whole number. 

Page 106 
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66. Is your organization paid on a fee for service or per unit basis for performing any of the following 

services for a client? (Please check all that apply) 

Frequency Percentage* 

Information/referral 55 11.65 

Options counseling 79 16.74 

Screening 59 12.50 

Assessment 83 17.58 

Application assistance 44 9.32 

Transition support 72 15.25 

Other, please specify** 44 9.32 

No response 294 62.29 

*Percentages do not add up to 100% as respondents could select more than one option.
 

**Free text responses accompanying this question are available in the appendix with supplemental questions.
 

67. [If any of the boxes are checked in previous question] What is the source of the fee 

unit payments? 

for service or per 

Frequency Percentage* 

Medicare 34 7.20 

Medicaid waiver 87 18.43 

Medicaid state plan 37 7.84 

Medicaid managed care organization 18 3.81 

State-funded program other than Medicaid 70 14.83 

Private health plan 5 1.06 

Provider 4 0.85 

Other, please specify** 49 10.38 

No response 297 62.92 

*Percentages do not add up to 100% as respondents could select more than one option.
 

**Free text responses accompanying this question are available in the appendix with supplemental questions.
 

Page 107 
 

 

 

Section E: LTSS Environment
 

68. Since this Local ADRC started serving consumers, has there been an impact on the LTSS or Home and 

Community Based (HCBS) system in your community? 

Frequency Percentage 

There has been an increase in the number of LTSS providers 335 70.97 

There has been an decrease in the number of LTSS providers 40 8.47 

No Response 97 20.55 

Total 472 100 

68. Since this Local ADRC started serving consumers, has there been an impact on the LTSS or Home and 

Community Based (HCBS) system in your community? 

Frequency Percentage 

There has been an increase in the quality of LTSS providers 346 73.31 

There has been an decrease in the quality of LTSS providers 27 5.72 

No Response 99 20.97 

Total 472 100 

Page 108 
 

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APPENDIX G. PROCESS EVALUATION LOCAL ADRC SURVEY FREE TEXT 

RESPONSES 

Section A. Baseline Characteristics
 

2. Which have had the most positive impact on your organization s ability to provide integrated, 

comprehensive access to long term care services and supports? 

Specify Other 

Outreach and marketing 

Increased awareness of LTSS options 

Implementation of a new very comprehensive assessment tool 

Increased education and training for staff 

Expanded our ability to serve populations other than 60+, including all ages for Options Counseling and 

PD & TBI functional assessments 

Infrastructure such as improved phone system 

Adding component of providing assistance to adults with disabilities allows for expansion of resources to 

encompass older adults 

Increased awareness 

Able to reach more people to explain their LTC options for them 

ADRC cross-training 

The database has gone through major changes since the ’03 award; however, some of these sections and

questions are not applicable since this is for the ADRC website 

Extension of care management services and consumer counseling 

Keeping staff 

In-house staff training 

Marketing and outreach to educate community 

Community education 

Outreach 

Process changes to intake and referral; standardized assessment; case management; care planning; follow 

up 

Enhanced marketing and outreach materials; IT enhancements 

Assist individuals and caregivers with streamlined access to multiple programs and multiple agencies for 

one point 

Marketing that we provide I&R services, which is a new service we now provide 

Change in organizational structure 

Allowed for entitlement benefit 

Page 109 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

5. Please indicate the extent to which Federal (AoA/CMS) grants have enabled your ADRC to realize any of 

the following outcomes. 

Specify Other 

We have not received any federal grants to assist our ADRC Very little 

IT improvement for tracking Somewhat 

No federal grant Somewhat 

Better visibility of agency and services Very much 

N/A Very little 

Not applicable Very little 

Better data sharing Somewhat 

Increase our agency’s knowledge of people with disabilities population Very much 

Resolve additional issues not previously discussed from follow-up 

assessment Somewhat 

Add new programs Somewhat 

The staff have increased the focus for provision of services Very much 

Building collaborate network of LTSS providers all focused on same goal Somewhat 

More referral options Very little 

Extend focus to aging caregivers of intellectually disabled individuals Very much 

N/A, we are not an AOA/ADRC site. We support the goals of the ADRC 

specific Federal grants. Very much 

Partnerships with hospitals and nursing homes and departments of 

developmental disabilities Very much 

Improve the overall quality of day-to-day operations Very much 

Evidence-based interventions Very much 

Legitimizes the under 60 populations we have been serving in the past and 

could not include in contacts Somewhat 

Improved IT systems to ensure efficient service delivery Very much 

Provide face-to-face options counseling Somewhat 

Provide more detailed and accurate information to consumers Very much 

Helping us begin a Care Transitions program with the hospitals Somewhat 

Create a central intake process internally Very much 

No other changes Very little 

Increase number of resources Very little 

We have had no federal funding since the original grant Very little 

To increase the capacity of the agency Very much 

Increase community outreach initiatives Very little 

Making services more accessible to older adults, adults with disabilities, 

and those who care for them Very much 

Increased outreach Somewhat 

Despite the establishment of a single point of entry, resources and services 

have not increased making problem solving challenging Very little 

Improve IT data structure Somewhat 

I&R becomes portable and face-to-face Very much 

Moves I&R to face-to-face meeting Very much 

Move I&R from telephone to person Very much 

Shifting the paradigm to be more inclusive Very much 

We are just beginning but anticipate the ADRC will provide heightened 

visibility and marketing to LTSS. We are still building partnerships and 

collaboratives necessary to put the next steps in place 

Very much 

Conducted focus groups regarding needs of consumers Somewhat 

No grant funds received Very little 

Page 110 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5. Please indicate the extent to which Federal (AoA/CMS) grants have enabled your ADRC to realize any of 

the following outcomes. 

Increase the IT architecture that supports the SLL and MN Help Network Somewhat 

Budgets are dropping in public entities Very little 

Support network, database and tracking capabilities, info and resources, 

best practices, program expansions Very much 

Update computer systems Somewhat 

None Very little 

Call center improvements Very much 

Able to improve workflow Somewhat 

To identify gaps and barriers and coordinate efforts to overcome these 

gaps and barriers in accessing services Somewhat 

We used the information in the binder to train all staff in customer service 

and delivering a quality product to our seniors Somewhat 

No other changes noted Very little 

Increased knowledge of under 60 disabled population by staff Very much 

Increased level of interns and volunteers Very much 

Address gaps in service, public education Somewhat 

Dedicate time to improving access to care Very much 

Increase in cross-training among community agencies and organizations to 

better support the consumer Very much 

Some technology changes Very little 

Improve the quality of I&R services Very much 

No additional staff or other changes Very little 

N/A Very little 

Provide training and community education opportunities Very much 

Increase awareness of programs and services available through crosstraining Very much 

Increase awareness of ADR Very much 

Increase knowledge about various resources Somewhat 

Expand services to include other organizations that would not otherwise 

provide services to seniors and adults with disabilities Very much 

Getting staff to work together outside of former program silos Somewhat 

Cross-training to equip all staff to assist consumers if needed Somewhat 

Standardize intake assessment and care planning Very much 

Improved technical systems Somewhat 

Increased marketing capabilities Very little 

Telephone systems and data management upgrade Somewhat 

Expand to Veterans outreach Very much 

We have been able to support and advocate for CILs across the state to 

work with their area ADRCs and understand the benefits of this 

partnership 

Somewhat 

Support service resources to meet unmet needs in home modifications and 

or new affordable housing construction or sufficient housing vouchers to 

deliver better transitional support 

Very little 

Streamlining intake and outreach throughout organizations Very much 

Improved IT infrastructure Very little 

We are changing and developing the way we provide services; for 

example, more short term interventions. All calls are routed through our 

I&A 

Somewhat 

Cross-training of partner agencies Somewhat 

Page 111 
 

5. Please indicate the extent to which Federal (AoA/CMS) grants have enabled your ADRC to realize any of 

the following outcomes. 

Standardized methods of working with peers Somewhat 

Arlington does not have an ADRC grant Very little 

Consolidate data Very little 

Secured local private funding to develop a public/private partnership in a 

local ADRC Very much 

Develop person-centered practices Somewhat 

Open communication with community based organizations Somewhat 

We have not begun a partnership with the state MFP grant Somewhat 

We have not begun a partnership with the state MFP grant Somewhat 

Enhance transition services to young adults aging out of the children’s

services world, prevention activities, service private pay consumers Very much 

Options Counseling grants, Enhanced Options Counseling Grant Very much 

Funding for smaller counties in region Very much 

Expand to a second location in the county we serve Very much 

Page 112 
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Section B. Populations Served
 

8. If you have one or more significant racial/ethnic sub populations in your 

service area, please list it here. 

Russian 

2 or more races 

2 or more races 

Portuguese; Latino 

Other race; multiple race 

Polish; limited English proficient 

Other minority- not identified 

More than one race; self-identifying as other races 

African American and Hispanic 

African American; Latino/Hispanic 

African; Russian; Middle Eastern 

African-American 

African-American; Latino/Hispanic; Asian 

African-American; Hispanic; Asian 

Alaska Native; Russian; Old Believers 

Alaskan Native; White 

American Indian 

American Indian 

American Indian 

American Indian; Hispanic 

American Indian or Alaska Native 

American Indian/Alaska Native 

Arab 

Arabic 

Asian (Chinese); Haitian; Russian 

Asian; Indian 

Bhutanese 

Black 

Black 

Black 

Black or African American 

Black or African American 

Black or African American 

Black or African American 

Burmese 

Caucasian 

Caucasian 

Caucasian 

Caucasian 

Caucasian/White 

Caucasian/White / Black or African American 

Caucasian 

French Canadian 

German 

GLBT 

Guatemalan 

Page 113 
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8. If you have one or more significant racial/ethnic sub populations in your 

service area, please list it here. 

Haitian 

Haitian 

HaitianHispanic 

Hispanic 

Hispanic 

Hispanic 

Hispanic 

Hispanic 

Hispanic 

Hispanic 

Hispanic 

Hispanic; African American 

Hispanic; African Americans 

Hispanic; Asian 

Hispanic; Burmese 

Hispanic; Haitian; Vietnamese; Russian 

Hispanic; Hmong; American Indian 

Hispanic/Latino 

Hmong 

Hmong 

Hmong 

Hmong; American Indian; Black 

Japanese 

Jewish 

Korean 

Korean 

Korean/Chinese/Lenape Indian/Iranian/Indo-Asian 

Portuguese; Cambodian 

Latino 

Latino 

Latino and Black 

Latino/Hispanic 

Latino/Hispanic 

Latino/Hispanic 

Latino/Hispanic 

Latino/Hispanic 

Latino/Hispanic 

Latino/Hispanic Origin 

Latino/Hispanic origin 

Latino/Hispanic Population 

Latino; Portuguese 

Mexican American 

Native American; Russian; Hispanic 

Nez Perce Tribe 

Polish; Italian; German; Greek; Irish 

Portuguese/Brazilian 

Portuguese/Cape Verdean 

Page 114 
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8. If you have one or more significant racial/ethnic sub populations in your 

service area, please list it here. 

Russian 

Russian 

Russian; Chinese; Haitian; Muslim 

Russian Immigrants 

Russian; Somalian; African; Haitian 

Russian; Ukraine; Somali; Burundi; Turkish 

Russian; Vietnamese 

Slavic 

Somali 

Somali; Russian; Asian; Hispanic 

Somalian refugees 

Somalian; Sudanese 

Some other race 

some other race 

South African populations 

Spanish 

Spanish-speaking clients 

Sudanese 

Vietnamese; Mexican 

Vietnamese; American Indian 

Amish population 

White 

white 

White 

White - non Hispanic 

13. To what extent is each of the following a barrier for individuals seeking Long Term Supports and Services 

both prior to receiving an ADRC grant and currently? 

Specify Other 

Other Prior Currently 

ADRC partner reported this data Sometimes a barrier Sometimes a barrier 

Age requirement: Wavier programs are age 

specific and often not available for people who 

are under 65 

Often a barrier Often a barrier 

Inadequate workforce Often a barrier Often a barrier 

Funding to pay for long-term care services and 

supports Often a barrier Often a barrier 

Medications review Often a barrier Often a barrier 

GLBT related issues Sometimes a barrier Sometimes a barrier 

Not enough waiver slots Often a barrier Often a barrier 

Low reimbursement rates for services provided Sometimes a barrier Sometimes a barrier 

Available services in rural areas Often a barrier Often a barrier 

Providers who no longer accept new Medicare 

patients Sometimes a barrier Often a barrier 

Lack of affordable and accessible housing options Often a barrier Often a barrier 

Physicians willing to take Medicare patients Often a barrier Sometimes a barrier 

Page 115 
Additional funding for Independent Living 

Centers Often a barrier Often a barrier 

Presumption of what folks need versus asking 

them what they want and giving them the 

information to make fully informed decisions 

Sometimes a barrier Often a barrier 

Access in doctor’s office is poor Often a barrier Often a barrier 

Page 116 
 

 

 

 

 

 

 

 

13a. Please indicate the current availability of the following services within your service area. 

Specify Other 

Other Current availability of the services 

within your service area 

ADRC partner reported this data Adequate availability 

Ex-offenders Not available 

Very rural state, very few public transportation options. As for PCA 

services, there is no waiting list for financial support, however 

finding a PCA can be very difficult. 

Available but inadequate to meet need 

SHICK Adequate availability 

Adult day care Not available 

Home-making services Available but inadequate to meet need 

Dental services that accept MA, long lists at free clinic Available but inadequate to meet need 

Dental services Available but inadequate to meet need 

Mental illness and VA services Available but inadequate to meet need 

Job coaching Available but inadequate to meet need 

Emergency assistance for the elderly in crisis during the weekend Not available 

Lack of home-making services for under 60 Available but inadequate to meet need 

Fully accessible interface of data for referrals and services between 

community providers of LTSS to truly have NWD model Not available 

Affordable integrated housing Available but inadequate to meet need 

Page 117 
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13b. For these services, to what extent is there provider choice? 

Specify Other 

Other Prior to First Grant Currently 

ADRC partner reported this data Adequate Adequate 

Ex-offenders No No 

Very rural state, very few public transportation options. As for 

PCA services, there is no waiting list for financial support, 

however finding a PCA can be very difficult. 

Limited Limited 

SHICK Adequate Adequate 

Adult day care No No 

Home-making services Limited Limited 

Dental services that accept MA, long lists at free clinic Limited Limited 

Dental services Limited Limited 

Mental illness and VA services Limited Limited 

Job coaching Limited Limited 

Emergency assistance for the elderly in crisis during the weekend No No 

Lack of home-making services for under 60 Limited Limited 

Fully accessible interface of data for referrals and services 

between community providers of LTSS to truly have NWD 

model 

No No 

Affordable integrated housing Limited No 

14a. How many consumers of each type were served in the most recent 6 months period (October 2012 March 

2013)? This question is specific to the consumers who access LOCAL ADRC services such as I&R/I&A, benefits 

or options counseling, Information and referral services, services to support transitions from residential or 

institutional facilities to the community. 

Consumers Under 60 

Specify Other 

Alzheimer’s Caregivers

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14b. How many consumers of each type were served in the most recent 6 months period (October 2012 March 

2013)? This question is specific to the consumers who access LOCAL ADRC services such as I&R/I&A, benefits 

or options counseling, Information and referral services, services to support transitions from residential or 

institutional facilities to the community. 

Consumers 60 and Over 

Specify Other 

Alzheimer’s caregivers and those with Alzheimer’s disease

55+ Senior Activity Centers 

Alizanza Latina Interagency Meetings 

American Indian 

Applying for home waiver HCBS 

Collaborated with Mental Health Navigators 

Deaf population 

Family/Friend 

Frail elders 

Hearing loss and deaf 

Hispanic 

HIV/AIDS at risk and tested positive; transgender 

Isolated population 

Kinship caregivers 

LGBT 

LGBT 

Low health literacy; hoarders 

Elder Benefit Specialist is tracking information for outreach effort to Latino community who have limited English 

proficiency 

Medicare beneficiaries 

Native American 

Native American 

Non-native English speakers 

Older adult refugees 

Older people and disabled 

Other disabilities 

LGBT 

Asian populations 

Persons with chronic conditions 

Private pay consumers 

Private pay individuals 

Sensory disabilities (hearing-vision) 

Substance abuse 

Tribal 

Under 60 

Vet service coordinator 

Veterans 

Veterans and Surviving spouses of Veterans 

Veterans 

Visual Disability 

Younger adults with disabilities 

Younger persons with disabilities 

At risk for falls 

Deaf or hearing loss 

Family members and others 

Page 119 
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14b. How many consumers of each type were served in the most recent 6 months period (October 2012 March 

2013)? This question is specific to the consumers who access LOCAL ADRC services such as I&R/I&A, benefits 

or options counseling, Information and referral services, services to support transitions from residential or 

institutional facilities to the community. 

Consumers 60 and Over 

Specify Other 

GLBT 

Hispanic or Latino 

Homelessness 

Korean 

Low income equals public benefit contacts 

Multidisciplinary team 

New advertising campaign 

No disability 

Others 

Other unspecified disability 

Seniors; youth with disabilities; LGBT seniors 

Substance abuse 

Targeting specific populations based on service area and demographic needs 

Under 60 – no disability reported 

Veterans 

Veterans 

We provide a wide range of outreach activities to target a very diverse group and locate activities that target minority 

groups 

Do not track this information (21 agencies) 

Page 120 
 

 

 

Section C: Service Provision
 

20 (a).How frequently do consumers ask about the following? For each, indicate “frequently,” 

“sometimes,” "infrequently”, or “never.” Advanced directives 

Specify Other 

ASAP Home Care Services 

Assisted Living and Support Home Care 

Assistive technology and communication alternatives 

Computer classes- driver and education permit 

Currently do not track this information 

Day Adult Health Service 

Dental Assistance/Care 

Dental services 

Dental- Vision and Hearing services 

Dialysis transportation 

Do not currently track this information 

Environmental Support 

Food Assistance 

For all services above the POINT provided; R-A 

Handyman services- ground upkeep services, long term care facility information, family issues 

Home Repair 

Homemaker Service 

I and R ( General Information) 

Legal Assistance 

Legal Services 

Legal and Yard Work 

Legal assistance- Housing Tax Credits 

Medical supplies 

Medicare physicians 

Money Management – Bill Payer Assistance 

Not currently tracking 

Not currently tracking this information 

Public Assistance Programs 

Received requests for assistance transferring in and out of state with services and benefits 

Transportation and financial assistances 

Transportation- Legal referrals 

Veteran Services 

Veterans Services 

Volunteer Opportunities, case management, hospice, money management, legal services, tax information 

and other insurance. 

We are currently not track this information 

We are currently not track this information 

We are currently not track this information 

Page 121 
 

 

20 (a).How frequently do consumers ask about the following? For each, indicate “frequently,” 

“sometimes,” "infrequently”, or “never.” Advanced directives 

Specify Other 

We are currently not track this information 

We are currently not track this information 

We are currently not track this information 

We are currently not track this information 

We are currently not track this information 

We are currently not track this information 

community supports 

County and local programs 

Dental , Vision and Hearing assistance 

Did not specify 

Do not currently track this information 

Do not currently track this information 

Guardianships- skilled nursing care, and assisted living (frequently) 

Home repair; Housekeeping, long term care facility information, family issues 

homemaker services 

Job coaching 

Legal-care giver agreements 

Medication information 

Roof repair vision, dental 

Transition for students 

We are currently not track this information 

We are currently not track this information 

26 (a) What is the number of individuals who were assisted with transition from hospital through 

formal care transitions intervention in this ADRC program service area this reporting period by 

participating hospital? 

Name of Hospital 1 

South Peninsula Hospital 

Bartlett Regional Hospital 

Summit Healthcare 

John C Lincoln North Mountain 

Carondelet St. Joseph's 

Mt. Graham 

Baxter Regional Medical Center 

Sharp Rehabilitation Hospital 

Sierra Nevada Memorial Hospital 

Riverside County Regional Medical Center 

CPMC 

Yale New Haven Medical Center 

Georgetown Hospital 

Florida Hospital System 

Southeast GA 

Page 122 
 

 

 

 

 

 

 

26 (a) What is the number of individuals who were assisted with transition from hospital through 

formal care transitions intervention in this ADRC program service area this reporting period by 

participating hospital? 

Name of Hospital 1 

Medical Center of Central Georgia 

Newton Medical Center 

Tanner Health System 

Mayo Health Systems of Waycross 

Hilo Medical Center 

Kauai Veterans Memorial Hospital 

Maui Memorial Medical Center 

Kootenai Health 

Presence Health 

Parkview Noble 

Reid Hospital 

Wishard and Eskenazi 

Daviess Community Hospital 

Clark Memorial Hospital 

IU Health Ball Memorial 

St. Joseph Regional Medical Center - Mishawaka 

St. Mary’s Medical Center

Unity Point Allen Hospital 

unknown 

Bi-state Care Transition Program starts May 2013 

Owensboro Medical 

Richland Parish Hospital 

Eastern Maine Health Care; TAMC 

Maine Medical Center 

Mid Coast Hospital 

Peninsula Regional Medical Center 

Anne Arundel Medical Center 

Howard County General Hospital 

Meritus Medical Center 

Atlantic General Hospital 

St. Anne’s Hospital

Berkshire Medical Center 

Anna Jaques 

UMass 

Faulkner 

Union Hospital 

Wing Memorial 

Norwood Hospital 

Winchester 

Lawrence Memorial Hospital 

Beverly Hospital 

Beverly Hospital 

Cambridge Hospital 

Leonard Morse Hospital 

University 

Henry Ford Macomb Hospital - Clinton Township Campus 

Page 123 
 

 

 

 

 

 

26 (a) What is the number of individuals who were assisted with transition from hospital through 

formal care transitions intervention in this ADRC program service area this reporting period by 

participating hospital? 

Name of Hospital 1 

Lakes Region General Healthcare 

NA 

Cheshire Medical Center and Dartmouth Hitchcock Keene 

Cape Regional Medical Center 

Underwood Memorial Hospital 

St. Joseph’s Hospital - Paterson 

Auburn Community Hospital 

WCA 

Lewis County General Hospital 

Orleans Community Hospital 

Cayuga Medical Center 

Presbyterian 

UNC Hospital 

Angel Hospital 

Northern Hospital 

Wake Med-Raleigh 

Fairfield Medical Center 

Kettering Medical Center 

SEORMC 

Akron City Hospital 

Samaritan 

Mercy&#x2F;St. Vincent&#39;s 

Fairfield Medical Center 

Holzer Medical Center 

Mercy Health (includes The Jewish Hospital and Mercy Fairfield) 

St. Ritas Medical Center 

Sacred Hear River Bend 

Salem Hospital 

Lebanon Community Hospital 

Harrisbug- Holyspirit- Pinnacle 

Excela Westmoreland 

Johnson City Medical Center 

Vanderbilt Univ.Med. Center 

Erlanger Health System 

Scott and White Memorial Hospital 

3 Tenet Hospitals 

Memorial Hermann Katy 

Texas Health Harris Methodist Hospital Fort Worth 

Clinch Valley Medical Center 

Restricted Information 

Lynchburg General 

Smyth County Community Hospital 

Riverside Shore Hospital 

Indian Path Medical Center 

Lewis Gale Pulaski Community Hospital 

Novant Medical Center Prince William 

Page 124 
 

 

26 (a) What is the number of individuals who were assisted with transition from hospital through 

formal care transitions intervention in this ADRC program service area this reporting period by 

participating hospital? 

Name of Hospital 1 

Southampton Memorial 

Augusta Health 

Providence Sacred Heart Medical Center 

Peace Health St. Joseph Hospital 

Yakima Valley Memorial Hospital 

Aurora Medical Center 

Mayo Clinic Health System 

Page 125 
 

 

 

 

 

 

26 (b) What is the number of individuals who were assisted with transition from hospital through 

formal care transitions intervention in this ADRC program service area this reporting period by 

participating hospital? 

Name of the Hospital 2 

Little Colorado 

John C Lincoln Deer Valley 

Carondelet St. Mary's 

North AR Regional Medical Center 

Rady ChildrenHospital 

Desert Regional Medical Center 

Howard University 

Clearview Regional Medical -Center 

Piedmont-Newnan 

Coffee County Regional Hospital 

Bonner General 

Parkview Randallia 

Fayette Memorial Hospital 

Veterans Administration Medical Center 

Good Samaritan Hospital 

St Vincent Anderson Regional 

Elhkart General Hospital 

Deaconess Hospital 

Covenant Medical Center 

unknown 

Henderson Methodist 

N/A 

Cary Medical Center 

Southern Maine Medical Center 

Miles Memorial Hospital 

McCready Memorial Hospital 

Morton Hospital 

Holy Family 

St Vincent’s

North Shore medical Center- Salem Hospital 

UMASS Medical 

Metrowest Framingham 

Melrose Wakefield Hospital 

Addison Gilbert Hospital 

UMASS Memorial 

William Beamont Hospitals – Troy Campus 

NA 

Shore Memorial Hospital 

St. Joseph’s Hospital – Wayne 

Brooks 

Carthage Area Hospital 

Carolina Medical center 

Hugh Chatham Memorial 

UNC 

Good Samaritan Hospital 

Union Hospital 

Page 126 
 

 

 

 

 

26 (b) What is the number of individuals who were assisted with transition from hospital through 

formal care transitions intervention in this ADRC program service area this reporting period by 

participating hospital? 

Name of the Hospital 2 

Akron General Hospital 

Med-Central Mansfield 

UTMC 

Marietta Memorial Hospital 

Southern Ohio Medical Center 

The Christ Hospital 

Albany General Hospital 

Excela Latrobe 

Indian Path Medical Center 

University Medical Center 

Metroplex Healthcare 

2 HCA Hospitals 

CHRISTUS St. Catherine 

Texas Health Harris Methodist Hospital Hurst-Euless Bedford 

Buchanan General Hospital 

Restricted Information 

Johnston Memorial Hospital 

Lonesome Pine Hospital 

Sentera Medical Center Northern Virginia 

Leigh –Sentara 

Providence Holy Family Hospital 

Skagit Valley Hospital 

HCA Regional 

Holy Family Memorial Medical 

Sacred Heart Hospital 

Page 127 
 

 

 

 

 

 

 

 

 

 

 

 

26 (c) What is the number of individuals who were assisted with transition from hospital through formal 

care transitions intervention in this ADRC program service area this reporting period by participating 

hospital? 

Name of the Hospital 3 

Scottsdale Healthcare Osborn 

CHVI 

Northwest Health Systems - Springdale 

Scripps Health- Sharp HealthCare and UCSD Health System 

Sibley Hospital 

Upson Regional 

Bacon County Hospital 

Rushville Hospital 

Methodist 

unknown 

N/A 

York Hospital 

Pen Bay Hospital 

Charlton Memorial 

Lawrence General 

Marlborough 

Metrowest Natick 

Whidden Hospital 

McLaren - Oakland 

Forsyth Medical Center 

Miami Valley Hospital 

Trinity Health Care System 

Aultman Hopsital 

Knox Community 

Adena Medical Center-Holzer Health System-Southern Ohio Medical Center 

Adena Regional Medical 

University Hospital and Clinton Memorial 

Excela Frick 

Sycamore Shoals Hospital 

Trousdale Medical Center 

Hamilton Heathcare 

Texas Health Arlington Memorial 

Russell County Medical Center 

Restricted Information 

Kootenai Medical Center 

Kennewick General 

St. Joseph&#39;s Hospital 

42. Please list LTSS programs and HCBS waivers (e.g. aged and disabled, MR/DD) that individuals are 

enrolled in. 

1. CCSP-Community Care Services Program-elderly and/or functionally impaired or have disabilities.2. 

SOURCE-Service Options Using Resources in Community Environment-primary enhanced case management 

under elderly and disabled waiver. Serves blind- aged- disabled who are SSI eligible. 3. ICWP-Independent Care 

Waiver Program-for Medicaid recipients who have severe physical disabilities- are between the ages of 21-64. 4. 

NOW-New Options Waiver and COMP-Comprehensive Supports Waiver Program-for people who have 

Page 128 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

42. Please list LTSS programs and HCBS waivers (e.g. aged and disabled, MR/DD) that individuals are 

enrolled in. 

developmental or intellectual disabilities. 5. GAPP-Georgia Pediatric Program--specialized skilled nursing services 

to medically fragile members with a current Individualized Family Service Plan- age birth to 3 years of age. 6. 

MFP-Money Follows the Person-helps people living in nursing homes and ICF-MR facilities to transition and 

resettle in to a community setting. 7. Older Americans Act programs Homemaker Home-delivered meals 

Congregate meals Caregiver Support Respite Personal support services 

1. CCSP-Community Care Services, Program-elderly and/or functionally impaired, or have disabilities.2. 

SOURCE-Service Options Using Resources in Community Environment-primary enhanced case management 

under elderly and disabled waiver. Serves blind- aged- disabled who are SSI eligible.3. ICWP-Independent Care 

Waiver Program-for Medicaid recipients who haves evere physical disabilities- are between the ages of 21-64.4. 

NOW-New Options Waiver and COMP-Comprehensive Supports Waiver Program-for people who have 

developmental or intellectual disabilities.5. GAPP-Georgia Pediatric Program--specialized skilled nursing services 

to medically fragile members with a current Individualized Family Service Plan- age birth to 3 years of age.6. 

MFP-Money Follows the Person-helps people living in nursing homes and ICF-MR facilities to transition and 

resettle in to a community setting. 

1915C HCBC Waiver LTSS Programs: Assisted Living Facilities- Residential Care Facilities- Adult Foster HomesRelative Adult Foster Homes- In-home Services 

A L Waiver FSW Waiver 

AD- HCBS 

ABI Waiver 

ABI waivers- PCA waivers- DD- aged and disabled waivers. 

ABIF rail elder Rolland 

Act 150 - Under 60 and Over 60OBRAIndependence Waiver Agency with Choice MFP Commcare Autism AIDS 

Waiver, Attendant Care Waiver, Consolidated Waiver for Individuals with MR 

Act-150IndependenceOBRACommcareAttendant Care Autism 

Actual numbers can be obtained from DPW. They track this information. 

Actual numbers can be obtained from DPW. They track this information. 

ADRC of Southeast Michigan is not currently operational. We are currently in emerging status and anticipate 

beginning to provide IA in Summer- 2013. 

Adult Day Care, Care Coordination for Elderly Virginians 1Congregate Nutrition Disease Prevention/Health 

Promotion Elder Abuse Emergency Home Delivered Nutrition Homemaker III-E Adult Day Care – Respite III-E 

Homemaker – Respite III-E Individual – Counseling III-E Info Referral/Assistance - AAIII-E Personal Care –

Respite III-E Transportation – AA Information and Referral/Assistance Legal Assistance Local AAA Personal Care 

Transportation 

Adult Day Care Coordination for Elderly Virginians 2CheckingCongregate Nutrition Disease Prevention/Health 

Promotion Elder Abuse Emergency Home Delivered Meals - Fee for Service Home Delivered Nutrition 

Homemaker III-E Homemaker – Respite III-E Info Referral/Assistance - AAIII-E Personal Care – Respite 

Information and Referral/Assistance Local AAA Personal Care Respite Homemaker Transportation Information on 

the number of persons enrolled in Medicaid and residing in institutions in MEOC's service area is available at the 

state level. 

Adult Day Health Adult Foster Care Day Habilitation Durable Medical Equipment/Oxygen Respiratory Early 

Intervention Group Adult Foster Care Home Health Hospice Independent Nursing Orthotics Prosthetics Personal 

Care Attendant Targeted Case Management 

Adult Foster Care (AFC)Community Attendant Services (CAS) Community Based Alternatives (CBA)Client 

Managed Personal Attendant Services (CMPAS)Day Activity and Health Services (DAHS)Emergency Response 

Services (ERS)Family Care (FC) ServicesHome Delivered Meals Services (HDM)Hospice Services In-Home and 

Family Support Program (IHFSP)Medically Dependent Children Program (MDCP)Primary Home Care 

(PHC)Residential Care (RC) Special Services to Persons with Disabilities (SSPD) 

Advantage Waiver 

Aged Disabled Waiver 

Aged Disabled Waiver Program Traumatic Brain Injury Waiver CHOICE 

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42. Please list LTSS programs and HCBS waivers (e.g. aged and disabled, MR/DD) that individuals are 

enrolled in. 

Aged Disabled Waiver Choice SSBG Title III 

Aged Disabled Wavier- CHOICE- Older Americans Act- SSBG 

Aged Disabled High/Highest Needs Moderate Needs 

Aged and Disabled Waiver Traumatic Brain Injury Waiver CHOICE in-home services SSBG in-home services 

Title III family Caregiver services SSBG and title III home delivered meals 

Aged and Disabled 

Aged and Disabled and Traumatic Brain Injury Medicaid Waivers. CHOICETIII programs Social Services Block 

Grant 

Aged and Disabled Medicaid Waiver- CHOICE- SSBG- TIII 

Aged and Disabled- MR/DD are both administered through State Medicaid Agency- Delaware Medicaid and 

Medical Assistance (DMMA). 

Aged and Disabled- Traumatic Brain Injury- CHOICE- SSBG 

Aged and Disabled Waiver- TBI Waiver 

Aged and Disabled Waiver, DD Waiver, Information and Assistance Care, Coordination Nutrition Services 

Homemaker Services Personal Care Services, Transportation, Legal Services, Respite Services, Health Screenings, 

Elder Abuse Prevention, Long Term Care , Ombudsman Caregiver Information- Referral and Support Housing 

Services 

Aged and Disabled waivers and Traumatic Brain Injury waivers 

Aged and disabled. ADRC's do not have access or the ability to track what the use of LTSS programs in the 

counties we serve. 

Aged and Disabled MR/DD 

Aged/Disabled Note: Information provided in question 41 was an estimate based on numbers provided in SART 

2011 plus 5% increase 

Aging Waiver Independence Waiver Under 60 ACW 

Aging Waiver- Comm Care Waiver- Independence Waiver- Attendant Care Waiver- OBRA Waiver- Act150 for 

under and over age 60- Home Support Services for over and under age 60- MR Waiver- Options Services 

including: Homemaker Service- Personal Assistance Service- Transportation Services- Family Caregiver Program. 

Aging Waiver- Consolidated Waiver- PFDS waiver- Options/Lottery- Family Caregiver Support Program (state)-

Family Caregiver Support Program (federal) 

Aging Waiver- Independence Waiver- COMMCARE Waiver- AIDs Waiver- Attendant Care Waiver- OBRA 

Waiver- LIFE/PACE/LTCCAP Program. ACT 150 Program. NON Medical Assistance Programs: Aging Block 

Grant Services. 

Aging Waiver- Under 60 Waiver- options 

Aging Waiver ,Attendant Care COMMCARE Independence Waiver, OBRALIFE Community BCOA Options 

Program 

Aging Waiver Options Family Caregiver Support Program 

Aging; IDD 

Aging MR/ID options 

AHCCCS (Medicaid) has a 1115 waiver. Other programs are OAA Title III funded programs- Elderventionombudsman consultation- legal services 

Alabama Cares Program (National Caregiver Program)Frail Elderly and Disabled Medicaid Waiver Program 

HIV/AIDS Medicaid Waiver Program In-home Services Program Ombudsman Program Residing in institutions is 

unknown. Other Public LTSS programs is unknown. 

All cluster 1 and 2 services funded with APC dollars including assisted transportation- care management- adult day 

social and medical MOW- congregate meals- housekeeping/HHA- nutrition counseling- and in-home CG 

education. The total unduplicated clients is 5-984. Cluster 3 services funded with APC dollars including 

transportation- senior center services- mental health- legal services- housing assistance - APS services- health 

EASE services- friendly visitor/telephone reassurance- and residential maintenance. The total of unduplicated 

clients is estimated to be 1-945. 10 Veterans are enrolled in the VDHCBSP during the reporting period. 219 

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42. Please list LTSS programs and HCBS waivers (e.g. aged and disabled, MR/DD) that individuals are 

enrolled in. 

people were enrolled in JACC during the reporting period. 77 were enrolled in PEER funding. 

All numbers listed in #42 are for Aging only. Other Core partners will not provide numbers for statistics. 151 

consumers are in the Aging Waiver program.1313 consumers receive other LTSS services through Aging:522 

Meals144 Family Caregiver program153 Options services (Personal care)37 Personal Emergency response units 

250 assessed for Level of care18 recertified for Personal Care home or Domiciliary Care94 assessed for community 

servcies64 protective services reports of need8 representative payee consumers 

Alzheimer Assisted Living Waiver, Day Support Waiver, Elderly or Disabled with Consumer Direction (EDCD) 

Waiver, HIV/AIDS Waiver, Individual and Family Developmental Disabilities Services Waiver, (IFDDS)Mental 

Retardation/Intellectual Disability (MR/ID) Waiver, Program for All-Inclusive Care for the Elderly 

(PACE)Technology Assisted Waiver 

Apprise MH/IDA sersa Care Hospice VNAARCAAACRI 

As stated in the other local level report for SLL and MN Help- this information is to cumbersome to pull from the 

MMIS system and therefore we are not able to provide it for the reporting period. 

ASC refers all HCBS waiver enrollment is maintained at DADS State level. CBA â€“ Community Based 

Alternatives MDCP Medically Dependent Children’s Program CLASS’s Community Living Assistance and

Support Services DBMD - Deaf Blind with Multiple Disabilities HCS’s“ Home and Community-based Services 

TxHml“ Texas Home Living Waiver The STAR+PLUS program - a Medicaid Waiver program through the Texas 

Health and Human Services (HHSC) - provides services through a managed care system. 

Assisted Living Waiver-PASSPORT Waiver-Care Coordination Program-HDM-Senior Dining Program-Senior 

Farmers Market Nutrition Program-Find A Ride 

At the moment Lower Rio Grande Aging and Disability Resource Center does not perform Public LTSS Program 

enrollment. They are referred out to partnering agencies and no formal data is being shared by the partners at this 

time. 

Attendant Care Waiver- COMMCARE Waiver- Independence Waiver- OBRA Waiver- 0192 (AIDS) Waiver- Act 

150 Attendant Care Program- Aging Waiver. PDA HCBS Services (OPTIONS- Caregiver Support Program -

federal and state- Home Delivered Meals- etc.)- Nursing Home Transition Under 60 and over 60. 

Autism Waiver Service Coordination Individual and Family Support Resource Coordination Respite Care 

Transitioning Youth with Disabilities Medical Assistance Waiver for Older Adults Long Term Care Ombudsman 

Program Adult Evaluation and Review Services Home Care/In Home Aide Services Social Services to Adults 

Senior Nutrition Program Adult Foster Care Unit Adult Public Guardianship Senior Mental Health Program Senior 

Assisted Living Group Home Subsidy 

Barren River Consumer Directed Options is an HCB waiver. 

Cap DA Innovations Waiver Adult Day Care Home and Community Care Block Grant Funds including nutritiontransportation- senior center- Home Delivered Meals- etc. Personal Care Services Adult Care Homes Family Care 

Homes Nursing Facilities Summit Support Services Home Health 

CAP/DA (Community Alternatives Program for Disabled Adults)NC Innovations Waiver (formerly Community 

Alternatives Program for People with I/DD)CAP-C (Community Alternatives Program for Children)Special 

Assistance Special Assistance-In Home 

Care Coordination for Elderly Virginians 1Care Coordination for Elderly Virginians 2Care Transitions Congregate 

Nutrition Disease Prevention/Health Promotion Emergency Home Delivered Nutrition III-E Adult Day Care –

Respite III-E Info Referral/Assistance - AAIII-E Other - SSIII-E Personal Care – Respite III-E Transportation – AA 

Information and Referral/Assistance Local AAA Local Contact Agency MDS 3.0Options Counseling Personal Care 

S.O.S. Referrals S.O.S. Service Implementations Socialization/Recreation Transportation Virginia Insurance 

Counseling and Assistance Program 

Case Management; Adult Protective Services- Congregrate and Home Delivered Meals; Transportation; Dementia 

Care Specialist- National Family Caregiver Support and Alzheimer's Family Caregivers Support Managed Care 

Programs: Family Care- Partnership and IRIS 

CCSP -SOURCE- ICWP- GAAP- HCBS- SOURCE- MR 

CCSP- SOURCE- ICWP- MR/NEW- Community Habilitation- GAPP private duty- GAPP Day Care- Title III 

HCBS non- Medicaid - Caregiver- HDM- Nutrition- transportation- case management 

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42. Please list LTSS programs and HCBS waivers (e.g. aged and disabled, MR/DD) that individuals are 

enrolled in. 

CCSP-Community Care Services Program - elderly and/or functionally impaired or have disabilities SOURCE -

enhanced case management under elderly and disabled waiver ICWP - Medicaid recipients who have severe 

physical disabilities and are between 21 and 64NOW - waiver program for people who have developmental or 

intellectual disabilities GAPP - specialized skilled nursing services to medically fragile members with current 

individualized family service plan- birth to 3 years MFP - helps people living in the nursing homes and ICF-MR 

facilities to transition and resettle in a community setting Older American's Act - homemaker- home-delivered 

meals- congregate meals- caregiver support- respite- personal support services 

CCSP-Community Care Services Program-elderly and/or functionally impaired or have disabilities. SOURCEService Options Using Resources in Community Environment-primary enhanced case management under elderly 

and disabled waiver. Serves blind- aged- disabled who are on SSI. CCSP and SOURCE are combining into one 

waiver program. ICWP-Independent Care Waiver Program-for Medicaid recipients who have severe physical 

disabilities- are between the ages of 21-64.NOW-New Options Waiver and COMP-Comprehensive Supports 

Waiver Program-for people who have developmental or intellectual disabilities. GAPP-Georgia Pediatric Programspecialized skilled nursing services to medically fragile members with a current Individualized Family Service 

Plan- age birth to 3 years of age. MFP-Money Follows the Person-helps people living in nursing homes and ICFMR facilities to transition and resettle into a community setting. 

CDO Waiver Homecare Services Adult Day Care Services 

CDO with HCB waiver Older Americans Act Home Community Based Service State Funded Adult DayHomecare- Participant Centered Assistance Program- KY Caregiver for Grandparents Ombudsman ADRC Senior 

Centers 

CFC - Choices for Care Home and community based Long Term Care Medicaid Waiver Program- offer individuals 

choice of setting to receive long term care services - home- another's home- residential care home- nursing home -

soon to include Adult Family Care homes. Participants have choice of provider agencies or can choose to self- or 

surrogate direct care. VIP - Veteran's Independence program - contract with state VA- AAA's and local financial 

management agency to provide home based services to 30 qualified veteran's in the state. Services are self-directed 

or can use a surrogate or agency to provide the in-home care services. Funds allocated can be used to purchase 

goods and services to help the veteran remain at home .Developmental Disabilities Waiver program serves 

individuals with intellectual limitations. Traumatic Brain Injury Waiver Participant Directed Attendant Care 

service/Attendant Services Program Meals on Wheels/Congregate meals programs Healthy Living programs SASH 

Community Health Teams 

CHCPEDMHASDDSCHCPE - Under 65 - waiting list 

CHOICE- SSBG- TIII- HDM- TIIIE NOTE: We have no knowledge of average number of individuals enrolled 

in Medicaid residing in Area IV 

CHOICES - TennCare - Medicaid Waiver Nutrition Programs Homemaker Personal Care Respite National Family 

Caregiver Program Options for Community Living 

CHOICES (aged and disabled)MR/DD 

Choices for Care home based services Choices for care flexible choices Moderate needs program Enhanced 

residential care program Nursing home services 

Choices for Care Program 

Choices for Care: Home Based Enhanced Residential Care Flexible Choices Moderate Needs Group for 

Homemaking 

Choices for Care Traumatic Brain Injury waiver Children’s Personal Care services Choices for Care/Flexible

Choices Attendant Services Program 

Choices for Independence- Home and Community Based Care for the elderly and chronically ill 

Choices for Independence Waiver- HCBC-Elderly and Chronically Ill 

Choices for Independence Waiver- HCBC-Elderly and Chronically Ill. 

Choices for Independence Waiver- HCBC-Elderly and Chronically Ill 

Choices HCBS Program 

Choices in Long Term Care 

Choices/Waiver Home Care Basic/Waiver Enhanced Community Options Program Respite/Over Income Home 

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42. Please list LTSS programs and HCBS waivers (e.g. aged and disabled, MR/DD) that individuals are 

enrolled in. 

Care Basic/Non Waiver Veterans Plus Personal Care Assistant Senior Care Organizations 

Chore Home Delivered Meals Congregate Meals Transportation Legal Assistance Information Assistance 

Residential Repair and Renovation Caregiver Access Assistance Caregiver Counseling/Support Groups/Caregiver 

Training Caregiver Respite Care CCEVP 2Volunteer Programs Emergency Fee for Service - Home Delivered 

Meals Respite Other Respite Personal care, Care Transitions Intervention Program Ombudsman Guardianship 

Health Information and Education SMP Home Health Personal Care Adult Day Care and Assisted LivingHabilitation Self-Directed Personal Assistance Intellectual Disability (ID) waiver Day Support waiver Individual 

and Family Developmental Disabilities Support waiver (IFDDS waiver)Elderly or Disabled with Consumer 

Direction waiver Technology Assisted (Tech) waiver 

CIP 1A- CIP 1B- CIP 1BL- CIP 1B ICF-MR- CIP 1B COP Match- CIP II- CIP II Diversion- CIP II RelocationCOP Waiver- Brain Injury Waiver 

Colts C Waiver PACDP CoMi Via Self Directed Med Fragile DD Waiver HIV 

Community Based Alternatives- In Home and Family Support Program- Medicare Savings Program- Extra Help 

Community Care Services Program Waiver Source Waiver SSI only Independent Care Waiver Program NOW -

MR/DDCOMP - MR/DD 

Community Care Services Program Independent Care Waiver Program Mental Retardation/New Options Comm 

Habilitation/Comp Sup SOURCEGAPP In-home Private Duty Nursing GAPP-Medically Fragile Daycare 

Community Long Term Care- LIS- Head and Spinal Cord Injury. Mental retardation and related disorders- HIV 

waiver- ABD 

Consolidated Waiver (ID)Person/Family Directed Services Waiver (ID)Attendant Care Waiver (Under 60 Physical 

Disability)Act 150 (Under 60 Physical Disability)Options (60+)Life Programs (55+)Aging Waiver 

(60+)Independence Waiver (Under 60 Physical Disability)COMCARE Waiver (TBI)AIDS Waiver HSDF 

Homemaking Services (18-59) 

Consumer Directed Option/waiver State Funded Homecare Program Adult Day Care Senior Centers National 

Family Caregivers Support Program Ombudsman SHIP Legal Assistance Chronic Disease Self-Management 

programs, Elder Abuse Prevention 

COPCOP Waiver Money Follows the Person Demonstration, CIP IICIP II Community Relocation, CIP IBCIP IA 

Brain Injury Waiver 

CT Homecare Program for Elders waiver. Acquired brain injury waiver, Personal Care Assistance waiver, Dept. of 

Developmental Disabilities individual and family supports waiver, Dept. of Developmental Disabilities 

Comprehensive waiver, Katie Beckett Waiver, WISE waiver through Dept. of Mental Health and Addiction 

Services, CT Homecare Program for Elders (state funded portion)CT Homecare Program for Disabled Adults (state 

funded (only 50 slots statewide), Alzheimer's Respite Program (state funded)National family Caregiver Support 

Program (Title III E) 

Data is not shared with AAA/ADRC 

Developmental Disabilities Services Program 

Do not have access to this information 

Due to the complexity in pulling this data from MMIS- managers have asked us to not make this request of the 

limited staff with this skill set. 

ED Waiver 

ED Waiver Alabama Cares 

ED Waiver HIV Waiver Alabama Cares/Caregiver Support Program Senior Companion Homemaker Services 

Home Delivered Meals 

ED Waivers- Homemaker Services; Alabama Cares/Caregiver Support Program; Home Delivered Meals; 

EBD Wavier (age18-64)- EBD (age 65+)- DD- supportive living services- Brain Injury- LTC Medicaid 

EDCD Waiver Medicaid Non-emergency Medical Transportation Home delivered Meals Non=Medicaid Personal 

Care Services Non-Medicaid Homemaker Services Non-Medicaid Respite Care Transportation Assistance 

Elderly Disabled Medicaid Waiver530 Medicaid Waiver 

Elderly and Persons with Disability Waiver and Medicaid 

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42. Please list LTSS programs and HCBS waivers (e.g. aged and disabled, MR/DD) that individuals are 

enrolled in. 

elderly waiver 

Elderly Waiver Ill and Handicap Waiver Brain Injury HIV/AIDS Physical Disability Long Term Care Insurance 

Medicare, Medicare Part D, Medicare Savings Program, Other, NOTE: This agency is not able to track all the data 

asked for above. This is a State program and this agency is not privy to other agency information. 

Family Care and IRIS 

Family Care- Family Care Partnership- PACE and IRIS 

Family Care- IRIS 

Family Care- IRISFamily care- IRIS- Partnership- SSI Managed care 

Family Care MCO – Northern Bridges Self Directed Supports - IRIS 

Family Care- PACE- Partnership- IRIS 

Family Care- Partnership and IRIS 

Family Care- Partnership and IRIS 

Family Care serving aged- physically disabled and developmentally disabled IRIS waiver serving aged- physically 

disabled and developmentally disabled 

Family Care -Western Wisconsin Cares Managed Care Organization IRIS (Include Respect I Self Direct) Self 

Directed Supports Waiver Alzheimer's and Family Caregivers 

Family Care/IRIS 

Family Care, Family Care Partnership IRIS 

Family Caregiver Support Program Memory Care and Wellness Services RDA DChronic Disease SelfManagement Care Transitions Lifespan Respite Kinship Caregivers Reverse Mortgage Counseling Military 

Services Navigator Title XIX Case Management Medicaid Personal Care 

Family Care IRIS 

Family Care IRIS 

Family Care IRIS 

Family Care IRIS 

Family Care IRIS 

Family Care IRIS (Include Respect I Self Direct)Medicaid Card Services 

Family Care Partnership IRIS 

Family Care Partnership IRIS - Self-directed support 

Family Care Partnership IRISPACESAIL 

Family Care- Partnership- IRIS- National Family Caregiver Support Program- Alzheimer Family Caregiver 

Support Program- Supportive Home Care 

FE- TBI- PD 

FEW; SHC; ECOP; Choices; Options counseling; Transitions Coaching; AFC; GAFC; PCA 

Food stamps ANDOAP Medicare Savings Program Medicaid Home Care Allowance EBD Waiver CMHS Waiver 

LEAP Housing Applications CSBG Low Income Subsidies- Medicare Social Security Rent- heat and rebate 

for question 41 and 43: KDADS will send the information to Lewin directly. 

Frail Elder Waiver; Money Follows the Person 

Frail Elder Waiver Money Follows the Person Waiver 

Frail Elder Waiver Program for All Inclusive Care of the Elderly Senior Care options PCA program State 

Homecare program Adult Family Care Group Adult Foster Care 

Frail Elderly Physically Disabled Traumatic Brain Injury ID/DD Autism Senior Care Act Older Americans Act 

Global Options 

Global Options (GO)- Statewide Respite (SWR)- Jersey Assistance for Community Caregivers (JACC)-

Homemaker Program 

Global Options and JACC (Jersey Assistance Community Caregiving) 

Global Options and JACC program. To further explain question # 41:Over last 6 months :Per month (25 GO nonAL)Per month (8 GO-AL)Per month (3 JACC) 

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42. Please list LTSS programs and HCBS waivers (e.g. aged and disabled, MR/DD) that individuals are 

enrolled in. 

Global Options for Long Term Care Jersey Assistance for Long Term Care 

GLOBAL OPTIONSJACCASSISTED LIVING 

Global Options Meals on Wheels Congregate Nutrition Program Legal Services Skyland’s Ride Assisted 

Transportation Home Health Services Health Prevention Services 

Go - Global Options Waiver JACC SRP Statewide Respite Program 

GOJACCPACEMFP Congregate Housing Statewide Respite 

Hawkeye Valley AAA ADRC Options Counselors assist clients in applying for Medicaid or the home and 

community based waiver programs. Options Counselors do not make financial eligibility determination for any of 

the public assistance programs. The waiver programs can take 1 month to 18 months for a person to be approved 

and is determined at the state Department of Human Services. The local ADRC does not have the ability to capture 

all current enrollment levels outside of the ADRC and Section Q. This is a state system and not determined on the 

local level. 

HCBS - Brain Injury HCBS - EBDHCBS - CMHS (Mental Illness)HCBS – AIDS Long Term Home Health Only 

HCA Adult Foster Care CDASS 

HCBS – In home Services HCBS - EHRS Services HCBS - Adult Day Services HCBS - Personal Assistant 

Program Medicare Part DLISMSPMFPVIP Caregiver Support 

HCBS Medicaid Waivers include: Community Care Services Program Medicaid Waiver Source Medicaid Waiver 

Independent Care Medicaid Waiver New Options Waiver Comprehensive Waiver Georgia Assistance Pediatric 

Program Waiver LTSS programs include: Case Management Congregate Meals Home-Delivered Meals 

Homemaker Services Caregiver Material Aid Personal Care Services In-home Respite Care Services*These 

services are funded through the Older Americans Act and State of Georgia funding. 

HCBS Medicaid Waivers including: Aging- Independence- Attendant Care- Act 150- autism-etc. Also includes 

consumers served through Lottery dollars. 

HCBS waiver (aged and disabled)Nursing Facility Long Term Care. We do carry the Medicaid case for clients who 

are enrolled with DD services however we do not do the service portion and do not have the numbers of those 

clients. 

HCBS Waiver: Global Options- the # listed is only for those cases managed at the Middlesex County Office of 

Aging Disabled Services. (There are multiple agencies that do case management for Middlesex County GO clientsnot tracked by this office.)Institutional Medicaid: Not tracked by this office. LTSS Programs: MCMAP- JACCStatewide Respite Program 

HCBS waiver, Michelle p waiver supports for community, living waiver , acquired brain injury waiver, brain 

injury trust program, personal care attendant program, KY Homecare Program Title III services, KY Grandparent 

Program ,KY Adult Day Program. Note for question 41: # of referrals is for NKADD/AAAIL only through the 

CDO program. It is unknown how many referrals are made to traditional providers in the NKY service area. 

HCBS Waivers include Aged and Disabled and Traumatic Brain Injury. Other public LTSS programs include 

CHOICE- local grants- SSBG- TITLE-3- TITLE-3D- TITLE-3E- United Way 

HCBS Waivers include: MR/DD (DD Basic- Basic Plus- Core and Community Protection) Waivers; 1915(c) 

waivers including Community Options Program Entry System (COPES); Medically Needy Residential Waiver 

(MNRW); Medically Needy In Home Waiver (MNIW); and Medicaid State Plan 1915i.Other public LTSS 

programs include: HCBS; Family Caregiver Support Respite Services; OAA/State-Funded Case Management; 

Medicaid Personal Care; Managed Care LTSS; Money Follows the Person (RCL); Washington Roads (StateFunded MFP); Private Duty Nursing; State-funded bed hold; and State-only-funded Adult Day Health- Chore- and 

Adult Family Home. Institutional: Nursing Facilities and Residential Habilitation Centers (RHC=ICF/MRs). 

HCBS-BI- HCBS-CMHS- HCBS-PLWA- HCBS-EBD- HCBS-SCI- HCBS-SLS- HCBS-DD- Supported Living 

Services- EBD- PACE- CDASS- HCA 

HCBS-CES- HCBS-CHCBS- HCBS-DD- HCBS-EBD- HCBS-CMHS- HCBS-SLS- HCBS-BI- HCBS-PLWAPCBS-PHW- HCBS-CDCE- HCBS-CWA- HCBS-CLLI 

HCBS-EBDHCBS-MIHCBS-BIHCBS-PLWA 

Home and Community Based Services Texas Home Living Program 

Home and Community Based Waiver Consumer Directed Option Michelle P Waiver, Consumer Directed Option, 

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42. Please list LTSS programs and HCBS waivers (e.g. aged and disabled, MR/DD) that individuals are 

enrolled in. 

Supports for Community Living Consumer Directed Option acquired Brain Injury LTC Consumer Directed Option, 

Kentucky Transitions Waiver 

Home and Community Based Waiver- Supports for Community Living Waiver- Michelle P Waiver- Money 

Follows the Person/Kentucky Transitions- Kentucky State Homecare Program- Adult Day Care- Title III 

Supportive Services- Title III Congregate Meals- Title III Home Delivered Meals- Title III Preventive HealthKentucky Family Caregiver Program- National Family Caregiver Support Program- Senior Community Services 

Employment Program (SCEP)- State Health Insurance Assistance Program (SHIP)- Nursing Home Ombudsman 

Agency. Enrollment numbers only include clients served by BGAAIL- no other providers (except for average 

number of individuals enrolled in Medicaid residing in institutions). 

Home Care Allowance HCBS-EBDCDAS Plus HCBSHCBS MILTHHPHW Eleven Nursing Facilities Fifteen 

Assisted Living Facilities 

Home Community Based Care- Elderly Chronic Ill (ECI)---Public name: Choices for Independence 

Home health aide, meals, case management personal response system supplies SME/DME 

Homemaker Title XXHCBS Waiver (ADSD)PASS Homemaker program (WCSS)Representative Payee Home 

Delivered Meals Case Management Lifespan (respite)Medication Management Visiting Nurse HCBS Waiver for 

People with Disabilities (WIN)Energy Assistance Group Home Waiver (ADSD) 

In Home Aid Service- Senior Care- Living at Home Waiver- Older Adults Waiver and Medical Assistance Personal 

Care Program 

In Illinois there are the following programs: Medicaid Waiver for DD population Medicaid Waiver for 60 years of 

age and older Medicaid Waiver for people with disabilities. Medicaid Waiver for Medically Fragile/Tech 

Dependent Children Medicaid Waiver Program children with DD support Medicaid Waiver Program for children 

with DD residential Medicaid Waiver for Persons with Brain Injury Supportive Living Facility waiver Cash 

Counseling Program - this is not in our area limited areas in IL Money Follows the Person Choices for Care -

assisting people before discharge from a hospital with their HCBLTSS and their institutional options Institutional: 

ICFICF/MR Inpatient Psych. Service for individuals under age 21Services for individuals 65 and older in an 

institution for mental illness, Skilled Care Nursing Facilities 

Include- Respect- I Self-Direct (IRIS)Family Care Community Options Program Medicaid 

INCOG AAA/ADRC assists with Medicare "e; D"e; enrollments and State Health Insurance Assistance 

Program (SHIP) counseling. In Oklahoma- individuals still need to contact the individual service providers for 

almost every enrollment option. 

Independence Waiver; Attendant Care Waiver; PDA Waiver; EPSDT Waiver. Drug Alcohol Programs.30 

Independence Waiver, Obra Waiver, CommCare WaiverAct150, Attendant Care Waiver, Aging Waiver, Options 

Program, LIFE Program, Dom Care Nursing Home Transition Program ,Family Caregiver Support Program 

Independence Waiver, OBRA Waiver, CommCare Waiver, Over 60 Waiver, HIVACT 150AutismEPSDTAttendant 

Care Lawrence County provides multiple different types of waivers. We provide most of the waivers that the state 

of PA offer. 

Individuals in our area can be enrolled in several different LTSS programs/HCBS Waivers including- CBA- HCSCLASS- DBMD- MDCP- TxHmL- and CAS. 

Kansas Department of Aging and Disability services will provide state-wide numbers directly to Lewin. 

KDADS will send the information to Lewin directly 

LIFE-Program for All-Inclusive Care for the Elderly-2 per month Penn Care / Aging Block Grant- Options and 

Family Caregiver Support programs- 2 per month 

Living At Home Waiver, Older Adult Waiver, Medical Day Care Waiver, Senior Care 

LTSS- Lighthouse- FAIR and Medicaid Personal Care Programs HCBS- I/DD Waiver- Aged Disabled Waiver 

Program- TBI Waiver Program, Current wait lists are present for FAIR and Lighthouse Programs. The Aged 

Disabled Waiver Program started managed enrollment on December 5- 2011. 

LTSS- Lighthouse- FAIR and Medicaid Personal Care Programs HCBS- I/DD Waiver- Aged Disabled Waiver 

Program- TBI Waiver Program, Current wait lists are present for FAIR and Lighthouse Programs. The Aged 

Disabled Waiver Program started managed enrollment on December 5- 2011. 

LTSS- Lighthouse- FAIR and Medicaid Personal Care Programs HCBS- I/DD Waiver- Aged Disabled Waiver 

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42. Please list LTSS programs and HCBS waivers (e.g. aged and disabled, MR/DD) that individuals are 

enrolled in. 

Program- TBI Waiver Program, Current wait lists are present for FAIR and Lighthouse Programs. The Aged 

Disabled Waiver Program started managed enrollment on December 2- 2011. 

LTSS- Lighthouse- FAIR and Medicaid Personal Care Programs HCBS- I/DD Waiver- Aged Disabled Waiver 

Programs- TBI Waiver, Current wait lists are present for FAIR and Lighthouse Programs. The Aged and Disabled 

Waiver Program started managed enrollment on December 5- 2011. 

LTSS- Lighthouse- FAIR and Medicaid Personal Care Programs HCBS- I/DD Waiver- Aged Disabled WaiverTBI Waiver Program, Current wait lists are present for FAIR and Lighthouse Programs. The Aged Disabled 

Waiver Program started managed enrollment on December 5- 2011. 

LTSS: Older Americans Act Social Service Block Grant CHOICE - state funded program HCBS Waivers: Aged 

and Disabled Traumatic Brain Injury. Does NOT include the MR/DD waivers. We do not have access to that 

information. We also cannot access the number of Medicaid funded individuals in institutions- so that is blank. 

MAABD- COPE- CHIP- Congregate Meals- Housing- Medicaid- Medicare Savings Program (MSP)- Low Income 

Subsidy (LIS)- SNAP/Food Stamps 

Mass Health MA PCA program, subsidized housing congregate housing, peer support groups, individual skills 

training, peer counseling, ADA Para transit or COA rides Meals on Wheels, ABI waiver, ATLPHMLPSSAPVR 

program, IL program, Options program 

Maui County Office on Aging does not serve individuals in public LTSS Program enrollments such as aged and 

disabled and MR/DD. 

Medicaid - Quest Expanded Access for Aged Blind and Disabled Kupuna Care Title III Programs 

Medicaid (general)Denali Kid Care Medicaid Waiver: Alaskans Living Independently (ALI): Adults w/Physical 

Disabilities (APDD) and Older Alaskans (OA)Medicaid Waiver: Children w/Complex Medical Conditions 

(CCMC)Medicaid Waiver: Intellectual and Developmental Disabilities (IDD)LTC (Nursing Home) Medicaid Adult 

Public Assistance (APA)Temporary Assistance Program General Relief Assistance (GRA)Chronic and Acute 

Medical Assistance (CAMA)Personal Care Attendant (Agency-based and Consumer Directed)Food Stamps State of 

Alaska Senior Benefits Nutrition and Transportation Services (Meals on Wheels- Care-a-van)Medicare Savings 

Program (QYMBY/SLMBY)E-mods TEFRA Senior In-home Services National Family Caregiver Support 

Program Adult Day Services Nursing Facility Transition Program Qualifying Income Trusts*Please note MiCIL 

(SAIL's data base) collects # of Medicaid recipients- not specifically # of waivers (question 41) 

Medicaid 1115 waiver LTSS includes Medicaid and OAA 

Medicaid 1115 waiver LTSS includes OAA Title III and Medicaid 

Medicaid 1115 waiver OAA Title III 

Medicaid 1115OAA Title III 

Medicaid 1115OAA Title III 

Medicaid 36Low-Income Subsidy 80Medicare Part D 259Food Stamps 57Parish Councils on Aging Serives 

177Foster Grandparent Program 86Plus more 

Medicaid Aged and Disabled Waiver TBI Waiver CHOICE SSBG Title III Title III-E 

Medicaid Elderly Disabled Waiver program. Medicaid HIV/AIDS Waiver program. SenioRx: Partnership for 

Medication Access program. State Health Insurance Assistance Program (SHIP).Alabama Cares program. Aspiring 

Senior Adult Program. Meals on Wheels program. Senior Center program. 

Medicaid Personal Care Adult Daycare 

Medicaid Personal Care COPES Family Caregiver Support Program (Respite and house-keeping and errands) 

Medicaid Waiver for Older Adults; Senior Care; Subsidy; Senior Inclusion Program; Caregiver Support. 

Medicaid Waiver for Older Adults Senior Care Senior Assisted Living Group Home Subsidy 

Medicaid waiver of Louisiana 

Medicaid Waiver- Under and Over 60 programs, Private Duty Nursing programs under and over 60Home and 

Community Based Services Program, Independent Housing Service Program for over and under 60 

Medicaid waiver, Elderly and Disability waiver 

Medicaid OAASCSAFCSP Nutrition Transportation 

Medical Alert systems, Home delivered meals, Congregate meals, Homemaker services, Life Coach 

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42. Please list LTSS programs and HCBS waivers (e.g. aged and disabled, MR/DD) that individuals are 

enrolled in. 

Mental Retardation/New Options Wavier ----Community Care Services 734----SOURCE 1118--ICWP--SOURCE 

Case Management--1163Comm Habilitation/Compup Sup 449 

MI Choice Waiver, Care Management Case Coordination and Support 

MI Choice Waiver, HAB Support Waiver, Nursing Facilities, CMH Waivers 

Money follows the person, Veterans Home Community Based CDSMPCT Home Care Program for Elders, 

Personal Care Assistant waiver, Traumatic Brain Waiver, Medicaid CT Money School Statewide Respite Program, 

National Family Caregiver Support Program COSTARR (care transitions) 

MW AND ALW 

N/A 

N/A 

Need to obtain information from Massachusetts Office of Long Term Care in Medicaid. 

New Choices- Aging- Physical Disability- ABI- Community Supports 

New Choices- Aging- Physical Disability- ABI- Community Supports 

New Choices- Aging- Physical Disability- ABI- Community Supports 

New Choices Waiver- Aging Waiver- Home Community Based Alternative- National Caregiver Support Program 

NF waiver- DD waiver- HIV waiver- IHSS- home delivered meals- case management 

NF/AH 

NHTD waiver, TBI waiver, Medicaid SNAPHEAP Home delivered meals, Caregiver respite EISEP Medical day 

care Social day care Medicare Savings Program 

NJ - Global Options for Long Term Care (Medicaid HCBS Waiver) NJ - Jersey Assistance to Community 

Caregiving OAA - Home Delivered Meals OAA - Housekeeping 

NOWCOMP 

Nursing facility waiver, IHSSMSSP Average monthly enrollment numbers for IHSS clients and individuals in 

Medicaid residing in institutions is not available. AIS implemented a new State system (CMIPS II) in September 

2012. IHSS data is in new system 

Nursing Home Transition Diversion Waiver ,Traumatic Brain Injury Waiver, Medicaid Personal Care 

OAA funded services - Home Delivered Meals- Respite- Congregate Meals- Adult Day Health- Homemaker 

AssistanceCCSP (ABD)- ICWP- COMP/NOW (DD)- SOURCE (SSI/ABD); GAPP (Pediatric) 

OAA Title IIIB- C and eState funded Options for Community Living HCBS Medicaid Waiver for the Elderly 

Older Adult Waiver 

Older Adult Waiver/Money Follows the Person Senior Care Guardianship Group Subsidy Housing Medical 

Assistance Personal Care 

Older Adult Waiver Living at Home 

Older Adult Waiver Medical Daycare Waiver Community Pathways Waiver Living At Home Waiver Medical 

Assistance Personal Care In near future: Options Counseling with Center for Independent Living Live Well 

Nutrition Program Living With Chronic Pain Program Living With Diabetes Program Healthy Fitness Center 

Community Transit Cecil County Senior Center Home Delivered Meals Assisted Living – Subsidy Caregiver 

Support Program SHIP - State Health Insurance Program SMP - Senior Medicare PatrolI A - Information and 

Assistance MAP - New Maryland Access Point - 2012-2013 

Older Adult Waiver Senior Care Medicaid Medicare QMB/SLMB Living at Home Waiver? 

Older Adults Waiver Day Habilitation/DD 

Older Adults Waiver, Senior Care Home Delivered Meals Assisted Living Subsidy, In-Home Aide Services, 

Information Assistance, Health Promotion (Educational Programs) 

Older Adults Waiver, The total of 59 is broken down to 38 residing in an Assisted Living Facility and 21 residing 

in their home. 

Older American’s Act programs: Homemaker Home-delivered meals Congregate meals Caregiver Support Respite 

Personal support services _______________________________HCBS Waivers1. CCSP-Community Care 

Services Program-elderly and/or functionally impaired or have disabilities.2. SOURCE-Service Options Using 

Resources in Community Environment-primary enhanced case management under elderly and disabled waiver. 

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42. Please list LTSS programs and HCBS waivers (e.g. aged and disabled, MR/DD) that individuals are 

enrolled in. 

Serves blind- aged- disabled who are SSI eligible. 3. ICWP-Independent Care Waiver Program-for Medicaid 

recipients who have severe physical disabilities- are between the ages of 21-64. 4. NOW-New Options Waiver and 

COMP-Comprehensive Supports Waiver Program-for people who have developmental or intellectual disabilities. 5. 

GAPP-Georgia Pediatric Program--specialized skilled nursing services to medically fragile members with a current 

Individualized Family Service Plan- age birth to 3 years of age. 6. MFP-Money Follows the Person-helps people 

living in nursing homes and ICF-MR facilities to transition and resettle in to a community setting. 

OPTIONS Family Caregiver Program Care Management 

Our members are enrolled in NOW/COMP waiver programs. 

Our service area remains under the old waiver system. I do not have current consolidated data on client numbers for 

this question but would anticipate having it for future surveys 

PA HCBS Medicaid Waivers, (physical disabilities- developmental disabilties- autism- aging- etc.)PA Lotteryfunded services, Private pay services 

PACE- EDCD. We do not have access to the number who are enrolled each month in the EDCD program. ALL 

Care for Seniors (PACE program at AASC) averages enrolling 1 to 2 per month. 

PAS Program- CHIP Waiver- Respite Care 

Passport and ALW 

PASSPORT HCBS Waiver, Assisted Living HCBS Waiver Caregiver Support Comcare Senior Community 

Services Block Grant 

PASSPORT Home and Community Based Waiver - aged and disabled Assisted Living Waiver Program, Choices 

Waiver Program, Caregiver Support Program, Community Service Block Grant, Older American Act Funded 

Programs 

PASSPORT Waiver – aged Assisted Living Waiver - aged and disabled, Choices Waiver – aged Senior Options 

Program, (aged- non-Medicaid) - 5000Senior Choices Program (aged- non-Medicaid) - 500 

PASSPORT Waiver--Numbers included above Assisted Living Waiver--Numbers included above Ohio Home Care 

Waiver--Numbers included above Care Coordination Program--not able to include numbers Local Levy Programs--

-not able to include numbers 

PDA- ACW- CSPPPD- ODP- Private Pay- Options Program- Home Delivered Meals- Family Caregiver SupportMedicare- Medicare PTt D- LIS – Extra help- MSP's thry DPW 

PDA Waiver Aging Block Grant Services, Independence OBRA Waivers, CommCare Attendant Care Waiver, Act 

150 Program, Adult Autism Waiver and Nursing Home Transition 

PDA Waiver- Independence Waiver- CommCare Waiver, - Attendant Care Waiver- OBRA Waiver- OptionsFamily Caregiver Support Program 

PDA waiver, Attendant CareCommCare Independence Act 150Consolidated Waiver for Individuals with 

Intellectual Disabilities, Infant- Roddlers and Families Waiver, Person/Family Directed Support Waiver, Options 

Program funded by the state department of aging 

PDA Waiver, Options Care Management Guardianship Family Caregiver Support Obra Waiver Independence 

Waiver MA Waiver- Over 60Comm Care Waiver, Act 150Act 150/Over 60/PFDS Waiver/Consolidated Waiver 

Personal Care Adult Day Health care Transition Coordination 

Physical Disabilities Wavier New Choices Wavier, Traumatic Brain Injury Wavier, Tech Support Wavier, MR/DD 

Wavier 

Please note- these are tracked by the Monroe County Department of Human Services Financial Assistance Division 

and data could not be pulled in the way the question was answered therefore entering data would skew total 

outcome of what you are requesting. Please contact Julie Allen Aldrich- Director- Monroe County Office for the 

Aging to discuss how/what information can be pulled from other agencies not under the ADRC in our community. 

Prior to submission of this report- I made several attempts to reach technical assistance for this report to try and 

identify how best to capture what we do and what is done in our community but separate and apart from our ADRC 

and NY Connects Program. Where we partner- monitor and collaborate- we do not own all of the data requestednor is it tracked in the way requested. LTSS Programs and HCBS waivers for Monroe County include: Personal 

Care Assistance- Consumer Directed Personal Care Assistance- Chronic Care Medicaid (Nursing Home Services)-

Traumatic Brain Injury (TBI Waiver). 

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42. Please list LTSS programs and HCBS waivers (e.g. aged and disabled, MR/DD) that individuals are 

enrolled in. 

Public LTSS: Home Care Allowance- Adult Foster Care HCBS: SLS- DD- EBD- CMH- PLWA- Children’s

Question 41: KDADS will send this information directly to Lewin Group Question 42:HCBS-FEHCBS-PDHCBSTBISenior Care Act-Kansas State funded Older Americans Act-Federal funded 

reflects only WOA 

Senior Care IHAS Respite IIIB IIIE Pathways Attendant Care MAPC Older Adult Waiver Living at Home Waiver 

DD Waiver 

Southwest Family Care Alliance IRIS 

SSBG- CHOICE- TIII- TIIIE- AD WAIVER AND TBI WAIVER 

SSI/SSDI Eligibility HIRSP Medicare Supplement MAPP Medicare Advantage Plans Medicare Coverage Medicare 

Part DQMB/SLMB/SLMB +Title III-C Home-Delivered Meals Title III-C-Congregate Dining Program Title III-B 

Vounteer Driver Program Family Care IRIS Alzheimer's Family Caregiver Support Program National Family 

Caregiver Support Program 

STAR+PLUS and Community Based Alternatives for adults with physical disabilities Home and Community 

Services for persons with intellectual and developmental disabilities Community Living Assistance and Support 

Services for persons with intellectual and developmental disabilities Deaf/Blind/Multiple Disabilities Medically 

Dependent Children's Program 

State funded Medicaid services- Home health Care Services- visiting nurse- meals- transportation- adult day careetc. 

State LTSS Services include Nutrition (Meals and Nutritional Supplements)- Personal Care- Nursing ServicesHomemaker Services- Assistive Devices- Emergency Response System- Specialized Medical Supplies- Specialized 

Medical Equipment- Tele health- Caregiver Services (Respite)- Adult Day Services. Elderly (Aged and Disabled) 

HCBS Waiver. 

State Medicaid Waiver Programs - PASSPORT and Assisted Living Waiver Programs County Levy Programs 

Statistics regarding the average number of individuals enrolled in Medicaid HCBS Waivers includes only the Aged 

Disabled Adult Waiver for adults age 60-64 with a disability and adults age 65+ and the Assisted Living Waiver for 

adults age 60-64 with a disability and adults age 65+.There are a total of 17 Waivers in the state of Florida- but 

these are the two at the ADRC. Note: Individuals counted here as enrolled in LTSS represent only some of the 

funding sources listed in question 74. Individuals served in other funding sources- including non-registered 

services- are not included in this count. 

TBI- ABI (2)- DDS (3)- MFP (No enrollees)- Frail Elder 

TBINHTDW Care at Home Long Term Home Health Care Program 

The above data is not collected by ILC. However HCBS waivers include; IDD- Children with Complex Medical 

Needs- Adults with Physical Disabilities- Older Alaskans. LTSS programs include Medicaid- Public AssistanceNutrition- Transportation- housing modifications- assistive technology- Social Security- Medicare- Family 

Caregiver Support- other support/peer groups. 

The Carbon County LINK was just recently started in the past seven months. I tried to retrieve this information- but 

did not receive answers from the agencies I requested. 

The database doesn't track this type of information 

The following State Home Care Programs - Frail Elder Waiver; Spousal Waiver; and Standard Mass Health Home 

and Community Based Waiver 

the Municipality does not track this information; is tracked by State of Alaska for each region. do not have access 

to this level of information locally. 

The questions above are programs not administered by Area VIII but rather by a Medical Corporation. 

Furthermore- each institution is administered by a corporation. There is no ay to a certain the exact numbers unless 

I secure them from the Montana Department of Public Health Human Services who may be compiling this 

information for both waiver and office of public assistance. 

These are numbers comprised of Medicaid HCBS waivers- average of residents enrolled in Medicaid residing in 

institutions- and home delivered meals- ERS- day activity health services- aged and disabled- MR/DD. The 400 

number only includes unit 55 and not the other service areas. 

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42. Please list LTSS programs and HCBS waivers (e.g. aged and disabled, MR/DD) that individuals are 

enrolled in. 

This data is not maintained at the local level. This data can be provided by the Texas Department of Aging 

Disability Services 

This information is not available at the local level. 

This information is not currently available to Passaic County ADRC. 

Through the LCA on average 4 individuals apply for Money Follows the Person a month. However- the real answer 

to these questions is that data is unknown. We are the connector do not have access to all of this data as we do not 

have a uniform reporting tool. Although we partner with local DSS's we still find some resistance in the notion that 

we will report all agency numbers for CRC totals. They believe we should only utilize the small amount of data 

obtained in the CRC tracking tool that is used by CRC partners in Mecklenburg and Cabarrus. Therefore- we don't 

have access to the numbers from DSS regarding enrollment in Medicaid and Medicaid Waiver CAP services. The 

only number we as the CRC can report regarding waiver services are those referred to the Money Follows the 

Person Program through the Local Contact Agency. Also- regarding questions about Care Transitions that begin at 

number 27-Our CRC is in the middle of a Care Transitions Project. We have not yet had to opportunity to compile 

data and assess the results. That is why the information was not available about the consumers served. Once the 

project is completed this information will be compiled and analyzed. Regarding question 14-The Centralina 

Regional CRC does not have a uniform electronic referral and reporting system. That makes compiling these 

reports particularly challenging. The total number we were able to obtain according to documentation of contacts 

was 6-336. However- we know this is just a fraction of the number of people actually served by the Centralina 

CRC. Due to differing reporting systems which collect differing information about clients many of these questions 

are unknown about those contacts - such as how many were over or under 60 and how many have disabilities. The 

reports we utilized included ODIS- the ombudsmen reporting system- ARMS I&A reports (which only include 

number of contacts)- programatic reports which show number of individuals served but not any demographics- etc. 

If there was an investment on a uniform referral and reporting system we would be able to provide these numbers 

and valuable data that is being requested. However at this time- due to differing reporting systems collecting a 

myriad of varying information this information in unavailable and not able to be compiled and reported. Man 

Traditional Older Americans Act Programs (Supportive Services- Nutritional Service- National Family Caregiver 

Support Program)Locally Funded Programs Title XX Funded Programs Alzheimer's Respite Funded Programs 

Senior Farmer's Market Nutrition Program Community Service Block Grant Funded Programs 

Unable 

Unable to provide numbers for all Medicaid HCBS Waiver enrollment for the entire PSA as we do not have access 

to this data... would include Channeling- Nursing Home Diversion- Aged and Disabled Adult- Assisted LivingBrain Spinal Cord Injury- PAC- Ryan White- and others. Unable to provide number of clients enrolled in Medicaid 

funded institutions .Unable to provide comprehensive numbers of all local programs for LTSS delivery in the PSA. 

Unavailable 

Unavailable data. Hawaii State Dept. of Human Services- MEDQUEST Division is the Medicaid agency on Kauai 

and has the information you are requesting. We do not have access to this information. 

unavailable information 

Under 60 Waivers- ODP Waivers- Aging Waiver 

Unknown 

Waiver for Older Adults WOA Living at Home Waiver LAH Medical Adult Day Care Waiver Senior Care 

MAPCSPIHAS 

Waivers include HCBS-BI- HCBS-EBD- HCBS-CMHS- HCBS-PLWA- HCBS-CLLI- HCBS-SCI- and the subcategories under them 

WAIVERS include the older adult waiver- the living at home waiver and the DDA waivers. The average numbers 

of institutions is numbers at the the three nursing homes that are located in Garrett County. The average number of 

individuals enrolled in other lTSS programs in Garrett County include TCA- Foster Care- Age Blind Disabled- SSIMedicare- SLIMB- Pregnant MCHIP- MCHIP and Baltimore Approved Waiver Clients. All of these individuals 

received Medical Assistance. Also- 22% of medical assistance is our physicians business here in Garrett County. 

Waivers: EDCD Personal Care; ECCD Adult Day Health Care; LTSS: Personal Care; Adult Day Health Care; 

Home Delivered Meals; Congregate Meals; Mental Health: Money Management; Guardianship; Nursing Case 

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42. Please list LTSS programs and HCBS waivers (e.g. aged and disabled, MR/DD) that individuals are 

enrolled in. 

Management. Our local Medicaid Office does not have access to information that would indicate how many 

Medicaid recipients live in residential settings (e.g.- nursing homes) vs how many receive community based 

waivers. Only the state has access to that information by locality. 

Waivers: Aged Disabled- Traumatic Brain Injury, CHOICE (Indiana funding)Title IIIC- Title IIIE- and SSBG 

Waivers, Core Community Svc DEA Assisted Living, DEA Community Svc Hab Community Svc Hab Group 

Home Intellectual Disability Preventative Community Svc RI Housing Assisted Living Self Directed Svc Shared 

Living Other LTSS Programs Group Homes ICF/MR Private ICF/MR Public RICLAS Severely Disabled Nursing 

Home care PACE Connect Care Choice. 

We are a small site and have just gotten our ADRC off a running in the last 6 months. 

We are not a CCU and do not have immediate access to the requested information 

We are unable to gather this information. We have requested this data from the local Medicaid Eligibility Office 

and have yet to receive approval. 

We do not enroll in Waivers 

We do not have access to the total number of waiver clients in Baltimore County. Waivers include OAW- LAHTBI- New Directions- Autism Waiver- Model Waiver- Medical Day Care Waiver and Residential Treatment Center 

Waiver. 

We do not have access to this information. It is monitored and regulated by the regional health departments and 

departments of social services. 

We do not keep record of this. 

We do not provide the above services. These programs are provided by Idaho Health and Welfare Medicaid 

services. 

We do not track all the info requested above for monthly reports. Aged and Disabled Waiver program IDD waiver 

program TBI waiver program Medicaid personal care program 

We do not track all the info requested above for monthly reports. Aged and Disabled Waiver program IDD Waiver 

program Traumatic Brain injury waiver Medicaid personal care program 

We do not track this at the local ADRC level. 

We do not track this information. 

We were unable to access current data for our area. All statistics available we for the calendar year 2012 only. 

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44. PUBLIC PROGRAMS, please list LTSS program 

1. CCSP-Community Care Services Program-elderly and/or functionally impaired or have disabilities.2. 

SOURCE-Service Options Using Resources in Community Environment-primary enhanced case management 

under elderly and disabled waiver. Serves blind- aged- disabled who are SSI eligible. 3. ICWP-Independent Care 

Waiver Program-for Medicaid recipients who have severe physical disabilities- are between the ages of 21-64. 4. 

NOW-New Options Waiver and COMP-Comprehensive Supports Waiver Program-for people who have 

developmental or intellectual disabilities. 5. MFP-Money Follows the Person-helps people living in nursing homes 

and ICF-MR facilities to transition and resettle in to a community setting. 6. Older American€TMs Act programs 

Homemaker Home-delivered meals Congregate meals Caregiver Support Respite Personal support services 

1915C HCBC Waiver LTSS Programs: Assisted Living Facilities- Residential Care Facilities- Adult Foster 

Homes- Relative Adult Foster Homes- In-home Services 

A reporting tool is not available in our ADRC software to presently extract this information. Likewise- we cannot 

answer Question 43 without a manual tabulation from a review of each client record. 

AD Waiver- HCBS Services 

A.L. Waivers Waiver 

Actual numbers can be obtained from DPW. They track this information. 

Actual numbers should be obtained from DPW. They track this information. 

ADI- ALW- MW- CDC+- HCE- CCE- OA3E- OA3B- OAC1- OAC2- NHD 

ADRC of Southeast Michigan is not currently operational. We are currently in emerging status and anticipate 

beginning to provide; A in Summer- 2013. 

Adult Day Care Care Coordination for Elderly Virginians 1Congregate Nutrition Disease Prevention/Health 

Promotion Elder Abuse Emergency Home Delivered Nutrition Homemaker III-E Adult Day Care - RespiteIII-E 

Homemaker – Respite III-E Individual – Counseling III-E Info Referral/Assistance - AAIII-E Personal Care –

Respite III-E Transportation – AA Information and Referral/Assistance Legal Assistance Local AAA Personal 

Care Transportation 

Adult Day Care, Care Coordination for Elderly Virginians 2CheckingCongregate Nutrition Disease 

Prevention/Health Promotion Elder Abuse Emergency Home Delivered Meals - Fee for Service Home Delivered 

Nutrition Homemaker III-E Homemaker – Respite III-E Info Referral/Assistance - AAIII-E Personal Care -

Respite Information and Referral/Assistance Local AAA Personal Care Respite Homemaker Transportation 

Adult Day Health Adult Foster Care Day Habilitation Durable Medical Equipment/Oxygen Respirator yearly 

Intervention Group Adult Foster Care Home Health Hospice Independent Nursing Orthotics Prosthetics Personal 

Care Attendant Targeted Case Management 

Adult Day Healthcare Personal Care 

AFCCCTPECOP Non Waiver Home Care Non Waiver Family Caregiver Support-Program Home Care Non 

WaiverMFPNapis-T3 meals PCA Respite/Over Income SCO- Fallon- United and CCA 

Aged Disabled 

Aged disabled and Options for Community Living - State Funded LTSS program. ADRC's do not have access to 

newly enrolled into Medicaid institutional services. 

Aged Disabled Waiver Program CHOICE 

Aged Disabled Waiver Choice SSBG Title III 

Aged Disabled Wavier- CHOICE- Older Americans Act- SSBG 

Aged Disabled High/Highest Needs Moderate Needs 

Aged and Disabled 

Aged and Disabled and Traumatic Brain Injury Medicaid Waivers. CHOICETIII programs Social Services Block 

Grant 

Aged and Disabled- MR/DD are both administered through State Medicaid Agency- Delaware Medicaid and 

Medical Assistance (DMMA). ADRC does not track this information. 

Aged and Disabled- TBI 

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44. PUBLIC PROGRAMS, please list LTSS program 

Aged and Disabled- Traumatic Brain Injury- CHOICE- SSBG 

Aged and Disabled Waiver CHOICE in-home Services SSBG in-home Services Title III-family caregiver services 

Aged and Disabled Waiver DD waiver Information and assistance Care Coordination Nutrition Services 

Homemaker Services Personal Care Services Transportation Legal Services Respite Services Health Screenings 

Elder Abuse Prevention Long Term Care Ombudsman Companion Services Caregiver Information- Referral and 

Support Housing Assistance 

Aged and Disabled Waivers and Traumatic Brain Injury Waivers 

aged waiver for Adult Daycare and/or personal care 

Aging- New Choices- Personal Disability Waiver 

Aging Waiver- Independence Waiver- COMMCARE Waiver- Attendant Care Waiver- AIDs Waiver- OBRA 

Waiver- LIFE/PACE/LTCCAP Program- ACT 150 Program. NON Medical Assistance Programs: Aging Block 

Grant Services. 

Alabama Cares Program (National Caregiver Program) Frail Elderly and Disabled Medicaid Waiver Program 

HIV/AIDS Medicaid Waiver Program In-home Services Program Ombudsman Program Residing in institutions is 

unknown. Other Public LTSS Programs is unknown. 

All cluster 1 and 2 services funded with APC dollars including assisted transportation- care management- adult day 

social and medical- MOW- congregate meals- housekeeping/HHA- in-home CG- friendly visitor/telephone 

reassurance- and residential maintenance. The total of unduplicated clients is estimated to be 1-945. 0 Veterans 

were newly enrolled in the VDHCBSP during this reporting period. 56 people were newly enrolled in JACC 

during the reporting period. 

All customers were age 60+ 

Alzheimer€TMs Assisted Living Waiver Day Support Waiver Elderly or Disabled with Consumer Direction 

(EDCD) WaiverHIV/AIDS Waiver Individual and Family Developmental Disabilities Services Waiver 

(IFDDS)Mental Retardation/Intellectual Disability (MR/ID) Waiver Program for All-Inclusive Care for the Elderly 

(PACE)Technology Assisted Waiver 

ASC only refers to HCBS program interest list Texas Department Of Aging Disability Services Medically 

Dependent Children Program (madcap) 4Texas Department Of Aging Disability Services Community Based 

Alternatives Program Star Plus 314Alamo Local Authority For Intellectual And Developmental Disabilities HCS 

and Texas Community Living 55 

Assisted Living Waiver- PASSPORT Home Care Waiver- HOME Choice- Ohio Home Care Waiver 

At this time the ADRC is not tracking this information- but will start to track this information. 

Autism Waiver Service Coordination Individual and Family Support Resource Coordination Respite Care 

Transitioning Youth with Disabilities Medical Assistance Waiver for Older Adults Long Term Care Ombudsman 

Program Adult Evaluation and Review Services Home Care/In Home Aide Services Social Services to Adults 

Senior Nutrition Program Adult Foster Care Unit Adult Public Guardianship Senior Mental Health Program Senior 

Assisted Living Group Home Subsidy 

Bristol enrolls consumers in the frail elder waiver- the state home care program- the personal care attendant 

program- and the elder nutrition program. Bristol also assesses and develops service plans for individuals in senior 

care options programs. 

CAP/DA (Community Alternatives Program for Disabled Adults)NC Innovations Waiver (formerly Community 

Alternatives Program for People with I/DD)CAP-C (Community Alternatives Program for Children)Special 

Assistance Special Assistance-In Home 

Care Coordination for Elderly Virginians 1Care Coordination for Elderly Virginians 2Care Transitions Congregate 

Nutrition Disease Prevention/Health Promotion Emergency Home Delivered Nutrition III-E Adult Day Care –

Respite III-E Info Referral/Assistance - AAIII-E Other - SSIII-E Personal Care – Respite III-E Transportation –

AA Information and Referral/Assistance Local AAA Local Contact Agency MDS 3.0Options Counseling Personal 

Care S. O.S. Referrals S.O.S. Service Implementations Socialization/Recreation Transportation Virginia Insurance 

Counseling and Assistance Program 

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44. PUBLIC PROGRAMS, please list LTSS program 

Case Management; Adult Protective Services- Congregate and Home Delivered Meals; Transportation; Dementia 

Care Specialist- National Family Caregiver Support and Alzheimer's Family Caregivers Support Managed Care 

Programs: Family Care- Partnership and IRIS 

CCSP- HCBSCCSP- SOURCE- ICWP- MR/NEW- Community Habilitation- GAPP Private Duty- GAPP Day Care- Title III 

HCBS Non- Medicaid- HDM- Caregiver- In Home- Nutrition- transportation- case manager. 

CCSP-Community Care Services Program - elderly and/or functionally impaired or have disabilities, MFP - helps 

people living in the nursing homes and ICF-MR facilities to transition and resettle in a community setting Older 

American's Act - homemaker- home-delivered meals- congregate meals- caregiver support- respite- personal 

support services 

CCSP-Community Care Services Program-elderly and/or functionally impaired or have disabilities. SOURCEService Options Using Resources in Community Environment-primary enhanced case management under elderly 

and disabled waiver. Serves blind- aged- disabled who are on SSI. CCSP and SOURCE are combining into one 

waiver program. ICWP-Independent Care Waiver Program-for Medicaid recipients who have severe physical 

disabilities- are between the ages of 21-64.NOW-New Options Waiver and COMP-Comprehensive Supports 

Waiver Program-for people who have developmental or intellectual disabilities. MFP-Money Follows the Personhelps people living in nursing homes and ICF-MR facilities to transition and resettle into a community setting 

CDO Waiver Homecare Services Adult Day Care Services 

CFC - Choices for Care Home and community based Long Term Care Medicaid Waiver Program- offers 

individuals’ choice of setting to receive long term care services - home- another's home- residential care homenursing home - soon to include Adult Family Care homes. Participants have choice of provider agencies or can 

choose to self- or surrogate direct care. VIP - Veteran's Independence program - contract with state VA- AAA's 

and local financial management agency to provide home based services to 30 qualified veteran's in the state. 

Services are self-directed or can use a surrogate or agency to provide the in-home care services. Funds allocated 

can be used to purchase goods and services to help the veteran remain at home. Developmental Disabilities Waiver 

program serves individuals with intellectual limitations. Traumatic Brain Injury Waiver Participant Directed 

Attendant Care service/Attendant Services Program Meals on Wheels/Congregate meals programs Healthy Living 

programs SASH Community Health Teams 

CHOICE and Medicaid Aged and Disabled Waiver and TBI waiver 

CHOICE- SSBG- TIII- HDM- TIIIE 

CHOICES - Tenn Care - Medicaid Waiver Nutrition Programs Homemaker Personal Care Respite National 

Family Caregiver Program Options for Community Living 

CHOICES (aged/disabled) 

Choices for Care Program Please note that we are unable to provide the number of clients newly enrolled in 

institutional services and the total number of clients enrolled in other public LTSS programs. 

Choices for Care: Home Based Enhanced Residential Care Flexible Choices Moderate Needs Group for 

Homemaking 

Choices for Care Traumatic Brain Injury waiver Children’s Personal Care services Choices for Care/Flexible 

Choices Attendant Services Program 

Choices for Independence- Home and Based Care for the Elderly and Chronically Ill 

Choices for Independence Waiver- HCBC-Elderly and Chronically Ill. The above information is not collected at 

the local level: please see state report. 

Choices for Independence Waiver- HCBC-Elderly and Chronically Ill 

Choices for Independence Waiver- HCBC-Elderly and Chronically Ill 

Choices for Independence Waiver- HCBC-Elderly and Chronically Ill 

Choices for Independence Waiver- HCBC-Elderly and Chronically Ill 

choices for Independence waiver HCBC-Elderly Chronically Ill 

Choices for Independence; HCBC -Elderly and Chronically Ill 

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44. PUBLIC PROGRAMS, please list LTSS program 

CHOICES in Long Term Care 

Chore Home Delivered Meals Congregate Meals Transportation Legal Assistance Information Assistance 

Residental Repair and Renovation Caregiver Access Assistance Caregiver Counseling/Support Groups/Caregiver 

Training Caregiver Respite Care CCEVP 2Volunteer Programs Emergency Fee for Service - Home Delivered 

Meals Respite Other Respite Personal Care Care Transitions Intervention Program Ombudsman Guardianship 

Health Information and Educations MP Home Health Personal Care Adult Day Care and Assisted LivingHabilitation Self-Directed Personal Assistance Intellectual Disability (ID) waiver Day Support waiver Individual 

and Family Developmental Disabilities Support waiver (IFDDS waiver)Elderly or Disabled with Consumer 

Direction waiver Technology Assisted (Tech) waiver 

Community Based Alternatives- In Home and Family Support Program- Medicare Savings Program- Extra Help 

Community Care Services Program Waiver Source Waiver SSI only Independent Care Waiver Program NOW -

MR/DDCOMP - MR/DD 

Community Care Services Program Independent Care Waiver Program Mental Retardation/New Options Comm. 

Habilitation/Comp Sup SOURCEGAPP In-home Private Duty Nursing GAPP-Medically Fragile Daycare 

Consolidated Waiver (ID)Person/Family Directed Services Waiver (ID)Attendant Care Waiver (Under 60 Physical 

Disability)Act 150 (Under 60 Physical Disability)Options (60+)Life Programs (55+)Aging Waiver 

(60+)Independence Waiver (Under 60 Physical Disability)COMCARE Waiver (TBI)AIDS Waiver HSDF 

Homemaking Services (18-59) 

Consumer Directed Option/waiver State Funded Homecare Program Adult Day Care Senior Centers National 

Family Caregivers Support Program Ombudsman SHIP Legal Assistance Chronic Disease Self-Management 

programs Elder Abuse Prevention 

COPCOP Waiver Money Follows the Person Demonstration CIP IICIP II Community Relocation CIP IBCIP IA 

Brain Injury Waiver 

CRIAAAAsera Care Hospice VNAMH/ID apprise 

CS Waiver- Aging Waiver- VA programs- Alternative programs. 

CT Homecare Program for Elders (Waiver)CT Homecare Program for Elders (state funded portion)Alzheimer's 

Respite care program National Family Caregiver Support Program Veterans Home and Community Based Service 

Program 

data not available at this time 

Data not shared 

Developmental Disabilities Services Medicaid for Working People with Disabilities 

Exampled Waiver 

ED Waiver Alabama Cares 

EBD age 65+ 

EDCD Waiver Medicaid non-emergency Medical Transportation Home Delivered Meals on-Medicaid Personal 

Care Services on-Medicaid Homemaker Services Transportation Assistance 

Elderly and Persons with Disability Waiver and Medicaid. 

Enroll clients in Aged and Disabled Adult MW and Assisted Living MW. Assist clients with ICP Medicaid 

placement. On Medicaid programs include OAA programs- Community Care for the Elderly- Home Care for the 

Elderly- Alzheimer's Disease Initiative Programs. 

Family Care- Family Care Partnership- PACE and IRIS 

Family Care- IRIS 

Family Care MCO – Northern Bridges Self Directed Supports - IRIS 

Family Care- PACE- Partnership and IRIS 

Family Care- Partnership and IRIS 

Family Care serving aged- physically disabled and developmentally disabled IRIS waiver serving aged- physically 

disabled and developmentally disabled 

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44. PUBLIC PROGRAMS, please list LTSS program 

Family Care -Western Wisconsin Cares Managed Care Organization IRIS (Include Respect I Self Direct) Self 

Directed Supports Waiver Alzheimer’s and Family Caregiver's Support 

Family Care/IRIS 

family care: 930IRIS: 93 

Family Care Family Care Partnership IRIS 

Family Caregiver Support Program Memory Care and Wellness Services RDAD Chronic Disease SelfManagement Care Transitions Lifespan Respite Kinship Caregivers Reverse Mortgage Counseling Military 

Services Navigator Title XIX Case Management Medicaid Personal Care 

Family Care IRIS 

Family Care IRIS 

Family Care IRIS 

Family Care IRIS 

Family Care IRIS (Include Respect I Self Direct) 

Family Care Partnership IRISPACESAIL 

Family Care- Partnership- IRIS- National Family Caregiver Support Program- Alzheimer’s Family Caregiver

Support Program- Supportive Home Care 

FE- TBI- PD 

Food stamps ANDOAP Medicare Savings Program Medicaid Home Care Allowanced Waiver CMHS Waiver 

LEAP Housing Applications CSBG Low Income Subsidies- Medicare Social Security Rent- heat and rebate 

Frail elder waiver 

Frail Elder Waiver; Money Follows the Person 

Frail Elder Waiver State Home Care Group Adult Foster Care Program for All Inclusive Care of the Elderly Senior 

Care Options Money Follows the Person Adult Foster Care PCA program Consumer directed care Enhanced 

Community Options 

Frail Elderly Physically Disabled Traumatic Brain Injury ID/DD Autism, Senior Care Act Older Americans Act 

Global Option (GO)- ACCAP- CRPD 

Global Options and JACC 

Global Options and JACC (Jersey Assistance Community Caregiving) 

Global Options for Long Term Care Jersey Assistance for Community Caregivers 

Global Options- JACC 

GLOBAL OPTIONSJACCASSISTED LIVING 

Global Options Meals on Wheels Congregate Nutrition Program Legal Services Skylands Ride Assisted 

Transportation Home Health Services Health Prevention Services 

GOJACCPACEMFP Congregate Housing Statewide Respite 

Hawkeye Valley AAA ADRC Options Counselors assist clients in applying for Medicaid or the home and 

community based waiver programs. Options Counselors do not make financial eligibility determination for any of 

the public assistance programs. The waiver programs can take 1 month to 18 months for a person to be approved 

and is determined at the state Department of Human Services. The local ADRC does not have the ability to 

capture all current enrollment levels outside of the ADRC and Section Q. This is a state system and not 

determined on the local level. 

HCB CDO Waiver 

HCBS Aging Waiver 500- Illinois Community Care Program. In Home Care Adult Day Services Emergency 

Home Response Money Management Medicare PART d 

HCBS Frail Elderly Waiver HCBS Physically Disabled Waiver HCBS Traumatic Brain Injury waiver Kansas 

Senior Care Act Program Older American's Act numbers for question 43 are unavailable at this time. 

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44. PUBLIC PROGRAMS, please list LTSS program 

HCBS Medicaid Waivers include: Community Care Services Program Medicaid Waiver Source Medicaid Waiver 

Independent Care Medicaid Waiver New Options Waiver Comprehensive Waiver Georgia Assistance Pediatric 

Program Waiver, LTSS programs include: Case Management Congregate Meals Home-Delivered Meals 

Homemaker Services Caregiver Material Aid Personal Care Services In-home Respite Care Services*These 

services are funded through the Older Americans Act and State of Georgia funding. 

HCBS Waiver: Global Options- the # listed is only for those cases managed at the Middlesex County Office of 

Aging Disabled Services. (There are multiple agencies that do case management for Middlesex 

County GO clients- not tracked by this office.)Institutional Medicaid: Not tracked by this office. LTSS Programs: 

MCMAP- JACC- Statewide Respite Program 

hcbs waiver, Michelle p waiver supports for community living waiver acquired brain injury waiver brain injury 

trust program personal care attendant program KY Homecare Program Title III service sky Grandparent Program 

KY Adult Day Program 

HCBS Waivers 

HCBS Waivers include Aged and Disabled and Traumatic Brain Injury. Other public LTSS programs include 

CHOICE- local grants- SSBG- TITLE-3- TITLE-3D- TITLE-3E- United Way 

HCBS Waivers include: MR/DD (DD Basic- Basic Plus- Core and Community Protection) Waivers; 1915(c) 

waivers including Community Options Program Entry System (COPES); Medically Needy Residential Waiver 

(MNRW); Medically Needy In Home Waiver (MNIW); and Medicaid State Plan 1915i.Other public LTSS 

programs include: HCBS; Family Caregiver Support Respite Services; OAA/State-Funded Case Management; 

Medicaid Personal Care; Managed Care LTSS; Money Follows the Person (RCL); Washington Roads (StateFunded MFP); Private Duty Nursing; State-funded bed hold; and State-only-funded Adult Day Health- Chore- and 

Adult Family Home. Institutional: Nursing Facilities and Residential Habilitation Centers (RHC=ICF/MRs). 

HCBS-BI- HCBS-CMHS- HCBS-EBD- HCBS-SLS- HCBS-DD- Supported Living Services- EBD- PACECDASS- HCA 

HCBS-EBD 

HCBS-Frail Elderly Waiver, HCBS-Physically disabled Waiver, HCBS-Traumatic Brain Injury Waiver Kansas 

Senior Care Act Program Older American Act IIIB Service older Americans Act Nutrition 

Home and Community Based Services Texas Home Living 

Home and Community Based Waiver Consumer Directed Option Michelle P Waiver Consumer Directed Option 

Supports for Community Living Consumer Directed Options, Acquired Brain Injury LTC Consumer Directed 

Option Kentucky Transitions Waiver 

Home and Community Based Waiver- Supports for Community Living Waiver- Michelle P Waiver- Money 

Follows the Person/Kentucky Transitions- Kentucky State Homecare Program- Adult Day Care- Title III 

Supportive Services- Title III Congregate Meals- Title III Home Delivered Meals- Title III Preventive HealthKentucky Family Caregiver Program- National Family Caregiver Support Program- Senior Community Services 

Employment Program (SCEP)- State Health Insurance Assistance Program (SHIP)*- Nursing Home Ombudsman 

Agency* (* Not included in total new enrollment in question 43).Enrollment numbers only include clients served 

by BGAAIL- no other providers. 

home and community based waiver enhanced residential care moderate needs program 

Home Care Allowance LTHH Only 

home health aide meals case management personal response system supplies SME/DME 

Homemaker Title XXHCBS Waiver (ADSD)PASS Homemaker program (WCSS)Representative Payee Home 

Delivered Meals Case Management Lifespan (respite)Medication Management Visiting Nurse HCBS Waiver for 

People with Disabilities (WIN)Energy Assistance Group Home Waiver (ADSD) 

IAAA had over 160 client’s contacts with the State Health Insurance Assistance Program. Screening and/or 

application assistance was provided with a majority of these contacts- however actual enrollment is almost always 

the responsibility of the contact due to the processes established by Medicare/Medicaid programs which are not 

under the auspices of the AAA network in Oklahoma. Enrollments are for LIS/Extra Help and Medicare D. 

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44. PUBLIC PROGRAMS, please list LTSS program 

In Illinois there are the following programs: Medicaid Waiver for DD population Medicaid Waiver for 60 years of 

age and older Medicaid Waiver for people with disabilities Medicaid Waiver for Medically Fragile/Tech 

Dependent Children Medicaid Waiver Program children with DD support Medicaid Waiver Program for children 

with DD residential Medicaid Waiver for Persons with Brain Injury Supportive Living Facility waiver Cash 

Counseling Program - this is not in our area limited areas in IL Money Follows the Person Choices for Care -

assisting people before discharge from a hospital with their HCBLTSS and their institutional options Institutional: 

ICFICF/Inpatient Psych. Service for individuals under age 21Services for individuals 65 and older in an institution 

for mental illness Skilled Care Nursing Facilities 

Individuals at Ethos are enrolled or participate in the following LTSS and HCBS Programs: State funded Home 

Care State Funded Enhanced Community Options Program (ECOP) 1915c Home and Community Based Services 

Waiver for frail elders, Mass Health Personal Care Attendant Program (consumer directed services)Title IIIC 

Nutrition Program (home delivered and congregate meals)Boston Money Management Program (representative 

payee and bill paying)Elder Protective Services Evidence based programs including Chronic Disease SelfManagement- Diabetes Self-Management- A Matter of Balance- Tai Chi for older adults- PEARLS- Health IdeasHealthy Eating- Stay Sharp- Powerful Tools for Caregivers Volunteer services such as Friendly Visitor- Medical 

Escort- shopping assistance Caregiver Support 

Information for question 43 and 44 not available to this reporter 

IRIS Family Care Community Options Program Medicaid Person Cares 

Legacy Waiver/ COP CIP 

LISLiving At Home Waiver Older Adult Waiver Medical Day Care Waiver Senior Care 

LTSS- Lighthouse- FAIR and Medicaid Personal Care Programs HCBS- I/DD Waiver- Aged Disabled Waiver 

Program- TBI Waiver Program Current wait lists are present for FAIR and Lighthouse Programs. The Aged 

Disabled Waiver Program started managed enrollment on December 5- 2011. 

LTSS- Lighthouse- FAIR and Medicaid Personal Care Programs HCBS- I/DD Waiver- Aged Disabled WaiverTBI Waiver Program Current wait lists are present for FAIR and Lighthouse Programs. The Aged Disabled 

Waiver Program started managed enrollment on December 5- 2011. 

LTSS- Lighthouse- FAIR and Medicaid Personal Care Programs HCBS- I/DD Waiver- Aged Disabled Waiver 

Program- TBI Waiver Program Current wait lists are present for FAIR and Lighthouse Programs. The Aged 

Disabled Waiver Program started managed enrollment on December 5- 2011. 

LTSS- Lighthouse- FAIR and Medicaid Personal Care Programs HCBS- I/DD Waiver- Aged Disabled Waiver 

Program- TBI Waiver Program Current wait lists are present for FAIR and Lighthouse Programs. The Aged 

Disabled Waiver Program started managed enrollment on December 2- 2011. 

LTSS- Lighthouse- FAIR and Medicaid Personal Care Programs HCBS- I/DD Waiver- Aged Disabled Waiver 

Programs- TBI Waiver Current wait lists are present for FAIR and Lighthouse Programs. The Aged and Disabled 

Waiver Program started managed enrollment on December 5- 2011. 

LTSS: Older Americans Act Social Service Block Grant CHOICE - state funded program HCBS Waivers: Aged 

and Disabled Traumatic Brain Injury Does NOT include the MR/DD waivers. We do not have access to that 

information. The number for the Medicaid institutional enrollment is the number of pre-admission screenings done 

during this period where the applicant was marked as Medicaid or Medicaid pending as their funding source. 

MAABD- COPE- CHIP- Congregate Meals- Housing- Medicaid- Medicare Savings Program (MSP)- Low Income 

Subsidy (LIS)- SNAP/Food Stamps 

Mass Health MA PCA program subsidized housing congregate housing peer support groups individual skills 

training peer counseling. ADA Para transit or COA rides Meals on Wheels ABI waiver ATLPHMLPSSAPVR 

program-Medicare-Medicaid-SSA-PVR-NSCCIL Program Options Program 

MCOA staff refers individuals who are likely eligible to the HCBS waiver programs and refer individuals with 

MR/DD to the LTSS program when appropriate. 

Medicaid 

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44. PUBLIC PROGRAMS, please list LTSS program 

Medicaid - Quest Expanded Access for Aged Blind and Disabled Kupuna Care Title III Programs 

Medicaid (general)Denali Kid Care Medicaid Waiver: Alaskans Living Independently (ALI): Adults w/Physical 

Disabilities (APDD) and Older Alaskans (OA)Medicaid Waiver: Children w/Complex Medical Conditions 

(CCMC)Medicaid Waiver: Intellectual and Developmental Disabilities (IDD)LTC (Nursing Home) Medicaid 

Adult Public Assistance (APA)Temporary Assistance Program General Relief Assistance (GRA)Chronic and 

Acute Medical Assistance (CAMA)Personal Care Attendant (Agency-based and Consumer Directed)Food Stamps 

State of Alaska Senior Benefits Nutrition and Transportation Services (Meals on Wheels- Care-a-van)Medicare 

Savings Program (QYMBY/SLMBY)E-mods TEFRA Senior In-home Services National Family Caregiver 

Support Program Adult Day Services Nursing Facility Transition Program Qualifying Income Trusts*Please note 

Mica (SAIL's data base) collects # of Medicaid recipients- not specifically # of waivers (question 43) 

Medicaid 1115 waiver, LTSS includes OAA Title III and Medicaid 

Medicaid 1115 waiver OAA Title III 

Medicaid 1115 waiver Other programs are OAA Title III funded programs- Eldervention- ombudsman 

consultation- legal services 

Medicaid 1115OAA Title III 

Medicaid 1115OAA Title III 

Medicaid Aged and Disabled Waiver, TBI Waiver, CHOICESSBG Title III Title III-E 

Medicaid Elderly Disabled Waiver program. Medicaid HIV/AIDS Waiver program. Senior Rx: Partnership for 

Medication Access program. State Health Insurance Assistance Program (SHIP).Alabama Cares program. Aspiring 

Senior Adult Program. Meals on Wheels program. Senior Center program. 

Medicaid Personal Care COPES Family Caregiver Support Program (Respite and house-keeping and errands) 

Medicaid Waiver for Older Adults; Senior Care; Subsidy; Senior Inclusion Program; Caregiver Support. 

Medicaid Waiver for Older Adults Senior Care Senior Assisted Living Group Home Subsidy 

Medicaid Waiver- Under and Over 60 programs Private Duty Nursing programs under and over 60Home and 

Community Based Services Program Independent Housing Service Program for over and under 60 

Medicaid waivers of Louisiana 

Medicaid OAASCSAFCSP Nutrition Transportation 

Multipurpose Senior Services Program Money follows the person 

n Home Aid Service- Senior Care- Living at Home Waiver- Older Adults Waiver and Medical Assistance Personal 

Care Program 

N/A 

N/A 

New Choice Waiver- Aging Waiver- Home Community Based Alternative- National Caregiver Support Program 

New Choices- Aging- Physical Disability- ABI- Community Supports 

NF/AH 

NHTD waiver, TBI waiver, Medicaid, SNAPHEAP Home delivered meals Caregiver respite EISEP Medical 

daycare Social daycare Medicare Savings Program 

NJ - Global Options for Long-term Care (Medicaid HCBS Waiver)NJ - Jersey Assistance for Community Care 

giving OAA - Home Delivered Meals OAA - Housekeeping 

None 

Note: This agency is not able to capture this information as it is currently at the State level and this agency not 

privy to this information. 

Nursing facility waiver, IHSSMSSP New enrollment numbers for IHSS clients and individuals in Medicaid 

residing in institutions is not available. AIS implemented a new State system (CMIPS II) in September 2012. 

IHSS data is in new system 

Nursing Home Transition Diversion Waiver Traumatic Brain Injury Waiver Medicaid Personal Care 

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44. PUBLIC PROGRAMS, please list LTSS program 

OAA funded services - Home Delivered Meals- Respite- Congregate Meals- Adult Day Health- Homemaker 

Assistance CCSP (ABD)- ICWP- COMP/NOW (DD)- SOURCE (SSI/ABD); GAPP (Pediatric) 

OAA Title IIIB- C and Estate funded Options for Community Living HCBS Medicaid Waiver for the Elderly 

Ohio Medicaid HCBS Waiver Programs ( PASSPORT- Assisted Living- Choices) 

Ohio Medicaid HCBS Waiver Programs (PASSPORT- Assisted Living- Choices)- Title III funded services- LevyLocal- Community Supported Services 

Oklahoma Advantage Program 

Older Adult Waiver 

Older Adult Waiver Medical Daycare Waiver Community Pathways Waiver Living At Home Waiver Medical 

Assistance Personal Care In near future: Options Counseling with Center for Independent Living Live Well 

Nutrition Program Living With Chronic Pain Program Living With Diabetes Program Healthy Fitness Center 

Community Transit Cecil County Senior Center Home Delivered Meals Assisted Living - Subsidy Caregiver 

Support Program SHIP - State Health Insurance Programs MP - Senior Medicare Patrol A - Information and 

Assistance MAP - New Maryland Access Point - 2012-2013 

Older Adult Waiver Senior Care Medicaid 

Older Adults Waiver Day Habilitation Program/DD 

Older Adults Waiver In addition to the 5 new clients enrolled into a Medicaid HCBS Waiver- there are 6 

individuals pending eligibility. Of the 6 pending- 4 currently reside in a nursing home- looking to move to an 

assisted living or at home and 2 currently reside at home. 

Older American€TMs Act programs: â€¢ Homemaker â€¢ Home-delivered meals€¢ Congregate meals â€¢

Caregiver Support€¢ Respite Personal support services _______________________________HCBS Waivers1.

CCSP-Community Care Services Program-elderly and/or functionally impaired or have disabilities.2. SOURCEService Options Using Resources in Community Environment-primary enhanced case management under elderly 

and disabled waiver. Serves blind- aged- disabled who are SSI eligible. 3. ICWP-Independent Care Waiver 

Program-for Medicaid recipients who have severe physical disabilities- are between the ages of 21-64. 4. NOWNew Options Waiver and COMP-Comprehensive Supports Waiver Program-for people who have developmental 

or intellectual disabilities. 5. GAPP-Georgia Pediatric Program--specialized skilled nursing services to medically 

fragile members with a current Individualized Family Service Plan- age birth to 3 years of age. 6. MFP-Money 

Follows the Person-helps people living in nursing homes and ICF-MR facilities to transition and resettle in to a 

community setting. 

Our members are enrolled in NOW/COMP waiver programs. 

PACE- EDCD. We know of 7 who were enrolled in PACE. 

Partnership Family Care IRIS 

PAS Program- CHIP Waiver- Respite Care 

Passport and ALW 

PASSPORT HCBS Waiver-Assisted Living HCBS Waiver- Caregiver Support-Comcare-Senior Community 

Services Block Grant 

PASSPORT Waiver--Numbers included above Assisted Living Waiver--Numbers included above Ohio Home 

Care Waiver--not able to include numbers Care Coordination Program--not able to include numbers Local Levy 

Programs---not able to include numbers 

PASSPORT-Assisted Living Waiver-Care Coordination Program-HDM-Senior Dining Program-Senior Farmers 

Market Nutrition Program-Find A Ride 

Personal Care Adult Day Healthcare Transition Coordination 

Question 38- Question 39- Question 41- and Question 42- Question 43 are tracked by Kansas Department of Aging 

and Disability Services via their Information Management System KAMIS- which at the local level the ADRC 

does not have the ability to pull the reports to abstain requested information for the above questions. KDADS will 

submit information regarding statewide numbers directly to Lewin. 

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44. PUBLIC PROGRAMS, please list LTSS program 

Question 43 44: currently not tracked. 

Question 43: KDADS will send this information directly to Lewin Group Question 44:HCBS-FEHCBS-PDHCBSTBISenior Care Act-Kansas State funded Older Americans Act-Federal funded 

RCCOA does not enroll clients- we only provide services to clients that are enrolled. 

reflects only WOA 

Same as #42 

Same as 42- this is for NM ADRC only 

Same as above 

Same as response above 

see # 42 

See 42 

see question #42 

see question 42 

See question 43.On average the LCA helps with 4 Money Follows the Person applications a month. 

SSBG- CHOICE- TIII- TIIIE- AD WAIVER AND TBI WAIVER 

SSI/SSDI Eligibility HIRSP Medicare Supplement MAPP Medicare Advantage Plans Medicare Coverage 

Medicare Part DQMB/SLMB/SLMB + Title III-C Home-Delivered Meals Title III-C-Congregate Dining Program 

Title III-B Volunteer Driver Program Family Care IRIS Alzheimer’s Family Caregiver Support Program National

Family Caregiver Support Program 

STAR+PLUS and Community Based Alternatives for adults with physical disabilities Home and Community 

Services for persons with intellectual and developmental disabilities Community Living Assistance and Support 

Services for persons with intellectual and developmental disabilities Deaf/Blind/Multiple Disabilities Medically 

Dependent Children's Program 

State Funded Options Homemaker Program State Funded Options Personal Care Program State Funded Options 

Home Delivered Meals Program Title IIIB Homemaker Program Title IIIC2 Home Delivered Meals Program 

State Home Care program - Frail Elder Waiver and Spousal Waiver 

State LTSS Services include Nutrition (Meals and Nutritional Supplements)- Personal Care- Nursing ServicesHomemaker Services- Assistive Devices- Emergency Response System- Specialized Medical SuppliesSpecialized Medical Equipment- Telehealth- Caregiver Services (Respite)- Adult Day Services. Elderly (Aged and 

Disabled) HCBS Waiver. 

State Medicaid Waiver Programs - PASSPORT and Assisted Living Waiver Programs County Levy Programs 

State plan Medicaid services 

State plan Home waiver PASSPORT Home Choice 

Statistics regarding the average number of individuals enrolled in Medicaid HCBS Waivers includes only the Aged 

Disabled Adult Waiver for adults age 60-64 with a disability and adults age 65+ and the Assisted Living Waiver 

for adults age 60-64 with a disability and adults age 65+.There are 17 Waivers in the state of Florida- but these are 

the two at the ADRC. Note: Individuals counted here as enrolled in LTSS represent only some of the funding 

sources listed in question 74. Individuals served in other funding sources- including non-registered services- are 

not included in this count. 

TBI- ABI (2)- DDS (3)- MFP (no enrollees)- Frail Elder 

The above data is not collected by ILC. However HCBS waivers include; IDD- Children with Complex Medical 

Needs- Adults with Physical Disabilities- Older Alaskans. LTSS programs include Medicaid- Public AssistanceNutrition- Transportation- housing modifications- assistive technology- Social Security- Medicare- Family 

Caregiver Support- other support/peer groups. 

The database doesn't track this type of information 

The following Sate Home Care programs - Frail Elder Waiver; and Spousal Waiver 

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44. PUBLIC PROGRAMS, please list LTSS program 

The questions above are programs not administered by Area VIII but rather by a Medical Corporation. 

Furthermore- each institution is administered by a corporation. There is no way to ascertain the exact numbers 

unless I secure them from the Montana Department of Public Health Human Services who may be compiling this 

information for both waiver and office of public assistance. 

This data is not maintained at the local level. This data can be provided by the Texas Department of Aging 

Disability Services 

This information is not available at the local level. 

This information is not currently available to Passaic County ADRC. 

This State ADRC office is a new site and will not be tracking this until July 1- 2013 

Unavailable 

Unavailable data. Hawaii State Dept. of Human Services- MEDQUEST Division is the Medicaid agency on Kauai 

and has the information you are requesting. We do not have access to this information. We do not enroll 

individuals into Medicaid. We only refer and assist individuals with their application. 

Unavailable information 

Unknown 

Unknown how many newly enrolled clients in IHSS- meals- or special case management fund. These intakes are 

done through the ADRC at DAAS Intake. Typically around 500 referrals a month would be made to LTSS 

services through the DAAS Intake line in this time frame. According to the ILC- consumers they work with are 

enrolled in the NF waiver. 

Waiver for Older Adults Waiving at Home Waiver LA Medical Adult Day Care Waiver Senior Care 

MAPCSPIHAS 

Waivers are not delineated out of the grand total. 

WAIVERS include the older adult waiver- the living at home waiver and the DDA waivers. The average numbers 

of institutions is numbers at the three nursing homes that are located in Garrett County. The average numbers of 

individuals enrolled in other LTSS programs in Garrett County include TCA- Foster Care- Age Blind DisabledSSI- Medicare- SLIMB- Pregnant MCHIP- MCHIP and Baltimore Approved Waiver Clients. All of these 

inviduals received Medical Assistance. Also- 22% of medical assistance is our physicians business here in Garrett 

County. 

Waivers: Aged Disabled- Traumatic Brain Injury CHOICE (Indiana funding)Title IIIC- Title IIIE- and SSBG 

Waiver score Community Svc DEA Assisted Living DEA Community Svc Hab Community SvcHab Group Home 

Intellectual Disability Preventative Community Svc RI Housing Assisted Living Self Directed Svc Shared Living 

Other LTSS Programs Group Homes ICF/MR Private ICF/MR Public ICLAS Severly Disabled Nursing Homecare 

PACE Connect Care Choice. 

We are not a CCU and do not have immediate access to the requested information 

We are unable to gather this information. We have requested this data from the local Medicaid Eligibility Office 

and have yet to receive approval. 

We do not enroll in waivers 

We do not have this information. 

We do not track the number of referrals/enrollments into the waiver programs or other Medicaid service. It should 

be noted that the AD Waiver and the IDD waiver programs have managed enrollment lists and are not actively 

enrolling any new clients on a regular basis. 

We do not track the number of referrals/enrollments in to the waiver programs It should be noted that the AD 

waiver and IDD waiver have managed enrollment or waiting lists and are not actively enrolling any new clients on 

a regular basis. 

We do not track this at the local ADRC level. 

We do not track this information. 

We have referred to these programs (CAS- HCS- and CBA) - but most applicants have reported they have either 

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44. PUBLIC PROGRAMS, please list LTSS program 

are waiting on a response/approval or have been placed on the waiting list. 

We only provide referrals to Idaho Health and Welfare Medicaid services. The ADRC not a direct service provider. 

We were unable to access current data. The only data available was for the calendar year 2012. 

What other public LTSS programs are included above?: 1. Older American€TMs Act programs, Homemaker Homedelivered meals, Congregate meals, Caregiver Support, Respite Personal support services 

40 (a) Does State ADRC have a database/MIS that does any of the following (Select all that apply)? 

Links to other databases (e.g., Medicaid waiver tracking systems, Money Follows the Person tracking 

system). If yes, specify other 

AIS Suite links to Medi-Cal verification system 

AT Network 

Read only for DSIS II MMIS. Service Providers throughout the aging disability network are maintained in the DE 

ADRC website & searchable database and print directory. 

Refernet 

Aging Infomation Management System - Georgia's state system 

Georgia Medicaid Web Portal maintained by the Georgia Department of Community Health 

MFP tracking system 

MCOA has recently been informed that the database is now shared with Department of Human Services for 

consumers placed in the Foster Family Home Program. 

Too numerous to list 20-25 

INsite 

IRis system is used for ADRC and it links; bridge; to our State system INsite 

INsite 

IRIS Insite 

Medicaid waiver tracking 

Medicaid Waiver 

PAS 

Louisiana Answers 

as requested 

Within same we can share records on same consumer- Medicare.gov 

LTSS 

LTSS MD Database 

MFP WOA 

Money Follows the Person tracking system 

MFP- Med Waiver 

track waivers- track MFP- Options counseling- ADRD grants 

MEC- MFP 

SIMS 

Eligibility Verification System for Mass Health 

Mass Health Consumer Status site 

IRis and Reporter 

State Eligibility System 

EISEP- Alzheimer's Association 

links and partnerships with 211 

Oregon ACCESS 

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40 (a) Does State ADRC have a database/MIS that does any of the following (Select all that apply)? 

Links to other databases (e.g., Medicaid waiver tracking systems, Money Follows the Person tracking 

system). If yes, specify other 

Oregon Access 

Waiver and MFP 

ACES 

Various State of WI databases 

State of Wisconsin ADRC database 

40 (b). Does State ADRC have a database/MIS that does any of the following (Select all that apply)? 

Specify other 

ADRC does not currently have a unified database 

Each organization has their own database to track consumer requests for;R- referrals made to consumers- and 

two of the three core partners maintain records for individuals consumers. 

No - currently using Excel 

Cirts and Vital Statistics 

Community Point-IRis numerous links as listed by providers 

The database is a shared system which is utilized by other community partners. With the permission of the 

client- information can unlock; and viewed by other partner agencies. 

Advanced Information Manager 

Our department is developing an integrated client data system now. 

Queen Anne's County is currently using the AIM system as their means of collecting data. Even though 

it does not meet all the requirements- we will continue using AIM until the State of Maryland institutes an 

ADRC/MAP tracking system. 

MASTS 

ADRC staff have access to NH Medicaid data base- New Heights and LOC information; ADRC staff have 

access EMR and E-Discharge at partner hospital (Cheshire Medical Center/Dartmouth Hitchcock 

Keene) 

Tracks referrals made to select community service providers 

Depends upon agency 

Several operating organizations have systems which perform these functions. 

MIS Software has been selected but not yet deployed 

MIS software has been selected but not yet deployed 

MIS software selected but not yet deployed 

MIS software has been selected but not yet deployed 

MIS software has been selected but not yet deployed. 

selected but not deployed 

MIS software has been selected but not yet deployed 

MIS software has been selected but not yet deployed 

MIS Software has been selected but not yet deployed 

state considering moving to AIRS Standards 

MIS software has been selected but not yet deployed 

MIS software has been selected but not yet deployed. 

MIS software has been selected but not yet deployed 

MIS software has been selected but not yet deployed. 

MSI software has been selected- but not yet deployed. 

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40 (b). Does State ADRC have a database/MIS that does any of the following (Select all that apply)? 

Specify other 

MIS software had been selected but not yet deployed 

MIS software has been selected but not deployed. 

MIS software has been selected- but not yet deployed. 

MIS software has been selected but not yet deployed 

Has been selected- not yet in place 

MIS software has been selected but not yet deployed. 

MIS software has been selected but not yet developed 

MIS Software has been selected but not yet deployed 

MIS software has been selected but not yet deployed 

MIS software has been selected but not yet deployed 

MIS software has been selected but not yet deployed 

MIS software has been selected but not yet developed. 

MIS software has been selected but not yet deployed 

MIS software has been selected- but not deployed 

Our MIS software system has been selected but not yet deployed 

MIS software has been selected but not yet deployed 

MIS soft selected but not deployed 

State is currently moving towards adoption of the AIRS Standards MIS Software has been selected but not yet 

deployed. 

MIS software has been selected but not yet deployed 

MIS software has been selected but not yet deployed. 

MIS software has been selected but not yet deployed 

Community Partner Program 

Enrollments in LTC programs 

Assist guide 

41 (b). Do operational partners have access to data they need for their operations such as data about your 

consumers/services? If yes, for what purpose? 

Specify the purpose 

To review client information for final enrollment determination- input client demographic information- input 

service utilization information- review client service utilization- and obtain summary reports on clients and 

services. 

HCBS waivers 

Data for referrals 

Contact information- needs assessment- # of hours approved for service requested 

Review client information- review client service utilization- obtain summary reports on clients and/or 

services 

We have signed MoUs with operational partners who can upon request access ADRC data for seamless service 

delivery. 

Evaluation and summary reports 

Client demographic information- obtain summary reports on services 

Input referrals via the ADRC secure referral system. 

Review and input service utilization. 

Review client information; input client demographics ;input service utilization; review client service utilizationobtain summary reports on clients and services 

Funded providers input client information and input data on units of service provided. 

Input service utilization information- obtain summary of reports- input referrals- review client information 

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41 (b). Do operational partners have access to data they need for their operations such as data about your 

consumers/services? If yes, for what purpose? 

Specify the purpose 

To review collected data to provide quality service 

To locate available community resources 

Some partners share the same data input system and is able to see client's information. 

Limited access to particular partners. Only one has access to client data. 

Review client information- input referrals- input information- review service information 

Access is limited to registration within the data system and generally for partners with contracts with the AAA. 

Select partners have additional access on services if required under their contract. 

Input service utilization information 

Review client information and capture service deliveries 

Review client information- input client demographic information- input referrals- input service utilization 

information 

To provide services to consumers & clients. 

Demographic data and information. Perhaps to access grants and community funding 

Tracking 

Input client demographic information- input referrals- obtain summary reports on clients and/or servicesinput utilization information- review client service utilization 

Review client info 

Billing units of services 

Referral to programs in house 

For client tracking and financial billing. 

Share info on common clients 

Review service usage- consumer demographics- notes regarding consumer needs- review service utilization 

Purpose is to reduce duplicate referral, services and prevent clients from receiving services they are not eligible 

for. Also to provide enhanced services to clients. 

As needed or requested 

The above examples are what the operational partners have access to through the LTSS md database 

Client information- tracking- referrals- service 

Review client info 

Review consumer info 

For operation purpose 

Linking ILC to AAA 

Referral information only 

All areas noted above 

Service providers receive demographic information in order to provide services under consumer care plan 

Service providers receive demographic information in order to provide services under consumers care plan 

For referrals and service coordination 

Other programs under ADSD have access to the same database; this allows them to view ;or add consumer data 

Same 

Review client service utilization/obtain summary reports on clients and services& review client 

information 

Seamless transition of clients 

CMCDHK staff have access to refer 7 client to streamline communication on behalf of consumers 

Client information- input client information- input referrals 

Review client shared client data; search for local resources 

Demographics- input referrals- input information 

Review client information; client intake; screening for community services; reporting 

Service documentation 

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41 (b). Do operational partners have access to data they need for their operations such as data about your 

consumers/services? If yes, for what purpose? 

Specify the purpose 

All of the above mentioned in question #47 

Client demographic data 

Consumer service data tracking- reporting 

Input service utilization information 

AAA providers use the same database 

Office for the aging services 

Service delivery 

Individual programs may access client service utilization- but details are confidential to program utilized. 

Review client information- referrals 

Review client information 

Review client information- input information 

Only the Mecklenburg CRC has an online referral and tracking system. 

Input and review client information- input referrals and track and review client service utilization 

Documentation of service delivery- input client data- obtain summary reports on clients and services. 

Resource database only 

The point shares limited data with the case management agencies with the purpose of following up on 

individuals referred for h& amp; cc-services (rather than by use of electronic database. 

Some providers input their data into system and run reports 

Input client demographic information- input service utilization information- obtain summary reports 

Reporting and monitoring purposes 

Serve common clients. 

Partners only have access to ADRC intake form and can track and monitor services noted by other referred to 

partners (if applicable). 

Mfp 

Review client service utilization 

Demographics- client information- services needed/provided/summaries 

Annual 704 report 

Information for grants 

Share resources 

To share information through peer place 

The personal care home maker agency receives an electronic referral with client information. The agency then 

keeps up the client record -- demographic information. 

Referrals to and from local center for independent living with consumer consent 

Some partners have access for all the reasons listed above 

All purposes listed 

Review client information 

Referral information on warm transfers 

DHHS for adult protection 

Shared consumers with client approval 

Data base of resources available 

Resource information only via website 

42 (a) Do service providers have access to data about our consumers? If yes, for what purpose? 

Specify the purpose 

Input referrals- input service utilization information 

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42 (a) Do service providers have access to data about our consumers? If yes, for what purpose? 

Specify the purpose 

data for referrals 

For collaboration on services for specific consumers if ROI signed 

contact information- needs assessment- # of hours approved and type of service requested 

This Region sends annual utilization/demographic data to providers 

To contact consumer to enroll in service 

service reports on clients 

for review and input client utilization 

review client information- input client demographic information-input service utilization information- review 

client service utilization- obtain summary reports on clients and services 

Enter client information- enter units of service provided. 

Obtain summary reports on clients and services- input service utilization information 

ADRC Partners ? 

To provide quality service 

Care Planning- Billing 

to review client information- to enter client data on services delivered and to provide a connected system for 

follow through upon referral and initiation of aging funded services 

Some providers have access to our database and is able to see limited client data 

Can change, update & add to information- run reports- track service provision. 

they have access only if they serve the individual in their program 

Read Only 

on admissions into services 

Access is tiered according to what is needed to fulfill contractual requirements with the AAA. 

input service utilization information 

Client information- and service deliveries 

review of client info- input client demographic info- input service utilization- review client service utilization-and 

obtain summary reports on clients services 

To provide services to consumers& clients. 

aggregate numbers only on types of clients- not client specific unless making a referral 

only for provision of service 

To assist in continuity of care 

Review and stats 

review client info 

obtain summary reports 

review client information- input client demographic information- input service utilization information- review 

client service utilization- obtain summary reports on clients and/or services 

service provision 

limited on as needed basis 

To record service delivery. 

See above. 

info on clients and services received 

To make referrals 

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42 (a) Do service providers have access to data about our consumers? If yes, for what purpose? 

Specify the purpose 

Only information needed to serve the individuals 

Service Providers can access client information if written consent is obtained from the client. Purpose is to reduce 

duplicate service referrals and to eliminate duplication of services. 

As requested to provide service 

review consumer info- billing for services provided 

Provider direct but it is limited- enough information to provide requested services and billing 

providers can view service utilization for their specific agency only 

Provider Direct/Service Providers 

Provider Direct for billing purposes 

Providers can see demographic information so they can follow-up with clients and can enter billing via the 

electronic system. 

See #86 for clarification 

Client service utilization specific to the provider. 

basic demographics 

Provider Direct 

Provider Direct 

Provider Direct 

for billing purposes 

Provider contractors need basic demographic information in order to provide the service needed 

Provider Direct system for vendors 

Provider Direct for Vendors 

Provider contractors need basic demographic information in order to provide the service needed 

Provider Direct - to receive referrals- fill requests for service- enter information for billing purposes. 

Billing 

ADSD providers have access to consumer data under the SAMS system. 

SAMS 

Review Client Utilization; Data Reporting field for Refer 7.5 

The goal is to improve streamlined access to data and avoid duplication and to allow partners to have better access 

to accurate up to date community resource information 

Review client service utilization- summary reports. Client information with a release 

review/input 

SERVICE DOCUMENTATION 

all of the above mentioned in question #48 

input client demographic and service utilization information 

client demographic data 

Referrals only 

Client service data tracking- demographics and demographics. Reports. 

To input client demographic information and client service information. 

Specific Data through SAMS 

Shared data with AAA 

utilization review- referrals 

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42 (a) Do service providers have access to data about our consumers? If yes, for what purpose? 

Specify the purpose 

input referrals- review client service utilization 

input client info- review information- obtain reports 

Those CRC partners who made referral or are referred to have access to electronic information in Mecklenburg 

County based on a verbal release by the consumer. 

View referrals 

review client information- input service utilization 

Review client information- enter service utilization as it relates to the specific service provided. 

to verify eligibility for billing 

referral/service delivery 

utilization - billing 

Service providers have access to date necessary to provide services to clients and caregivers. The POINT shares 

data with service providers manually as necessary for each individual referral. 

input client demographic information- input service utilization information- obtain summary reports 

Congregate Nutrition and Senior Centers 

input demographic data 

Partnering service providers are able to review client intake information- input referrals- and input on assistance 

provided. Basically service providers are able to track and monitor assistance provided to consumer by partnering 

agencies. 

review client service utilization 

summaries - not client specific upon request 

RSA USOR have access only for monitoring purposes 

We share assessment information when it relates to programs and services with client permission. 

CFC waiver clients only 

Client assessments 

Access provided with client consent. 

Personal Care providers receive referrals 

Review client information- input client demographic information- input referrals- input service utilization 

information- review client service utilization- obtain summary reports on clients; or services. 

all purposes listed above 

County Aging providers share same consumer database 

obtain summary reports 

Need to know or enrolled in their program 

Informational only- unmet needs- etc. 

47. On which topics, if any, would you like to receive additional assistance from technical assistance 

provider? 

Our agency would like to receive additional assistance on how to obtain funding for Care Transitions. 

Data collection systems that work well for multiple programs. 

Data base and standardized collection of data in order to report outcomes. Currently supervise the HMIS team for 

the Municipality and am familiar with Bowman Systems Service Point and have some knowledge of more 

sophisticated data bases. Currently are using MiCil which does not have the ability to capture data that is required 

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47. On which topics, if any, would you like to receive additional assistance from technical assistance 

provider? 

for this report. ADRC is slated to move to SAMS system in the future but still need information on how to best 

capture and record data while serving maximum number of individual Information on options counseling--a 

training course for counselors and standardized forms. 

Current data collection system does not provide ability to answer a number of questions in this survey. We are able 

to count hours of services- but not individuals. 

To justify funding requests and administer service provide contracts. 

Hands-on Options Counseling Training 

Standardized consumer information sheet and data collection. 

We are always looking for best practices and/or forms that may help us track consumers or provide better service. 

Advocates would like a standardized database for data collection. 

sustainability 

Quality Assurance and Care Transitions. The ADRC operates an informal Care Transitions Program and we do 

have statistical data that can be provided if requested. DSAAPS is working on system improvements to retrieve 

the demographic data needed to complete Section B. Populations Served. 

SMMCLTCP 

Thorough explanation/training of all questions on the SART. 

I would like assistance on completing the SART report specific to agencies that do not qualify as an ADRC site. 

Improving consumer services; program planning- performance data. 

building firewalls for fee-for-service; developing HIPAA policies and procedures 

Sustainability and obtaining and maintaining formal partnerships 

How to meet the follow-up requirement with the limited time and staff available. When ask consumer do not want 

a follow-up call...they will call us if they have another need/ request for information. 

Operationalizing Options Counseling according to ACL Draft Standards. 

Would appreciate marketing tips and suggestions that have worked in other areas. 

Nothing to request at this time 

NA 

None 

How to appropriately respond to the report based on state implementation of the ADRC? Some areas in which 

data is required- don't have access to this and need to indicate N/A or unavailable- but cannot. 

Justification for funding 

Training of the best way to collect the required data. 

presently satisfied 

ADRC standard operating procedures - national/state 

Need consistent/reliable method to collect local and statewide data in Maryland for MAP. Much of the data being 

requested by SART and this survey is not currently collected in a manner conducive to report generation in our 

state. State guidance is lacking in this area. 

Templates for MOUs with partner agencies would be helpful. Also- shared database with partner agencies would 

facilitate enhanced communication. 

It would be most helpful if the technical assistance provider would be able to assist local ADRCS in establishing a 

data collection system that reflects the information expected to be reported on within the SART and/or the local 

National Evaluation Survey. All ADRC's are at different stages and/or levels of operation. Many operate- such as 

ours- with tracking what is required of the original SART report through excel spreadsheets since our data 

programs are limited (due to limited funding) or no in house IT (since part of local government- IT concentrates 

only on the daily internal data needed for county operations). Based on not having prior knowledge on what the 

survey was looking to collect nor having a seamless manner in which to collect data- the numbers collected may 

not be an accurate reflection of the work conducted during this reporting period. 

not sure 

None at this time. 

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47. On which topics, if any, would you like to receive additional assistance from technical assistance 

provider? 

Learning about benchmarked studies from other ADRCs and improving evaluation- by using known tools- which 

work for evaluation. 

None needed at this time. 

Our current AIM (Aging Information Management) database is not able to capture much of the information that 

you are requesting for this survey. We are in need of additional; A and support staff. 

all relevant topics 

none 

None. 

Would appreciate advance notice of data that will be requested for upcoming reports- in order to keep track of or 

develop- a tracking system to obtain the data. 

What is the information that is being collected used for? How will it help us? 

Eligibility Screening Module; Initial Screening of ADRC Clients 

None at this time- thank you. 

Measuring outcomes and quality. 

Affordability of warm transfer systems that may work with several partner agencies. 

none 

Satisfaction surveys and follow-up questions 

This section is not applicable to the website. 

Additional Comments:For question 48. We provide this data in the form of dashboards to partners. We do not 

share however details of consumer data due to MN Data Privacy Practices Act requirements and HIPPA. Each of 

these sections should have a notes section. For instance for the Client Feedback Survey section I would have put 

in information but it wouldn't allow me to indicate this is a percentage of callers who respond- 95% and the 

number of consumers provided by the SLL to customers is also a % based on population and planning and service 

area. Please add Notes sections to each section of this report for staff to provide additional information to the TAE. 

Thanks :) 

Program planning and implementation for staff and clients. Management techniques best used to chart success 

and failures of program plan- staff accountability and client satisfaction. 

A better of understanding of running reports for data collection. 

Enhancing data collection software- thus- systems would better integrate for reporting purposes. 

all of the above 

Program Planning; funding sources 

Warm transfer options 

Matrix Management as it applies to a successful ADRC model Technology Assistance widely promoting and 

enhancing the ADRC/NWD technology systems we have in place now so that health care and social service 

partners will work with and help us develop what we have rather than create something new 

Creating accurate reports from SAMS 

Data collection tools and processes. 

All questions and reported answers based on software tracking tool developed by Peer place. We do not track all 

data the same way it is being asked for in this report. If data needs to be collected differently going forward for 

accurate reporting- data collection should be designed using this reporting tool as the basis to pull data when 

needed and data entry should be standardized across the country. The cost born to make these changes at the local 

level would be astronomical. 

The Ashe County CRC would like to see a database system in place so that all providers would have access to 

consumer information when needed. 

Regarding 49-53 Follow-up differs regarding the service. For most CRC; A situations the idea is follow-up would 

occur one week after contact. However for Options Counseling we follow a 30- 60- 90 day follow-up schedule. 

For Money Follows the Person we complete surveys one year after transitioning and 2 years after transitioning. So 

the follow-up procedures vary greatly depending on the program. 57. Technical Assistance on data tracking would 

be greatly appreciated and very useful. Ever since the creating of NC Carelink was ended and there is no word of a 

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47. On which topics, if any, would you like to receive additional assistance from technical assistance 

provider? 

replacement- we have no developing or functional reporting system. How can we best collect and provide the data 

needed for CRC reports? 

Our CRC does not have a web based system to track numbers- therefore it is almost impossible to provide much of 

the information requested. 

None 

Tracking measurable outcomes through customer service. 

Securing Funding for ADRC capacity. 

# 56 will not save my answers. The first four boxes should be saved. 

None 

I did not receive the information from the agencies I followed up with for these particular questions. 

Integration of 2-1-1 call center activity into ADRC statistical reporting 

Taxonomy 

More demographic information on Over 60- Under 60; e.g.- are they MA eligible? 

Not sure 

At this time information is adequately distributed. 

THE POINT would like training on best practices for dealing with difficult clients and or callers. 

We need more intense proactive training modules for various reporting documentation. This includes Information 

Referral- I-Care- Family Caregiver- Ombudsman reporting procedures. 

Consumer Choice Programming Options Counseling - HCBS 

How to pull accurate reports. 

We appreciate more assistance in supporting partnerships. In our model- the partners do not have a strong 

incentive to actively support the day to day activities of the ADRC in providing an on-call model 

help/information/referral phone line to over 250-000 seniors as well as persons with disabilities- helping 

professionals- and caregivers. Sample Memorandums of understanding between partners and best practices would 

be very helpful. We have not seen this addressed greatly in the TAE newsletter or on-line resources. 

N/A 

CCTP List Bill Submissions 

How to accurately track consumer information in the above required information to ensure that we are providing 

the most accurate up to day data on all of the activities and services we are providing. 

I would like to have more feedback from the reports submitted and the information gathered by the provider. 

How to capture measured outcomes is always a challenge for newer ADRC's to implement? It would be nice if the 

technical assistance provider could provide us a tool that we could use that will help us answer SART questions 

better and measure outcomes in a more streamlined way for all ADRC's. 

clarification for our state agency on our ability to provide services (e.g.- Care Transitions) under contract with 

profit- and not-for-profit providers and draw on Title III revenues if contractual revenues are not sufficient. Our 

state unit on agency prohibits us from using Title III to supplement contractual revenues--which makes it 

extremely difficult to diversify our funding streams. 

Reporting. 

Serving LGBT older adults 

How to best do a quantitative performance eval with very limited staff and with consumers who often do not have 

computer or phone access. 

The use of Options Counseling with people with intellectual disabilities and youth in general 

We already frequently request assistance to add topics or understand how to get more information out of our 

agency databases to help us with reports or when needing stats for contracts or funding. We need a better 

understanding of this SART report and what we include for services and consumers. Topics like: When you are 

talking about our agency and its service area - do we comment on unmet need if it's not something we have ability 

to control? Example: there is an unmet need for homemakers in our service area- but we do not hold the contract 

on this. 

How to better track the data for these reports and create simpler reports. 

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47. On which topics, if any, would you like to receive additional assistance from technical assistance 

provider? 

We would like more training on how best to use Refer on a daily basis and to our advantage to our organization. 

Veteran Assistance Programs Informal Caregivers 

All ADRCs are to develop sustainability plans that include adequate reimbursements or fees for service. ADRCs 

are to serve individuals of all incomes. What are ADRCs charging individuals with incomes that do not make them 

eligible for public funds - and for what services? Refer to your Question 82 on fees or service or per unit fee for 

the specific services identified in that question. What business plan tool kits are available to help ADRCs with this 

sustainability component? 

Modernized telephone service Website chat interaction in secure environment 

None at this time 

None 

None 

We are in startup mode and creating a QA policy at present time. Our phone system will accommodate warm 

transfers in the very near future 

successful and affordable care transition projects in action 

Program Planning 

none 

49 (a) If yes, to which of the following populations is the eligibility screening instrument administered ? 

Specify other populations 

All qualified 

All 

18-64 

All populations 

we assist all callers who identify as 60 years of age and older; however as of April 2013 we now assist any caller 

requesting Medicaid Waiver services who is at least 18 years of age or older 

age 60- 64 

Aged 60 and older 

Age 60 and older 

Aged 60+ 

caregiver-Title IIIE 

60+ population 

Caregiver 

Alzheimer; Dementia 

Dementia 

Any Aged 55+ 

All age 18 plus consumers 

Any older adult or adult with a disability seeking LTSS services. 

Income assessment 

If individual is applying for a Medicaid Waiver or the Senior Care program- MAP staff complete a Referral form 

for AERS screening. 

All disabilities 

All disabilities are served by the Center for Living Working- Inc. 

Caregivers- relatives 

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49 (a) If yes, to which of the following populations is the eligibility screening instrument administered ? 

Specify other populations 

Screen by age 

Age 60-65 

Any other disability not listed 

Income 

ADRC of Southeast Michigan is not currently operational. We are currently in emerging status and anticipate 

beginning to provide in Summer- 2013. When our ADRC is operational- we will be doing this. 

Anyone under 65 too 

Age 60 and older. 

ALL (and everyone) are screened 

Financial 

Family caregiver 

Adults 18 and older who might be eligible for long term care services and family caregivers 

60 and older 

As needed for all callers 

All populations that contact us 

Dementia 

Everyone is screened 

Depends upon agency 

Depends on specific operating organization 

Under 60 years of age 

We serve older adults (60+) and people with physical disabilities. These consumers may also have one or more 

of the diagnosis above. 

People 60 and older 

Age and disability 

Any age and any disability. 

Everyone who calls is screened for program eligibility 

Combination of all Core Partners 

All apply for Medicare recipients and for Other - Private pay services and All age 60 and over who contact the 

agency are screened for eligibility. All HDM applicants - regardless of age- are screened. 

Age 60 -65 

Age 60+ and adults w/disabilities 

Anyone who is requesting in-home services that relate to our contracted in-home services 

All populations 

functional assessment 

60+ 

Aged 60 and over or if under 60 if having passed a Medicaid Personal Care screening 

Aged 60 and older 

Aged 60 and older 

Mental illness when dual diagnosis 

Adult w/a disability; child w/a disability who is 17.5 years of age 

Consumers with Mental Illness as a comobidty to PD or Frail Elderly. Terminal Illness. 

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49 (a) If yes, to which of the following populations is the eligibility screening instrument administered ? 

Specify other populations 

Under age 60 only 

49 (b). What kind of information is collected? 

Specify other kind of information collected 

Current public benefits 

If doing benefits counseling or options counseling would collect all the information listed. 

Demographic information is collected and other items depending on consumer needs and requests for 

service. 

Veteran status 

Nutrition status 

Open-ended question regarding any current concerns. 

Geographic 

Medications- financial assistance- Medicare status/medicaid status other insurance- VA benefits or if 

veteran- if renting or own home- caregiver stress and disabilities 

Prescreening intake form does not officially include info about health status and adls - but we ask about 

those items to make a preliminary determination of need and eligibility. 

Current and needed services 

Insurance provider; Medicare; Medicaid 

Community supports 

Needs 

As it pertains to the questions they ask or requested services 

Type of community assistance receiving; type of natural support - i.e. Family- friends- faith-based 

community; transportation 

Emergency contacts 

Map collects demographics- living situation- caregivers- LTSS received- income and assets. Aers collects 

health status- cognitive- behaviors. The future level i screen will incorporate most of the items above. 

As needed to determine appropriate assistance. 

Housing needs and what else consumer will share. 

Independent living services needed 

ADRC of southeast Michigan is not currently operational. We are currently in emerging status and 

anticipate beginning to provide; in summer- 2013. When our ADRC is operational- we will collect this data. 

Info collected only as needed and applicable 

This information is contingent however on the consumers' willingness to share and is not for financial 

eligibility determinations but for serving the consumer with ltcoc. 

Case by case- based on needs. 

Medical diagnoses- if applicable living environment 

Initial item or service they are seeking 

Other social programs and other supports 

All of the above where applicable. 

How they would like to be assisted 

Information collected is based on need of client 

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49 (b). What kind of information is collected? 

Specify other kind of information collected 

Depends on specific operating organization 

Any information that may be needed for making an appropriate referral for on behalf of the individual or 

contact. 

Nutrition 

Any age- any disability 

Type of disability 

Disability; living situation; benefits person receiving. 

Level of peer or ally support- employment status 

Disability and life goal 

Emotion; support system; substance abuse 

Directions to home- health insurance- what services do they need? Emergency contacts 

Veteran 

Oral health needs 

All information is not collected in every situation. It depends on the nature of the request and what the 

professional interviewer feels would be beneficial to gather so that the consumer can have the best possible 

ADRC experience. 

Employment- goals- medications 

Employment status; needs; health related services needs with level of help needed; communication and 

cognition; mental health; substance use; as well as a risk determination 

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50 (b). How do clients in your state/site complete and file applications for financial eligibility for Medicaid 

or publicly funded LTSS? 

Specify other eligibility screening modules 

Persons can call their local county human services and ask to have an application mailed to them 

Medicare Savings Program Applications 

Deterlevelmined at care coordination 

Referral to ID H;W office 

Callers may request or start an application by phone- which is then mailed for person signature- then returned by 

mail/fax/in person 

Financial eligibility for Medicaid generally requires an in-person application at the local Department of 

Community Based Services office. (The exception is for Medicare Savings Programs.) Most LTSS available 

through the Bluegrass AAAIL that have financial eligibility require an in-person assessment application. 

Applicants must apply in person at the local state office. 

Directed to DCBS Offices 

We screen for eligibility. 

people call to get list of documents to bring to local office to apply 

In person at DHHS 

Applications are faxed back to State using a secure fax 

Is dependent upon the application. For many Medicaid programs online application is possible and then may 

require an in-person visit to the Dept. of Social Services. Other programs (e.g. - Medicaid HCBS Waiver) require 

a paper application that is mailed to the applicant. 

LOCAL COA 

HANDLED BY CWA 

Has to be done through County Welfare Board location and by County Welfare Board Staff. 

All is dependent on what the consumer wants- what is required- or what the other service provider will accept. 

Applications are completed during in-home visits and scanned and emailed to the county JFS 

Paper copies are obtained via mail- completed by hand and faxed to the County office. 

n/a 

Local DHS office and FTAAAD 

ADRC Staff Assist 

Vision and Texas Ramp Project 

Person to person interviews are initiated and application is submitted online. 

LIS -Prescription Assistance Programs 

Referrals to Triple A- Life Run- Social Security Office 

Applications can be accessed- completed- and submitted on line. They can also be completed by hand and 

turned in by mail- or a state office. ADRC staff can also fax in a completed hand application 

you can call to get assistance with completing the forms 

Referred to Dept. of Family Svcs 

Most are completed at local Dept. of Health and Human Resources office 

Most are completed at local Dept. of Health and Human Resources office 

Applications may be filled out verbally over the phone with an Economic Support Staff. 

Applications are mailed or brought on visit by ADRC staff 

51 (a). In what ways do ADRC staff assist clients with financial eligibility applications for Medicaid LTSS 

Programs? 

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Specify other 

Follow-up with client on application status 

Assistance is provided to client on the amount of supports needed. 

Refer for advocacy and legal services for appeals. 

Assist with appeals but do not manage them 

We offer to become authorized representatives for clients needing that level of assistance. 

Organization has desire and staff capacity to assist with application- however we have no funding to do so. 

We also provide copies of application and contacts of who can assist with filling out the application and who can 

check the status of their application 

Assist consumer with appeals process 

Assist with appeals process. 

We occasionally assist with required financials and appeals 

Assist them with appeals. 

Serving Health Information Needs of Elders (SHINE) 

This is done primarily with volunteer supports 

Advocate; assist with appeal process 

Give info on meeting spend down- pooled trusts 

Depends upon the agency 

Assist with appeals as appropriate. 

We administer the Medicaid program. 

Send the application to Division of Elderly Affairs- the Division then assigns the case to a LTSS 

Applications 1-. Food Stamps thru SC Maps and scmapp.sc.gov and 2 ABD Medicaid 1 referral- CLTC Referral 

Form 

We refer to local CLTC; Medicaid office as necessary 

Advocate for the client as needed within the system. 

Refer to partners for actual assistance 

Assisting clients in the above activities are dependent on the peers abilities 

Submit to DSS 

ADRC staff mail or hand out applications 

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52 (a). In what ways do ADRC staff assist clients with financial eligibility applications for publicly 

funded LTSS* other than Medicaid LTSS? 

Specify other 

Assistance is provided to client on the amount of supports needed. 

ADRC coordinates SCA and OAA programs 

Food Stamp Applications 

Assist with appeals process. 

Occasionally assist individuals with financial eligibility applications for publicly-funded LTSS other that 

Medicaid 

Assist them with appeals. 

ADRC of Southeast Michigan is not currently operational. We are currently in emerging status and 

anticipate beginning to provide IA in Summer- 2013. When our ADRC is operational- we will be doing 

this. 

Advocate; assist with appeal process 

Processing of paperwork for the applications 

Depends upon the agency 

Contact the programs to help identify the issues that is preventing the completing of the application. 

Advocate for the client as needed within the system. 

Refer to our partners for assistance 

Assisting the peer on the basis of the peers abilities 

Submit to DSS 

No other public-funded LTSS 

52 (b). Please describe the publicly funded LTSS services in your state. This includes LTSS programs 

funded solely by state or county 

Medicaid Waiver- Alabama Cares 

D Waiver Alabama Cares 

Senior Rx Progam: Advocacy and assistance in gaining FREE or reduced-cost access to prescribed 

medications. Alabama Elderly Simplified Application Project (AESAP): Simplified application process for 

persons age 60+ that provides a monthly financial benefit to purchase food. Transportation. Home-Bound 

Meals: Daily meals to include breakfast and lunch to seniors who are homebound Medicaid Waiver 

(ED/HIV AIDS): Comprehensive services to allow an individual to remain in their home. Part-D Evidence 

based Interventions: Chronic Disease Self-Management Program. 

Home; Community Based; D Waivers 

Alabama Cares- caregiver respite program Title III Homemaker Services 

Senior Rx- SHIP- Ombudsmen- Alabama Cares- Medicaid Waiver- Legal Services- Project Share through 

Huntsville Utilities 

However HCBS waivers- personal care services- chore services- Medicaid- Public Assistance- NutritionTransportation- housing modifications- assistive technology- Social Security- Medicare- ACHIA- Family 

Caregiver Support- other support/peer groups. 

Medicaid waiver Senior Benefits 

Medicaid (general)Denali Kid Care Medicaid Waiver: Alaskans Living Independently (ALI): Adults 

w/Physical Disabilities (APDD) and Older Alaskans (OA)Medicaid Waiver: Children w/Complex Medical 

Conditions (CCMC)Medicaid Waiver: Intellectual and Developmental Disabilities (IDD)LTC (Nursing 

Home) Medicaid Adult Public Assistance (APA)Temporary Assistance Program General Relief Assistance 

(GRA)Chronic and Acute Medical Assistance (CAMA)Personal Care Attendant (Agency-based and 

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52 (b). Please describe the publicly funded LTSS services in your state. This includes LTSS programs 

funded solely by state or county 

Consumer Directed)Food Stamps State of Alaska Senior Benefits Nutrition and Transportation Services 

(Meals on Wheels- Care-a-van)Medicare Savings Program (QYMBY/SLMBY)E-mods TEFRA Senior Inhome Services National Family Caregiver Support Program Adult Day Services Nursing Facility Transition 

Program Qualifying Income Trusts 

Area Agency on Aging- Centers for Independent Living- Division of Developmental Disabilities- Arizona 

Division of Aging and Adult Services- State Health Insurance Assistance Program- Adult Protective 

Services- Medicaid (AHCCCS/ALTCS)- long term supports and service providers (home health agencies 

and nursing facilities)- critical pathway providers (hospital discharge staff). 

Arizona Long Term Care (Medicaid)- ADRC services 

It is the Arizona Long Term Care System (ALTCS) 

Medicaid (Arizona Health Care Cost Containment System / Arizona Long Term Care [ALTCS])Some 

systems are supported by the OAA with limited state funding 

AHCCCS/Medicaid- AAA and Division of Developmentally disabled (DDD) - are the only publicly funded 

systems in this area. 

Elder Choices (Aged 65 and over Waiver)Living Choices (Assisted Living Waiver)Alternatives (Adults 

with Physical Disability age 21-64 Waiver)Independent Choices (State Plan - Consumer Directed Cash and 

Counseling Personal Care Program - age 18 and over)State Plan Personal Care Program (age 60 and over) 

MSSP- SOAR- Linkages- Care Transitions- and IHSS. 

Renter Deposit assistance programs Nevada County Senior Outreach Nurses Home Modification Program 

County Medical Services Program (CMSP) 

DAAS Intake processes referrals for In Home Supportive services- home delivered meals- a special case 

management service funded by local money- hospital to home transitional care services- and general 

information and referral. 

Medicaid Long Term Care Medicaid Medicare Savings Program Working Adults with Disabilities 

Medicaid Adults Without Dependent Children Medicaid 

Access to LTSS is through many means: ADRC (ARCH in Colorado) Community Centered BoardsCounty Departments of Human/Social Services- Disability Determination Services- Medicaid- PACE 

(Program for All-Inclusive Care for the Elderly)- Single Entry Points- Independent Living Centers. LTSS 

Services include: Institutional Care- skilled nursing facilities. Home and Community Based Services: 

Assisted Living Residences- (Alternative Care Facilities in Colorado)- Home health care- Personal 

Assistance Services- Adult Day Programs- Older Americans Act Programs 

Food stamps Medicare Savings LEAP OAP Housing Applications, CSBG Low Income SubsidiesMedicare Social Security Rent- heat and rebate 

All as mentioned before and Money Follows the Person- just getting started. 

LTC Medicaid- Home Care Services- HCBS- Older Americans Act programs- ARCH- Colorado Choice 

Transitions- ADRC Options Counseling 

Medicaid waivers: Connecticut Homecare Program for Elders; Traumatic brain injury; mental health 

waiver; personal care attendant waiver- developmental disability waiver; CT Homecare Program for 

disabled adults; (Pilot Program).Alzheimer Caregiver Respite Program- National Caregiver Respite 

Program and Supplemental Services- Meals on Wheels- Dial-a-Ride services- Para transit servicessubsidized housing with congregate meals and house cleaning- subsidized assisted living facilitiessubsidized elderly and disabled housing- private assisted living- continuing care retirement communitieshome of the aged settings; community agencies funded by Older American dollars which includes legal 

services- homemaking- mental health- chore service- outreach- transportation- financial assistance- aging in 

place assessments- peer counseling- senior centers- adult day centers- assistive technology assistanceemployment counseling- re-balancing of Medicaid dollars for assistance to people transitioning from skilled 

nursing facility to home- ADA consulting- mobility assistance- Bureau of Rehab services- care transitionssupport specialist for mental health consumers. Financial support programs such as energy assistancerental rebate- SNAP- Medicare Savings Program- Prescription Assistance. 

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52 (b). Please describe the publicly funded LTSS services in your state. This includes LTSS programs 

funded solely by state or county 

CT administers the CT Home Care Program- a Medicaid waiver for older adults which will include younger 

adults with disabilities beginning July-2013.The Agency on Aging administers the Veterans Home Based 

program Katy Beckett waiver Personal Care Assistant waiver Medicaid Statewide Respite Care National 

Family Care giver Support Centers for Independent Living 

CT Homecare Program for Elders (state funded)CT Homecare program for disabled (state funded- only 50 

slots)Alzheimer's Respite Care Program ( state funded) 

Medicaid – Insurance NAPTANFDDSDMHASDSS - Cash assistance 

Medicaid LTSS Supplemental Nutrition Assistance Program Energy Assistance Emergency Funds Home 

Modifications State Rental Assistance Program Transportation Housing (SRAP) 

Publicly funded LTSS services through the ADRC include state funded Community Care for the ElderlyAlzheimer's Disease Initiative- Home Care for the Elderly. These do not have a financial eligibility. The 

ADRC does the screening/prioritization and releases clients for service in order of priority when funding is 

available. The ADRC also assists with financial eligibility for publicly funded programs such as SNAP 

(food stamps) and Low Income Subsidy/Extra Help which are not Medicaid. Department of Children and 

Families does the same for state funded Community Care for Disabled Adults-and Home Care for Disabled 

Adults. These do not have a financial eligibility. 

HCBS non-Medicaid Services County Funded Services 

Community Care Services Program Independent Care Waiver Program Mental Retardation/New Options 

Comm. Habilitation/Comp Sup SOURCEGAPP In-home Private Duty Nursing GAPP-Medically Fragile 

Daycare 

Food Stamps- LIHEAP- Medicare Savings Plans 

LTSS programs available include: Case Management Congregate Meals Home-Delivered Meals 

Homemaker Services Caregiver Material Aid Personal Care Services In-home Respite Care Services State 

Health Insurance Assistance Program (Georgia Cares) -- this is the CMS SHIP program Money Follows 

Person Transition Coordination MS Local Contact Agency ADRC Enhanced Options Counseling (Hospital 

On-Site Options Counseling)HCBS Medicaid Waiver - 1915 C Elderly and Disabled Waiver (formerly 

known as the Community Care Services Program Medicaid Waiver) 

The Home and Community Based Service Program receives funds as outlined in the Older American's Act 

and from the state of Georgia. The Community Care Services Programs received Medicaid funds. Funding 

is also donated by groups and individuals. 

Home Delivered Meals Congregate Meals Homemaker Assistance Respite Care Adult Day Health 

Community Living Program (Consumer-Directed)Medicaid waiver programs (CCSP- SOURCEICWP)Kinship Cares (Grandparents Raising Grandchildren)Alzheimer's Services 

(Education/Training/Daily Living Aids) 

Our organization is not a LTSS funded provider. 

1. CCSP-Community Care Services Program-elderly and/or functionally impaired or have disabilities.2. 

SOURCE-Service Options Using Resources in Community Environment-primary enhanced case 

management under elderly and disabled waiver. Serves blind- aged- disabled who are SSI eligible. 3. 

ICWP-Independent Care Waiver Program-for Medicaid recipients who have severe physical disabilitiesare between the ages of 21-64. 4. NOW-New Options Waiver and COMP-Comprehensive Supports 

Waiver Program-for people who have developmental or intellectual disabilities. 5. GAPP-Georgia 

Pediatric Program--specialized skilled nursing services to medically fragile members with a current 

Individualized Family Service Plan- age birth to 3 years of age. 6. MFP-Money Follows the Person-helps 

people living in nursing homes and ICF-MR facilities to transition and resettle in to a community setting. 7. 

Older Americans Act programs Homemaker Home-delivered meals Congregate meals Caregiver 

Support Respite Personal support services 

1. Community Care Services (CCSP)Provision of twenty-four hour- seven-day-per-week availability for 

medically-impaired individuals and their families to determine service needs and interventions; planarrange- coordinate- monitor and evaluate services; communicate with medical professionals; and refer to 

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52 (b). Please describe the publicly funded LTSS services in your state. This includes LTSS programs 

funded solely by state or county 

community resources as appropriate2. Elderly Legal Assistance Program (ELAP) Legal advice- counseling 

and representation by an attorney or other person acting under the supervision of an attorney: 

(NAPIS_2010)3. Georgia CaresProvides information to individuals regarding their eligibility for benefitsone-on-one assistance with pursuing claims/benefits- and advocacy on behalf of the beneficiary4. 

Gateway/ADRC Options Counseling Long-term support options counseling is an interactive decision 

support process whereby consumers- family members- and/or significant others are supported in their 

deliberations to determine appropriate long-term care choices in the context of the consumers€TM needspreferences- values- and individual circumstances. (AoA definition 2010)Gateway/ADRC Specialists will 

be trained to provide options counseling via telephone during FY2014.5. Money Follows the Personal€¢

Gateway/ADRCs MDSQ Options Counseling: Long-term support options counseling is an interactive 

decision support process whereby consumers- family members- and/or significant others are supported in 

their deliberations to determine appropriate long-term care choices in the context of the consumer€TMs

needs- preferences- values- and individual circumstances for individuals currently living in nursing 

facilities and is provided face-to-face (AoA definition 20010.)6. Home and Community Based Services 

(HCBS) In-Home Services€¢ HCBS Homemaker Services: Assistance with preparing meals- shopping for 

personal items- managing money- using the telephone or doing light housework (NAPIS_5_2010)â€¢

HCBS Personal Care Services: Personal assistance- stand-by assistance- supervision or cues 

(NAPIS_5_2010)7. Home and Community Based Services (HCBS) Caregiver Services HCBS Caregiver 

Respite Care: In-Home: services which offer temporary- substitute supports or living arrangements for care 

recipients in order to provide a brief period of relief or rest for caregivers. Respite Care includes personal 

care- homemaker- and other in-home respite. (NAPIS_5_2010) 8. Home and Community Based Services 

(HCBS) Kinship Care Services€¢ HCBS Kinship Caregiver Group: Activities provided on behalf of

kinship caregivers and kinship care receivers to support their continued independence and well-being9. 

Home and Community Based Services (HCBS) Nutrition and Wellness Programs â€¢ HCBS 

Nutrition/Wellness: Congregate Meals: A meal provided to a qualified individual in a congregate or group 

setting. The meal as served meets all of the requirements of the Older Americans Act and State/Local laws. 

"e; (NAPIS_5_2010)â€¢ HCBS Nutrition/Wellness: Home Delivered Meals: A meal provided to a 

qualified individual in his/her place of residence. The meal is served in a program administered by SUAs 

and/or AAAs and meets all of the requirements of the Older Americans Act and State/Local laws. 

(NAPIS_5_2010) May include assistive technology for dining. (DAS) HCBS Nutrition/Wellness: Nutrition 

Counseling€¢ HCBS Nutrition/Wellness: Health Promotion and Disease Prevention Group10. Home and

Community Based Services (HCBS) Case Management. Assistance either in the form of access or care 

coordination in circumstances where the older person or caregiver is experiencing diminished functioning 

capacities- personal conditions- or other characteristics which require the provision of services by a formal 

service provider and/or family caregivers. Activities of case management include such practices as 

assessing needs- developing care plans- authorizing and coordinating services among providers- and 

providing follow-up and reassessment- as required "e; (NAPIS_5_2010)11. Other Home and 

Community Based Services (HCBS). HCBS Information and Assistance: A service that: (A) provides 

individuals with information on services available within the communities; (B) links individuals to the 

services and opportunities that are available within the communities; (C) to the maximum extent 

practicable- establishes adequate follow-up procedures. Internet web site; hits& ; are to be counted only if 

information is requested and supplied. Quote; (NAPIS_5_2010) HCBS Telephone Reassurance: Interaction 

with individuals by telephone to reduce social isolation- provide support and ensure health and safety. 

(DAS) HCBS Home Modification/Home Repair: Provision of housing improvement services designed to 

promote the safety and well-being of adults in their residences- to improve internal and external 

accessibility- to reduce the risk of injury- and to facilitate in general the ability of older individuals to 

remain at home. May also include the purchase and installation of assistive technology or devices such as 

locks- smoke detectors- tub rails- improved lighting- etc. For Kinship Care- items could include but are not 

limited to safety electrical plugs- child safety gates- and window/drawer safety latches.(DAS) HCBS 

Transportation (DHS Unified): Provision of DHS Unified Transportation as a means of transporting clients 

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52 (b). Please describe the publicly funded LTSS services in your state. This includes LTSS programs 

funded solely by state or county 

from one location to another. Does not include any other activity. (DAS)12. Long-term Care Ombudsman 

(LTCO)Provision of services that protect and improve the quality of care and quality of life for residents of 

long-term care facilities through advocacy for and on behalf of residents and through the promotion of 

community involvement in long-term care facilities13. Alzheimer Programs& Personal care for dependent 

elders in a supervised- protective- and congregate setting during some portion of a day. Services offered in 

conjunction with adult day care typically include social and recreational activities- training- and 

counseling..."e; (NAPIS_ 5_2010) 14. Chronic Disease Self-Management Program (CDSMP)A 

Stanford University evidence-based program facilitated by non-health professionals to improve the skills 

needed to manage day-to-day problems with chronic disease. Skills taught include appropriate exercisecommunication- nutrition and pain management techniques. (DAS)15. Other Services- Programs- or Grant 

Funded Projects€¢ Medicare Improvements for Patients and Providers Act (MIPPA): This act- signed into 

law on July 15- 2008- encompasses significant changes and opportunities for Medicare beneficiariesparticularly those who are low-income. A Care Transitions: Created by Section 3026 of the Affordable Care 

Act- the Community-Based Care Transition Program (CCTP) provides funding to test models for 

improving care transitions for high-risk Medicare patients by using services to manage patients transitions 

from acute-care hospitals with high readmission rates to another setting- such as a long-term care facility or 

the patients home 

Information and Referral/ Assistance - The provision of information- assessing the needs of individuals and 

referring them to appropriate services- advocacy- crisis intervention and follow up- as defined by the 

Alliance for Information and Referral Systems (AIRS). Short Term Crisis Intervention - Short-term crisis 

intervention is used to prevent unnecessary institutionalization- whether that is short-term hospitalization or 

long-term placement- and to stabilize individuals and their families in times of immediate need before they 

have been connected to ongoing support and services. It usually involves intensive supports over a period of 

a few days. Benefits Counseling - Benefits counseling involves counseling individuals about public 

benefits- assisting in applying for benefits- and offering guidance regarding appeals for denied applications. 

Options Counseling - Options Counseling is a person-centered- interactive- decision-support process 

whereby individuals receive assistance in their deliberations to make informed long-term support choices in 

the context of their own preferences- strengths- and values. Planning for Future LTC Needs - The process 

of planning for ones€TMs future long term care needs. For ADRCs- this may involve the provision of 

information- options counseling and resources about retirement planning- financial planning- LTC 

insurance- and reverse mortgages. SHIP Counseling - The State Health Insurance Assistance Program- or 

SHIP- is a national program that offers one-on-one counseling and assistance to people with Medicare and 

their families. Peer Counseling - Centers for Independent Living offer peer counseling as a core service--

individuals with disabilities serve as role models to peers- providing information and support- and facilitate 

decision making. Adult Protective Services - Adult Protective Services (APS) strive to insure the safety and 

well-being of elders and adults with disabilities who are in danger of being mistreated or neglected- are 

unable to take care of themselves or protect themselves from harm- and have no one to assist them. In most 

states- APS caseworkers are the first responders to reports of abuse- neglect- and exploitation of vulnerable 

adults. Independent Living Skills Training - Centers for Independent Living offer skills training as a core 

service - training activity- focusing development of practical skills people with disabilities need to achieve 

or increase independence. Advocacy - Centers for Independent Living offer advocacy as a core service 

utilizing a process that emphasizes consumer control and self-reliance. An array of approaches aimed at 

assisting persons with disabilities to take charge or their life choices- act on their own behalf- and overcome 

situations that reduce the potential for independence. The Alliance for Information and Referral Systems 

defines advocacy as a key part of Information and Referral- to ensure that people receive the benefits and 

services to which they are entitled and that organizations within the established service delivery system 

meet the collective needs of the community. Caregiver Support Services - education- information- supportcounseling- respite- training- and other types of supports (usually provided on a short-term basis or 

intermittently) provided to family caregivers and other informal caregivers who provide support for older 

adults or people with disabilities. Prevention- Health Promotion- or Risk Reduction Programs â€“ programs

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52 (b). Please describe the publicly funded LTSS services in your state. This includes LTSS programs 

funded solely by state or county 

that aim to reduce risk of disease- prevent disease and its negative consequences- and enable individuals to 

increase their control over and improve their health. Employment Services or Service Coordination -

activities provided to assist individuals in securing employment or acquiring learning skills that promote 

opportunities for employment. Housing Services or Service Coordination - assistance with locating and 

securing appropriate- affordable- and accessible housing in a variety of community-based settings 

depending on the level of need. Assistive Technology pieces of equipment and other items or installations 

that are used to increase- maintain- or improve functional capabilities of individuals with disabilities. Home 

Modification Services - retrofits or adjustments to existing homes that are undertaken to improve physical 

accessibility for older adults and people with disabilities. These can take a variety of forms depending on 

the level of investment and the scope of the improvement and address any number of obstacles to 

independent living. Home modifications range from simple improvements such as adding non-slip strips to 

bathroom floors or other smooth surfaces- improving lighting- providing telephones with large numbers and 

letters- and installing grab bars and lever door handles. More complex (and expensive) modifications 

include- but are not limited to- the installation of ramps- chair lifts- stair glides- widened doorways- roll-in 

showers- and lowered countertops. 

Kupuna Care Title III Programs 

Nursing facility costs. Community based waiver services in certified care and foster homes for adults. 

Home delivered meals. In home supports for individuals living in their own home or with others and at 

risk for nursing facility admission; partially covered by Hawaii's Medicaid Managed Care model. 

Community based supports funded by State funds (Kupuna Care program). 

Home-delivered meals Personal Care Homemaker Chore Adult Day Care Transportation Financial 

Assistance Medical Food Stamp Community Services for Developmentally Disabled Vocational 

Rehabilitation for the Blind Public Housing 

ABD services are provided through two Managed Care Organizations that utilize a medical model of 

service provision. This leaves a huge gap in the; social; services that are often quite warranted in order to 

help the ABD population improve or maintain functional levels. Sometimes the ABD population is too; 

poor; to receive OAA-funded HCBS- but not; sick; enough to receive in-home supports and services 

through the Managed Care Organizations.DD/MR services are provided through a participant-directed 

model. 

aged and disabled waiver, respite nutrition meals, case management adult protection nursing home and 

assisted living ombudsman homemaker 

State Senior Services Act- Older American's Act- and Medicaid 

#NAME? 

Medicaid Waiver HCBS -Illinois Community Care Program: Comprehensive Care Coordination In Home 

Care Adult Day Services Emergency Home Response Money Management 

Medicaid Waiver for DD population Medicaid Waiver for 60 years of age and older Medicaid Waiver for 

people with disabilities Medicaid Waiver for Medically Fragile/Tech Dependent Children Medicaid Waiver 

Program children with DD support Medicaid Waiver Program for children with DD residential Medicaid 

Waiver for Persons with Brain Injury Supportive Living Facility waiver Cash Counseling Program - this is 

not in our area limited areas in IL Money Follows the Person Choices for Care Institutional: ICFICF/MR 

Inpatient Psych. Service for individuals under age 21Services for individuals 65 and older in an institution 

for mental illness Skilled Care Nursing Facilities 

CHOICE- Home and Community Based Services funding provided by Indiana for individuals who are at 

risk of institutional placement. 

In the State of Indiana- the Area Agencies on Aging / ADRC's are the single points of entry to LTSS 

services. ADRC staff provide options counseling and eligibility screening for LTSS. Funding sources for 

LTSS include: Medicaid Waiver- CHOICE (state funded)- SSBG and Title 3 programs. 

CHOICE 

The CHOICE (Community and Home Options to Institutional Care for the Elderly and Disabled) Program 

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52 (b). Please describe the publicly funded LTSS services in your state. This includes LTSS programs 

funded solely by state or county 

is a resource that eligible individuals are using to receive support services in their homes. Services provided 

may include case management- transportation- attendant care- home delivered meals- homemaker servicesvarious therapies provided in the home- respite care- access to adult day programs in the communitymedical supplies and other services necessary to prevent residential placement into nursing homes- group 

homes- state hospitals and other large group living facilities. The program serves those who are 60 years of 

age or older and persons with disabilities of all ages who are eligible due to long term or lifelong limitations 

such as dependence on others to bathe- dress- eat- or go to the bathroom; limitations in ability to express 

personal needs and/or understand the communication of others; limitations in learning and maintaining selfcare- communication- social and/or domestic skills; limitations in the ability to move purposefully between 

environments; and limitations in the ability to make decisions- show acceptable judgment- and/or recognize 

the consequences of ones€TMs actions. The program is available regardless of income- but there is a basic 

fee or cost share for services based on a sliding fee scale. 

CHOICE 

Aged and Disabled Waiver Traumatic Brain Injury Waiver CHOICE in-home servicesSSBG in-home 

services Title III family caregiver services 

CHOICE 

CHOICE- SSBG- TITLE-3- TITLE-3D- TITLE-3E- HCBS WAIVERS- UNITED WAY- LOCAL 

GRANTS 

Medicaid state plan Medicaid waivers CHOICE - state funding HCBSOlder Americans Act Social Service 

Block grant Transportation assistance for city transit systems VA Medicare Township Trustee 

Aged and Disabled and Traumatic Brain Injury Medicaid Waivers. CHOICETIII programs Social Services 

Block Grant 

TIII- TIIIE- SSBG- CHOICE AND MEDICAID WAIVER FUNDING 

CHOICE? 

CHOICESSBG Title III Title III-E 

The Options Counselors assist clients in understanding the publicly funded LTSS services as well as assist 

them in completing the Medicaid and/or the waiver applications for home and community based services. 

Options Counselors do not determine eligibility for these publicly funded programs. 

Senior Care Act Sedgwick County In-home Program 

Senior Care Services- Older Americans Act funded services- Money Follows the Person- Home Health 

services- Community Transition Opportunities 

HCBS (Home and Community Based Services) waivers of Physically Disabled- Traumatic Brain InjuryFrail Elderly- that the ADRC focuses on. There are other waivers that the ADRC does not work with. 

Senior Care Act services--State funded in home services for those over 60 based on sliding fee scale. Older 

American's Act services-funded through federal Older American's Act dollars. 

These services include the HCBS Medicaid waiver programs including FE- PD and TBI that the ADRC 

currently assesses functional eligibility for. In addition- for individuals over the age of 60- the state funds a 

program for in-home assistance called Senior Care Act that is based on a client's functional eligibility and 

copay determined by income and asset information. 

Older Americans Act and Senior Care Act 

Senior Care Act and Older American Act 

State funded Senior Care Act Program. This is a co-pay program based on the customer's income and 

assets. 

Frail Elderly Physically Disabled Traumatic Brain Injury ID/DD Autism Senior Care Act Older Americans 

Act Case Management Durable Medical Equipment Advocacy Information/Referral In-home services Legal 

Transportation Nutrition 

Homecare services for Home making- personal care- respite- escort to Dr.- Home Repair. Personal Care 

Attendant Services Adult Day Care Services Home and Community Based Waiver Services Michelle P 

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52 (b). Please describe the publicly funded LTSS services in your state. This includes LTSS programs 

funded solely by state or county 

Waivers Waivers ABI Waivers TBI Trust Funds Hart Supportive Living Disease Prevention and Health 

Promotion Services 

Program Name: Adult Day Care Program/ Alzheimer Respite. Description of Services: Provides a limited 

amount of funding to assist with paying for adult day care and Alzheimer respite services. Eligibility: 

Applicants must meet one of the following criteria: Be age 60 or older- physically disabled or frail as a 

result of a medical condition- and need supervision/assistance during the day; Be age 60 or older- mentally 

confused- and need supervision to prevent injury and assure proper nutrition/medication use; Be age 60 or 

older and need individualized attention and social structure because of emotional or social needs; Be any 

age with a diagnosis of Alzheimer disease or related dementia. Documentation Needed: Proof of age and 

income. Cost: Fees are based on income using a sliding fee scale. Extraordinary medical expenses may be 

considered. Program Name: Bluegrass Help at Home Registry. Description of Services: The Bluegrass 

Help-at-Home Registry is an online resource that connects people who need in-home assistance with people 

who want to provide those services (usually for a fee). The searchable directory can be used for services 

such as personal care- housekeeping- respite/sitting- escort/transportation- shopping- meal preparationlawn care- home repair- live-in help- and other activities. Eligibility: Must live in or want to work in the 

Bluegrass Region. Documentation Needed: Service providers must agree to a criminal background check 

through the Administrative Offices of the Courts. Cost: Service providers must pay a fee for a criminal 

background check. Program Name: Consumer Directed Option/ Home Community Based Waiver. 

Description of Services: The Consumer Directed Option (CDO) allows people who are eligible for 

Medicaid Waiver services to choose their own providers for nonmedical waiver services. Services (based 

on need) may include homemaking- personal care- respite- attendant care- minor home adaptation- and 

medical supplies. The Bluegrass AAAIL provides assessment and Support Broker services for people in the 

Home Community Based (HCB) Waiver. Eligibility: 1. Must be elderly or disabled and meet nursing 

facility level of care. 2. Must apply for and meet special financial eligibility requirements to qualify for 

Medicaid. Documentation Needed: Applicants must have a physician’s recommendation that- without 

services- placement in a Nursing Facility or Intermediate Care Facility would be appropriate. Must provide 

financial and other documentation required to apply for Medicaid. Cost: Participants may have a monthly 

patient liability- based on their income. Patient liabilities are determined by the local Department of 

Community Based Services office as part of the Medicaid application process. Program Name: Kentucky 

Family Caregiver Program. Description of Services: Provides supportive services to grandparents who are 

the primary caregiver of a grandchild who is 18 or younger. Services include: Financial assistance for the 

purchase of clothing- respite assistance- educational supplies or assistance- medical and dental serviceslegal services- and other authorized expenses; Information and assistance; Counseling and information 

about support groups and caregiver trainings. Eligibility:1. The child’s parents may not live in the home. 2.

Gross household income cannot exceed 150% of the federal poverty level. 3. The grandparent cannot 

receive state Kinship Care for caring for the grandchild. 4. The grandparent must meet the following 

requirements: Be a Kentucky resident; Be related to the grandchild by blood- through marriage or 

adoption; and Be the child’s primary caregiver. Documentation Needed: Must complete an application and

provide proof of income. Program Name: Kentucky State Homecare Program. Description of Services: 

Provides the frail elderly who have functional disabilities or chronic health/social problems with basic 

services. Care plans are designed to help participants remain in the community and prevent early or 

unnecessary institutionalization. Services (based on need) may include: Homemaking; Personal care; 

Home delivered meals; Respite care; Escort to medical appointments or other essential services; Chore; 

Minor home repair. Eligibility: Must be 60 or older and determined eligible by a qualified case manager. 

Individuals must need assistance in at least two Activities of Daily Living (such as eating- bathingdressing- toileting and getting in and out of bed)- or three Instrumental Activities of Daily Living (including 

meal preparation- laundry- housekeeping- and grocery shopping). They may also have a combination of 

deficiencies to be eligible for program services. Documentation Needed: Proof of age and income. Cost: 

Fees are based on income using a sliding fee scale. Extraordinary medical expenses may be considered. 

Program Name: National Family Caregiver Support Program. Description of Services: Provides supports 

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52 (b). Please describe the publicly funded LTSS services in your state. This includes LTSS programs 

funded solely by state or county 

for family caregivers- including: Funding for respite care; Funding for supplemental services- such as 

equipment or supplies- to help with caregiving; Information and assistance- Trainings- and Other 

supportive services for caregivers. Eligibility: The program serves: Caregivers of any age who care for a 

family member aged 60 or older; Caregivers of any age who care for a family member aged 55 or older 

with a diagnosis of Alzheimer Disease-related dementia; Grandparents or other relatives at least 55 years 

old who are the primary caregivers for children aged 18 or younger. There are no income restrictions and no 

income or asset testing. Documentation Needed: Must complete an application and caregiver selfassessment. Program Name: Nutrition Services. Description of Services: The Nutrition Services Program 

for older adults includes (1) congregate meals that are served in area Senior Centers and nutrition sites- and 

(2) home delivered meals for people who are homebound. Eligibility for Congregate Meals: An individual 

must: Be aged 60 or older- Be the spouse of an individual aged 60 or older- or Have a disability and live at 

home with an eligible older individual. Eligibility for Home Delivered Meals: An individual must: Be 

homebound due to illness or disability; Be aged 60 or older- the spouse of an individual aged 60 or olderor have a disability and live at home with an eligible older individual; Be unable to attend a congregate site 

because of illness or an incapacitating disability; and Not have a person in the home able to prepare a 

nutritious meal on a regular basis. Documentation Needed: Verification of age. Cost: There is no fee but 

donations are encouraged. Program Name: Senior Center Services. Description of Services: Local senior 

centers provide: Supportive services; Social activities Information and assistance; Health promotionrecreation and education programs; Transportation; Advocacy; Congregate meals; Home delivered 

meals; In-home supports (personal care- homemaking- respite- chore); Escort; Friendly visiting; 

Telephone reassurance; and many other services. Eligibility: Participants must be at least 60 years old or be 

the adult disabled dependent of a senior. Documentation Needed: Some activities require advance 

registration. Cost: Most activities are free- but some may require a fee. Donations are accepted. Program 

Name: Senior Community Services Employment Program (SCSEP). Description of Services: SCSEP is a 

community service and work-based training program for older workers. The program provides subsidizedservice-based training for low-income individuals 55 or older who are unemployed and have poor 

employment prospects. Participants work up to 20 hours per week in community service activities for 

minimum wage. The ultimate goal is to help participants transition into unsubsidized positions in the public 

or private sectors. Eligibility: Participants must: Be at least 55 years old- Be unemployed- Be a resident of 

the Bluegrass Region- and Have a family income of no more than 125% of the federal poverty level. 

Program Name: Legal Assistance. Description of Services: Legal Aid Services provide leadership for 

improving the quality and quantity of legal and advocacy assistance as a means for ensuring a 

comprehensive elder rights system. Legal Aid Services Assistance is provided district-wide by Legal Aid of 

the Bluegrass and the Access to Justice Foundation. They provide free civil legal advice- assistance- and 

referrals for older Kentuckians on issues such as: Medicare; Medicaid; Prescription Drug Assistance; 

Consumer Issues; Family Law; Power of Attorney; Guardianship; Housing and Property; Estate Planning; 

Debt Collection; and Living Wills. No assistance is provided to individuals seeking advice and consult in 

matters of criminal law. Eligibility: Legal Services Assistance recipients (or their caregivers) must be at 

least 60 years of age. There are no income restrictions- however many services are targeted at low and 

moderate income individuals. Documentation Needed: Depends on service provided. Cost: There are no 

charges for services provided with federal Title III funds. Contributions are strongly recommended but not 

required; they are accepted anonymously to ensure equal treatment. Program Name: State Health Insurance 

Program. Description of Services: The Kentucky State Health Insurance Assistance Program (SHIP) 

provides information- counseling and assistance to seniors and disabled individuals- their family members 

and caregivers. Trained counselors can help eligible individuals with: Understanding Medicare and/or 

Medicaid coverage and supplemental insurance; Understanding and comparing supplemental policies and 

plans; Filling out prescription drug discount program applications; and Applying for public benefits. 

Eligibility: Must meet one of the following criteria: Be at least 60 years old- Be a disabled individual with 

Medicare- or Be a family member or caregiver for a senior or disabled individual with Medicare. 

Documentation Needed: Depends on the type of assistance needed. Cost: None. Program Name: Nursing 

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52 (b). Please describe the publicly funded LTSS services in your state. This includes LTSS programs 

funded solely by state or county 

Home Ombudsman Agency of the Bluegrass. Description of Services: Ombudsman Services are funded 

through the Nursing Home Ombudsman Agency of the Bluegrass. This agency provides services to 

institutionalized elderly throughout the Bluegrass Region. Every nursing home and family care home in the 

Bluegrass area has a local Ombudsman who serves as an advocate for the rights of the residents and helps 

to resolve problems. Each nursing home resident is visited at least once a month. The Ombudsman Program 

also provides training and public education in Elder Abuse Prevention designed to alleviate situations of 

abuse- neglect- self neglect and exploitation among older persons in family and personal care homes. The 

Ombudsman Agency: Provides regular friendly visitors to residents of long-term care facilities Protects 

the rights of citizens Identifies- investigates- and works to resolve resident concerns Empowers residents 

and families to make informed choices Monitors and works to enact laws protecting older Kentuckians 

Eligibility: Ombudsman Services are available to any individual district-wide who is a resident of a longterm care facility- a family member- friend- or concerned party- and the community at-large who 

acknowledges the need for and the right to quality care in long-term care facilities. Cost: There are no fees 

or charges associated with the services- although donations are accepted. 

Adult Day Home care Kentucky Caregiver for Grandparents Participant Centered Attendant Care Program 

Medicaid- food stamps- Medicaid Waiver programs 

We don't have funding solely by state or county 

Various Medicaid Waiver program In-Home Services Adult Day Care Services 

HCBW- Home and Community Based Waiver LIS-Low Income Subsidy MSP-Medicare Savings Program 

SNAP 

We are not a state agency. The state agency would have to answer. 

Long Term Personal Care Services- Community Choices Waiver- Adult Day Health Care- New 

Opportunities Waiver 

Medicaid Food Stamps Food Boxes Title III Services 

The office work together to pool resources in meeting the needs requested 

See State of Maine report 

This information is not available at the local level. 

Maine Care for LTC- Medicare Saving Program; Supplemental Nutrition Assistance- Low Cost Drugs. 

In Home Aid Services Senior Care National Family Caregiver Support Services Waivers 

Medicaid Waivers Senior Care Medical Assistance Personal Care In-Home Aid Service 

Medical Assistance- Food Stamps- Temporary Cash Assistance. 

Food Stamps- Group Senior Housing Subsidy- National Family Caregiver Program- IIB in-home servicesIHAS- MAPC- Energy Assistance- Prescription Drug Assistance 

Older Adult Waiver Living at Home Waiver Medical Day Care Waiver Money Follows the Person Senior 

Care 

Medicaid Waiver- LAH Waiver- Money Follow the Person- Senior Care- MOW- National Family 

Caregivers Support Program. 

LTC program that has as its goal to keep clients in the least restrictive environment. The program provides 

care management and some services to individuals who eligible. (State /county funded.)IHAS Program 

that gives persona care/chores and respite to eligible clients (State Funded)Senior Center Plus Program 

that provides care for frail elderly and disabled clients in the Senior Center setting (fee for 

Service)MAPCSP Personal Care assistance for eligible Medicaid recipients in Anne Arundel County. 

Federal/State funded) 

Senior Care - provides supportive services (adult day care- in-home care- medical supplies- emergency 

response system and medications) to persons age 65 and older to remain in their homes as long as possible. 

Senior Centers - 14 sites in Baltimore City; provides social- recreational- educational and health driven 

services and activities Transportation - Taxi-Card/Taxi Access - cab door to door mobility services 

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52 (b). Please describe the publicly funded LTSS services in your state. This includes LTSS programs 

funded solely by state or county 

Guardianship - court appointed guardian of person; provides life management services for persons age 65 

and older who have been adjudicated disabled by the Circuit Court. Footnote: Medical Assistance Personal 

Care 50% State funded Medicaid Waiver for Older Adults Money Follows the Person 

Maryland Department of Aging Cecil County Senior Services and Community Transit (AAA)Maryland 

Access Point (MAP)- under AAA Cecil County Health Department- AERS- Core Service- DDA Cecil 

County Housing Authority - Section 8Cecil County Department of Social Service: Energy AssistanceMedicaid Application- Food Stamps- IHAS Employed Individuals with Disabilities Program 

(EID)Maryland Primary Adult Care (PAC) Program Maryland Energy Assistance Program (Electric 

Universal Service Program)Medical Assistance Medicare Part D (Low-Income Subsidy)Medicaid Waiver 

for Older Adults Qualified Medical Beneficiary Program Special Low Income Medicare Beneficiary 

Program Senior Care Program SNAP (Food Stamp Program)State of MD Drug Assistance Program 

Supplemental Security Income State of MD Homeowners Tax Credit Program State of MD Renters Tax 

Credit Program60+ Legal Aid Program Senior Housing Subsidy Program Ombudsman Services Program 

Maryland Caregiver Program State Health Insurance Program (SHIP)Senior Medicare Patrol 

(SMP)Veterans Programs 

Medicaid HCBS Waivers - Waiver for Older Adults (50+ years); Living at Home Waiver (18-64 years); 

TBI Waiver; DDA Waivers; Medical Adult Day Care Waiver Medical Assistance Personal Care Program -

any age; must be on Medicaid and meet ADL/IADL requirement Medicaid Programs - Medicaid- SNAPTAMF- etc. Title II B and ESenior Care Program - state-funded- for individuals 65+ who meet functional 

and income/asset eligibility Senior Assisted Living Group Home Subsidy - state-funded- for individuals 

62+ who are currently living in a small ALF setting and meet income/asset eligibility Attendant Care 

Program - 18-64 year; person must meet physical disability and income eligibility; self-directed personal 

care services n Home Aide Services - administered by the Department of Social Services; must meet 

functional and income eligibility Home Delivered Meals 

Energy Assistance Homeowners/Renters Tax Credit Forms 

Autism Waiver Service Coordination Provides service coordination to children diagnosed with severe 

autism- ages birth - 21 years- who are currently enrolled in the Autism Waiver program. Individual and 

Family Support Monitors funding provided by the State of Maryland's Developmental Disabilities 

Administration (DDA) for family and individual support services for individuals with developmental 

disabilities. Resource Coordination Assists individuals with developmental disabilities who receive funding 

from the Developmental Disabilities Administration (DDA) in obtaining the best quality and most 

appropriate services and supports with available resources within the community. Resource Coordinators 

provide case management and advocate for individuals receiving services. Respite Care Provides 

occasional- temporary relief to individuals and families who are giving full-time care to children- adults 

with disabilities- or seniors. Care is provided by trained- certified care workers in the family's home or in 

the care worker's home. Transitioning Youth with Disabilities Assists students with developmental 

disabilities in the process of exiting from the school system- and their families with transitioning into adult 

services for ongoing supports through the Developmental Disabilities Administration (DDA). Services 

include adult vocational training- day habilitation- or supported employment services. Medical Assistance 

Waiver for Older Adults A program to enable older adults to remain in a community setting even though 

their age or disability might warrant placement in a long-term care facility (nursing home). MAW allows 

services that are typically covered by Medicaid in a long term care facility to be provided to eligible 

persons in their own homes or in assisted living facilities. Services provided may include personal carerespite care- home delivered meals- assisted living services- family or consumer training- personal 

emergency response systems- dietitian/nutritionist services- assistive devices- environmental adaptations 

and assessments and behavior consultation services. Case management is provided by local Area Agency 

on Aging (AAA).Long Term Care Ombudsman Program A program of advocates for residents living in 

nursing homes and licensed assisted living facilities- including elderly group homes. The program has a 

large number of trained volunteers who regularly visit long-term care facilities- monitor conditions and 

care- and provide a voice for those unable to speak for themselves. Ombudsman help residents and their 

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52 (b). Please describe the publicly funded LTSS services in your state. This includes LTSS programs 

funded solely by state or county 

families understand and exercise their rights guaranteed by federal and state law. Adult Evaluation and 

Review Services provides evaluation and assistance to seniors and adults with disabilities who are at risk of 

institutionalization. AERS staff conduct comprehensive evaluations to identify available services to help 

individuals remain in the community- or in the least restrictive environment- while functioning at the 

highest possible level of independence and personal well- being. The evaluation may be conducted in the 

home setting or the individual's current location. Upon completion of the evaluation- the multidisciplinary 

team develops a plan of care that identifies services needed to help the person remain at home or in the least 

restrictive environment. Home Care/In Home Aide Services provides self-care services to frail seniors and 

adults with disabilities to help them remain in their own homes. The goal is to prevent or reduce the length 

of institutionalization- and help relieve caregivers of some of their responsibilities of care for disabled 

family members. Social Services to Adults provides short-term case management- and seeks to enable 

maximum client self-sufficiency in the community and to reduce inappropriate institutionalization. SSTA 

case management is geared to mitigating those factors that may lead to abuse- neglect- self-neglect and/or 

exploitation. Often the case management is related to a specific need such as personal care- or the need for 

assessment to determine a plan of care. Senior Nutrition Program provides meals in congregate settings 

where activities and services for seniors are available; nutrition education- screening counseling are also 

available. The program also serves as a central contact for home delivered meals- referring seniors to Meals 

on Wheels that serve their addresses. Meals are nutritious and suitable for persons with diabetes- heart 

disease and hypertension because they meet federal standards that include each meal providing at least 1/3 

of the recommended dietary allowances for older adults and complying with the Dietary Guidelines for 

Americans. Kosher- Chinese- Korean and Vietnamese meals and programming targeted to these ethnic 

groups are available at certain sites. Senior Nutrition Hotline: 240-777-1100: Available Wednesday 

mornings from 9:00-11:00 a.m. Offers reliable diet and nutrition information to Montgomery County 

Seniors. Adult Foster Care Unit provides supervised housing and assistance to disabled adults- using family 

homes and small assisted living homes in the community. Case management is provided- as well as subsidy 

when funds are available. Adult Public Guardianship provides surrogate decision making for disabled 

adults adjudicated as incapacitated by the Circuit Court- and in need of the service. The program provides 

case management under the direction of the court and is only considered when there are no other 

alternatives. Senior Mental Health Program Outreach mental health services for seniors who cannot or will 

not go to office-based services; mental health consultation to assisted living providers- senior center 

directors- Housing Opportunities Commission resident counselors; education to the public about mental 

health issues; drop-in groups at senior centers; senior mental health education and consultation to DHHS 

staff. Senior Assisted Living Group Home Subsidy pays a portion of the cost for clients to live in licensed 

senior group homes in Montgomery County. 

Senior Care- provides an array of services for those 65 and older who are at risk for nursing home 

placement. Older Adults Waiver- provides assisted living or in-home services for individuals 50 and older 

that medically meet a nursing home level of care. Home Delivered Meals- provides meals for frail elderly 

adults. Assisted Living Subsidy- provides financial assistance to assisted living residents. Health 

Promotion- provides educational programs. Information Assistance- provides information- assistance- and 

referral services. SSTA- Social Services to Adults administered through DSS. In-Home Aid Servicesprovides light chore services for elderly lacking a support system. National Family Caregivers- provides 

information- assistance- support- training- and respite. 

Options Counseling 

Options Program 

see # 42 

State Funded Home Care State MA Traumatic Head Injury State Funded DDS State Funded DMH 

Adult Family Care: consumers can have someone move in to take care of them or they can move in with 

someone Community CHOICES: Nursing facility eligible consumers receive services based on need 

Consumer directed care: state home care program where consumers can hire their own worker Elder care 

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52 (b). Please describe the publicly funded LTSS services in your state. This includes LTSS programs 

funded solely by state or county 

advice Enhanced community options program: nursing home eligible consumer not on Mass Health can 

receive service level ~ $750/month Group Adult Foster Care: consumers receive daily PC Home and 

community based waiver: nursing facility elders receive services based on need Family caregiver support 

Money management program PACEPCA program SCO State Home care Supportive living sites options 

program 

Anything available to consumer including ASAP services such as Community Choices Program and 

Enhanced Community Options Program- Home Care Basic and Home Care Basic Waiver Programs- PCA 

program- PACE- SCO- AFC- GAFC. 

State Home Care program that provides subsidized Home care services to eligible elders age 60 and older. 

Options Counseling provides education- counseling and linkages to services for disables; 18 and over and 

elders. 

Frail Elder Waiver- Money Follows the Person 

Home and Community Based Waiver/Community Choices Enahnced Community Option Program Home 

Care Basic Non Waiver/Consumer Directed Care Service Option Adult Family Care Group Adult Foster 

Care Personal Care Attendant Program Senior Care Options Program 

Office of Services to the Aging/Older Americans Act programs; Medicaid Home Help; MI Choice 

Medicaid Waiver; PACE; VA 

Waiver Programs Nursing Facilities Home Help CMH Services 

About 70% of Michigan's Skilled Nursing Facility residents rely on the Medicaid entitlement to pay for 

their stay. Michigan has long-running home and community-based waivers which support additional 

persons who meet a SNF level of care and Medicaid financial requirements who wish to age in place- or 

transition from a SNF to home- or to a licensed setting. 

Same as the SLL description and the report was attached. 

Not applicable for the website. 

http://www.dhs.state.mn.us/main/groups/aging/documents/pub/dhs16_144888.pdfThis is a detailed 

description of a report provided to the department explaining the long term services and supports across 

Minnesota. 

LIEAP--Low Income Energy Assistance program -- helps individuals receive financial with their heating 

bills CSFP -- commodity supplemental food program -for those 60 and older or some WIC children --

qualify income wise to receive supplemental box of food monthly SSA LIS extra help for their Rx costsreducing their costs for copays at the pharmacy- have to be income eligible and resource eligible- can 

reduce costs of their premiums and deductibles. SNAP -- Supplemental Nutrition Assistance Program- only 

income eligible HOMEOWNER/RENTER TAX CREDIT -- have to be 62 yrs of age- and has an income 

eligibility and have to reside in their own home or Assisted Living or Long Term Care Facility COUNTY 

PROPERTY TAX ASSISTANCE PROGRAM -- income eligibility and resources for reducing ones 

property taxes 

Elderly Tax Credit- Big Sky RX 

Most public programs but there are several foundations as well. Neighborworks- Food Bank- Set Free 

Minorities- Inter-faith Alliance- City County Health Department- City County Health Care Clinic- Center 

for Mental Health- Area VIII Agency on Aging. 

Lyon County Aging and Disability Resource Center (ADRC) Site provides assistance with accessing the 

following LTSS programs so individuals are able to continue living independently or assistance with 

choosing and paying for a Long Term Care Facility: Community Options Program for the Elderly (COPE); 

Assisted Living (AL) Waiver- Home and Community Based Waiver (CHIP)- Waiver for the Elderly in 

Adult Residential Care (WEARC). Additionally- Lyon County Human Services provides Case 

Management- transportation- 3 nutrition sites- home delivered meals- and homemaking services. 

Assisted Living Waiver- CHIP- Congregant Meals- COPE- Institutional Medicaid- Medicaid- MedicareMeals on Wheels- State Independent Living- State Personal Assistance Services- Title III- title XX 

Homemaker- WEARC Waiver- Adult Day Program- DME- Guardianship- Home Care Agency- HousingPage 183 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

52 (b). Please describe the publicly funded LTSS services in your state. This includes LTSS programs 

funded solely by state or county 

Housing-Rural- PERS- Respite Care- Senior Center- SNAP- Transportation- Disability RX- Senior RXSHIP- Utility Assistance 

HCBS (CHIP)Homemaker Services (Title XX)Assisted Living (AL) Waiver COPE (Community Options 

Program for the Elderly)Disability Services Disability Rx WEARC (Waiver for the elderly in adult 

residential care)Homemaker (WC)Case Management (WC)Adult Day Care (WC)Geriatric Health and 

Wellness Services (Visiting Nurse/medication management - WC)Representative Payee (WC)Home 

Delivered Meals/Congregate Meals (WC)ADRC (WC) 

Clients have multiple options as to where to apply- thus- tracking is often challenging as systems don't 

seem to connect easily. There is participant directed services found mostly in the waiver programshowever- there is some consumer choice in state plan services. While choice is available- finding providers 

to provide services at that given rate is challenging given the rural nature of Belknap County. Some of the 

towns around the lake are so poorly undeserved by providers- even for the insured. Publicly funding 

programs remain fragmented- however there is a lot of discussion around no-wrong-door- thus allowing for 

clients to be served more effectively and efficiently. 

We have three waivers: Choices for Independence HBCB LTC; Acquired Brain Injury and 

Developmentally Disabled and nursing home services. 

Publicly funded LTSS services include HCBC- DD and TBI waivers for Medicaid. Each program provides 

case management to eligible individuals- and services/supports are coordinated based on the needs of the 

consumer. Differences occur in each waiver based on funding and need. 

New Hampshire is committed to providing home and community based services that promote 

independence- safety and dignity. Choices for Independence is a Medicaid- funded program that supports 

choices for adults who meet both financial and medical requirements. 

JACC- SWR- Homemaker 

Older Americans Act; Jersey Assistance for Community Caregiving 

JACC 

Jersey Assistance for the Community Caregiver (JACC) 

Global Options- JACC (Jersey Assistance Community Caregiving)- NJ Care- PACE 

State Medicaid plan services: Meals- transportation- certified home health- caregiver support- home 

modification- nursing home- medical supplies- visiting nurse-m adult day care etc. 

Jersey Assistance for Long Term Care (JACC)Statewide Respite Program Adult Day Services for persons 

with Alzheimer Disease or Related Disorder Personal Assistance Service Program (PASP) assistance to 

adults with disabilities who are employed- involved in community work or attend school. Older American 

Act Title IIIB Services i.e. Transportation- Meals on Wheels. Personal Assistance 

GOJACCPACEMFP Congregate Housing Statewide Respite 

GO- JACC- Respite- MCMAP (Middlesex County Multi Assistance Program)- Senior Meal Program 

JACC- CARES- Statewide Respite and local community grants. Home Energy and Weatherization 

Programs PAAD Medicaid 

We provide Care Management under the Global Options Medicaid Waver program coordinating LTSS 

Program for the consumer. JACC is a non-Medicaid LTSS program. The State Respite Program provides 

further LTSS program. 

Waivers- PCO- nursing Homes- PACE 

Nursing Home Transition Diversion Waiver Traumatic Brain Injury Waiver Medicaid Personal Care 

Expanded In Home Services for the Elderly (EISEP)Caregiver Respite (Title IIIE) 

For Monroe County- we have: Food Stamps- Public Assistance (TANF and Safety Net)- Medicaid- Chronic 

Care Medicaid- Transportation- New York State for the Elderly funding- Administration on Community 

Living/AOA funding- waiver programs- HEAP- Nutrition- Medicaid Savings Program- Senior Medicare 

Patrol- HIICAP/SHIP- RSVP- EPIC- Senior Companion- Kinship Care (Kinship Navigator)- Senior 

Community Services Employment Program (Title V)- EISEP and Ancillary Services- Supplemental 

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52 (b). Please describe the publicly funded LTSS services in your state. This includes LTSS programs 

funded solely by state or county 

Security Income- SSD- HUD/Section 8 Housing- Home Delivered Meals- Social Adult Day and Medical 

Day Services- Legal Services- Certified Home Health Aid Program- Ombudsman- Personal Care and Chore 

Services- Nutrition Counseling- et. all 

EISEP 

SULLIVAN NYCONNECTS (ADRC)Congregate Meals (Title III C-1)Homebound Meals (Title III C2)Nutrition Counseling (CSI)Caregiver Resource Center (CRC and Title III-E)Medicare Savings Program 

(MSP)Low Income Subsidy (LIS) Extra Help Supplemental Nutrition and Assistance Program 

(SNAP)Home Energy Assistance Program (HEAP)Long Term Home Health Care Program Personal Care 

Consumer Directed Personal Assistance Children with Special Needs 

Medicaid Medicare SNAPHEAPHUD Home delivered meals transportation meal sites Medicare savings 

program 

Weatherization- Medicare Saving Program- Snap- Heap- Cash Assistance- MA- Tax relief- Home 

Delivered Meals- Eisep- Epic- SSI- LIS 

The Ashe County CRC is housed at Ashe Services for Aging which include the Senior Center. At the 

Senior Center- we hold the SHIIP Program along with LIS support- Transportation Shuttle program along 

with many others. We also house the Adult Day Care- the Congregate Program- Home Delivered MealsIndependent Living apartments that are income based- The Ashe Assisted Living and Memory Care- The 

CAP DA Program- In-home Aide Program- and more. 

We assist with people signing up for Medicare- Extra Help for the costs of Prescription Drugs- Part D 

Plans- CAP services and Money Follows the Person. The Department of Social Services handle 

applications for Medicaid. 

LTSS for older adults and adults with disabilities in Wake County/NC include: Information and Assistance 

Options Counseling Transportation Elderly and Disabled Transportation Assistance Program 

(EDTAP)Accessible Raleigh Transportation (ART) Program Travel Training for Adults with Disabilities 

Housing and Home Repair Services Energy Assistance Food Assistance At-Risk Case Management 

Individual and Family Adjustment Services Respite- In-Home and Group Family Caregiver Support Peer 

Mentoring for Adults with Disabilities Health Promotion/Disease Prevention Legal Services In-Home 

Aides Personal Care Services CAP-DAPACE (hopefully to open soon in our area)Congregate Nutrition 

Home Delivered Meals Senior Centers Adult Day Care Adult Day Health State-County Special Assistance 

for Adults State-County Special Assistance In-Home Adult Placement Services Medicare Savings Program 

Long-Term Care Medicaid Private Living Assistance Medicaid Adult Care Homes Family Care Homes 

Skilled Nursing Facilities Money Follows the Person Adult Foster Care Adult Protective Services Adult 

Guardianship Services Hospice and Palliative Care Services Vocational Rehabilitation Vocational 

Rehabilitation--Independent Living Services Veterans Services Adjustment Services for the Blind and 

Visually Impaired Medical Eye Care Program LTSS specifically for individuals with I/DD include: 

Community Guide Developmental Therapy Personal Assistance Vocational/Day Activity Services 

(Supported Employment- Adult Developmental/Vocational Program- Leisure Services- Supported 

Retirement)Residential Services (ICF-MR group homes- group living for adults- alternative family livingsupported living)State Developmental Centers NC Innovations (Medicaid waiver program)NC START 

(Systemic-Therapeutic Assessment-Respite and Treatment for adults with I/DD age 18 and over with 

complex behavioral or MH needs)LTSS specifically for individuals with MH or SA needs include: 

Assertive Community Treatment Crisis Assessment and Stabilization and Crisis Residential Services 

Integrated Dual-Diagnosis Treatment Outpatient Therapy Drop-In Center Psychosocial Rehabilitation 

Substance Abuse Detoxification Substance Abuse Intensive Outpatient Treatment Substance Abuse 

Residential Services Wellness Management and Recovery for individuals with serious mental illness State 

psychiatric hospitals 

Care Coordination Programs: Programs are designed to provide home and community based services to 

consumers so that they may remain safely in their home. Caregiver Support: Funding source Older 

Americans Act Senior Community Services: Funding source State Block Grant Comcare HSL: Funding 

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52 (b). Please describe the publicly funded LTSS services in your state. This includes LTSS programs 

funded solely by state or county 

source county levy dollars 

HEAP- Food Stamps 

Waiver Programs Money follows the person programs 

PASSPORT Home Choice Ohio Benefits Bank MIPPA Long Term Care Consults Caregiver Support OAA 

Medicaid Home Health Kinship Navigator 

Assisted Living Medicaid Waiver Program Caregiver Support Choices Medicaid Waiver Program 

Long-term Care Consultations Office of the State Long-term Care Ombudsman Older Americans Act 

PACE PASSPORT Medicaid Waiver Program Senior Services Property Tax Levies 

The LTSS publicly funded that are managed and administered at the local level by AAA 3 are 

PASSPORT- Waiver -Assisted Living Waiver- Home First- State Block funded Care Coordination Program 

-Home delivered Meals- Senior Dinning Program- Congregate Meals - Senior Farmers Market Nutrition 

Program - Senior Emergency Home repair- Alzheimer Respite and Find A Ride. Local and State 

Ombudsman is support by state awards of SLTC funds-NF bed fees -Federal VII and Elder Abuse 

/Transition Funds. Local Council on Aging throughout the Area Agency on Aging 3 service are supported 

by local levies and United Way funds. These funds support Outreach- Information and ReferralTransportation- Minor Chore- Elderly Day Care and Homemaking at the local level. 

No programs solely funded by state or county. 

No programs are solely funded by state or county. 

SNAP- Weatherization- Rural Development Loans- Utility Assistance 

No programs solely funded by state or county 

In Oregon- LTSS programs include Nursing Facilities (Institutions)- Assisted Living Facilities- Residential 

Care Facilities- Adult Foster Homes- Relative Adult Foster Homes- and In-home Services. 

Developmental Disability Waiver Mental Health Services Oregon Project Independence Family Caregiver 

Program 

Waivers and Act 150 

Aging Waiver - Provides long-term care services to qualified older Pennsylvanians living in their homes 

and communities. AIDS Waiver - Provides home and community based services to eligible persons age 21 

or older who have symptomatic HIV Disease or AIDS. Attendant Care / Act 150 - Information for 

mentally-alert Pennsylvanians with physical disabilities. COMMCARE Waiver - Home and communitybased program developed for individuals who experience a medically determinable diagnosis of traumatic 

brain injury. Consolidated Waiver for Individuals with Intellectual Disabilities - Provides services to 

eligible persons with intellectual disabilities so that they can remain in the community. Independence 

Waiver - Provides services to persons with physical disabilities to allow them to live in the community and 

remain as independent as possible. Infant- Toddlers- and Families Waiver - Provides services to children 

from birth to age three in need of Early Intervention services who would otherwise require the level of care 

provided in an Intermediate Care Facility (ICF). LIFE (Living Independence for the Elderly) - Managed 

care program for frail- elderly recipients who have been determined to need & quot; nursing facility level of 

care " but wish to remain in their home and community as long as possible. OBRA Waiver - Provides 

services to persons with severe developmental physical disabilities- such as cerebral palsy- epilepsy or 

similar conditions. Person/Family Directed Support Waiver - Provides services to eligible persons with 

mental retardation so that they can remain in the community. 

Act 150Aging Waive Attendant Care COMMCARE Independence OBRALIFE Community 

Act 150 - Over 60 and Under 60OBRAIndependence Waiver Agency with Choice MFP CommCare AIDS 

Waiver Attendant Care Waiver Autism Waiver Consolidated Waiver for Individuals with MR 

Act-150Attendant Care Independence Commcare OBRA Autism 

Act 150AgingMR/ID Options 

Aging Waiver- Act 150- PFDS Waiver- Consolidated Waiver- Family Caregiver Support- OBRA waiverPage 186 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

52 (b). Please describe the publicly funded LTSS services in your state. This includes LTSS programs 

funded solely by state or county 

Independence Waiver- Attendant Care waiver- COMM Care waiver 

Waivers and Act 150 

Waivers and Act 150 

PDA Waiver Attendant Care Comm Care Independence Act 150Consolidated Waiver for Individuals with 

Intellectual Disabilities Infant- Toddlers- and Families Waiver Person/Family Directed Support Waiver 

Available in the state- but no current county participants in the: AIDS Waiver LIFE 

Attendant Care Waiver- COMMCARE Waiver- Independence Waiver- OBRA Waiver- 0192 (AIDS) 

Waiver- Aging Waiver- and Act 150 Attendant Care Program. 

HCBS Medicaid Waivers including: Aging- autism- independence- attendant care- Act 150- etc. 

PDA Waiver- Independence Waiver- CommCare Waiver- Attendant Care Waiver- OBRA WaiverOptions- Act 150 

Aging Waiver Act 150OptionsFamily Care Giver Support 

Aging Waiver Act 150Independent Waiver 

Waivers and Act 150 program. 

CommCare Waiver- Aging Waiver- ACt 150- Attendant Care Waiver- Independence Waiver- MR WaiverOBRA Waiver- Options Services 

Independence Waivers; Act 150. 

Over 60RespiteEPSDTOBRACOMMCAREIndependenceAct 150AutismHIVAs earlier listed we provide 

most of the waivers available in Pennsylvania. 

List waivers and Act 150 

Waivers and Act 150 

Waivers and Act 150 

Aging Waiver- COMMCARE Waiver- Attendant Care Waiver- Independence Waiver- OBRA Waiver- Act 

150 Program- HCBS thru AAA Block Grant Funding- LIFE/LTCCAP (PACE) Program- AIDS Waiver. 

Aging Waiver - Provides long-term care services to qualified older Pennsylvanians living in their homes 

and communities. AIDS Waiver - Provides home and community based services to eligible persons age 21 

or older who have symptomatic HIV Disease or AIDS. Attendant Care / Act 150 - Information for 

mentally-alert Pennsylvanians with physical disabilities. COMMCARE Waiver - Home and communitybased program developed for individuals who experience a medically determinable diagnosis of traumatic 

brain injury. Consolidated Waiver for Individuals with Intellectual Disabilities - Provides services to 

eligible persons with intellectual disabilities so that they can remain in the community. Independence 

Waiver - Provides services to persons with physical disabilities to allow them to live in the community and 

remain as independent as possible. Infant- Toddlers- and Families Waiver - Provides services to children 

from birth to age three in need of Early Intervention services who would otherwise require the level of care 

provided in an Intermediate Care Facility (ICF). LIFE (Living Independence for the Elderly) - Managed 

care program for frail- elderly recipients who have been determined to need " nursing facility level of 

care" but wish to remain in their home and and community as long as possible. OBRA Waiver -

Provides services to persons with severe developmental physical disabilities- such as cerebral palsyepilepsy or similar conditions. Person/Family Directed Support Waiver - Provides services to eligible 

persons with mental retardation so that they can remain in the community. 

Waivers and Act 150 

Waivers and Act 150 

Waiver and Act 150 

PA HCBS Medicaid Waivers and Act 150PA Lottery-funded services ,State-funded human services 

programs 

Independence Waiver Obra Waiver CommCare Waiver Attendent Care Waiver Aging WaiverACT 150 

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52 (b). Please describe the publicly funded LTSS services in your state. This includes LTSS programs 

funded solely by state or county 

Waivers and Act 150 

Waivers and Act 150 

Not Known 

Consolidated Waiver (ID)Person/Family Directed Services Waiver (ID)Attendant Care Waiver (Under 60 

Physical Disability)Act 150 (Under 60 Physical Disability)Options (60+)Life Programs (55+)Aging Waiver 

(60+)Independence Waiver (Under 60 Physical Disability)COMCARE Waiver (TBI)AIDS Waiver HSDF 

Homemaking Services (18-59) 

Waiver Act 150 

Waivers and ACT 150 

Waivers and Act 150 

Options Care Management Home Community Services Guardenship Family Caregiver Support Program 

PDA Waiver OBRA Independence MA Waiver Act 150PFDS Waiver Consolidated Waiver 

Aging Waiver Program- Act 150- CSPPPD Waivers- Attendant Care WaiverThe following LTSS services are provided in Rhode Island. The description of the services is as follows: 

Waivers Core Community Svcs -- Community Services are provided as needed to clients and caregiverssuch as: regional POINT services at nine locations across Rhode Island and SHIP services provided at six 

locations across Rhode Island. Case management agencies are also included within the core community 

services in Rhode Island. Through case management services- clients receive an assessment of their needs. 

A case manager develops a plan of care which includes options for community-based services. The case 

manager will assist in securing needed services- monitor the care plan- and offer training and support for 

family caregivers. Clients with limited incomes and scarce cash resources may qualify for free or reducedcost home care services. There are seven case management agencies strategically located across Rhode 

Island. THE POINT also refers clients to adult day care centers- where seniors and adults with disabilities 

are able to have a meal and perform activities- while being supervised by trained and qualified staff. These 

DEA licensed centers provide frail and functionally-challenged adults (including those with Alzheimer 

disease and related dementia) with care and supervision in a safe environment. Services include therapeuticrecreation and health services- and respite for caregivers. There are 19 adult day centers in Rhode Island. 

DEA Assisted Living -- DEA distributes assisted living waivers- which are paid for by Medicaid. 

Placement into any facility is done by an intake process performed by THE POINT staff. Once a referral is 

determined and given to DEA- they assign the case to a case management agency- who in turn places the 

client into the appropriate assisted living setting. Preventative Community Svcs. DEA offers preventive 

services to seniors at no cost under the ACA- in partnership with the Rhode Island Department of Human 

Services and the Rhode Island Department of Health. Preventative services are a defined pattern of nursing 

and medical care that focuses on disease prevention and health maintenance. It includes early diagnosis of a 

disease- discovery and identification of people at risk for developing specific problems- counseling- and 

other necessary measures of intervention to avert a health issue. Screening tests- health education- and 

immunization programs are common examples of preventative care in Rhode Island (e.g. the Living Well 

Program- a Chronic Disease Self-Management program which is a partnership between DEA- Department 

of Health and THE POINT at United Way of Rhode Island. RI Housing Assisted Living -- Rhode Island 

Housing oversees the management of 20-000 apartments for low-income seniors- families and persons with 

disabilities. Approximately 15-000 of these apartments are in Section 8 status. In this category- 30 percent 

of a tenants income is used to pay rent. The remaining 5-000 apartments qualify for a variety of subsidies 

which keep the rents affordable to low-income households. Shared Living-- Shared Living is a form of selfdirected care in which a person who is eligible for Medicaid long-term care- and who cannot live 

independently- can choose to live in a caregivers’ home. The Shared Living caregiver is responsible for

providing a home-like environment to the beneficiary- as well as personal care- meals- transportation- and 

other individual needs which include helping with laundry- shopping or paying bills. One of the benefits of 

the Shared Living program is that a person can age in place that is- stay in one stable setting as their health 

needs change. Hab Community Svcs/ Hab Group Home -- The Hab services and group homes provide both 

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52 (b). Please describe the publicly funded LTSS services in your state. This includes LTSS programs 

funded solely by state or county 

individual one-on-one living assistance- as well as shared group experiences to individuals with disabilities 

for the enhancement of their social skills and other needs. Other LTSS Programs Assisted Living Facilities -

- Rhode Island defines an assisted living residence as any facility that provides lodging- meals and personal 

assistance- including help with the activities of daily living- medication management and monitoring of 

resident health and safety for two or more adults. Assisted living residences can be identified by any namesuch as a sheltered care home or a board and care residence- as long as they meet the established definition 

for assisted living. In RI- there are 37 assisted living facilities. Group Homes â€“ Rhode Island offers group 

home services to Rhode Islanders with disabilities- including those with intellectual disabilities. A group 

home in Rhode Island is defined as a small supervised residential facility- as it is for the mentally ill or 

wards of the state- where residents typically participate in daily tasks and are often free to come and go on a 

voluntary basis. ICF/MR Private -- Programs for individuals with intellectual disabilities- managed 

independently by either private not-for-profits- or independent organizations. The clients may be covered 

by Medicaid- Medicare- or a private insurance carrier. ICF/MR Public â€“ Programs managed by the

Rhode Island Department of Human Services mainly for individuals with intellectual disabilities. Medicaid 

typically covers the cost of clients in these facilities. RICLAS -- As one of the first community providers of 

service to people with developmental disabilities in Rhode Island- Rhode Island Community Living and 

Supports (RICLAS) has over 25 years of experience in providing a network of supports tailored to 

individual needs. RICLAS is licensed by the State of Rhode Island as a provider of services. RICLAS 

follows all applicable state laws and regulations- and receives oversight by the Office of Facilities and 

Program Standards and Licensure within the Department of Behavioral Healthcare- Developmental 

Disabilities and Hospitals. The standards set by the Division of Developmental Disabilities (DDD) form the 

framework of the service system and are fully described under rules and regulations. RICLAS supports 

adult men and women in a variety of homes- apartments- and day support services throughout the state. 

Trained and experienced staff advocates for individual rights- promotes opportunities- and helps people 

develop competencies in both residential and work activity settings. PACE -- PACE Organization of Rhode 

Island serves as a catalyst for change in the Long Term Care industry. The program provides the right careat the right time- in the right setting for participants. The PACE model of care is unique because of its use 

of an interdisciplinary team. Team members meet daily to discuss the needs of clients. These meetings 

allow open communication of issues so that team members can resolve problems promptly- avert serious 

medical concerns and plan for changes that will best address the needs of clients. The team includes: a 

medical director and nurse practitioner- nursing staff- social work staff- certified nursing assistance stafftransportation- activities staff- nutritionist services- and rehabilitation staff. Connect Care Choice -- In 

Rhode Island Connect Care Choice is managed by the Rhode Island Department of Human Services. CCC 

is a health care option for adults who have Medical Assistance coverage and are 21 years of age or older. 

The goal of Connect Care Choice is to improve access to primary care- help coordinate health care needsand link clients to support services within the community. 

We have Long-Term Care Services administered by Medicaid. This includes the Home-Based Waiver 

Services Program administered by the Medicaid Program. 

There are two (2) publicly funded LTSS services in SC for seniors and people with disability. The first is 

the SC Department of Health and Human Services HCBS Waiver Program called Community Long Term 

Care (CLTC). CLTC offers an array of services from age 65 and older- physical disability- brain injuryHIV/AIDS and PDD. The applications for these services can be found on-line- at the local Medicaid 

office- from the Aging- Disability and Transportation Resource Center (ADTRC) and/or through other 

providers of services. Each waiver program has so many slots or clients they can serve. The waiting list is 

currently a statewide waiting list and it can take up to 3-6 months to get a slot after the client has met 

financial and level of care requirements. The other LTSS service is funded through the Older Americans 

Act and state funded services administered by the State Unit on Aging- The Lieutenant Governor's Office 

on Aging (LGOA)- managed by the AAA/ADTRC and provided by local service providers. The services 

they provide are congregate and home delivered meals- transportation- home care and evidence based 

programs. Funding for these programs is limited and most services typically have a waiting list. 

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52 (b). Please describe the publicly funded LTSS services in your state. This includes LTSS programs 

funded solely by state or county 

CLTC 

We assist clients in filling out Extra Help for Medicare benefits and LIS- QMB- SLMB- and Food Stamp 

applications. 

State LTSS Services include Nutrition (Meals and Nutritional Supplements)- Personal Care- Nursing 

Services- Homemaker Services- Assistive Devices- Emergency Response System- Specialized Medical 

Supplies- Specialized Medical Equipment- Tele health- Caregiver Services (Respite)- Adult Day Services. 

Tennessee's CHOICES program provides the elderly (65 years of age and older) adults with physical 

disabilities (21 years of age and older) who are eligible for TennCare with needed long term services and 

supports in the home/community setting or nursing home which help meet both the medical and nonmedical need of people with a chronic illness- physical disability and intellectual disability who cannot care 

for themselves for long periods of time. Long-term care can be provided at home- in the community- in 

assisted living or in nursing homes. 

State funded OPTIONS for Community Living 

Title III homemaker and home delivered meals OPTIONS (state funded) homemaker- home delivered 

meals- personal care Family Caregiver homemaker- home delivered meals- respite care 

State Funded Options Homemaker Program State Funded Options Personal Care Program State Funded 

Options Home Delivered Meals Program 

Choices - TennCare- Medicaid Waiver Older Americans Act Services (Nutrition- Personal CareHomemaker)National Family Caregiver Program Options for Community Living Program 

Options for Community Living Wal-Mart Foundation 

You can get long-term care services through the state if you have Medicaid. If you don’t have Medicaidyou can apply for it by using the Application for Assistance in Texas . The Texas Health and Human 

Services Commission will decide if you are able to get Medicaid. A State case worker will determine 

functional eligibility. 

Medicare Savings Program- Community Attendant Services- Extra Help- SNAP- Medicaid Buy In- etc. 

Several Medicaid Waivers Older Americans Act Rehabilitation Act Dept. Of Education 

DADS administers all waiver (HCS- CLASS- DBMD- TXHML) SDHS has MDCP and other kids 

programs. DADS has breakdown of how many & quote; slots& quote; are in use and number of 

individuals’ on interest list for each.

Community-Based Alternatives (CBA) waiver: This waiver is a home and community-based services 

waiver that provides services so that people do not have to live in a nursing home or intermediate care 

facility. In some cases- enrolling in this program also means enrolling in the STAR+PLUS managed care 

program. The CBA waiver covers people with disabilities as well as older adults. STAR+PLUS 

Program:This is a managed care program serving people with mental and physical disabilities and older 

adults who need long-term care. Participants in this program choose a health plan from the options available 

in their counties- and Medicaid helps pay for services from these providers. Many support services can be 

provided in the home- helping people avoid moving into institutions. Enrollment in the STAR+PLUS 

program is mandatory for people who live in certain areas and receive Medicaid. These people include 

those with mental or physical disabilities- and all people who receive SSI- and all those who qualify for 

Community-Based Alternative (CBA) services. The main feature of STAR+PLUS is support coordinationso clients have to work with state Medicaid agencies and their local health care providers to determine 

which services will be available to them. Community Living Assistance and Support Services 

(CLASS):This waiver is the complement to the CBA waiver for people with physical and intellectual 

disabilities who need lower level of care. It provides services for people who dont want to move into an 

intermediate care facility- but who also need long-term care. Consolidated waiver program: This waiver is 

supposed to offer services from many other waivers- including the CBA and CLASS waivers- Home and 

Community Services- and Children’s program- to people who live in certain areas. Multiple Disabilities 

waiver: This waiver serves people who are deaf and blind who also have at least one other disability. In 

order to be eligible- the person with the disability must receive services in the community. Home and 

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52 (b). Please describe the publicly funded LTSS services in your state. This includes LTSS programs 

funded solely by state or county 

Community-Based Services (HCS) Program: This service provides care for people with intellectual and 

developmental disabilities of all ages who want to live at home rather than in institutions. The services are 

available statewide- but you might have to wait until a waiver slot becomes available. Medically Dependent 

Children Program (MDCP):This program provides in-home services to children with disabilities. Texas 

Home Living Program: This program serves people with intellectual and developmental disabilities who 

need support to live independently in their homes. It provides a wide array of services. Integrated Care 

Management Program (ICS) for SSI and related: This program is like the STAR+PLUS program- but is 

available in different areas. This program provides both immediate care and long-term care services- and 

full Medicaid benefits. It is supposed to support people to live in their own homes by making services 

available to them outside of institutions. This program is mandatory for people with disabilities who use 

Medicaid- are over the 21- and receive SSI. It is optional for people under 21.Adult Foster Care 

(AFC)Adult Foster Care (AFC) provides a 24-hour living arrangement with supervision in an adult foster 

home for persons who- because of physical- mental- or emotional limitations- are unable to continue 

independent functioning in their own homes. Community Attendant Services (CAS)Community Attendant 

Services (CAS) is a non-technical- non-skilled service providing in-home attendant services to individuals 

with an approved medical need for assistance with personal care tasks. CAS is available to eligible adults 

and children whose health problems cause them to be functionally limited in performing activities of daily 

living according to a practitioner statement of medical need. Client Managed Personal Attendant Services 

(CMPAS)Under the CMPAS program- DADS contracts with licensed agencies to provide personal 

assistance services to individuals with physical disabilities who are mentally and emotionally competent 

and able to supervise their attendant or who have someone who can supervise the attendant for them. 

Individuals’ interview- select- train- supervise- and release their personal assistants. Licensed Personal 

Assistance Services agencies determine eligibility and the amount of care needed- develop a pool of 

potential personal assistants- and provide emergency back-up personal assistants. Day Activity and Health 

Services (DAHS)Day Activity and Health Services (DAHS) facilities provide daytime services Monday 

through Friday to individuals residing in the community in order to provide an alternative to placement in 

nursing homes or other institutions. Services are designed to address the physical- mental- medical- and 

social needs of individuals. Emergency Response Services (ERS)Emergency Response Services (ERS) are 

provided through an electronic monitoring system used by functionally impaired adults who live alone or 

who are socially isolated in the community. In an emergency- the individual can press a call button to signal 

for help. The electronic monitoring system- which has a 24-hour- seven-day-a-week monitoring capabilityhelps to ensure that the appropriate person or service agency responds to an alarm call from an individual. 

Family Care (FC) Services Family Care (FC) is a non-skilled- non-technical attendant care service available 

to eligible adults who are functionally limited in performing activities of daily living. Home Delivered 

Meals Services (HDM)The Home Delivered Meals program provides a nutritious meal delivered to the 

individuals home to ensure he or she gets at least one healthy meal per day. In-Home and Family Support 

Program (IHFSP) Direct grant benefits to individuals with physical disabilities and/or their families. 

Eligible individuals are empowered to choose and purchase services that help them to remain in their own 

home. Medically Dependent Children Program (MDCP)The Medically Dependent Children Program 

(MDCP) provides a variety of services to support families caring for children who are medically dependentand to encourage de-institutionalization of children in nursing facilities. Primary Home Care (PHC)Primary 

Home Care (PHC) is a non-technical- non-skilled service providing in-home attendant services to 

individuals with an approved medical need for assistance with personal care tasks. PHC is available to 

eligible adults whose health problems cause them to be functionally limited in performing activities of daily 

living according to a practitioners’ statement of medical need. Residential Care (RC)The Residential Care 

(RC) program provides services to eligible adults who require access to care on a 24-hour basis but do not 

require daily nursing intervention. Services include- but are not limited to: personal care- home 

management- escort- 24-hour supervision- social and recreational activities- and transportation. Services 

provided under the RC program are delivered through one of two arrangements: residential care and 

emergency care.---Residential Care is a 24-hour living arrangement in which the individual pays room and 

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52 (b). Please describe the publicly funded LTSS services in your state. This includes LTSS programs 

funded solely by state or county 

board and keeps a monthly allowance for personal and medical expenses. The remainder of his income is 

contributed to the total cost of his care.---Emergency Care is a living arrangement that provides services to 

eligible individuals while case managers seek a permanent care arrangement. Emergency care individuals 

do not contribute toward the cost of their care. Special Services to Persons with Disabilities (SSPD)Special 

Services to Persons with Disabilities (SSPD) include services provided to community individuals in a 

variety of settings. These services are designed to assist individuals in developing the skills needed to 

remain in the community as independently as possible. Area Agencies on Aging Access Assistance 

Services Access and assistance services provided by AAAs (directly- through contracts or vendor 

agreements- and community referrals) help individuals who are older- family members and other caregivers 

receive the information needed to locate and access community services- public and private- and formal and 

informal. Area Agencies on Aging Caregiver Support Services The Older Americans Act- National Family 

Caregiver Support Program (NFCSP) provides critical support needed by families to assist them in 

maintaining their caregiver roles. Under this program- informal caregivers are defined as individuals caring 

for family members- or others- age 60 or older grandparents- or other relative- age 55 or older caring for a 

relative children) age 18 or younger; and individuals caring for persons of any age- with Alzheimer disease 

and related disorders with neurological and organic brain dysfunction. Area Agencies on Aging In-Home 

Support Services Area Agencies on Aging (AAA)- provide in-home services (through contract- vendor 

agreement- and community referral) to individuals who are older to allow the individual to remain safely in 

their home. These services support a comprehensive- coordinated community-based system that results in a 

continuum of support. OAA funds are used to support and promote resources in the community to assure 

the provision of a full-range of coordinated and accessible services. Area Agencies on Aging Nutrition 

Services Area Agencies on Aging (AAA)- and the service providers with which they establish contracts or 

vendor agreements- support a statewide system of nutrition services. These services include congregate 

meals- home delivered meals- nutrition education- nutrition counseling and nutrition consultation .Local 

Authorities General Revenue Service The Local Authority (LA) serves as the point of entry for publicly 

funded IDD programs whether publicly or privately operated. In addition- LAs provide or contract to 

provide an array of services for persons in the IDD priority population with general revenue funds. 

Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID) 

Program The Intermediate Care Facility for Individuals with an Intellectual Disability or a Related 

Condition (ICF/IID) Program provides residential and habilitation services to people with a diagnosis of 

intellectual disability or a related condition. State Supported Living Centers There are 13 state supported 

living centers that provide 24-hour/day residential- treatment and training services for persons with a 

diagnosis of an intellectual disability. Each facility is certified as an Intermediate Care Facility for 

Individuals with an Intellectual Disability (ICF/IID)- a Medicaid-funded federal/state service program. 

Guardianship is a legal method to protect individuals’ well-being when they cannot protect themselves. A 

guardian is a court-appointed person or entity who makes decisions on behalf of an incapacitated person. 

Chapter 13 of the Probate Code defines the purpose- laws- and responsibilities of a Guardian. Promoting 

Independence an individual is a Medicaid recipient in a Texas nursing facility- he or she can request 

services in his or her own community under the "e; Money Follows the Person "e; Program 

without being placed on a waiver interest list. 

HCS Waiver Program Texas Home Living a 1915c Waiver that does not include medical or residential 

services Community Based Alternatives CLASS Personal Attendant Services 

In Region 10 the following publicly funded LTSS services are: CCAD- STAR+PLUS Waiver- CMPASIHFSP- MDCP- CLASS- SSI- QMB- SLMB- QI- ADWI- MBIFood Stamps (SNAPS)- Public Housing (PHA)- Utility Assistance- Prescription Assistance Programs 

(LIS)- Medicare part D- Prescription Discount ProgramsWe have the Social Security Office that individuals can go directly- receive assistance/directions for 

applying. Many individuals that come through ADRC are advised that assistance can also be received 

through Local Triple A- Dept. Of Human Services- and Life Run Agencies. 

regional homemaker- respite- transportation- nutrition- residential repair- income support and health 

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52 (b). Please describe the publicly funded LTSS services in your state. This includes LTSS programs 

funded solely by state or county 

maintenance services through the area agency on aging for older adults state in-home services through the 

Texas Department of Aging and Disability Services for older and disabled persons with low incomes and 

limited resources community-based services for persons with mental illness through the local mental health 

authorities community-based services for persons with intellectual and developmental disabilities through 

the local authorities vocational rehab and independent living services through the Texas Department of 

Assistive and Rehabilitative Services independent living advocacy and skills training through the 

independent living centers- funded by the Texas Department of Assistive and Rehabilitative Services and 

the U.S. Department of Education 

In Home and Family Support Program provides persons with physical disabilities a cash grant to purchase 

medically necessary approved items that will allow the person to live independently or a family member to 

remain in their family arrangement. Community Based Alternatives program provides home and 

community based services to people 21 and older as a cost effective alternative to a nursing home. 

Medicare Savings Program assists individuals that meet the income guidelines and have Medicare by 

paying for their Part B premium costs. Extra Help assists individuals that meet the income guidelines by 

paying for the Part D premium and assisting in the payment of the drugs that the individual takes. 

Ability First is a resource site to assist individuals with Independent Living Goals. 

Aging Services- Independent LivingAlternatives program 

Home Community Based Alternatives 

Services include case management- adult day programs- caregiver support- residential care homes- assisted 

living- and skilled nursing facilities. 

Developmental Disabilities Services Program Medicaid for Working People with Disabilities 

Caregiver Respite programs Dementia Respite Veterans Independence Project funding Moderate Needs 

Group Program for Homemaking 

Choices for Care- Money follows the person- Attendant Services Program- Adult Day- Home HealthAAA... 

Vermont has a vast array of programs for people with disabilities. We pride ourselves on making sure that 

people have choices to stay as independent as possible some of our programs are as followed: The 

Attendant Services Program that supports independent living for adults with disabilities who need physical 

assistance with daily activities.. Program participant hire- train- supervise- and schedule their personal care 

attendant or attendants. Children's Personal Care Services (CPCS) is a state plan Medicaid program 

available to children under the age of 21- with a significant disability or health condition that substantially 

impacts care giving needs and/or the development or self-care needs. The goal of CPCS is to provide 

supplemental assistance with self-care and activities of daily living to Medicaid eligible children with 

significant disabilities or health conditions in the home and in the community. This support is meant to 

supplement- not replace- parental roles Choices for Care is a Medicaid-funded- long-term care program to 

pay for care and support for older Vermonters and people with physical disabilities. The program assists 

people with everyday activities at home- in an enhanced residential care setting or in a nursing facility. 

Developmental disability services assist children- adolescent- and adults who have a developmental 

disability to live- attend school- work- and recreate in their communities 

EDCD wavier- PACE program. 

Medicaid Waiver- Nutrition- Adult Day Program- Nursing Case Management- Senior Adult Mental HealthMoney Management- Legal Services- Assisted Transportation Services 

Adult Day Care, Care Coordination, Care Coordination for Elderly Virginians (CCEVP)Checking Chore 

Chronic Disease Self-Management (CDSMP) and Diabetes Self-Management Communication- ReferralInformation and Assistance (CRIA)Community Living Program (CLP)Congregate Nutrition Disease 

Prevention and Health Promotion Elder Abuse Prevention Emergency Employment - Title III Employment 

- Title VFan Care and Summer Cooling Guardianship Health Education and Screening Home Delivered 

Nutrition Home Health Homemaker I. D. Discount Legal Assistance Local Contact Agency (LCA) Staff 

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52 (b). Please describe the publicly funded LTSS services in your state. This includes LTSS programs 

funded solely by state or county 

Information for Money Follows the Person (MFP)Long-Term Care Coordinating Activities long-Term Care 

Ombudsman Medication Management Money Management Options Counseling Personal Care Preparation 

and Administration of the Area Plan Public Information / Education Residential Repair and Renovation 

Respite Care Senior Farmers' Market Nutrition Program (SFMNP) Socialization and Recreation 

Transportation Virginia Insurance Counseling and Assistance Program (VICAP)Volunteer Adult Protective 

Services intellectual Disability (ID) waiver Day Support waiver Individual and Family Developmental 

Disabilities Support waiver (IFDDS waiver)Elderly or Disabled with Consumer Direction waiver 

Technology Assisted (Tech) waiver 

Our agency has Adult Daycare- Home Care- Personal Care- Transportation- Local Long-Term Care 

Ombudsman- Home Delivered Meals- Congregate Meals- Checking Service- Emergency Response 

System- Emergency Food Bank- Case Management- Senior ID cards- Elder Abuse- Legal AssistanceCaregiver Support (Respite- Access Assistance- Supplemental Services)- VICAP- Information and 

Assistance. 

Medicaid long term care waivers such as the Elderly and Disabled Waiver including consumer-directedhome delivered meals- homemaker- companion- respite- adult day health care- congregate nutritionpersonal emergency response system- Program of All-inclusive Care for the Elderly (PACE)- options 

counseling- transportation. 

OAA programs- Medicaid and SNAP 

Medicaid- SNAP- EDCD Waivers- Fuel Assistance- Cooling Assistance- Weatherization- Auxiliary 

Grants- Housing Assistance 

Medicaid waiver services Respite Grant Companion service Adult Day Health Care grants Caregiver 

support and counseling PACESHIPSNAP Home-delivered Meals Centers for Independent Living Grants 

for Assisted Living MFP Medical Transportation (Medicaid and New Freedom Grants)Rehab services 

Home modifications Assistive Technology Services to Blind and Visually Impaired Services for People 

who are Deaf or Hard of Hearing: Technology Assistance Program (TAP) Virginia Relay 

OAA funded Home-delivered meals OAA funded personal care- homemaker and chore services OAA State 

funded Respite Svcs. OAA funded transportation (for medical appts.)OAA and State funded Case 

Management OAA and State funded Home repairs 

Care Coordination for Elderly Virginians 1Care Coordination for Elderly Virginians 2Care Transitions 

Congregate Nutrition Disease Prevention/Health Promotion Emergency Home Delivered Nutrition III-E 

Adult Day Care – Respite III-E Info Referral/Assistance - AAIII-E Other - SSIII-E Personal Care – Respite 

III-E Transportation – AA Information and Referral/Assistance Local AAA Local Contact Agency MDS 

3.0Options Counseling Personal Care S.O.S. Referrals S.O.S. Service Implementations 

Socialization/Recreation Transportation Virginia Insurance Counseling and Assistance Program 

Senior Citizens Services Act Family Caregiver Support Kinship Caregiver Support Kinship Navigator OAA 

Services 

The publicly funded LTSS services in Northwest Regional Council's service area (Whatcom- Skagit- San 

Juan- and Island Counties) include: Medicaid Medicare Nursing Facilities Assisted Living Facilities Adult 

Family Home Home and Community Based Services Money Follows the Person (MFP)Home Health 

Services Housing Transportation Adult Protective Services Long Term Care Ombudsman Case 

Management Care Transitions Medicaid Personal Care (MPC)Community Options Program Entry System 

(COPES)Family Caregiver Support Program/Respite Services Aging and Disability Resource 

Centers/Senior Information and Assistance Personal Care Adult Day Services Skilled Nursing Congregate 

and Home Delivered Meals Individual Education and Training Personal Emergency Response Devices 

Medical Equipment and Supplies Home Modifications 

Family Caregiver Support Program Chronic Disease Self-Management Care Transitions Lifespan Respite 

Kinship Caregivers Military Services Navigator Title XIX Case Management Medicaid Personal Care 

Medicaid Personal Care COPES Family Caregiver Program Services (housekeeping and errands- RespiteDME- home evals- counselling- support groups- training)Home delivered and congregate meals (OAASCSA- title dollars)transportation (OAA- SCSA- title dollars) Footcare (SCSA)Oral Health clinics (SCSA) 

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52 (b). Please describe the publicly funded LTSS services in your state. This includes LTSS programs 

funded solely by state or county 

Medicaid personal care program Lighthouse Fair 

Lighthouse- FAIR- Medicaid Personal Care and Hospice Programs- Aged Disabled Waiver- TBI WaiverI/DD Waiver 

Lighthouse- FAIR- Medicaid Personal Care and Hospice Programs- Aged Disabled Wavier- TBI WaiverI/DD Waiver 

Medicaid personal care program Light house FAIR 

Lighthouse- FAIR- Medicaid Personal Care and Hospice Programs- Aged Disabled Waiver- TBI WaiverI/DD Waiver 

Lighthouse- FAIR- Medicaid Personal Care and Hospice Programs- Aged Disabled Waiver- TBI WaiverI/DD Waiver 

Lighthouse- FAIR- Medicaid Personal Care and Hospice Programs- Aged and Disabled Waiver- TBI 

Waiver- I/DD Waiver 

Lighthouse-State funded program that provides in home care to clients 60 and over who do not received 

ADW services FAIR-State funded program that provides services (respite) to caregivers of Alzheimer and 

related dementia clients. LIFE-Legislative Initiative Funds for the Elderly. Every senior center receives 

money they can use as want- i.e. Lighthouse- FAIR- Meals Aged and Disabled Waiver-Medicaid funded 

(Federal and State) program for in home care for citizens over 60 and the disabled. TBI Waiver-Medicaid 

funded (Federal and State) programs for care of those with traumatic brain injury IDD Waiver-Medicaid 

funded (Federal and State) program for those with developmental disabilities Medicaid Personal CareMedicaid funded (Federal and State) programs for in home care for those who have traditional Medicaid. 

Family Care - MCOIRIS - Self Directed Support Program Legacy Waiver Counties 

Family Care IRISCOPCIP Family Care Partnership PACE 

Family Care is a managed care program that provides long term care supports for those that meet both 

functional and financial eligibility. The care team includes the member- his/her family or natural supportsa care manager and nurse from the managed care organization. RIS is a self-directed care program in which 

the member is given a budget and sets up his/her own care plan with the aid of a consultant. Community 

Options Program is administered by the local Human Service Dept. in Kewaunee county with funding from 

the state DHS department. Person Care programs are funded through Medicaid. 

Family Care IRIS 

Legacy Waiver in ADRC of the Northwood IRIS Family Care 

Cip 1A- Cip1B Cop Cop-W- CCS-CSP Crisis Program- Family Care- IRIS- CIPII- CRS-Brain Trauma 

Waiver Partnership- Pace- Katie Beckett- Alzheimer and Family Care Givers Support 

85.21 Transportation- Adult Daycare- Long Term Care Waivers- Nutrition program for disabled under age 

60 

In our region: Family Care- IRIS- institutional care 

Energy assistance-Section 8 vouchers- Senior Care prescription assistance- subsidized housing 

Family Care- Partnership- IRIS- National Family Caregiver Support Program- Alzheimer Family Caregiver 

Support Program- Supportive Home Care 

Family Care through CMOs and IRIS 

Family Care IRIS 

The Personal Care Program provides services that are medically oriented activities related to assisting a 

recipient with activities of daily living necessary to maintain the recipient in his or her place of residence in 

the community. Congregate Meal Program provides congregate services such as meals served in a common 

dining room- locations in your community where you can join other seniors for a nutritious meal served in a 

relaxed and friendly atmosphere. The Home Delivered Meal Program is for people age 60 or older who are 

homebound due to health reasons- and physically or emotionally unable to travel for a meal with others. It 

is for those who are unable to obtain food and prepare nutritious meals for themselves on a daily basis. 

Meals are delivered by sensitive- caring persons- many of them volunteers- who are concerned with the 

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52 (b). Please describe the publicly funded LTSS services in your state. This includes LTSS programs 

funded solely by state or county 

well-being of each participant. The National Family Caregiver Support Program maintains and improves 

the ability of the caregiver in the home by coordinating formal and informal support services. The intent of 

this program is to provide information- support and assistance to family caregivers who are caring for a 

person 60 or over. The Alzheimer's Family Caregiver Support Program is available to help families caring 

for a loved one who has been diagnosed with Dementia. The AFCSP provides services and funding for 

Alzheimer's patients and their caregivers. The purpose of the program is to provide opportunities to 

maintain persons with dementia in community placement. Eligible individuals can receive a small grant 

annually to help pay for needed services and supplies. A Dementia Care Specialist is available to help guide 

you in making a decision to enroll in the program- or to provide you with a consultation to learn more about 

dementia- resources and support available throughout Jefferson County. Transportation - The Human 

Services Volunteer Driver Program is intended to provide Driver/Escort Services to the elderly and persons 

with disabilities to get to medical appointments. This program is only available to those individuals who 

have no other means of transportation. Elder Benefit Specialists help the elderly who are encountering 

problems with private or government benefit programs. They are highly knowledgeable in the following 

areas: Medicare- Food Share- Social Security Disability- Supplemental Security Income (SSI)- Senior Care 

and Medical Assistance. Benefit Specialists are trained and guided by attorneys who specialize in elder and 

disability benefits law. They are often called "e; the red tape cutters "e;- and their mission is to 

help people figure out what benefits they are entitled to and what they must do to receive them. Publicly 

Funded Long Term Care Programs: Family Care and Partnership are Wisconsin's flexible health and longterm managed care programs. Family Care provides a full range of long-term care services. Partnershipadds medical care to the long-term support services in Family Care. IRIS is a Wisconsin program where 

consumers self-direct their publicly funded community-based- long-term care supports and services. PACE 

is not offered in Jefferson County at this time. 

Only Medicaid except for some small federal Aging programs. Every funding source has been folded into 

the Medicaid Waivers. 

Family Care Partnership IRISPACESAIL All are LTC Medicaid waivers. IRIS is a self-directed option and 

the only one besides SAIL which is considered a "e; fee for service & quote; program. 

Food Share Energy Assistance 

Family Care IRIS 

Family Care IRIS 

SSI/SSDI Eligibility HIRSP Medicare Supplement MAPP Medicare Advantage Plans Medicare Coverage 

Medicare Part DQMB/SLMB/SLMB +Title III-C Home-Delivered Meals Title III-C-Congregate Dining 

Program Title III-B Volunteer Driver Program Family Care IRIS Alzheimer's Family Caregiver Support 

Program National Family Caregiver Support Program Community Options Program (COP) 

Family Care- IRIS 

Family Care/IRISIIIB/IIIEAFCSP 

55 (d). For which of the following populations is the functional assessment used? 

Specify Other 

All qualified- not dependent on diagnosis 

Everyone that meets eligibility 

Age 60+ 

Aged 60 and older 

Aged 60 and over. Often individuals also have physical disabilities; DD- Brain Injury- HIV; AIDS- medical 

fragility- and; or mental illness. 

Age 60+ 

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55 (d). For which of the following populations is the functional assessment used? 

Specify Other 

60 and up 

60-64 for Senior Care Act and Older Americans Act 

Age 60 and older 

Not applicable - we do not use a functional assessment 

See State of Maine report 

Addictions 

Disability not described above and; or younger than 65 with a disability 

The DD population uses its own assessment tool. Not sure about Brain Injury and Autism 

Functional assessments are used as needed regardless of the population; a person fits within. 

All disabilities 

All disabilities. 

All assessments are self-assessments with ILC Peer Guides because we are and ILC. 

Age 60 and older 

Age 60 and older 

Age 60 and up 

Age 60 and older 

Aged 60+ and older 

family caregiver 

60 and older 

We use the same tool for all parties at present 

Under 65 and disabled 

none 

Alzheimer dementia 

MFP 

All Choices for Care waiver programs and caregiver respite programs 

60 and older 

60+ 

Individuals 60-64 

Aged 60 and older 

aged 60 and older 

Mental illness when dual diagnosis 

any customer who is in a dual service group aged or disabled plus above 

adults with a diagnosed disability currently receiving benefits for that disability or have applied 

HIV; AIDS if consumer becomes disabled; mental health as a co-morbidity 

Under age 60 only 

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56 (a). Is your organization involved in planning for your state’s Exchange? 

If yes, please describe your organization’s role 

Collaborator 

Arkansas is a state partnership state with the federally facilitated exchange so we are working on the 

implementation of that for october 1- 2013. 

We have had some initial conversations and awaiting the rfp for it to become a navigator. 

Working with the exchange to become navigaters 

We are looking at the potential of applying to be navigators. Even if we are not- we are planning for the 

exchange by educating our i r and ship staff and volunteers about the exchange and the expansion in 

medicaid eligibility so that we can assist consumers who contact us. 

Ship counselors- ckf site 

Sharing expertise and experience with statewide consortia 

ADRC working to partner with local extension offices 

State is in planning stages 

Attending organizational; planning meetings. 

Provider 

We are considering becoming a navigator 

Attending meetings with partner agencies who will have a key role. 

On local planning committee 

Planning an affordable care act panel discussion sponsored by the health department and in 

collaboration with the health department- upper bay counseling and support services- union hospitalCecil county public libraries and the local management board 

Our county hd was awarded a connector grant for the 3 lower counties on the eastern shore of maryland 

Ma has an exchange 

We have an exchange 

The commonwealth of Massachusetts has mandatory universal health care 

Ma has universal health care 

Ma has had mandatory universal health care since 2006. 

State of Massachusetts has an exchange 

It is already developed in ma 

Ma already has an exchange 

Commonwealth of Massachusetts has mandatory universal health care 

Mass health 

Ma has universal healthcare 

Mass. Has an exchange 

State of ma 

Mass health in mass 

Commonwealth of Massachusetts has mandatory universal health care 

Ma has a universal healthcare since 2008. 

Mass has mandatory health care 

Ma has an exchange 

Commonwealth of Massachusetts has mandatory universal health care 

Commonwealth of Massachusetts has mandatory universal health care 

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56 (a). Is your organization involved in planning for your state’s Exchange? 

If yes, please describe your organization’s role 

Commonwealth of Massachusetts has mandatory universal health care 

Ma already has exchange in use. 

Mass already has an exchange 

Massachusetts 

Unsure of agency’s role in the state’s exchange at this time.

The area agency on aging and the blue water center for independent living are working closely on the 

aca developments. 

As indicated ADRC state level staff have been redeployed to help get this up and running for the state. 

Minnesota ADRC staff has been temporarily redeployed to work on the exchange. The sll staff may 

become navigators and ipas. 

Sit on subcommittee 

Lyon county human services will partner with the state to provide assistance to individuals wanting to 

sign up for the exchanges 

Provide public comment 

Currently participating in workgroups- however- this is in early stages 

Insurance exchange strategy implementation meetings 

None at this time 

Please see answer provided under Sullivan county service link response 

In collaboration with other agencies working on rfp 

Service link is the state health insurance program -- as part of the service link network which has a 

service link adrc hub established in every county of the state and linked via the service link networkrefer 7 an existing warm transfer set up and key local partners we see ourselves as obvious local hubs for 

overseeing and training and potentially housing health exchange navigators. 

Ashe services for aging senior center is also the shiip site and have agreed to be the health insurance 

exchange for ashe county. 

Conversations are just taking place at the NCAAA meeting this month to learn more about the exchange 

and what the role of crc's and aaa's will be. 

We are in the process of submitting a letter of intent 

Apprise training to prepare for increased calls 

On several advisory boards and looking into the navigator piece 

Advisory capacity 

If Texas opts out of exchange ADRCs will work with federal exchange ill contract 

We are currently researching the possibility of applying to be participants. 

Educator 

Very small role; advisory; capacity on the green mtn. Care board advisory committee 

Participate in local strategy and input sessions. Also applied to become an HBE navigator agency. 

Lacrosse county human services is the governing body and they are working with IM to develop the 

process 

Economic support 

56 (b) .Is your state/site examining ways to align functional eligibility determination for publicly 

funded LTSS with Medicaid financial eligibility determination carried out through the Exchange 

website? 

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If yes, please specify 

The state is looking to streamline. 

The state is trying to develop a system where we can share information; streamline process to give us 

access to EMS and track Medicaid applications 

Only discussion and planning at this point 

Our state is in the planning stages 

Planning committee 

MA has universal health care 

Already developed in MA 

MA has Universal Healthcare 

State of MA 

We are working hand in hand to figure it out 

MA has had universal healthcare since 2008 

See above 

Commonwealth of Massachusetts has mandatory Universal Health Care 

Massachusetts 

This is likely to be in place sometime late 2014- July or later 

The state is planning to do this but not on 1;1;14. Likely July or sometime thereafter. 

Training to staff 

Balanced Incentive Program 

RFPs have been requested in VA. We have signed letters of intent to participate. 

57 (a). Are any of your organization’s functions reimbursed under Federal financial participation 

(FFP) or Federal medical assistance percentage (FMAP)? If so please specify the functions. 

Yes, the following are reimbursed under FFP. 

Medicaid Waiver 

Medicaid Waiver 

ADRC Staff Salary and Fringe 

SEP-Options for Long Term Care 

ARCH- Options Counseling- Older Americans Act programs 

Intake; Screening- Medicaid Benefits Counselors (eligibility assistance) and Medicaid Waiver Specialists 

(program management) 

Options Counseling and Assessment 

Functional Assessment Instrument 

Medicaid 

case management 

MFP 

For administrative expenses incurred in the course of administering Title XIX and Title IV-E of the 

Social Security Act. 

HCB Waiver 

All Medicaid Services 

Choices Program- Home Care Waiver 

Waiver services 

Medicaid Waiver 

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57 (a). Are any of your organization’s functions reimbursed under Federal financial participation 

(FFP) or Federal medical assistance percentage (FMAP)? If so please specify the functions. 

Yes, the following are reimbursed under FFP. 

Waiver services 

Medicaid Waiver 

The SLL will begin doing the PASRR function effective 10;1;14 and through this work the SLL will 

receive FFP- contingent on CMS approval. 

Medicaid Minutes 

Work with clients new to Medicaid program 

New Medicaid applications 

Assessment and counseling 

Local Contact Agency- Child Support 

Medicaid programs 

RSVP- Caregiver Support- Home Delivered MealsAdult Protective Services worker- Case Manager- Eligibility Specialist 

Applications for Medicaid 

ADRC Activities and Nursing Home; ICF MR Relocation Activities 

Information and Assistance with regard to Medicaid 

Any time and work involved in MA functions or screening for MA related services or supports. Care 

Coordination and Quality Improvement Activities - long term care functional screen administration- long 

term care functional screen other-Adrc staff training related to MA 

Outreach and facilitating applications- services coordination- functional screen admin- updates- training 

Medicaid intake; Scheduling 

Long Term Care Functional Screening- Disability Applications etc. 

MA related activities and NH relocation 

57 (b). Are any of your organization’s functions reimbursed under Federal financial participation 

(FFP) or Federal medical assistance percentage (FMAP)? If so please specify the functions 

Yes, the following functions are reimbursed under FMAP 

Medicaid Waiver 

ED Medicaid Waiver 

Medicaid Waiver Programs 

CT Homecare Program and Money follows the Person 

Medicaid Waiver Admin. 

Options Counseling and Assessment 

HCB Waivers 

Medical Assistance Personal Care 

Personal Care Management Program 

case management- long term care facility approvals- LTSS services- Personal Care Attendant Program 

Adult Day Health 

currently FMAP funding does provide funding for options counseling 

I ; A- OC 

Medicaid Administration 

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57 (b). Are any of your organization’s functions reimbursed under Federal financial participation 

(FFP) or Federal medical assistance percentage (FMAP)? If so please specify the functions 

Yes, the following functions are reimbursed under FMAP 

PASSPORT- Assisted Living Waiver- Choices Waiver. 

Screening-Assessment and Case Management 

Adult Protective Services worker- Case Manager- Eligibility Specialist 

Link Coordinator- Outreach ; education- Options Counseling 

LINK Coordinator; outreach and education; options counseling 

Link Coordinator and Outreach ; Education 

Link Coordinator- Outreach and Education- Options 

Link Coordinator- Outreach ; Education- Options Counseling 

Link Coordinator- Outreach ; Education- Options Counseling 

Link coordinator- Outreach ; Education- Options Counseling 

Link Coordinator- Outreach ; Education- Options Counseling 

LINK Coordinator- Outreach ; Education- Options Counseling 

Link Coordinator- Outreach ; Education- Options Counseling 

LINK Coordinator- Outreach ; education- Options Counseling 

Link Coordinator-Outreach and Education-Options Counseling. 

LINK Coordinator- Outreach and education- and Options Counseling 

Link Coordinator- Outreach- Education- Options Counseling 

Link Coordinator- Outreach ; Education- Options Counseling 

Link Coordinator Outreach ; Education- Options Counseling 

Link Coordinator- Outreach; education- Options Counseling. 

Link Coordinator- Outreach ; education- Options Counseling 

Link Coordinator- Outreach ; education- Options Counseling 

Link Coordinator- outreach and education 

Link Coordinator- Outreach ; Education 

Link Coordinator- Outreach- Education- Options Counseling 

Link Coordinator- Outreach ; education- Options Counseling 

Link Coordinator- Outreach and education- Options Counseling 

Link Coordinator- Outreach ; Education- Options Counseling 

LINK Coordinator- outreach and education 

Link Coordinator- Outreach ; Education- Options Counseling 

LINK Coordinator- Outreach ; Education- and Options counseling 

Link Coordinator- Outreach ; Education- Options Counseling 

Link Coordinator- Outreach ; education- Options Counseling 

Link Coordinator- Outreach and Education- Options Counseling 

Link Coordinator- Outreach and education- options counseling 

LINK Coordinator - outreach; education- Options Counseling. 

Link Coordinator- Outreach and education- Options Counseling 

Link Coordinator- Outreach; Education- Options Counseling. 

Link Coordinator- outreach ; education- Options counseling 

We bill Medicaid for services we provide under the Medicaid Waiver program. 

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57 (b). Are any of your organization’s functions reimbursed under Federal financial participation 

(FFP) or Federal medical assistance percentage (FMAP)? If so please specify the functions 

Yes, the following functions are reimbursed under FMAP 

Personal Care- Adult Day Healthcare 

Admin Claiming and Medicaid Transportation 

Enrollment and counseling of MA funded programs 

Eligibility determination 

any work involving MA 

100 % Time Reporting 

I and A- assessment- ADRC activities 

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Section D. Organization Characteristics
 

61a. What organizations comprise the core operating organizations? 

Specify Other 

Community Action 

Easter Seals- Public Health- Home Health- Hospice- Human Resources 

Medicare SHIP office 

Pima County ADRC: PCOA- DIRECT- AHCCCS & ALTCS- DES & DDD- CPSA- Southern AZ VA- AZ 

Veterans Services- Pima County Public Fiduciary- Evercare Select- Mercy Care Plan- DES & APS- Sonoran 

UCEDD 

Hospital Social Workers- DDD 

APS- IHSS- MSSP- Linkages- SOAR-Ombudsman 

County Organized Health Plan (Medi-Cal) 

Single Entry Point for Medicaid Waivers 

Human Services 

APS 

Senior Centers 

Access Agency - Connecticut Community Care- Inc. 

Home Healthcare- GA Cares-Medicare Insurance counseling- Adult Protective Services 

DFCS- AAA Subcontractors 

Hospital: Maui Memorial Medical Center; Public Health Nursing; Adult Protective Services 

Dept. of Rehabilitation Services 

Community Action Agency 

Energy Assistance & Weatherization 

SHIP 

DCF 

Extension service- consumers 

Contracted Service Providers 

Transportation Providers 

Statewide care coordination for home & community based LTSS. 

Department of Social Services; Local Health Department 

Lifestyles of Southern Maryland 

Department of Health 

DSS- Non-Profits 

Department of Social Services and Local Health Department 

Dept. of Social Services- Mental Health Authority 

DSS 

Department of Health 

Holly Communities- Neighborhood Service Center- St. Vincent DePaul-United Needs and Abilities 

(formally Epilepsy Assoc.) Choptank Electric Co-op- Women in Need- St. Joseph House 

Aging Services Access Point 

61a. What organizations comprise the core operating organizations? 

Specify Other 

MassHealth Personal Care Management 

ASAP & AAA 

ESPNS; NSCC; Consumers; Seniors 

Workforce development 

Old Colony Elder Services is a Aging Services Access Point (ASAP). Bristol Elder Services- Coastline 

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Elderly Services and South Shore Elder Services are AAAs and ASAPs. 

Ombudsman Services 

LTSS Provider Organizations 

The ADRC of the Thumb is comprised of 59 organizations- businesses and individuals across three counties. 

Various types of providers that meet the inclusion & exclusion criteria of the website. 

County based LTCC Units 

Food Banks 

Non-profit organization for aging and disability services 

Specify Other: Senior Social Services 

Public Health 

Monadnock ServiceLink ADRC; Monadnock Collaborative- 501(c)3; Regional Hospital (Cheshire Medical 

Center & Dartmouth Hitchcock Keene); Institute on Disability & IHPP; Keene State College; Monadnock 

Volunteer Center & RSVP Program 

Protective services-APS 

Health & Human Services 

Health Dept 

Local DSS 

The Department of Social Services Adult Service Department is a COE for the Ashe County CRC. 

Department of Social Services 

Council on Aging- Department on Aging- Center for Independent Living 

Geriatric care management agency; Hospice and Palliative Care organization; organization which trains and 

matches volunteers with older adults and adults with disabilities for transportation- caregiver supportfriendly visiting & telecare- and chore services 

Hospitals- NFs- Public Health 

Beaver County Behavioral Health (MHMR) 

UDS 

Center for Community Resources 

Living Unlimited- Goodwill- PA Housing Authorities 

CILs 

County Transportation 

Coordinated Services 

Employment One-Stop- County Substance Abuse Agency- United Way 

Rhode Island Department of Human Services funding 

Department of Human Services- Division of Developmental Disabilities 

61a. What organizations comprise the core operating organizations? 

Specify Other 

DHS 

Local Authority 

ECI- & DADS Regional Services 

Gateway to Care 

MHMR 

DWS- Senior Centers 

Vermont Brain Injury Association- Green Mountain Self Advocates and Vermont Family Network 

Department of Social Services 

Community action agency 

Local Departments of Social Services 

Department of Social Services 

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ProjectHomes - Housing rehab agency 

Catholic Charities- Community-Minded Enterprises- Lutheran Community Services 

APS- Children’s Waiver program

DHS - Office of Resource Center Development 

Tribal 

63a. With which organizations do LOCAL ADRC have a partnership and what is the strength of 

relationship? 

the 

Specify Other 

State Departments (with cabinet-level secretaries) 

211- VBCIL- TBIA-GRN MTN family- other AAAS 

Aging 

CCO 

Centers for Independent Living 

Department of Behavioral Healthcare- Developmental Disabilities and Hospitals (BHDDH) 

Department of Commerce 

Department of Elder Affairs 

Department of Insurance-SHIIP 

Department of Public Welfare 

Developmental Disabilities Council 

DOAS 

EOEA 

Executive Office of Elder Affairs 

Executive Office of Elder Affairs 

Holly Community Inc.-

Montana Independent Living Program 

63a. With which organizations do LOCAL ADRC have a partnership and what is the strength of 

relationship? 

the 

Office of Vocational Rehabilitation 

Ohio Department of Aging 

Ohio’s Benefit Bank

PA Dept of Aging 

Partnership Carson City- City of Carson- multiple community partners 

Take Me Home WV-MFP 

Texas Medical Foundation 

TN Dept. of Commerce & Ins. 

UCONN Health Center 

WI Dept of Health Services 

State Agencies (located within state departments) 

APPRISE 

Board of Ed Services for the Blind- Bureau of Rehab services- Oak Hill & NEAT Project 

DADS Regional Services 

Department of Rehabilitation 

Dept of Health Public Health Nursing 

DHS - Office of Resource Center Development 

Division of Services for the Blind 

Mass Rehab Commission 

Medicare Information Office 

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OVR 

Public Welfare 

PVR (MRC in MA) for CL services including IL 

Senior Law 

SHIBA (Statewide Health Insurance Benefits Advisors) 

SHIP program 

TRIAD & Home to Home Foundation 

Wisconsin Bureau on Aging and Disability Resources 

Local Government Agencies 

Apprise- Ombudsman Program- RSVP- SCSEP- Community Action. 

Area Agency on Aging- Capital Area Community Services- MPROCenter for Independent Living- Hospitals- Community CollegeDept of Human Services- Nursing HomesBehavioral Health 

Bureau of Elderly and Adult Services 

Center for Independent Living; Developmental disabilities 

CIL 

CIL 

CIL - Society for Equal Access 

County commissioners of our 11 counties 

County Community Services (ADRC of Linn County) 

63a. With which organizations do LOCAL ADRC have a partnership and what is the strength of the 

relationship? 

County Department of Human Services and several of its Divisions including: Office of Mental Health- Division of 

Children and Family Services (Adult Protective)- Division of Financial Assistance (Housing- Medicaid- Food 

stamps)- Youth Bureau (Intergenerational Programming) 

County Elderly Activities Division: Nutrition Program- Coordinated Services for the Elderly- Senior Employment 

County Health & Human Services 

County Mental Health Dept. 

County Substance Abuse Agency 

County Veteran Service Commissions 

Department of Disability and Aging Services 

Holly Community Inc. 

Includes a wide variety of Aging & Disability Organizations 

Independent living 

Legal Aid 

Mental Health Intellectual Disabilities Coordinated Services Drug & Alcohol 

San Antonio Coalition for Veterans 

School Systems in Central- MA 

Senior centers 

SHIBA 

Transportation 

Veterans Office 

Federal Agencies 

Administration on Community Living (through contracts from New York State Office of the Aging) 

CNCS 

Congressman Tom Marino Office 

Inter-tribal council of NV 

Local Senior Service Agencies 

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Local Tribal Agency 

Medicaid Transportation - Provide directly 

Social Security Administration 

Social Security Administration 

SSA Admin 

Organizations providing Direct Services 

14 Senior Centers- City Reach- 1 Home Health Agency and Host of other Local organizations 

Adult Day Care & Day Health Programs- Hospice- PACE 

Beaver LIFE 

Blind Assoc. 

Buffalo River Services 

Caresource 

Community Action- Inc. 

63a. With which organizations do LOCAL ADRC have a partnership and what is the strength of the 

relationship? 

Community Care of Wake and Johnston Counties 

Department of the Blind 

Disability Partner - Holly Community Inc. 

Employment One Stop 

Employment program 

Hospice of the Foothills- Community Center & Congregate Meals- Alta Regional- & Domestic Violence Coalition 

Laurel Legal- Home & Community Services- Thorne Group- Seniors Helpers. 

MA Association for the Blind and Regional Transit Authorities 

MMAP 

physician practice 

San Francisco Transitional Care Program 

Senior Companion 

Summit Independent Living 

Transition Connections and Interim Health Care 

Veterans Hospital- Wilkes Barre PA 

West Branch Drug & Alcohol 

Advocacy/Referral Organizations 

AARP- Aloha Independent Living Hawaii- Alu Like- American Heart Association- Dept of Veterans Affairs 

CBOC- Disability Rights Hawaii- Hawaii disability Rights Center- Food Basket- Office of Economic OpportunityHawaii Island Adult Care- Hawaii Island Rural Health Association- Hawaii State council on Developmental 

Disabilities- Hospice of Hilo- Parkinson’s Support Group- Project Dana- Services For Seniors- Special Olympics 

Hawaii- Full Life Inc.- UHH College of Pharmacy- Legal Aid Society 

Alcoholic Anonymous 

Disability Rights VT 

Elder Justice Coalition West Central Ohio 

Inglis- JEVS and Homemakers Services of the Metropolitan Area 

Lifestyles of S. Maryland 

Long Term Care Ombudsman 

LTC Ombudsman 

Meals on Wheels 

Monroe County Legal Assistance Center 

Nursing Facilities 

Ombudsman Program 

Operation Able and Shine counselors 

Red Cross 

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Self Determination Housing Project of PA Way Out 

Self-Advocates Becoming Empowered 

Senior Centers 

Single Entry Point 

Wide Variety of Organizations and Services. Community and State Universities; Private Colleges. 

63b. What is the type of partnership agreement? 

Specify Other 

State Departments (with cabinet-level secretaries) 

Health 

MAP site is under the Health Department 

Human Services 

ADRC is part of Human Services 

ADRC Partnership Agreements 

Housed within 

Oversight through Aging 

Parent department 

Other 

Medicinal equipment providers 

State Agencies (located within state departments) 

Aging 

ADRC statewide advisory board 

Current agency 

HCS Office 

Located within - Aging oversees ADRC 

Oversees local ADRC 

Oversight 

Partnership Agreements 

The State Unit on Aging administers the ADRC 

This is a Department in Ohio-see above 

Developmental Disabilities 

ADRC statewide advisory board 

In the process of applying to be a case management provider for Supports for Community Living 

Waiver 

Part of CSB combined agency 

Acquired or Late-Onset Disabilities 

ADRC statewide advisory board 

Disability Rights of Washington State (Protection & Advocacy) 

Part of Division of Aging and Adult Services 

Partnership Agreement 

Mental Health 

ADRC statewide advisory board 

Both are divisions within DSS 

Director severs on Board 

Part of CSB combined agency 

Ashe County CRC needs to update the MOU due to Daymark becoming the local mental health 

provider. 

Medicaid 

Both are Divisions within DSS 

Provider for Support Broker and Financial Management Services for Medicaid Waivers. 

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63b. What is the type of partnership agreement? 

Specify Other 

We are a vendor for PCA Services 

Housing 

Involved with housing issues and participate on workgroups 

Part of CSB combined agency 

Self Determination Housing 

We have contracts for Supportive Housing Sites 

Education 

Internships & Placements 

Special project using students for social work area. 

Working towards a formal MOU 

Other 

Adult Protective Services 

Internships 

Local Government Agencies 

Area Agency on Aging 

(self) 

AAA is ADRC 

AAA is ADRC 

ACMS is the local AAAD 

ADRC administering agency 

ADRC is a function of the ATRC AAA 

ADRC is a program located within the AAA 

ADRC is the AAA 

ADRC is the AAA 

Aging & Community Services is the AAA that covers Bartholomew- Brown- Decatur- Jacksonand Jennings Counties for Indiana. All AAAs in Indiana are also designated as ADRCs. 

ARCH housed within AAA 

As part of the State level MOU 

CENLA AAA 

Combined as one unit 

Agency on Aging 

MAP is the local Area Agency on Aging 

Mercer ADRC is the AAA 

Minuteman is a AAA 

NIAAA is the AAA 

Our ADRC and AAA are fully integrated 

Oversight 

Part of AAA 

Self 

The AAA is at the center of ADRC operations in the county 

The AAAD is the designated ADRC for our 13 county catchment area. 

The ADRC is part of the AAA 

The ADRC is the AAA 

The ADRC is the AAA 

The SLL is managed by the AAA 

This ADRC is also Area 7 Agency on Aging and Disability 

This Agency is a AAA 

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63b. What is the type of partnership agreement? 

Specify Other 

This is our organization 

We are AAA 

We are AAA 

We are AAA & ADRC 

We are the AAA 

We are the AAA 

We are the AAA 

We are the AAA 

We are the AAA 

We are the AAA 

We are the AAA 

We are the AAA 

We are the AAA. 

We are the AAA. 

We are the Agency 

We are the Area Agency on Aging 

We are the local AAA 

We are the Local Area Agency on Aging for Area 1 

Within Human Svc & Health Dept- One Supervisor for ADRC & Aging Services 

County Health Department 

ADRC is located in public health department 

Boston Public Health Commission 

Consensus Agreement 

Heath Dept is by town and city in MA 

Lead agency 

On ADRC Advisory Committee. In process of developing MOU for more formalized partnership 

for cross-training- warm hand-off 

Part of the same organizational unit 

same department- same director 

County Medicaid Office 

Benefits Counseling staff comes to ADRC organizations monthly to train staff and work with 

consumers. 

County Dept of Social Services 

Covered under State contract 

same department- same director 

section of our department 

We are the Medicaid office 

County Department on Aging 

ACMS serves as County Office on Aging 

ADRC is a program under Harford County Office on Aging 

aging unit is part of ADRC 

City Dept on Aging 

Lead Agency 

one combined agency 

Our Aging Services are by town and city- not county in MA 

section of our department 

The AAA is located within the county aging services agency 

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63b. What is the type of partnership agreement? 

Specify Other 

The Ashe County CRC is housed at Ashe Services for Aging- Inc. 

This Agency is a AAA & Dept of Aging 

We are both ADRC and Aging unit 

Country Department on Disability 

aging and disability services are combined in the county 

Our Dept on Disability is by town and city in MA 

This Agency is a AAA & Dept of Aging that merged with the County Dept of Disabilities 

We are both ADRC and DD unit 

County Housing Office 

Housing Authorities are by city and town in MA 

Located in the same County Department 

Reno Housing Authority 

There is no County Housing Office 

Library 

The AAAD has a LOA & rents space for an outreach office from the Dickson county library. 

Other 

Service provider 

Federal Agencies 

Local Veterans Administration 

Partnership Agreement 

Provider Agreement 

VA rep holds monthly benefits meetings at VPAS’ corporate office

VIP program 

Local Indian Health Service 

No Indian Health Services in the County 

Other 

Medicaid Transportation - Provide directly 

Partnership Agreement 

Organizations Providing Direct Services 

211 or Other Call Center 

Boston Elder Info joint program 

Draft Statement of Understanding 

I am the 211 data entry manager of the Ashe County 211 service 

Partnership Agreement 

Specify Other: posting of our info online 

Program of Northwest IN Comm Action 

Referrals to 211 

The 211 System has not been a large component of the county 

The county operates its own 3-1-1 service 

We were the 211 for our area until Dec 31- 2012 

Community Health Center 

On ADRC Advisory Committee. In process of developing MOU for more formalized partnership 

for cross-training- warm hand-offs. 

Referrals to health centers 

The county funds health clinics for people without insurance. 

Community Mental Health Clinic 

Part of CSB combined agency 

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63b. What is the type of partnership agreement? 

Specify Other 

Part of same organizational unit 

Section of our department 

Deaf Service Center 

No deaf service center nearby 

Hospital/Medical Center 

Care Transitions 

CCTP 

Coalition Charter Agreement 

Geriatric Support Service Coordinators for Commonwealth Care Alliance SCO members served 

at Boston Medical Center 

In planning stages for Care Transitions 

One local hospital developed a policy statement for VPAS to provide Care Transitions with 

hospital’s patients

Referrals made 

The ADRC has LOA’s with three hospitals for Care transition services.

Transitions programs 

School for the Blind 

No school for blind in Cecil county 

No School for the Blind in the County 

School for the Deaf 

No school for deaf in Cecil county 

No School for the Deaf in the County 

The ARC 

Via CSB 

United Way 

Agency is yearly contributor 

This is limited though to just some AAA offices. 

United Way is the 211 agency previously listed 

Vocational/Rehabilitation Services 

Advisory Council 

Via CSB 

Other 

Advisory Council 

On ADRC Advisory Committee. In process of developing MOU for more formalized partnership 

for cross-training- warm hand-offs. 

Advocacy/Referral Organizations 

AIDS Coalition 

As needed basis 

No AIDS Coalition known 

No relationship 

Not a large organization in the County 

Referral 

Alzheimer’s Association 

ADRD Grant 

As needed basis 

Partnership Agreement 

Referral 

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63b. What is the type of partnership agreement? 

Specify Other 

Service Provider 

Support groups 

American Council for the Blind 

No known affiliation 

Autism Society State/Regional Chapter 

Health Department Core Services- DDA 

No relationship 

Brain Injury Association State/Regional Chapter 

As needed basis 

Long Term Care: Union Hospital Adult Daycare 

Referral 

Centers for Independent Living 

ADRC partner agency 

Chair of ADRC Board 

Draft MOU in process 

HCI is our disability partner for MAP 

Organization is a Center for Independent Living 

Part of Pioneer Valley ADRC 

Partnership Agreement 

Perform options counseling 

Referral 

We do not have an active CIL in our service area 

Easter Seals 

As needed basis 

Currently working on an MOU with an Easter Seals program- Care Project 

Newsletter 

No Easter Seals in Cecil County (in Delaware)- working on relationship. 

Referral 

Epilepsy Foundation State/Regional Chapter 

No information on this 

No relationship 

Referral 

National Association of Mental Illness State/Regional Chapter 

Member of ADRC Board 

Referral 

Referrals 

Via CSB 

National Autism Association State/Regional Chapter 

No relationship 

National Multiple Sclerosis Society State/Regional Chapter 

No relationship 

Referral 

Referrals 

State Association for the Deaf 

No relationship 

United Cerebral Palsy 

Core Partner 

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63b. What is the type of partnership agreement? 

Specify Other 

Fiscal intermediary 

Fiscal intermediary for PCA program 

No relationship 

Serve as a fiscal intermediary for two programs we run 

They are a PCA vendor for many consumers 

Other 

Co-located within the AAA 

Senior Centers 

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66. Is your organization paid on a fee for service or per unit basis for performing any of the 

following services for a client? 

Specify Other 

Aging waiver enrollment services, Nursing home transition services 

Medicaid waiver and Money Follows the Person is paid on a Fee-for-service basis but it is under the Long 

Term Care Division of the Department as opposed to the ADRC Division 

We have begun offering technical assistance ADA assessments for fees 

Paid contract amount not fee 

Dee ADRC report 

Marketing 

Guardian Court Ordered Fees 

Personal Care, Respite, ADB, Case Management 

Case management 

Care management 

PCA 

PAR 

Waiver case management 

Options Counseling services is funded by Massachusetts General Law Chapter 211 

Care management 

CCTP Program 

MDS Section Q 

MGL 211 Funds for OC 

PSS 

Protective Services, Care management, Personal Care Attendant, Senior Care Options and Family 

Caregiver Support 

Cost reimbursement 

Reverse Mortgage Counseling 

Case management 

Lump sum based on previous work 

Choices CM, home care purchase of services, ECOP CM 

Homebound meals and dining site meals 

Family caregivers, Memory Care, and Wellness Services, RDAD 

Older Americans Act Funds Federal 

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67. What is the source of the fee for service or per unit payments? 

Specify Other 

State department of public welfare 

MFP Grant through BMS 

MFP Grant through BMS 

MFP Grant through BMS 

VD-HCBS 

Section Q 

Older American Act 

CA Community Transition Demonstration Project 

Guardian Client Estates 

Veterans 

VD-HCBS 

MFP Grant 

CMS Grant 

MFP Grant 

MFP Grant 

Veterans Independence Project 

NCOA 

FSSA SNAP 

Title III – MFP 

CMS 

Care Transition Program, CMS 

MDS Section Q 

Federal dollars 

Senior Center Plus 

Federal Medicaid and State GPR 

Some clients pay for services 

DHHS and NCOA 

Medicaid state funded for presumptive enrollments 

Dually eligible for Medicaid/Medicare 

Older Americans Act and Medicaid Administrative Claims 

100% Time Reporting 

MFP Grant 

Energy Assistance Program (EAP formally LIHEA) 

AoA Grant 

Participant donations 

University of Washington 

Federal funds 

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Section E – LTSS Environment
 

69 . Please add any additional thoughts about Local ADRC and either its operations and/or its 

results. 

Since being designated as an ADRC the ATRC-AAA has been more effective as no-wrong door agency. 

Having a central; R Coordinator has resulted in consumers being more thoroughly screened for all 

services for which they might be eligible. The quality of consumer care from first contact to enrollment 

in multiple programs has increased. The area that the ADRC covers is primary rural with a majority of the 

population being minority and a great percentage of the population being below the poverty limit. We as 

an ADRC are reaching out and interacting with the different areas within the region more effectively and 

frequently than in the past. 

1. Our numbers reflex only incoming calls to; R - we have other departments such as SHIP- Senior RXSCSEP- Ombudsman which calls are directed to each department. 

The South Central Alabama Aging and Disability One-Stop Center is currently working on formal 

partnerships with the Pike County Public Health Department (pilot MOU/hopeful to spread to all PHD's) 

and the STAR Program under the Alabama Department of Rehabilitation Services (which will be 

partnering also with the local Care Project- medical supply reutilization). We still have a partnership with 

211- but it's only moderately functional because 211 is decentralized. 

SARCOA is organized and developed through local partnerships and funding. SARCOA did not receive 

a federal or state ADRC grant during this reporting period. The Care Transition Program did not begin 

until April 2013 therefore there is no current data to report for the previous 6 months. The ;R/A 

department does collect consumer demographics however items such as disability is not available based 

on age ranges. Question 74 The budget listed for Title II is for Title III. 

We became an ADRC in October 2012. Our funding for the ADRC in Alabama is very limited. We have 

implemented new ways in West Alabama to train staff so they can field the numerous and various calls 

received. Our new designation of ADRC has created more visibility in our community. We were able to 

create a in depth directory of services to distribute to the public for reference. Which has opened the door 

for more professionals- agencies- caregivers and clients to find out about our local services. As well as 

open the eyes to the AIRS I/R-Aging specialist on how to get the whole picture of all services that the 

client may be in need of and qualify for (example- food stamps- LIHEAP- LIS- etc.)However- our state 

network as a whole does not currently receive funds for LTSS or care management models. So many of 

the questions asked on this survey were difficult to answer as we were not sure how to answer. 

ADRC staff seen an increase from the consumers we serve are getting more services provided to them 

that they did not know that was available for them. We are still working on outreach to all of our 

communities we serve. 

Some of the answers were left blank as a result of our inability to collect this data. Alaska is struggling in 

its effort to obtain a reliable data collection system for the four VERY different ADRCs. 

The MOA ADRC has been in existence since 2008. Prior to that time the MOA did not have a focused 

program area for seniors and persons with disabilities. Since the inception of the ADRC- the public 

health department has increased its visibility in serving this population of Anchorage and has the strong 

backing of the department. The ADRC continues to carve out its place in the service arena in Anchorage. 

Primary services include ;R; Short-term service coordination and Options Counseling with short-term 

service coordination being the primary. On-going development at the state level include designation of 

the ADRC to screen for Medicaid waiver eligibility. At the local level- this next grant year the ADRC 

grant and the Medicare Counseling Office grant have been combined to create greater coordination and 

sharing of resources in the two programs. Current staffing has been stagnant for about 3 years with 1.75 

FTE employed by the Municipality through grant funds; .5FTE under contract at local senior center and a 

program manager that oversees the program paid through Municipal operation funds. Currently 3 staff 

are certified through AIRS. Staffing remains a challenge in pursuing and completing the goals of the 

project. As the volume of contacts increases due to greater visibility- current staffing is reaching 

capacity. Local funds are not available at this time. The MOA ADRC is working closely with the staff to 

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69 . Please add any additional thoughts about Local ADRC and either its operations and/or its 

results. 

assess need and potential funding sources. Regarding the survey--please note the following challenges: 

Section B-the current data base used by the MOA ADRC does not separate out persons over 60 and under 

60 in regards to type of disabilities. These figures are an average based on the percentage of those over 

60 and under 60. The number of referrals is a total--many consumers may have received more than one 

referral. Unable to differentiate ages for options counseling. The majority of our consumers seeking 

options counseling are over the age of 60 or caring for someone over 60. Section C--the local ADRC does 

not capture this information and defers to the state to report on this information. Currently the number of 

ADRC clients that are referred to public LTSS is not tracked at the local ADRC. The data base that is 

currently being used is unable to do this and the local ADRC is looking into alternative ways to track for 

next FY. In addition- the ADRC is not linked with public LTSS systems in a way that this information 

would be readily accessible. There are plans to develop this in the future. 

As noted earlier- the data base used by SAIL does not currently collect numbers of individuals for many 

of the questions asked. Instead- the data base collects hours of service. This is an issue that our state grant 

administrators are aware of and we are working to resolve. Also- the Care Transitions program has not 

been utilized during this reporting period by our local hospital. The form provided would not allow 0 to 

be entered/saved. 

There is limited computer access for consumers in the counties we serve- particularly in consideration of 

the population served. Caregivers or case managers may be invaluable tools in accessing this resource. 

Budget figures do not include DDD and Medicaid. 

Regarding #82 and #83- none were noted. Regarding question 48: frequency of follow up depends on the 

reason for contact. Staff FTE includes the AAA and the CIL. Medicaid staff are included at the state level. 

No additional comments. 

Please note that on questions 85 and 86 there has not been an increase or decrease noted. Regarding 

question 48: Depends on request. Budget and Staffing reflects AAA and the Cil for Yuma and La Paz 

Counties; the CIL for Mohave County data was not available. Budget does not include DDD and 

Medicaid. Note: This ADRC is ; AZ Links Western Arizona; and consists of three counties: MohaveYuma and La Paz. 

Section B Populations questions 14-21 is for PCOA (AAA) only questions 27-40 care transitions is only 

PCOA question 40: the standardized OC tools are not used by Medicaid; Medicaid does offer Question 

52: depends on service 65 - do not know 71 - do not know 74: AAA and CIL are non-profit- DDD and 

ALTCS/Medicaid are state agencies Budget figures do not include DDD and Medicaid. 

Budget figures do not include DDD and Medicaid. 

The answer to question 85 no change. Quote; Reporting requirements like this multipart one make one 

question whether being an ADRC without any additional funding is a viable option. Budget and staff do 

not include DDD and Medicaid. Question 48 - 51: ;not consistent- depends on issue; Question 15: did not 

collect this information 

AIS has partnered with 13 hospitals in San Diego County to provide care transitions. AIS is one of the 8 

Counties that will be participating in the Dual Eligible Demonstration in California (Cal Misconnect) and 

has partnered with 4 health plans to provide coordinated care for seniors who receive Medical and 

Medicare benefits. 

In 2008 Cal Optima received a 3- year ADRC development grant. Cal Optima partnered with the Office 

on Aging (OoA) and Dayle McIntosh Center (DMC) to develop the Aging Disability Resource 

Connection of Orange County. Since the launch of the ADRC- the agencies have developed close 

working relationships. Below summarizes some of our ADRC activities: Website The most significant 

accomplishment was development of the ADRC website at www.adrcoc.org Hosted and maintained by 

OoAo Content updates drafted by Cal Optimao Update SLA is 2 weeks; however- typically takes over a 

month€¢ Free access to consumers and providers€¢ Includes a robust directory o Same directory used by 

OoA ;A/R staff‚ OoA adds listings and updates (though broad-based updates not completed in recent 

years)o Hosted by RTM under contract with OoA RFP anticipated within year as contract due to expire 

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69 . Please add any additional thoughts about Local ADRC and either its operations and/or its 

results. 

ï‚§ Cost of changes vary by complexity CL tools added o Search for organizations with staff who speak

other languages Feature allows main site and directory listings to be translated into other languages. 

Education ADRC and its partners have collaborated on various education initiatives such as Disability 

Rights Workshop- Roundtable on Services for Children with Special Needs and on-going Snack Learns to 

enhance providers knowledge of community programs and benefits including application processes and 

eligibility requirements 2011 and 12: 11 Snack Learns over 400 unduplicated attendees 2013: 4 sessions 

held or scheduled ï‚§ 1/29: Gizmos and Gadgets (Assistive Devices and Technology) 4/30: CBAS 

(approximately 100 people registered)‚§ 7/30: Benefits and Programs for non-citizens (lawful and 

undocumented)ï‚§ 10/30: Behavioral Health Programs in OC (e.g.- OCHCA/MH- ReconnectDuals)Information Referral- Options Counseling OoA is primary contact for ;A/R and Options 

Counseling€¢ DMC provides ;A/R and Options Counseling for consumers with disabilities€¢ DHCS is

expected to apply for ACA funding for new options counseling grants available to ADRCs in Duals 

counties. Transitions DMC is Money Follows the Person grantee under the California Community 

Transitions program and Local Contact Agency for SNF referrals for residents interesting in transitioning 

home. o Cal Optima Long Term Care department and DMC meet quarterly to discuss transitions in 

progress- address issues- if any- and other opportunities for collaboration (e.g.- earlier this month- Cal 

Optima hosted an education event for clinicians on alternatives to institutionalized care. DMC presented 

on the California Community Transitions program- along with presenters on Community-Based Adult 

Services (formerly adult day health care) and in-home supportive services. A Cal Optima completed 2 

CTI pilots and is launching expansion 2010/11Volunteer model piloted with Mission Hospital o 2011/12 

OneCare pilot with Cal Optima RN/SW coach at 3 select hospitals 2012/13 Cal Optima Quality 

Improvement Program launched in April to further leverage the ADRC pilots MOUs ADRC initiative 

increased collaboration- but MOUs did not significantly change how programs operated internally- nor 

how they worked with other community providers. Other Cal Optima sought input from OoA and DMC 

in developing its initial response to the California’s Department of Health Care Service’s Request for

Solution with respect to the duals demonstration. Orange County was one of 8 counties selected to 

participate in California’s program; Cal Optima- as the county’s Medi-Cal plan is OCs participating plan. 

DMC has regularly attended recurring stakeholder meetings and has provided American Sign language 

interpreters- where needed by attendees. CalOptima and OoA collaborated on a tool for adult day health 

care staff and other health care providers to identify community resources to be used in the event ADHC 

was terminated. This tool also gave providers information about agencies with staff fluent languages 

other than English to assist in identifying culturally and linguistically appropriate resources. 

Successes’ Formal Consensus Agreement with critical path way providers of Improved call center triage 

protocol Developed Universal At-Risk Definition- used by organizations in Consensus Agreement 

Improved screening tools- revised to more accurately assess client risk in facilitating referrals to care 

management to Expanded integrated intake system within the call center i.e.- application supportseligibility screening. o Developed a Universal Referral form to streamline referral among partner agencie 

so ADRC collaboration with Partners- Critical Pathway Providers and Stakeholders has lead to increased 

cooperation when responding to at-risk_ consumers as evident expedited access to nutrition programscare management and IHSS support. Implementation of option counseling and short term care 

coordination Protocol so Expanded online LTC service resource for consumer so The ADRC ability to 

serve the needs of people of all ages with disabilities increased by consolidating resources maintained by 

the ILC and Office on Aging. Produced a Provider Resource Guide Development of Stakeholder and 

Leadership Advisory Groups to guide ADRC Priorities Established regular meetings and communication 

with key stakeholder Produced o Cross Training of AAA and ILC staffs to improve option counseling 

skill set Implementation of Care Transition Intervention Coleman Model Formal CTI MOU with 

Riverside County Regional Medical Center (RCRMC)o ILC Nursing Facility to Home Transitions ADRC 

branding with the use of the generic ADRC Logo ADRC has collaborated with two non-profit agencies 

to produce a Resource magazine that highlights assistive devices and technologies to present to 

individuals with physical- cognitive and sensory limitation options for independence Developed strong 

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69 . Please add any additional thoughts about Local ADRC and either its operations and/or its 

results. 

relationship with senior housing managers- social workers and administrators of skilled nursing facilities. 

Educated those organizations as to ADRC LTC services that can be provided ADRC grant award for 

PACE expansion to Riverside County’s Development of new CTI Partner - IEHP Barriers’ Budget cuts to

ADRC baseline and County funding; ADRC staff furlough and mandatory Friday closure State budget 

constraints and the current economic environment have lead to reduced resources- decrease in charitable 

contributions- and increase service demands on community providers and stakeholders. o Turnover of 

Partner Organizational leaders resulting in restarting system change negotiations Reduction of Medical 

Waiver programs for the frail consumers’ Elimination of Linkages and ADHC as State Options Some

seniors and people with disabilities are unable to remain in the community or transition to community 

living because affordable and accessible housing is scarce Some seniors and people with disabilities have 

been unable to obtain accessible and affordable transportation due to funding cuts and reductions in routes 

and voucher availability The ADRCs phone system and Data management systems are not currently 

integrated; this makes verification and consistency in data collection and reporting more complicated. 

Lessons-learned: o Fiscal challenges and revenue insufficiencies have implications on effecting change of 

organization infrastructure and its related service delivery systems. Partners tend to turn the focus- efforts 

and resources inward during fiscal crisis Using ADRC partnerships to leverage programs and services is 

essential in meeting the LTC needs of expanding target populations; especially during difficult 

economical time’s Begin communication about the ADRC initiative early Critical Pathway Providers to

garner support for streamlining consumer access. o Establishing MOUs with external partners is a 

significant challenge and takes longer than anticipated; however- once MOUs are established- they prove 

to be effective in preserving partnership agreements over time and through organizational change. o It is 

essential to meet with Executive level and Supervisorial level staff when forming a systemic change and 

partnerships. The evolution of the ADRC is makes data collection a moving target of sorts. As data is 

being collected- changes to required and desired data elements are occurring. 

Alamosa is a small ADRC providing ARCH services through the AAA. We are not what is classified as a 

fully-functioning ADRC as we do not work with Medicaid or have access to Medicaid services or waivers 

or anything of that sort so we are not able to answer all questions of the survey. In regards to the surveymost of the questions- we believe- are geared towards bigger ADRCs that incorporate all aspects of what 

an ADRC is supposed to be. It was difficult for us to answer some of the questions because we are so 

small and do not collect the data as it is requested on this survey- but will change our methods to fit the 

criteria the survey is asking so that we will better be able to complete the survey more appropriately. 

The amount of providers has stayed the same in our area- however- some providers have changed or 

modified their services. We have acquired another homemaking and personal care service provider after 

one of our HHA stopped doing unskilled services. Thus- the amount of service providers has remained the 

same. ARCH/ARDC has been a big asset for our rural communities and helping clients to connect to 

services. Assisting clients in their own settings and being able to network between agencies on behalf of 

clients has helped get clients services more expediently. Information and referrals through ARCH/ARDC 

has also helped bridge the connection and knowledge base of agencies and streamlines efforts to service 

the adult population in our region. ARCH/ARDC also helps strengthen the relationships between 

agencies. 

The Northeastern Colorado ARCH is small and have struggles because of sustainability. The 16 Area 

Agencies on Aging did apply for and receive a grant from the Colorado Health Foundation for the next 2 

years- and also to do a study on how to remain sustainable. Some of the questions did not apply. Would 

of like more options. 

We are still new and have had 6 months of activity- so some questions do not apply just yet. We are 

hosting an AIRS training in Durango- Colorado on May 24- 2013. 

Being a newly formed ADRC in eastern CT- there has been significant collaboration between Partners 

(Disabilities Network of Eastern CT and Senior Resources Area on Aging). As we work together- there 

will be an increasing amount of assistance provided to the consumers in our community. We look 

forward to making a positive difference. 

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69 . Please add any additional thoughts about Local ADRC and either its operations and/or its 

results. 

ADRC produces collaboration between agencies that provide services for older adults. With the ADRC 

being the one stop resource center- consumers are reporting that they are connected with services much 

faster. **Question #85 - As a result of re-balancing of Medicaid dollar- resources that would have been 

available in the community have been allocated to individuals in skilled nursing facilities transitioning 

home. Because of that- some Medicaid waiver programs have been closed to people in the community. 

With the ADRC funding- Counselors are able to help clients live longer in the community rather than 

being institutionalized. Clients are being helped to maintain adequate affordable housing- tap into 

benefits- utilize resources in the service area- caregivers are receiving necessary respite services- clients 

are able to transition from being incarcerated to the community- employment etc. 

The ADRC in Delaware is unique because we are both the SUA and AAA. Some of the data that is 

requested in this report will be provided only in the State Level Report. In addition- the questions 

surrounding the Care Transitions were for a Formal Program and currently Delaware operates an Informal 

Program. However- we do have statistical data that we would be happy to provide if requested. All of 

the budgetary requests at the local level are provided in the State level report. 

The CSRA services a 14 county community area providing Assess- Answers- Action and Advocacy. 

Care Transition Program is a 30 day intervention and was started December 2012. Money Follows the 

Person Program is gaining momentum and set goals were reached in February for the years. We have met 

and exceeded goals for program but are continuing to move forward.. 

The Middle Georgia ADRC is funded through ACL/AoA- State of Georgia- CMS (SHIP- Medicaid 

Waiver and Money Follows Person)- local and in kind support. The Middle Georgia ADRC does not 

receive fee-for service at this time- current funding that supports the ADRC excluding direct client service 

dollars is administrative funding. 

The ADRC Specialist has worked to promote partnerships with LTSS or HCBS providers in the region. 

Regarding question #29. I was not able to include the fourth hospital with whom our agency provides 

Care Transitions services: West Georgia Health System: two individuals. 

The ADRC is an extremely important part of our agency. We believe the future of services to our growing 

aging and disabled population will be through the ADRC. Because of the sheer numbers the nation's 

economic situation- services to those populations must change from the traditional model of service 

provision (eg. directly providing support services vs. referral to other agencies with only those in the 

absolute greatest need being provided supportive services by the AAA's contractors. 

The ECIAAA is completing this survey from the point of view of what were able to learn through the 

implementation ADRC Pilot with Starting Point- ADRC/Macon County Health Department. The ADRC 

Pilot ended September 30- 2012. By testing successful service delivery designs by Starting Point ADRCECIAAA was able to launch designated Coordinated Points of Entry (CPoEs) in FY 2011. Twelve 

designed CPoEs provide coverage to ECIAAA's entire Planning Service Area (16 counties). During FY 

2011- we established the following award standards for each CPoE:1. Minimum of 7 hour coverage;2. 

AIRS Certified Staff requirement;3. ESP Data Resource Access;4. Warm transfer telephone 

capabilities;5. Memoranda of Understanding with Centers of Independent Living;6. Live staff answering 

the phone;7. Collaboration with other Aging Disability Stakeholders;8. Establishment of the Aging 

Disability Resource Network;9. Established Consumer direction in OAA programs;9. ECIAAA has 

provided training on person-centered care planning; options-counseling; motivational interviewing. 

ECIAAA is working towards converting the CPoE concept already implemented in PSA 05 to the next 

level - to a fully functioning Aging Disability Resource Center and Network in our 16-county area. 

ECIAAA- under special funding through IDOA- will be pilot-testing Options Counseling services in 

accordance with the ACL Draft Standards during FY 2013. 

With the available resources the NE IL AoA is able to provide information and referral. The partners in 

our region consist of 6 CCUs and 4 CILs. The latter of which we have MOUs with. After the recent 

Options Counseling training some of these agencies may be poised to pilot Options Counseling service. 

The Western Illinois Area Agency on Aging continues to expand its Aging and Disability Resource 

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69 . Please add any additional thoughts about Local ADRC and either its operations and/or its 

results. 

Network- working together with its partners for cross training and a universal referral system. WIAAA 

did was not funded for Options Counseling in the past but plans to do Options Counseling on a limited 

basis in 2014. We have developed a good working relationship with our multiple partners and work 

closely with them through our regional committee meetings. 

Aging In-Home Services launched a formal Medicare funded Care Transitions program in March 2013 

within the ADRC. The data in the Care Transitions section reflects referrals received March 2013. Once 

the formal program is fully operational- it will include 11 hospitals. Data supplied on previous SART 

reports pertained to a pilot Care Transitions program that included one hospital. The services available to 

clients at the first point of contact have vastly improved since the development of the ADRC. In addition 

to Options Counseling by phone or in person- face to face (in-home) assessments are now available to 

individuals in need of LTSS Services. The education- training and knowledge of our staff has also 

increased. Prior to the development of the ADRC- it was not a requirement to have a bachelor degree in 

the information assistance department. The ADRC is now staffed with certified case managers with a 

minimum of a bachelor degree. 

We are an Area Agency on Aging that also became an ADRC. 

The ADRC funding and resources provided with technical assistance has greatly enhanced our capacity to 

better meet LTSS needs and person centered is more focused and understood. 

We have reached out to other organizations to partner. It often does not get formalized because of 

HIPAA or other issues. As the ADRC- we still struggle with serving individuals with disabilities other 

than the typical AAA clients. Other agencies do not seem to want to work with us in a comprehensive 

disability capacity. Hopefully as things move forward- we can integrate more with the other agencies to 

strengthen the &duotone stop shop; idea for anyone with any disability without those agencies feeling 

threatened. 

Becoming an ADRC has helped to expand our availability to help those in our area. We are doing more 

outreach and more persons in need are aware of our existence. 

Our need in the community is great and our resources are extremely limited. 

The ADRC has and is playing a pivotal role in assisting our community. We are gradually raising 

awareness of our existence and developing community partners. We are now working directly with the 

hospitals and hope to have staff onsite. 

Our agency has worked with the other ADRC in the state of Iowa and the State Unit on Aging in actively 

development of tools; policies and procedures- and trainings for the ADRC staff. Our agency partnered 

with local hospitals in an informal care transitions pilot program for 18 months with no funding for 

Options Counseling activities. Our informal care transitions pilot program is a social service based model 

with the Options Counselor meeting with the patients- co-learner and family members to identify needs 

and resources and to provide them information- assistance and referrals for services post discharge. 

Options Counselors provided person-directed interactive decision support in deliberating patient€TMs

preferences- strengths- and values for long term support and services- so they understood what assistance 

is available and what home and community based services would help the patient to successfully 

transition home from the hospital or from a skilled nursing facility. 

The ADRC has been active with the development of State OC training protocols- development of State 

OC forms- tools and procedures. The functioning ADRC's in the State have an extensive level of 

cooperative spirit- partnership and investment in building the ADRC system. 

We do not feel that there has been an increase or decrease in providers or quality of service. 

ADRC has been the glue that has kept the overly aggressive Managed Care Medicaid program (KanCare) 

together. Medicaid case management has rapidly declined in quality. Many clients do not know who their 

case manager(s) are. Telephone systems are automated at each MCO and there is no ready access to a 

case manager. The ADRC is still the organization that has the reputation of the personal touch. While 

KDADS has begun to adjust the state MIS and a large amount of information can be put into the system 

reporting of statistics is marginal. 

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69 . Please add any additional thoughts about Local ADRC and either its operations and/or its 

results. 

Question 15---data is entered into KAMIS and KDADS web applications and the local level ADRC is not 

able to pull data specific to requested information for this question. 

If the state allowed us to be a fully functioning (including marketing- quality assurance) ADRC- we could 

address quality assurance issues- marketing--in general- a more robust service. 

We do our best. The staffing includes programs not directly associated with the ADRC. Front line staff 

include OKEP staff- Housing Staff- Case Managers for SCA and OAA- Nutrition supervision staff. 

question #85 - Unknown - to be determined 

The Kansas Department on Aging and Disability Services has been very helpful in the implementation of 

the ADRC services in our area. Their staff are easily accessible and always willing to assist with ADRC 

concerns. Since 1997- the statewide AAA's coordinated the Frail Elderly waiver to a high level of quality 

service. We have been able to enrich the new waivers we serve (PD and TBI) under the ADRC- and this 

has resulted in an increased quality of service to this population. Our ADRC launched a bi-state 

Transitions in Care Program with the Kansas City Quality Improvement Consortium. We have been 

assigned 2 hospitals in our service area and are expecting referrals to start May 2013. 

I have worked here in the Aging Program over 24 years. I feel that with the ADRC concept- staff are able 

to see a broader view of assisting people. ADRC staff are able to build the resource directory and be 

knowledgeable about the services. Also the ADRC staff are able to be utilized for marketing the program. 

ADRC staff are able to be a resource for case managers to go to without calling around to find resources 

in all the counties that we service. This funding allows for ADRC staff to spend their time assisting 

people with finding resources- counseling and follow up. ADRC staff provide more resources for those 

waiting on waiting list for services. The ADRC staff assist with a lot of the callers that just need 

assistance and may not need a direct services. This frees up the case managers time immensely so they 

can assist - assess and case manage more needy vulnerable clients that are in the home receiving in home 

services. 

We have not realized a change in the LTSS providers- structure or availability of services and funding as 

a result of ADRC. The ADRC has had an impact on our outreach and availability of access for the 

community- but as had no impact on provider size- availability of services and funding. 

ADRC has added to the quality improvement of access to long term care- however- as anecdotally 

reported by callers or recipients of long term care/waiver providers that are reimbursed by Medicaid 

quality of those services has declined in proportionately to the lowered reimbursement rate and reduction 

in hours provided to the client. 

We are proud to be a part of the system. 

Orleans ADRC has an Options Counselor who provides transition support/coordination for individuals 

moving out of Nursing Homes. This position is funded by a Money Follows the Person Supplement grant 

contract between us and office of Aging and Adult Services. Approximately- 90 have completed 

applications and 10 have transitioned to the community- over the past year. 

Information regarding enrollment into LTSS and HCBS or employment of these providers in the state of 

Maine is not available at the local level. 

Spectrum Generations is a leader in the current and future successes in the six counties of central Maine’s

citizens aging in place. We strive to develop both private and public resources- coupled with strong 

partnerships to meet the needs of the people who are aging- disabled or caregiving. Increased- dependable 

funding is critical to delivering services with continued service quality. Service demands are growing and 

will continue to grow since demographics show Maine is and will continue to be- one of the oldest states 

in the country. Maine is also a very rural and economically challenged state. These factors tend to limit 

services and opportunities for consumers- making the AAA/ADRC work even more important. 

Unfortunately- sequestration has resulted in significant cuts in services to consumers. Their impact 

includes staffing reductions which will result in: a€¢ An estimated 71 fewer caregivers receiving the

support and counseling they need to keep their loved one at home- aging in place; a€¢ An estimated 2-200 

fewer people will receive ADRC Counseling that would have provided them with information and referral 

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69 . Please add any additional thoughts about Local ADRC and either its operations and/or its 

results. 

assistance with issues concerning health insurance counseling and prevention of Medicare and Medicaid 

fraud€¢ An estimated 6 fewer Health and Wellness trainings will be held- eliminating this service for 

approximately 40 people€¢ Meals on Wheels will only be delivered once per week (1 hot meal and 4

frozen meals) instead of the 2 deliveries per week that has included health and safety checks€¢ 4-200 

Meals on Wheels will be cut from shut-ins who rely on a daily meal to maintain health. A Meals on 

Wheels wait list will be implemented and number of meals capped€¢ 17-800 community dining meals 

will no longer be available to seniors seeking a balanced meal and social contact; and a€¢ 5% reduction

each in Legal Services for the Elderly contract and transportation funding€¢ Three community centers

hours were shorted to operate only 4 hours daily and one was reduced to three days per week€¢ 

Community dining was eliminated at one site We are very concerned with the lack of reauthorization of 

the OAA. Our AAA/ADRC resources- networks and trusted- quality community services can make 

significant positive impacts on the successful implementation of the ACA. Older and disabled adults and 

their caregivers depend on our AAA/ADRC services and options from Spectrum Generations- based on a 

foundation of core OAA support. In summary- our AAA/ADRC services are critical in central Maine. 

We are energized to seek new business opportunities in anticipation of a changing horizon- melding 

traditional social services with medical options. We need strong core funding to make this possible in this 

challenging environment. We also need doors opened on the state and national level that allow utilization 

of the wealth of resources and network strength that currently exists with the AAA/ADRC- allowing 

consumers€TM needs to be flexibly and efficiently met.

There has been no real change seen in the number of providers available or in their quality 

The decrease is not actually quality- but quantity. The actual quality decrease comes from the plethora of 

residential staffing agencies working in the home and community based services. More often than nottheir services are not up to standards. The Charles County Office on Aging is part of Charles County 

Government. We have always had a very comprehensive; A component. No matter what a person's job 

title is- all staff answer phones and address any issues that the caller has. Although we now have a toll 

free number for our ADRC- calls continue to come into our office on all lines. We have seen a growth in 

our aging population while at the same time experiencing a cut in funding for services. There is growth in 

resources for Medicaid eligible individuals through rebalancing initiatives- but for those individuals just 

above those limits we have little to offer except ;person-centered; counseling on how they might try and 

make their resources stretch or use informal supports to help them. We feel the most value in being an 

ADRC would be to have an intake database that can be shared by all partners. That way all in the 

information is readily available and everyone can see what referrals have been made- what actions were 

taken- what follow-up has been done- etc. We could also pull statistics for our reports from this database. 

All; A functions need to be brought under the ADRC and there needs to be one comprehensive means of 

collecting and reporting data. The Maryland Department on Aging has been very forward thinking in its 

approach to get on board with rebalancing initiatives- but is lacking in providing guidance and standards 

for the individual counties acting as ADRC's. 

During the six month period (October 2012 -March 2013) Frederick County Department of Aging has 

served 3-409 unduplicated clients- providing 18-730 Units of Service. We have recently created a Client 

Satisfaction Survey and will begin implementation shortly. 

The Harford County ADRC is facing the same challenge that all Maryland ADRC's are facing in terms of 

increased demand for services- growing mandates- shrinking budgets and insufficient supports for 

growing staffing to meet these needs. Full efficiency of the ADRC programs/initiatives cannot be 

realized without adequate staffing and the growth of local services and resources to meet specific 

consumer’s needs.

MAC INC. serves a four-county population that is rural and economically disadvantaged. We are 

constantly looking for funding sources. The agency does a ;lot with a little. Quote; 

Baltimore City MAP continues to create and expand partnerships- provide staff training and update the 

MAP website as part of the process in becoming a fully functioning ADRC. The lack of adequate staffing 

is a major concern and impacts expanded service delivery. 

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69 . Please add any additional thoughts about Local ADRC and either its operations and/or its 

results. 

MAP Cecil County received a grant from the Maryland Department of Aging in July 2012. Since the 

inception of the grant- an Aging and Disability Resource Manager and Information Referral Specialist 

was hired- an MOU will be established with a Community Independent Living center (co-location at the 

new MAP Center)- a new technology room with over $10-000.00 of assistive technology was finalizedand an Interagency Subcommittee was set up. Plans are being made for hearing screening- Medicare 

Open Enrollment- and event outreach throughout the County. 

NOTE: Question 72 does not save the response. Response is Not Sure. 

This is a hard survey for us to answer in Montgomery County. As described earlier- the county 

incorporated most core health- human and social services under one Department of Health and Human 

Services in 1996. That restructuring included the integration of senior and disability services into one 

agency. Thus- many of the goals of the national ADRC effort were fulfilled here many years ago. We do 

not claim to have achieved perfect integration of services. In fact- the department continues to devote 

major human and financial resources to further develop business processes and I.T. systems designed to 

support these goals. In a department with 1600 employees- a $250 million operating budget- and 

ambitious integration goals of its own- the small ADRC grants from the State can have only a limited 

impact. 

Queen Anne's County is not fully functioning as an ADRC (MAP). There is no standardized tracking 

system to collect data in place at this time. Information provided in this survey are estimates based on 

data that has been entered into the AIM system. 

Our Agency utilizes the AIM (Aging Information Management) for our electronic resource database. We 

are not able to capture a great deal of information asked on these reports in specific categories. We are 

also very limited to having 3 ;A/;R staff who serve our three counties and we have a large volume of 

calls/contacts. Not all consumers have a detailed intakes completed on their behalf unless we see the need 

to follow up for Case Management. It also takes a great deal of time to enter the data that we do collect 

into the AIM system and have to manually hand count the information you are requesting. 

Question 13: Due to geography and population there is a limited number of services available and for 

most services no choice. Private pay services do offer choice of nursing care and home services. Most 

public funded services only have one provider. Many services offered in the Eastern part of state are not 

here for example: Transitional housing- SCO's- Adult foster in subsidized housing- supportive 

housing.....Question 15: Our data base does not allow us to separate age and disability Question 39: We 

do no track the information requested. Question 80: Very small agency. Most staff are cross trained to 

multiple jobs from Peer Counseling- Advocacy to benefit counseling etc. 

Question 84 and Question 85 - No change 

Q. 6: Percentages were obtained from a report by Barnstable County and consists of data for Barnstable 

County only. It does not include Dukes County or Nantucket County that are also in our service area. 

These percentages are 2011 estimates. 10: Answer is based on report by Barnstable County with 

estimated data for 2011 and consists of data for Barnstable County only. It does not include Dukes 

County or Nantucket County that are also in our service area. Q. 14: Data does not include consumers 

who needed information referral services’. 15: Data do not include consumers who needed information

and referral services. Data is listed as under age 60- but includes all ages including those over 60. 

Intellectual and developmental disabilities are included with cognitive. The rest of the fields are left 

blank because we do not collect this information. 21: We do not collect this data. 38: We do not collect 

this data. 39: This question will be answered by the state. 41 45: Our ADRC partner is answering these 

questions’. 52: Last contact varies upon the needs and goals of the consumer. 54: We do not have warm

transfer capabilities’. 58 60: This question will be answered by our ADRC partner. 64: This question will

be answered by our ADRC partner. 74. This question will be answered by our ADRC partner. 80: We 

have a small staff. All advocates perform the services. I was instructed to put 1 FTE in each category. 82 

83: We are not paid on a fee-for-service or per-unit basis. Note: This is a frustrating report to complete 

because it doesn't fit our circumstances. 

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69 . Please add any additional thoughts about Local ADRC and either its operations and/or its 

results. 

Section B questions 15- 19- 18 and 20 we are unable to answer. Central MA Agency on Aging does not 

collect information on a consumer’s disability- age or income. The only direct service we provide is 

Information and Referral and the information collected is whatever the consumer would like to share with 

the call taker. Section C. Central MA Agency on Aging does not provide Care Transitions or Options 

Counseling. Also in question 38 consumers are referred to multiple private and public providers when 

they contact the agency. Section D Question 74: Central MA Agency on Aging is the Area Agency on 

Aging for Central Massachusetts. In this question we recorded all Title III funds that come into our office. 

Some of these funds are granted to our ADRC partners. Question 79In MA there are no County Offices so 

for the portion of the survey to record partnerships we answered by using local state and federal sites 

instead of county offices. Health and Human Services is one agency in the state of MA. The Executive 

Office of Elder Affairs- the State Unit on Aging- is under HHS. For our partnerships we are more closely 

partnered with the Executive Office of Elder Affairs and that is who we hold a contract with. 

Question 28- Includes Coleman numbers only not case management numbers Question 31- all participants 

have Medicare the program does not track whether or not consumer has another insurance Questions 32 

and 33- Referrals are made but program does not track this information Questions 84 and 85- Berkshire 

County is geographically large which makes it very hard to service all areas. In Berkshire County there 

are a limited amount of providers willing to service all areas. There are also provider availability issues 

and staff turnover is high which results in a lack of care or inconsistent care for some consumers. 

Comments: Section B- question 10-re:under insured only includes numbers for Barnstable County (does 

not include Dukes/Nantucket)Section B- question 15-did not have breakdown on data below 60- over 60-

all data entered under over 60 category. 1733 calls total-78 on under 60Section C- question 46 track 

referrals made to; consumer type- should read for answer provided for Section D- question 74- reads 

AOA Title II grant funds- typo- should read Title III funds? Response is for Title III funds. 

Question 38 - our referrals are categorized as the following: housing and housing/information - 27public 

benefits - 21long term planning - 28general information - 19discharge planning - 15services -

30Questions 39- 41-44 - EOEA will respond directly to ACL/Lewin 

The ADRC has allowed us to empower consumers to a greater degree. The Independent Living 

philosophy- that consumers have the right to succeed or fail in the community- has informed our work in 

long term care facilities and the community. For any questions that refer to; county; level of governmentwe have used the city level. Massachusetts does not have a county-based system. For the budget- we 

have noted our portion of ADRC funding although we are not the direct grantee. For questions 14 and 15 

our data are included with Boston Elder INFO/Boston Senior Home Care which serves as our Information 

and Referral department. Data for questions 39- 41- 42- 43- 64 will be provided by the State. 

Please find further clarification/comments below on specific questions from FCHCC.Questions:3. 

FCHCC identifies all of the; radio buttons; best describe the reason why FCHCC became a part of the 

Pioneer Valley ADRC.6. Percentages are from American Community Services (ACS) 5 year estimate 

from 2007-11 for 60+ population. The numbers listed are only for Franklin County (26 towns) the 

additional 4 towns covered by FCHCC are in Worcester County. That percentage is 3.1%.7. Percentages 

are from ACS 5 year estimate from 2007-11 for 60+ population. The numbers listed are only for Franklin 

County (26 towns) the additional 4 towns covered by FCHCC are in Worcester County. Those 

percentages are for Caucasian/White: 95%; Black or African American: 1.6%; American Indian or Alaska 

Native: .1%; Asian: 1.8%; and Nation Hawaiian or Other Pacific Islander: 0%.14. This number is based 

on unduplicated consumers.15. The numbers listed under the current consumer under 60 and over 60 are 

based on unduplicated consumers. Please note that a consumer could have more than one of the 

disabilities/impairments listed and those numbers cannot be identified. For the low income and limited 

English proficiency those numbers are not tracked specifically.27. FCHCC provides Care Transitions 

(CT) to all those who live in the 30 towns FCHCC covers. Despite our efforts- FCHCC has not received 

any evidence-based CT intervention referrals. FCHCC continues to work with our local hospitalsphysician groups- nursing facilities and visiting nurse associations regarding CT referrals. FCHCC has 

developed a universal referral form for formal referral sources ease. FCHCC will begin a pilot project in 

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69 . Please add any additional thoughts about Local ADRC and either its operations and/or its 

results. 

the near future with one our nursing facilities. FCHCC receives many other requests from our local 

hospitals- physician groups- nursing facilities and visiting nurse associations.28-33. FCHCC has no data 

to report at this time.34. The marketing plan is general- agency not ADRC specific.38. FCHCC does not 

track the referrals made to outside agencies specific to those listed. 39. EOEA to provide answer.41-44. 

EOEA to provide answer.48. Basic demographics are accessable.49. It depends on the type of request 

made by the consumer. There may be times that there is follow-up required and other times there is 

not.50. Again how many times follow up is completed depends on the request made be the consumer. It 

could be multiple times or just once.51- 52. The timing of the first and last follow up again depends on 

the consumer's type of request. 53. This depends on if the consumers has given permission to share this 

information. 64. EOEA to provide answer.74. FCHCC checked off Administration of Aging Title II 

Grant. This was checked thinking it was meant to be TIII. If it is not TIII please disregard. In regards to 

the specific funding and total budget- the funds come to the State from the Federal government which is 

then distributed to the PVADRC (GSSS oversees the distribution of funds). GSSS then distributes the 

funding to the AAA's and ILC. 77. PVADRC consists of: 4 ASAP/AAA's and 1 ILC. Our meetings 

include the core group however- there many other interactions with other community service 

organizations e.g. VA- DDS- Alzheimer's Association- etc. depending on type of needs being identified. 

80. FCHCC has staff trained in CT. 84. FCHCC reports no change. 

Management at Greater Lynn Senior Services found the request for complete fiscal information 

burdensome and not helpful in determining if ADRCGNS- Inc. is serving all populations- all ages and all 

economic levels in a consumer directed approach. Some of the questions regarding Home Care 

Consumers were also irrelevant in evaluating the success of our ADRCGNS- Inc. and/or GLSS' role in 

the ADRCGNS- Inc. which is so much more than traditional home care programs. 

Continued need for affordable housing options Need for additional waivers to assist with service options 

for discharges back to the community 

Without the user of the products/services being the evaluator- chooser- engager- then there is no long 

term hope for change. We have seen that once the user- consumer- senior- person wants something and 

then chooses it- only then might it become a habit or recurring solution for a healthy life. The paradigm 

shifts going on within our ADRC over the past decade have further validated in our minds the above 

principle- and we are committed to making those changes within our organizations and our communities 

and our service provision- on a local level. If the consumer is not benefiting- then we do not want to do 

it€¦and to determine if the consumer is benefiting- as the IL world has taught us- nothing about me 

without me. 

Question #14. Minuteman does not extract this data Question #31. Minuteman does not collect this data 

Question #32. Direct enrollment is not part of the Coleman model Question #33. Minuteman does not 

track this information Question #38. Minuteman does not track this information Question #46. Please note 

that we do not use a link- we access with a login 

This survey was unreasonably difficult to complete and it was way too long. The parameters were 

unclear- the terminology unclear and inconsistent . Throughout the completion- we were instructed to 

include items that do not reflect how we do business. As an agency that has been providing services to 

elders for 39 years- the implication that the number of people we serve is the result of the ADRC is 

inaccurate. Repetition of information that is identical for all organizations in this state further wastes 

valuable staff time. In Massachusetts- Health Human Services is 1 Cabinet Agency- not 2. it would have 

been helpful if this 'survey' had provided definitions as they apply to this document process. LTSS- for 

instance- is not defined so we are not clear exactly what programs and functions were expected to be 

included. we did our best to answer questions that left a lot of room for interpretation. 

Without the user of the products/services being the evaluator- chooser- engager- then there is no long 

term hope for change. We have seen that once the user- consumer- senior- person wants something and 

then chooses it- only then might it become a habit or recurring solution for a healthy life. The paradigm 

shifts going on within our ADRC over the past decade have further validated in our minds the above 

principle- and we are committed to making those changes within our organizations and our communities 

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69 . Please add any additional thoughts about Local ADRC and either its operations and/or its 

results. 

and our service provision- on a local level. If the consumer is not benefitting- then we do not want to do 

it€¦and to determine if the consumer is benefitting- as the IL world has taught us- nothing about me 

without me. 

Without the user of the products/services being the evaluator- chooser- engager- then there is no long 

term hope for change. We have seen that once the user- consumer- senior- person wants something and 

then chooses it- only then might it become a habit or recurring solution for a healthy life. The paradigm 

shifts going on within our ADRC over the past decade have further validated in our minds the above 

principle- and we are committed to making those changes within our organizations and our communities 

and our service provision- on a local level. If the consumer is not benefiting- then we do not want to do 

it€¦and to determine if the consumer is benefiting- as the IL world has taught us- nothing about me 

without me. 

Somerville Cambridge Elder Services is a lead CBO for the Mystic Valley Basin Care Transitions 

Collaborative and due to the fee for service funding model through Medicare it is had to establish our 

revenues for that program accurately at this time- as our project launched December 2012 and billing has 

a lag-time. 

This document and the information it gathers is not conducive to the Independent Living Centers. it 

measures many things that our date system does not. 

I am including all my comments below about specific questions: .Question 10: We are in Massachusetts 

and have mandated health insurance- so only a very small percentage of the population is without health 

insurance. According to a report by the Blue Cross Massachusetts Foundation- only 3.9% of the 

Commonwealth's under-65 population was uninsured from 2008 to 2010. The towns with the highest 

uninsured are not located within Springwell's catchment area- so our uninsured population is under 2%. 

. 

.Question 12: I had a hard time showing where changes occurred as only offered 3 choices (no- limitedadequate). It would have been easier to answer these questions more specifically using a rating system 

(i.e.: from 1 to 5â€¦) With both Language Barriers and Cultural barriers- while they are sometimes 

barriers to LTSS- the situation has improved in the ability to overcome these issues and serve people of 

diverse language and cultural backgrounds (for example- prior to 2006- we had language skills in our 

direct case management staff of two languages (English and Russian). In 2013- we have direct case 

management staff language skills in 12 languages). While this doesn't meet the language needs of all the 

consumers in our area- it is an improvement and we actively recruit for additional languages to help 

reduce language barriers. .Sexual 

Orientation barriers: the situation is improving with increased awareness and training- however this 

remains a barrier- especially with Nursing Home placements and with some vendor home health workers 

not being accepting of same sex couples or transgender individuals. 

.Housing barriers: while this is ;sometimes a barrier; for both time periods- housing has gotten to be a 

tougher barrier to overcome during the recent period due to waiting lists and lack of affordable/accessible 

housing.. 

.Question 13: Again- I had a hard time showing where changes occurred as only offered 3 choices (nolimited- adequate). Would have been easier to answer using a rating system (i.e.: from 1 to 5â€¦) Also 

challenging to answer Available/ Avail but inadequate/not available for a broad question example 

Medicaid waivers in my area there is broad availability for Medicaid waivers for people over 60- however 

there are extremely limited/inadequate availability for Medicaid waivers for persons under 60 with 

disabilities. For Personal care services- there is availability- but not necessarily affordability- so often 

consumers cannot utilize as much personal care as they need as a LTSS.. 

.Question 15: our process does not track emergent/emergency cases separately- nor is low income coded 

for R calls or Options Counseling consumers. Springwell works with persons with limited English 

proficiency- however our computer system does not track this in the; R log. .We 

also have data that we assisted an additional 24 consumers under 60 with disabilities to transition out of 

institutional facilities back to the community during the Oct 2012-Mar 2013 time period- but I did not 

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69 . Please add any additional thoughts about Local ADRC and either its operations and/or its 

results. 

have type of disability available for this report.. 

.Question 32 and 33: As Springwell initially followed the Coleman model for CTI which precludes the 

CTI Coach from making direct referral to programs and encourages the participant to self-refer- this data 

has not been tracked. Springwell also has a more innovative transitions model- however I am not 

including that referral data in this report as it does not appear to match the parameters of these questions 

on care coordination.. 

.Question 38: Springwell practice is to provide referrals and resource lists to all Options Counseling 

consumers. Massachusetts has a wealth of state/federal-subsidized programs including volunteer and 

nutrition programs that do not require financial eligibility so these are shared with all OC consumers. The 

resources sheets also include private-pay agencies and organizations. . 

.Question 39: Intentionally left blank as the Commonwealth of Massachusetts will be providing the data 

for this question for the Metro Boston ADRC.. 

.Question 41 through 44: Intentionally left blank as the Commonwealth of Massachusetts will be 

providing the data and responses for these questions for the Metro Boston ADRC.. 

.Question 46: the database does track some of the referrals made for consumers- but not all referrals. Our 

system does not link to Medicaid€TMs database- however staff have access through a log-in/password to 

the Commonwealth€TMs Medicaid database.. 

.Question 64: Intentionally left blank as the Commonwealth of Massachusetts will be providing the data 

for this question.. 

.Question 71: We were involved in the past were in Massachusetts- so we already have an active and 

working state exchange and have had mandated health care for many years. . 

.Question 79: In MA- the Executive Office of Health and Human Services is the parent agency to sixteen 

agencies- including the Dept. of Elder Affairs- Massachusetts Rehabilitation Commission- MassHealth 

(Medicaid). Springwell has contracts with and receives funding these agencies. Area Agency on Aging 

Springwell IS the local AAA.Re: County agencies the Commonwealth does not organize most of these 

services on a County-basis- but on Town-basis- so I left these questions blank.. 

.Question 80: Benefits counseling- however Springwell uses ten trained volunteers- supervised by two 

full-time VISTA volunteer coordinators- to provide benefits counseling/assistance to consumers. 

.Care Transition Services: Springwell has two staff persons (who are Options Counselors) trained to 

provide the Coleman Model of Care transitions. However- the amount of time dedicated to CTI does not 

rise to any significant portion of an FTE. If you were using the term care transition services in a broader 

sense (meaning social workers who work with persons in a SNF/rehab to help them re-enter the 

community) we have two FTEs doing this work. 

.Crisis intervention services: Springwell also has the contract to provide Adult Protective Services for 17 

towns. We have ten FTEs working in this program- however I am not sure if that is what you are asking 

about in this question. 

Part B question 12 Access to Dr's office is shameful. Many still cannot give people who use wheelchairs 

thorough exams. Part B question 15. Not yet available on our new system Question 33 We do not get into 

hospitals. Folks usually discharged to NH before we know about them. Question 38 we do not yet capture 

this information. Housing is an ENORMOUS Problem. Accessible- affordable and available. This survey 

was confusing and entirely too long. Some information is approximate as putting the results of all the 

different reports is very difficult. 

The information being asked for in this survey was not clear. Further- it was difficult to compile accurate 

data because some of it was not tracked by our organization. Care Transition numbers requested have 

been given by Elder Services of Worcester as they are the contract holder. Tri-Valley subcontracts with 

Worcester and its numbers are included in Worcester’s. Section B. number 14- the number of older adults 

served. We are unclear as to how to answer the question because there would be a bit of duplication. We 

were not able to discern what was being requested. 

Please note that responses for question numbers # 39- #41-#42-#43- and #44 will be provided by 

Executive Office of Elder Affairs. 

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69 . Please add any additional thoughts about Local ADRC and either its operations and/or its 

results. 

ADRC of Southeast Michigan is not currently operational. We are currently in emerging status and 

anticipate beginning to provide ;A in Summer- 2013. 

While all of the specific figures were unavailable for this particular survey- we can say with definite 

certainty that the quality of service has improved since the development of the ADRC of SWWC. 

Community organizations have come together as partners to share ideas and work together with the 

common goal of serving the individuals in our community in a more person centered way providing 

improved streamlined access to services. As an emerging ADRC- we are taking this time to develop 

policies and procedures that will work across the board for all partners within the ADRC of SWWC. We 

continually strive to meet the benchmarks that will lead us to our goal of a fully functional ADRC. 

Becoming an ADRC partner raises awareness about what organizations in our community can do to assist 

the individuals who contact us. Working together with those ADRC partners opens us a whole new realm 

of community resources- and in turn helps us to provide a better quality service overall. 

We are an emerging ADRC Collaborative that is still in the formative process. Some of the ADRC 

Partner agencies provide ADRC Services such as Information and Assistance- Assessment and Options 

Counseling but we have no ADRC Funding and no joint data collection systems in place at this time. It 

was difficult to answer many of the report questions on behalf of the Collaborative but as we develop 

more tools such as software for data collection and sharing referrals we will have a system to record that 

is being served through the ADRC System. 

Dear TAE Website- the ADRC of the Thumb is a loosely knit group of 59 providers across three very 

rural Michigan counties. LTSS service providers in these counties have longstanding and very welldeveloped existing relationships throughout the continuum of care for all people with emphasis on the 

older adults and people with disabilities in Huron- Sanilac and Tuscola counties. This ADRC HAS NOT 

EMERGED. Staff are being trained in Options Counseling and AIRS A certifications obtained. While all 

are in favor of Michigan's new web-based resource database www.michigan.gov/adrc and the toll-free 

phone number to access the same- it is an un-natural arrangement for a caller to access the Area Agency 

60 miles from where they live and at the same time equally awkward for that caller to reach an AIRS 

trained professional at a satellite office of the Center for Independent Living. At the same time- as you 

might suspect in rural America resources are limited and operational funding has not appropriated. There 

are several competing efforts and programs that work alongside the ADRC initiatives making some 

question the necessity of the ADRC effort. 

ADRC Capital Area is not up and running yet - we are in the emerging/planning phase 

We are not a fully functioning ADRC. We receive no funding from any source for the ADRC. This is an 

unfunded state mandate. 

This is hard to measure with the database. We do know there has been an increase in providers in the 

database as well and the data is continuously updated and enhanced. 

We are always open to work with new partners. Always try to provide as many services as possible for 

our vulnerable elderly and/or disabled individuals. 

This has been an interesting survey- considering we are self-funded as an ADRC. Three or Four years 

ago we had a one-year Benefits Checkup grant which gained us the designation ADRC. Since then no 

other funding has come to support an ADRC until this year. We have a One year Options Counseling 

Pilot Grant totaling $11-000. We hope there will be some REAL ADRC funding coming in the future. 

Otherwise the next sequester cuts will definitely continue eliminating resources for our seniors and our 

ADRC designation is at risk. 

Area VIII Agency on Aging is a Department of Cascade County Aging Services- and thus must also 

incorporate county policy along with the federal and state regulations for an ADRC. The ADRC fits in 

with Aging Services as we work to expand community knowledge of the vast support services available 

to our senior clientele and now the disabled clientele as well. often times these two categories are 

combined in one individual and it is of a great value to ensure the resources within the community are 

able to be broad-based and able to handle the varying needs of our community as a whole. 

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69 . Please add any additional thoughts about Local ADRC and either its operations and/or its 

results. 

Area X Agency on Aging is a frontier single county agency with one Indian Reservation. We provide 

direct services and are the focal point for LTSS. We do informal care plans with other agencies to provide 

services for our elderly and disabled. 

East Valley Family Services is a very cooperative ADRC site. We pride ourselves on nurturing current 

partnerships and consistently seeking new partnerships to better the agency and the services available to 

our clients. We offer a full scope of services- including assessment- resources and referrals to our clients. 

We also work very closely with the Family Resource Centers to provide streamlined access to services 

across the lifespan. 

LCHS employs one full-time ADRC Specialist who provides ;R- Options Counseling- and Eligibility 

access. In comparison to some ADRC sites that are able to provide 40 hours per week of service at one 

site- LCHS provides services in four (4) different communities. Lyon County's unique geography 

requires the ADRC Specialist to spend at least 10% of her time per week traveling to each communitywhich is approximately 4 hours per week. The ADRC Specialist averages 5 on-site appointments per day 

and 1 home visit per week. Each appointment averages one (1) to two (2) hours. LCHS plays a critical 

role in a number of collaborative efforts and initiatives designed to increase the effectiveness of 

advocating for seniors and individuals with disabilities. These efforts streamline services- provide a onestop shop- and help those planning for their future to maximize resources. LCHS Social and Senior 

Services Divisions will continue working together to provide a one-stop shop for all consumers seeking 

resources and services. LCHS will also continue to cultivate partnerships with agencies such as Lyon 

Sherriff's Office and Elder Protective Services who often refer at-risk individuals- knowing that staff is 

well-versed in understanding the level of service required for each individual. LCHS strives to ensure 

that individual's needs are sufficiently met- allowing them to continue living successfully and 

independently- and will continue to place all efforts towards helping and advocating for those in need. 

The staffing numbers are a representation of staff paid for by Monadnock Service Link ADRC through 

our Service Link contract with NH BEAS- some small private donation assistance- private grant funding 

that supports the Service Link ADRC work (primarily NH Family Caregiver focus at this point). The 

FTE number includes co-location at the CMC/DHK but does not include NH state staff which is colocated at our office on day a week and paid for through separate NH DFA dollars. It also does not 

include GSIL FTEs who are co-located with our ADRC. There are two on-site employees. It also does 

not include administrative staff from the Monadnock Collaborative and Cheshire Medical Center that 

provides in-kind support to the ADRC or the hours of our interns and other regular volunteers and board 

members. I think the hybrid ADRC model for streamlining access to services and providing access to 

information is firmly established in our state. Regarding the questions about increased numbers since the 

ADRC grant- I wasn't sure which ADRC grant the question referred to. In general- numbers for 

Monadnock and Sullivan County Service Link ADRC have remained someone steady over the last three 

years with some increases and changes and in certain areas. Statewide there has been a significant focus 

on how calls and information is documented. My concern continues to be about getting data that means 

something relative to data gathered elsewhere rather than increased numbers while clearing showing the 

need for information and supported options. Part of our role is to support our partners in providing those 

options effectively and I'm not always sure we document that effectively. 

Sullivan County Service Link has a very strong presence as the State Health insurance program and is 

starting to become a more rounded options counseling program. The addition of a focus on caregiver 

assessment and outreach and Veterans Directed Services is making a noticeable difference in this 

program. We are building a partnership with Valley Regional Hospital through family caregiver work 

that we hope to expand into a more formal approach to care transitions work in the next year. 

Low Medicaid related reimbursement rates are adversely affecting the number of available providers. 

Managed Medicaid Long Term Care Services will further affect the quality of services in New Jersey. 

For question 38- this ADRC is not specifically funded for Options Counseling as OCCO provides this 

service upon conducting the clinical assessment for GO- however- the a number provided consists of 

programs referred and funded through PEER- JACC- and other APC providers. A total of 6444 has been 

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69 . Please add any additional thoughts about Local ADRC and either its operations and/or its 

results. 

tallied. Also- included is the number of referrals to OCCO for GO clinical assessments conducted by the 

ADRC. However- this ADRC does not administer Medicaid funded services such as GO- food stampsTAN-F etc. As per the CWA- approximately 500 cases are carried by Medicaid caseworkers who 

incorporate these programs. 

I believe that there are plenty of consumers that are in need of services- but there are barriers that we 

struggle with in Camden County with current staffing issues that result in wait times (i.e. to get a hold of 

intake workers at BOSS- to get an appt. for a home visit from Medicaid). As far as Case Managementthere are staffing issues which makes us no longer able to accept new Global Options (non-AL) cases and 

keeping AL caseloads within a reasonable amount. Staffing issues also impacts on the length of our 

JACC waiting- which is currently about 1 year long.*** This report was completed to the best of our 

ability as some of the data we are unable/do not currently collect. Some of the numbers may not be 

completely accurate- but were best estimations. Anything that was left blank was because of it being not 

applicable or unknown. 

The Cumberland County ADRC did not receive any direct grant funds for the implementation of the 

ADRC; therefore- some questions were left blank as they did not apply to this site. 

Additional Funds are needed to support current staff and as service need increases additional staff will be 

required. 

ADRC Grant money is needed in order to support and expand the purpose and function of the ADRC. 

First- the Monmouth County ADRC RECEIVES NO ADRC GRANT FUNDING!!!My comments about 

this survey: The survey is poorly written. Many of the questions are ambiguous- e.g. what 

does;significant; mean? Question #7: Latino/Hispanic origin: __Yes %- __No %. What does that mean? 

Others are slanted for a specific all or nothing response- i.e. significantly increased- significantly 

decreased- stayed the same. For many questions- the answer was; Somewhat Increased/Decreased;; I did 

not respond to these questions. On the questions dealing with the approximate timing of the first and last 

follow-up with consumers after initial contact- all the responses were definitive. There should have been 

an ;Other; answer where we could explain that contacts depend on the case; you were looking for a one 

answer fits all. There are other comments my staff and I had and if anyone reads this far- please call me at 

732-431-7450 and we will provide them to you. 

ADRC grants have not been available during the restructuring of the Passaic County AAA while 

transitioning to the ADRC process. Future FFP funding will provide the local AAA the resources 

necessary to effectively and efficiently provide comprehensive service deliveries to the vulnerable 

populations specifically needing LTSS. 

Union County has not received any funding to support ADRC staff / activities. However- the application 

process for Medicaid Waiver Programs has been greatly improved in regard to processing time. 

The NY Connects Long Term Care Office continues to work cooperatively and collaboratively with other 

local agencies- county and state agencies to improve the long term care services system in Cayuga 

County. The NY Connects office is a single point of entry that provides the community with information 

about availability and access to long term care services and support. We offer Cayuga County residents 

assistance with planning for and obtaining cost-effective and appropriate long term care services for 

themselves- or someone they know or are caring for- regardless of age or income. We provide a free inhome assessment to assist in developing a care plan based on the client's needs and services availablemake referrals to appropriate agencies- pre-screen for Medicaid eligibility and complete PRI screenings 

for long term placement in a facility in the event the client can no longer safely stay at home. 

Please note that this survey was completed to the best of our ability at this time with resources available. 

Need for IR/IA is great. Larger need for funding to support the staff to perform these functions. Every 

year we are asked to collect more and more data even though our funding continues to decline and the 

ability to fill vacancies or create positions to fill the need continue to decline. While we have tons of data 

collected- we are unable to pull the data in the requested fashion as the software was developed far before 

this report was requested and we have not collected all of the requested information since the infancy of 

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69 . Please add any additional thoughts about Local ADRC and either its operations and/or its 

results. 

the program. Requirements have changed throughout (i.e. LEP). 

We do not have access to much of the information requested 

We are limited in the services we provide based on decreased funding- increased need- and limited 

staffing. 

The ADRC money has allowed us to work effectively together with our DSS and OFD offices. We hold 

joint meetings and trainings- consult each other on subject matter that is particular to our offices and share 

clients in order to get the best services for those clients. It has also supported our continued efforts to 

provide Enhanced Options Counseling and Options counseling to seniors- and their formal and informal 

caregivers. 

Thank you for the opportunity to provide a narrative. Since the creation of Centralina CRC Connector we 

have been able to expand CRC efforts in Region F. Cabarrus and Mecklenburg CRC's have been 

operating under the no-wrong door model for years and we were able to take the best practices and 

lessons learned and expand the CRC philosophy and practices to other counties in our region. The CRC 

offers a change in the way we as service providers do business. This is a purposeful initiative to better 

serve older adults and expand and improve services for people with disabilities. We have learned that for 

years’ service providers who worked with older adults operated soloed from service providers who work 

with people with disabilities. This was a great disadvantage for the consumer. We now know that there is 

a great benefit in partnering to better work together to serve the community. The CRC offers meaningful 

working partnerships- training and best practices in customer service and person-centered thinking to 

improve customer service and ease of access to resources for the consumer. We still have a long way to 

go with formalizing reporting and data sharing. However- the CRC has made great strides in community 

partnership and service provision for older adults and people with disabilities. We are developing systems 

of data collection- but it will take time. Especially with limited resources. Now days with budgets being 

restricted- it is more important than ever to continue this community effort that has and will continue to 

expand services and improve the quality of services for older adults and people with disabilities in our 

community. Since 2004 the CRC has been able to create a more coordinated system of informationassistance and access for older adults and people with disabilities. Efforts have been made to pave the 

way for enhanced individual consumer choice. Locally- we have made specific strides in the area of 

hospital collaboration and partnerships. Communication is more open and referrals are being shared more 

seamlessly within the CRC. Including the NC Options Counseling Certification Process and curriculum 

with CRC efforts has made a positive impact on agency buy-in as well as providing a more educated and 

credentialed network of staff for consumers to encounter through their CRC access among agencies. 

Agencies work well in the local CRC collaborative and we continue to come together for a common 

purpose- to provide a quality service and access for consumers. 

As stated previously it has been difficult to provide an accurate picture of the services that we provide in 

terms of numbers served etc. The information that was provided was not provided by each of the major 

agencies who participate- rather it was info that was provided by a few. Many of the questions were 

designed for ADRC states rather than our current structure and were very difficult to answer. It is our 

hope that we will be able to provide a better picture in the future- should funding sources become 

available to assist us in this area. 

The challenging economic environment and the lack of funding has made it difficult to hold together 

partnerships between the core operating partners. The lack of funding has also made it difficult to 

encourage agencies in the various counties to expand CRC activity and invest the significant human 

resources required to make the CRC a reality in their respective communities. Significant strides were 

made in Rockingham County to address hospital re-admissions and demonstrate the really positive impact 

partnerships with home and community based organizations and the supports they provide can have on 

reducing hospital re-admissions. This work has temporarily ended due to a lack of funding to underwrite 

the salary of the staff person who was dedicated to this effort. The establishment of the Area Agency on 

Aging’s as Local Connectors in North Carolina has created greater accountability and a unified system for

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69 . Please add any additional thoughts about Local ADRC and either its operations and/or its 

results. 

conducting the work of the CRC across the region and hopefully the state. The AAA provided free of 

charge access to a web-based Client Referral/Tracking Tool. This is possibly the single most significant 

occurrence this reporting period due to the increased capacity to realize the vision of providing a streamlined- no-wrong door approach to information and assistance. The disparity and differences between the 

aging and disability networks have been difficult to overcome. Without the commitment of the aging 

network to the CRC concept- it is unlikely that the CRC could exist. 

I am using this space to explain responses/lack of responses to specific questions. Section B.15. The 

number of individuals under 60 with multiple disabilities includes 13-541 people with disabilities served 

by Adult Economic Services at Wake County Human Services. They do not track according to type of 

disability. Section B.16.-21. Although our numbers over time indicate increases in the number of people 

we are serving- we do not know whether we are seeing significant increases or different/more complete 

ways of tracking. The answers to these questions would vary according to the specific operating 

organization. Section C.25.-26. Many of our operating organizations work to help seniors and adults 

with disabilities remain in their own homes for as long as is safely possible. These organizations track 

their outcomes in different ways. Section C.27.-31. CATCH- the formal care transitions programlaunched at the end of January 2013 and gradually was being rolled out to include all the hospitals during 

this reporting period. Section C.32. This information was not tracked. Section C.35.-36. The Wake CRC 

developed a standard screening /referral tool to be used before the planned implementation of 

NCcareLINK- a statewide database and screening/tracking/referral tool. When state budget cuts 

eliminated funding for the initiative- operating organizations returned to using their own tools. Section 

C.39. The Wake CRC was one of two sites in NC selected as a pilot site for the development of Options 

Counseling Standards and Training. The numbers reported include the number of individuals (23) 

provided Options Counseling by our certified Options Counselors. The numbers also include numbers 

from one of our operating organizations. Hospice of Wake County and Horizons Palliative Care provided 

Options Counseling to 2199 individuals they served as part of their LTSS case management. Their 

Options Counselors are almost all social workers- but they are not certified as Options Counselors. 

Satisfaction surveys were given to 11 of the 23 individuals provided Options Counseling by our certified 

counselors. The surveys were returned directly to UNC CARES- evaluator for the OC pilot- and we have 

not seen results. Section C.55. Each operating organization collects its own performance data. The data 

is collected for the CRC network twice each year for the SART. Options Counseling data for the CRC 

has been tracked on an ongoing basis. Section C.66.-70. Comprehensive assessment of eligibility for 

LTSS can differ according to population group. Section D.79. The partners reported do not include our 

core operating organizations or their various components. For example- our core operating organization 

Wake County Human Services includes public health- housing and homeless services- veterans' servicesMedicaid services- Senior and Adult Community services- Adult Guardianship- and Adult Protective 

Services- among others. Section D. 80. The FTE numbers for Options Counseling include numbers for 

our certified Options Counselors and one of our operating organizations (Hospice of Wake County and 

Horizons Palliative Care) which provides this service only to the individuals they serve through their 

LTSS case management services. 

The data provided here does not fully capture the work done by the AAA/ADRN. Items left blank may be 

unanswered due to lack of data. Because of funder demands- we use several different IT systems- not all 

of which are owned by us- to capture information and not all the information that you've asked about is 

readily available. Tracking data would be somewhat easier if we knew ahead of time what kind of data 

you are interested in. It's difficult to piece together 6 months' worth of activity and the questions seem to 

vary from one reporting period to the next. Thank you. 

We have been able to form core partnerships with other funding organizations and have developed a 

single-point of entry for consumers utilizing 211 and ADRC for all 4 counties in service area. We have 

shared resources- funding and training opportunities and now have 24/7 crisis intervention available. 

The Front Door will play an increasingly vital role- yet the funding has been cut by % in the past 2 years. 

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69 . Please add any additional thoughts about Local ADRC and either its operations and/or its 

results. 

Re: #84 There has been neither an increase or decrease in the number of LTSS providers. 

The answer for questions 84 85 is the same- no change. 

For question 39- NWSDS does not keep formal track of where consumers receive Options Counseling. In 

addition- since no surveying was done during the six month period- NWSDS is unable to indicate 

consumer satisfaction. For question 43- NWSDS records the total newly enrolled (not broken down). For 

October 1- 2012 to March 31- 2013- the total was 192.For questions 84 and 85- NWSDS answer is no 

change. There was neither an increase or decrease. For the six month reporting period- the ADRC 

reporting system was not used for one month. For this reason- some of the data is under reported. This is 

because the other system does not have the same reporting capabilities. 

The 211 system is being developed in the Region- and this has a very large impact on the development of 

the LINK. 

Although ADRC has been operating for a bit now- I believe that we still need to know long-rangemedium-range and short-range plans for the ADRC. I think this would help all counties to better 

understand their role- the purpose and focus. I also believe this will help with the Core Partners. 

I am new to this position and over time more facts will be learned and better statistics can be obtained. 

The base of Core Partners appear to be excellent and the collaborative partners seem to want to be 

involved in the Link. 

The Cambria County Link program is beginning to make its presence known in the community. 

Many of these questions were hard to answer- as we have been up and going for six months. I feel good 

that we have been developing many relationships between both County Agencies and Providers. Most of 

these questions were not ones that I would feel comfortable answering at this point. 

Our ADRC is a network of core/collaborative partners and we have seen a wonderful support for the 

program by providers and agencies. This has led to really good information sharing about services and 

programs among the members. The result of this is better quality referrals to services and expedient 

service provision for consumers and their families. 

Overall- Col-Mont Link has offered consumers who were unaware of these services info assistance to 

access these services through partner agencies. The goal is to continue to educate empower these 

consumers through encouraging better communication between agencies through cross-trainings. 

We are very proud of the response the Crawford County Link has received from so many organizationsagencies and businesses that serve the populations we are trying to reach. For a small- rural county- we 

have had great success in recruiting so many Collaborative Partners to our Crawford County Link. One 

challenge faced by all of our partnering agencies- is time. Our partnering agencies have been very 

supportive in attending quarterly Cross-Trainings that we have been holding for three ADRC/Link sites in 

our area. Our partners do express lack of time to regularly attend every other month Collaborative Partner 

meetings in this county. Core Partners have also expressed time restraints for having their staff become 

certified AIRS specialists. Many of our Core and Collaborative Partners belong to more than one Link in 

Pennsylvania and must often choose attending one Link's meetings over the other due to proximity. Our 

group has been steadily working to become a fully functional ADRC site with assistance from our state 

and regional program offices. We have also appreciated the good ideas that have been provided by the 

ADRC-TAE staff via their website. 

Through the Delaware County LINK we have sponsored very effective training events for staff and 

participants. We have held events to enhance outreach and bring resources and assistance to people who 

may not have otherwise had access to the help. We have also been able to market these programs. We 

have enhanced awareness of the Delaware County LINK and the partner agencies. 

The Erie County Link- along with its Core Partners and Collaborative Partners is designed to assist 

consumers with services to retain independence-make connections with organizations that provide needed 

services and assist consumers with applications to determine funding eligibility. The Erie County Link 

practices the ;No Wrong Door Policy;. The Core and Collaborative Partners meet monthly and the 

meetings are well attended. 

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69 . Please add any additional thoughts about Local ADRC and either its operations and/or its 

results. 

Franklin County LINK has brought together LTSS providers across our county- has developed a 

relationship with other community agencies- and provided a forum for resource sharing. 

Indiana County Link has been growing over the past few years. We are serving more consumers in both 

over 60 and under populations and education in the community for elderly and those 18 and over with a 

disability has been significant. No person 18 and over with a disability or those 60 and over should be 

without proper services to maintain them with the great influence ADRC has had in the county. Access to 

services is easily obtained in the county. 

As a Pilot program for Options Counseling- the Lackawanna County LINK to Aging and Disability 

Resources has had some strong successes and some frustrating impediments over the last six months ( 

10/1/2012-3/31/2013). The LINK program itself had to be repositioned to several Agencies/Organizations 

at higher levels in order to be accepted/adapted as a e; Partner; in the Human Services arena in 

Lackawanna County. The key areas of Hospitals- Housing- and Transportation had no penetration at alland had to be addressed on an ASAP basis prior to implementing a formal Outreach/Marketing Plan. The 

concept of Options Counseling has been extremely well received- but it is just beginning to be embraced 

and utilized by Collaborative Partners. They are now recognizing the value/benefit of the Option 

Counselor in the e; No Wrong Door; philosophy- and this will continue to be critical to the success of the 

program. As far as impediments are concerned- SAMS I R was supposed to be operative by the end of 

January- 2013- and is still not available as a measurement tool. This has necessitated the utilization of 

paper tracking vs. electronic monitoring- and this is obviously labor-intensive and not very 

effective/productive relative to the information needs of a newly implemented program. My final 

comments center on Outreach. Marketing Plans can include several vehicles- e.g.- Direct Mail- Television 

Advertising- Interactive ( Internet)- but in most cases they will only produce a ;spike; in new callers over 

a limited period of time. I believe that over time- Collaborative Agencies/Organizations will grasp the 

value and utility of Options Counseling relative to our target population of the underserved and 

uninformed- and they will actively refer potential consumers who are in need of LTSS to an Options 

Counseling site ( this is happening with a few progressive organizations). In the meantime- I believe that 

we can become more proactive toward reaching these individuals in need through a e; Retail; approachi.e. contacting other entities that have a strong and current knowledge of individuals/families who are 

distressed and in need of Long Term Services and Supports. One example of such a ;Retail; entity would 

be faith based providers- who have an intimate knowledge of the families that they are serving- and who 

are anxious to assist their constituencies in any way that they candid would also like to express my 

appreciation to the LINK Program Management team- and David Drexner in particular. As a pilot 

program here in Lackawanna County- and accountable for the introduction of Options Counseling to the 

LINK equation- we received excellent direction and support in navigating some uncharted waters. 

We have answered the questions on this report as accurately as we can give the time and information we 

have. 

I have filled the evaluation to the best of my knowledge. The ADRC program has only been in existence 

in Lawrence County for two years. There has been significant growth on people receiving services. I am 

not hundred percent sure though it is due to the fact ADRC is doing its best to educate the public on what 

is out there or because Lawrence County is a very high rate of elderly population. Either way the 

numbers are growing and we are doing our best to let the people know what is available to them. It is 

definitely a struggle because the program is so new and not exactly sure what is expected of us. It would 

be great if Pennsylvania could come up with a better plan on how they want things done. Having the 

virtual approach and every county doing things differently it is definitely a struggle. 

The past six months have been a difficult time for the Lycoming-Clinton LINK. State Medicaid changes 

have resulted in limited face to face collaboration and interaction between both Core Partners and 

Collaborative Partners. Still- our primary goal remains the same. We want to maintain the 'no wrong 

door' approach to Information and Referral. We have- in concert with other local LINKS- participated in 

radio advertising and television advertising - to raise awareness of the LINK. We have billboards 

throughout our two county area advertising the Core Partners. We maintain a strong newspaper campaign 

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69 . Please add any additional thoughts about Local ADRC and either its operations and/or its 

results. 

- once again advertising the Core partners. We have an active 2-1-1 program. We maintain active 

participation in multiple community organizations (United Way Task Force- Lycoming County Housing 

Coalition- Lycoming County Governor's Committee on Employment of People with DisabilitiesCommunity Elder Providers meetings) as a way to provide information and education to agencies in the 

community. We continue to get the word out - explaining what the LINK is- what the LINK does- and 

how the LINK can help. 

While we all share the database- I am given no other significant information from any of the core 

partners. 

We think this has the potential to strengthen partnerships- interagency cooperation- no-wrong door 

service- greater quality cross-systems training. AIRS certification and Options Counseling training would 

be excellent additions to enabling the ADRC to increase quality of service to every caller/visitor. 

The Pike County LINK to Aging Disability Resource LINK Coordinator is hearing good feedback from 

the people in the community while participating in Marketing Outreach Events. Aging Adults People 

with Disabilities- Consumers of Services- Caregiver's- Families- Advocates Human Resource Agencies 

all agree Pike County LINK to Aging Disability Resources is a much needed service for Families in the 

Community. To be LINKED to Long-Term Support Services so families can plan for the future 

Independence. 

The Schuylkill Link just started 10/11 and is still not set up yet to serve consumers- but have been making 

referrals when needed. We are working on a strong collaborative base and getting prepared for options 

counseling. 

The Allegheny Link has been successful in becoming the ;go-to; agency for difficult issues. We have been 

extremely effective in building collaboration and partnerships across the community. We also value our 

independent status that allows us to act without regard to loyalty issues. If an agency is performing poorly 

or if consumers are citing issues with specific programs- we are able to react. We continue to work to 

strengthen our partnerships and form new ones when strategically appropriate. We work very well with 

our local SHIP and are planning large community education events around the Health Insurance 

Marketplace and Medicaid Expansion. Within the past 12 months- our program was evaluated by an 

internal office. The high-level outcomes are below:- 96% of individuals responding to the Consumer 

Satisfaction Survey were happy with their overall experience with the Allgheny Link.- 94% of individuals 

responding to the Consumer Satisfaction Survey were satisfied with the Allegheny Link's ability to help 

them locate services they needed.- 88% of individuals responding to follow up calls report that they are 

receiving or in the process of receiving services to fill the need they reported when initially contacting the 

Allegheny Link as a direct result of Allegheny Link involvement. 

Has been a very positive experience and we look forward to further collaboration and cross trainings. 

Public awareness is needed to educate the public on where and how they can locate services. The LINK is 

a vital part of the process. This program has fostered relationships built on the common good for the 

community. It has allowed services to grow and access much needed advertising to reach consumers they 

may not have had the chance to do. It promotes the option of community care services for consumers 

who may be placed in a long term placement. In doing so saving valuable funds. Although long term 

facilities are on the board- they have educated themselves on how many programs work and thus 

improving their discharging abilities to the community. Plans are in the process to further reach the public 

on a monthly basis and more cross training opportunities. The Link provides the following functions:1.) 

monthly face to face meetings with core and collaborative boards.2.) special outreach projects conducted 

twice a year providing speakers- info- and vendor contact.3.) marketing- radio announcements ( 70-000 

listeners- onsite radio events twice yearly) - ads newspaper readership- about 20-000 and local ads 

reaching 5-000-pharmacy ads 3000) materials to promote the LINK and collaborative- distributes by 

collaborative and core partners.4.) Healthfairs- 2-3 a year reach 1000 plus attendees 5.) Cross trainingsheld 3-4 times a year- collaborative partners are invited along with appropriate staff. Programs covered 

are on pertinent topics such as Estate recovery- Assistive technology- health and wellbeing. All topics 

were well received and attendees came away with important information to share with their clientele. 

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69 . Please add any additional thoughts about Local ADRC and either its operations and/or its 

results. 

Number 84 - left blank - one Core partner answered that there has been an increase of LTSS providersanother answered it remains the same- and another answered there has been decrease. Number 85 - left 

blank because there has been little or no change in the quality of LTSS in Warren/Forest Counties. 

Warren/Forest Counties have a high level of cooperation among area services. 

THE POINT experienced changes in staffing during this time period due to a reduction in funding. Staff 

levels went from 5.3 to 4.3. However- THE POINT enhanced their already strong relationship with: the 

Rhode Island Division of Elderly Affairs by working closely with the project manager to implement 

changes to day-to-day activities of POINT services and handling each and every caller- walk-in and 

outreach client with a triage form- addressing their needs according to protocol; Rhode Island Department 

of Human Services by learning further about LTSS services and placement clients into the appropriate 

facilities; Rhode Island Department of Health by receiving funding to finance chronic disease selfmanagement classes for seniors- adults with disabilities- and caregivers. During this period- THE POINT 

rebuilt relationships with agencies in the community- re-trained its staff and enhanced the ;no wrong door; 

approach to services. This approach is defined within the POINT manual; the philosophy of working 

together- innovative thinking and new ways of sharing information to achieve the best possible client 

outcomes. The vision for a No Wrong Door€_ is to be client-centered- accessible and possess coordinated 

services. a No Wrong Door€_ is about being helpful from a whole-of-client need perspective- considering 

all the services a client may require. By adopting a holistic- client-centered focus- staff will be able to 

identify clients with complex or multiple needs and focus their intensive efforts on responding to those 

needs. This will ensure that those clients are linked to the right range of services and receive an 

appropriate response. Clients will not have to negotiate access to multiple departmental service areas on 

their own. The a No Wrong Door€_ approach to work is a key vehicle to embed a philosophy and planned

approach to client-centered service delivery across THE POINT. This approach will undoubtedly deliver 

better outcomes for clients. With this innovative training and a No Wrong Door€_ approach- THE POINT 

is able to provide a higher quality of options counseling- better customer service- and a higher level of 

service overall to its clients. THE POINT program coordinator is planning to attend the Alliance of 

information Referral Systems conference- with a track on aging- to be held in Portland- Oregon. As an 

outcome from the conference- we are hoping that she will learn from other ADRCs across the country 

how they provide essential services- options counseling- short term-case management and ultimately the a 

No Wrong Door€_ approach. This is an exciting time for our POINT office- as we look forward to the 

Health Exchange in Rhode Island- where more than 40-000 Rhode Islanders below the poverty level 

(138%) will qualify for enrollment into a Medicaid plan. Rhode Islanders without health insurance will be 

able to shop through the Exchange for their best health care options. 

The impact of LTSS or Home and Community Based Services have seen a drastic increase. Many clients 

are applying for these services to help with their daily lives. Many clients prefer to stay in a home setting 

as long as they can. The LTSS program helps clients with their goals. The increase in applications has 

dramatically increased within the last several years. 

All referrals are listed in SC Access case notes. They do not seem to be reflected as the report indicates 

that 1862 of the 2183 clients served in past six months have not been referred. This is not accurate. 

The Department of Social Services is comprised of various Divisions including the Division of Adult 

Services and Aging (State Unit on Aging) which administers the ADRC and the Options Counseling 

Grant. The Division of Adult Services and Aging employs sixty-five ASA Specialists located in twentyfour local state offices. The ASA Specialists perform various duties including intake and referral- intake 

and assistance- options counseling- assessment- care planning- and follow-up (case management). Five 

of the local offices are designated as an ADRC Call Center with designated county coverage areas. A 1-

800 toll free telephone number is assigned to each call center. The 1-800 numbers are marketed to the 

general public- however- all of the local offices perform intake and also function as a single point of 

entry. The Division of Adult Services and Aging is utilizing existing FTE positions and local rural state 

office infrastructure- programs- and funding to incorporate the ADRC functions into the current system. 

This has been accomplished by reviewing- evaluating- and reworking processes- tools- policies- and 

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69 . Please add any additional thoughts about Local ADRC and either its operations and/or its 

results. 

procedures. The goal remains to integrate the criteria of a fully functional ADRC into the state system 

and not overlay it as an additional program or service. Due to the above information the Local and State 

Reports contain duplicative information because we only report from a State Level. 

Additional funding for LTSS services has improved the agency's ability to serve consumers. There are 

still lengthy waiting lists for home-delivered meals and other in-home services for consumers not eligible 

for the CHOICES- Medicaid waiver program. 

When GNRC received the ADRC grant in 10/05- the number of days from initial contact by a consumer 

to the 1st day of in-home services averaged 203 days. As a result of ADRC streamlining efforts- the 

average number of days is down to 60-90 days. GNRC has not received additional ADRC funds since the 

initial award. GNRC secured an Option D Care Transition grant from AOA in 2010 and has utilized a no 

cost extension to develop relationships with other hospitals in our geographic area.GNRC was 

instrumental in implementing Tennessee's Med Waiver program and in developing the provider network 

that was taken over by the Choices Network in 2010. Due to budget cuts at the state and federal levelsGNRC has not been able to connect consumers to services since November- 2012. Currently the Choices 

program is the only LTSS program with no waiting list. The wait lists for other services have grown to be 

2-3 years long. This is before the impact of Sequestration cuts. 

- The ASC in partnership with the Bexar AAA has established a Memorandum of Understanding with the 

Retired Senior Volunteer Program (RSVP) in San Antonio. This partnership just went into effect but 

should increase the ability of the ASC program to diversify 

N/A 

Please request a link from Patricia Bordie at DADS regarding the Central Texas ADRC video that was 

developed by DADS Media Division. This video was developed to assist in helping other areas of the 

state establish ADRCs 

Since the inception of the ADRC there has been an increase in the awareness of LTSS and/or Home and 

Community Based system in our community. One of our partner agencies the Coastal Bend Center for 

Independent Living has been very involved in this arena. 

The Concho Valley ADRC has expanded its service area and increased services to all ages- disabilities 

and ethnicity. The State balancing incentive program has impacted the Center a great deal. We are now 

the local contact agency providing options counseling for non-Medicaid relocation from nursing facilities 

in two regions- covering 31 counties. We have increased our service numbers and increased the overall 

service access in our area- through our partnering agencies. We have relocated our office in a larger 

facility and our currently working on contracts with our key partnering agencies to provide ADRC 

services. We will soon be installing computer systems at various public locations through the rural service 

areas to better assist those facing barriers in connecting with the Center. In the coming months- we will 

be offering a region wide cross training workshop for all partners and service agencies in our region. Our 

challenges have been in developing a brand or identity that our community and partners can identify with 

and understand. We hope to continue to grow and develop our partnerships and provide services that best 

meet the needs of our Consumers. 

For questions 84 and 85: there has not been an impact on LTSS or HCBS in the community. 

Having definitive questions for the SART at the beginning of the six months could result in more accurate 

reporting. This six months East Texas ADRC transitioned in the responsible person who was reporting 

the SART data. In the completion of this SART period some opportunities for data collection were noted. 

This report is very challenging as every 6 months we modify our intake process based on the data 

requested on the previous SART reports. The data requested appears to be fluid and we are not provided a 

template that would allow us to gather the appropriate information. We have submitted this report as 

accurate as possible based on the information we collect. We will modify our intake process to ensure we 

are better prepared for our next report. 

Since Lower Rio Grande Aging and Disability Resource Center started serving consumers- the STARPLUS managed care program was initiated in our serving area which initially created some gaps in 

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69 . Please add any additional thoughts about Local ADRC and either its operations and/or its 

results. 

service but overtime- the quality of LTSS services seems to have improved slightly. 

Lubbock County ADRC has been very strong in establishing community partner relationships. We have 

assisted many consumers in addressing their unmet needs by linking- and referring them to available 

supports/services through community agencies. We have been very creative many times in getting 

several agencies involved concurrently to meet unmet needs of our consumers. Many of the local agencies 

staff contact Option Navigator when they need assistance with very challenging cases that cannot be met 

through community agencies. Option Navigator has also been very successful in getting vested partners to 

address unmet consumer needs that local community agencies are not able to meet. Our strength is in 

having knowledge of what each agency offers- agency requirements- and the documentation needed at 

point of scheduled appointments. We have a long ways to go- but these are the areas of strength that we 

are very good at and proud of. 

We have greatly benefitted from participation in the ADRC. Our AAA staff have become much more 

knowledgeable of programs serving younger consumers and much more tightly networked with the 

agencies that provide direct services to younger persons. 

More resources and funding is necessary to address the growing need of the populations that we serve. 

We continue to build on the work of previous years to establish a strong network of programs and 

services aligned to serve older adults- people with disabilities and their family caregivers. 

BIAVT has no means to track the LTSS providers’ numbers or quality of service in the state. BIAVT has

offered a multitude of trainings on the topic of brain injury and how to best work with brain injury 

survivors. In the long run- increased awareness should increase the quality of care but it is difficult to 

measure. The ;A part of BIAVT provides resources and may increase the chance of the providers of those 

services maintaining a level of customers to enable them to continue to offer those services. Since we 

serve all ages- we work with educational institutions as well. One goal is to help students receive the 

services they need during their healing process so they do not need to be part of the mental health or 

correctional systems at a later date. We also are working with the Correctional System in VT- educating 

the staff on how to help those who have been identified as having a brain injury and also to increase 

awareness of the individuals with unidentified brain injuries. The LTSS options for those who do not 

receive the services in a way that will enable them to succeed- is repeated incarceration. As you can seeLTSS has many meanings for our population. Long-term is also a very subjective term for our 

population. The ADRC is an important organization and it is very beneficial for BIAVT to be part of it. 

The main service we provide is peer support and peer education done by volunteers. 

This agency is continually looking for ways of sustainability. This is a great program. 

SVCOA continues to be a positive force in making our region a better place to live and grow old- which 

is accomplished with our ongoing relationships with community partners and the development of 

relationships with new community partners as we expand our ;A department to ensure consumers have 

appropriate information and referral at any point of entry. Please note that our point person for completing 

this report is out unexpectedly on medical leave and thus staff who are not familiar with this report 

worked to compile the above information. Please let us know if any questions arise. Thanks. 

We are finally moving ahead as an ADRC adding services- and attracting new clients but it has been a 

slow process. 

This is the first SART report for Loudoun County AAA. We are in the beginning stages of discussions 

with possible partnering organizations. We began PeerPlace approximately 6+ months ago. This is the 

first SART report for Loudoun County AAA. We are in the beginning stages of discussions with possible 

partnering organizations. Loudoun County AAA has some unique challenges because we are a division 

under the county€TMs Department of Parks- Recreation and Community Services. We will continue to 

seek opportunities for partnerships and formal agreements with local health and human service providers 

by using the vision for No Wrong Door and the fully-functional definition of ADRC to guide the 

discussion in this endeavor. We will also be discussing with the VA state unit on aging how we might 

work to revise the current Loudoun AAA organizational infrastructure to become more aligned with a 

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69 . Please add any additional thoughts about Local ADRC and either its operations and/or its 

results. 

county government human services department in order to increase synergy for the NDW vision. 

PAA has enjoyed a solid working relationship in various forms with public and private providers of LTSS 

since 1974. PAA has a solid reputation among citizens- local governments- local state government 

agencies- businesses and non-profit organizations. Our effort in becoming an ADRC per state guidance 

has been severely hampered by the client data software created by the SUA for use by public and private 

providers of LTSS. Some questions in this survey- 15 and 39 for example- request client data that is not 

available in the reporting tools created for our state contracted software. That is unfortunate and it would 

clearly be helpful to have such reporting tools. We do not have the staff time to review each client file to 

extract the data requested and to meet the deadline for this survey. For questions 39 and 40 on Options 

Counseling. staff have been trained on the state standards for Options Counseling- but counseling 

conducted since that time followed the procedures in place before the training. Presently- most staff have 

not been thoroughly trained and comfortable with updates to the state's software that capture Options 

Counseling data and procedures according to the new standards. So- although we indicate standards are in 

place- behavior modifications in fully adopting the standards and related reporting- have yet to be fully 

implemented. At such time that the state develops a comprehensive- user-friendly and intuitive client 

data/data sharing tool- PAA another Area Agencies on Aging will be in a position to attract additional 

Authorized Users/Partners and develop a true No Wrong Door program at the local level. In the 

meantime- the AAAs will use their software in relative isolation. New technology should not create a new 

silo which is what has happened in Virginia. In addition- we have seen that occur- unfortunately- over the 

last 4 years with our local health systems. As noted in response to Question 78- PAA has developed the 

beginnings of an ADRC program- representing public and private providers of LTSS and consumers that 

was launched by local private funding. This occurred when the state software did not attract local users 

and our private funder expected and deserved a return on their investment. Components of our local 

efforts in becoming a fully functional ADRC or Network have been endorsed by two former Virginia 

Secretaries of Health and Human Resources. We have local success that can be replicated in other 

communities among a wide range of LTSS providers. We know a one-stop can be created but it must be 

done right and for the right reason - that being consumer satisfaction in receiving streamlined information 

and access to community LTSS. This was an excellent survey and underscores the depth to which we 

should collect- and be able to report on- data from our software to gauge our progress and impact on 

advancing our ADRC operation. If this survey is to be conducted again- please allow for at least 60 days 

advance notice with the questions available at initial announcement. 

AAA/Aging and Transportation Services are managed as a division of RRCS; administrative functions are 

combined with the community services board under one board of directors. 

We are continually looking to grow and improve our ADRC services and operations- while attempting to 

maintain quality of service and outcomes. Maintenance of ongoing partnerships while building new 

partnerships and relationships is a constant challenge. As we bring more partners onto the No Wrong 

Door tools- we should begin to see operational efficiencies build exponentially- as the tools are improved 

and adapted to meet our changing realities. Efforts to co-locate some core services should improve 

communications and collaborative opportunities in addition to technological advances. 

Due to unforeseen circumstances the SAAA was still able to provide services to our seniors in the 

Northern Shenandoah Valley. 

VPAS enjoys being a leader in the ADRC movement and has worked collaboratively with other providers 

to create ADRC communities within our planning district. VPAS has worked diligently with our partner 

Center for Independent Living- VAIL- to enhance services to individuals with disabilities. We have 

conducted joint staff trainings- and created MOAs to better serve individuals and to reach a greater 

population. We have found the partnership to be beneficial to both entities and to the individuals we 

serve. We continue to seek out ways to enhance our service delivery together. 

I don't have comments about ALTCEW. I do want to comment on this survey. I have left many parts of it 

blank either because we don't collect that particular data element or we don't collect it in the manner you 

asked for it. There was no way to convey that explanation to you in the survey or to tell you what we do 

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69 . Please add any additional thoughts about Local ADRC and either its operations and/or its 

results. 

collect. You used different age categories than we normally use (65 instead of 60+). You also asked for 

age by subcategories and we don't collect the data that way. Some of the questions for which you wanted 

answers are not within our span of control. It is very difficult to answer ;all or none; questions when in 

fact we have ;some; of the information. In some questions the choices appeared as if you are steering us to 

a certain answer. I am concerned about what you might do with the results of this survey given it is poorly 

designed. You don't get the data you want because we had no warning of what to collect. We don't have 

the opportunity to describe what we do because there is no place to enter the information. 

The Pierce County ADRC has been instrumental in pulling together the many disparate LTSS providers in 

the county - becoming a vehicle for dialogue and collaboration. We produce a monthly ADRC Enewsletter distributed to providers in the county. We also host a monthly networking meeting for all 

LTSS providers. The ADRC holds a bi-monthly Community Forum for all our ADRC partner 

organizations. 

Our agency continues to provide detailed service to our consumers. However- we have lost funding for 

the SHIP program and therefore we had to lose on site staff. Our remaining ADRC counselors are trained 

to handle these issues but now will have to add this to their duties. Whereas before we had staff paid to 

handle those services specifically. We need to find more ways to get our name and services out there to 

the public. But with limited funding we are not able to. People are always thankful to find an agency to 

takes a genuine interest in their need and one that follows up to see they get what they need. Or 

sometimes just to listen and show compassion. 

Some of the information that was collected through this evaluation survey was not tracked- therefore may 

not have been answered in the appropriate sections. Question # 74. Please refer to the Petersburg local 

office evaluation survey to see the amount of funding allocated. 

Some of the information that was collected through this evaluation survey was not tracked- therefore may 

not have been answered in the appropriate sections. 

Our agency continues to provide a valuable and detailed service to our consumers. However- we have lost 

funding as of 4-1-13 to have a dedicated SHIP counselor. Our ADRC counselors are all cross trained and 

can provide this service as needed. But this stretches our counselors’ time that they would have used to

spend on helping clients with long term care services. The issues many times are connected-but we feel 

that especially at Medicare open enrollment that this may become a difficult issue. Our consumers often 

express that they are just happy that someone takes the time to listen to their problem and try to find a 

solution versus just being given a number or sent on to the next place. It is important to have enough staff 

and it is also important for us to get our services well known to the public. Our particular site has 

increased its walk in numbers greatly since moving to our current location. These numbers are higher than 

our main office in this region. But due to loss of funding it is anticipated that we will have to close this 

site soon. 

Some of the information that was collected through this evaluation survey was not tracked- therefore may 

not have been answered in the appropriate sections. Question # 74. Please refer to the Petersburg local 

office evaluation survey to see the amount of funding allocated. 

Some of the information that was collected through this evaluation survey was not tracked- therefore may 

not have been answered in the appropriate sections. Question # 74. Please refer to the Fairmont and/or 

Petersburg local office evaluation survey to see the amount of funding allocated. 

Some of the information that was collected through this evaluation survey was not tracked- therefore may 

not have been answered in the appropriate sections. 

This State ADRC Center has only been operational since February- 2013. We are contracted through the 

AAA and are located at the State Unit on Aging but hope to be funded at the end of the contract through 

the State funding for the ADRC's. We serve the entire State not limited counties by area. The projection 

is that there will be increased contacts at this location because of its location within the State Unit on 

Aging. 

All the I A staffed are trained to do the options counseling- enrollment counseling- functional screensMA applications- so FTE will be the same in each box as an ;A staff does all functions. 

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69 . Please add any additional thoughts about Local ADRC and either its operations and/or its 

results. 

I don't feel the numbers given to answer your specific questions- adequately illustrates the amount of 

people impacted by our agency. 

The ADRC of the Northwoods opened Spring of 2012 and slowly rolled out office openings and staff 

hire. Future surveys will allow for more detailed information regarding the impact of our services on the 

customers and geographic areas we serve. We serve 4 counties. A long term care skilled provider closed 

but we had a high quality assisted living open in another county. 

The ADRC of WW has made an impact on 1000's of people trying to navigate the long term care system. 

Many people did not know that there is support and help to remain in their own home. Physicians need to 

be educated to have their patients call the ADRC instead of recommending assisted living. Too often 

people think that because their physician has recommended an out of home placement that is the only 

option. The medical community is coming around slowly but all individuals should be screened at time 

of entry to a long term residential placement to see if there is any other option that is appropriate to meet 

their needs. Rehab should of course be excluded. 

Clarification on a couple questions:33. Jefferson County does not have a formal Care Transition program 

but we work closing with the area hospitals and nursing homes to relocate consumers into long term care 

programs- or to discuss options for going home private pay. One area hospital is providing a Health 

Transition Program- and believes that it has been quite successful.39. We send out satisfaction surveysbut as they are mostly anonymous for return- we have not been tracking date wise. Our ADRC has been 

trained (in October of 2012) and has showed an improvement thus far in 2013 in the area of Options 

Counseling. A suggestion if this evaluation is to be done again- is to prep the ADRC's on what 

information you are requesting as we can then track the information. For example- we do not track 

location of Options Counseling- there is not an area in our present database to set that up- at least not on 

the local level- that information is in the notes- so it is still obtaining if requested- it is quite burdensome 

to gather that information from our current system- that if known- we would have tracked in an excel 

spreadsheet. Just an FYI. 

The Milwaukee County Aging Resource Center is the largest of the ADRCs in Wisconsin. Due to our 

high volume of consumers we operate differently than others around the State. Our model is designed to 

absorb high call volume and distribute the follow-up efficiently to general access or emergency services 

(Elder Abuse and Adult Protective services). We answer 2000 calls per month. Approximately 500 of 

these calls are assigned for follow-up. We accept 100 applications per month for Home Delivered Meals 

on behalf of our AAA. We assist in processing up to 100 applications for County Transportation. All our 

Call Center operators are required to obtain AIRS certification (8 staff). Our Options Counseling do not 

typically obtain the certification. 

Hours available to clients and funding has decreased due to State budget cuts(via the two State programs; 

SWFCA and IRIS). 

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APPENDIX H. PROCESS EVALUATION STATE ADRC SURVEY RESPONSE 

TABLES
 

Section A. Baseline Characteristics
 

1. Click here to review federal funding received by your state since [ENTER YEAR OF RECEIPT OF ADRC 

GRANT]* for the development of ADRCs. On a scale of 1 to 5, how would you rate your state’s progress since 

[YEAR] in improving access to the following services, with 1 being “Poor” and 5 being “Excellent ? 

1 (Poor) 2 3 4 5 (Excellent) No Response 

Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

Information, 

referral, awareness 

of LTSS options 

0 0.00 1 2.08 9 18.75 18 37.50 19 39.58 1 2.08 

Options counseling 

and assistance 

2 4.17 5 10.42 16 33.33 12 25.00 12 25.00 1 2.08 

Streamlined 

eligibility 

determination for 

public programs 

2 4.17 12 25.00 22 45.83 7 14.58 4 8.33 1 2.08 

Person-centered 

transition support 

3 6.25 7 14.58 11 22.92 19 39.58 7 14.58 1 2.08 

*In each online survey, “YEAR” was modified based on when the site received its first ADRC grant. This applies to all instances in 

which “YEAR” is included in the question.

2. States used federal grant funding in a variety of ways to develop their aging and disability networks. On a scale 

of 1 to 5, indicate the importance of each of the following in improving access to LTSS in your state since YEAR, 

with 1 being “not important at all” and 5 being “very important”. 

1 

(Not 

important) 

2 3 4 5 

(Very 

important) 

No Response 

Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

Development of new 

partnerships 

0 0.00 0 0.00 1 2.08 8 16.67 37 77.08 2 4.17 

Staffing 1 2.08 1 2.08 6 12.50 18 37.50 20 41.67 2 4.17 

Advisory council 0 0.00 3 6.25 13 27.08 20 41.67 10 20.83 2 4.17 

Development of 

shared data systems 

1 2.08 6 12.50 8 16.67 14 29.17 17 35.42 2 4.17 

Web based 

information and 

referral 

1 2.08 1 2.08 9 18.75 11 22.92 24 50.00 2 4.17 

Other, please specify* 0 0.00 0 0.00 4 8.33 5 10.42 7 14.58 32 66.67 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

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3. When your State applied for its first ADRC grant in YEAR, what were your goals for the 

project? Check all that apply. 

Frequency Percentage* 

To better integrate the delivery of LTSS for the aging and disability 

populations 

44 91.67 

To develop or strengthen agency/organizational partnerships 45 93.75 

To improve data or IT infrastructure 34 70.83 

To improve marketing or awareness efforts related to Long Term Care 

Services and Supports (LTSS) 

36 75.00 

To expand services to additional populations 30 62.50 

To expand services to additional geographic locations 18 37.50 

Other, please specify** 9 18.75 

*Percentages do not add up to 100% as ADRCs could choose multiple options.
 

**Free text responses accompanying this question are available in the appendix with supplemental questions.
 

4. Please indicate how your State initially selected local sites to receive ADRC funds. 

Select all that apply. 

Frequency Percentage* 

Selected sites that were already integrated to help them 

maintain or expand their efforts 

10 20.83 

Selected sites that were partially integrated to support 

further integration 

12 25.00 

Selected AAA’s already in operation 33 68.75 

Selected organizations that were currently serving the 

aging community (e.g., senior centers) 

17 35.42 

Selected sites that were currently serving the disability 

community (e.g., CILS) 

17 35.42 

Selected county offices because existing infrastructure was 

available 

3 6.25 

Other, please specify** 14 29.17 

* Percentages do not add up to 100% as respondents could select more than one option.
 

**Free text responses accompanying this question are available in the appendix with supplemental questions.
 

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4a. Indicate the extent to which the grants your state received for ADRC development contributed to the 

following: 

Very much Somewhat Very little No response 

Freq. % Freq. % Freq. % Freq. % 

Increase the skills of existing staff 38 79.17 9 18.75 1 2.08 0 0.00 

Recruit or attract more experienced 

staff 

9 18.75 26 54.17 12 25.00 1 2.08 

increased /expand populations served 26 54.17 18 37.50 4 8.33 0 0.00 

Increase the number of consumers 

served 

24 50.00 21 43.75 2 4.17 1 2.08 

Increase the number of partnerships 39 81.25 9 18.75 0 0.00 0 0.00 

Increase range of services offered 24 50.00 17 35.42 7 14.58 0 0.00 

Make other changes (please specify)* 13 27.08 5 10.42 1 2.08 29 60.42 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

5. How has the ADRC grant(s) affected the resources or resource allocation at your 

organization/network or within your state? If there is more than one ADRC in your state, select the box 

if the item is true for at least one ADRC. (Select all that apply). 

At the Site or Local level At the State Level 

Frequency Percentage* Frequency Percentage 

Helped us leverage other funds (including 

reimbursement for specific functions) 

29 60.42 32 66.67 

Improved staff training opportunities 38 79.17 33 68.75 

Increased service efficiency 36 75.00 20 41.67 

Contributed to the development of a statewide 

database of Long Term Supports and Service 

and/or consumers 

26 54.17 34 70.83 

Promoted the development of standard 

operating procedures 

33 68.75 39 81.25 

Increased the level of coordination between 

organizations serving older individuals and 

individuals with disabilities 

41 85.42 44 91.67 

Improved awareness/marketing 

campaigns/activities 

36 75.00 33 68.75 

*Percentages do not add up to 100% as respondents could select more than one option. 

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6. Within the last 12 months, has the State conducted a community long term service and 

support needs assessment? 

Frequency Percentage 

Yes, we assessed the needs in all ADRC communities in our State 12 25.00 

Yes, we assessed the needs in some of the ADRC communities in 

our State 

3 6.25 

No, but we did complete a community needs assessment, for at least 

some of the ADRC or communities in our State within the past 

three years 

10 20.83 

No, a community needs assessment was not completed within the 

past three years 

21 43.75 

No Response 2 4.17 

Total 48 100 

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7. What barriers do individuals in your state encounter in accessing LTSS? For each barrier listed below, indicate the extent to which this was a 

barrier in YEAR when the state first began developing its ADRC network and the extent to which it is currently a barrier. 

YEAR 2012 

Not a 

barrier 

Sometimes a 

barrier 

Often a 

barrier 

No response Not a 

barrier 

Sometimes 

a barrier 

Often a 

barrier 

No response 

# % # % # % # % # % # % # % # % 

Non-availability of needed 

services and supports 

1 2.08 24 50.00 22 45.83 1 2.08 2 4.17 35 72.92 10 20.83 1 2.08 

Limits on Medicaid HCSBS 

waiver enrollment 

16 33.33 13 27.08 17 35.42 2 4.17 14 29.17 25 52.08 7 14.58 2 4.17 

Limits on enrollment in 

state-only funded LTSS 

7 14.58 23 47.92 16 33.33 2 4.17 8 16.67 28 58.33 10 20.83 2 4.17 

Quality of available LTSS 9 18.75 33 68.75 3 6.25 3 6.25 16 33.33 28 58.33 1 2.08 3 6.25 

Lack of health Insurance 2 4.17 27 56.25 16 33.33 3 6.25 3 6.25 31 64.58 11 22.92 3 6.25 

Providers not accepting 

consumers with Medicaid 

6 12.50 32 66.67 7 14.58 3 6.25 7 14.58 30 62.50 8 16.67 3 6.25 

Lack of accommodations for 

consumers with disabilities 

6 12.50 24 50.00 15 31.25 3 6.25 9 18.75 30 62.30 6 12.50 3 6.25 

Language barriers 9 18.75 31 64.58 6 12.50 2 4.17 15 31.25 30 62.50 1 2.08 2 4.17 

Cultural barriers 9 18.75 33 68.75 4 8.33 2 4.17 11 22.92 35 72.92 0 0 2 4.17 

Religious barriers 26 54.17 19 39.58 0 0 3 6.25 26 54.17 18 37.50 1 2.08 3 6.25 

Sexual orientation barriers 17 35.42 26 54.17 2 4.17 3 6.25 23 47.92 21 43.75 1 2.08 3 6.25 

People needing services do 

not have a permanent 

address 

8 16.67 29 60.42 8 16.67 3 6.25 8 16.67 31 64.58 6 12.50 3 6.25 

Consumers lack 

transportation 

0 0 14 29.17 32 66.67 2 4.17 0 0 20 41.67 26 54.17 2 4.17 

Stigma, discrimination and 

prejudice against older 

adults 

22 45.83 21 43.75 2 4.17 3 6.25 24 50.00 20 41.67 1 2.08 3 6.25 

Stigma, discrimination and 

prejudice against persons 

with disabilities 

12 25.00 23 47.92 10 20.83 3 6.25 13 27.08 27 56.25 5 10.42 3 6.25 

Providers have high staff 3 6.25 27 56.25 15 31.25 3 6.25 3 6.25 30 62.50 12 25.00 3 6.25 

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7. What barriers do individuals in your state encounter in accessing LTSS? For each barrier listed below, indicate the extent to which this was a 

barrier in YEAR when the state first began developing its ADRC network and the extent to which it is currently a barrier. 

YEAR 2012 

Not a 

barrier 

Sometimes a 

barrier 

Often a 

barrier 

No response Not a 

barrier 

Sometimes 

a barrier 

Often a 

barrier 

No response 

# % # % # % # % # % # % # % # % 

turnover 

Providers lack appropriate 

trained staff 

3 6.25 31 64.58 11 22.92 3 6.25 10 20.83 30 62.50 5 10.42 3 6.25 

Service provider 

hours/locations are hard to 

access 

7 14.58 31 64.58 7 14.58 3 6.25 10 20.83 30 62.50 5 10.42 3 6.25 

Other, specify* 0 0 2 4.17 2 4.17 44 91.67 0 0 1 2.08 3 6.25 44 91.67 

Other, specify* 0 0 1 2.08 4 8.33 43 89.58 0 0 2 4.17 3 6.25 43 89.58 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

8a. Indicate the current availability of the following services within your service area. 

Adequate availability Available but 

inadequate to meet the 

need 

Not available No response 

Frequency Percentage Frequency Percentage Frequency Percentage Frequency Percentage 

Safe and affordable housing options 1 2.08 44 91.67 1 2.08 2 4.17 

Peer support services/groups 22 45.83 23 47.92 0 0.00 3 6.25 

HCBS Medicaid Waiver Programs 14 29.17 30 62.50 0 0.00 4 8.33 

Caregiver Support (i.e. respite program, 

support groups, or counseling) 

15 31.25 31 64.58 0 0.00 2 4.17 

Nutrition Programs 16 33.33 29 60.42 0 0.00 3 6.25 

Employment Services 11 22.92 33 68.75 0 0.00 4 8.33 

Education services 21 43.75 21 43.75 0 0.00 6 12.50 

Legal Services 15 31.25 30 62.50 0 0.00 3 6.25 

Transportation Services 3 6.25 43 89.58 0 0.00 2 4.17 

Socialization/recreation programs 23 47.92 22 45.83 0 0.00 3 6.25 

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8a. Indicate the current availability of the following services within your service area. 

Adequate availability Available but 

inadequate to meet the 

need 

Not available No response 

Frequency Percentage Frequency Percentage Frequency Percentage Frequency Percentage 

Mental/behavioral health services 3 6.25 40 83.33 1 2.08 4 8.33 

Ombudsman services 26 54.17 20 41.67 0 0.00 2 4.17 

Health Prevention and screening services 12 25.00 32 66.67 0 0.00 4 8.33 

Emergency services/crisis intervention 13 27.08 30 62.50 0 0.00 5 10.42 

Nursing home transition 17 35.42 27 56.25 2 4.17 2 4.17 

Hospital transition programs 4 8.33 35 72.92 6 12.50 3 6.25 

Nursing home (institutional) diversion 

programs 

8 16.67 30 62.50 6 12.50 4 8.33 

Nursing home services 37 77.08 7 14.58 0 0.00 4 8.33 

Assisted living services 28 58.33 15 31.25 0 0.00 5 10.42 

Shared living programs 6 12.50 22 45.83 15 31.25 5 10.42 

Adult day care 12 25.00 33 68.75 0 0.00 3 6.25 

Consumer-directed LTSS 11 22.92 30 62.50 4 8.33 3 6.25 

Income assistance 6 12.50 36 75.00 1 2.08 5 10.42 

Energy assistance 10 20.83 35 72.92 0 0.00 3 6.25 

Personal care/attendant services 16 33.33 29 60.42 0 0.00 3 6.25 

Medicaid HCBS waiver programs 14 29.17 29 60.42 1 2.08 4 8.33 

Independent Living supports (e.g., skills 

training, vocational programs, peer support) 

11 22.92 32 66.67 1 2.08 4 8.33 

Other, specify* 0 0.00 3 6.25 1 2.08 44 91.67 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

8b. For the following services, to what extent is there provider choice? 

Prior to First Grant Currently 

No Limited Adequate No response No Limited Adequate No response 

# % # % # % # % # % # % # % # % 

Safe and affordable housing 

options 

5 10.42 36 75.00 4 8.33 3 6.25 2 4.17 36 75.00 7 14.58 3 6.25 

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8b. For the following services, to what extent is there provider choice? 

Prior to First Grant Currently 

No Limited Adequate No response No Limited Adequate No response 

# % # % # % # % # % # % # % # % 

Peer support 

services/groups 

1 2.08 33 68.75 10 20.83 4 8.33 0 0.00 28 58.33 16 33.33 4 8.33 

HCBS Medicaid Waiver 

Programs 

2 4.17 27 56.25 15 31.25 4 8.33 0 0.00 25 52.08 19 39.58 4 8.33 

Caregiver Support (i.e. 

respite program, support 

groups, or counseling) 

5 10.42 31 64.58 10 20.83 2 4.17 1 2.08 26 54.17 19 39.58 2 4.17 

Nutrition Programs 4 8.33 26 54.17 15 31.25 3 6.25 1 2.08 26 54.17 18 37.50 3 6.25 

Employment Services 2 4.17 31 64.58 10 20.83 5 10.42 1 2.08 31 64.58 11 22.92 5 10.42 

Education services 1 2.08 26 54.17 15 31.25 6 12.50 1 2.08 21 43.75 20 41.67 6 12.50 

Legal Services 4 8.33 33 68.75 8 16.67 3 6.25 2 4.17 31 64.58 12 25.00 3 6.25 

Transportation Services 3 6.25 40 83.33 3 6.25 2 4.17 1 2.08 41 85.42 4 8.33 2 4.17 

Socialization/recreation 

programs 

1 2.08 23 47.92 20 41.67 4 8.33 0 0.00 25 52.08 19 39.58 4 8.33 

Mental/behavioral health 

services 

5 10.42 33 68.75 5 10.42 5 10.42 2 4.17 37 77.08 4 8.33 5 10.42 

Ombudsman services 5 10.42 19 39.58 22 45.83 2 4.17 5 10.42 20 41.67 20 41.67 3 6.25 

Health Prevention and 

screening services 

5 10.42 30 62.50 7 14.58 6 12.50 0 0.00 29 60.42 13 27.08 6 12.50 

Emergency services/crisis 

intervention 

5 10.42 30 62.50 8 16.67 5 10.42 3 6.25 27 56.25 13 27.08 5 10.42 

Nursing home transition 15 31.25 25 52.08 6 12.50 2 4.17 2 4.17 30 62.50 14 29.17 2 4.17 

Hospital transition 

programs 

21 43.75 21 43.75 2 4.17 4 8.33 1 2.08 37 77.08 6 12.50 4 8.33 

Nursing home (institutional) 

diversion programs 

15 31.25 24 50.00 4 8.33 5 10.42 5 10.42 29 60.42 9 18.75 5 10.42 

Nursing home services 1 2.08 13 27.08 30 62.50 4 8.33 1 2.08 12 25.00 31 64.58 4 8.33 

Assisted living services 3 6.25 15 31.25 24 50.00 6 12.50 0 0.00 14 29.17 28 58.33 6 12.50 

Shared living programs 19 39.58 18 37.50 4 8.33 7 14.58 11 22.92 26 54.17 4 8.33 7 14.58 

Adult day care 4 8.33 32 66.67 9 18.75 3 6.25 1 2.08 32 66.67 12 25.00 3 6.25 

Consumer-directed LTSS 12 25.00 27 56.25 5 10.42 4 8.33 0 0.00 35 72.92 9 18.75 4 8.33 

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8b. For the following services, to what extent is there provider choice? 

Prior to First Grant Currently 

No Limited Adequate No response No Limited Adequate No response 

# % # % # % # % # % # % # % # % 

Income assistance 8 16.67 27 56.25 6 12.50 7 14.58 5 10.42 29 60.42 7 14.58 7 14.58 

Energy assistance 4 8.33 30 62.50 10 20.83 4 8.33 3 6.25 30 62.50 11 22.92 4 8.33 

Personal care/attendant 

services 

2 4.17 31 64.58 12 25.00 3 6.25 0 0.00 29 60.42 16 33.33 3 6.25 

Medicaid HCBS waiver 

programs 

2 4.17 32 66.67 10 20.83 4 8.33 0 0.00 27 56.25 17 35.42 4 8.33 

Independent Living 

supports (e.g., skills 

training, vocational 

programs, peer support) 

4 8.33 36 75.00 4 8.33 4 8.33 3 6.25 34 70.83 7 14.58 4 8.33 

Other, specify* 1 2.08 2 4.17 0 0.00 45 93.75 0 0.00 3 6.25 0 0.00 45 93.75 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

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Section B. Organizational Characteristics
 

9a. For the current Fiscal Year (2013), what is the approximate amount of funding from each of 

the following sources? 

Received Funding in Prior 

Fiscal Years 

Frequency Percentage* 

Administration on Aging Title IV ADRC Grant 37 77.08 

Administration of Aging Title II Grant 6 12.50 

CMS Real Choice Systems Change Grants 14 29.17 

CMS Person-Centered Hospital Discharge Planning Grant 7 14.58 

Patient protection and Affordable Care Act Grant 7 14.58 

Veteran’s Administration 10 20.83 

Money Follows the Person Demonstration 24 50.00 

State Transformation Grant 5 10.42 

Alzheimer’s Disease Demonstration Grant 21 43.75 

Evidence-Based Disease Prevention Grant 14 29.17 

Program of All-Inclusive Care for the Elderly (PACE) 7 14.58 

Medicare Improvements for Patients and Providers Act (MIPPA) 26 54.17 

Respite Care Act funds 11 22.92 

Rehabilitation Services Administration (RSA) 2 4.17 

Substance Abuse and Mental Health Services Administration 

(SAMHSA) – Mental Health Transformation Grant 

0 0.00 

Agency for Health Care Research and Policy – Chronic Disease 

Self- Management Grant 

4 8.33 

Administration for Children and Families, Office of Community 

Services – Low Income Home Energy Assistance Program 

(LIHEAP) 

7 14.58 

Health Resources and Services Administration on HIV/AIDS 

Bureau – Ryan White Fund 

2 4.17 

State Unit on Aging 22 45.83 

State General Revenue 31 64.58 

County of Local Government 3 6.25 

Private entities/grants – Hospitals or other businesses 1 2.08 

Medicaid for Direct Services (State and Federal) 12 25.00 

Medicaid for Federal Financial Participation 11 22.92 

Care Transitions Income 3 6.25 

Consumer Fees or Cost Sharing 4 8.33 

Charitable Donations 3 6.25 

Other, please specify** 15 31.25 

*Percentages do not add up to 100% as respondents could select more than one option.
 

**Free text responses accompanying this question are available in the appendix with supplemental questions.
 

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9b. For the current Fiscal Year (2013), what is the approximate amount of funding from each of the following sources? (In $ amounts) 

Amount of Funding during the Current Fiscal Year 

$0 $>0-200,000 $200,001-

500,000 

$500,001-

1,000,000 

>$1,000,000 No 

Response/ 

Not 

Applicable 

Range Mean Median Mode 

# % # % # % # % # % # % Min Max 

AoA Title IV ADRC Grant 0 0.00 15 31.25 9 18.75 6 12.50 1 2.08 17 35.42 $173,419 $1,219,535 $3777,774 $202,000 $700,000 

AoA Title II Grant 0 0.00 0 0.00 5 10.42 0 0.00 2 4.17 41 85.42 $215,214 $25,977,966 $4,113,775 $341,225 No mode 

CMS Real Choice Systems 

Change Grants 

1 2.08 0 0.00 2 4.17 0 0.00 0 0.00 45 93.75 $0 $423,434 $372,472 $372,472 No mode 

CMS Person-Centered Hospital 

Discharge Planning Grant 

0 0.00 2 4.17 0 0.00 0 0.00 0 0.00 46 95.83 $55,191 $109,167 $82,179 $82,179 No mode 

Patient protection and 

Affordable Care Act Grant 

1 2.08 0 0.00 2 4.17 0 0.00 2 4.17 43 89.58 $0 $2,536,660, $1,538,064 $1,520,299 No mode 

Veteran’s Administration 0 0.00 2 4.17 1 2.08 0 0.00 1 2.08 44 91.67 $10,800 $1,007,148 $376,683 $244,392 No mode 

Money Follows the Person 

Demonstration 

0 0.00 5 10.42 3 6.25 1 2.08 9 18.75 30 62.50 $16,639 $10,724,985 $2,552,968 $986,917 No mode 

State Transformation Grant 0 0.00 0 0.00 0 0.00 0 0.00 1 2.08 47 97.92 N/A N/A N/A N/A N/A 

Alzheimer’s Disease 

Demonstration Grant 

0 2.08 3 6.25 5 10.42 2 4.17 1 2.08 36 75.00 $1 $1,444,818 $419,300 $234,267 No mode 

Evidence-Based Disease 

Prevention Grant 

0 0.00 0 0.00 6 12.50 1 2.08 0 0.00 41 85.42 $257,206 $1,000,000 $464,759 $400,000 $400,000 

Program of All-Inclusive Care 

for the Elderly (PACE) 

0 0.00 0 0.00 0 0.00 0 0.00 4 8.33 44 91.67 $1,536,550 $34,000,000 $13,161,091 $8,553,907 No mode 

Medicare Improvements for 

Patients and Providers Act 

(MIPPA) 

2 4.17 2 4.17 2 4.17 0 0.00 0 0.00 42 87.50 $0 $307,645 $189,042 $208,516 No mode 

Respite Care Act Funds 0 0.00 7 14.58 4 8.33 0 0.00 0 0.00 37 77.08 $1,400 $329,500 $134,099 $78,000 No mode 

Rehabilitation Services 

Administration (RSA) 

0 0.00 0 0.00 0 0.00 0 0.00 1 2.08 47 97.92 N/A N/A N/A N/A N/A 

SAMHSA – Mental Health 

Transformation Grant 

0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 48 100 N/A N/A N/A N/A N/A 

Chronic Disease SelfManagement Grant 

0 0.00 3 6.25 1 2.08 0 0.00 0 0.00 44 91.67 $23,230 $399,933 $128,673 $45,765 No mode 

Low Income Home Energy 

Assistance Program (LIHEAP) 

0 0.00 0 0.00 2 4.17 0 0.00 3 6.25 43 89.58 $375,000 $24,669,815 $10,054,010 $4,727,416 No mode 

Ryan White Fund 0 0.00 0 0.00 0 0.00 0 0.00 1 2.08 47 97.92 N/A N/A N/A N/A N/A 

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9b. For the current Fiscal Year (2013), what is the approximate amount of funding from each of the following sources? (In $ amounts) 

Amount of Funding during the Current Fiscal Year 

$0 $>0-200,000 $200,001-

500,000 

$500,001-

1,000,000 

>$1,000,000 No 

Response/ 

Not 

Applicable 

Range Mean Median Mode 

# % # % # % # % # % # % Min Max 

County of local Government 0 0.00 0 0.00 0 0.00 0 0.00 1 2.08 47 97.92 N/A N/A N/A N/A N/A 

Private entities/grants – 

Hospitals or other businesses 

0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 48 100 N/A N/A N/A N/A N/A 

Medicaid for Federal Financial 

Participation 

0 0.00 1 2.08 1 2.08 2 4.17 5 10.42 39 81.25 $1 $44,845,022 $8,251,900 $1,500,000 No mode 

Care Transitions Income 0 0.00 0 0.00 1 2.08 0 0.00 0 0.00 47 97.92 N/A N/A N/A N/A N/A 

Consumer Fees or Cost Sharing 0 0.00 1 2.08 0 0.00 0 0.00 0 0.00 47 97.92 N/A N/A N/A N/A N/A 

Charitable Donations 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 48 100 N/A N/A N/A N/A N/A 

Other, please specify* 0 0.00 5 10.42 0 0.00 2 4.17 6 12.50 35 72.92 $9,833 $25,928,391 $3,004,093 $984,218 No mode 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

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9c. For the current Fiscal Year, what is the approximate amount of funding from each of the following sources? 

Amount of Funding during the Current Fiscal Year 

$0 $>0-

1,000,000 

$1,000,001-

5,000,000 

$5,000,001-

10,000,000 

>$10,000,0 

00 

No 

Response/ 

Not 

Applicable 

Range Mean Median Mode 

# % # % # % # % # % # % Min Max 

State Unit on Aging 0 0.00 5 10.42 6 12.50 4 8.33 8 16.67 25 52.08 $15,280 $882,612,000 $47,471,633 $5,900,000 No mode 

State General Revenue 0 0.00 7 14.58 11 22.92 2 4.17 12 25.00 16 33.33 $58,841 $711,318,000 $43,214,158 $4,586,049 No mode 

Medicaid for Direct 

Services (State and 

Federal) 

0 0.00 3 6.25 1 2.08 0 0.00 6 12.50 38 79.17 $1 $1,156,735,729 $278,529,242 $116,514,397 No mode 

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9d. For the current Fiscal Year, what is the approximate amount of 

funding from each of the following sources? 

Total Budget for FY 2013 

Frequency Percentage 

$0 0 0.00 

$>0-1,000,000 8 16.67 

$1,000,001-5,000,000 8 16.67 

$5,000,001-20,000,000 7 14.58 

$20,000,001-50,000,000 6 12.50 

>$50,000,000 8 16.67 

No response 11 22.92 

Total 48 100 

Min $196,640 

Max $25,000,000,000 

Mean $772,249,877 

Median $5,146,027 

Mode $3,000,000 

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10a. With which organizations do [STATE LEAD ORG] have a partnership? 

Frequency Percentage* 

State Departments (with cabinet-level secretaries) 

Health 35 72.92 

Human Services 36 75.00 

Aging 20 41.67 

Other (specify)** 11 22.92 

State Agencies (located within state departments) Frequency Percentage* 

Aging 27 56.25 

Developmental Disabilities 47 97.92 

Acquired or Late-Onset Disabilities 26 54.17 

Mental Health 44 91.67 

Medicaid 46 95.83 

Housing 34 70.83 

Education 24 50.00 

Other (specify)** 11 22.92 

Local Government Agencies Frequency Percentage* 

Area Agency on Aging 40 83.33 

County Health Department 22 45.83 

County Medicaid Office 19 39.58 

County Department on Aging 20 41.67 

County Department on Disability 13 27.08 

County Housing Office 10 20.83 

Library 9 18.75 

Other (specify)** 4 8.33 

Federal Agencies Frequency Percentage* 

Local Veterans Administration 42 87.50 

Local Indian Health Service 15 31.25 

Other (specify)** 6 12.50 

Organizations providing Direct Services Frequency Percentage* 

211 or other call center 39 81.25 

Community Health Clinic 16 33.33 

Community Mental Health Clinic 14 29.17 

Deaf Service Center 18 37.50 

Hospital/Medical Center 27 56.25 

School for the Blind 12 25.00 

School for the Deaf 11 22.92 

The ARC 16 33.33 

United Way 19 39.58 

Vocational/Rehabilitation Services 30 62.50 

Other (specify)** 4 8.33 

Advocacy/Referral Organizations Frequency Percentage* 

AIDS Coalition 11 22.92 

Alzheimer’s Association 42 87.50 

American Council of the Blind 9 18.75 

Autism Society state/regional chapter 12 25.00 

Brain Injury Association state/regional chapter 23 47.92 

Centers for Independent Living 45 93.75 

Easter Seals 21 43.75 

Epilepsy Foundation state/regional chapter 10 20.83 

National Association of Mental Illness state/regional 

chapter 

14 29.17 

National Autism Association state/regional chapter 9 18.75 

National Multiple Sclerosis Society state/regional 

chapter 

12 25.00 

State Association for the Deaf 12 25.00 

United Cerebral Palsy 12 25.00 

Other (specify)** 10 20.83 

*Percentages do not add up to 100% as respondents could select more than one option.
 

*Free text responses accompanying this question are available in the appendix with supplemental 

questions.
 

10b. What is the strength of the relationship? 

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Weak 

Functionality 

Moderate 

Functionality 

High 

Functionality 

No Response/ Not 

Applicable 

State Departments 

(with cabinet-level secretaries) Freq. % Freq. % Freq. % Freq. % 

Health 0 0.00 15 31.25 20 41.67 13 27.08 

Human Services 0 0.00 12 25.00 23 47.92 13 27.06 

Aging 0 0.00 2 4.17 18 37.50 28 58.33 

Other (specify)* 0 0.00 2 4.17 6 12.50 40 83.33 

State Agencies 

(located within state departments) Freq. % Freq. % Freq. % Freq. % 

Aging 0 0.00 1 2.08 25 52.08 22 45.83 

Developmental Disabilities 4 8.33 27 56.25 15 31.25 2 4.17 

Acquired or Late-Onset Disabilities 5 10.42 8 16.67 12 25.00 23 47.92 

Mental Health 7 14.58 26 54.17 11 22.92 4 8.33 

Medicaid 0 0.00 16 33.33 30 62.50 2 4.17 

Housing 9 18.75 19 39.58 5 10.42 15 31.25 

Education 9 18.75 9 18.75 3 6.25 27 56.25 

Other (specify)* 0 0.00 5 10.42 5 10.42 38 79.17 

Local Government Agencies Freq. % Freq. % Freq. % Freq. % 

Area Agency on Aging 0 0.00 2 4.17 37 77.08 9 18.75 

County Health Department 7 14.58 12 25.00 3 6.25 26 54.17 

County Medicaid Office 2 4.17 10 20.83 7 14.58 29 60.42 

County Department on Aging 0 0.00 4 8.33 16 33.33 28 58.33 

County Department on Disability 2 4.17 6 12.50 5 10.42 35 72.92 

County Housing Office 4 8.33 4 8.33 2 4.17 38 79.17 

Library 3 6.25 5 10.42 0 0.00 40 83.33 

Other (specify)* 0 0.00 1 2.08 1 2.08 46 95.83 

Federal Agencies Freq. % Freq. % Freq. % Freq. % 

Local Veterans Administration 11 22.92 20 41.67 11 22.92 6 12.50 

Local Indian Health Service 6 12.50 6 12.50 2 4.17 34 70.83 

Other (specify)* 0 0.00 2 4.17 3 6.25 43 89.58 

Organizations providing Direct 

Services Freq. % Freq. % Freq. % Freq. % 

211 or other call center 7 14.58 22 45.83 9 18.75 10 20.83 

Community Health Clinic 5 10.42 10 20.83 1 2.08 32 66.67 

Community Mental Health Clinic 6 12.50 7 14.58 1 2.08 34 70.83 

Deaf Service Center 3 6.25 12 25.00 3 6.25 30 62.50 

Hospital/Medical Center 1 2.08 22 45.83 3 6.25 22 45.83 

School for the Blind 7 14.58 4 8.33 1 2.08 36 75.00 

School for the Deaf 5 10.42 6 12.50 0 0.00 37 77.08 

The ARC 4 8.33 11 22.92 1 2.08 32 66.67 

United Way 8 16.67 9 18.75 2 4.17 29 60.42 

Vocational/Rehabilitation Services 3 6.25 21 43.75 6 12.50 18 37.50 

Other (specify)* 0 0.00 0 0.00 3 6.25 45 93.75 

Advocacy/Referral Organizations Freq. % Freq. % Freq. % Freq. % 

AIDS Coalition 6 12.50 4 8.33 1 2.08 37 77.08 

Alzheimer’s Association 2 4.17 20 41.67 20 41.67 6 12.50 

American Council of the Blind 4 8.33 5 10.42 0 0.00 39 81.25 

Autism Society state/regional 

chapter 9 18.75 3 6.25 0 0.00 36 75.00 

Brain Injury Association 

state/regional chapter 4 8.33 8 16.67 11 22.92 25 52.08 

Centers for Independent Living 5 10.42 19 39.58 19 39.58 5 10.42 

Easter Seals 7 14.58 8 16.67 6 12.50 27 56.25 

Epilepsy Foundation state/regional 

chapter 8 16.67 2 4.17 0 0.00 38 79.17 

National Association of Mental 

Illness state/regional chapter 8 16.67 6 12.50 0 0.00 34 70.83 

National Autism Association 

state/regional chapter 8 16.67 1 2.08 0 0.00 39 81.25 

National Multiple Sclerosis Society 

state/regional chapter 7 14.58 3 6.25 2 4.17 36 75.00 

State Association for the Deaf 6 12.50 6 12.50 0 0.00 36 75.00 

United Cerebral Palsy 7 14.58 1 2.08 4 8.33 36 75.00 

Other (specify)* 0 0.00 3 6.25 6 12.50 39 81.25 

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*Free text responses accompanying this question are available in the appendix with supplemental questions. 

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10c. What is the type of partnership agreement? 

Funding 

Relationship Formal MOU Contract Cooperative 

Informal 

Working 

Relationship 

Other No Response/ 

Not Applicable 

State Departments (with cabinet-level 

secretaries) Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

Health 7 14.58 12 25.00 10 20.83 12 25.00 12 25.00 3 6.25 16 33.33 

Human Services 15 31.25 11 22.92 10 20.83 12 25.00 7 14.58 6 12.50 13 27.08 

Aging 9 18.75 2 4.17 6 12.50 2 4.17 1 2.08 10 20.83 30 62.50 

Other (specify)* 7 14.58 4 8.33 3 6.25 5 10.42 4 8.33 3 6.25 39 81.25 

State Agencies (located within state 

departments) Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

Aging 15 31.25 2 4.17 5 10.42 7 14.58 4 8.33 12 25.00 22 45.83 

Developmental Disabilities 7 14.58 11 22.92 4 8.33 18 37.50 26 54.17 9 18.75 1 2.08 

Acquired or Late-Onset Disabilities 4 8.33 2 4.17 1 2.08 10 20.83 13 27.08 11 22.92 24 50.00 

Mental Health 3 6.25 6 12.50 3 6.25 17 35.42 28 58.33 8 16.67 5 10.42 

Medicaid 24 50.00 20 41.67 14 29.17 16 33.33 14 29.17 10 20.83 3 6.25 

Housing 2 4.17 4 8.33 1 2.08 10 20.83 19 39.58 8 16.67 17 35.42 

Education 1 2.08 1 2.08 0 0.00 6 12.50 13 27.08 2 4.17 30 62.50 

Other (specify)* 2 4.17 3 6.25 1 2.08 5 10.42 3 6.25 6 12.50 38 79.17 

Local Government Agencies Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

Area Agency on Aging 33 68.75 13 27.08 34 70.83 19 39.58 8 16.67 4 8.33 8 16.67 

County Health Department 3 6.25 4 8.33 3 6.25 7 14.58 10 20.83 4 8.33 29 60.42 

County Medicaid Office 2 4.17 5 10.42 1 2.08 3 6.25 11 22.92 5 10.42 27 56.25 

County Department on Aging 9 18.75 3 6.25 8 16.67 4 8.33 5 10.42 7 14.58 28 58.33 

County Department on Disability 2 4.17 1 2.08 1 2.08 2 4.17 5 10.42 7 14.58 36 75.00 

County Housing Office 0 0.00 0 0.00 0 0.00 2 4.17 6 12.50 3 6.25 39 81.25 

Library 0 0.00 0 0.00 0 0.00 1 2.08 6 12.50 2 4.17 39 81.25 

Other (specify)* 2 4.17 0 0.00 2 4.17 1 2.08 0 0.00 1 2.08 45 93.75 

Federal Agencies Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

Local Veterans Administration 10 20.83 2 4.17 6 12.50 11 22.92 19 39.58 6 12.50 9 18.75 

Local Indian Health Service 3 6.25 1 2.08 1 2.08 4 8.33 4 8.33 2 4.17 38 79.17 

Other (specify)* 4 8.33 0 0.00 2 4.17 1 2.08 3 6.25 1 2.08 42 87.50 

Organizations providing Direct Services Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

211 or other call center 3 6.25 8 16.67 3 6.25 17 35.42 20 41.67 4 8.33 12 25.00 

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10c. What is the type of partnership agreement? 

Funding 

Relationship Formal MOU Contract Cooperative 

Informal 

Working 

Relationship 

Other No Response/ 

Not Applicable 

Community Health Clinic 0 0.00 0 0.00 0 0.00 4 8.33 14 29.17 3 6.25 32 66.67 

Community Mental Health Clinic 0 0.00 0 0.00 2 4.17 3 6.25 8 16.67 3 6.25 36 75.00 

Deaf Service Center 3 6.25 0 0.00 3 6.25 5 10.42 10 20.83 4 8.33 32 66.67 

Hospital/Medical Center 2 4.17 6 12.50 3 6.25 9 18.75 18 37.50 6 12.50 22 45.83 

School for the Blind 0 0.00 0 0.00 1 2.08 4 8.33 7 14.58 3 6.25 39 81.25 

School for the Deaf 1 2.08 1 2.08 1 2.08 4 8.33 6 12.50 3 6.25 39 81.25 

The ARC 2 4.17 1 2.08 3 6.25 3 6.25 11 22.92 2 4.17 34 70.83 

United Way 1 2.08 1 2.08 1 2.08 3 6.25 13 27.08 5 10.42 31 64.58 

Vocational/Rehabilitation Services 3 6.25 6 12.50 1 2.08 12 25.00 14 29.17 6 12.50 20 41.67 

Other (specify)* 3 6.25 1 2.08 3 6.25 2 4.17 0 0.00 2 4.17 45 93.75 

Advocacy/Referral Organizations Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

AIDS Coalition 1 2.08 0 0.00 0 0.00 2 4.17 8 16.67 0 0.00 40 83.33 

Alzheimer’s Association 12 25.00 7 14.58 10 20.83 17 35.42 23 47.92 4 8.33 6 12.50 

American Council of the Blind 1 2.08 1 2.08 1 2.08 0 0.00 3 12.50 1 2.08 41 85.42 

Autism Society state/regional chapter 1 2.08 0 0.00 1 2.08 1 2.08 7 14.58 0 0.00 39 81.25 

Brain Injury Association state/regional 

chapter 

5 10.42 2 4.17 4 8.33 9 18.75 13 27.08 4 8.33 27 56.25 

Centers for Independent Living 18 37.50 17 35.42 17 35.42 17 35.42 20 41.67 5 10.42 3 6.25 

Easter Seals 3 6.25 4 8.33 7 14.58 5 10.42 11 22.92 1 2.08 28 58.33 

Epilepsy Foundation state/regional 

chapter 

0 0.00 0 0.00 0 0.00 2 4.17 5 10.42 0 0.00 42 87.50 

National Association of Mental Illness 

state/regional chapter 

0 0.00 0 0.00 0 0.00 2 4.17 9 18.75 1 2.08 36 75.00 

National Autism Association 

state/regional chapter 

0 0.00 0 0.00 0 0.00 0 0.00 5 10.42 0 0.00 43 89.58 

National Multiple Sclerosis Society 

state/regional chapter 

0 0.00 1 2.08 0 0.0 3 6.25 8 16.67 2 4.17 40 83.33 

State Association for the Deaf 0 0.00 0 0.00 0 0.00 2 4.17 6 12.50 2 4.17 40 83.33 

United Cerebral Palsy 2 4.17 2 4.17 2 4.17 4 8.33 5 10.42 0 0.00 40 83.33 

Other (specify)* 1 2.08 5 10.42 1 2.08 5 10.42 3 6.25 3 6.25 39 81.25 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

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10d. What types of resources are shared? 

Co-located 

staff 

Shared 

monetary 

resources 

Shared 

information Joint training Joint program sponsorship 

Shared nonmonetary 

resources 

Shared data No shared 

resources 

No response/ 

Not applicable 

State Departments (with 

cabinet-level secretaries) Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

Health 2 4.17 9 18.75 25 52.08 16 33.33 20 41.67 7 14.58 15 31.25 4 8.33 17 35.42 

Human Services 10 20.83 18 37.50 28 58.33 19 39.58 19 39.58 10 20.83 17 35.42 1 2.08 18 37.50 

Aging 7 14.58 6 12.50 8 16.67 9 18.75 7 14.58 5 10.42 8 16.67 0 0.00 36 75.00 

Other (specify)* 3 6.25 7 14.58 8 16.67 6 12.50 4 8.33 2 4.17 5 10.42 0 0.00 40 83.33 

State Agencies (located within 

state departments) Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

Aging 12 25.00 12 25.00 18 37.50 16 33.33 14 29.17 13 27.08 14 29.17 0 0.00 29 60.42 

Developmental Disabilities 6 12.50 6 12.50 40 83.33 24 50.00 15 31.25 4 8.33 12 25.00 2 4.17 4 8.33 

Acquired or Late-Onset 

Disabilities 5 10.42 6 12.50 17 35.42 11 22.92 9 18.75 0 0.00 7 14.58 2 4.17 28 58.33 

Mental Health 4 8.33 4 8.33 33 68.75 27 56.25 19 39.58 3 6.25 12 25.00 3 6.25 7 14.58 

Medicaid 9 18.75 21 43.75 37 77.08 28 58.33 26 54.17 12 25.00 28 58.33 3 6.25 5 10.42 

Housing 2 4.17 2 4.17 22 45.83 9 18.75 7 14.58 3 6.25 10 20.83 5 10.42 21 43.75 

Education 2 4.17 1 2.08 13 27.08 4 8.33 4 8.33 1 2.08 0 0.00 2 4.17 30 62.50 

Other (specify)* 1 2.08 2 4.17 9 18.75 7 14.58 8 16.67 1 2.08 3 6.25 0 0.00 38 79.17 

Local Government Agencies Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

Area Agency on Aging 5 10.42 23 47.92 39 81.25 35 72.92 28 58.33 11 22.92 37 77.08 0 0.00 9 18.75 

County Health Department 1 2.08 1 2.08 17 35.42 8 16.67 8 16.67 0 0.00 5 10.42 1 2.08 30 62.50 

County Medicaid Office 3 6.25 2 4.17 17 35.42 12 25.00 6 12.50 1 2.08 8 16.67 1 2.08 29 60.42 

County Department on Aging 3 6.25 5 10.42 14 29.17 10 20.83 8 16.67 3 6.25 10 20.83 0 0.00 34 70.83 

County Department on 

Disability 1 2.08 1 2.08 9 18.75 6 12.50 2 4.17 1 2.08 5 10.42 0 0.00 39 81.25 

County Housing Office 0 0.00 0 0.00 8 16.67 2 4.17 1 2.08 0 0.00 1 2.08 0 0.00 40 83.33 

Library 0 0.00 0 0.00 6 12.50 1 2.08 0 0.00 0 0.00 0 0.00 0 0.00 42 87.50 

Other (specify)* 1 2.08 0 0.00 3 6.25 2 4.17 1 2.08 1 2.08 1 2.08 0 0.00 45 93.75 

Federal Agencies Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

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10d. What types of resources are shared? 

Co-located 

staff 

Shared 

monetary 

resources 

Shared 

information Joint training Joint program sponsorship 

Shared nonmonetary 

resources 

Shared data No shared 

resources 

No response/ 

Not applicable 

Local Veterans Administration 1 2.08 3 6.25 32 66.67 14 29.17 11 22.92 3 6.25 9 18.75 4 8.33 11 22.92 

Local Indian Health Service 0 0.00 2 4.17 8 16.67 3 6.25 3 6.25 0 0.00 1 2.08 1 2.08 39 81.25 

Other (specify)* 0 0.00 1 2.08 6 12.50 1 2.08 2 4.17 0 0.00 3 6.25 0 0.00 42 87.50 

Organizations providing Direct 

Services Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

211 or other call center 1 2.08 2 4.17 25 52.08 13 27.08 6 12.50 2 4.17 14 29.17 3 6.25 17 35.42 

Community Health Clinic 0 0.00 0 0.00 12 25.00 3 6.25 2 4.17 0 0.00 1 2.08 1 2.08 34 70.83 

Community Mental Health 

Clinic 0 0.00 2 4.17 9 18.75 3 6.25 2 4.17 0 0.00 1 2.08 1 2.08 38 79.17 

Deaf Service Center 0 0.00 1 2.08 11 22.92 5 10.42 3 6.25 0 0.00 1 2.08 1 2.08 34 70.83 

Hospital/Medical Center 5 10.42 3 6.25 20 41.67 12 25.00 5 10.42 5 10.42 8 16.67 0 0.00 26 54.17 

School for the Blind 0 0.00 0 0.00 7 14.58 2 4.17 0 0.00 0 0.00 0 0.00 1 2.08 40 83.33 

School for the Deaf 0 0.00 1 2.08 7 14.58 1 2.08 2 4.17 1 2.08 1 2.08 0 0.00 40 83.33 

The ARC 0 0.00 1 2.08 11 22.92 5 10.42 5 10.42 0 0.00 1 2.08 0 0.00 36 75.00 

United Way 0 0.00 0 0.00 14 29.17 6 12.50 2 4.17 0 0.00 1 2.08 0 0.00 34 70.83 

Vocational/Rehabilitation 

Services 2 4.17 5 10.42 20 41.67 13 27.08 7 14.58 1 2.08 3 6.25 1 2.08 25 52.08 

Other (specify)* 0 0.00 2 4.17 3 6.25 2 4.17 2 4.17 1 2.08 2 4.17 0 0.00 45 93.75 

Advocacy/Referral 

Organizations Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

AIDS Coalition 1 2.08 1 2.08 8 16.67 3 6.25 2 4.17 1 2.08 2 4.17 0 0.00 40 83.33 

Alzheimer’s Association 1 2.08 4 8.33 37 77.08 23 47.92 16 33.33 2 4.17 11 22.92 1 2.08 8 16.67 

American Council of the Blind 0 0.00 1 2.08 7 14.58 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 41 85.42 

Autism Society state/regional 

chapter 0 0.00 0 0.00 7 14.58 0 0.00 1 2.08 0 0.00 0 0.00 0 0.00 41 85.42 

Brain Injury Association 

state/regional chapter 2 4.17 5 10.42 20 41.67 10 20.83 7 14.58 3 6.25 7 14.58 0 0.00 28 58.33 

Centers for Independent 

Living 2 4.17 12 25.00 35 72.92 22 45.83 16 33.33 5 10.42 20 41.67 1 2.08 9 18.75 

Easter Seals 1 2.08 4 8.33 14 29.17 7 14.58 6 12.50 3 6.25 4 8.33 0 0.00 33 68.75 

Epilepsy Foundation 0 0.00 0 0.00 7 14.58 1 2.08 1 2.08 0 0.00 0 0.00 0 0.00 41 85.42 

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10d. What types of resources are shared? 

Co-located 

staff 

Shared 

monetary 

resources 

Shared 

information Joint training Joint program sponsorship 

Shared nonmonetary 

resources 

Shared data No shared 

resources 

No response/ 

Not applicable 

state/regional chapter 

National Association of Mental 

Illness state/regional chapter 0 0.00 0 0.00 7 14.58 4 8.33 1 2.08 0 0.00 1 2.08 0 0.00 40 83.33 

National Autism Association 

state/regional chapter 0 0.00 0 0.00 5 10.42 1 2.08 0 0.00 0 0.00 0 0.00 0 0.00 43 89.58 

National Multiple Sclerosis 

Society state/regional chapter 0 0.00 1 2.08 8 16.67 1 2.08 2 4.17 0 0.00 1 2.08 0 0.00 40 83.33 

State Association for the Deaf 0 0.00 0 0.00 8 16.67 2 4.17 1 2.08 0 0.00 0 0.00 0 0.00 39 81.25 

United Cerebral Palsy 1 2.08 4 8.33 9 18.75 5 10.42 3 6.25 2 4.17 4 8.33 0 0.00 39 81.25 

Other (specify)* 0 0.00 1 2.08 8 16.67 4 8.33 3 6.25 1 2.08 2 4.17 1 2.08 39 81.25 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

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11. Approximately, how many FTEs (Full time equivalents) at the State level perform each of the following functions? 

0 1 2-4 5-7 8-10 >10 No response Range Mean Median Mode Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Min Max 

Information & 

Referral/Information & 

Assistance (I&R/I&A) 

1 2.08 10 20.83 12 25.00 3 6.25 2 4.17 3 6.25 17 35.42 0 65 6.57 2.75 1 

Options counseling/ 

counseling to provide indepth person centered 

decision support 

2 4.17 7 14.58 8 16.67 1 2.08 1 2.08 3 6.25 26 54.17 0 700 42.94 2.25 1 

Benefits 

counseling/eligibility 

determination 

2 4.17 4 8.33 8 16.67 1 2.08 1 2.08 5 10.42 27 56.25 0 600 41.54 2.50 2 

Care transition services 3 6.25 4 8.33 2 4.17 3 4.17 1 2.08 0 0.00 35 72.92 0 7.5 3.36 3 1 

Crisis Intervention 

services 3 6.25 3 6.25 1 2.08 2 4.17 1 2.08 1 2.08 37 77.08 0 11 4.82 5 1 

Independent Living 

services 3 6.25 3 6.25 1 2.08 2 4.17 0 0.00 0 0.00 39 81.25 0 6 3 2.50 1 

Advocacy services 2 4.17 6 12.50 3 6.25 3 6.25 2 4.17 1 2.08 31 64.58 0 28 5.27 2.50 1 

Providing administrative 

or other support for the 

above functions 

2 4.17 10 20.83 10 20.83 4 8.33 2 4.17 5 10.42 15 31.25 0 105 8.21 3 1 

Note: Responses have been rounded to the nearest whole number. 

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12. At the State level, how many FTE (Full time equivalents) are dedicated to -

working with ADRC(s) in your State? 

Frequency Percentage 

0 0 0.00 

1 14 29.17 

2-4 12 25.00 

5-7 8 16.67 

8-10 0 0.00 

>10 4 8.33 

No response 10 20.83 

Total 48 100 

Min 0.50 

Max 21 

Mean 4.03 

Median 2 

Mode 1 

Note: Responses have been rounded to the nearest whole number. 

13. Is your organization paid on a fee for service or per unit basis for performing any of the following 

services for a client (Please check all that apply)? 

Frequency Percentage* 

Information/referral 1 2.08 

Options Counseling 2 4.17 

Screening 0 0.00 

Assessment 1 2.08 

Application assistance 1 2.08 

Transition support 1 2.08 

Other, please specify** 4 8.33 

*Percentages do not add up to 100% as respondents could select more than one option.
 

**Free text responses accompanying this question are available in the appendix with supplemental questions.
 

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14. [If any of the boxes are checked in previous question] What is the source of the fee for service or per 

unit payments? 

Frequency Percentage* 

Medicare 0 0.00 

Medicaid Waiver 2 4.17 

Medicaid State plan 0 0.00 

Medicaid managed care organization 0 0.00 

State-funded program other than Medicaid 1 2.08 

Private health plan 0 0.00 

Provider 0 0.00 

Other, please specify** 3 6.25 

*Percentages do not add up to 100% as respondents could select more than one option.
 

**Free text responses accompanying this question are available in the appendix with supplemental questions.
 

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APPENDIX I. PROCESS EVALUATION STATE ADRC SURVEY FREE TEXT 

RESPONSES 

Section A. Baseline Characteristics
 

2. States used federal grant funding in a variety of ways to develop their aging and disability networks. On a 

scale of 1 to 5, indicate the importance of each of the following in improving access to LTSS in your state since, 

with 1 being “not important at all” and 5 being “very important”. 

Specify Other 

All of these areas are important. Local sites used funds for some or all of these areas. 

Coordination of LTSS to facilitate access. 

Establishment of a centralized phone number through 211 CareLine. 

Authorizing and administering a Face-to-Face options counseling initiative via the ADRC network. 

Training 

Creating formal referral protocol with critical pathway providers. 

Evaluation Frameworks 

Improving current partnerships 

Outreach and Marketing 

Training and shared understanding of the goal 

Consumer focus groups to learn about how our target populations access LTSS when they are not already in the 

system 

Funding 

State Leadership- Professional Development- QA; CQI 

Wisconsin had ADRCs before the Federal ADRC grants were available. Federal ADRC grants helped Wisconsin 

expand its program to additional counties and improve the quality of ADRC services. 

3. When your state applied for its first ADRC grant in YEAR, what were your goals for the project? Check all 

that apply. 

Specify Other 

Streamline eligibility and provide a resource regardless of age- disability or service that is unbiased 

Common intake form 

Provide seamless Medicaid financial eligibility; Provide one-stop entry for long term care services; Develop and 

implement a web-based case management information system; Improve access to services- coordinate servicesenhance choice & provide counseling about services and choices. 

To improve access to services 

To develop consumer direction model and a hybrid model allowing for participants to choose consumer directed 

services- traditional or combination of both to best meet his/her needs 2.a. Evaluate project to obtain data as to 

whether aging network services are successful in maintaining nursing home eligible older adults in the community and 

in averting or delaying spend-down to Medicaid eligibility 

Development of standardized operating processes and procedures. 

Compelling policy direction to continue ADRC program development statewide; Replicable Statewide Model 

To implement our ADRC model statewide and have all ADRCs providing high quality services consistent with that 

model 

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4. Please indicate how your State initially selected local sites to receive ADRC funds. Select 

all that apply. 

Specify Other 

Sites chosen by former ADSS Commissioner 

Competitive Application Process 

Selected based on existing infrastructure and ability to implement 

The Delaware ADRC was designed to operate as a statewide ADRC. 

We are not a local site 

Competitive process 

Selected region because of it was rural and partnership with Medicaid. 

Selected sites that were fully functional ADRCs (NY Connects) 

Selected site that was experienced with professional I&R services 

Selected local offices within state agency infrastructure 

Selected sites who already had a vision; mission; infrastructure and role in community for the 

provision of unbiased I&A- and are viewed as key access points to LTSS. 

Selected the sites that already had the vision for leveraging technology and partnerships to 

increase access to HCBS 

High Functioning, serving under 60 persons with disabilities 

Through a comprehensive selection process- selected county and non-profit organizations that 

submitted a plan to meet the State' requirements for ADRCs. Successful applicants included 

county human service departments- county aging offices- and county aging units. 

4a. Indicate the extent to which the grants your state received for ADRC development contributed to the 

following: 

Specify Other 

The purpose of the ADRCs is to provide a coordinated- multi-access one stop system that integrates information- referral 

and eligibility determination functions for elders- persons with disabilities and caregivers. The ADRC facilitates 

customer-friendly access to long-term care services and benefits for elders- persons with disabilities- and their caregivers. 

The grants provided opportunities to facilitate the statewide system changes necessary to accomplish the purpose and 

streamline access to long-term care services. 

MIS integration 

partnerships- database development- working towards centralized I/R&A system 

Expand statewide 

Provide interagency and inter-professional cross training opportunities. 

Outreach & marketing efforts 

Brought focus on options counseling and person centered planning 

Sustainability with other state funding- integrated into the State Plan on Aging for NH 

Established an IT client-tracking system 

Leverage other opportunities such as a number of AAAs/NY Connects partnering with hospitals and other entities 

on ACA Section 3026 grants 

LCA Designation- development of staff with Options Counseling certification- increased number of staff with SHIIPexpanded knowledge of Person Centered thinking concepts and practices- Transition efforts and improved local 

community networking 

Increased consistency of consumer access to information and referral. 

Marketing plan and upgraded phone systems across the state 

Page 271 
 

4a. Indicate the extent to which the grants your state received for ADRC development contributed to the 

following: 

Specify Other 

Create a shared understanding of how to share options with consumers 

build infrastructure across organizations- enhance data capacity 

Develop statewide web-based technology and develop protocols and language to utilize it in a universal way 

Colocation within ADRC of partners and Subject Matter Populations (SMEs) serving diverse populations 

Identified factors related to customer satisfaction and improved the quality of ADRC services. All of the above occurred 

due to state funding for ADRCs that preceded Federal grants and have continued. 

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7. Community Needs: The next set of questions is designed to gather information about the conditions in the service network for your state. 

Please think about the status of your state as a whole. 

Specify Other 

Other 

(YEAR) 

Other, Please 

specify (YEAR) Other (2012) Other, Please specify (2012) Other (YEAR) Other, Please specify (YEAR) Other (2012) Other, Please specify (2012) 

Often a 

Barrier 

Appropriate 

Housing 

Often a 

Barrier 

Appropriate 

Housing Often a Barrier Elder Rights and Protections Often a Barrier Elder Rights and Protections 

Often a 

Barrier 

Lack of affordable 

and accessible 

housing 

Often a 

Barrier 

Lack of 

affordable and 

accessible 

housing 

Often a Barrier 

Lack of 

community based 

LTSS 

infrastructure 

Often a Barrier 

Lack of community 

based LTSS 

infrastructure 

Sometimes a 

Barrier 

Lack of funding 

for LTSS - localstate- and federal 

funding reductions 

Often a 

Barrier 

Lack of funding 

for LTSS - localstate- and federal 

funding 

reductions 

Often a Barrier 

Lack of a 

comprehensive 

and coordinated 

IT system to 

replace 

fragmented and 

siloed systems 

Often a Barrier 

Lack of a 

comprehensive and 

coordinated IT 

system to replace 

fragmented and 

siloed systems 

Sometimes a 

Barrier 

Physical location 

of participant 

Sometimes a 

Barrier 

Physical location 

of participant 

Sometimes a 

Barrier 

Self-isolation due 

to perceived 

stigma 

Sometimes a 

Barrier 

Self-isolation due 

to perceived stigma 

- - - - Often a Barrier 

Too few 

providers to meet 

needs or provide 

choice- especially 

HHAs and other 

in home care 

providers. 

Sometimes a 

Barrier 

Too few providers 

to meet needs or 

provide choiceespecially HHAs 

and other in home 

care providers. 

8. Please indicate the Current availability of the following services within your service area. For the following services, prior to the first ADRC 

grant, to what extent was there provider choice? 

Specify Other 

Other (Current 

Availability) 

Specify other 

(Current 

Other (Provider 

Choice prior to 

Specify other (Provider 

Choice prior to first 

Other (Provider 

choice currently) 

Specify other (Provider 

choice currently) 

Page 273 
 

 

 

 

 

 

Availability) first ADRC grant) ADRC grant) 

Not available 

Specify Other: Elder 

Rights and 

Protection 

No Specify Other: Elder 

Rights and Protection Limited Specify Other: Elder Rights and Protection 

Available but inadequate to 

meet need - Limited - Limited -

Available but inadequate to 

meet need 

Specify Other: 

Private Pay - full 

menu of services 

and supports; TBI 

Services 

Limited 

Specify Other: Private Pay 

- full menu of services and 

supports; TBI Services 

Limited 

Specify Other: Private 

Pay - full menu of 

services and supports; 

TBI Services 

Available but inadequate to 

meet need 

Specify Other: 

Availability varies - - - -

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Section B. Organizational Characteristics
 

9. For the current Fiscal Year, what is the approximate amount of funding 

from each of the following sources? 

Specify Other 

SHIP 

Mental Health Trust Authority 

MFP ADRC grant funds received by Medicaid State Office 

SHIP, OAA Title IIIB - Aging I&R only, RSA - Disability I&R 

Tobacco funds 

Award: 90CT0163, In ADRC Care Transitions Project (CFDA: 93.048 – Special 

Programs for the Aging Title IV and Title II Discretionary Projects) 

CMS SHIP Funding, SMP, LTCCE Allocation Passthrough (combo of state, 

federal, and private dollars), ISG Grant 

Federal grants total 

Voluntary Consumer Contributions Title III 

Local funds 

RI Pharmaceutical Assistance for Elderly ($472,609) 

Other Federal 

OAA Title III (B, CI, C2, D, E) & NSIP, Title VII, Title V, Senior Farmers 

Market Nutrition Program 

CMS MFP & ADRC Expansion Grant 

9. What is the type of partnership agreement? 

Specify Other 

State Departments (with cabinet-level secretaries) 

Health 

EOA is attached agency to DOH 

Part of umbrella agency 

Interagency Charter for EBI Leadership Team, workgroups 

Human Services 

Our agency 

Part of umbrella agency 

Governmental Service Agreement 

SUA is a part of DHS 

DEA is a division of the Dept of Human Services 

We are part of Human Services 

Aging 

Our agency 

See Division level 

State agency responsible for ADRC grant efforts 

We are the SUA 

MDoA is the SUA 

Part of umbrella agency 

Aging and Disability is the State Authority on Aging 

Aging is a Division within the Dept of Human Services 

The ADRC is administered by the SUA 

We are aging is part of the department – under the Secretary 

Page 275 
 

 

 

 

 

 

 

 

9. What is the type of partnership agreement? 

Other 

DOI – MIPPA 

Oversight of agency 

Delegated Authority to perform certain functions (e.g. LTSS Medicaid eligibility, oversight) 

State Agencies (located within state departments) 

Aging 

Located within, Aging oversees ADRC 

Delaware ADRC is an integral part of DHSS and is both housed and staffed by DSAAPD 

We are the SUA 

MDoA is the SUA 

We are the Executive Office of Elder Affairs 

The MBA is the SUA 

SUA is aging 

We are the SUA 

The ADRC is within the SUA of DSS 

DAIL is the SUA and Aging Unit 

Our Division is Aging 

We are the State Aging Agency 

Developmental Disabilities 

Representation on the DD Council 

Gov. appointment to DD Council 

ICOA has a representative that sits on the Council of Developmental Disabilities 

Serve on DD Council 

OES has integrated with Disability Services 

DD is also a part of DHS 

DAIL is the DD Agency 

Serve on DD Council Board; serve on advisory councils for each other 

Within same Department 

Acquired or Late-Onset Disabilities 

Governor Office on Disability 

Part of DHS Division of Aging and Adult Services 

No specific entity 

Individuals with “Acquired or Late-onset Disabilities” is a target population for DSAAPD 

OES has integrated with Disability Services 

Integrated leadership for comprehensive waiver 

DIV of VR and DIV of Services for the Blind and DIV of Services for Deaf and Hard of Hearing 

This is a part of DHS 

DAIL is the agency for individuals age 18 and over with disabilities 

This is another division within our shared agency 

Combined with Aging in same agency 

Mental Health 

CDSMP partner 

DSAAPD & ADRC work collaboratively with DSAMH and their statewide network of service 

professionals to support the needs of older adults and persons with physical disabilities, their caregivers 

and services providers throughout the aging & disability network 

Serve on Mental Health Planning Council 

Located within Medicaid agency 

Integrated leadership for BIP 

Page 276 
 

 

 

 

9. What is the type of partnership agreement? 

Co-Chair Interagency Geriatric Mental Health and Chemical Dependence Planning Council 

A division of DSS 

Part of same department 

Medicaid 

Money Follows the Person partner 

DSAAPD and ADRC have a strong working relationship with DE’s Division of Medicaid and Medical 

Services (DMMA) – State Medicaid Agency. Partnership agreements and activities include: formal 

MOU, designation of ADRC as Local Contact Agency for MDS, survey data and referrals from nursing 

homes for options counseling ; I&R and enrollment support for LTC Medicaid Managed care, etc. 

Part of umbrella agency 

Integrated leadership for comprehensive waiver 

GSA 

Workgroups, BIP 

DHS Aging and People with Disabilities is the Medicaid entity for LTSS. APD has an MOU with the 

Oregon Health Authority as the State Medicaid entity with the exception of LTSS. 

A division of DSS 

Cabinet level department, delegated authority to perform certain functions (e.g. LTSS Medicaid 

eligibility, oversight) 

Housing 

Limited work with Housing Coalition 

DSAAPD and ADRC partners with the State Housing Authority and other housing partners through a 

designated Senior Planner who works collaboratively to develop and coordinate Housing support and 

resources 

Legislative relationship recently established 

Review and comment on certain documents and applications 

RIDEA awards funding on a competitive basis to private and public elderly housing for security 

improvements; housing complexes also required to comply with RIDEA rules regarding security and 

safety 

Involved with housing issues and participate on workgroups 

Work together under two different Secretariats; Housing has contracts with CILs and AAAs but not 

directly with the state agency 

Part of same department 

Education 

DOE is on our advisory council for aging 

Coordination on some programs affecting children as well as specialized staff training 

Other 

Rehab 

MBA works with a total of 16 state agencies to support the SLL One Stop Shop 

Interlocal Agreement & State Rehab Division 

Superstorm Sandy, relationship with Emergency Preparedness and Community Affairs 

In combination, the checked boxes apply. Not all apply to each entity specified in the “other” category

Adult Services and Adult Protective Services will merge with our agency as of July 1, 2013 

Local Government Agencies 

Area Agency on Aging 

In DE, there are no AAAs; DSAAPD functions both as the SUA & AAA 

Nine ADRCs are located in AAAs 

Annual Implementation Plan 

Page 277 
 

 

 

 

 

9. What is the type of partnership agreement? 

Administrative Lead for ADRC (contractor) 

County Health Department 

See State Section: DSAAPD works closely with Division of Public Health, the state’s health department

and all local health clinics and community partners throughout DE 

Local district health offices work more directly with the AAAs 

Done at the local ADRC level 

Joint CDSME Programming; Joint assessments between Health Depts and AAAs 

County Medicaid Office 

See State section: In DE there are no county Medicaid offices 

Done at the local ADRC level 

County Medicaid offices are overseen by Aging and People with Disabilities 

No such entity in Virginia 

Our department has delegated authority to perform local Medicaid office functions on their behalf 

County Department on Aging 

Under the AAA 

See State Section: In DE, there are no county departments on aging, only DSAAPD 

Done at the local ADRC level 

In MN, this would be the LTCC Units 

Annual Implementation Plan 

Some AAAs are designated as part of county government but they still operate as a AAA not a county 

Dept of Aging; all AAAs receive some level of funding from local government 

Same as AAAs (all AAAs are local governments (i.e. COGs, counties, or combo of county and city) 

Country Department on Disability 

No such entity 

Same as above 

Done at the local ADRC level 

Serve on Executive Leadership Committee on Aging and Disability 

Agency has regional offices that work closely with county government but do not receive funding from 

local government; all CILs receive some level of funding from local government 

Part of same state agency 

County Housing Office 

See state section 

Done at the local ADRC level 

Housing Vouchers for MFP participants 

Library 

Done at the local ADRC level 

The majority of local libraries across the state serve as SeniorNavigator Centers – local touch-points for 

information regarding supports for older adults and adults with disabilities 

Other 

Completing formal MOU 

Federal Agencies 

Local Veterans Administration 

Idaho Commission on Aging is working with the VA to establish a VD-HCBS program 

Done at the local ADRC level 

Working on MOU 

Local Provider Agreements between AAAs & COFA and VAMC 

VD-HCBS program 

VD-HCBS program 

Local Indian Health Service 

Page 278 
 

 

 

 

 

 

 

9. What is the type of partnership agreement? 

Establishing relationships for information sharing, advocacy, and capacity building 

Done at the local ADRC level 

Other 

Office of Violence Against Women grant to educate law enforcement and legal support & judges about 

elder abuse 

Organizations Providing Direct Services 

211 or Other Call Center 

Each ADRC has an MOU with the local 211 

Part of Advisory Group 

United Way 211, which is co-located with THE POINT, provides phone coverage when The POINT is 

closed 

Part of NW-AIRS, participate in Advisory Committees 

Community Health Center 

Some local AAAs have MOUs 

See State section 

ADRC has the connection with local clinics 

Community Mental Health Clinic 

Work in progress to strengthen partnerships 

Done at the local ADRC level 

Part of Advisory Group 

Deaf Service Center 

Some AAAs have MOUs; serve on ADSS’s advisory board; work in progress to strengthen relationships

In DE, Deaf Services are integrated throughout the disability service provider network, including the 

CILs and Hearing Loss Association of DE which provides support for persons who are deaf or have 

hearing loss 

Done at the local ADRC level 

ADRC partner by statute 

Hospital/Medical Center 

State staff working on transition projects; some local AAAs have MOUs for ADRC or care transitions. 

ADSS has active relationship with Alabama Hospital Association. 

In 2009, DSAAPD & ADRC initiated a formal MOU with Christiana Care Health System (CCHS), the 

largest acute care hospital in DE. DSAAPD has continued to work closely with the hospital, along with 

DE’s QIO and all other acute care hospitals and community stakeholder to improve transitions of care 

statewide. 

Maui Memorial Hospital 

Done at the local ADRC level 

Hospitals have agreements with AAAs as formal partners in ADRC and share information through the 

ADRC technology. Some AAAs have co-located staff as part of the Care Transitions Program. On the 

state level, the DIV is working with the Hospital and Healthcare Association to look at ways that we can 

provide a state level approach to support care transitions. 

State MH Hospitals are part of Same Department 

School for the Blind 

Alabama Institute for the Deaf and Blind is the state agency for all deaf and blind services and support in 

the state. Representation on ADSS Advisory Board. Refer back to comments on Deaf Service Center. 

N/A, DSAAPD/ADRC partners at the state level with Division for the Visually Impaired (DVI) and its 

community partners to provide support for personas who are blind or have other visual impairments 

Done at the local ADRC level 

School for the Deaf 

See comments above 

Page 279 
 

 

 

 

 

 

 

 

 

 

 

 

 

9. What is the type of partnership agreement? 

N/A, DSAAPD/ADRC partners with all CILs and other community partners to provide support for 

persons who are deaf or have other hearing impairments 

Done at the local ADRC level 

The ARC 

Working with the ARC on the Lifespan Respite Grant along with the Office of Aging and Adult Services 

On a local level the ARC serves on some of the Local Advisory Councils as a stakeholder in ADRC, all 

of the ARC services are listed in the ADRC database 

United Way 

Have worked in partnership with strategic planning and disaster relief 

DSAAPD/ADRC work collaboratively with United Way through several key partners and programs, such 

as Delaware 211 and Stand By Me, a national financial empowerment program 

Done at the local ADRC level 

Part of Advisory Group 

On a local level the United Way serves on some of the Local Advisory Councils as a stakeholder in 

ADRC, all of the United Way’s services are listed in the ADRC database

Vocational/Rehabilitation Services 

Done at the local ADRC level 

Vocational Rehab is a department within the Massachusetts Rehabilitation Commission 

Interlocal 

Voc Rehab is a division of DAIL 

Voc Rehab is part of the same agency as the Div for Aging, Managers work closely together to cross 

support programs where possible 

Part of same department, oversee SILC and plan 

Other 

Manages the statewide provider database for ADRC; Private sector lead for VA for ADRC technology; 

provides access to and help technical assistance/desk support for the ADRC technology 

Statewide ADRC Advisory Committee 

Advocacy/Referral Organizations 

AIDS Coalition 

Alzheimer’s Association 

DSAAPD/ADRC has been working together with DE’s Alzheimer’s Assoc & community partners to 

develop the Alzheimer’s State Plan

Outreach and education by statute 

ADSSP Grant is helping VA develop an evidence-based practice; AA is working with VA to ensure that 

ADRCs are dementia capable 

ADRC Advisory Council participation 

American Council for the Blind 

See State/Local sections 

Autism Society State/Regional Chapter 

Brain Injury Association State/Regional Chapter 

DSAAPD/ADRC work closely with the BIA of DE and community partners to provide support for 

person with acquired or traumatic brain injuries 

ADRC partner 

Brain Injury Division is part of same agency as Aging; this division works closely with the Brain Injury 

Association of VA 

Participate in Options Counseling Training, sponsored by our department 

Centers for Independent Living 

Serve on the SILC 

The CILs are funded by the MA Rehabilitation Commission 

Page 280 
 

 

 

 

 

 

 

- - -

 

-

- -

 

9. What is the type of partnership agreement? 

At the state level, several CILs are LTCOP contractors. At the local level, most AAAs/COFA’s have 

highly functional working relationships. CILS are contractors of AAAs, members of NY Connects Long 

Term Care Councils and Chair those Councils in same areas 

Contract for LCA 

Oversight of CILs takes place within the same agency as the Division for Aging, CILs and AAAs work 

closely with agency through SILAS (Strengthening Independent Living and Aging Services), an advisory 

group focused on fostering greater collaboration between CIL and AAA network 

Easter Seals 

Collaborating on Lifespan Respite Grant and Voucher program 

Epilepsy Foundation State/Regional Chapter 

National Association of Mental Illness State/Regional Chapter 

Serve on Mental Health Planning Council 

National Autism Association State/Regional Chapter 

National Multiple Sclerosis Society State/Regional Chapter 

LSR Coalition Member 

Collaborating on Lifespan Respite Grant and Voucher program 

State Association for the Deaf 

See State/Local section 

Part of same department 

United Cerebral Palsy 

Other 

Developing training program 

MLTSS Steering Committee representative of AARP, PACE, ADRC, MCOs, Adult Day, Medicaid, 

DDD, DDS 

Statewide ADRC Advisory Committee 

13. Is your organization paid on a fee for service or per unit basis for performing any 

of the following services for a client? 

Specify Other 

N/A - DSAAPD is a State Agency and Delaware’s ADRC is fully integrated into this agency

Veteran’s program

None 

Admin and other support, Marketing 

14. [If any of the boxes are checked in previous question] What is the source of the fee 

for service or per unit payments? 

Specify Other 

N/A - DSAAPD is a State Agency and Delaware’s ADRC is fully integrated into this agency

Money Follows the Person and Veteran Directed 

Older Americans Act 

Page 281 
 

- -

 

 

 

’

- -

 

 

 

APPENDIX J. PROCESS EVALUATION AAA SURVEY RESPONSE TABLES 

Section A. Baseline Characteristics
 

1. Has your organization realized an improvement in ability to provide integrated, comprehensive access to 

long term care services and supports (e.g., provide one stop or streamlined benefits access, increase awareness 

of LTSS options, provide assistance to consumers such as counseling regarding LTSS choices or transitions 

from institutions back into the community) over the past 8* years? 

Frequency Percentage 

Yes 13 86.67 

No 2 13.33 

No response 0 0.00 

Total 15 100 

*The time frame is noted as 7 years in the AAA survey; however, due to a delay in fielding the survey, the time frame was changed 

to 8 years to capture the appropriate information. 

2. Which have had the most positive impact on your organization s ability to provide integrated, 

comprehensive access to long term care services and supports (e.g., provide one stop or streamlined benefits 

access, increase awareness of LTSS options, provide assistance to consumers such as counseling regarding 

LTSS choices or transitions from institutions back into the community)? (Select up to two) 

Frequency Percentage 

Partnerships developed/expanded 12 80.00 

Staffing changes 2 13.33 

Shared Data 4 26.67 

Focus on providing person-centered, selfdirected services 4 26.67 

Other, specify** 0 0.00 

*Percentages do not add up to 100% as respondents could select more than one option.
 

**Free text responses accompanying this question are available in the appendix with supplemental questions.
 

4. Is your site interested in becoming an ADRC or becoming part of an ADRC in the future? 

Frequency Percentage 

Yes; If yes, what is your current stage or 

status in becoming an ADRC? 13 86.67 

No; If no, please explain why you do not 

plan to become an ADRC? 2 13.33 

Other, please specify 0 0.00 

Total 15 100 

Page 282 
 

Section B. Populations Served
 

7. For the following items, please indicate the demographic composition of 

your service area. 

Latino/Hispanic Origin 

Frequency Percentage 

0% 0 0.00 

>0-5% 8 53.33 

6-10% 1 6.67 

11-20% 3 20.00 

>20% 2 13.33 

No response 1 6.67 

Total 15 100.00 

Min (%) 0.50 

Max (%) 30.00 

Mean (%) 8.53 

Median (%) 4.70 

Mode (%) 1.00 

Page 283 
 

 

 

 

 

7. For the following items, please indicate the demographic composition of your service area. (This question applies to the community that [LOCAL AAA] 

serves.) 

Caucasian/White Black or African American American Indian or 

Alaska Native Asian Nation Hawaiian or Other Pacific Islander 

Frequency Percentage Frequency Percentage Frequency Percentage Frequency Percentage Frequency Percentage 

0% 0 0.00 0 0.00 0 0.00 0 0.00 1 6.67 

>0-5% 0 0.00 6 40.00 12 80.00 13 86.67 8 53.33 

6-10% 0 0.00 2 13.33 0 0.00 0 0.00 0 0.00 

11-20% 0 0.00 2 13.33 0 0.00 0 0.00 0 0.00 

21-50% 1 6.67 4 26.67 0 0.00 0 0.00 0 0.00 

51-75% 4 26.67 0 0.00 0 0.00 0 0.00 0 0.00 

76-100% 10 66.67 0 0.00 0 0.00 0 0.00 0 0.00 

No response 0 0.00 1 6.67 3 20.00 2 13.33 6 40.00 

Total 15 100 15 100 15 100 15 100 15 100 

Min (%) 48.00 0.11 0.02 0.06 0.00 

Max (%) 99.50 50.00 3.00 2.80 1.00 

Mean (%) 82.02 12.12 0.99 1.11 0.39 

Median (%) 85.10 7.35 1.00 1.00 0.15 

Mode (%) 73.00 1.00, 21.00 1.00, 0.40 1.00 0.10 

Page 284 
 

 

 

 

9. What percentage of your service area is living at or below the poverty line? 

Frequency Percentage 

At or below the poverty line (those who specified a percentage) 12 80.00 

Not sure, but a significant population lives under the poverty line 3 20.00 

Not sure, but the population is small or negligible 0 0.00 

Total 15 100 

9a. What percent of your service area is living at or below the poverty 

line? 

Frequency Percentage 

0% 0 0.00 

>0-10% 1 0.67 

11-25% 8 53.33 

26-50% 1 0.67 

51-100% 1 0.67 

No response 4 26.67 

Total 15 100 

Min (%) 7.30 

Max (%) 53.90 

Mean (%) 19.50 

Median (%) 17.50 

Mode (%) 11.00 

10. What percentage of your service area is uninsured/does not have health insurance 

coverage? 

Frequency Percentage 

Uninsured (those who specified a percentage) 6 40.00 

Not sure, but a significant population is 

uninsured 7 46.67 

Not sure, but the population is small or negligible 6 6.67 

No Response 1 6.67 

Total 15 100 

Page 285 
 

 

 

10a. What percent of your service area is uninsured /does not have health 

insurance coverage? 

Frequency Percentage 

0% 0 0.00 

>0-10% 1 6.67 

11-25% 5 33.33 

26-50% 0 0.00 

51-100% 0 0.00 

No response 9 60.00 

Total 15 100 

Min (%) 7.00 

Max (%) 19.70 

Mean (%) 14.85 

Median (%) 16.25 

Mode (%) No mode 

12. Within the last 12 months, has a community LTSS needs assessment been conducted? 

Frequency Percentage 

Yes 2 13.33 

No, but we did complete a community needs 

assessment within the past three years 9 60.00 

No, but a community needs assessment was not 

completed within the past three years 3 20.00 

No Response 1 6.67 

Total 15 100.00 

Page 286 
 

 

 

 

 

 

 

 

 

 

 

13. To what extent is each of the following a barrier for individuals seeking LTSS services approximately 8 years ago or if you do not have information that goes 

back that far, as far back as you do have information and currently? 

Prior Currently 

Not a barrier Sometimes a 

barrier 

Often a 

barrier No response Not a barrier Sometimes a barrier 

Often a 

barrier No response 

Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

Lack of LTSS- Needed 

services are not offered 1 6.67 6 40.00 7 46.67 1 6.67 1 6.67 9 60.00 4 26.67 1 6.67 

Lack of available LTSS slots 

(i.e. long waiting lists) 1 6.67 5 33.33 8 53.33 1 6.67 1 6.67 3 20.00 10 66.67 1 6.67 

Poor service quality 9 60.00 4 26.67 1 6.67 1 6.67 9 60.00 5 33.33 0 0.00 1 6.67 

Lack of health insurance 1 6.67 7 46.67 6 40.00 1 6.67 1 6.67 7 46.67 6 40.00 1 6.67 

Providers not accepting 

consumers with Medicaid 1 6.67 9 60.00 4 26.67 1 6.67 1 6.67 7 46.67 6 40.00 1 6.67 

Barriers based on consumer 

disabilities 2 13.33 10 66.67 2 13.33 1 6.67 2 13.33 11 73.33 1 6.67 1 6.67 

Language barriers 7 46.67 6 40.00 1 6.67 1 6.67 6 40.00 7 46.67 1 6.67 1 6.67 

Cultural barriers 7 46.67 6 40.00 1 6.67 1 6.67 8 53.33 5 33.33 1 6.67 1 6.67 

Religious barriers 12 80.00 2 13.33 0 0.00 1 6.67 12 80.00 2 13.33 0 0.00 1 6.67 

Sexual orientation barriers 12 80.00 2 13.33 0 0.00 1 6.67 12 80.00 2 13.33 0 0.00 1 6.67 

People needing services do 

not have a permanent 

address 

9 60.00 5 33.33 0 0.00 1 6.67 8 53.33 6 40.00 0 0.00 1 6.67 

Consumers lack 

transportation 0 0.00 4 26.67 10 66.67 1 6.67 1 6.67 4 26.67 9 60.00 1 6.67 

Stigma, discrimination and 

prejudice against older 

adults 

8 53.33 6 40.00 0 0.00 1 6.67 8 53.33 6 40.00 0 0.00 1 6.67 

Stigma, discrimination and 

prejudice against persons 

with disabilities 

7 46.67 6 40.00 1 6.67 1 6.67 8 53.33 5 33.33 1 6.67 1 6.67 

Providers have high staff 

turnover 4 26.67 4 26.67 6 40.00 1 6.67 3 20.00 7 46.67 4 26.67 1 6.67 

Providers lack appropriate 

trained staff 4 26.67 8 53.33 2 13.33 1 6.67 5 33.33 7 46.67 2 13.33 1 6.67 

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13. To what extent is each of the following a barrier for individuals seeking LTSS services approximately 8 years ago or if you do not have information that goes 

back that far, as far back as you do have information and currently? 

Prior Currently 

Not a barrier Sometimes a 

barrier 

Often a 

barrier No response Not a barrier Sometimes a barrier 

Often a 

barrier No response 

Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

Service provider 

hours/locations are hard to 

access 

6 40.00 6 40.00 2 13.33 1 6.67 6 40.00 6 40.00 1 6.67 2 13.33 

Other, please specify* 0 0.00 0 0.00 0 0.00 15 100 0 0.00 0 0.00 0 0.00 15 100 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

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13. Please indicate the current availability of the following services within your service area. 

Adequate availability Available but inadequate 

to meet the need Not available No response 

Frequency Percentage Frequency Percentage Frequency Percentage Frequency Percentage 

Safe and affordable housing options 3 20.00 11 73.33 0 0.00 1 6.67 

Peer support services/groups 4 26.67 9 60.00 1 6.67 1 6.67 

HCBS Medicaid Waiver Programs 2 13.33 10 66.67 1 6.67 2 13.33 

Caregiver Support (i.e. respite program, 

support groups, or counseling) 4 26.67 9 60.00 1 6.67 1 6.67 

Nutrition Programs 6 40.00 8 53.33 0 0.00 1 6.67 

Employment Services 5 33.33 8 53.33 1 6.67 1 6.67 

Education services 11 73.33 3 20.00 0 0.00 1 6.67 

Opportunities to develop advanced 

directives 8 53.33 6 40.00 0 0.00 1 6.67 

Transportation services 3 20.00 11 73.33 0 0.00 1 6.67 

Opportunities for socialization/recreation 5 33.33 7 46.67 1 6.67 1 6.67 

Mental health services 2 13.33 11 73.33 1 6.67 1 6.67 

Ombudsman services 11 73.33 3 20.00 0 0.00 1 6.67 

Health prevention and screening services 5 33.33 9 60.00 0 0.00 1 6.67 

Emergency services/crisis intervention 2 13.33 12 80.00 0 0.00 1 6.67 

Transition programs (from hospitals, 

nursing homes etc.) 5 33.33 9 60.00 0 0.00 1 6.67 

Nursing home (institutional) diversion 

program 

7 46.67 7 46.67 0 0.00 1 6.67 

Nursing home/residential beds 11 73.33 3 20.00 0 0.00 1 6.67 

Income Assistance 2 13.33 11 73.33 1 6.67 1 6.67 

Energy assistance 3 20.00 11 73.33 0 0.00 1 6.67 

Personal Care services 3 20.00 11 73.33 0 0.00 1 6.67 

Medicaid waivers 4 26.67 9 60.00 0 0.00 2 13.33 

Independent living services (e.g., skills 

training, peer support) 2 13.33 9 60.00 3 20.00 1 6.67 

Other, please specify* 0 0.00 0 0.00 0 0.00 15 100 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

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13. For these services, to what extent is there provider choice both prior to receiving an ADRC grant and currently? 

Prior Currently 

No Limited Adequate No response No Limited Adequate No response 

Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

Safe and affordable housing 

options 2 13.33 8 53.33 4 26.67 2 6.67 2 13.33 6 40.00 6 40.00 1 6.67 

Peer support services/groups 1 6.67 8 53.33 5 33.33 1 6.67 1 6.67 8 53.33 5 33.33 1 6.67 

HCBS Medicaid Waiver 

Programs 2 13.33 8 20.00 3 20.00 2 13.33 2 13.33 8 53.33 3 20.00 2 13.33 

Caregiver Support (i.e. 

respite program, support 

groups, or counseling) 

2 13.33 9 60.00 3 20.00 1 6.67 2 13.33 8 53.33 4 26.67 1 6.67 

Nutrition Programs 1 6.67 6 40.00 7 46.67 1 6.67 1 6.67 8 53.33 5 33.33 1 6.67 

Employment Services 0 0.00 10 66.67 4 26.67 1 6.67 2 13.33 9 60.00 3 20.00 1 6.67 

Education services 1 6.67 5 33.33 8 53.33 1 6.67 1 6.67 5 33.33 7 46.67 2 13.33 

Opportunities to develop 

advanced directives 0 0.00 7 46.67 7 46.67 1 6.67 0 0.00 6 40.00 8 53.33 1 6.67 

Transportation services 0 0.00 13 86.67 1 6.67 1 6.67 1 6.67 10 66.67 3 20.00 1 6.67 

Opportunities for 

socialization/recreation 0 0.00 9 60.00 5 33.33 1 6.67 0 0.00 7 46.67 7 46.67 1 6.67 

Mental health services 2 13.33 11 73.33 1 6.67 1 6.67 2 13.33 11 73.33 1 6.67 1 6.67 

Ombudsman services - - 6 40.00 8 53.33 1 6.67 0 0.00 5 33.33 9 60.00 1 6.67 

Health prevention and 

screening services 1 6.67 8 53.33 5 33.33 1 6.67 0 0.00 8 53.33 6 40.00 1 6.67 

Emergency services/crisis 

intervention 1 6.67 11 73.33 2 13.33 1 6.67 1 6.67 12 80.00 1 6.67 1 6.67 

Transition programs (from 

hospitals, nursing homes 

etc.) 

2 13.33 9 60.00 3 20.00 1 6.67 0 0.00 11 73.33 3 20.00 1 6.67 

Nursing home (institutional) 

diversion program 0 0.00 9 60.00 5 33.33 1 6.67 1 6.67 7 46.67 6 40.00 1 6.67 

Nursing home/residential 

beds 0 0.00 5 33.33 9 60.00 1 6.67 0 0.00 4 26.67 10 66.67 1 6.67 

Income Assistance 2 13.33 12 80.00 - - 1 6.67 2 13.33 12 80.00 - - 1 6.67 

Energy assistance - - 12 80.00 2 13.33 1 6.67 - - 12 80.00 2 13.33 1 6.67 

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13. For these services, to what extent is there provider choice both prior to receiving an ADRC grant and currently? 

Prior Currently 

No Limited Adequate No response No Limited Adequate No response 

Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

Personal Care services 1 6.67 13 86.67 - - 1 6.67 1 6.67 11 73.33 2 13.33 1 6.67 

Medicaid waivers 1 6.67 9 20.00 3 20.00 2 13.33 1 6.67 9 60.00 3 20.00 2 13.33 

Independent living services 

(e.g., skills training, peer 

support) 

3 20.00 8 53.33 3 20.00 1 6.67 3 20.00 9 60.00 2 13.33 1 6.67 

Other, please specify* 0 0.00 1 6.67 0 0.00 14 93.33 0 0.00 0 0.00 0 0.00 15 100 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

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14. How many consumers of each type were served in the most recent 6 months period 

(October 2012 March 2013)? This question is specific to the consumers who access LOCAL 

AAA services such as I&R/I&A, benefits or options counseling, Information and referral 

services, services to support transitions from residential or institutional facilities to the 

community. 

Total Number of Older Adults (60+) 

Frequency Percentage 

0-100 0 0.00 

101-500 2 13.33 

501-1000 1 6.67 

1001-2500 0 0.00 

2501-5000 1 6.67 

5001-10,000 0 0.00 

>10,000 2 13.33 

No response 9 60.00 

Total 15 100 

Min 250 

Max 43,939 

Mean 10,199 

Median 1,757 

Mode No mode 

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14. How many consumers of each type were served in the most recent 6 months period (October 2012 March 2013)? This question is specific to the consumers who access LOCAL AAA services 

such as I&R/I&A, benefits or options counseling, Information and referral services, services to support transitions from residential or institutional facilities to the community. 

Consumers Under 60 

0 >0-25 26-50 51-100 101-200 >200 No response Range Mean Median Mode 

Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Min Max 

Individuals with Disabilities 

Physical Disabilities 0 0.00 1 6.67 0 0.00 2 13.33 1 6.67 0 0.00 11 73.33 12 167 84.75 80 No mode 

Cognitive Impairment 0 0.00 3 20.00 0 0.00 0 0.00 0 0.00 0 0.00 12 80.00 4 15 10.33 12 4,12,15 

Intellectual Disabilities 0 0.00 1 6.67 2 13.33 0 0.00 0 0.00 0 0.00 12 80.00 5 45 25.67 27 5,27,45 

Developmental Disabilities 0 0.00 3 20.00 0 0.00 0 0.00 0 0.00 0 0.00 12 80.00 3 25 11.33 6 3,6,25 

Mental Illness 0 0.00 2 13.33 0 0.00 0 0.00 0 0.00 0 0.00 13 86.67 1 15 8 8 1,15 

Multiple Disabilities 0 0.00 1 6.67 0 0.00 2 13.33 0 0.00 0 0.00 12 80.00 25 75 55 65 25,65,75 

Caregivers 

Informal/family caregiver 0 0.00 2 13.33 1 6.67 2 13.33 1 6.67 0 0.00 9 60.00 2 93 62.17 47.5 No mode 

Paid Caregiver 0 0.00 3 20.00 0 0.00 0 0.00 0 0.00 0 0.00 12 80.00 5 15 8.67 6 5,15 

Health and Human 

Services Professional 

1 6.67 1 6.67 0 0.00 0 0.00 0 0.00 0 0.00 13 86.67 0 8 8 8 8 

Special Subpopulations 

Traumatic Brain Injury 

(TBI) 

0 0.00 4 26.67 0 0.00 0 0.00 0 0.00 0 0.00 11 73.33 1 10 3.5 4.5 1 

Emergent/ 

Emergency Cases 

0 0.00 3 20.00 0 0.00 0 0.00 0 0.00 0 0.00 12 80.00 1 10 5.33 5 1,5,10 

Low income 0 0.00 1 6.67 0 0.00 1 6.67 1 6.67 1 6.67 11 73.33 25 506 177.25 89 No mode 

Limited English 

proficiency 

0 0.00 0 0.00 1 6.67 1 6.67 0 0.00 0 0.00 13 86.67 50 67 58.5 58.5 50,67 

Is the LOCAL AAA 

making any special efforts 

to target a particular 

population not listed 

above? If yes, please 

specify* 

0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 N/A N/A N/A N/A N/A 

Other, please specify* 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 N/A N/A N/A N/A N/A 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

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14. How many consumers of each type were served in the most recent 6 months period (October 2012 March 2013)? This question is specific to the consumers who access LOCAL AAA services 

such as I&R/I&A, benefits or options counseling, Information and referral services, services to support transitions from residential or institutional facilities to the community. 

Consumers 60 and over (Currently) 

0 >0-25 26-50 51-100 101-200 >200 No response Range Mean Median Mode 

Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Min Max 

Individuals with Disabilities 

Physical Disabilities 0 0.00 1 6.67 0 0.00 0 0.00 3 20.00 1 6.67 10 66.67 25 3261 738 115 No mode 

Cognitive Impairment 0 0.00 1 6.67 1 6.67 0 0.00 2 13.33 0 0.00 11 73.33 16 142 77.5 76 No mode 

Intellectual Disabilities 0 0.00 1 6.67 0 0.00 0 0.00 1 6.67 0 0.00 13 86.67 20 157 88.5 88.5 20,157 

Developmental Disabilities 0 0.00 1 6.67 0 0.00 1 6.67 0 0.00 0 0.00 13 86.67 5 89 47 47 5,89 

Mental Illness 0 0.00 1 6.67 0 0.00 1 6.67 0 0.00 0 0.00 13 86.67 2 80 41 41 2,80 

Multiple Disabilities 0 0.00 1 6.67 0 0.00 0 0.00 0 0.00 3 20.00 11 73.33 20 3261 936.75 233 2,80 

Caregivers 

Informal/family caregiver 0 0.00 0 0.00 0 0.00 2 13.33 1 6.67 2 13.33 10 66.67 6 600 240.8 150 No mode 

Paid Caregiver 1 6.67 1 6.67 0 0.00 0 0.00 1 6.67 0 0.00 12 80.00 0 150 83 83 5,150 

Health and Human Services 

Professional 

1 6.67 1 6.67 0 0.00 0 0.00 0 0.00 0 0.00 13 86.67 0 25 25 25 25 

Special Subpopulations 

Traumatic Brain Injury (TBI) 0 0.00 1 6.67 0 0.00 0 0.00 0 0.00 0 0.00 14 93.33 9 9 9 9 9 

Emergent/Emergency Cases 0 0.00 3 20.00 0 0.00 0 0.00 0 0.00 0 0.00 11 73.33 11 75 29.75 16.5 No mode 

Low income 0 0.00 0 0.00 0 0.00 0 0.00 1 6.67 3 20.00 11 73.33 175 9785 2802.75 625.5 No mode 

Limited English proficiency 0 0 0 0.00 0 0.00 0 0.00 0 0.00 2 13.33 13 86.67 628 2609 1618.5 1618.5 628,2609 

Is the LOCAL AAA making 

any special efforts to target a 

particular population not listed 

above? If yes, please specify* 

0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 1 6.67 14 93.33 4200 4200 4200 4200 4200 

Other, please specify* 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 N/A N/A N/A N/A N/A 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

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14b. Over the past 8 years, the number of clients under 60 served by LOCAL AAA 

has : 

Frequency Percentage 

Significantly increased 8 53.33 

Significantly decreased 0 0.00 

Stayed the same 5 33.33 

No response 2 13.33 

Total 15 100 

15b. Over the past 8 years, the number of consumers 60 and over served by LOCAL AAA 

has : 

Frequency Percentage 

Significantly increased 9 60.00 

Significantly decreased 0 0.00 

Stayed the same 3 20.00 

No response 3 20.00 

Total 15 100 

16b. Over the past 8 years, the number of consumers with physical disabilities served by LOCAL AAA 

has: 

Frequency Percentage 

Significantly increased 7 46.67 

Significantly decreased 0 0.00 

Stayed the same 6 40.00 

No response 2 13.33 

Total 15 100 

17b. Over the past 8 years, the number of consumers with mental/emotional disabilities served 

by LOCAL AAA has: 

Frequency Percentage 

Significantly increased 5 33.33 

Significantly decreased 0 0.00 

Stayed the same 7 46.67 

No response 3 20.00 

Total 15 100 

Page 295 
 

 

18b. Over the past 8 years, the number of consumers with multiple disabilities served by LOCAL AAA 

has: 

Frequency Percentage 

Significantly increased 7 46.67 

Significantly decreased 0 0.00 

Stayed the same 6 40.00 

No response 2 13.33 

Total 15 100 

19b. Over the past 8 years, the number caregivers served by LOCAL AAA has: 

Frequency Percentage 

Significantly increased 12 80.00 

Significantly decreased 0 0.00 

Stayed the same 1 6.67 

No response 2 13.33 

Total 15 100 

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Section C: Service Provision
 

20. How frequently do consumers ask about the following? 

Frequently Sometimes Infrequently Never No response 

Freq. % Freq. % Freq. % Freq. % Freq. % 

Advanced directives 4 26.67 6 40.00 4 26.67 0 0.00 1 6.67 

Advocacy 6 40.00 6 40.00 2 13.33 0 0.00 1 6.67 

Caregiver support 13 86.67 1 6.67 0 0.00 0 0.00 1 6.67 

Respite services 12 80.00 2 13.33 0 0.00 0 0.00 1 6.67 

Chronic health conditions 7 46.67 7 46.67 0 0.00 0 0.00 1 6.67 

Education 0 0.00 6 40.00 8 53.33 0 0.00 1 6.67 

Employment 2 13.33 6 40.00 4 26.67 2 13.33 1 6.67 

Energy assistance 9 60.00 3 20.00 2 13.33 0 0.00 1 6.67 

Home modification 11 73.33 2 13.33 1 6.67 0 0.00 1 6.67 

Affordable housing 9 60.00 5 33.33 0 0.00 0 0.00 1 6.67 

Income Assistance 11 73.33 3 20.00 0 0.00 0 0.00 1 6.67 

Medicaid eligibility and 

services 12 80.00 2 13.33 0 0.00 0 0.00 1 6.67 

Medicare eligibility and 

services 13 86.67 1 6.67 0 0.00 0 0.00 1 6.67 

Mental/behavioral health 

services 2 13.33 9 60.00 3 20.00 0 0.00 1 6.67 

Nutrition services 10 66.67 4 26.67 10 66.67 0 0.00 1 6.67 

Ombudsman/abuse or 

neglect issues 9 60.00 5 33.33 0 0.00 0 0.00 1 6.67 

Independent living 

services 7 46.67 7 46.67 0 0.00 0 0.00 1 6.67 

Personal care/attendant 

care services 10 66.67 3 20.00 1 6.67 0 0.00 1 6.67 

Preventative health 

services 2 13.33 9 60.00 3 20.00 0 0.00 1 6.67 

Recreation opportunities 1 6.67 5 33.33 6 40.00 1 6.67 2 13.33 

Services for emergent 

care/crisis intervention 0 0.00 11 73.33 3 20.00 0 0.00 1 6.67 

Support groups 4 26.67 7 46.67 3 20.00 0 0.00 1 6.67 

Transition services 5 33.33 5 33.33 4 26.67 0 0.00 1 6.67 

Transportation 11 73.33 3 20.00 0 0.00 0 0.00 1 6.67 

Other, specify* 0 0.00 0 0.00 0 0.00 0 0.00 15 100 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

21. Does [Local AAA] engage in advocacy activities for older 

adults? 

Frequency Percentage 

Yes 14 93.33 

No 0 0.00 

No Response 1 6.67 

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Total 15 100 

22. Does [Local AAA] engage in advocacy activities for persons with disabilities? 

Frequency Percentage 

Yes 10 66.67 

No 3 20.00 

No Response 2 13.33 

Total 15 100 

23a. Is diversion from nursing home or other institutional residential 

facilities an outcome sought to be achieved? 

Frequency Percentage 

Yes 13 86.67 

No 1 6.67 

No Response 1 6.67 

Total 15 100 

23b. How is [Local AAA] measuring and tracking this? 

Frequency Percentage 

Staff track using standard electronic 

system 7 46.67 

Staff track using hardcopy/paper system 2 13.33 

An external group (e.g., an evaluator, 

auditor) tracks using a standard system 1 6.67 

Staff track using an informal system 2 13.33 

No Response 3 20.00 

Other, specify* 0 0.00 

Total 15 100 

*Free text responses accompanying this question are available in the appendix with 

supplemental questions. 

24. Does your organization provide transition services to consumers 

discharged from an acute care setting? 

Frequency Percentage 

Yes 4 26.67 

No 10 66.67 

No Response 1 6.67 

Total 15 100 

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25. [Local AAA] Clients provided Care Coordination/ Transition Assistance 

0 >0-100 101-200 201-300 301-400 >400 No Response Range Mean Median Mode # % # % # % # % # % # % # % Min Max 

Number of 

individuals assisted 

with transition from 

hospital ONLY 

through formal care 

transition programs 

(evidence-based CT 

intervention or 

innovative model) 

0 0.00 1 6.67 0 0.00 1 6.67 0 0.00 0 0.00 13 86.67 14 211 112.5 112.5 14,211 

Number of 

participants carried 

over from last 6 

months (October 

2012-March 2013) 

(started program 

within last 6 months 

and continued with 

the intervention) 

1 6.67 1 6.67 0 0.00 0 0.00 0 0.00 0 0.00 13 86.67 0 85 85 85 85 

Number of 

participants whose 

cases were closed 

during the last 6 

months (October 

2012-March 2013) 

(i.e., participants 

whose transition 

services were ended 

either because of a 

readmission or new 

admission to a care 

facility or because 

the transition period 

ended) 

0 0.00 1 6.67 1 6.67 0 0.00 0 0.00 0 0.00 13 86.67 4 126 65 65 4,126 

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25. [Local AAA] Clients provided Care Coordination/ Transition Assistance 

0 >0-100 101-200 201-300 301-400 >400 No Response Range Mean Median Mode # % # % # % # % # % # % # % Min Max 

Number of 

participants that 

readmitted within 30 

days of discharge 

0 0.00 2 13.33 0 0.00 0 0.00 0 0.00 0 0.00 13 86.67 1 16 8.5 8.5 1,16 

Number of 

participants that 

readmitted within 30 

days and re-entered 

the care transition 

program 

1 6.67 1 6.67 0 0.00 0 0.00 0 0.00 0 0.00 13 86.67 0 2 2 2 2 

26. What is the number of the individuals who were assisted with transition from hospital through formal care transitions intervention in this [Local 

AAA] program service area in this reporting period by participating hospital? 

0 >0-200 201-400 401-600 601-800 No Response Range Mean Median Mode Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Min Max 

No. of Individuals 

for Hospital 1 0 0 1 6.67 1 6.67 0 0.00 0 0.00 13 86.67 14 211 112.5 112.5 14,211 

No. of Individuals 

for Hospital 2 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 0 0 NA NA NA 

No. of Individuals 

for Hospital 3 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 0 0 NA NA NA 

27. What is the number of the individuals who were assisted with transition from hospital through formal care transitions intervention on 

across all participating hospitals in this [Local AAA] program service area this reporting period by age group? 

0 >0 250 251 500 501 750 751 1000 >1000 No Response Range Mean Median Mode # % # % # % # % # % # % # % Min Max 

Aged 60 

and Over 0 0.00 2 13.33 0 0.00 0 0.00 0 0.00 0 0.00 13 86.67 174 211 192.5 192.5 174,21 

1 

Under 

Age 60 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100.00 0 0 NA NA NA 

Page 300 
 

 Age 

unknown 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100.00 0 0 NA NA NA 

Page 301
 
 

 

 

 

 

 

28. What is the number of the individuals who were assisted with transition from hospital through formal care transitions intervention in this 

[Local AAA] program service area this reporting period by health insurance group? 

0 >0-100 101-200 201-300 301-400 >400 No 

Response Range Mean Media 

n 

Mode 

# % # % # % # % # % # % # % Min Max 

Medicare 0 0.00 0 0.00 2 13.33 0 0.00 0 0.00 0 0.00 13 86.67 167 174 170.50 170.50 167, 

174 

Medicaid 0 0.00 1 6.67 0 0.00 0 0.00 0 0.00 0 0.00 14 93.33 40 40 40 40 40 

DualEligible 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 0 0.00 0 0.00 0 

No 

insurance 0 0.00 1 6.67 0 0.00 0 0.00 0 0.00 0 0.00 14 93.33 4 4 4 4 4 

Private 

insurance 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 NA NA NA NA NA 

Veterans 

Admin on 

Services 

0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 NA NA NA NA NA 

Other 

unknown 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 NA NA NA NA NA 

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29. What is the number of the individuals who were assisted with transition from hospital through formal care transitions intervention across all 

participating hospitals in this [Local AAA] program service area in the past 6 months (October 2012 March 2013) who were referred to one or 

more health/prevention programs? 

0 >0-25 26-50 51-75 76-100 >100 No 

response Range Mean Median Mode 

# % # % # % # % # % # % # % Min Max 

Chronic Disease 

Self-Management 

Program 

1 6.67 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 14 93.33 0 0 NA NA NA 

Diabetes SelfManagement 

Program 

1 6.67 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 14 93.33 0 0 NA NA NA 

Exercise Program 0 0.00 0 0.00 0 0.00 1 6.67 0 0.00 0 0.00 14 93.33 70 70 70 70 70 

Mental Health and 

Substance Misuse 0 0.00 1 6.67 0 0.00 0 0.00 0 0.00 0 0.00 14 93.33 2 2 2 2 2 

Falls Management 

and Prevention 1 6.67 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 14 93.33 0 0 NA NA NA 

Alzheimer’s 

program 

1 6.67 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 14 93.33 0 0 NA NA NA 

Medication 

Management 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 1 6.67 14 93.33 140 140 140 140 140 

Home injury/ Risk 

Screenings 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 1 6.67 14 93.33 140 140 140 140 140 

Other 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 N/A N/A N/A N/A N/A 

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30a. What is the number of the individuals who were assisted with transition from hospital through formal care transitions intervention across all 

participating hospitals in this [Local AAA] program service area in this reporting period that were referred to one or more of the following long term 

services or supports? 

0 >0-25 26-50 51-75 76-100 >100 No 

response Range Mean Median Mode 

# % # % # % # % # % # % # % Min Max 

Additional Options 

Counseling 0 0.00 1 6.67 0 0.00 0 0.00 0 0.00 3 20.00 11 73.33 6 574 230.25 170.5 No 

mode 

Home Delivered meals 0 0.00 3 20.00 0 0.00 0 0.00 0 0.00 2 13.33 10 66.67 2 642 160.8 25 No 

mode 

Nutrition services or 

nutrition counseling 0 0.00 0 0.00 0 0.00 1 6.67 0 0.00 2 13.33 12 80.00 52 1468 550 130 52,130,1 

468 

Care giver support 0 0.00 2 13.33 0 0.00 1 6.67 1 6.67 1 6.67 10 66.67 2 254 82 70 No 

mode 

Personal 

care/homemaker/ 

chore maker services 

0 0.00 1 6.67 0 0.00 1 6.67 0 0.00 1 6.67 12 80.00 15 105 57.33 52 15,52, 

105 

Transportation 0 0.00 4 26.67 0 0.00 0 0.00 0 0.00 0 0.00 11 73.33 4 25 16.5 18.5 No 

mode 

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31a. Do you have a marketing plan? 

Frequency Percentage 

Yes, our marketing plan is operational 5 33.33 

Yes, we have a plan but it is not operational yet 3 20.00 

No, we don’t have a plan at this time 5 33.33 

No Response 2 13.33 

Total 15 100 

31b. Does [Local AAA] utilize a standard operating procedure to assess consumer 

need? 

Frequency Percentage 

Always 9 60.00 

Sometimes 3 20.00 

Never 1 6.67 

No Response 2 13.33 

Total 15 100 

32. Is the consumer assessment tool and/or basic consumer needs assessment process common across 

partner organizations? 

Frequency Percentage 

Yes, common across all partners 5 33.33 

Yes, common across some partners 5 33.33 

No, each partner organization uses their own assessment 

tool/process 3 20.00 

No Response 2 13.33 

Total 15 100 

33. Does your organization/network provide “Options Counseling” or other one or one 

counseling designed to support consumers ability to make informed decisions about 

their long term care? 

Frequency Percentage 

Yes 8 53.33 

No 5 33.33 

No Response 2 13.33 

Total 15 100 

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34. Referrals to Public and Private Services this Reporting Period 

0 >0-1000 1001-

2000 

2001-

3000 

3001-

4000 >4000 No response Range Mean Median Mode 

# % # % # % # % # % # % # % Min Max 

What is the number of Local AAA clients 

referred to or given an application for a public 

program, including Older Americans Act; 

Medicare; Medicaid; Food Stamps; TANF; 

Social Security (SSI or SSDI); LI-HEAP; 

VDHCBS; Other State-funded and countyfunded programs for Medicaid; Other? 

0 0.00 5 33.33 0 0.00 0 0.00 0 0.00 1 6.67 9 60.00 40 12,379 2400 528.5 No mode 

What is the number of Local AAA clients 

referred to some other type of service (non-public 

services, resources or program)? 

0 0.00 5 33.33 0 0.00 0 0.00 0 0.00 1 6.67 9 60.00 20 12,000 2225 245.5 No mode 

What is the number of Local AAA clients that 

were not referred to any type of service? 2 13.33 3 20 0 0.00 0 0.00 0 0.00 0 0.00 10 66.67 0 374 139 40 3,40,374 

What is the number of Local AAA Unknown 

clients (remainder of all clients)? 2 13.33 2 13.33 0 0.00 0 0.00 0 0.00 0 0.00 11 73.33 0 25 15 15 5,25 

Total 0 0.00 4 26.67 1 6.67 0 0.00 0 0.00 1 6.67 9 60.00 135 12,379 2613 703.5 No mode 

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35. [Local AAA] Clients provided Options Counseling by age during this Reporting period. 

0 >0-1000 1001-2000 2001-3000 3001-4000 >4000 No Response Range Mean Median Mode 

Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Min Max 

Clients Aged 60 

and Over 0 0.00 4 26.67 0 0.00 0 0.00 0 0.00 1 6.67 10 66.67 10 12,305 2726.4 557 No 

mode 

Clients Under 

Aged 60 0 0.00 5 33.33 0 0.00 0 0.00 0 0.00 0 0.00 10 66.67 11 150 97 104 No 

mode 

Clients Age 

Unknown 2 13.33 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 13 86.67 0 0 NA NA NA 

Total 0 0.00 4 26.67 0 0.00 0 0.00 0 0.00 1 6.67 10 66.67 21 12,379 2823 672 No 

mode 

35. [Local AAA] Clients provided Options Counseling by method during this Reporting period. 

0 >0-1000 1001-2000 2001-3000 3001-4000 >4000 No Response Range Mean Median Mode Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Min Max 

In Person 0 0.00 3 20.00 0 0.00 0 0.00 0 0.00 1 6.67 11 73.33 218 10,522 2911.5 453 No mode 

By Phone 0 0.00 3 20.00 1 6.67 0 0.00 0 0.00 0 0.00 11 73.33 71 1857 633 302 No mode 

Electronic 

Communication 

(e.g., email or 

website chat) 

0 0.00 2 13.33 0 0.00 0 0.00 0 0.00 0 0.00 13 86.67 37.5 25 50 37.5 25,30 

Total 0 0.00 2 13.33 0 0.00 0 0.00 0 0.00 1 6.67 12 80.00 4515.3 495 12,379 672 No mode 

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35. [Local AAA] Clients provided Options Counseling by setting during this Reporting period. 

0 >0-1000 1001-2000 2001-3000 3001-4000 >4000 No Response Range Mean Median Mode Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Min Max 

Local AAA 0 0.00 4 26.67 0 0.00 0 0.00 0 0.00 0 0.00 11 73.33 177 300 218.75 199 No mode 

Hospital 1 6.67 2 13.33 0 0.00 0 0.00 0 0.00 0 0.00 12 80.00 0 35 20 20 5,35 

Nursing facility/ 

Institution 0 0.00 4 26.67 0 0.00 0 0.00 0 0.00 0 0.00 11 73.33 12 150 50.5 20 No mode 

At the client’s 

community residence 2 13.33 1 13.33 0 0.00 0 0.00 0 0.00 1 6.67 11 73.33 0 11,894 4185.33 464 198, 464, 

11,894 

Other 0 0.00 2 13.33 0 0.00 0 0.00 0 0.00 0 0.00 13 86.67 51 226 138.5 138.5 51,226 

Total 0 0.00 3 20.00 0 0.00 0 0.00 0 0.00 1 6.67 11 73.33 192 12,379 3487.5 689.5 No mode 

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35. [Local AAA] Clients provided Feedback about Options Counseling during this Reporting period. 

0 >0-200 201-400 401-600 601-800 800-1000 No Response Range 

Mean Median Mode Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Min Ma 

x 

What is the number of LOCAL 

AAA Clients who report that 

options counseling enabled them 

to make well informed decisions 

about their LTSS? 

0 0.00 1 6.67 3 20.00 0 0.00 0 0.00 0 0.00 11 73.33 64 350 275.00 343 No mode 

What is the number of LOCAL 

AAA clients surveyed this 

reporting period? 

1 6.67 1 6.67 0 0.00 1 6.67 1 6.67 0 0.00 11 73.33 0 672 430.67 520 

100, 

520, 

672 

36. Does [Local AAA] or network have a standardized tool or process to provide options 

counseling? 

Frequency Percentage 

Yes 7 46.67 

No 4 26.67 

Not applicable 1 6.67 

Don’t know 1 6.67 

No Response 2 13.33 

Total 15 100.00 

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37. Average monthly Public LTTS Program Enrollment in WHOLE [Local AAA] SERVICE AREA: 

This set of questions is asking about all current enrollment levels in these programs in the Local AAA service area. 

0 >0-1000 1001-

2000 

2001-

3000 

3001-

4000 >4000 No Response Range Mean Median Mode 

# % # % # % # % # % # % # % Min Max 

What is the average number of individuals 

enrolled in Medicaid HCBS Waivers in 1 6.67 7 46.67 0 0.00 0 0.00 0 0.00 0 0.00 7 46.67 0 471 180 111 No mode 

Local AAA Service area each month? 

What is the average number of individuals 

enrolled in Medicaid residing in 

institutions in Local AAA Service area 1 6.67 3 20.00 0 0.00 2 13.33 0 0.00 0 0.00 9 60.00 0 2,562 975.2 15 No mode 

each month? 

What is the average number of individuals 

enrolled in other public LTSS programs in 

Local AAA Service area each month? 

Please list LTSS programs and HCBS 

waivers (e.g., aged and disabled, MR/DD) 

that individuals are enrolled in 

2 13.3 

3 3 20.00 0 0.00 0 0.00 0 0.00 2 13.33 8 53.33 0 17,78 7 4875 55 No Mode 

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38.Total New Enrollment among [Local AAA] CLIENTS ONLY in Public LTSS Programs 

0 >0-1000 1001-

2000 

2001-

3000 

3001-

4000 >4000 No Response Range Mean Median Mode 

# % # % # % # % # % # % # % Min Max 

What is the LOCAL AAA Clients who are 

newly enrolled into a Medicaid HCBS 

Waiver (including individuals enrolled by 

LOCAL AAA staff and individual referred 

for assessment/ 

application by LOCAL AAA staff)? 

0 0.00 4 26.67 0 0.00 0 0.00 0 0.00 0 0.00 11 73.33 2 404 164.0 

0 125.00 No mode 

What is the LOCAL AAA Clients who are 

newly enrolled into a Medicaid institutional 

services (including individuals enrolled by 

LOCAL AAA staff and individual referred 0 0.00 3 20.00 0 0.00 0 0.00 0 0.00 0 0.00 12 80.00 36.00 215.0 

0 98.67 45.00 36,45,215 

for assessment/application by LOCAL AAA 

staff)? 

What is the total number of clients newly 

enrolled in other public LTSS programs in 

LOCAL AAA Service Area month (should 

include LOCAL AAA Clients and might 

include Non-LOCAL AAA clients)? 

1 6.67 3 20.00 0 0.00 0 0.00 0 0.00 0 0.00 11 73.33 0.00 500.0 

0 

194.0 

0 50.00 32,50,500 

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39. For data collected on consumers, are staff required to follow the Alliance of Information 

and Referral Systems (AIR) standards? 

Frequency Percentage 

Yes, with all consumers 3 20.00 

Yes, with specific groups of consumers- Please 

specify 0 0.00 

Never 4 26.67 

No Response 8 53.33 

Total 15 100 

40. Does [Local AAA] have a database /MIS that does any of the following? (Select all that apply) 

Frequency Percentage* 

Track consumer requests for information and referrals 7 46.67 

Track referrals made to consumers 5 33.33 

Maintain records on individual consumers 8 53.33 

Maintain a list of services/service providers 11 73.33 

Links to other databases (e.g., Medicaid waiver tracking 

systems, Money Follows the Person tracking system). If yes, 

specify_____________________ 

3 20.00 

Other, specify** 0 0.00 

* Percentages do not add up to 100% as respondents could select more than one option.
 

**Free text responses accompanying this question are available in the appendix with supplemental questions.
 

41. Do operational partners have access to data about their operations such as data about your consumers/services? 

If yes, for what purposes? (review client information, input client demographic information, input referrals, input 

service utilization information, review client service utilization, obtain summary reports on clients and/or services) 

Frequency Percentage 

Yes 4 26.67 

No, but there are plans to develop that capacity 3 20.00 

No, and there are no current plans to do this 4 26.67 

No Response 4 26.67 

Total 15 100 

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42. Do service providers have data about your consumers? If yes, for what purposes? (review client information, 

Input client demographic information, input referrals, input service utilization information, review client service 

utilization, obtain summary reports on clients and/or services) 

Frequency Percentage 

Yes (Specify) 3 20.00 

No, but there are plans to develop that capacity 4 26.67 

No, and there are no current plans to do this 5 33.33 

No Response 3 20.00 

Total 15 100 

42a. Do staff follow up with consumers after their initial contact with your organization? 

Frequency Percentage 

Always 12* 80.00* 

Sometimes – Under what Circumstances_________________ 0 0.00 

Never 0 0.00 

No Response 3* 20.00* 

Total 15 100 

*These numbers are updated based on the extra information available from questions 42b, 42c and 42d. 

42b. How many times does staff follow up with consumers after their initial contact with 

your organization? 

Frequency Percentage 

Once 4 26.67 

Multiple times 8 53.33 

No Response 3 20.00 

Total 15 100 

42c. What is the approximate timing of the first follow up with consumers after their initial 

contact with your organization? 

Frequency Percentage 

One to two weeks after service 10 66.67 

Three weeks after service 0 0.00 

One to two months after service 2 13.33 

Three to five months after service 0 0.00 

Six months after service 0 0.00 

One year or longer after service 0 0.00 

No Response 3 20.00 

Total 15 100 

42d. What is the approximate timing of the last follow up with consumers after their initial 

contact with your organization? 

Frequency Percentage 

One week after the service 2 13.33 

Two weeks after the service 4 26.67 

Three weeks after service 1 6.67 

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42d. What is the approximate timing of the last follow up with consumers after their initial 

contact with your organization? 

Frequency Percentage 

One to two months after service 2 13.33 

Three to five months after service 1 6.67 

Six months after service 0 0.00 

One year or longer after service 1 6.67 

No Response 4 26.67 

Total 15 100 

43. When consumers are referred to other agencies or organizations, are those 

providers contacted as a part of the follow up procedure? 

Frequency Percentage 

Always 4 26.67 

Sometimes – Under what circumstances 0 0.00 

Never 0 0.00 

No Response 11 73.33 

Total 15 100 

44. Approximately what percentage of consumers who are referred to other organizations 

receive a warm transfer”? (e.g., Simultaneous transfer of a telephone call and its 

associated data from one agent to another agent or supervisor) 

Frequency Percentage 

0% 0 0.00 

>0-20% 2 13.33 

21-40% 1 6.67 

41-60% 0 0.00 

61-80% 0 0.00 

81-100% 1 6.67 

No response 11 73.33 

Total 15 100 

Min (%) 10.00 

Max (%) 90.00 

Mean (%) 33.75 

Median (%) 17.50 

Mode (%) 10.00 

45. Does your organization routinely collect quantitative performance data about its services and 

consumers? 

Frequency Percentage 

Yes 8 53.33 

No 4 26.67 

No Response 3 20.00 

Total 15 100 

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46. Indicate any of the ways that your organization uses performance data (Select all that apply) 

Frequency Percentage* 

To justify funding requests 7 46.67 

To improve consumer service 7 46.67 

To administer service provider contracts 5 33.33 

To provide information on stakeholders (governing board, 

advocacy organizations, local government, etc.) 5 33.33 

For program planning 8 53.33 

Do not use performance data 0 0.00 

* Percentages do not add up to 100% as respondents could select more than one option. 

48. When a client contacts the AAA about LTSS and supports LTTSS, do AAA staff administer a 

screening questionnaire to make a preliminary determination of eligibility and need for public funded 

LTSS? 

Frequency Percentage 

Yes 7 46.67 

No 2 13.33 

Other, specify** 0 0.00 

No Response 6 40.00 

Total 15 100 

**Free text responses accompanying this question are available in the appendix with supplemental questions. 

Page 315 
 

 

 

 

 

 

49a. If yes, to which of the following populations is the eligibility screening instrument administered? 

Frequency Percentage* 

Aged 65 and older 7 46.67 

Physical Disability 5 33.33 

Intellectual Disability/Development Disability 2 13.33 

Brain Injury 1 6.67 

HIV/AIDS 0 0.00 

Medically fragile 4 26.67 

Autism 0 0.00 

Mental Illness 1 6.67 

Other, specify** 4 26.67 

* Percentages do not add up to 100% as respondents could select more than one option.
 

**Free text responses accompanying this question are available in the appendix with supplemental questions.
 

49b. What kind of information is collected? Check all that apply. 

Frequency Percentage* 

Demographic information (i.e., age, gender, 

ethnicity, marital status) 10 66.67 

Living Arrangements 8 53.33 

Caregivers 10 66.67 

Health Status 9 60.00 

Activities of Daily living (ADL) 9 60.00 

Instrumental Activities of Daily Living (ADL) 8 53.33 

Cognitive functions 7 46.67 

Troublesome Behaviors 4 26.67 

LTSS currently received 8 53.33 

Income 8 53.33 

Assets 6 40.00 

Other, specify 1 6.67 

* Percentages do not add up to 100% as respondents could select more than one option.
 

**Free text responses accompanying this question are available in the appendix with supplemental questions.
 

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50. How do clients in your state/site complete and file applications for financial eligibility for Medicaid or 

publicly funded LTSS? 

Frequency Percentage* 

Applications are accessed on-line, printed, completed by 

hand, and returned to state or county office. 7 46.67 

Applications are accessed on-line, completed online, 

printed, and returned to state or county office. 7 46.67 

Applications are accessed online, completed online, and 

submitted to the state or county electronically. 8 53.33 

Paper copy applications are obtained at various locations 

including [insert locations], completed by hand, and 

returned either in person or by mail to a state or county 

office 

7 46.67 

Other 0 0.00 

* Percentages do not add up to 100% as respondents could select more than one option.
 

**Free text responses accompanying this question are available in the appendix with supplemental questions.
 

51. In what ways do AAA staff assist clients with financial eligibility applications for Medicaid LTSS Programs? 

Frequency Percentage* 

We do not assist clients with financial eligibility applications 2 13.33 

Advise the client where s/he can obtain an application 10 66.67 

Assist the client in completing the application 6 40.00 

Assist the client in collecting the required financial documentation 4 26.67 

Check on the status of the client’s application 5 33.33 

Notify the client when the application has been 

approved/disapproved 3 20.00 

Manage appeals by clients whose applications were not approved 3 20.00 

Other, specify** 0 0.00 

*Percentages do not add up to 100% as respondents could select more than one option.
 

**Free text responses accompanying this question are available in the appendix with supplemental questions.
 

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52. In what ways does AAA staff assist clients with financial eligibility applications for publicly funded LTSS* other 

than Medicaid LTSS? 

Frequency Percentage* 

We do not assist clients with financial eligibility applications 3 20.00 

Advise the client where s/he can obtain an application 10 66.67 

Assist the client in completing the application 5 33.33 

Assist the client in collecting the required financial documentation 4 26.67 

Check on the status of the client’s application 5 33.33 

Notify the client when the application has been approved/disapproved 3 20.00 

Manage appeals by clients whose applications were not approved 2 13.33 

Other, specify** 0 0.00 

*Percentages do not add up to 100% as respondents could select more than one option.
 

**Free text responses accompanying this question are available in the appendix with supplemental questions.
 

53. Does your state/site permit presumptive financial eligibility in order to 

expedite the provision of LTSS to clients while their financial eligibility 

applications are being processed? 

Frequency Percentage 

Yes 2 13.33 

No 8 53.33 

In Progress 0 0.00 

No Response 5 33.33 

Total 15 100 

Eligibility Screening Module: Functional Assessment
 

54. Does your state/site use a universal, comprehensive assessment instrument for 

functional (level of care) eligibility determinations for LTSS? 

Frequency Percentage 

Yes 10 66.67 

No 1 6.67 

No, but in development 0 0.00 

No Response 4 26.67 

Total 15 100 

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55a. If yes, what best describes the kind of instrument your state/site is using? Check one. 

Frequency Percentage 

A custom –designed instrument developed by state staff 8 53.33 

A custom-designed instrument developed by a vendor 

specifically for our state 1 6.67 

An instrument developed by a vendor that is also used by 

other states 0 0.00 

Other, specify** 0 0.00 

No Response 6 40.00 

Total 15 100 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

55b. What best describes the process for how the assessor completes the instrument? (Check all that apply) 

Frequency Percentage* 

The assessor completes a paper form while interviewing the client; there is no 

electronic data entry. 4 26.67 

The assessor completes a paper form while interviewing the client and later 

inputs the data on an electronic form at the office 6 40.00 

The assessor completes an electronic form while interviewing the client, which 

is later downloaded into electronic database. 3 20.00 

The assessor completes a web-based form while interviewing the client and the 

client’s data is entered “real time” into an electronic database. 3 20.00 

*Percentages do not add up to 100% as respondents could select more than one option. 

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’

55c. Do you work with consumers to develop a care plan? 

Frequency Percentage 

Yes, with all consumers 2 13.33 

Yes, under certain circumstances (Please specify_____) 0 0.00 

No, that is not part of this service 4 26.67 

No Response 9 60.00 

Total 15 100 

55d. For which of the following populations is the functional assessment used? 

Frequency Percentage* 

Aged 65 and older 8 53.33 

Physical disability 3 20.00 

ID/DD 1 6.67 

Brain Injury 1 6.67 

HIV/AIDS 0 0.00 

Medically fragile 3 20.00 

Autism 0 0.00 

Mental Illness 1 6.67 

Other, specify** 6 40.00 

* Percentages do not add up to 100% as respondents could select more than one option.
 

**Free text responses accompanying this question are available in the appendix with supplemental questions.
 

56a. Is your organization involved in planning for your state s Exchange? 

Frequency Percentage 

Yes 1 6.67 

No 8 53.33 

Not sure 2 13.33 

No Response 4 26.67 

Total 15 100.00 

56b. Is your state/site examining ways to align functional eligibility determination for publicly funded 

LTSS with Medicaid financial eligibility determination carried out through the Exchange website? 

Frequency Percentage 

Yes 1 6.67 

No 0 0.00 

Not sure 1 6.67 

No Response 13 86.67 

Total 15 100 

57. Are any of your organization s functions reimbursed under Federal financial participation (FFP) 

or Federal medical assistance percentage (FMAP)? If so please specify the functions. 

Frequency Percentage 

No, none of our functions* are reimbursed under FFP or 

FMAP 10 66.67 

Yes, the following functions* are reimbursed under FFP. 0 0.00 

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57. Are any of your organization s functions reimbursed under Federal financial participation (FFP) 

or Federal medical assistance percentage (FMAP)? If so please specify the functions. 

Frequency Percentage 

Yes, the following functions* are reimbursed under 

FMAP. 0 0.00 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

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Section D. Organization Characteristics
 

58. For the current Fiscal Year, what is the approximate amount of funding from each of the following 

sources? 

Received Funding in Prior Fiscal 

Years 

Frequency Percentage* 

Administration on Aging Title IV ADRC Grant 2 13.33 

Administration of Aging Title II Grant 1 6.67 

CMS Real Choice Systems Change Grants 1 6.67 

CMS Person-Centered Hospital Discharge Planning Grant 0 0.00 

Patient protection and Affordable Care Act Grant 0 0.00 

Veteran’s Administration 0 0.00 

Money Follows the Person Demonstration 3 20.00 

State Transformation Grant 0 0.00 

Alzheimer’s Disease Demonstration Grant 0 0.00 

Evidence-Based Disease Prevention Grant 6 40.00 

Program of All-Inclusive Care for the Elderly (PACE) 0 0.00 

Medicare Improvements for Patients and Providers Act (MIPPA) 2 13.33 

Respite Care Act funds 2 13.33 

Rehabilitation Services Administration (RSA) 0 0.00 

Substance Abuse and Mental Health Services Administration 

(SAMHSA) – Mental Health Transformation Grant 0 0.00 

Agency for Health Care Research and Policy – Chronic Disease 

Self- Management Grant 1 6.67 

Administration for Children and Families, Office of Community 

Services – Low Income Home Energy Assistance Program 

(LIHEAP) 

0 0.00 

Health Resources and Services Administration on HIV/AIDS 

Bureau – Ryan White Fund 0 0.00 

State Unit on Aging 7 46.67 

State General Revenue 5 33.33 

County of local Government 3 20.00 

Private entities/grants – Hospitals or other businesses 2 13.33 

Medicaid for Direct Services (State and federal) 1 6.67 

Medicaid for Federal Financial Participation 0 0.00 

Care Transitions Income 1 6.67 

Consumer Fees or Cost Sharing 1 6.67 

Charitable Donations 1 6.67 

Other, please specify** 1 6.67 

*Percentages do not add up to 100% as respondents could select more than one option.
 

**Free text responses accompanying this question are available in the appendix with supplemental questions.
 

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58. For the current Fiscal Year, what is the approximate amount of funding from each of the following sources? 

Amount of Funding during the Current Fiscal Year 

$0 $>0-

10,000 

$10,001-

50,000 

$50,001-

100,000 

$100,001-

500,000 

>$500,00 

0 

No 

response/ 

Not 

applicable 

Range Mean Median Mode 

# % # % # % # % # % # % # % Min Max 

AoA Title IV ADRC 

Grant 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 1 6.67 14 93.33 N/A N/A N/A N/A N/A 

AoA Title II Grant 0 0.00 0 0.00 0 0.00 0 0.00 1 6.67 0 0.00 14 93.33 N/A N/A N/A N/A N/A 

CMS Real Choice 

Systems Change Grants 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 N/A N/A N/A N/A N/A 

CMS Person-Centered 

Hospital Discharge 

Planning Grant 

0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 N/A N/A N/A N/A N/A 

Patient protection and 

Affordable Care Act 

Grant 

0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 N/A N/A N/A N/A N/A 

Veteran’s Admin. 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 N/A N/A N/A N/A N/A 

Money Follows the 

Person Demon. 0 0.00 2 13.33 1 6.67 0 0.00 0 0.00 0 0.00 12 80.00 $2,605 $10,592 $7,710 $9,934 N/A 

State Transformation 

Grant 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 N/A N/A N/A N/A N/A 

Alzheimer’s Disease 

Demonstration Grant 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 N/A N/A N/A N/A N/A 

Evidence-Based Disease 

Prevention Grant 0 0.00 3 20.00 3 20.00 0 0.00 0 0.00 0 0.00 9 60.00 $2,200 $37,719 $19,179 $17,731 No mode 

Program of AllInclusive Care for the 

Elderly (PACE) 

0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 N/A N/A N/A N/A N/A 

Medicare Improve for 

Patients and Providers 

Act (MIPPA) 

0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 N/A N/A N/A N/A N/A 

Respite Care Act funds 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 N/A N/A N/A N/A N/A 

Rehab. Services Admin. 

(RSA) 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 N/A N/A N/A N/A N/A 

SAMHSA – Mental 

Health Transformation 

Grant 

0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 N/A N/A N/A N/A N/A 

Chronic Disease SelfMgmt Grant 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 N/A N/A N/A N/A N/A 

Low Income Home 

Energy Assistance 

Program (LIHEAP) 

0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 N/A N/A N/A N/A N/A 

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58. For the current Fiscal Year, what is the approximate amount of funding from each of the following sources? 

Amount of Funding during the Current Fiscal Year 

$0 $>0-

10,000 

$10,001-

50,000 

$50,001-

100,000 

$100,001-

500,000 

>$500,00 

0 

No 

response/ 

Not 

applicable 

Range Mean Median Mode 

# % # % # % # % # % # % # % Min Max 

Ryan White Fund 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 N/A N/A N/A N/A N/A 

State Unit on Aging 0 0.00 0 0.00 3 20.00 0 0.00 0 0.00 3 20.00 9 60.00 $21,993 $1,871,905 $828,994 $592,309 No mode 

State General Revenue 0 0.00 0 0.00 0 0.00 1 6.67 3 20.00 0 0.00 11 73.33 $87,304 $119,420 $112,126 $114,082 No mode 

County of local 

Government 0 0.00 0 0.00 0 0.00 1 6.67 1 6.67 0 0.00 13 86.67 $90,000 $345,000 $217,500 $217,500 No mode 

Private entities/ 

grants – Hospitals or 

other businesses 

0 0.00 0 0.00 0 0.00 0 0.00 1 6.67 0 0.00 14 93.33 N/A N/A N/A N/A N/A 

Medicaid for Direct 

Services (State and 

Federal) 

0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 N/A N/A N/A N/A N/A 

Medicaid for Federal 

Financial Participation 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 N/A N/A N/A N/A N/A 

Care Transitions 

Income 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 N/A N/A N/A N/A N/A 

Consumer Fees or Cost 

Sharing 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 N/A N/A N/A N/A N/A 

Charitable Donations 0 0.00 0 0.00 1 6.67 0 0.00 0 0.00 0 0.00 14 93.33 N/A N/A N/A N/A N/A 

Other, please specify* 0 0.00 0 0.00 0 0.00 0 0.00 2 13.33 2 13.33 11 73.33 $364,348 $1,519,706 $994,802 $1,047,577 No mode 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

Page 324 
 

 

 

 

 

 

58. For the current Fiscal Year, what is the approximate amount of 

funding from each of the following sources? 

Total Budget for FY 2013 

Frequency Percentage 

$0 0 0.00 

$>0-500,000 0 0.00 

$500,001-2,000,000 2 13.33 

$2,000,001-10,000,000 4 26.67 

$10,000,001-20,000,000 0 0.00 

>$20,000,000 0 0.00 

No response 9 60.00 

Total 15 100 

Min $1,048,951 

Max $6,179,099 

Mean $2,697,778 

Median $2,286,201 

Mode No mode 

59. What best characterizes the operation of your agency? 

Frequency Percentage 

Single point of entry: one agency maintains a knowledgebase on LTSS options 

and assists consumers in making decisions about the best and most feasible 

options for LTSS 

3 20.00 

No wrong door: multiple agencies are knowledgeable about LTSS options and 

cooperate to assist consumers regardless of which agency the consumer first 

contacts 

9 60.00 

No response 3 20.00 

Total 15 100 

60. Do you identify your structure as any of the following? 

Frequency Percentage 

Independent, non-profit 3 20.00 

Part of city government 0 0.00 

Part of county government 0 0.00 

Part of COG or RPDA 9 60.00 

Other, specify** 0 0.00 

No response 3 20.00 

Total 15 100 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

63. With which organizations do [LOCAL AAA] have a partnership? 

State Departments (with cabinet-level secretaries) Frequency Percentage* 

Health 8 53.33 

Human Services 9 60.00 

Other (specify)** 0 0.00 

State Agencies (located within state departments) Frequency Percentage* 

Aging 9 60.00 

Page 325 
 

 

 

 

 

 

 

63. With which organizations do [LOCAL AAA] have a partnership? 

Developmental Disabilities 6 40.00 

Acquired or Late-Onset Disabilities 5 66.67 

Mental Health 7 46.67 

Medicaid 8 53.33 

Housing 5 33.33 

Education 4 26.67 

Other (specify)** 0 0.00 

Local Government Agencies Frequency Percentage* 

Area Agency on Aging 6 40.00 

County Health Department 7 46.67 

County Medicaid Office 6 40.00 

County Department on Aging 5 33.33 

County Department on Disability 2 13.33 

County Housing Office 5 33.33 

Library 4 26.67 

Other (specify)** 0 0.00 

Federal Agencies Frequency Percentage* 

Local Veterans Administration 9 60.00 

Local Indian Health Service 3 20.00 

Other (specify)** 0 0.00 

Organizations providing Direct Services Frequency Percentage* 

211 or other call center 8 53.33 

Community Health Clinic 6 40.00 

Community Mental Health Clinic 4 26.67 

Deaf Service Center 4 26.67 

Hospital/Medical Center 7 46.67 

School for the Blind 0 0.00 

School for the Deaf 0 0.00 

The ARC 5 33.33 

United Way 6 40.00 

Vocational/Rehabilitation Services 7 46.67 

Other (specify)** 0 0.00 

Advocacy/Referral Organizations Frequency Percentage* 

AIDS Coalition 1 6.67 

Alzheimer’s Association 10 66.67 

American Council of the Blind 1 6.67 

Autism Society state/regional chapter 1 6.67 

Brain Injury Association state/regional chapter 4 26.67 

Centers for Independent Living 6 40.00 

Easter Seals 1 6.67 

Epilepsy Foundation state/regional chapter 0 0.00 

National Association of Mental Illness state/regional 

chapter 1 6.67 

National Autism Association state/regional chapter 0 0.00 

National Multiple Sclerosis Society state/regional 

chapter 0 0.00 

State Association for the Deaf 1 6.67 

United Cerebral Palsy 0 0.00 

Page 326 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

63. With which organizations do [LOCAL AAA] have a partnership? 

Other (specify)** 0 0.00 

*Percentages do not add up to 100% as respondents could select more than one option.
 

**Free text responses accompanying this question are available in the appendix with supplemental 

questions.
 

63. What is the strength of the relationship? 

Weak 

Functionality 

Moderate 

Functionality 

High 

Functionality 

No Response/ 

Not Applicable 

State Departments 

(with cabinet-level secretaries) Freq. % Freq. % Freq. % Freq. % 

Health 4 26.67 5 33.33 1 6.67 5 33.33 

Human Services 1 6.67 5 33.33 5 33.33 4 26.67 

Other (specify)* 0 0.00 0 0.00 0 0.00 15 100 

State Agencies 

(located within state departments) Freq. % Freq. % Freq. % Freq. % 

Aging 0 0.00 2 13.33 9 60.00 4 26.67 

Developmental Disabilities 3 20.00 3 20.00 2 13.33 7 46.67 

Acquired or Late-Onset 

Disabilities 2 13.33 4 26.67 1 6.67 8 53.33 

Mental Health 2 13.33 6 40.00 1 6.67 6 40.00 

Medicaid 2 13.33 5 33.33 3 20.00 5 33.33 

Housing 2 13.33 4 26.67 1 6.67 8 53.33 

Education 2 13.33 4 26.67 0 0.00 9 86.67 

Other (specify)* 0 0.00 0 0.00 0 0.00 15 100 

Local Government Agencies Freq. % Freq. % Freq. % Freq. % 

Area Agency on Aging 0 0.00 2 13.33 6 40.00 7 46.67 

County Health Department 1 6.67 7 46.67 2 13.33 5 33.33 

County Medicaid Office 1 6.67 4 26.67 3 20.00 7 46.67 

County Department on Aging 1 6.67 2 13.33 3 20.00 9 60.00 

County Department on Disability 0 0.00 3 20.00 1 6.67 11 73.33 

County Housing Office 0 0.00 5 33.33 1 6.67 9 60.00 

Library 3 20.00 2 13.33 0 0.00 10 66.67 

Other (specify)* 0 0.00 0 0.00 0 0.00 15 100 

Federal Agencies Freq. % Freq. % Freq. % Freq. % 

Local Veterans Administration 4 26.67 5 33.33 0 0.00 6 40.00 

Local Indian Health Service 1 6.67 1 6.67 2 13.33 11 73.33 

Other (specify)* 0 0.00 0 0.00 0 0.00 15 100 

Organizations providing Direct 

Services Freq. % Freq. % Freq. % Freq. % 

211 or other call center 1 6.67 3 20.00 5 33.33 6 40.00 

Community Health Clinic 4 26.67 2 13.33 1 6.67 8 53.33 

Community Mental Health Clinic 1 6.67 4 26.67 0 0.00 10 66.67 

Deaf Service Center 1 6.67 3 20.00 1 6.67 10 66.67 

Hospital/Medical Center 2 13.33 5 33.33 1 6.67 7 46.67 

School for the Blind 1 6.67 0 0.00 0 0.00 14 93.33 

School for the Deaf 1 6.67 0 0.00 0 0.00 14 93.33 

The ARC 2 13.33 4 26.67 0 0.00 9 60.00 

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63. What is the strength of the relationship? 

Weak 

Functionality 

Moderate 

Functionality 

High 

Functionality 

No Response/ 

Not Applicable 

United Way 2 13.33 3 20.00 2 13.33 8 53.33 

Vocational/Rehabilitation Services 2 13.33 5 33.33 0 0.00 8 53.33 

Other (specify)* 0 0.00 0 0.00 0 0.00 15 100 

Advocacy/Referral Organizations Freq. % Freq. % Freq. % Freq. % 

AIDS Coalition 1 6.67 1 6.67 0 0.00 13 86.67 

Alzheimer’s Association 2 13.33 5 33.33 4 26.67 4 26.67 

American Council of the Blind 1 6.67 1 6.67 0 0.00 13 86.67 

Autism Society state/regional 

chapter 1 6.67 1 6.67 0 0.00 13 86.67 

Brain Injury Association 

state/regional chapter 2 13.33 2 13.33 1 6.67 10 66.67 

Centers for Independent Living 1 6.67 5 33.33 2 13.33 7 46.67 

Easter Seals 1 6.67 1 6.67 0 0.00 13 86.67 

Epilepsy Foundation state/regional 

chapter 1 6.67 0 0.00 0 0.00 14 93.33 

National Association of Mental 

Illness state/regional chapter 1 6.67 0 0.00 1 6.67 13 86.67 

National Autism Association 

state/regional chapter 1 6.67 0 0.00 0 0.00 14 93.33 

National Multiple Sclerosis Society 

state/regional chapter 1 6.67 0 0.00 0 0.00 14 93.33 

State Association for the Deaf 2 13.33 0 0.00 0 0.00 13 86.67 

United Cerebral Palsy 1 6.67 0 0.00 0 0.00 14 93.33 

Other (specify)* 0 0.00 0 0.00 0 0.00 15 100 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

Page 328 
 

 

 

 

 

 

 

 

 

 

 

 

63. What is the type of partnership agreement? 

Funding 

Relationship Formal MOU Contract Cooperative 

Informal 

Working 

Relationship 

Other No Response/ 

Not Applicable 

State Departments (with 

cabinet-level secretaries) Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

Health 0 0.00 0 0.00 0 0.00 4 26.67 7 46.67 0 0.00 7 46.67 

Human Services 4 26.67 1 6.67 4 26.67 5 33.33 4 26.67 0 0.00 6 40.00 

Other (specify)* 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 

State Agencies (located 

within state departments) Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

Aging 7 46.67 1 6.67 8 53.33 6 40.00 2 13.33 0 0.00 5 33.33 

Developmental Disabilities 0 0.00 0 0.00 0 0.00 4 26.67 5 33.33 0 0.00 8 53.33 

Acquired or Late-Onset 

Disabilities 0 0.00 0 0.00 1 6.67 3 20.00 4 26.67 0 0.00 10 66.67 

Mental Health 0 0.00 1 6.67 0 0.00 4 26.67 6 40.00 0 0.00 8 53.33 

Medicaid 3 20.00 0 0.00 3 20.00 5 33.33 5 33.33 0 0.00 7 46.67 

Housing 0 0.00 0 0.00 0 0.00 3 20.00 5 33.33 0 0.00 10 66.67 

Education 1 6.67 1 6.67 0 0.00 4 26.67 2 13.33 0 0.00 11 73.33 

Other (specify)* 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 

Local Government Agencies Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

Area Agency on Aging 1 6.67 1 6.67 1 6.67 3 20.00 3 20.00 2 13.33 8 53.33 

County Health Department 0 0.00 0 0.00 0 0.00 8 53.33 7 46.67 0 0.00 6 40.00 

County Medicaid Office 0 0.00 0 0.00 0 0.00 6 40.00 4 26.67 0 0.00 9 60.00 

County Department on Aging 3 20.00 1 6.67 3 20.00 4 26.67 4 26.67 0 0.00 10 66.67 

County Department on 

Disability 0 0.00 0 0.00 1 6.67 2 13.33 2 13.33 0 0.00 12 80.00 

County Housing Office 0 0.00 0 0.00 0 0.00 4 26.67 2 13.33 1 6.67 10 66.67 

Library 0 0.00 0 0.00 0 0.00 3 20.00 3 20.00 0 0.00 11 73.33 

Other (specify)* 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 

Federal Agencies Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

Local Veterans 

Administration 0 0.00 0 0.00 0 0.00 6 40.00 6 40.00 0 0.00 9 40.00 

Local Indian Health Service 1 6.67 0 0.00 1 6.67 1 6.67 3 20.00 0 0.00 12 80.00 

Other (specify)* 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 

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63. What is the type of partnership agreement? 

Funding 

Relationship Formal MOU Contract Cooperative 

Informal 

Working 

Relationship 

Other No Response/ 

Not Applicable 

Organizations providing 

Direct Services Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

211 or other call center 1 6.67 2 13.33 1 6.67 5 33.33 4 26.67 1 6.67 7 46.67 

Community Health Clinic 0 0.00 0 0.00 0 0.00 5 33.33 4 26.67 1 6.67 9 60.00 

Community Mental Health 

Clinic 0 0.00 0 0.00 0 0.00 3 20.00 2 13.33 0 0.00 11 73.33 

Deaf Service Center 0 0.00 0 0.00 0 0.00 4 26.67 2 13.33 0 0.00 11 73.33 

Hospital/Medical Center 0 0.00 0 0.00 0 0.00 7 46.67 6 40.00 0 0.00 8 53.33 

School for the Blind 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 

School for the Deaf 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 

The ARC 0 0.00 0 0.00 0 0.00 5 33.33 3 20.00 0 0.00 10 66.67 

United Way 1 6.67 0 0.00 0 0.00 4 26.67 3 20.00 1 6.67 9 60.00 

Vocational/Rehabilitation 

Services 0 0.00 0 0.00 0 0.00 7 46.67 4 26.67 0 0.00 8 53.33 

Other (specify)* 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 

Advocacy/Referral 

Organizations Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

AIDS Coalition 0 0.00 0 0.00 0 0.00 0 0.00 1 6.67 0 0.00 14 93.33 

Alzheimer’s Association 1 6.67 3 20.00 0 0.00 6 40.00 3 20.00 0 0.00 5 33.33 

American Council of the 

Blind 0 0.00 0 0.00 0 0.00 1 6.67 1 6.67 0 0.00 14 93.33 

Autism Society state/regional 

chapter 0 0.00 0 0.00 0 0.00 1 6.67 1 6.67 0 0.00 14 93.33 

Brain Injury Association 

state/regional chapter 0 0.00 0 0.00 1 6.67 1 6.67 3 20.00 0 0.00 11 73.33 

Centers for Independent 

Living 0 0.00 0 0.00 0 0.00 5 33.33 5 33.33 0 0.00 8 53.33 

Easter Seals 0 0.00 0 0.00 0 0.00 1 6.67 0 0.00 0 0.00 14 93.33 

Epilepsy Foundation 

state/regional chapter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 

National Association of 

Mental Illness state/regional 0 0.00 0 0.00 0 0.00 1 6.67 1 6.67 0 0.00 14 93.33 

Page 330 
 

 

 

 

 

 

 

63. What is the type of partnership agreement? 

Funding 

Relationship Formal MOU Contract Cooperative 

Informal 

Working 

Relationship 

Other No Response/ 

Not Applicable 

chapter 

National Autism Association 

state/regional chapter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 

National Multiple Sclerosis 

Society state/regional chapter 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 

State Association for the Deaf 0 0.00 0 0.00 0 0.00 1 6.67 1 6.67 0 0.00 14 93.33 

United Cerebral Palsy 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 

Other (specify)* 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

Page 331 
 

 

 

 

 

 

 

 

 

 

 

 

 

63. What types of resources are shared? 

Co-located 

staff 

Shared 

monetary 

resources 

Shared 

information Joint training 

Joint 

program 

sponsorship 

Shared nonmonetary 

resources 

Shared data No shared 

resources 

No response/ 

Not 

applicable 

State Departments (with cabinetlevel secretaries) Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

Health 0 0.00 0 0.00 6 40.00 3 20.00 2 13.33 0 0.00 1 6.67 1 6.67 8 53.33 

Human Services 0 0.00 2 13.33 9 60.00 6 40.00 4 26.67 0 0.00 3 20.00 0 0.00 6 40.00 

Other (specify)* 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 

State Agencies (located within state 

departments) Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

Aging 0 0.00 5 33.33 10 66.67 8 53.33 6 40.00 0 0.00 7 46.67 0 0.00 5 33.33 

Developmental Disabilities 0 0.00 0 0.00 5 33.33 3 20.00 0 0.00 0 0.00 1 6.67 0 0.00 9 60.00 

Acquired or Late-Onset Disabilities 0 0.00 0 0.00 3 20.00 2 13.33 1 6.67 0 0.00 1 6.67 0 0.00 11 73.33 

Mental Health 0 0.00 1 6.67 5 33.33 2 13.33 0 0.00 0 0.00 1 6.67 0 0.00 10 66.67 

Medicaid 0 0.00 1 6.67 5 33.33 4 26.67 2 13.33 0 0.00 1 6.67 0 0.00 9 60.00 

Housing 0 0.00 0 0.00 5 33.33 2 13.33 0 0.00 0 0.00 1 6.67 0 0.00 10 66.67 

Education 0 0.00 0 0.00 4 26.67 2 13.33 1 6.67 0 0.00 2 13.33 0 0.00 11 73.33 

Other (specify)* 0 0.00 0 0.0 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 

Local Government Agencies Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

Area Agency on Aging 0 0.00 3 20.00 4 26.67 3 20.00 1 6.67 1 6.67 3 20.00 0 0.00 11 73.33 

County Health Department 0 0.00 0 0.00 9 60.00 5 33.33 1 6.67 0 0.00 3 20.00 0 0.00 6 40.00 

County Medicaid Office 0 0.00 0 0.00 8 53.33 3 20.00 0 0.00 0 0.00 2 13.33 0 0.00 7 46.67 

County Department on Aging 0 0.00 2 13.33 5 33.33 5 33.33 3 20.00 1 6.67 4 26.67 0 0.00 10 66.67 

County Department on Disability 0 0.00 0 0.00 3 20.00 2 13.33 0 0.00 0 0.00 2 13.33 0 0.00 12 80.00 

County Housing Office 0 0.00 0 0.00 3 20.00 1 6.67 0 0.00 0 0.00 1 6.67 0 0.00 12 80.00 

Library 0 0.00 0 0.00 4 26.67 1 6.67 0 0.00 0 0.00 1 6.67 0 0.00 11 73.33 

Other (specify)* 0 0.00 0 0.0 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 

Federal Agencies Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

Local Veterans Administration 0 0.00 0 0.00 8 53.33 2 13.33 0 0.00 0 0.00 2 13.33 0 0.00 7 46.67 

Local Indian Health Service 0 0.00 0 0.00 2 13.33 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 13 86.67 

Other (specify)* 0 0.00 0 0.0 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 

Organizations providing Direct Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

Page 332 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

63. What types of resources are shared? 

Co-located 

staff 

Shared 

monetary 

resources 

Shared 

information Joint training 

Joint 

program 

sponsorship 

Shared nonmonetary 

resources 

Shared data No shared 

resources 

No response/ 

Not 

applicable 

Services 

211 or other call center 1 6.67 3 20.00 8 53.33 4 26.67 2 13.33 1 6.67 5 33.33 0 0.00 7 46.67 

Community Health Clinic 0 0.00 0 0.00 6 40.00 1 6.67 0 0.00 0 0.00 1 6.67 0 0.00 9 60.00 

Community Mental Health Clinic 1 6.67 0 0.00 4 26.67 1 6.67 0 0.00 0 0.00 1 6.67 0 0.00 11 73.33 

Deaf Service Center 0 0.00 0 0.00 4 26.67 1 6.67 0 0.00 1 6.67 2 13.33 0 0.00 11 73.33 

Hospital/Medical Center 0 0.00 0 0.00 7 46.67 2 13.33 1 6.67 0 0.00 2 13.33 0 0.00 8 53.33 

School for the Blind 0 0.00 0 0.0 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 

School for the Deaf 0 0.00 0 0.0 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 

The ARC 0 0.00 0 0.00 5 33.33 2 13.33 0 0.00 0 0.00 1 6.67 0 0.00 10 66.67 

United Way 0 0.00 0 0.00 5 33.33 2 13.33 1 6.67 0 0.00 2 13.33 0 0.00 10 66.67 

Vocational/Rehabilitation Services 0 0.00 0 0.00 7 46.67 1 6.67 0 0.00 0 0.00 2 13.33 0 0.00 8 53.33 

Other (specify)* 0 0.00 0 0.0 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 

Advocacy/Referral Organizations Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

AIDS Coalition 0 0.00 0 0.00 1 6.67 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 14 93.33 

Alzheimer’s Association 0 0.00 2 13.33 9 60.00 7 46.67 3 20.00 0 0.00 3 20.00 0 0.00 5 33.33 

American Council of the Blind 0 0.00 0 0.00 1 6.67 1 6.67 0 0.00 0 0.00 1 6.67 0 0.00 14 93.33 

Autism Society state/regional 

chapter 0 0.00 0 0.00 1 6.67 1 6.67 0 0.00 0 0.00 1 6.67 0 0.00 14 93.33 

Brain Injury Association 

state/regional chapter 0 0.00 1 6.67 3 20.00 2 13.33 0 0.00 0 0.00 2 13.33 1 6.67 11 73.33 

Centers for Independent Living 0 0.00 0 0.00 7 46.67 3 20.00 0 0.00 0 0.00 2 13.33 0 0.00 8 53.33 

Easter Seals 0 0.00 0 0.00 1 6.67 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 14 93.33 

Epilepsy Foundation state/regional 

chapter 0 0.00 0 0.0 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 

National Association of Mental 

Illness state/regional chapter 0 0.00 0 0.00 1 6.67 1 6.67 0 0.00 0 0.00 1 6.67 0 0.00 14 93.33 

National Autism Association 

state/regional chapter 0 0.00 0 0.0 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 

National Multiple Sclerosis Society 

state/regional chapter 0 0.00 0 0.0 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 

State Association for the Deaf 0 0.00 0 0.00 1 6.67 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 14 93.33 

Page 333 
 

 

 

63. What types of resources are shared? 

Co-located 

staff 

Shared 

monetary 

resources 

Shared 

information Joint training 

Joint 

program 

sponsorship 

Shared nonmonetary 

resources 

Shared data No shared 

resources 

No response/ 

Not 

applicable 

United Cerebral Palsy 0 0.00 0 0.0 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 

Other (specify)* 0 0.00 0 0.0 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 100 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

Page 334 
 

-

 

 

 

 

 

64. Approximately, how many FTEs (Full time equivalents) perform each of the following functions? 

0 1 2-4 5-7 8-10 >10 No response Range Mean Median Mode # % # % # % # % # # % # % Min Max 

Information & Referral/ 

Information & Assistance 

(I&R/I&A) 

0 0.00 5 33.33 2 13.33 1 6.67 1 2.83 0 0.00 6 40.00 1 9 3 1 1 

Options counseling/ 

counseling to provide indepth person centered 

decision support 

0 0.00 5 33.33 1 6.67 2 13.33 0 2.06 0 0.00 7 46.67 1 6 2 1 1 

Benefits counseling/ 

eligibility determination 0 0.00 2 13.33 4 26.67 1 6.67 1 3.13 0 0.00 7 46.67 1 9 3 2 1 

Care transition services 1 6.67 4 26.67 1 6.67 0 0.00 0 1.20 0 0.00 9 60.00 0 2 1 1 1 

Crisis Intervention 

services 1 6.67 4 26.67 0 0.00 0 0.00 0 1.00 0 0.00 10 66.67 0 1 1 1 1 

Independent Living 

services 1 6.67 2 13.33 1 6.67 0 0.00 0 2.17 0 0.00 11 73.33 0 5 2 1 

Advocacy services 0 0.00 2 13.33 3 20.00 3 20.00 1 3.50 0 0.00 5 33.33 1 9 4 4 No mode 

Providing administrative 

or other support for the 

above functions 

0 0.00 2 13.33 7 46.67 1 6.67 1 3.32 0 0.00 4 26.67 1 9 3 2 2 

Note: Responses have been rounded to the nearest whole number. 

Page 335 
 

 

 

65. How many front line staff are Alliance of Information and Referral Systems 

(AIRS) certified? 

Number of AIRS certified 

Frequency Percentage 

0 2 13.33 

1 1 6.67 

2-4 3 20.00 

5-7 0 0.00 

8-10 0 0.00 

>10 0 0.00 

No response 9 60.00 

Total 15 100 

Min 0 

Max 4 

Mean 2.50 

Median 2.50 

Mode No mode 

Note: Responses have been rounded to the nearest whole number. 

65. How many front line staff are Alliance of Information and Referral Systems 

(AIRS) certified? 

Total Number of Frontline Staff 

Frequency Percentage 

0 1 6.67 

1 1 6.67 

2-4 1 6.67 

5-7 2 13.33 

8-10 1 6.67 

>10 0 0.00 

No response 9 60.00 

Total 15 100 

Min 0 

Max 8 

Mean 4.40 

Median 4 

Mode 5 

Note: Responses have been rounded to the nearest whole number. 

Page 336 
 

- - -

 

 

- - -

 

 

 

66. Is your organization paid on a fee for service or per unit basis for performing any of the following 

services for a client? 

Frequency Percentage* 

Information/referral 1 6.67 

Options counseling 1 6.67 

Screening 1 6.67 

Assessment 0 0.00 

Application assistance 1 6.67 

Transition support 2 13.33 

Other, please specify** 0 0.00 

No response 13 86.67 

*Percentages do not add up to 100% as respondents could select more than one option.
 

**Free text responses accompanying this question are available in the appendix with supplemental questions.
 

67. [If any of the boxes are checked in previous question] What is the source of the fee for service or per 

unit payments? 

Frequency Percentage* 

Medicare 2 13.33 

Medicaid waiver 1 6.67 

Medicaid state plan 1 6.67 

Medicaid managed care organization 1 6.67 

State-funded program other than Medicaid 1 6.67 

Private health plan 0 0.00 

Provider 0 0.00 

Other, please specify** 0 0.00 

No response 13 86.67 

*Percentages do not add up to 100% as respondents could select more than one option.
 

**Free text responses accompanying this question are available in the appendix with supplemental questions.
 

Page 337 
 

 

 

 

Section E: LTSS Environment
 

68. Since this [LOCAL AAA] started serving consumers, has there been an impact on the LTSS or Home and 

Community Based (HCBS) system in your community? 

Frequency Percentage 

There has been an increase in the number of LTSS 

providers 10 66.67 

There has been an decrease in the number of LTSS 

providers 0 0.00 

No Response 5 33.33 

Total 15 100 

68. Since this [Local AAA] started serving consumers, has there been an impact on the LTSS or Home and 

Community Based (HCBS) system in your community? 

Frequency Percentage 

There has been an increase in the quality of LTSS services 10 66.67 

There has been an decrease in the quality of LTSS services 0 0.00 

No Response 5 33.33 

Total 15 100 

Page 338 
 

 

 

 

 

 

APPENDIX K. PROCESS EVALUATION AAA SURVEY FREE TEXT RESPONSES 

Section B. Populations Served
 

13 (c) Is the LOCAL AAA making any special efforts to target a particular population not listed above? If 

yes, Specify others: Consumers 60 and over (Currently) 

CCTP- Medicare eligible patients at risk of re-admission in 30 days of hospital discharge. 

Section C. Service Provision
 

40. Please list LTSS Programs and HCBS waivers (e.g., aged and disabled, MR/DD) that individuals are 

enrolled in. 

Congregate Nutrition HD Min-Home-Level I-II-III Transportation Home Health Mental Services for Blind and 

Visually Impaired Independent Living Rehab Living Services for Blind: In Home Services Adult Day Care/Health 

Food and Nutrition Independent Living. 

Elderly, Disabled, 1-125 

Long-term Medicaid BA Waiver Program CASS 

Medicare Savings Programs, Care Attendant Services, Primary Home Care, In-Home and Family Support, and 

Family Services. Medicaid Nursing Home Applications. 

Please contact IOWA DHS for this information 1-866-788-1805 

This is not what we do- I have no idea 

42. Please list LTSS Programs and HCBS waivers (e.g., aged and disabled, MR/DD) that individuals are enrolled 

in. 

Elderly, Disabled, 1-125 

Long term Medicaid CBA Waiver Program CASS 

Medicare Savings Program, Care Attendant Services, Primary Home care, In Home and Family Support, Family Services, 

Medicaid Nursing Home Applications. 

Please contact Iowa DHS for this information. I-866-788-1805 

This is not what we do. I have no idea. 

Unsure at this time. 

45 (a). Specify the purpose 

Iowa DHS and our agency share information on case management clients 

OFA –CCU-Medicaid 

State Unit on Aging only 

Page 339 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

46 (a). Specify the purpose 

All Block Grant provider do the same intake and have access to that information 

Input, review client data, review service utilization, obtain summary reports 

Referrals 

58 (a). Specify others 

What information we collect depends upon the program that will serve them best 

59 (a). Specify locations if paper copy applications are obtained at various locations, completed by hand, and 

returned either in person or by mail to a state or county office. 

DADS Regional offices 

DSS, Health Depts., Senior Centers, LTC facilities 

Departments of Social Services 

HHSC –AAA-Skilled Nursing Facilities 

Both 

Most Human Service Agencies 

Provider Level 

62. Please describe the publicly funded LTSS services in your state. This includes LTSS programs funded solely by 

state or county. 

Long-term Medicaid CBA Waiver Program CASS 

Medicaid, TANF, Food stamps, Emergency Assistance 

Medicaid, Medicaid Savings Program Low Income Subsidy ,Food Stamps, Low income, HousingIn, Home Family 

Support Community Attendants and Services, Primary Home care Aid and attendance. 

Pace- Legal Aid- Health Department- Voc Rehab- Independent Living Services- Are You Okay- Project LifesaverHospice- Senior Centers- Social Security- Senior Health Insurance Information Program- Veterans Services- Adult 

Daycare- Adult Day Health- City/County Recreation Programs For Older Adults- Senior Employment Programs (Urban 

League- Older Workers Programs Through Esc)- Alzheimer's Support Programs- Family Caregiver Program- Home 

Modification/Housing Home Improvement- Services For The Blind- Services For Deaf &Amp; Hard Of Hearing- Chronic 

Disease Self-Management Programs- Senior Centers- Care Transitions Program Through Catawba Regional Hospice-

&Amp; Palliative Care- Nutrition Programs(Home Delivered Meals- Congregate Meals)- Salvation Army- Veterans 

Services-Cooperative Extension Programs- Evidence Based Health Programs For Older Adults- Unifour Senior GamesSenior Games- Unifour Silver Arts Programs- Reverse Mortgage Counseling- Adult Protective Services-Subsidized 

Housing- Medication Assistance Programs- Low Cost Health And Dental Clinics- Food Banks/Pantries- Alzheimer's 

Care/Support-Joblink- Volunteer Income Tax Assistance Programs- Transportation- Mental Health Programs - Geriatric 

Specialty Team- Ombudsman- Area Agency On Aging- Nc Disability Rights- Medicare- Medicaid- Nursing Home Abuse 

Center- Scam Jam- Consumer Credit Counseling Services- Home Foreclousure Program- Insurance Counseling- Energy 

Assistance Programs(Lieap- Crisis)- Homestead Exemption- Circuit Breaker Tax Program- Older Worker's ProgramDial-A-Ride- Nc Assistive Technology Program- Senior Companion- NC 211-Senior Legal Helpline- Habitat For 

Humanity- Women's Resource Center- Women's Shelter Home- Christian Ministries Programs For Food- ClothingUtilities AssistanceThe Medicaid Home and Community Based Services, Elderly Waiver (HCBS Elderly) provides service funding and 

individualized supports to maintain eligible members in their own homes or communities who would otherwise require 

care in a medical. 

Page 340 
 

 

60+ 

Age 60 and older 

Anyone age 60 and older requesting traditional in-home and respite care services 

Caregiver programs 

Age 60 and older 

Age 60+ 

69 (b). If yes, please describe your organization’s role: 

Partner with consumer Health Insurance Marketplace Enrollment Service Proposal to CMS Navigator Grant 

70 (b) If yes, please describe. 

Partner with consumer Health Insurance Marketplace Enrollment Service Proposal to CMS Navigator Grant 

Page 341 
 

 

 

 

Section D. Organization Characteristics
 

79b. What is the type of partnership agreement? 

a. Specify Other 

Local Government Agencies 

Area Agency on Aging 

We are the AAA 

We are the AAA 

County Housing Office 

The Section 8 office is located within our COG 

Organizations Providing Direct Services 

211 or Other Call Center 

We provide a small amount of funding to our local 211 

Community Health Center 

Long history here – we were primary partner in starting the Health Clinic in one of our four counties 

Page 342 
 

 

 

 

 

 

 

 

APPENDIX L. PROCESS EVALUATION SUBGROUP ANALYSIS BY AGENCY
 

LOCATION
 

Exhibit 1: Impact of ADRC Grants on Contributing to the Development of Statewide Database of LTSS
 

Services or Consumers
 

Impact on LTSS Database Rural Urban Total 

No 56.59 67.17 64.21 

Yes 43.41 32.83 35.79 

Total 100 100 100 

p < .05 

Exhibit 2: Impact of Partnerships on Ability to Provide LTSS 

Impact of Partnerships Rural Urban Total 

No 28.68 18.67 21.48 

Yes 71.32 81.33 78.52 

Total 100 100 100 

p < .05 

Exhibit 3: Impact of Shared Data on Ability to Provide LTSS 

Impact of Shared Data Rural Urban Total 

No 74.42 84.94 82.00 

Yes 25.58 15.06 18.00 

Total 100 100 100 

p < .01 

Exhibit 4: Conducted Community LTSS Needs Assessment within the Last 12 Months 

Conducted Community LTSS Needs Assessment Rural Urban Total 

No, a community needs assessment was not 

completed within the past three years 26.45 34.71 32.41 

No, but we did complete a community needs 

assessment within the past three years 40.50 28.66 31.95 

Yes 33.06 36.62 35.63 

Total 100 100 100 

p < .05 

Page 343 
 

 

 

 

 

Exhibit 5: Current Availability of Transportation Services 

Transportation Services Rural Urban Total 

Adequate availability 8.13 8.46 8.37 

Available but inadequate 86.99 91.22 90.05 

Not available 4.88 0.31 1.58 

Total 100 100 100 

p < .01 

Exhibit 6: Current Availability of Mental Health Services 

Mental Health Services Rural Urban Total 

Adequate availability 23.39 14.47 16.97 

Available but inadequate 74.19 84.28 81.45 

Not available 2.42 1.26 1.58 

Total 100 100 100 

p < .05 

Exhibit 7: Lack of Health Insurance as a Barrier to LTSS 

Lack of Health Insurance Rural Urban Total 

Not a barrier 5.83 13.14 11.11 

Sometimes a barrier 69.17 65.06 66.20 

Often a barrier 25.00 21.79 22.69 

Total 100 100 100 

p < .10 

Exhibit 8: Frequency of Consumer Requests about Medicare Eligibility 

Medicare Eligibility and 

Services Rural Urban Total 

Frequently 89.19 81.46 83.54 

Sometimes 10.81 14.90 13.80 

Infrequently 0.00 3.64 2.66 

Never 0.00 0.00 0.00 

Total 100 100 100 

p < .10 

Page 344 
 

 

 

 

 

 

 

Exhibit 9: Frequency of Consumer Requests about Personal Care/Attendant Services 

Personal Care/Attendant 

Services Rural Urban Total 

Frequently 72.07 82.78 79.90 

Sometimes 24.32 14.90 17.43 

Infrequently 3.60 2.32 2.66 

Never 0.00 0.00 0.00 

Total 100 100 100 

p < .10 

Exhibit 10: Frequency of Consumer Requests about Affordable Housing Services 

Affordable Housing Services Rural Urban Total 

Frequently 56.76 85.48 77.78 

Sometimes 32.43 13.86 18.84 

Infrequently 9.01 0.66 2.90 

Never 1.80 0.00 0.48 

Total 100 100 100 

p < .001 

Exhibit 11: Provision of Transition Services to Consumers Discharged from an Acute Care Setting 

Transition Services Rural Urban Total 

No 71.43 56.01 60.23 

Yes 28.57 43.99 39.77 

Total 100 100 100 

p < .01 

Exhibit 12: Use of Common Consumer Assessment Tool and/or Basic Consumer Needs Assessment 

across Partner Organizations 

Consumer Assessment Tool Rural Urban Total 

No, each partner organization uses 

their own assessment tool/process 46.96 47.10 47.06 

Yes, common across some partners 33.91 24.84 27.29 

Yes, common across all partners 19.13 28.06 25.65 

Total 100 100 100 

p < .10 

Page 345 
 

 

 

 

 

 

APPENDIX M. PROCESS EVALUATION SUBGROUP ANALYSIS BY
 

ORGANIZATIONAL STRUCTURE
 

Exhibit 1: Reasons to Become an ADRC 

Reasons to Become ADRC Government Independent Total 

To better integrate service provision 

systems 44.08 27.32 36.67 

To develop or strengthen 

agency/organizational partnerships 24.49 42.27 32.35 

To expand services to additional 

geographic locations 0.82 1.03 0.91 

To expand services to additional 

populations 20.82 17.01 19.13 

To improve data or IT infrastructure 0.82 2.58 1.59 

To improve marketing or awareness efforts 

related to LTSS 8.98 9.79 9.34 

Total 100 100 100 

p < .001 

Exhibit 2: Impact of ADRC Grants on Contributing to the Development of Statewide Database of LTSS 

Services or Consumers 

Impact on LTSS Database Government Independent Total 

No 60.75 68.12 63.98 

Yes 39.25 31.88 36.02 

Total 100 100 100 

p < .10 

Exhibit 3: Impact of Partnerships on Ability to Provide LTSS 

Impact of Partnerships Government Independent Total 

No 24.53 17.87 21.61 

Yes 75.47 82.13 78.39 

Total 100 100 100 

p < .10 

Exhibit 4: Impact of Staffing Changes on Ability to Provide LTSS 

Impact of Staffing Changes Government Independent Total 

No 72.08 81.64 76.27 

Yes 27.92 18.36 23.73 

Total 100 100 100 

p < .05 

Exhibit 5: Lack of Health Insurance as a Barrier to LTSS 

Lack of Health Insurance Government Independent Total 

Not a barrier 7.35 16.33 11.34 

Sometimes a barrier 65.31 66.33 65.76 

Often a barrier 27.35 17.35 22.90 

Total 100 100 100 

p < .01 

Page 346 
 

 

 

 

 

Exhibit 6: Frequency of Consumer Requests about Medicare Eligibility 

Medicare Eligibility and 

Services Government Independent Total 

Frequently 86.81 78.07 82.94 

Sometimes 11.49 17.65 14.22 

Infrequently 1.70 4.28 2.84 

Never 0.00 0.00 0.00 

Total 100 100 100 

p < .005 

Exhibit 7: Provision of Transition Services to Consumers Discharged from an Acute Care Setting 

Transition Services Government Independent Total 

No 67.22 52.68 60.54 

Yes 32.78 47.32 39.46 

Total 100 100 100 

p < .01 

Exhibit 8: Use of Common Consumer Assessment Tool and/or Basic Consumer Needs Assessment across 

Partner Organizations 

Consumer Assessment Tool Government Independent Total 

No, each partner organization uses their 

own assessment tool/process 56.67 36.60 47.70 

Yes, common across some partners 19.58 31.96 25.12 

Yes, common across all partners 23.75 31.44 27.19 

Total 100 100 100 

p < .001 

Page 347 
 

 

 

 

APPENDIX N. PROCESS EVALUATION SUBGROUP ANALYSIS BY
 

OPERATIONAL STRUCTURE
 

Exhibit 1: Reasons to Become an ADRC 

Reasons to Become ADRC Centralized Decentralized Mixed Total 

To better integrate service provision 

systems 26.56 17.07 44.37 36.67 

To develop or strengthen 

agency/organizational partnerships 15.63 60.98 27.99 32.35 

To expand services to additional 

geographic locations 3.13 2.44 0.00 0.91 

To expand services to additional 

populations 31.25 10.98 18.77 19.13 

To improve data or IT infrastructure 1.56 1.22 1.71 1.59 

To improve marketing or awareness 

efforts related to LTSS 21.88 7.32 7.17 9.34 

Total 100 100 100 100 

p < .001 

Exhibit 2: Seeks Outcome of Diversion from Nursing Home or Other Institutional Residential Facilities 

Diversion from Nursing 

Home Centralized Decentralized Mixed Total 

No 17.65 3.57 3.97 5.95 

Yes 82.35 96.43 96.03 94.05 

Total 100 100 100 100 

p < .001 

Exhibit 3: Extent to which Federal Grants Increased the Number of Consumers 

Impact on Number of 

Consumers Centralized Decentralized Mixed Total 

Very much 40.00 33.73 48.65 44.54 

Somewhat 34.29 54.22 41.22 42.54 

Very little 25.71 12.05 10.14 12.92 

Total 100 100 100 100 

p < .001 

Page 348 
 

 

 

 

 

 

 

Exhibit 4: Impact of ADRC Grants on Improving Staff Training Opportunities 

Impact on Staff Training Centralized Decentralized Mixed Total 

No 26.39 15.29 29.84 26.69 

Yes 73.61 84.71 70.16 73.31 

Total 100 100 100 100 

p < .05 

Exhibit 5: Impact of Partnerships on Ability to Provide LTSS 

Impact of Partnerships Centralized Decentralized Mixed Total 

No 27.78 10.59 23.17 21.61 

Yes 72.22 89.41 76.83 78.39 

Total 100 100 100 100 

p < .05 

Exhibit 6: Impact of Person Centered Services on Ability to provide LTSS 

Impact of Person Centered 

Services Centralized Decentralized Mixed Total 

No 55.56 36.47 59.68 54.87 

Yes 44.44 63.53 40.32 45.13 

Total 100 100 100 100 

p < .001 

Exhibit 7: Lack of Health Insurance as a Barrier to LTSS 

Lack of Health Insurance Centralized Decentralized Mixed Total 

Not a barrier 5.97 28.40 7.85 11.34 

Sometimes a barrier 58.21 59.26 69.28 65.76 

Often a barrier 35.82 12.35 22.87 22.90 

Total 100 100 100 100 

p < .001 

Exhibit 8: Frequency of Consumer Requests about Medicare Eligibility 

Medicare Eligibility and 

Services Centralized Decentralized Mixed Total 

Frequently 90.00 70.73 84.81 82.94 

Sometimes 10.00 19.51 13.70 14.22 

Infrequently 0.00 9.76 1.48 2.84 

Never 0.00 0.00 0.00 0.00 

Total 100 100 100 100 

p < .001 

Exhibit 9: Frequency of Consumer Requests about Affordable Housing Services 

Page 349 

Affordable Housing 

Services Centralized Decentralized Mixed Total 

Frequently 64.29 86.59 78.60 77.78 

Sometimes 28.57 13.41 18.08 18.91 

Infrequently 5.71 0.00 2.95 2.84 
 

 

 

 

 

 

 

 

Never 1.43 0.00 0.37 0.47 

Total 100 100 100 100 

p < .05 

Exhibit 10: Provision of “Options Counseling” or One-on-One Counseling Designed to Support 

Consumers 

Options Counseling Centralized Decentralized Mixed Total 

No 21.74 7.23 23.13 19.96 

Yes 78.26 92.77 76.87 80.04 

Total 100 100 100 100 

p < .01 

Exhibit 11: Provision of Transition Services to Consumers Discharged from an Acute Care Setting 

Transition Services Centralized Decentralized Mixed Total 

No 73.24 41.67 62.89 60.54 

Yes 26.76 58.33 37.11 39.46 

Total 100 100 100 100 

p < .001 

Exhibit 12: Use of Common Consumer Assessment Tool and/or Basic Consumer Needs Assessment 

across Partner Organizations 

Consumer Assessment Tool Centralized Decentralized Mixed Total 

No, each partner organization uses 

their own assessment tool/process 64.06 32.10 48.44 47.70 

Yes, common across some partners 15.63 27.16 29.76 27.19 

Yes, common across all partners 20.31 40.74 21.80 25.12 

Total 100 100 100 100 

p < .001 

Exhibit 13: Use of Alliance of Information and Referral Systems (AIRS) Standards 

Use of AIRS Standards Centralized Decentralized Mixed Total 

Never 43.40 24.66 41.71 38.28 

Yes, with all consumers 56.60 75.34 58.29 61.72 

Total 100 100 100 100 

p < .05 

Page 350 
 

 

 

 

 

 

APPENDIX O. PROCESS EVALUATION SUBGROUP ANALYSIS BY NUMBER OF
 

CONSUMERS SERVED
 

Exhibit 1: Seeks Outcome of Diversion from Nursing Home or Other Institutional Residential Facilities 

Diversion from Nursing 

Home 0 to 500 500 to 2500 2500+ Total 

No 13.58 5.39 2.72 6.08 

Yes 86.42 94.61 97.28 93.92 

Total 100 100 100 100 

p < .01 

Exhibit 2: Extent to which Federal Grants Increased/Expanded Populations Served 

Impact on Populations 0 to 500 500 to 2500 2500+ Total 

Very much 32.10 40.85 52.82 43.41 

Somewhat 53.09 45.12 39.44 44.70 

Very little 14.81 14.02 7.75 11.89 

Total 100 100 100 100 

p < .05 

Exhibit 3: Extent to which Federal Grants Increased the Number of Consumers 

Impact on Number of 

Consumers 0 to 500 500 to 2500 2500+ Total 

Very much 32.50 46.25 51.39 45.31 

Somewhat 50.00 42.50 42.36 44.01 

Very little 17.50 11.25 6.25 10.68 

Total 100 100 100 100 

p < .05 

Exhibit 4: Extent to which Federal Grants Increased the Number of Partners 

Impact on Partners 0 to 500 500 to 2500 2500+ Total 

Very much 48.10 54.60 64.29 56.81 

Somewhat 39.24 39.26 30.00 35.86 

Very little 12.66 6.13 5.71 7.33 

Total 100 100 100 100 

p < .10 

Page 351 
 

 

 

 

 

 

Exhibit 5: Impact of ADRC Grants on Contributing to the Development of Statewide Database of LTSS
 

Services or Consumers
 

Impact on LTSS 

Database 0 to 500 500 to 2500 2500+ Total 

No 73.81 63.74 55.78 62.94 

Yes 26.19 36.26 44.22 37.06 

Total 100 100 100 100 

p < .05 

Exhibit 6: Impact of Partnerships on Ability to Provide LTSS 

Impact of Partnerships 0 to 500 500 to 2500 2500+ Total 

No 28.57 22.81 13.61 20.65 

Yes 71.43 77.19 86.39 79.35 

Total 100 100 100 100 

p < .05 

Exhibit 7: Conducted Community LTSS Needs Assessment within the Last 12 Months 

Community LTSS needs 

Assessment 0 to 500 500 to 2500 2500+ Total 

No, a community needs assessment 

was not completed within the past 

three years 

42.31 29.17 29.17 31.79 

No, but we did complete a 

community needs assessment within 

the past three years 

38.46 33.33 27.78 32.31 

Yes 19.23 37.50 43.06 35.90 

Total 100 100 100 100 

p < .01 

Exhibit 8: Frequency of Consumer Requests about Medicaid Eligibility 

Medicaid Eligibility and 

Services 0 to 500 500 to 2500 2500+ Total 

Frequently 77.22 89.38 96.92 89.43 

Sometimes 20.25 9.38 3.08 9.49 

Infrequently 2.53 1.25 0.00 1.08 

Never 0.00 0.00 0.00 0.00 

Total 100 100 100 100 

p < .001 

Exhibit 9: Frequency of Consumer Requests about Affordable Housing Services 

Affordable Housing 

Services 0 to 500 500 to 2500 2500+ Total 

Frequently 70.51 77.02 82.31 77.51 

Sometimes 19.23 21.12 15.38 18.70 

Infrequently 8.97 1.24 2.31 3.25 

Page 352 
 

 

 

 

Never 1.28 0.62 0.00 0.54 

Total 100 100 100 100 

p < .05 

Exhibit 10: Use of Screening Questionnaire to Make a Preliminary Determination of Eligibility and Need 

for Publicly-Funded LTSS 

Determination of 

eligibility 0 to 500 500 to 2500 2500+ Total 

No 25.00 22.08 12.98 19.39 

Yes 75.00 77.92 87.02 80.61 

Total 100 100 100 100 

p < .10 

Exhibit 11: Use of Alliance of Information and Referral Systems (AIRS) Standards 

Use of AIRS Standards 0 to 500 500 to 2500 2500+ Total 

Never 54.69 37.50 29.13 38.28 

Yes, with all consumers 45.31 62.50 70.87 61.72 

Total 100 100 100 100 

p < .01 

Page 353 
 

APPENDIX P: OUTCOME EVALUTION AGENCY REFERENCE GUIDE
 

Page 354
 
 

 

 

 

 

 

 

Agency Reference Guide
 

`
 

Recruitment Training for the ACL-Funded 

Evaluation of Access to Long-Term Services 

and Supports 

Spring 2013 

Abt Associates Inc. 

4550 Montgomery Avenue 

Suite 800 North 

Bethesda, MD 20814 

IMPAQ International, LLC
 

10420 Little Patuxent Parkway
 

Suite 300
 

Columbia, MD 20144
 
 

 - -

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Agency Reference Guide 

Recruitment Training for the ACL Funded Evaluation of Access to Long 

Term Services and Supports 

Table of Contents 

1. Introduction ............................................................................................................ 1
 

2. Project Background ................................................................................................. 3
 

2.1 Evaluation Components..........................................................................................4
 

2.2 What's In It for Your Agency͍ .................................................................................6
 

3. Partner Roles and Process Overview ........................................................................ 7
 

3.1 Role of the Agency Specialist ..................................................................................8
 

3.2 Role of the Research Team .................................................................................. 10
 

3.3 Overview of Data Collection Process................................................................... 11
 

4. Eligibility Criteria and Procedures........................................................................... 12
 

4.1 Eligibility............................................................................................................... 12
 

4.2 Procedure for Screening Clients .......................................................................... 14
 

4.3 Informing Eligible Clients about the Survey......................................................... 23
 

4.4 Obtaining Client Contact Information ................................................................. 25
 

4.5 Sending Client Contact Information to the Research Team ................................ 29
 

5. Interviewing Techniques........................................................................................ 30
 

5.1 Preparation and Organization ............................................................................. 31
 

5.2 Techniques for Gaining Client Cooperation......................................................... 32
 

5.3 Techniques for Eliciting Accurate and Complete Responses............................... 35
 

5.4 Ending the Interview............................................................................................ 39
 

6. Appendix............................................................................................................... 40
 

Appendix A: Client Screening Tool................................................................................... 41
 

Appendix B: Study Description/Agreement to Participate................................................ 46
 

Appendix C: Data Collection Tool .................................................................................... 48
 

Appendix D: Tips for Successful Interviewing................................................................... 53
 

Appendix E: Recruitment Training for ACL-Funded Evaluation of Access to Long-Term 

Services and Supports ............................................................. Error! Bookmark not defined.
 

Abt Associates Inc. Contents | pg. i
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Agency Reference Guide 

1. Introduction 

The Aging and Disability Resource Center (ADRC) program is 

designed to provide individuals of all ages, disabilities, and income 

levels with integrated access to community-based long-term services 

and supports (LTSS). The Administration for Community Living 

(ACL), which co-sponsors the program with the Centers for Medicaid 

& Medicare Services (CMS), contracted with IMPAQ International 

LLC and Abt Associates Inc. to implement a rigorous evaluation of 

the ADRC program to assess the efficacy of the ADRC program at 

meeting the LTSS needs of the aging and disability populations. This 

is the first national evaluation since the program’s inception in 2003.

Your Role is Critical! 

 The success of the national LTSS Study hinges on the 

participation of ADRC and AAA staff. 

A central feature of the national evaluation is an assessment of the 

experiences of clients who receive information and referral (I & R), 

Option Counseling, Care Transitions, Benefits Supports and a range 

of other services from the ADRC or Area Agency on Aging (AAA) 

agencies. Your role in the outcome evaluation is critical. In fact, the 

success of the national LTSS Study hinges on the investment of 

ADRC and AAA staff to screen and enroll eligible clients into this 

study. 

Your Role Includes Four Steps 

1. Screening clients for study eligibility 

2. Telling eligible clients about the study and obtaining 

verbal consent 

3. Collecting client contact information 

4. Sending contact information and data to the research 

team 

Abt Associates Inc. Introduction | pg. 1 

THIS DOCUMENT IS A REFERENCE GUIDE FOR STAFF WHO AsSIST 

CLIENTS SEEKING SERVICES FROM ADRC AND AAA AGENCIES 

THAT HAVE AGREED TO PARTICIPATE IN THE NATIONAL 

EVALUATION OF THE ADRC PROGRAM. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

Agency Reference Guide 

The reference guide describes the steps and materials needed to 

accomplish these tasks, in addition to background information that 

provides context for your role in the evaluation. The remaining 

sections of the guide are organized into the following chapters: 

	 Chapter 2 provides general background information about the 

overall national evaluation. 

 Chapter 3 introduces client eligibility, and provides an 

overview of roles and responsibilities for this evaluation. 

 The procedures that agency staff will be asked to follow when 

screening and recruiting clients are detailed in Chapter 4, and 

 Chapter 5 contains interviewing tips that you may refer to as 

needed. 

	 The Appendix includes complete versions of the Part 1. 

Client Screening Tool; the Part 2. Study 

Description/Agreement to Participate; and the Part 3. Data 

Collection Tool. It also includes Tips for Successful 

Interviewing, and the Webinar Training Slides. 

Abt Associates Inc.	 Introduction | pg. 2 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Agency Reference Guide 

2. Project Background 

Abt Associates Inc. 

Since the first round of ADRC grants were awarded in 2003, the 

mission of the program has been to provide individuals of all ages, 

disabilities, and income levels with integrated access to communitybased LTSS. Targeted and local ADRC evaluations suggest that the 

program is meeting its goals. However, to confidently report on the 

effectiveness of the ADRC program in achieving its mission, a 

comprehensive evaluation is needed. For this reason, the ACL 

contracted with IMPAQ International LLC and Abt Associates Inc. to 

implement a rigorous national evaluation of the ADRC program. 

Through the random selection of ADRC and AAA sites, the 

evaluation is designed specifically to: 

Produce generalizable outcomes about the degree to which ACL 

through its grant funding, is meeting the LTSS needs of older 

Americans and individuals with disabilities; 

Identify strategies that sites utilize to effectively integrate and 

streamline access to LTSS; 

Lead to program refinement and continuous quality management; and, 

Enable ACL to accurately report on the efficacy of ACL-funded 

LTSS programs to government agencies and the public. 

Through this evaluation, ACL specifically seeks to understand 

whether and how aging network sites are meeting the LTSS needs of 

the aging and disability populations. 

Project Background | pg. 3 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Agency Reference Guide 

2.1 Evaluation Components 

The evaluation contains two components: a process evaluation and 

an outcome evaluation. Both components of the study are described 

here to give you the big picture; however, this reference guide is 

primarily focused on providing you information related to your role of 

screening clients for the outcome evaluation. Figure 1 illustrates how 

each component contributes to the evaluation. 

Figure 1. Components of the National Evaluation. 

Process Evaluation 

An assessment of how the program operates (i.e., the program 

processes) will be undertaken by the reserach team. The purpose is to 

determine the extent to which ADRC grantees are providing the full 

range of high quality services (e.g., streamlining access to public 

programs, serving as a One-Stop-Shop/No Wrong Door). 

To collect data for this assessment, a web-based survey was 

administered. The directors (or other key leadership staff) of all 

ADRCs, State Units on Aging, and the participating AAA sites were 

invited to participate in this survey. Information gathered during the 

process evaluation will help to inform the findings of the outcome 

evaluation. 

Outcome Evaluation 

Overall, the outcome evaluation is intended to help ACL determine 

the extent to which grantees are meeting the LTSS needs of all 

individuals it serves and whether or not those individuals are satisfied 

with the information and referral services that they receive. 

Specifically, the two primary outcomes of this component of the 

evaluation are to compare: 

1.	 The LTSS experiences of ADRC older adult consumers (i.e., 60+) 

to the LTSS experiences of the AAA consumers, in communities 

not served by an ADRC; and 

2.	 The LTSS experiences of ADRC consumers with disabilities to 

the LTSS experiences of AAA consumers, in communities not 

served by an ADRC. 

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Agency Reference Guide 

This comparison will help ACL understand how and whether the 

ADRC service approach differs from the approaches used by another 

type of agency, AAAs in this case. 

ADRC and AAA sites will be recruited for participation in the 

outcome evaluation. The key component of the outcome evaluation is 

a brief (15-20 minute) Participant Experience Survey that will be 

administered to eligible ADRC and AAA clients screened and 

recruited from the participating sites. 

Your role will be to identify clients who are eligible to participate in 

the study. The research team will conduct the survey and analyze the 

results. 

Abt Associates Inc. Project Background | pg. 5 
 

 

 

 

 

 

 

Agency Reference Guide 

2.2 What’s In It for Your Agency? 

In addition to standard demographic information, the Participant 

Experience Survey contains questions relating to a participant’s

experience interacting with your agency, including: their initial 

contact, the assistance received toward obtaining services requested, 

and the services received. Participating agencies will receive a report 

containing agency-specific information and national comparison 

information that can be used to review program performance. 

The report will present the results of the data collected during the 

process and outcome evaluations. This report will provide sitespecific data as well as aggregate data for all participating 

organizations of their type (i.e., ADRC and AAA). It will also 

describe best practices and make recommendations for improving the 

LTSS supported by ACL-funded programs. 

Abt Associates Inc. Project Background | pg. 6 
 

 

 

 

 

 

Agency Reference Guide 

3. Partner Roles and Process Overview 

This section of the reference guide provides an overview of partner 

roles and the process by which they will work together in the study. 

Figure 2 illustrates the roles of the various partners in the outcome 

evaluation. 

Figure 2. Roles and Responsibilities 

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Agency Reference Guide 

3.1 Role of the Agency Specialist 

As an agency specialist, or someone who serves as the first line of 

communication with clients, you are critical to the success of the 

outcome evaluation. Agency specialists are responsible for screening 

clients, informing eligible clients about the Participant Experience 

Survey and obtaining their verbal consent, obtaining client contact 

information and other relevant data, and transmitting contact 

information and data to the reserach team on a monthly basis. 

Agency Specialists' Responsibilities 

 Screen clients for eligibility 

 Inform clients about the survey and obtain consent 

 Collect client contacts 

 Transmit information 

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Agency Reference Guide 

The procedures listed below and described in more detail in Chapter 4 

will be followed: 

A client contacts the organization (ADRC or AAA) either in-person 

or by telephone. 

The client speaks with an agency specialist as would normally occur. 

Once rapport has been established, the agency specialist administers 

the Client Screening Tool (See Appendix A). Some screening 

questions will have been answered during the routine 

conversation; others will need to be asked specifically for the 

study. 

If the client is eligible for the study the agency specialist describes the 

study to the client and invites him/her to participate in a 15 to 20 

minute survey at a later date, and requests permission to share his 

or her contact information with the reserach team (See Appendix 

B for Study Description/Agreement to Participate). 

If the client agrees to participate in the study, the agency specialist 

will obtain a few more pieces of information that will be used to 

contact the client approximately one month later (See Appendix C 

for Data Collection Tool). 

Client information will be recorded by hand using the 

screening/recruitment tools described above and in more detail 

below. At the end of each week, the agency specialist will 

forward the recorded information to Abt by FedEx using 

addressed, pre-paid envelopes provided by the research team. 

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Agency Reference Guide 

3.2 Role of the Research Team 

The research team is responsible for providing technical support to 

agency specialists with all of their evaluation-related activities and 

conducting the Participant Experience Survey. 

For assistance with evaluation activities, you may contact CoPrincipal Investigator, Rosanna Bertrand, or research team member, 

Louisa Buatti. 

Technical Support Contacts 

Contact Person 

Rosanna Bertrand, Ph.D. 

(617) 349-2556 

ADRC_AAA_Recruitment@abtassoc.com 

Louisa Buatti 

(301) 634-1711 

ADRC_AAA_Recruitment@abtassoc.com 

Note: The email address above is a hyperlink. Right click on the hyperlink to 

send an email to that address. If you type the address into an email, type 

ADRC_AAA_Recruitment@abtassoc.com 

The research team will use the client contact information and data 

provided by the participating agencies to contact potential 

participants, obtain their informed consent, and conduct the 

Participant Experience Survey. Upon receiving the client 

information, the research team will telephone the clients who agreed 

to participate in the study. During the telephone call, the research 

team will: 

Remind the participant of his or her contact with the ADRC or AAA. 

Ask the participant to participate in 15–20 minute telephone survey. 

Read a formal statement of informed consent and ask the participant 

to provide verbal agreement. 

Administer the telephone survey or make arrangements to call back at 

a more convenient time. 

The research team will enter responses to the survey into a data base. 

Responses to the survey will be reported to ACL in the aggregate; 

individual survey participants will not be identified. 

Abt Associates Inc. Partner Roles and Process Overview| pg. 

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Agency Reference Guide 

3.3 Overview of Data Collection Process 

Figure 3, below, is a flow chart of the activities to be carried out by 

each of the partners. 

Figure 3. Activity Flow Chart 

Abt Associates Inc. Partner Roles and Process Overview| pg. 

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 Has no apparent physical, cognitive, or mental conditions 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Agency Reference Guide 

4. Eligibility Criteria and Procedures 

Chapter 4 describes 1) eligibility criteria for the Participant 

Experience Survey, and 2) procedures for screening clients, informing 

eligible clients about the Participant Experience Survey, and 

transmitting contact information to the research team. For additional 

guidance on interviewing techniques including terminating an 

interview, please refer to Chapter 5 or Appendix D for a list of tips for 

successful interviewing. 

4.1 Eligibility 

Who is eligible to participate in the outcome evaluation and complete 

the Participant Experience Survey? 

Client eligibility is determined by age, disability status, receipt of 

certain information/counseling services, as well as the professional 

status of the caregiver. 

A person is eligible to participate in the outcome 

evaluation if he or she 

 Does not have a legal guardian 

 Is not a professional caregiver 

 Is proficient in either English or Spanish 

 Is 18 years or older with a disability OR is 60 years or older 

 Received a specific service (e.g., I & R services, options 

counseling, peer support, benefit eligibility determination, or 

transition assistance) 

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Agency Reference Guide 

Figure 4 graphically represents the process for determining eligibility. 

Step-by-step instructions for determining eligibility will be discussed 

in greater detail in Section 4.2. 

Figure 4. Eligibility Flow Chart 

ELIGIBLE

All clients who contacted the ADRC or AAA during the recruitment period

Has a legal guardian? 

Yes NO 

Is a professional caregiver?

Yes NO 

Has English or Spanish proficiency?

No YES 

Is age 18-59 with disability or age>=60?

No YES 

Is physically/cognitively competent to complete the telephone survey?

No YES 

Received specific services? 

YES No

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Agency Reference Guide 

4.2 Procedure for Screening Clients 

As noted previously, agency specialists will screen clients for 

eligibility for the Participant Experience Survey. To screen clients, 

you will use the form Part 1: Client Screening Tool (See Appendix 

A). Depending on the responses to the questions on this form, clients 

will be either eligible or ineligible for the survey (see also Figure 4). 

The Client Screening Tool contains a total of eight (8) questions. The 

answers to some of these questions will be pre-populated by the 

reserach team. Other questions may be answered during the course of 

the routine discussion with the client. If a question has already been 

answered during the conversation, do not ask the client the question 

again. Instead, fill in the response and return to where you left off, 

proceeding through the remaining questions consecutively. 

If the client does not understand the question the first time that it is 

read, please re-read the question again, exactly as written. If the 

client still does not understand the question, you may paraphrase, or 

ask the question in a way that you think the client will understand. If 

the client does not understand (or hear) the question after three 

(3) tries, the client is ineligible for the study. In this event, please 

record “Yes” for Question 8 of the Client Screening Tool and 

discontinue the screening. 

When a Client Doesn't Understand a Yuestion 

1. Read the question. If the client doesn't understand: 

2. Re-read the question. If the client still does understand: 

3. Paraphrase the question. If the client still doesn't undertand: 

4. The client is ineligible. 

Additional detail on ineligibility based on physical, cognitive, or 

mental conditions are provided in Section 4.1.8. It is important that 

you complete one form for each client. Be sure to fill in every blank 

space and answer every question, if possible. 

Please record the information by hand directly onto the client 

recruitment tools (i.e., Part 1. Client Screening Tool, Part 2. Study 

Description/Agreement to Participate, and Part 3. Data Collection 

Tool). 

The three screening/ recruitment tools (described below) will be 

stapled together as sets and a generous supply of them will be mailed 

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Agency Reference Guide 

to all sites. Every set will contain a unique client ID number that will 

appear on each page; please be sure that sets remain stapled together 

to ensure that client responses on all three tools are assoicated with 

one ID number. 

It is very important that you ask all the questions that appear on the 

tools, and record all of the data that you collect and return them to the 

research team. Please note that all data should be forwarded to the 

team even if the client is inelgibile for the study and only a 

minimal amout of data were collected. 

4.2.1 Client Screening Tool: Instructions 

Instructions for using the Client Screening Tool are located at the top 

of the first page of the screening tool. Please be sure to familiarize 

yourself with the instructions before you begin screening. 

In addition to these instructions, it is important to keep in mind that 

TEXT IN CAPITAL LETTERS is an instruction to the agency 

specialist. “Text in quotation marks” is a question that the agency

specialist should ask aloud of the client. 

4.2.2 Client Screening Tool: Questions 1 and 2 

The responses to Questions 1 and 2 will be prepopulated by the 

reserach team before you begin the screening process. If for some 

reason this information is not on your screening tool, please email or 

call the technical support contacts (see page 10 or page 38 for contact 

information). 

1. Agency Name________________ [WILL BE PREPOPULATED BY RESEARCH TEAM] 

2. Agency Type [WILL BE PREPOPULATED BY RESEARCH TEAM] 

 ADRC
 

 AAA
 

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Agency Reference Guide 

4.2.3 Client Screening Tool: Question 3 

The agency specialist should check the box that best reflects the 

client’s response. Be sure to clearly check only one box. 

If the client responds “Don’t Know” or if client refuses to answer, the

client is ineligible for the study. 

For clients who are ineligible for the study, you are finished with the 

recruiting process. Please record the information completed to that 

point; the agency will submit these data to the research team. See 

3. ASK: “For whom did you contact the agency?”

 Self*
 

 Parent
 

 Child
 

 Other relative
 

 Friend
 

 Neighbor
 

 Client/Patient*
 

 Other: _____
 

 DK
 

 REF
 

Section 4.5 for details. 

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Agency Reference Guide 

Self 

If the client responds “Self” to Question 3, the agency specialist

should ask the client, “Do you have a legal guardian?” Note that a 

legal guardian is a person appointed by the court to handle personal 

decision making for a person who is deemed incapable of managing 

his or her own affairs. 

If the client responds “Yes” to the question about having a legal

guardian, the client is ineligible for the study. For clients who are 

ineligible for the study, you are finished with the recruiting process. 

Please record the information completed to that point;the agency will 

submit these data to the research team. See Section 4.5 for details. 

Client/Patient 

If the client responds “Client/Patient” to Question 3, the agency

specialist should ask “Are you a professional caregiver such as a 

physician, hospital discharge planner, nursing home staff?”

If the client responds “Yes” to the question about being a professional 

caregiver, the client is ineligible for the study. For clients who are 

ineligible for the study, you are finished with the recruiting process. 

Please retain the information completed to that point; the agency will 

submit these data to the research team. See Section 4.5 for details. 

*IF SELF ASK: “Did you have a legal guardian? That is someone appointed by the court to hand 

your affairs.”

 Yes
 

 No
 

IF YES, CLIENT HAS A GUARDIAN, CLIENT IS INELIGIBLE FOR THE STUDY. 

DISCONTINUE SCREENER. 

*IF CLIENT/PATIENT ASK: “Are you a professional caregiver such as a physician, hospital

discharge planner, or nursing home staff?”

 Yes
 

 No
 

IF YES TO PROFESSIONAL CAREGIVER, CLIENT IS INELIGIBLE FOR THE 

STUDY. DISCONTINUE SCREENER. 

[RESPONSE TO THE FOLLOWING QUESTION SHOULD BE MADE FOR THE 

PERSON IDENTIFIED IN QUESTION ABOVE]
 

Abt Associates Inc. Partner Roles and Process Overview| pg. 

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Agency Reference Guide 

4.2.4 Client Screening Tool: Question 4 

For Question 4, the agency specialist should ask the client, “Are you 

proficient in English or Spanish?”

If the client responds “No” to Question 4, the client is ineligible for

the study. For clients who are ineligible for the study, you are 

finished with the recruiting process. Please retain the information 

completed to that point; the agency will submit these data to the 

research team. See Section 4.5 for details. 

4. Are you proficient in English or Spanish? 

 Yes
 

 No
 

IF NO, DISCONTINUE SCREENER. 

Abt Associates Inc. Partner Roles and Process Overview| pg. 

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Agency Reference Guide 

4.2.5 Client Screening Tool: Question 5 

For Question 5, the agency specialist should ask the client, “What is 

your age?” OR, if the client is contacting the agency on behalf of 

another person, the agency specialist should ask “What is the age of

the person for whom this contact was made?”

Write the client’s response on the line below the question to indicate 

the number of years of age of the client or the person for whom the 

contact with the agency was made. 

If the client is unable to remember his or her age or the age of the 

person for whom the contact was made, ask the client, “Do you recall

the year of birth?”

Write the year of birth on the line below the question. 

Additional Question 

The agency specialist should ask the following question, if the 

information is not normally collected by the agency, “I’d like to ask

you a few additional questions to see if you are eligible to participate 

in a satisfaction survey. Is it okay if I ask these questions?”

If the client responds “No” to Question 5, the client is ineligible for

the study. For clients who are ineligible for the study, you are 

finished with the recruiting process. Please retain the information 

completed to that point; the agency will submit these data to the 

research team. See Section 4.5 for details. 

5.	 ASK, “What is the age of the consumer (i.e., the person for whom contact was made)?”

____________ Years 

PROBE IF UNABLE TO REMEMBER AGE: DO YOU RECALL THE YEAR OF 

BIRTH? _________________
 

[RESPONSE TO THE FOLLOWING QUESTION SHOULD BE MADE FOR THE 

PERSON IDENTIFIED IN QUESTION 3 ABOVE] 

IF THE FOLLOWING INFORMATION IS NOT NORMALLY COLLECTED BY YOUR 

AGENCY, PLEASE READ THE FOLLOWING TO THE CLIENT: “I’d like to ask you a 

few additional questions to see if you are eligible to participate in a telephone satisfaction 

survey. Is it ok if I ask these questions?”

 Yes
 

 No
 

IF NO, DISCONTINUE SCREENER. 

Abt Associates Inc. Partner Roles and Process Overview| pg. 

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Agency Reference Guide 

4.2.6 Client Screening Tool: Question 6 

Question 6 contains several parts. The agency specialist should ask 

each part of the question, items a through g. 

To determine if the client is eligible for the study, refer back to the 

response to Question 5. If the age indicated by Question 5 is less 

than 60 years, the client must respond “YES” to at least one item in 

Question 6 to be eligible for the study. 

6.	 ASK, “Do you (OR THE PERSON FOR WHOM CONTACT WAS MADE, IF NOT SELF)

have a disability...”

a.	 Are you deaf or do you have serious difficulty hearing?
 

 Yes
 

 No
 

 DK
 

 REF
 

b.	 Are you blind or do you have serious difficulty seeing, even when wearing glasses? 

 Yes 

 No 

 DK 

 REF 

c.	 Because of a physical, mental, or emotional condition, do you have serious difficulty 

concentrating, remembering, or making decisions? 

 Yes 

 No 

 DK 

 REF 

d.	 Do you have serious difficulty walking or climbing stairs?
 

 Yes
 

 No
 

 DK
 

 REF
 

e.	 Do you have serious difficulty dressing or bathing?
 

 Yes
 

 No
 

 DK
 

 REF
 

f.	 Because of a physical, mental, or emotional condition, do you have serious difficulty 

doing errands alone such as visiting a doctor’s office or shopping?

 Yes
 

 No
 

 DK
 

 REF
 Abt 

20 
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Agency Reference Guide 

If the client is ineligible for the study, the agency specialist will 

discontinue the screener. For clients who are ineligible for the study, 

you are finished with the recruiting process. Please retain the 

information completed to that point; the agency will submit these data 

to the research team. See Section 4.5 for details. 

4.2.7 Client Screening Tool: Questions 7 and 8 

Question 7 has several parts. The agency specialist should answer 

this question based on his or her observations of the client. 

If the response to all items in Question 7 is “No”, the client is

ineligible for the study; however, the agency specialist should note 

the services received or requested by the client. For clients who 

are ineligible for the study, you are finished with the recruiting 

process. Please retain the information completed to that point; the 

agency will submit these data to the research team. See Section 4.5 

for details. 

The answer to this Question 8 requires a subjective response on the 

part of the agency specialist. Please use your experience working 

with older adults and/or persons with disabilities to inform your 

7.	 As a result of this contact, did/will the client (OR THE RECIPIENT OF LTSS) receive any 

of the following services? 

a.	 Information Assistance and/or Referral(s) (not including options counseling) 

 Yes 

 No 

b.	 Options Counseling or Peer Support/Peer Counseling
 

 Yes
 

 No
 

c.	 Benefits Counseling or Eligibility Determination
 

 Yes
 

 No
 

d.	 Transition Assistance
 

 Yes
 

 No
 

e.	 Crisis Intervention
 

 Yes
 

 No
 

f.	 Life Skills Training and Support
 

 Yes
 

 No
 

IF NO TO ALL RESPONSES IN 7 ABOVE, CLIENT IS INELIGIBLE FOR THE 

STUDY. DISCONTINUE SCREENING. 

NOTE SERVICES RECEIVED OR CLIENT REQUEST ________________________ Abt 

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Agency Reference Guide 

8.	 Based on your observation, does the client have any apparent physical, cognitive, or mental 

conditions that would prevent him/her from making an informed decision about taking part 

in this study and/or participating in a 15-20 minute telephone survey? 

 Yes
 

 No
 

response. 

The text box below lists the conditions in which a client is ineligible 

for the study after asking the same questions three (3) times. 

Conditions for Ineligibility 

after Three Attempts 

 Does not understand due to impaired hearing* or cognition 

 Provides nonsensical responses 

 Has difficulty concentrating and appears to be drifting 

 Finds responding to the screening burdensome to the 

extent that you believe completing a 15-20 minute 

telephone survey would be unduly taxing 

*	 If communication difficulty is due to hearing 

impairment, inquire whether or not the client is set up 

If any of the conditions for ineligibility apply, please record “Yes” for

Question 8 and discontinue the screening. The possible exception is if 

“Yes” was for hearing impairment, but is set up with

Telecommunications Relay Service (TRS). If yes, then the client may 

be eligible as the survey can be administered through this service. 

TRS will be addressed in Part 3. Data Collection Tool. 

For clients who are ineligible for the study, you are finished with the 

recruiting process. Please retain the information completed to that 

point; the agency will submit these data to the research team. See 

Section 4.5 for further details. 

For clients who are eligible to participate in the survey, you will 

continue the recruiting process by describing the study, as described 

in Section 4.3. 

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Agency Reference Guide 

4.3 Informing Eligible Clients about the Survey 

Agency specialists will inform eligible clients about the Participant 

Experience Survey using the document Part 2: Study 

Description/Agreement to Participate (see Appendix B). The way 

you introduce the study will have a strong influence on the client’s

decision whether or not to participate. An effective introduction is 

conducted in a serious, pleasant and confident manner and makes 

clients believe that: 

The study is worth their time 

They are important 

You want to hear what they have to say 

Before you meet with your first client, you should read the statement 

carefully out loud to be sure that you are comfortable with the words 

and are familiar with the phrasing. 

Tips for Introducing the Study 

 Don't assume that a client will or will not participate 

 Pay attention to your voice quality 

 Sound confident 

 Smile-in person and over the phone 

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Agency Reference Guide 

The agency specialist should read the statement of informed consent 

word for word to each client. 

PART 2. STUDY DESCRIPTION/AGREEMENT TO PARTICIPATE 

PLEASE COMPLETE THIS FORM AND RECORD THE RESPONSE. 

INSTRUCTIONS: READ THE FOLLOWING STATEMNT TO EACH PERSON WHO IS 

ELIGIBLE TO PARTICIPATE IN THE STUDY. 

“The Administration for Community Living has contracted with IMPAQ International and Abt 

Associates to conduct a study about the experiences of people like you in obtaining communitybased supports and services. Your opinion is very important, which is why you are being invited 

to participate in a 15 to 20 minute survey which will ask you about your experiences today. If you 

agree, your name will be added to a list of possible participants, and if randomly selected from the 

list, someone from Abt SRBI, the company conducting the survey, will contact you by telephone 

within the next month to tell you more about the study and confirm whether or not you want to 

participate. 

Right now, I am asking your permission to share some information about you with Abt SRBI so 

that they will be able to call you about participating in the survey. With your permission, I would 

like to share your name, phone number, the reason you contacted us today, and a few other pieces 

of information such as information about possible disabilities. Your name or other identifying 

information will be used only to contact you and will not be stored in the same data file with your 

responses to the survey or used in any written materials generated in this study. Your decision will 

not affect your relationship with this agency nor your eligibility to receive their services. 

“May I share this information so that Abt SRBI can contact you to participate in the survey?”

 Yes
 

 No
 

IF NO, SAY, “Thank you for your consideration.”

Next, the agency specialist will obtain verbal consent from the client 

for the research team to contact him/her, and check the box that 

represents the client’s response.

If the client’s response is “No” to the question about sharing contact

information for participation in the study, the agency specialist’s role

in recruiting this client is finished. Say, “Thank you for your

consideration.” Record the response as this information will be 

submitted with other data to the research team. 

If the client’s response is “Yes” to this question, say “Thank you” and 

continue to Part 3: Data Collection Tool. A description of 

procedures for using the Data Collection Tool is found in Section 4.4. 

The Data Collection Tool is in Appendix C. 

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Agency Reference Guide 

4.4 Obtaining Client Contact Information 

For those who agree to participate, ask the questions in Part 3: Data 

Collection Tool, copied below and found in Appendix C. Instructions 

for using the Data Collection Tool are located at the top of the first 

page of the tool. Be sure to familiarize yourself with the instructions, 

before you begin data collection. 

PART 3. DATA COLLECTION TOOL 

PLEASE ASK ALL QUESTIONS ON THIS FORM AND BE SURE TO RECORD ALL RESPONSES. 

INSTRUCTIONS: 

COMPLETE THE INFORMATION BELOW FOR EACH PERSON WHO AGREED TO 

SHARE CONTACT INFORMATION WITH THE RESEARCH TEAM IN ORDER TO 

RECEIVE A FOLLOW-UP CALL TO PARTICIPATE IN A TELEPHONE SURVEY. 

THROUGHOUT THIS DOCUMENT, THE CLIENT REFERS TO THE PERSON WHO 

CONTACTED THE AGENCY. 

Please carefully record responses for each client who agreed to share 

contact information so that he/she can receive a call to participate in 

the study. Be sure to answer every question, if appropriate. 

Tips for Completing the Data Collection Tool 

 Be sure to provide responses to all questions 

 Be sure to check boxes clearly 

 Sign and date the form 

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Agency Reference Guide 

4.4.1 Data Collection Tool: Questions 1 – 9. 

The agency specialist should ask the client Questions 1–9. It is not 

necessary to read each of the response choices to the client. The 

agency specialist should select the best answer based on the client’s 

response. However, you may read each of the answers to the client to 

1. Date of Contact with Agency (month, date, year) _ _/_ _/_ _ 

2. ASK: What is your name (First, Middle, Last) ___________ ____________ ____________ 

3. ASK: What is your home zip code? _ _ _ _ _ 

4. ASK: What is the best phone number where you can be reached by the research team? 

Client phone number (_ _ _) _ _ _ - _ _ _ _ 

5. ASK: What is the best time for someone to call you about participating in the study? 

Preferred time to call _ _:_ _ AM PM 

Preferred day to call? _____________ 

6. ASK: Would you prefer to take the telephone survey in Spanish? 

 No 

 Yes 

7. ASK: Would you like to use TRS service for the study? 

 No 

 Yes 

8. ASK: What was the main reason that you contacted us today? SELECT ONLY ONE 

RESPONSE. 

 Income assistance 

 Energy assistance 

 Medicare questions 

 Medicaid questions (including questions about HCBS waivers) 

 Housing 

 Personal Care 

 Transportation 

 Nutrition 

 Chronic health conditions 

 Employment 

 Support groups 

 Recreation opportunities 

 Caregiver/respite support 

 Home modification 

 Attendant care services 

 Advocacy 

 Education 

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 Services for emergent care/crisis intervention 

 Preventative health services 

 Ombudsman/abuse or neglect issues 

 Advanced directives 

 Mental health 

 Transition services 

 Other independent living supports or services 

 Other, please specify ________________________ 

9. ASK: Is this the first time you contacted this agency? 

 First time contact 

 Repeat contact 

elicit a response if it would be useful. 

4.4.1	 Data Collection Tool: Questions 10 - 11. 

The agency specialist should answer Questions 10–11 based on 

your experience with the client. These questions should not be 

asked of the client. 

10.	 Mode of Contact with Agency 

 Visited 

 Telephoned 

11.	 IF THE CLIENT STOPPED THE QUESTIONNAIRE BEFORE COMPLETING IT, 

PLEASE SELECT THE BEST/MOST LIKELY REASON FOR STOPPING: 

 Client refused to answer 

 Client’s cognitive abilities prevented completion of questionnaire 

 Client’s physical condition prevented completion of the questionnaire

 Client’s emotional condition prevented completion of the questionnaire

	 Other, please explain ________________________________________ 

4.4.2. Data Collection Tool: Item 12. 

The agency specialist should sign his or her name and write the 

12. The signature of the person who administered this questionnaire indicates that he/she has read 

the above statement to the consumer/consumer representative and that the person has agreed 

to have his/her personal information released to Abt SRBI for the purpose of the evaluation. 

Name _____________________________ Date ______________________________ 

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Agency Reference Guide 

date in the spaces provided for Item 12. 

For questions regarding how to use the screening tool or complete the 

data collection tool, please contact the project Co-Principal 

Investigator, Rosanna Bertrand, or team member, Louisa Buatti 

(please see page 10 or page 38 for contact information). 

Abt Associates Inc. Partner Roles and Process Overview| pg. 

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THE AGENCY SPECIALIST WILL SUBMIT ALL CLIENT DATA TO THE 

RESEARCH TEAM. SEE SECTION 4.5 FOR DETAILS. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

Agency Reference Guide 

4.5 Sending Client Contact Information to the 

Research Team 

Agency specialists will send client contact information to the research 

team at the end of each week, or at a minimum, at the end of each 

month. 

Information collected on the following documents should be 

submitted: 

Part 1: Client Screening Tool (for all clients, whether eligible or 

not) 

Part 2: Study Description/Agreement to Participate (for all 

clients, whether they agree to participate or not) 

Part 3: Data Collection Tool (for clients who agree to participate) 

4.5.1 Submit client data via FedEx 

Your agency will receive a supply of FedEx envelopes and pre-paid, 

addressed labels in which to return the data forms. 

Immediately following client visits, place their forms (whether full or 

partial data) in one of the FedEx envelopes. Accumulate and store 

client forms in the envelope in a locked cabinet to ensure client 

confidentiality. 

At the end of each week secure the pre-paid label to the envelope and 

take it to a FedEx location for shipment. You may find locations of 

nearby FedEx locations at the following address: 

http://www.fedex.com/Dropoff/start?locale=en_US 

It is also possible to register, free of charge, for FedEx pick-up. See 

the following address for information regarding arranging FedEx 

pick-up. 

Abt Associates Inc. Partner Roles and Process Overview| pg. 

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Agency Reference Guide 

5. Interviewing Techniques 

We are aware that for most of you, the topics and techniques provided 

in Sections 5.1 and 5.2 are part of your daily routine and that you are 

very adapt at interacting with older adults and adults with disabilities. 

Our intent is to provide these sections for newer staff, as well as for 

staff wanting to refresh or enhance their interviewing skills. Sections 

5.3 and 5.4, on the other hand, provide specific techniques related to 

study data collection. We present these sections to familiarize you 

with research interview methods. 

For quick reference, a Checklist of Successful Interview Tips is 

provided in Appendix D. 

Agency specialists have three overarching objectives in the national 

evaluation of LTSS: 

	 Gaining client cooperation to participate, 

	 Eliciting complete and accurate responses from the client, and 

	 Recording the data in a way that can be read and interpreted 

by the research team. 

The first two goals are directly related to how the interview is 

conducted. This section provides suggestions for successful 

interviewing to help you meet your objectives beginning with your 

activities prior to the interview. 

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5.1 Preparation and Organization 

The first and most important aspect of conducting a client interview is 

to be organized and prepared. 

The most effective interviewer is one who comes to the interview 

fully prepared by knowing and understanding the questions, and 

anticipating issues that the client may raise. 

The effective interviewer also comes to the interview organized with 

the appropriate documents in front of him or her and in the correct 

order. It is discouraging for a client to wait while an interviewer 

fumbles though paperwork, so please be prepared. 

Prior to screening and recruiting clients, agency specialists also 

should have participated in the training webinar that was presented by 

the IMPAQ/Abt research team. In addition, they should have 

reviewed this reference guide, paying particular attention to Chapter 

4, Procedures. Please be sure to review each of the tools multiple 

times. 

Important Aspects of a Successful Interivew 

 Be organized and prepared 

 Participate in the training webinar 

 Review the reference guide 

 Review the screening and data collection tools 

Abt Associates Inc. Partner Roles and Process Overview| pg. 

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5.2 Techniques for Gaining Client Cooperation 

Generally, people will feel free to speak their minds if they are at ease 

and believe that you are interested in what they have to say. Effective 

interviewers put the client at ease; they are articulate, good listeners 

Characteristics of an 

Effective Interviewer 

 Puts clients at ease 

 Articulates 

 Establishes rapport 

 Non-judgmental 

 Good listener 

 Patient 

 Respects Privacy 

 Persists but is not aggressive 

 Probes 

 Paces 

 Paraphrases 

 Ends with a thank you 

and patient. In addition, a good 

interviewer knows how to balance 

persistence and aggressiveness. 

Remember to thank clients for 

their time regardless of whether or 

not they agree to participate. 

The following subsections 

describe a variety of techniques 

that successful interviewers 

employ to gain cooperation from 

clients. 

5.2.1. Put Clients at Ease 

One technique for putting clients at ease relates to the interviewer’s

“voice personality.” Your tone of voice, attentiveness, and receptive 

manner can make the difference between a completed interview and a 

refusal to participate. 

Interviewers can put clients at ease by doing the following: 

 Reading the questions in a friendly, natural manner; 

 Speaking at a moderate speed, and 

 Sounding interested. 

Smiling while you ask the questions, whether in person or over the 

phone, tends to produce a welcoming voice. 

Physical cues can be effective at putting clients at ease if you are 

conducting the interview in person. Pay attention to your body 

language to be sure that it is open and welcoming. 

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5.2.2 Articulate 

Speaking clearly and deliberately so that the client both hears and 

understands you is a basic skill for effective interviewing with any 

population. However, this is particularly important for your clients 

who are older and/or disabled and, therefore, more likely than other 

adults to experience physical or cognitive impairments. 

Speak clearly, slowly, and deliberately;
 

Look directly at the client (if an in-person interview), and
 

Gauge the volume of your voice.
 

For this population speaking clearly and at a slower more deliberate 

pace is essential, but you already know that. In addition, if you are 

conducting a face-to-face interview, be sure to look directly at the 

client rather than down at your paperwork or at your computer as this 

will help the client to hear and understand your words. 

For face-to-face as well as telephone interviews, gauge the necessary 

volume of your voice at the beginning of the interview and try to 

maintain that level of volume throughout the interview. Also, be 

conscious of not letting your voice trail off at the end of a sentence or 

a phrase. 

5.2.3 Establish Rapport 

Rapport can be defined as a harmonious relation. To establish 

rapport, introduce yourself and your role in the evaluation. 

Clients need the freedom to say what they feel and think, without 

being influenced by anything the interviewers might say. You should 

strive to be nonjudgmental, noncommittal, and objective. Try to act 

neutral so that the client feels comfortable answering the questions 

truthfully and completely. 

Through actions and words, assure clients that there are no wrong or 

right answers. 

Be a good listener and be patient. 

Use reinforcements. 

Avoid judgemental responses. 

Some clients may need to think about a question for a moment before 

answering. Others may need to “tell a story” as part of their response. 

Do not interrupt or rush the client. In order to establish rapport, the 

client needs to feel as though you care about― and are interested in―

what he or she has to say. Respect the individual’s privacy and 

maintain confidentiality. 

Abt Associates Inc. Partner Roles and Process Overview| pg. 

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Agency Reference Guide 

When clients seem hesitant, you should assure them that responses 

will be shared only with the research team and that their names will 

not be associated with any of the other information that they give. 

Collecting their names and contact information is done only so that 

the research team can contact them for survey administration. 

In addition, if the topic is sensitive in nature to the client, be sure that 

you are not within hearing range of other staff or clients. If possible, 

take the client to a private area to complete the interview. If it is a 

telephone interview, assure them that the call is not being monitored 

or recorded. 

Reinforcements, words you add to keep the conversation going, are a 

good way to strengthen rapport. However, be cautious in using 

reinforcements as they must be neutral rather than conveying any 

judgment, positive or negative. Neutral reinforcements that may be 

used include, "Okay" and "Thank you." Always avoid responses such 

as “Oh, really?” and “Wow!”

Remember, nothing in your 

words or manner should imply 

criticism, surprise, approval, or 

disapproval of either the client’s

questions or answers. 

Responses to Avoid 

 “Oh, really͍” 

 “Wow͊” 

 “Oh, boy͊” 

 “Great Answer” 

 “Hmmmm͙͙” 

Abt Associates Inc. Partner Roles and Process Overview| pg. 

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Agency Reference Guide 

5.3 Techniques for Eliciting Accurate and Complete 

Responses 

5.3.1 Be Persistent not Aggressive 

A good interviewer is persistent but not aggressive in order to gain the 

client’s permission to conduct the survey and to gather answers to

questions that the client is hesitant to share. 

Three of the most effective techniques that you may employ to elicit 

accurate and complete responses from clients are: 

 Probing, 

 Pacing, and 

 Paraphrasing. 

Probing 

Probing is one of the most useful techniques for obtaining accurate 

information, but it must be used carefully in order to avoid 

introducing the interviewer’s perspective into the responses. 

Probing is described as using words or techniques to encourage a 

client to share more accurate information. It is one of the most 

challenging and important aspects of interviewing. Probes are used 

when: 

 A client’s answer is irrelevant. 

 A client’s answer is unclear. 

U 

s 

e 

o 

n 

l 

y 

n 

e 

u 

t 

r 

Example of Probing 

"In the past 12 months, has a doctor, nurse, or other health 

professional given you advice about your weight?" 

Irrelevant answer: "My husband is on a diet." 

Unclear answer: "People are always telling me I need to gain 

some weight." 

Probe: ΗWhat's your best guess͍Η 

"I just need your opinion." 

"If you had to choose, which would you pick?" 

al probes 

The most important thing to keep in mind when you are probing for 

answers is to use only neutral probes that don’t suggest answers.

Abt Associates Inc. Partner Roles and Process Overview| pg. 

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R 

a 

t 

h 

e 

r 

t 

h 

a 

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Agency Reference Guide 

Repeating the question is one of the best neutral probes and one 

you’ll probably use often. 

Never "lead" a client to a particular answer. This is difficult 

because it would seem natural to do so in ordinary conversation. 

Example of Leading the Client's Response 

ΗIn the last 12 months, how many times did you go to a doctor's office 

or clinic to get care for yourself? Would you say:" 

A. None D. 3 - 4 times 

B. Once E. 5 to 9 times 

C. Twice	 F. 10 times or more 

Client: ΗOh, gosh, I don't go very often... in last year, just a few times.Η 

Interviewer: "So, would you say twice, or three times?" 

suggesting an actual number, the proper probe would be a neutral 

probe like the ones suggested above: "What's your best guess?" or 

"Which would you pick?" 

Know when to stop probing 

It is important to know when to stop probing in order to keep from 

annoying the client. 

You should stop probing when: 

	 You have obtained the necessary information. 

	 You have encouraged the client to clarify the meaning of his or 

her own words, so that we know exactly what he/she had in mind. 

	 The client becomes irritated or annoyed. 

	 The client has nothing more to say. 

Abt Associates Inc. Partner Roles and Process Overview| pg. 

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Pacing an Interview 

The pace of an interview is the mode or rate of progressing and can be 

a powerful tool. In general, you want an even pace throughout the 

interview. However, sometimes you will need to increase the pace 

while other times you’ll want to decrease it.

Remember an effective interviewer is a good listener! 

In order to employ pacing as an effective technique, it is important to 

listen to the client as the overall pace has to match the needs of the 

client. Some clients, like those who have difficulty hearing, need you 

to speak slowly. On the other hand, people who have told you that 

they are very busy may not cooperate if they think the interview will 

take too much time. You can usually get the sense of pace for the 

survey with the client by the way they speak. If they seem impatient, 

try to move along at a faster pace. 

When to go quickly 

There are some places in the survey where you will want to adjust 

your pace for maximum results. One effective interviewer technique 

involves reading the introduction section a little quicker. Because this 

is a common place for clients to quit or hang up, don’t pause for very

long at the end of the introduction—read the first question right away. 

When to go slowly 

A mistake made by some interviewers is to speed up at the end of an 

interview because they are getting tired and no longer have the 

patience they had in the beginning. Clients can feel this and often 

interpret it as a lack of caring. They can feel your restlessness and 

will often just quit. 

Paraphrasing 

Sometimes a client may not understand a question that you have 

asked. As noted in Chapter 4, the agency specialist should paraphrase 

the question. That is, ask the question in a way that you think the 

client will understand. You may wish to paraphrase a question after 

you have asked the question as written twice, and the client still does 

not provide a relevant and clear response. 

Effective interviewers are able to paraphrase to elicit appropriate 

responses. 

In order to do that you will need to be very familiar with the 

questions, pay close attention to what the client is saying and be 

familiar with the issues that are being addressed by the questions. 

Remember, you are trying to elicit responses to the questions in the 

survey specifically. You may use neutral probes after paraphrasing 

Abt Associates Inc. Partner Roles and Process Overview| pg. 

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Agency Reference Guide 

the question if the client does not provide a relevant or clear response 

to the rephrased question. 

If you find that clients are having difficulty understanding a question 

or questions and you are unable to rephrase the question in a way that 

the clients understand, please contact the evaluation technical support 

team (see page 10 or page 38 for contact information). 

Abt Associates Inc. Partner Roles and Process Overview| pg. 

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Agency Reference Guide 

5.4 Ending the Interview 

When concluding an interview, please be sure to ask the clients if they 

have any lingering questions and respond to the best of your ability. 

If a client poses a question regarding the study that you are unable to 

answer, please contact the research team and then forward the 

response to the client. 

The end of the interview is also an opportune time to once again 

assure clients that the information that they provided during the 

interview will be kept confidential and only shared with the research 

team. Also, for clients who have agreed to participate in the study, 

remind them that their names or contact information will not be linked 

to their responses to other questions that you asked them, nor will 

their names be linked to the responses that they give on the survey 

itself. 

Thank clients for their time regardless of whether or not they agree to 

participate. 

This step may seem obvious, but it doesn’t hurt to be reminded of it,

especially when we are ending interviews with clients who did not 

agree to participate in the study. It is not uncommon to forget to 

thank these folks for taking the time to hear about the study even 

though they decided not to participate. 

For clients who are eligible and agree to participate, let them know 

that they will be contacted within one month by the research team to 

set up a time for survey participation. 

Technical Support Contacts 

Contact Person 

Rosanna Bertrand, Ph.D. 

(617) 349-2556 

ADRC_AAA_Recruitment@abtassoc.com 

Louisa Buatti 

(301) 634-1711 

ADRC_AAA_Recruitment@abtassoc.com 

Note: The email address above is a hyperlink. Right click on the hyperlink to 

send an email to that address. If you type the address into an email, type 

ADRC_AAA_Recruitment@abtassoc.com 

Abt Associates Inc. Partner Roles and Process Overview| pg. 

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Agency Reference Guide 

6. Appendix 

The Appendices A–C contain the three tools that will be used by 

agency specialists in recruiting clients for the Participant Experience 

Survey. Appendix D includes a checklist of tips for successful 

interviewing. 

 Appendix A: Client Screening Tool 

 Appendix B: Study Description/Agreement to Participate 

 Appendix C: Data Collection Tool 

 Appendix D: Tips for Successful Interviewing 

Abt Associates Inc. Appendix | pg. 40 
 

 

Agency Reference Guide 

Appendix A: Client Screening Tool 

Abt Associates Inc. Appendix A | pg. 41
 
 QUESTIONS 7 AND 8 SHOULD BE FILLED IN BY THE AGENCY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Agency Reference Guide 

PART 1. CLIENT SCEENING TOOL 

PLEASE ASK ALL QUESTONS ON THIS FORM AND BE SURE TO RECORD ALL RESPONSES. 

INSTRUCTIONS FOR COMPLETING THIS FORM: 

THROUGHOUT THIS DOCUMENT, CLIENT REFERS TO THE PERSON WHO IS MAKING CONTACT WITH YOUR 

AGENCY. CONSUMER IS THE PERSON FOR WHOM THE LONG TERM SUPPORTS AND SERVICE ARE INTENDED. 

SOME SCREENING QUESTIONS ARE PREPOPULATED, AND OTHERS MAY BE ANSWERED DURING THE COURSE 

OF THE ROUTINE DISCUSSION WITH THE CLIENT. 

 QUESTIONS 1 AND 2 WILL BE PREPOPULATED BY THE RESEARCH TEAM. 

 QUESTIONS 3-6 SHOULD BE ASKED IF NOT ANSWERED DURING THE ROUTINE CLIENT DISCUSSION. 

1.	 Agency Name ________________________________[WILL BE PREPOPULATED BY 

RESEARCH TEAM] 

2.	 Agency Type [WILL BE PREPOPULATED BY RESEACH TEAM] 

 ADRC
 

 AAA
 

3.	 AS<: “For whom did you contact the agency͍” 

 Self* 

 Parent 

 Child 

 Other relative 

 Friend 

 Neighbor 

 Client/Patient* 

 Other: ____ 

 DK
 

 REF
 

IF DK OR REF, CLIENT IS INELIGIBLE FOR THE STUDY. DISCONTINUE SCREENER. 

ΎIF SELF AS<: “Do you have a legal guardian͍ That is someone appointed by the 

court to handle your affairs.” 

Yes No 

 

IF YES. CLIENT HAS A LEGAL GUARDIAN, CLIENT IS INELIGIBLE FOR THE STUDY. 

DISCONTINUE SCREENER. 

Abt Associates Inc.	 Appendix A | pg. 42 
 

 

 

 

 

 

 

 

 

 

 

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Agency Reference Guide 

ΎIF CLIENT/PATIENT AS<: “Are you a professional caregiver such as a physician, hospital 

discharge planner, 

or nursing home staff?” 

Yes No 

 

IF YES TO PROFESSIONAL CAREGIVER, CLIENT IS INELIGIBLE FOR THE STUDY. DISCONTINUE 

SCREENER. 

[RESPONSE TO THE FOLLOWING QUESTION SHOULD BE MADE FOR THE PERSON
 

IDENTIFIED IN QUESTON 3 ABOVE] 

4.	 Are you proficient in English or Spanish? 

Yes No 

 

IF NO, DISCONTINUE SCREENER. 

1. 

5.	 ASK, “What is the age of the consumer (i.e., the person for whom contact was made)͍” 

______________ Years 

PROBE IF UNABLE TO REMEMBER AGE: DO YOU RECALL THE YEAR OF BIRTH? 

[RESPONSE TO THE FOLLOWING QUESTION SHOULD BE MADE FOR THE PERSON
 

IDENTIFIED IN
 

QUESTION 3 ABOVE] 

IF THE FOLLOWING INFORMATION IS NOT NORMALLY COLLECTED BY YOUR AGENCY, 

PLEASE READ THE FOLLOWING TO THE CLIENT: “I'd like to ask you a few additional 

questions to see if you are eligible to participate in a telephone satisfaction survey. Is it okay 

if I ask these questions͍” 

Yes No 

 

IF NO, DISCONTINUE SCREENER. 

6.	 AS<, “Do you (OR THE PERSON FOR WHOM CONTACT WAS MADE, IF NOT SELF) have a 

disability͙.” 

a.	 Are you deaf or do you have serious difficulty hearing? 

□	 Yes 

□	 No 

□	 DK 

□	 REF 

Abt Associates Inc.	 Appendix A | pg. 43 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Agency Reference Guide 

b. Are you blind or do you have serious difficulty seeing, even when wearing glasses? 

□	 Yes 

□	 No 

□	 DK 

□	 REF 

c.	 Because of a physical, mental, or emotional condition, do you have serious difficulty 

concentrating, remembering, or making decisions? 

□	 Yes 

□	 No 

□	 DK 

□	 REF 

d.	 Do you have serious difficulty walking or climbing stairs? 

□	 Yes 

□	 No 

□	 DK 

□	 REF 

e.	 Do you have serious difficulty dressing or bathing? 

□	 Yes 

□	 No 

□	 DK 

□	 REF 

f.	 Because of a physical, mental, or emotional condition, do you have serious difficulty 

doing errands alone such as visiting a doctor's office or shopping͍ 

□	 Yes 

□	 No 

□	 DK 

□	 REF 

IF AGE IS LESS THAN 60 AND NONE OF THE ITEMS IN YUESTION 6 WERE “YES” CLIENT IS 

INELIGIBLE FOR THE STUDY. DISCONTINUE SCREENING. 

INSTRUCTIONS: QUESTIONS 7 AND 8 SHOULD BE ANSWERED BY AGENCY BASED 

ON OBSERVATIONS OF THE CLIENT. 

7.	 As a result of this contact, did/will the client (OR THE RECIPIENT OF LTSS) receive any of 

the following services?
 

Yes No
 

a.	   Information Assistance and/or Referral(s) (not including options 

counseling) 

b.	   Options Counseling or Peer Support/Peer Counseling 

c.	   Benefits Counseling or Eligibility Determination 

d.	   Transition assistance 

e.	   Crisis intervention 

f.	   Life skills training or support 

Abt Associates Inc.	 Appendix A | pg. 44 
 

 

 

 

 

 

 

 

 

 

Agency Reference Guide 

IF NO TO ALL RESPONSES IN 7 ABOVE, CLIENT IS INELIGIBLE FOR THE STUDY. DISCONTINUE 

SCREENING. 

NOTE SERVICES RECEIVED OR CLIENT REQUEST _________________________________ 

8.	 Based on your observation, does the client have any apparent physical, cognitive, or 

mental conditions 

that would prevent him/her from making an informed decision about taking part in this 

study and /or participating in a 15-20 minute telephone survey? 

Yes	 No 

 

IF YES TO ITEM 8, CLIENT IS INELIGIBLE FOR THE STUDY. 

IF NO, CONTINUE TO SECTION 2. STUDY DESCRIPTION/AGREEMENT TO PARTICIPATE. 

For questions regarding how to use the screening tool or complete the form, please contact 

the project Co-Principal Investigator, Rosanna Bertrand or team member, Louisa Buatti: 

Technical Support Contacts 

Contact Person 

Rosanna Bertrand, Ph.D. 

(617) 349-2556 

ADRC_AAA_Recruitment@abtassoc.com 

Louisa Buatti 

(301) 634-1711 

ADRC_AAA_Recruitment@abtassoc.com 

Note: The email address above is a hyperlink. Right click on the hyperlink to send an 

email to that address. If you type the address into an email, type 

ADRC_AAA_Recruitment@abtassoc.com 

Abt Associates Inc.	 Appendix A | pg. 45 
 

 

Agency Reference Guide 

Appendix B: Study Description/Agreement to Participate 

Abt Associates Inc. Appendix B | pg. 46
 
 

 

 

 

 

 

 

 

 

 

Agency Reference Guide 

PART 2. STUDY DESCRIPTION/AGREEMENT TO PARTICIPATE 

PLEASE COMPLETE THIS FORM AND RECORD THE RESPONSE. 

INSTRUCTIONS: READ THE FOLLOWING STATEMENT TO EACH PERSON WHO IS 

ELIGIBLE TO PARTICIPATE IN THE STUDY. 

“The Administration for Community Living has contracted with IMPAY International and Abt 

Associates to conduct a study about the experiences of people like you in obtaining 

community-based supports and services. Your opinion is very important, which is why you 

are being invited to participate in a 15 to 20 minute survey which will ask you about your 

experiences today. If you agree, your name will be added to a list of possible participants, 

and if randomly selected from the list, someone from Abt SRBI, the company conducting the 

survey, will contact you by telephone within the next month to tell you more about the study 

and confirm whether or not you want to participate. 

Right now, I am asking your permission to share some information about you with Abt SRBI 

so that they will be able to call you about participating in the survey. With your permission, I 

would like to share your name, phone number, the reason you contacted us today, and a few 

other pieces of information such as information about possible disabilities. Your name or 

other identifying information will be used only to contact you and will not be stored in the 

same data file with your responses to the survey or used in any written materials generated 

in this study. Your decision will not affect your relationship with this agency nor your 

eligibility to receive their services. 

May I share this information so that Abt SRBI can contact you for participation in the 

survey͍” 

Yes No 

 

IF NO, SAY “Thank you for your consideration.” 

Abt Associates Inc. Appendix B | pg. 47 
 

 

Agency Reference Guide 

Appendix C: Data Collection Tool 

Abt Associates Inc. Appendix C | pg. 48
 
 

 

 

 

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PART 3. DATA COLLECTION TOOL 

PLEASE ASK ALL QUESTIONS ON THIS FORM AND BE SURE TO RECORD ALL RESPONSES. 

INSTRUCTIONS:
 

COMPLETE THE INFORMATION BELOW FOR EACH PERSON WHO AGREED TO SHARE
 

CONTACT INFORMATION WITH THE RESEARCH TEAM IN ORDER TO RECEIVE A
 

FOLLOW-UP CALL TO PARTICIPATE IN A TELEPHONE SURVEY.
 

THROUGHOUT THIS DOCUMENT, THE CLIENT REFERS TO THE PERSON WHO 

CONTACTED THE AGENCY.
 

1.	 Date of Contact with Agency (month, date, year) _ _ /_ _ /_ _ 

2.	 ASK: What is your name (First, Middle, Last) _____________, ________, 

3.	 ASK: What is your home zip code? _ _ _ _ _ 

4.	 AS<: “What is the best phone number where you can be reached by the research 

team͍” 

Client Phone number (_ _ _) _ _ _ - _ _ _ _ 

5.	 AS<: “What is the best time for someone to call you about participating in the 

study͍” 

Preferred time to call _ _: _ _ AM PM
 

Preferred day to call? __________________
 

6.	 AS<: “Would you prefer to take the telephone survey in Spanish͍” 

 No 

 Yes 

7.	 AS<: “Would you like to use TRS service for the study͍” 

 No
 

 Yes
 

Abt Associates Inc.	 Appendix C | pg. 49 
 

 

 

 

Agency Reference Guide 

8.	 AS<: “What was the main reason that you contacted us today͍” 

SELECT ONLY ONE RESPONSE. 

 Income assistance 

 Energy assistance 

 Medicare questions 

 Medicaid questions (including questions about HCBS waivers) 

 Housing 

 Personal care 

 Transportation 

 Nutrition 

 Chronic health conditions 

 Employment 

 Support groups 

 Recreation opportunities 

 Caregiver/respite support 

 Home modification 

 Attendant care services 

 Advocacy 

 Education 

 Services for emergent cares/crisis intervention 

 Preventative health services 

 Ombudsman/abuse or neglect issues 

 Advanced directives 

 Mental health 

 Transition services 

Abt Associates Inc.	 Appendix C | pg. 50 
 

 

 

Agency Reference Guide 

	 Other Independent living supports or services 

	 Other, please specify ________________________________ 

9.	 AS<: “Is this the first time you contacted this agency͍”
	

 First time contact
 

 Repeat contact
 

QUESTIONS 10-11 SHOULD BE ANSWERED BY THE AGENCY. 

10. Mode of Contact with Agency
 

 Visited
 

 Telephoned 

Abt Associates Inc.	 Appendix C | pg. 51 
 

 

 

 

 

Agency Reference Guide 

11. IF THE CLIENT STOPPED THE QUESTIONNAIRE BEFORE COMPLETING IT, PLEASE 

SELECT THE BEST/MOST LIKELY REASON FOR STOPPING: 

 Client refused to answer 

 Client's cognitive abilities prevented completion of questionnaire 

 Client's physical condition prevented completion of the questionnaire 

 Client's emotional condition prevented completion of the questionnaire 

 Other, please explain ________________________________________ 

12.	 The signature of the person who administered this questionnaire indicates that 

he/she has read the above statement to the consumer/consumer representative and 

that the person has agreed to have his/her personal information released to Abt SRBI 

for the purpose of the evaluation. 

Name______________________ Date_______________________ 

For questions regarding how to use the screening tool or complete the data collection tool, 

please contact the project Co-Principal Investigator, Rosanna Bertrand or team member, 

Louisa Buatti: 

Technical Support Contacts 

Contact Person 

Rosanna Bertrand, Ph.D. 

(617) 349-2556 

ADRC_AAA_Recruitment@abtassoc.com 

Louisa Buatti 

(301) 634-1711 

ADRC_AAA_Recruitment@abtassoc.com 

Note: The email address above is a hyperlink. Right click on the hyperlink to send an 

email to that address. If you type the address into an email, type 

ADRC_AAA_Recruitment@abtassoc.com 

Abt Associates Inc.	 Appendix C | pg. 52 
 

 

Agency Reference Guide 

Appendix D: Tips for Successful Interviewing 

Abt Associates Inc. Appendix F | pg. 53
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Agency Reference Guide 

TIPS FOR SUCCESSFUL INTERVIEWING
	

Characteristics of an effective interviewer 

Articulate 

A good listener 

Patient and does not interrupt or rush the client 

Persistent but not aggressive, to gain the client’s permission to

conduct the survey and to gather answers to questions that the 

client is hesitant to share 

Understands the issues 

Understands the questions and can rephrase them if necessary 

Able to put clients at ease, assuring them that there are no right or 

wrong answers 

Organized and prepared. Before beginning with a client, the 

interviewer must have completed all paperwork from the prior 

interview and be ready with new tools. 

Ends the questions by thanking the client 

Respects the individual’s privacy and maintains confidentiality

Tips for being a good interviewer 

Reviews the material and procedures before speaking with the client. 

Is confident 

Pays attention to voice quality 

Doesn’t assume the client will- or will not participate 

Asks the questions exactly as they are written. You must ask the 

questions exactly as all the other interviewers do so that the 

results can be combined and interpreted meaningfully. 

Asks the questions in a respectful manner and do not imply that some 

answers are “better” than others.

When an answer is unclear, asks the question again or asks it in a 

slightly different way, being careful not to change the meaning or 

“lead” the client into a particular response. 

If an answer seems inconsistent with previous information given, tries 

to discover the truth by asking another question or asking a 

question slightly differently. 

Abt Associates Inc. Appendix F | pg. 54 
Sincerely,

The National Evaluation

Team

 

 

 

 

 

APPENDIX Q: OUTCOME EVALUTION THANK YOU POSTCARD
 

To our ADRC and AAA partners, 

Thank you for your support on the 

LTSS project. 

We look forward to our continued 

collaboration in the new year. 

Happy 2014! 

Sincerely,
 

The National Evaluation Team
 

ADRC_AAA_Recruitment@abtassoc.com | Abt Associates 

55 Wheeler Street | Cambridge, MA 02138 

O: 617.520.3015 | www.abtassociates.com 

Page 463 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

APPENDIX R. OUTCOME EVALUATION PARTICIPANT EXPERIENCE SURVEY
 

INSTRUCTIONS TO ABT SRBI: PREPOPULATE (PP) INFORMATION IN [ ] FROM CLIENT 

SCREENING TOOL (ES) AND DATA COLLECTION (DC) TOOLS. THESE PREPOPULATED 

DATA WILL BE USED THROUGHOUT THE SURVEY TO ORIENT THE RESPONDENT TO 

THEIR EXPERIENCE WITH THE AGENCY AT THE TIME OF THE CONTACT IN WHICH THEY 

WERE SCREENED FOR ELIGIBILITY FOR THE STUDY. 

[ID Number – Footer ES/DC] 

[Agency Type – ES 2] 

ADRC 

AAA 

[Need Spanish interpreter – DC 6] 

Yes 

No 

[Need TRS service - DC 7] 

Yes 

No 

[Preferred call time – DC 5] 

PP1. [Agency Name – ES 1] ______________________________ 

PP2. [Respondent Type – ES 3] 

Self 

Parent 

Child 

Other relative 

Friend 

Neighbor 

Client/Patient 

Other: ____ 

[CATI INSTRUCTION: There are several places in the questionnaire where there is a “you/your [insert PP2]” 

construction or a “your/your [insert PP2]” construction, sometimes paired with the grammatical “are/is”
 

construction. If the PP2. Respondent Type is “Self”, use the first option (“you”). If the Respondent Type is 

anything else besides “Don’t Know” or “Refused”, use the second option (“your [insert PP2]”).]
 

PP3. [Study Type – ES 5/ES 6] 

Older Adult (response to 5=≥60) 

Disability (yes to any 6a-6f) 

PP4. [Result of Contact – ES 7] 

Information Assistance and/or Referral(s) (not including options counseling)____________ 

Options Counseling or Peer Support/Peer Counseling 

Page 464 
 

 

 

________________________________________________________________________________ 

 

 

 

 

 

 

 

 

 

 

 

 

 

Benefits Counseling or Eligibility Determination 

Transition assistance _________________________________ 

Crisis intervention 

Life skills training or support 

PP5. [Date of Contact – DC 1] 

(month, date, year) _ _ /_ _ /_ _ 

PP6. [Reason for contacting the agency (client’s need at time of the time of contact) – DC 8] 

PP7. [Mode of Contact – DC 10] 

In-person visit 

Telephone call 

PP8. [Respondent Name – DC 2] 

PP9. [Respondent Age – ES 5] 

1. Introduction 

"Hello, may I speak to _________ [insert PP8]? 

Hello, my name is [insert survey administrator name]. 

I am calling on behalf of the United States Administration for Community Living to ask about the quality of 

your experience with [insert PP1] on [insert pp5]. 

[INTERVIEWER NOTE: IF RESPONDENT DOES NOT REMEMBER CALLING OR VISITING THE
 

AGENCY, PLEASE JOG THEIR MEMORY BY MENTIONING IT BY NAME [INSERT PP1].
 

[PROGRAMMER NOTE: INCLUDE A SCREEN-OUT PUNCH FOR THOSE WHO INSIST THEY HAD
 

NO CONTACT WITH [INSERT PP1] AGENCY.]
 

During that [insert PP7; if blank, use ‘initial contact’] you talked to staff about service needs for you/your
 

[insert PP2], concerning [insert PP6]. At that time you said that you would be willing to participate in an
 

interview about your experience. Can I ask you some questions about that experience? It will only take 20 

minutes. 

I.1. Is now a good time for the interview about your experiences? 

Yes [If yes, skip to Statement of Informed Consent]
 

No, this is a bad time [GO TO I.2] 

No, I don’t remember calling agency [THANK AND END CALL] 

REF, no I don’t want to do an interview [GO TO I.3] 

I.2 When would be a better time to call back to do the interview? 

Page 465 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Gives call back time __________________________________ [SET CALLBACK, THANK AND END
 

CALL]
 

DK [END CALL]
 

REF [END CALL]
 

I.3 Can I ask why you are not interested in participating? _____________ 

DK 

REF 

Thank you for your time [end the call]. 

PARTICIPANT EXPERIENCE SURVEY STATEMENT OF INFORMED CONSENT 

I will read to you a statement of informed consent that will provide you with information about the survey and 

inform you of your rights as a survey respondent. The Administration for Community Living is sponsoring a 

national evaluation of the accessibility of community long-term supports and services. You are receiving this 

call because you contacted [PP1, name of agency] on [PP5, insert date] and gave your permission for a 

research team to contact you to participate in a brief telephone survey about your experience. The survey is 

being conducted by Abt SRBI on behalf of the Administration for Community Living. Your input about your 

experiences in obtaining community-based supports and services is important to us. Your participation in this 

20 minute survey is completely voluntary and you may choose to discontinue the interview at any time, for any 

reason. 

We will combine the information that we gather from all participants (about 3,400), and include the findings in 

a report that will be prepared for the Administration for Community Living for the purpose of improving its 

services. Your name or any other identifying information will not be used in any report generated in this study. 

Your confidentiality will be protected to the extent provided by law. There will be no direct benefit to you from 

participating in the evaluation, nor will your or your family’s services be impacted in any way by your 

responses to this survey. The information you provide will help the Administration for Community Living 

improve its services for both older Americans and individuals with disabilities. 

I.4. Do you agree to participate in this research study and begin study procedures as we have discussed? 

Agree [CONTINUE TO INTRO BEFORE P.1 AND A.1] 

Disagree [GO TO I.5] 

I.5. Can you tell me why you don’t wish to participate in the interview? _________________

DK 

REF 

[THANK AND END] 

2. Participant Experience Survey 

If you have any questions during the interview, please stop and ask me. Also, please let me know if you do not 

understand a question or if you would like me to repeat it. 

Page 466 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_________________________________________________ 

 

Section A. Initial Contact 

[IF PP7 IS BLANK, ASK A.0]
 

[THE ANSWER FOR A.0 WILL BECOME THE VALUE FOR PP7.]
 

A.0 Was the initial contact with [insert PP1] a telephone call or in-person visit? 

1. In-person visit 

2. Telephone call 

3. DK 

4. RF 

[IF DK OR RF, USE ‘INITIAL CONTACT’ FOR VALUE OF PP7]

[IF ES6=4 (undetermined study type, PP3), ASK A.0b]
 

A.0b I just need to verify your current age to be sure you are eligible for the study. Are you 60 years of age or 

older?
 

1. Yes 

2. No 

3. DK 

4. RF 

[IF A.0b = YES, GO TO SENTENCE BEFORE A.1 – “The first set of questions...”; OTHERWISE READ

THE FOLLOWING]: 

I’m sorry, but you are ineligible for this study. Thank you for your time. Goodbye. [TERMINATE 

INTERVIEW] 

The first set of questions has to do with the experiences that you had when you had a [insert PP7] with [insert 

PP1] on [insert PP5]. 

A.1. When you contacted [insert PP1], you said that the main reason for your [insert PP7] was [insert PP6]. 

Is that correct? 

YES [If yes, skip to A.3, else continue to A.2] 

NO 

DK 

REF 

A.2. I’m sorry; please tell me, what was the main reason that you contacted [insert PP1] on [insert PP5]? 

[RECORD RESPONSE; CODING WILL BE DONE IN POST-PRODUCTION] 

Safe and affordable housing options 

Peer support services/groups 

HCBS Medicaid Waiver Programs 

Caregiver Support (i.e. respite programs, support groups, or counseling) 

Page 467 
 

 

 

 

 

 

 

 

 

Nutrition Programs 

Employment services 

Education services 

Opportunities to develop advanced directives 

Transportation services 

Opportunities for socialization/recreation 

Mental health services 

Ombudsman services/Services related to abuse or neglect 

Health prevention and screening services 

Services for emergent cases/Crisis intervention 

Transition programs (from hospitals, nursing homes etc.) 

Nursing home (institutional) diversion programs 

Nursing home/residential beds 

Income assistance 

Energy assistance 

Personal care services 

Independent Living services (e.g., home modification, attendant care) 

Independent Living Skills training 

Other 

(VOL) DK 

(VOL) REF 

A.3. From where did you first find out about [insert PP1]? [CHECK MOST APPROPRIATE RESPONSE] 

Family member, friend or other acquaintance 

Hospital/Clinic/Doctor 

Nursing Home/Assisted Living 

Phone Book 

Brochure/Flyer 

Referral from senior center 

Referral from another agency/organization 

Through work 

Internet/Website 

Media/Newspaper/TV/Radio 

Other ______________________ 

DK 

REF 

A.4. Was [insert PP1] the first organization that you contacted about [insert PES A.2 if answered OR PP6]? 

Yes 

No 

DK 

REF 

Section B. Agency Efficiency 

Page 468 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

These next questions are about your experience during your [insert PP7] with [insert PP1] on [insert PP5]. 

B.1. [ASK ONLY IF PP7 = IN-PERSON VISIT; ELSE SKIP TO B.2] When you contacted the [insert 

PP1], how long did you wait during the initial contact to talk with someone who could help you with [insert 

PES A.2 IF ANSWERED OR PP6]? [DO NOT READ RESPONSES, PLEASE CHECK APPROPRIATE 

RESPONSE] 

Minimal wait (less than five minutes) 

Five to 10 minutes 

10 minutes to 20 minutes 

Over 20 minutes 

DK 

REF 

B.2. Were you able to talk to a representative during your first [insert PP7] with [insert PP1]? 

YES 

NO 

DK 

REF 

[IF ‘YES’ AT B.2, SKIP TO B.4. ELSE, ASK B.3]

B.3. Do you recall how many additional contacts you had to make before you were able to talk with a 

representative, including calls where you left a message on a machine? [DO NOT READ RESPONSES] 

[PROBE: IF NOT SURE, PROBE FOR BEST ESTIMATE AND READ CHOICES] 

None 

One 

Two 

Three 

Four or more 

DK 

REF 

B.4. Including the contact that you made with [insert PP1] on [insert PP5], how many times have you had to 

describe your request for services to [insert PP1], or explain what you needed? [DO NOT READ 

RESPONSES] 

One time 

Two times 

Three or four times 

Five or more times 

DK 

REF 

Page 469 
 

 

 

 

 

 

 

B.5. Throughout your contact with [insert PP1] did any of the following circumstances reduce or prevent your 

ability to resolve your issue? [READ EACH ITEM TO GET A YES/NO ANSWER] 

YES NO DK REF 

[insert PP1]’s hours of operation 1 2 3 4 

Difficulty reaching [insert PP1]’s staff 1 2 3 4 

Language or communication problems 1 2 3 4 

Lack of staff professionalism 1 2 3 4 

Lack of staff knowledge 1 2 3 4 

Lack of staff follow through 1 2 3 4 

Page 470 
 

 

 

 

 

 

 

 

 

 

 

 

 

Section C. Effectiveness of Agency Representative 

C.1. Did you feel the representative at [insert PP1] paid close attention to what you were saying? 

[READ CHOICES] 

Yes, definitely 

Yes, probably 

No, probably not 

No, definitely not 

DK 

REF 

C.2. In your opinion, how knowledgeable was the representative at [insert PP1] about the reason you 

contacted them, that is [insert PES A.2 if answered; else insert PP6]? Were they... 

[READ CHOICES] 

Very knowledgeable, 

Somewhat knowledgeable, 

Not very knowledgeable, or 

Not at all knowledgeable 

DK 

REF 

C.3. When you had a [insert PP7] with [insert PP1] on [insert PP5], was the information you received from 

the representative at [insert PP1] ...
 

[READ CHOICES]
 

Very clear and understandable, 

Somewhat clear and understandable, 

Not very clear or understandable, or
 

Not at all clear or understandable?
 

DK 

REF
 

C.4. Based on your request for help with [insert PES A.2 if answered; else insert PP6] when you contacted 

[insert PP1], did the representative ask questions that made you feel that the needs for which you initially 

contacted the agency were being correctly assessed? 

YES 

NO 

DK 

REF 

C.5. If assistance was requested, did the representative at [insert PP1] work with you to develop a plan 

outlining your next steps in meeting your/your [insert PP2]’s ongoing need for services or supports?

Page 471 
 

 

 

 

 

[INTERVIEWER NOTE: IF RESPONDENT IS UNCLEAR AS TO WHAT YOU MEAN BY ‘ SERVICES

AND SUPPORTS’, YOU MAY OFFER THIS DESCRIPTION: “SERVICES AND SUPPORTS ARE 

THINGS YOU MAY NEED TO MEET YOUR HEALTH OR PERSONAL CARE NEEDS AND TO ASSIST 

YOU WITH THE BASIC PERSONAL TASKS OF EVERYDAY LIFE ”.]

YES 

NO 

No assistance requested for long term care needs 

DK 

REF 

[if yes at C.5, go to C.6; otherwise skip to D.1] 

C.6. Does this plan accurately reflect your/your [insert PP2]’s needs and preferences for resolving the issue that 

you called about, that is [insert PES A.2 if answered; else insert PP6]? 

[READ CHOICES] 

Yes, definitely 

Yes, probably 

No, probably not 

No, definitely not 

DK 

REF 

Page 472 
 

 

 

 

 

Section D. Institutional Diversion 

D.1. When you contacted [insert PP1], were you considering a move to a long-term care facility, such as a 

nursing home, for yourself/your [insert PP2]? 

YES 

NO 

DK 

REF 

D.2. Did the representative you talked to at [insert PP1] on [insert PP5] help you to understand choices for 

staying in the community to avoid or delay moving to a nursing home or other long-term care facility? 

YES 

NO 

DK 

REF 

D.3. How likely is it that you/your [insert PP2] will have to move into a nursing home within the next five 

years? Would you say that it is...

[READ CHOICES] 

Very likely, 

Somewhat likely, 

Somewhat unlikely, or 

Very unlikely 

DK 

REF 

Page 473 
 

 

 

 

 

 

 

 

 

 

 

 

 

Section E. Assistance with Services 

From the next set of questions, we would like to learn about your experiences in obtaining the services for 

which you contacted [insert PP1] on [insert PP5]. 

E.1. Did you receive access to the service that you/your [insert PP2] needed directly from [INSERT PP1] or 

indirectly by a referral to another agency? 

Directly ([insert PP1] provided the service) [If selected, skip to Section E1] 

Indirectly (you were referred elsewhere) 

Both/some services provided by [insert PP1] staff and some through referrals 

DK 

REF 

E.2. Did the representative of [insert PP1] help you/your [insert PP2] to connect with the services you/your 

[insert PP2] needed? 

YES [If yes, continue to E.3; else skip to Section E1] 

NO 

DK 

REF 

E.3. Did the representative of [insert PP1] transfer your call to an agency or organization that provided 

you/your [insert PP2] with your/your [insert PP2]’s needed or requested services?

YES 

NO 

DK 

REF 

[IF YES, SKIP TO E.6, OTHERWISE, GO TO E.4]] 

E.4. Did the representative of [insert PP1] give you contact information (telephone number, address, web 

address) of an agency or organization that provided you/your [insert PP2] with needed or requested services? 

YES [If yes, skip to E.6; else continue to E.5] 

NO 

DK 

REF 

E.5. Did the representative of [insert PP1] contact the service provider and arrange for them to contact you? 

YES [If yes, continue to E.6; else, skip to Section E1] 

NO 

DK 

REF 

Page 474 
 

 

 

 

 

_______________________________________ 

 

 

 

 

 

 

 

 

E.6. When you contacted the provider about the services you were seeking, did that provider already have the 

information that you gave to [insert PP1] or did you have to explain your/your [insert PP2]’s need again?

[READ CHOICES] 

Provider had the information 

Provider had the information but it wasn’t correct or it was incomplete and you had to start the process again 

Provider did not have the information and you had to start the process again 

DK 

REF 

E.7. As a result of your contact with [insert PP1], to what supports and services were you transferred or 

referred? [RECORD RESPONSE BELOW (CODING WILL BE DONE IN POST-PRODUCTION)] 

Safe and affordable housing options 

Peer support services/groups 

HCBS Medicaid Waiver Programs 

Caregiver Support (i.e. respite programs, support groups, or counseling) 

Nutrition Programs 

Employment services 

Education services 

Opportunities to develop advanced directives 

Transportation services 

Opportunities for socialization/recreation 

Mental health services 

Ombudsman services/Services related to abuse or neglect 

Health prevention and screening services 

Services for emergent cases/Crisis intervention 

Transition programs (from hospitals, nursing homes etc.) 

Nursing home (institutional) diversion programs 

Nursing home/residential beds 

Income assistance 

Energy assistance 

Personal care services 

Medicaid waiver assistance 

Independent Living services (e.g., skills training, peer support) 

Other _______________ 

None 

DK 

REF 

E.8. What was the result of the referral? [READ FROM THE FOLLOWING LIST AND CHECK THE 

MOST APPROPRIATE RESPONSE] 

You/your [insert PP2] received services [If selected, skip to Section E1] 

You/your [insert PP2] DID NOT receive services [Ask E.9] 

Page 475 
 

___________________________ 

 

 

 

 

 

 

 

 

 

 

It’s too soon to tell [If selected, skip to Section E1] 

(VOL) Don’t Know [If selected, skip to Section E1] 

(VOL) Refuse [If selected, skip to Section E1] 

E.9. You said that you/your [insert PP2] did not receive the services through the referral; why do you think that 

is? [RECORD RESPONSE; CODING WILL BE DONE IN POST-PRODUCTION] 

The services were not what [insert PP2] wanted/needed 

The service/program is not accepting applications/there is a waitlist 

It is too expensive 

There is no transportation 

The service or program is not available at times needed 

[insert PP2] is not eligible
 

I tried to contact the service or program that was referred, but was busy/unavailable 

Line was busy
 

Wait time too long
 

Other ___________________ 

Have not yet contacted, but plan to 

Have no plans to contact the service or program 

Please Specify reason ____________________ 

DK 

REF
 

Section E1. Assistance with Medicaid Eligibility Determination
 

The next set of questions has to do with information and help that you may have received from [insert PP1] on
 

whether or not you/your [insert PP2] are/is eligible for the Medicaid program in this state. Medicaid can
 

provide financial assistance from the federal government for paying for your healthcare or for services you
 

might need to support yourself living at home or in another community residence. Just to be clear, this section
 

will not discuss Medicare, which is a public health insurance program for people age 65 or older and people 

under age 65 that have certain disabilities.
 

Continue
 

(VOL) Already receive Medicaid benefits [SKIP TO SECTION E2]
 

(VOL) Did not talk about being eligible for Medicaid benefits [SKIP TO SECTION E2]
 

E1.1. Did you receive specific information on applying for financial assistance for healthcare and residential
 

support services from the federal government? 

YES 

NO [SKIP TO E1.7]
 

DK 

REF
 

Page 476 
 

 

 

 

 

 

 

 

 

 

 

E1.2. Did you complete an application for financial assistance for healthcare and residential support services 

from the federal government? 

YES [If yes, continue to E1.3]
 

NO [ASK E1.2a]
 

DK [GO TO E1.7]
 

REF [GO TO E1.7]
 

E1.2a. Why not? __________________ [GO TO E1.7]
 

E1.3. Were you provided with help by the [insert PP1] in completing the application for financial assistance for
 

healthcare and residential support services from the federal government?
 

YES 

NO 

DK 

REF
 

E1.4. Did the [insert PP1] help explain what information concerning your finances and care needs might be
 

needed to determine if you were eligible for federal assistance for healthcare and residential support services?
 

YES 

NO 

DK 

REF
 

E1.5. How long did you wait to find out if you/your [insert PP2] [are/is] eligible for financial assistance for
 

healthcare and residential support services from the federal government? [DO NOT READ RESPONSES,
 

CHECK APPROPRIATE RESPONSE] 

One day or less 

Two to six days 

One week 

More than one week, but less than a month 

Over a month 

Still waiting
 

DK 

REF
 

E1.6. Did the [insert PP1] mention they were helping you to apply for the Medicaid program, or did they use a
 

different name to describe this financial assistance program? 

YES, Medicaid [GO TO E1.7]
 

NO, some other program [ASK E1.6a]
 

DK [GO TO E1.7]
 

REF[GO TO E1.7]
 

Page 477 
 

 

 

 

 

 

 

 

 

 

 

E1.6a. What was the name of this program? __________________ [ SPECIFY] 

E1.7. Were you given information by the agency about other types of insurance, including private coverage and 

other types of government insurance, besides Medicaid/[answer from E1.6a]? [PROGRAMMER NOTE: IF 

ANSWER TO E1.6a. IS “DON’T KNOW” OR “REFUSED”, SKIP TO E2.1.]

YES 

NO 

DK 

REF 

[ASK E1.7a IF ‘YES’ AT E1.7; OTHERWISE SKIP TO E2.1]

E1.7a Which other insurance resources were you given information on? ______________________________ 

Section E2. Assistance with One-on-One Options Counseling 

E2.1. Did you REQUEST a conversation with someone to talk with about understanding and selecting the longterm services beyond information and referral, such as home delivered meals, personal care, help around the 

house,transportation, or other similar kinds of services? 

YES 

NO 

DK 

REF 

[ASK E2.2 IF ‘YES’ AT E2.1; OTHERWISE SKIP TO SECTION E3]

E2.2. Did you HAVE a conversation with someone about understanding and selecting the long-term services
 

beyond information and referral?
 

YES 

NO [Skip to Section E3]
 

DK [Skip to Section E3]
 

REF [Skip to Section E3]
 

E2.3. Did the person you talked to about understanding and selecting the long-term services visit you at your
 

home/your [insert PP2]’s home?
 

YES 

NO 

DK 

REF
 

E2.4. Following the first conversation, did this person follow-up with you either by phone calls and/or
 

additional in-home visits?
 

Page 478 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YES 

NO 

DK 

REF 

E2.5. Did the information and support from the person you talked to about understanding and selecting the 

long-term services help you to: [READ CHOICES] [RANDOMIZE ITEMS] 

Yes, Yes, No, No, n/a; DK; RF 

definitely probably probably not definitely not 

Better understand your/your [insert PP2]’s long term service and support options?
 

Make a decision about long-term support services?
 

Get in touch with public programs?
 

Get in touch with private services including services that you have to pay for
 

yourself?
 

Obtain long-term support planning or services that fit within your budget?
 

E2.6. How satisfied or dissatisfied are you with the service you received from the person you talked to about 

understanding and selecting the long-term services? [READ CHOICES]
 

Very satisfied 

Somewhat satisfied 

Somewhat dissatisfied 

Very dissatisfied 

DK 

REF
 

Section E3. Care Transition Services
 E3.1. Based on your contact with [insert PP1], did you/your [insert PP2] receive services that helped you/your 

[insert PP2] to transition from a hospital or other acute care facility into the community?
 

YES 

NO 

DK 

REF
 

[ASK E3.2 IF ‘YES’ AT E3.1; OTHERWISE SKIP TO SECTION F]

E3.2. Based on your contact with [insert PP1], did you/your [insert PP2] receive any of the following 

services? [READ CHOICES] 

YES NO DK REF 

A contact before discharge to assess your/your [insert PP2]’s

discharge needs.................................................... 1 2 3 4 

An explanation of your/your [insert PP2]’s discharge 

instructions.......................................................... 1 2 3 4 

Post discharge services such as transportation to the doctor, 

help filling prescriptions, or household help................... 1 2 3 4 

Follow-up phone call or visit within 48 hours of discharge.... 1 2 3 4 

Page 479 
E3.3. How satisfied or dissatisfied are you with the transition services you/your [insert PP2] received? 

[READ CHOICES] 

Very satisfied 

Somewhat satisfied 

Somewhat dissatisfied 

Very dissatisfied 

DK 

REF 

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Section F. Services Received from the [insert PP1] 

Now I’d like to ask you some questions about the overall results of your contact with [insert PP1]. 

F.1. Did you/your [insert PP2] ever receive the service for [insert PES A.2 if answered; else insert PP6] that
 

you were seeking based on your contact with [insert PP1]? 

[READ CHOICES]
 

YES, within one week of contact 

YES, after more than a week 

NO, have not yet received the service 

DK 

REF 

[ASK F.2 IF ‘NO’ AT F.1; OTHERWISE SKIP TO F.3] 

F.2. Why do you think you/your [insert PP2] have/has not received the services for [insert PES A.2 if 

answered; else insert PP6]? [READ CHOICES] [RANDOMIZE ORDER] [MULTIPLE SELECTION] 

[WAIT FOR RESPONSE AFTER EACH CHOICE] 

The services are not available. 

You/your [insert PP2] are/is on a waitlist. 

You/your [insert PP2] could not get to the services (e.g., hours of operation, transportation barriers)
 

The information and help received from [insert PP1] was not useful. 

You/your [insert PP2] did not follow-up on the information and/or referral.
 

You/your [insert PP2] no longer need the services. 

Difficulties filling out paperwork
 

Not being the right age for these services
 

Some other reason [SPECIFY]
 

DK
 

RF
 

F.3. Since contacting the [insert PP1] on [insert PP5], have you been in touch with any other agencies similar 

to [insert PP1] to receive [insert PES A.2 if answered; else insert PP6]? 

YES 

NO 

DK 

REF 

[ASK F.3a. IF ‘YES’ AT F.3; OTHERWISE GO TO F.5] 

F.3a. What other agencies or organizations were contacted? __________________ 

F.4. Were there any needs that this other agency or organization was able to meet that [insert PP1] was NOT 

able to meet? 

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YES [GO TO F.4a] 

NO [SKIP TO F.5] 

DK [SKIP TO F.5] 

REF [SKIP TO F.5] 

F.4a What needs was this other agency or organization able to meet? ___________________ 

Now, turning back to [INSERT PP1]... 

F.5. As a result of your conversations with [insert PP1] staff, did you realize that you/your [insert PP2] had a 

need or concern that you did not know that you/your [insert PP2] had before contacting the [insert PP1]? 

YES 

NO 

DK 

REF 

F.6. Did the [insert PP1] follow up with you to find out how useful the information they provided was or how 

the referral turned out? 

YES 

NO 

DK 

REF 

F.7. On the following scale, as a result of your contact with [insert PP1], how satisfied or dissatisfied are you 

with... [RANDOMIZE ORDER FOR ITEMS 1-7, ALWAYS ASK ITEM 8 LAST] 

Very satisfied Somewhat satisfied Somewhat Very dissatisfied; 

dissatisfied DK; REF
 

The services that you/your [insert PP2] received directly from [insert PP1]? [ONLY 

ASK IF E.1 = 1 OR 3]
 

Completeness of the information that you received?
 

The degree to which their services met your specific needs ?
 

The accuracy of the information provided?
 

The support you received related to decision-making?
 

The professionalism of the staff?
 

The ease of working with [insert PP1] to resolve the issue related to [insert PES A.2 if
 

answered or PP6]? 

The quality of the services that you/your [insert PP2] received from agencies you were
 

referred to by [insert PP1]? [INCLUDE A NOT APPLICABLE PUNCH FOR THIS
 

ITEM][ONLY ASK IF E.1 = 2 OR 3]
 

[FOR EACH ITEM THAT IS ANSWERED ‘SOMEWHAT DISSATISFIED’ OR ‘VERY DISSATISFIED’,

ASK]:
 

F.7a. Please tell me why you were [somewhat or very] dissatisfied with [item].
 

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F.8. As a result of your contact with the [insert PP1], would you say that you are..... 

[READ CHOICES] 

Much more certain about your/your [insert PP2]’s long term care options 

A little more certain 

About the same 

A little more confused about your/your [INSERT PP2]’s long term care options, or 

Much more confused 

DK 

REF 

F.9. To what degree has the information you received from [insert PP1] been useful to you as you select the 

long term care options that are best for you/your [insert PP2]? [READ CHOICES] 

Very useful 

Somewhat useful 

Not too useful 

Not useful at all 

DK 

REF 

F.10. Would you tell a friend or relative who needed help to contact the [insert PP1]? 

YES 

NO 

DK 

REF 

F.11. How likely is it that you would contact the [insert PP1] if you needed services in the future? 

[READ CHOICES] 

Very likely 

Somewhat likely 

Somewhat unlikely 

Very unlikely 

DK 

REF 

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Section G. Heath and Demographic Information 

In the next set of questions we would like to learn a little about your/your [insert PP2]’s health and health 

insurance. 

G.1. Do you/Does your [insert PP2] have any of the following types of health insurance? [Record all that 

apply] [READ CHOICES] 

YES NO Don’t 

Know 

REF 

Medicare 

Private Health Insurance 

Some other kind of health 

insurance[specify]______________ 

No insurance 

G.2. At the present time, would you say you/your [insert PP2]’s health is excellent, good, fair, or poor? 

Excellent 

Good 

Fair 

Poor 

(VOL) [insert PP2] has passed away 

DK 

REF 

G.3. Have/has you/your [insert PP2] been admitted to a hospital in the past 6 months? 

Yes 

No 

DK 

REF 

The last set of questions will tell us a little more about you/your [insert PP2]. This information is used to 

describe the group of persons included in the study and will not be used to identify you/your [insert PP2] as an 

individual. We will use this information to determine whether or not the [insert PP1] and other similar agencies 

are reaching all members of the community. 

G.4. [Ask only if PP2= SELF, else go to G.5] 

What is your date of birth? [month/day/year] 

G.5. What is the date of birth of the person for whom you contacted the agency? [month/day/year] 

G.6. What is your/your [insert PP2]’s gender? [BY OBSERVATION UNLESS NEEDED] 

Male 

Female 

DK 

REF 

Page 484 
 

 

 

 

 

 

 

G.7. What is the highest grade or year of school you/your [insert PP2] have/has completed? [READ AS 

NEEDED TO PROBE] 

No formal schooling 

First through 7th grade 

8th grade 

Some high school 

High school graduate or high school equivalency (GED) 

Some college 

Associates degree 

Four-year college graduate 

Some graduate school 

Graduate and professional degrees 

(VOL) DK 

(VOL) REF 

G.8. Are you/Is your [insert PP2] Hispanic, Latino, or of Spanish origin?
 

[INTERVIEWER NOTE: IF RESPONDENT SAYS THEY ARE MEXICAN, MEXICAN AMERICAN,
 

CHICANO, PUERTO RICAN OR CUBAN, COUNT THAT AS A ‘YES’.]

Yes 

No, not of Hispanic, Latino, or Spanish origin 

DK 

REF 

G.9. What is your/your [insert PP2]’s race? One or more categories may be selected.

[READ LIST AND MULTIPLE RECORD] 

White 

Black or African American 

American Indian or Alaska Native 

Asian or Asian American 

Native Hawaiian or other Pacific Islander 

(VOL) Other (SPECIFY) 

(VOL) DK 

(VOL) Refused 

G.10a. And now, what was your/your [insert PP2]’s total household income last year from all sources before

taxes? Include your/your [insert PP2]’s income and income from anyone else living in your/your [insert 

PP2]’s household. Do not tell me the amount. Please just tell me the answer that best represents your/your 

[insert PP2]’s household income.

[CHECK APPROPRIATE RESPONSE] [READ CHOICES] [PROBE: Your best estimate is fine.] 

1. Less than or equal to $40,000 [GO TO G.10b] 

2. More than $40,000 to $80,000 [GO TO G.10c] 

3. More than $80,000 [GO TO G.10d] 

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4. (VOL) [insert PP2] has passed away [SKIP TO G.14] 

5. (VOL) Don’t know [GO TO G.11] 

6. (VOL) Refused [GO TO G.11] 

G.10b. Was that: 

1. Less than or equal to $20,000 or 

2. More than $20,000 

3. (VOL) Don’t know

4. (VOL) Refused 

[GO TO G.11] 

G.10c. Was that: 

1. Less than or equal to $60,000, or 

2. More than $60,000 

3. (VOL) Don’t know

4. (VOL) Refused 

[GO TO G.11] 

G.10d. Was that: 

1. Less than or equal to $100,000 

2. More than $100,000 to $150,000, or 

3. More than $150,000 

4. (VOL) Don’t know

5. [VOL] Refused 

[SKIP TO G.14 IF RESPONDENT SAID THEIR [INSERT PP2] PASSED AWAY IN G.2] 

G.11. What is your/your [insert PP2]’s marital status? Are you/Is your [insert PP2] .....

Married 

Living together 

Widowed 

Divorced 

Separated 

Single, never married 

(VOL) DK 

(VOL) Refused 

G.12. With whom, if anyone, do you/does your [insert PP2] live? [READ LIST; SELECT ONE] 

Alone 

With a spouse or partner 

With one or more other family members 

With one or more friends/people who are not related to me 

Other residents (e.g., roommate) in a residential setting 

(VOL) DK 

(VOL) REF 

We will now be asking some questions about your current housing situation...

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G.13. Of the following choices, which one most closely describes your/your [insert PP2]’s living situation? Do
 

you/Does your [insert PP2] live in...... [READ CHOICES] 

[INTERVIEWER NOTE: SEE FAQ FOR DEFINITIONS OF THESE ITEMS IF NEEDED]
 

My/His or her own house or apartment 

Non-medical custodial housing 

In an assisted living facility 

In a nursing home 

In a continuing care retirement community 

In some other setting [specify] ____________________________ 

[IF YES TO ‘G.13.3, SKIP TO G.14a] 

G.14. Have you/has your [insert PP2] ever lived in an assisted living setting? 

Yes [ASK G.14a]
 

No [SKIP TO G.15]
 

(VOL) DK [SKIP TO G.15]
 

(VOL) REF [SKIP TO G.15]
 

G.14a. How long did you/your [insert PP2] live in the assisted living setting? __ _ /_ _ (months/years)
 

[DON’T ASK G.15 IF RESPONDENT ANSWERED “4. In a nursing home” IN G.13, BUT DO ASK G15a]

G.15. Have you/has your [insert PP2] ever lived in a nursing home? 

Yes 

No 

(VOL) DK 

(VOL) REF 

[ASK G.15a IF ‘YES’ AT G.15 OR CHOICE 4 AT G.13. OTHERWISE, GO TO END]

G.15a. How long did you/your [insert PP2] live in the nursing home?__ _ /_ _ (months/years)
 

THANK YOU VERY MUCH FOR TAKING THE TIME TO SHARE YOUR EXPERIENCES OF SEEKING
 

INFORMATION ABOUT SERVICES IN YOUR COMMUNITY. IT IS OUR HOPE THAT THE
 

INFORMATION THAT YOU PROVIDED WILL HELP IMPROVE THE ACCESSIBILITY AND QUALITY
 

OF SERVICES IN YOUR COMMUNITY.
 

[CATI: ADD THESE QUESTIONS TO THE SCRIPT IMMEDIATELY AFTER THE RESPONDENT 

INTRODUCTION]
 

CP1. Is this number that I called you on a cell phone?
 

(If asked why: I just want to offer to call you on a land-line phone, or at a time when you are not driving 

if this is a cell phone) 

Yes (GO TO CP2)
 

No (SKIP TO A) 

REFUSAL - SOFT (SOFT REFUSAL - THANK & END)
 

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REFUSAL - HARD (HARD REFUSAL - THANK & END)
 

CP2. Is there a land line where you would prefer me to call to conduct the interview? 

Yes (UPDATE PHONE TO LAND LINE & SCHEDULE CB) 

No, continue on cell phone 

REFUSAL – SOFT (SOFT REFUSAL - THANK & END) 

REFUSAL - HARD (HARD REFUSAL - THANK & END) 

CP3. Are you currently driving, or someplace else where it IS NOT safe to talk on your cell phone? 

YES/CALL ME LATER (SCHEDULE CALLBACK) 

No, respondent can talk now 

REFUSAL – SOFT (SOFT REFUSAL - THANK & END) 

REFUSAL - HARD (HARD REFUSAL - THANK & END) 

CP4. Is now a good time to talk? 

(INTERVIEWER: IF EVENINGS / WEEKENDS ARE BETTER BECAUSE RESPONDENT IS NOT 

CHARGED FOR CELL USAGE, SCHEDULE CALLBACK AND RECORD COMMENTS) 

Yes, now is fine (CONTINUE TO A1a)
 

No, another time is better (SCHEDULE CALLBACK & record comments about best call times)
 

REFUSAL – SOFT (SOFT REFUSAL - THANK & END)
 

REFUSAL - HARD (HARD REFUSAL - THANK & END)
 

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APPENDIX S. OUTCOME EVALUATION SURVERY ADMINISTRATION
 

Sample Transfer and Disposition Code 

Both landline and cell sample were provided through the recruitment process conducted by staff of the sampled 

ADRCs and AAAs. The sample was transmitted from Abt Associates to its subsidiary Abt SRBI via the secure 

file transfer protocol system Move-It DMZ. There was only one replicate, with sample released for dialing as it 

came in from Abt. A total of 1,169 phone numbers were dialed. 

Upon completion of an interview, or final disposition of the call, each record was assigned a final disposition 

code based on the American Association for Public Opinion Research (AAPOR) definitions. AAPOR’s 

recommended final disposition codes are the latest and most successful effort to standardize final disposition 

codes and the outcome rates calculated from them. 

Phone Survey Administration 

The ADRC Evaluations Study telephone survey was fielded from July 1st, 2013 until April 2nd, 2014, and was 

split into three phases: the cognitive test, the pre-test, and the main telephone survey. The cognitive test was 

conducted from July 1st, 2013 until July 14th, 2013. The average interview length was 38 minutes (39 for 

landline and 38 for cell). The pre-test was conducted from August 7th, 2013 until August 13th, 2013. The 

average interview length was 21 minutes (21 for landline and 21 for cell). The main telephone survey was 

conducted from August 20th, 2013 until April 2nd, 2014. The average interview length was 22 minutes (22 for 

landline and 22 for cell). 

The survey included questions about clients’ experience working with their local ADRC or AAA, the efficiency

of these agencies in dealing with their clients’ problems, the effectiveness of the specific agency representative 

they worked with, moving to a long-term care facility, how well the clients were able to actually obtain the 

services they were looking for from the facility, getting assistance with Medicaid eligibility determination, 

getting assistance with one-on-one options counseling, getting help from the agency on transitioning from a 

hospital or other acute care facility into the community, whether they actually received the services they were 

asking for and if not, why not, and details about their health and demographic characteristics. 

Language 

Interviews were conducted in English and Spanish. Both translations were programmed into the CATI script. 

Call Protocol 

Records were dialed a maximum of 30 times. Numbers were dialed until they achieved a terminal disposition or 

reached maximum attempts. Messages were left on voicemail after the 16th and 20th attempts. Up to one 

refusal conversion attempt was made within the telephone survey call for initial, non-harsh (“soft”) refusals. 

Calls were made between 9 am and 9 pm every day of the week, and callback appointments were set and made 

with respondents. In accordance with laws prohibiting cell phone numbers being called by automated dialers, 

all cell phone numbers were manually dialed. 

Cognitive Test and Pre-Test Phases 

Forty cognitive interviews were conducted between the dates of July 1st and July 14th. Respondents were 

administered the actual questionnaire with a total of 55 cognitive probes inserted throughout the interview. 

Because of the large number of cognitive probes, there were two groups of 20 respondents each who were 

administered half of the probes. Group A was administered probes P1-P30, and Group B was administered 

probes P1-P5 and P31-P55. 

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After administration, a cognitive report was written. A verbatim record of answers from the cognitive probes 

was provided. Along with the verbatim response was a question by question analysis of the cognitive probes. 

This analysis provided results and recommendations for changes to the main questions, based on respondents’

answers to the probes and notes from the interviewers. A record of nonresponse was also provided for the main 

questions that at times added to recommendations for changes to the questionnaire. 

There were several recommendations which required feedback from Abt and ACL to ensure Abt SRBI’s

suggested changes were in line with what the client intended the questions to ask. These recommendations were 

discussed with the ACL client, Abt and IMPAQ staff. These changes were detailed in the report titled “5177

ADRC Evaluations - Cognitive Testing Topline Report 7-24-13 (2)-Jenkins comments” (see Attachment J). 

SRBI’s recommended changes fell into the following categories: 

 If needed, reminders as to which ADRC or AAA the respondent contacted. 

 In certain places, making questions more specific, using references to the initial contact with the ADRC 

or AAA on the date specified in the sample file for the need that they provided. 

 Streamlining questions, including changes in wording and the incorporation or removal of parenthetical 

statements in a way that is easier for respondents to understand and for interviewers to administer. 

 In a couple of places where the respondent type (PP2) is not the self, clarifying whether the question is 

asking about the patient or the caretaker, or both. 

 Providing definitions of certain terms that are used in the questions, and at times providing examples of 

these terms. 

 Clarifying references to the agency they initially contacted and agencies or organizations that the initial 

agency referred them to. 

 Providing transition sentences, phrases or paragraphs between series of questions that differ in focus. 

 A few technical changes, including “read choices” instructions and “not applicable” response options.

 Splitting a double-barreled item into two items, or changing the wording of it. 

Most of the recommended changes were made, and the revised survey (sans cognitive probes) was then 

prepared for the pre-test. A pre-test of 70 interviews was then administered for a week, mostly to make sure the 

timing fell approximately within the budgeted 20 minute length. There was a questionnaire produced which 

showed all the changes that took place from the original IRB and OMB-approved questionnaire to the final 

questionnaire that was fielded. This document was titled “5177 ADRC EVALUATIONS PARTICIPANT 

EXPERIENCE SURVEY_track changes for OMB.”

Details on the CATI System 

Abt SRBI has been conducting CATI surveys for more than 20 years. As a dedicated survey research 

organization, all of Abt SRBI’s CATI facilities are designed with the objective of collecting high quality data 

through any design. All Abt SRBI interviewers work from physical Abt SRBI call centers located in the U.S. 

Abt SRBI has over 430 dedicated CATI stations across five call centers located in: New York City, NY; Fort 

Meyers, FL; West Long Branch, NJ; Huntington, WV; and Hadley, MA. Each CATI station is connected to a 

network system where the data from each completed interview is continuously saved and stored on our secure 

servers. The CATI servers are built on a Storage Area Network (SAN) at a facility with a high level of physical 

security and redundant power. 

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Abt SRBI’s CATI data collection system uses IBM’s data collection software which runs on a RedHat Linux

server platform. Interviewers dial manually for cell phone samples or automatically via predictive dialers for 

landline samples. Some of the capabilities of this system are: customizable, automated sample management 

rules; customizable, automated interim and final call dispositions; real-time data entry; random respondent 

selection from multiple eligibles; error, range, and consistency checking; complex skip patterns; real-time 

interviewer monitoring; single, multiple, numeric, real, or open-ended responses; ability to rotate and randomize 

lists, questions, and blocks of questions; and detailed and flexible call scheduling capability. Abt SRBI’s 

programmers have worked with the Quancept CATI system for over 10 years and have programmed over 500 

telephone surveys annually, including the 2011 LACHS, the NYCCHS, and nine state BRFSS surveys since 

2005. 

Toll-free number 

A toll-free number was set up at the New York field office that conducted the interviews, in order to field any 

questions or concerns about the study. A voicemail message was recorded on this phone number, and Abt 

SRBI’s staff responded to every voicemail left by respondents.

Respondent Demographic Characteristics 

A comparison of demographics for cognitive interview completes, pre-test completes, main interview 

completes, and total completes follows.2 

Exhibit 1. PES Respondent Demographic Characteristics 

Cognitive 

Completes 

N 40 

Pre test 

Completes 

N 70 

Main 

Completes 

N 515 

Total 

Completes 

N 625 

Gender 

Male 25% 24.3% 30.9% 29.8% 

Female 75% 75.7% 68.9% 70.1% 

Age 

Less than 18 0% 1.4% 0.2% 0.4% 

18 – 24 0% 0% 1.2% 1% 

25 – 34 5% 0% 1.4% 1.4% 

35 – 44 7.5% 1.4% 3.5% 3.5% 

45 – 54 17.5% 8.6% 6.8% 7.7% 

55 – 64 30% 20% 19.8% 20.5% 

65 – 74 15% 24.3% 25.2% 24.5% 

75+ 25% 42.9% 39.8% 39.2% 

Health Insurance 

2 Some percentages may not add up to 100% for a given question as a result of respondents reporting they do not know the answer or 

refusing to answer. Additionally, the percentages in multiple response questions may not add up to 100% if respondents selected more 

than one response. 

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Cognitive 

Completes 

N 40 

Pre test 

Completes 

N 70 

Main 

Completes 

N 515 

Total 

Completes 

N 625 

Medicare 47% 53.4% 51.2% 51.1% 

Private Health Insurance 16% 33% 28.5% 28.2% 

Some other kind of health insurance 10% 1% 3.8% 3.9% 

No insurance 2% 2.9% 2.7% 2.6% 

Medicaid (added code) 18% 5.8% 9.9% 10% 

State/County medical assistance program 

(added code) 3% 1% 1% 1.1% 

TriCare/Champ/Veterans/Military coverage 0% 1% 1% 0.9% 

Supplemental Coverage (added code) 3% 0% 1% 1% 

Ethnicity 

Hispanic 2.5% 1.4% 3.7% 9.4% 

Not Hispanic 97.5% 98.6% 95.3% 89.8% 

Race [Multiple Response] 

White 78.6% 90.4% 78.8% 80.1% 

Black or African American 16.7% 5.5% 13.8% 13% 

American Indian or Alaska 

Native 4.8% 2.7% 3.4% 3.4% 

Asian or Asian American 0% 0% 0% 0% 

Native Hawaiian or other 

Pacific Islander 0% 0% 0.2% 0.2% 

Other 0% 1.4% 2.3% 2% 

(VOL) Hispanic/Latino 0% 0% 0% 0% 

Income 

Less than or equal to $20,000 72.5% 52.9% 60.2% 60.2% 

$20,001 - $40,000 20% 30% 18.8% 20.2% 

$40,001 - $60,000 0% 4.3% 4.5% 4.2% 

$60,001 - $80,000 2.5% 0% 2.9% 2.6% 

$80,001 - $100,000 0% 1.4% 0.8% 0.8% 

$100,001 - $150,000 0% 0% 0.6% 0.5% 

More than $150,000 0% 0% 0% 0% 

Language of Interview 

English 20% 100% 99.6% 99.7% 

Spanish 80% 0% 0.4% 0.3% 

Education 

No formal schooling 5% 1.4% 1% 1.3% 

Grades 1-8 10% 8.3% 8.6% 8.6% 

Some high school 12.5% 8.6% 10.5% 10.4% 

HS grad or GED 32.5% 35.7% 37.7% 37.1% 

Some college 25% 21.4% 15.9% 17.1% 

Associates degree 7.5% 7.1% 5.4% 5.8% 

Four-year college graduate 2.5% 7.1% 8.7% 8.2% 

Some graduate school 0% 2.9% 1.4% 1.4% 

Graduate and professional degrees 5% 4.3% 4.7% 4.6% 

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Cognitive 

Completes 

N 40 

Pre test 

Completes 

N 70 

Main 

Completes 

N 515 

Total 

Completes 

N 625 

Marital Status 

Married 25% 22.9% 27% 26.4% 

Living Together 0% 2.9% 0.4% 0.6% 

Widowed 27.5% 35.7% 33.6% 33.4% 

Divorced 32.5% 22.9% 22.7% 23.4% 

Separated 5% 2.9% 2.9% 3% 

Single, never married 10% 10% 10.3% 10.2% 

Household Composition 

Alone 52.5% 52.9% 41.7% 43.7% 

With a spouse or partner 22.5% 24.3% 24.7% 24.5% 

With one or more other family members 22.5% 12.9% 24.1% 22.7% 

With one or more friends/people who are not 

related to me 2.5% 1.4% 2.5% 2.4% 

Other residents in a residential setting 0% 5.7% 4.7% 4.5% 

Household Type 

Own house or apartment 82.5% 81.4% 79.8% 80.2% 

Non-medical custodial housing 2.5% 0% 1.4% 1.3% 

In an assisted living facility 5% 10% 4.5% 5.1% 

In a nursing home 0% 1.4% 2.3% 2.1% 

In a continuing care retirement 

community 0% 0% 0.8% 0.6% 

In some other setting 5% 1.4% 2.7% 2.7% 

With family/friend/partner 5% 2.9% 6.4% 5.9% 

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APPENDIX T. OUTCOME EVALUATION ADRC SURVEY RESPONSE TABLES 

The following tables contain tabulations of responses to the Participant Experience Survey questions. 

Frequencies indicate the number of respondents selecting each response, while percentages are weighted 

following the methodology outlined in section 1.4 of the Outcome Evaluation Analysis Report. The final 

sampling weight is a combination of a base weight and an adjustment for nonresponse at the agencylevel. 

Section PPS. Pre-Populated Information Based on the Client Screening Tool (ES) and 

Data Collection (DC) Tools
 

Agency Type ES2 

Frequency Percentage 

ADRC Certainty 300 6.89 

ADRC Rural 93 26.49 

ADRC Urban 159 66.62 

Total 552 100 

Needs Spanish Interpreter DC6 

Frequency Percentage 

Yes 548 97.76 

No 4 2.24 

Total 552 100 

Need TRS service DC 7 

Frequency Percentage 

Yes 543 96.21 

No 6 1.63 

No Response 3 2.16 

Total 552 100 

Preferred Call Time DC5 

No Data Available 

PP1. Agency Name ES 1 

Frequency Percentage 

Ability Resources 3 1.42 

Appalachian Agency for Senior Citizens 6 3.77 

Area IV-Agency on aging and Community 12 19.49 

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PP1. Agency Name ES 1 

Frequency Percentage 

Action Programs (Area 4) 

Area V- Southeast Idaho Area Agency on 

Aging 2 0.54 

Area VI 8 0.37 

Choices in Living Resource Center 165 3.79 

Community Choices: North Central Region 9 2.48 

Concho Valley ADRC 5 1.49 

Essex County 4 2.82 

Generations 17 5.99 

Kiamichi Economic Development District of 

Oklahoma (KEDDO) AAA 1 0.30 

Larimer County ARCH 1 0.15 

Lifelong Links ARDC Heritage AAA 25 1.53 

Mesa County ARCH 7 1.07 

Nevada County 17 1.04 

North West Senior and Disability Services 81 21.72 

North West Missouri Area Agency on Aging 

(NWAA) 11 0.34 

San Juan Basin ARDC 7 0.32 

Senior Linkage Line, Disability Linkage Line 135 3.10 

Service Link Resource Center of Coos County 21 12.87 

West Virginia Aging and Disability ResourceFairmount Site 15 15.40 

Total 552 100 

PP2. Respondent Type ES3* 

Frequency Percentage 

Self 292 59.12 

Parent 144 22.26 

Child 17 2.67 

Other Relative 69 12.82 

Friend 11 0.78 

Neighbor 2 0.05 

Client/Patient - -

Other* 17 2.31 

Total 552 100 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

PP3. Study Type ES 5/ES 6 

Frequency Percentage 

Older Adult 88 19.86 

Page 495 
Disability 131 22.11 

Older Adult and Disability 313 52.62 

Neither Older Adult nor 

Disability 2 1.65 

No Response 18 3.76 

Total 552 100 

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PP4. Result of Contact ES7 

Yes No No Response Total 

Frequency Percentage Frequency Percentage Frequency Percentage Frequency Percentage 

Information 

Assistance and/or 

Referral(s) (not 

including options 

counseling) 

394 85.50 157 14.48 1 0.02 552 100 

Options Counseling 

or Peer Support/Peer 

Counseling 

239 27.70 310 71.99 3 0.31 552 100 

Benefits Counseling 

or Eligibility 

Determination 

175 51.57 375 48.38 2 0.05 552 100 

Transition 

Assistance 13 1.93 537 98.02 2 0.05 552 100 

Crisis Intervention 2 1.90 548 98.05 2 0.05 552 100 

Life skills training or 

support 3 0.32 547 99.63 2 0.05 552 100 

Page 497 
 

 

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PP5. Date of Contact – DC1 * 

*Responses to this question are available in the appendix with supplemental questions. 

PP6. Reason for Contacting the Agency (Client s Need at Time of the Time of Contact) 

Frequency Percentage 

Income Assistance 18 3.80 

Energy Assistance 10 3.23 

Medicare Questions 88 22.45 

Medicaid Questions (Including Questions About HCBS 

Waivers) 67 21.21 

Housing 40 6.27 

Personal Care 111 9.14 

Transportation 16 2.01 

Nutrition 17 7.18 

Chronic Health Conditions 2 0.42 

Employment 2 0.05 

Support Groups 2 0.08 

Recreation Opportunities 1 0.06 

Caregiver/Respite Support 16 1.45 

Home Modification 7 4.69 

Attendant Care Services 36 0.93 

Advocacy 3 0.31 

Education 1 0.02 

Services for Emergent Cares/Crisis Intervention 1 0.02 

Preventative Health Services 3 0.14 

Ombudsman/Abuse or Neglect Issues 1 0.06 

Advanced Directives 3 1.11 

Transition Services 9 0.45 

Other Independent Living Supports or Services 15 3.33 

Other 83 11.59 

Total 552 100 

PP7. Mode of Contact DC 10 

Frequency Percentage 

In-person visit 50 13.59 

Telephone call 502 86.41 

Total 552 100 

PP8. Respondent Name DC2 

No Data Available 

PP9. Respondent Age ES5 

Respondent Age 

Page 498 
 

 

 

Frequency Percentage 

Less than 18 2 0.29 

18-45 40 4.08 

46-59 90 18.54 

60-84 316 57.44 

85 and above 94 15.11 

No Response 11 4.54 

Total 552 100 

Min 7 

Max 99 

Mean 68.98 

Median 68 

Mode 64 

I.1 Is now a good time for the interview about your experiences? 

Frequency Percentage 

Yes 552 100 

No, this is a bad time - -

No, I don’t remember calling agency - -

Refused, no I don’t want to do an interview - -

Total 552 100 

I.2 When would be a better time to call back to do the interview? 

Frequency Percentage 

Not Applicable 552 100 

Gives call back time __ - -

Don’t Know - -

RF - -

Total 552 100 

I.3 Can I ask you why are you not interested in participating? 

Frequency Percentage 

Not Applicable 552 100 

Don’t Know - -

RF - -

Total 552 100 

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I.4 Do you agree to participate in this research study and begin study procedures as we have 

discussed? 

Frequency Percentage 

Agree 552 100 

Disagree - -

Total 552 100 

I.5 Can you tell me why you don’t wish to participate in the interview? 

Frequency Percentage 

Not Applicable 552 100 

Don’t Know - -

Refused - -

Total 552 100 

CP1. Is this number that I called you on a cell phone? 

Frequency Percentage 

Yes 157 22.44 

No 395 77.56 

Refused (Soft) - -

Refused (Hard) - -

Total 552 100 

CP2. Is there a land line where you would prefer me to call to conduct the interview? 

Frequency Percentage 

Yes - -

No, continue on cell phone 157 100 

Refused (Soft) - -

Refused (Hard) - -

Total* 157 100 

* This question was only asked of those who responded “Yes” to question CP1.

CP3. Are you currently driving, or someplace else where it IS NOT safe to talk on your cell 

phone? 

Frequency Percentage 

Yes/Call me later - -

No, respondent can talk now 157 100 

Refused (Soft) - -

Refused (Hard) - -

Total* 157 100 

* This question was only asked of those who responded “No, continue on cell phone” to question CP2.

CP4. Is now a good time to talk? 

[INTERVIEWER: IF EVENINGS/WEEKENDS ARE BETTER BECAUSE RESPONDENT IS 

Page 500 
 

 

NOT CHARGED FOR CELL USAGE, SCHEDULE CALLBACK AND RECORD COMMENTS] 

Frequency Percentage 

Yes, now is fine 157 100 

No, another time is better - -

Refused (Soft) - -

Refused (Hard) - -

Total 157 100 

* This question was only asked of those who responded “No, respondent can talk now” to question CP3.

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Section A. Initial Contact
 

A.0. Was the initial contact with [insert PP1] a telephone call or in person visit? * 

Frequency Percentage 

In-Person Visit - -

Telephone call - -

Don’t Know - -

RF - -

Not Applicable 552 100 

Total 552 100 

* This question was only asked if PP7 was blank. 

A.0b. I just need to verify your current age to be sure you are eligible for the study. Are you 60 

years of age or older? * 

Frequency Percentage 

Yes 1 0.02 

No - -

Don’t Know - -

RF - -

Not Applicable 551 99.98 

Total 552 100 

* This question was only asked if QES6 had the value “Neither Older Adult nor Disability.”

A.1 When you contacted the [insert PP1], you said that the main reason for your [insert PP7] was insert [PP6]. Is 

that correct? 

Frequency Percentage 

Yes 512 93.44 

No 35 5.96 

Don’t Know 5 0.61 

Refused - -

Total 552 100 

A.2. I’m sorry; please tell me, what was the main reason that you contacted [insert PP1] on [insert PP5]? * 

Frequency Percentage 

Safe and affordable housing options 1 0.35 

Peer support services/groups - -

HCBS Medicaid Waiver Programs - -

Caregiver Support (i.e. respite program, support groups, or 

counseling) - -

Nutrition Programs 2 8.29 

Employment Services - -

Education services - -

Opportunities to develop advanced directives - -

Transportation services - -

Opportunities for socialization/recreation - -

Mental health services 1 4.08 

Ombudsman services - -

Page 502 
 

 

 

 

 

 

 

 

 

 

A.2. I’m sorry; please tell me, what was the main reason that you contacted [insert PP1] on [insert PP5]? * 

Frequency Percentage 

Health prevention and screening services 2 4.78 

Emergency services/crisis intervention - -

Transition programs (from hospitals, nursing homes etc.) 1 4.08 

Nursing home (institutional) diversion program - -

Nursing home/residential beds 1 0.35 

Income Assistance 4 5.72 

Energy assistance 1 0.35 

Personal Care services 3 4.78 

Independent living services (e.g., home modification, attendant 

care) 1 15.64 

Independent Living Skills training - -

Other, please specify 21 50.88 

(VOL) DK 2 0.70 

(VOL) REF - -

Total 40 100 

*Verbatim responses to this question are available in the appendix with supplemental questions. 

A.3. From where did you first find out about the [insert PP1]? [CHECK MOST APPROPRIATE RESPONSE] 

Frequency Percentage 

Family member, friend or other acquaintance 161 35.44 

Hospital/Clinic/Doctor 32 5.81 

Nursing home/Assisted Living 19 2.18 

Phone Book 11 3.85 

Brochure/Flyer 19 0.74 

Referral from Senior Center 20 1.55 

Referral from another agency/organization 147 26.67 

Through work 25 2.67 

Internet/Website 42 4.68 

Media/Newspaper/TV/Radio 22 7.88 

Other* 15 1.40 

Don’t Know 39 7.12 

RF - -

Total 552 100 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

A.4. Was [insert PP1] the first organization that you contacted about [insert PES A.2 if answered OR PP6] 

Frequency Percentage 

Yes 398 79.45 

No 132 18.45 

Don’t Know 22 2.10 

Refused - -

Total 552 100 

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Section B: Agency Efficiency
 

B.1. [ASK ONLY IF PP7 IN PERSON VISIT; ELSE SKIP TO B.2] When you first contacted the [insert PP1], 

how long did you wait during the initial contact to talk with someone who could help you with [insert PES A.2 If 

answered OR PP6]? [DO NOT READ RESPONSES, PLEASE CHECK APPROPRIATE RESPONSE] 

Frequency Percentage 

Minimal wait (less than five minutes) 30 57.27 

Five to 10 minutes 10 13.92 

10 minutes to 20 minutes 7 16.18 

Over 20 minutes 1 11.95 

Don’t Know 2 0.68 

Refused - -

Total * 50 100 

*This question was asked of all those where PP7 had a value of “In-Person Visit.”

B.2. Were you able to talk to a representative during your first [insert PP7] with [insert PP1]? 

Frequency Percentage 

Yes 437 76.59 

No 81 16.22 

Don’t Know 34 7.18 

Refused - -

Total 552 100 

B.3. Do you recall how many additional contacts you had to make before you were able to talk with a 

representative, including calls where you left a message on a machine? [DO NOT READ RESPONSES] [PROBE: 

IF NOT SURE, PROBE FOR BEST ESTIMATE AND READ CHOICES] 

Frequency Percentage 

None 6 2.68 

One 32 39.56 

Two 20 13.25 

Three 14 8.02 

Four or more 15 10.99 

Don’t Know 28 25.49 

Total* 115 100 

*This question was asked to all those not responding “Yes” to question B2.

B.4. Including the contact that you made [insert PP1] on [insert PP5], how many times have you had to describe 

your request for services to [PP1], or explain what you needed? [ DO NOT READ RESPONSES] 

Frequency Percentage 

One time 394 70.27 

Two times 84 17.04 

Three or four times 28 2.45 

Five or more times 18 3.59 

Don’t Know 28 6.65 

Refused - -

Page 504 
 

Total 552 100 

Page 505
 
 

 

 

 

B.5 Throughout your contact with [insert PP1] did any of the following circumstances reduce or prevent your ability to resolve your issue? [READ EACH 

ITEM TO GET A YES/NO ANSWER] 

Yes No Don’t Know Refused Total 

Frequency Percentage Frequency Percentage Frequency Percentage Frequency Percentage Frequency Percentage 

[PP1]’s hours of 

operation 37 7.61 507 91.92 8 0.47 - - 552 100 

Difficulty 

reaching the 

[insert PP1]’s 

staff 

73 16.66 474 82.37 5 0.97 - - 552 100 

Language or 

communication 

problems 

19 3.75 531 94.35 2 1.89 - - 552 100 

Lack of staff 

professionalism 25 5.09 519 93.54 8 1.36 - - 552 100 

Lack of staff 

knowledge 45 8.27 493 90.20 13 1.47 1 0.06 552 100 

Lack of staff 

follow through 61 9.43 467 83.32 23 7.23 1 0.02 552 100 

Page 506 
 

 

 

 

 

 

Section C: Effectiveness of Agency Representative
 

C.1. Did you feel 

CHOICES] 

the representative at [insert PP1] paid close attention to what you were saying? [READ 

Frequency Percentage 

Yes, definitely 430 83.52 

Yes, probably 80 10.20 

No, probably not 14 1.88 

No, definitely not 19 3.31 

Don’t Know 9 1.10 

Refused - -

Total 552 100 

C.2. In your opinion, how knowledgeable was the representative at [insert PP1] about the reason you contacted 

them, that is [insert PES A.2 if answered; else insert PP6]? Were they ...... [READ CHOICES] 

Frequency Percentage 

Very knowledgeable 410 78.45 

Somewhat knowledgeable 92 14.33 

Not very knowledgeable 25 2.91 

Not at all knowledgeable 11 2.10 

Don’t Know 14 2.21 

Refused -

Total 552 100 

C.3. When you had a [insert PP7] with [insert PP1] on [insert PP5], was the information you received from the 

representative at [insert PP1]........[READ CHOICES] 

Frequency Percentage 

Very clear and understandable 425 82.99 

Somewhat clear and understandable 82 11.14 

Not very clear or understandable 19 2.18 

Not at all clear or understandable 14 2.64 

Don’t Know 12 1.06 

Refused - -

Total 552 100 

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C.4. Based on your request for help with [insert PES A.2 if answered; else insert PP6] when you contacted [insert 

PP1], did the representative ask questions that made you feel that the needs for which you initially contacted the 

agency were being correctly assessed? 

Frequency Percentage 

Yes 471 87.17 

No 62 8.34 

Don’t Know 19 4.49 

Refused - -

Total 552 100 

C.5. If the assistance was requested, did the representative at [insert PP1] work with you to develop a plan 

outlining your next steps in meeting your/your [insert PP2] s ongoing need for services or supports? 

[INTERVIEWER NOTE: IF RESPONDENT IS UNCLEAR AS TO WHAT YOU MEAN BY SERVICES AND 

SUPPORTS’, YOU MAY OFFER THIS DECRIPTION: “SERVICES AND SUPPORTS ARE THE THINGS 

YOU MAY NEED TO MEET YOUR HEALTH OR PERSONAL CARE NEEDS AND TO ASSIST YOU WITH 

THE BASIC PERSONAL TASKS OF EVALUATION”.] 

Frequency Percentage 

Yes 336 69.16 

No 111 15.78 

No assistance requested for long term 

care needs 84 10.43 

Don’t Know 21 4.63 

Refused - -

Total 552 100 

C.6. Does the plan accurately reflect your/your [insert PP2] s needs and preferences for resolving the issue that you 

called about, that is [insert PES A.2 if answered; else insert PP6]? 

Frequency Percentage 

Yes, definitely 233 70.84 

Yes, probably 63 18.74 

No, probably not 14 2.09 

No, definitely not 8 4.82 

Don’t Know 18 3.51 

RK - -

Total 336 100 

*This question was asked to all those who responded “Yes” to question C5.

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Section D. Institutional Diversion
 

D.1. When you contacted the [insert PP1], were you considering a move to a long term care setting, such as a 

nursing home, for yourself/your [insert PP2]? 

Frequency Percentage 

Yes 94 14.28 

No 456 85.43 

Don’t Know 2 0.29 

Refused - -

Total 552 100 

D.2. Did the representative you talked to at the [insert PP1] on [inset PP5] help you to understand other choices for 

staying in the community to avoid or delay moving to a nursing home or other long term care facility? 

Frequency Percentage 

Yes 206 31.15 

No 332 65.09 

Don’t Know 14 3.76 

Refused - -

Total 552 100 

D.3. How likely is it that you/your [insert PP2] will have to move into a nursing home within the next five years? 

Would you say that it is..... 

Frequency Percentage 

Very likely 102 19.78 

Somewhat likely 83 9.53 

Somewhat unlikely 63 11.15 

Very unlikely 260 52.81 

Don’t Know 43 6.71 

Refused 1 0.02 

Total 552 100 

Page 509 
 

 

 

 

 

 

 

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Section E. Assistance with Services
 

E.1. Did you receive access to the service that you/your [insert PP2] needed directly from them or indirectly from 

[INSERT PP1] or indirectly by a referral to another agency? 

Frequency Percentage 

Directly ([insert PP1] provided the service) 284 58.91 

Indirectly (you were referred elsewhere) 178 27.55 

Both/some services provided by [insert PP1] staff and some through 

referrals 29 3.94 

Don’t Know 57 8.93 

Refused 4 0.67 

Total 552 100 

E.2. Did the representative of the [insert PP1] help you/your [insert PP2] to connect with the services you/your 

[insert PP2] needed? 

Frequency Percentage 

Yes 135 61.91 

No 123 35.65 

Don’t Know 10 2.44 

Refused - -

Total * 268 100 

*This question was asked of all those who did not respond “Directly” to question E1.

E.3 Did the representative of the [insert PP1] transfer your call to an agency 

you/your [insert PP2] with your/your [insert PP2] s needed or requested services? 

or organization that provided 

Frequency Percentage 

Yes 35 25.72 

No 93 71.64 

Don’t Know 7 2.65 

Refused - -

Total * 135 100 

*This question was asked of all those who responded “Yes” to question E2.

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E.4. Did the representative give you contact information (telephone number, address, web address) 

of an agency or organization that provided you/your [insert PP2] with needed or requested 

services? 

Frequency Percentage 

Yes 88 73.25 

No 12 26.75 

Don’t Know - -

Refused - -

Total * 100 100 

*This question was asked of all those who did not respond “Yes” to question E3.

E.5 Did the representative of [PP1] contact the service provider and arrange for them to contact 

you? 

Frequency Percentage 

Yes 3 22.73 

No 8 76.82 

Don’t Know 1 0.45 

Refused - -

Total * 12 100 

*This question was asked of all those who responded “No” to question E4.

E.6. When you contacted the provider about the services you were seeking, did that provider 

already have the information that you gave to [insert PP1] or did you have to explain your/you 

[insert PP2] s need again? [READ CHOICES] 

Frequency Percentage 

Provider had the information 39 30.84 

Provider had the information but it was not 

correct or it was incomplete and you had to 

start the process again 

4 6.23 

Provider did not have the information – had to 

start the process again 61 48.35 

Don’t Know 21 14.48 

Refused 1 0.11 

Total 126 100 

*This question was asked of all those who responded “Yes” to any of questions E3, E4, and E5.

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E.7. As a result of your contact with [insert PP1], to what supports and services were you transferred or 

referred? [RECORD RESPONSE BELOW (CODING WILL BE DONE IN POST PRODUCTION)] * 

Frequency Percentage ** 

Safe and affordable housing options 5 2.06 

Peer support services/groups 1 0.28 

HCBS Medicaid Waiver Programs - -

Caregiver Support (i.e. respite program, support groups, or 

counseling) 2 0.21 

Nutrition Programs - -

Employment Services - -

Education services - -

Opportunities to develop advanced directives - -

Transportation services 1 0.11 

Opportunities for socialization/recreation - -

Mental health services 2 0.39 

Ombudsman services 1 0.28 

Health prevention and screening services 5 4.06 

Emergency services/crisis intervention - -

Transition programs (from hospitals, nursing homes etc.) 3 0.50 

Nursing home (institutional) diversion program 1 4.77 

Nursing home/residential beds 1 1.28 

Income Assistance - -

Energy assistance 2 0.39 

Personal Care services 2 1.35 

Medicaid Waiver Assistance - -

Independent living services (e.g., skills training, peer support) 7 4.63 

Other, please specify 56 37.74 

None 1 0.11 

DK 22 23.16 

REF - -

* This question was asked of all those who responded “Yes” to any of questions E3, E4, and E5. Responses to this question are 

available in the appendix with supplemental questions.
 

**Percentages do not add up to 100% as respondents could select more than one option.
 

Page 512 
 

 

 

 

 

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E.8. What was the result of the referral? [READ FROM THE FOLLOWING LIST AND CHECK THE MOST 

APPROPRIATE RESPONSE] 

Frequency Percentage 

You/your [insert PP2] received services 52 43.33 

You/your [insert PP2] did not receive services 19 20.46 

It’s too soon to tell 52 33.80 

Don’t Know 2 2.31 

Refused 1 0.11 

Total 126 100 

*This question was asked of all those who responded “Yes” to any of questions E3, E4, and E5.

E.9. You said that you/your [insert PP2] did not receive the services through the referral; why do you think it is? 

[RECORD RESPONSE; CODING WILL BE DONE IN POST PRODUCTION] * 

Frequency Percentage 

The services were not what [insert PP2] 

wanted/needed 2 37.39 

The service/program is not accepting 

applications/there is a waitlist 1 6.09 

It is too expensive 1 0.52 

There is no transportation - -

The service or program is not available at times 

needed 1 6.78 

[insert PP2] is not eligible 3 1.57 

I tried to contact the service or program that was 

referred, but was busy/unavailable - -

Line was busy - -

Wait time was too long - -

Other, ______________ 6 8.70 

Have not yet contacted, but plan to 4 2.09 

Have no plans to contact the service or program 

Please specify ______________________ - -

DK 1 36.87 

REF - -

Total ** 19 100 

*Responses to this question are available in the appendix with supplemental questions. 

**This question was asked of all those who responded “You/your [insert PP2] did not receive services” to question E8.

Page 513 
 

 

 

 

 

 

 

 

 

 

Section E1. Assistance with Medicaid Eligibility Determination
 

E.1. The next set of questions has to do with information and help that you may have received from [insert PP1] on 

whether or not you/your [insert PP2] are/is eligible for the Medicaid program in this state. 

Frequency Percentage 

Continue 447 80.87 

(VOL) Already receive Medicaid benefits 34 7.19 

(VOL) Did not talk about being eligible for Medicaid benefits 71 11.93 

Total 552 100 

E.1.1 Did you receive specific information on 

support services from the federal government? 

applying for financial assistance for healthcare and residential 

Frequency Percentage 

Yes 146 33.78 

No 273 58.19 

Don’t Know 28 8.02 

Refused - -

Total 447 100 

*This question was asked of all those who responded “Continue” to the Section E1 screener.

E1.2 Did you complete an application for financial assistance for healthcare and residential support services from 

the federal government? 

Frequency Percentage 

Yes 70 46.74 

No 94 49.28 

Don’t Know 10 3.99 

Refused - -

Total 174 100 

*This question was asked of all those who did not respond “No” to question E1.1.

E1.2a Why not? 

*Responses to this question are available in the appendix with supplemental questions. 

E1.3 Were you provided with the help by the [insert PP1] in completing the application for financial assistance for 

healthcare and residential support services from the federal government? 

Frequency Percentage 

Yes 39 70.14 

No 29 27.48 

Don’t Know 2 2.38 

Page 514 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

” 

E1.3 Were you provided with the help by the [insert PP1] in completing the application for financial assistance for 

healthcare and residential support services from the federal government? 

Frequency Percentage 

Refused - -

Total * 70 100 

*This question was asked of all those who responded “Yes” to question E1.2. 

E1.4 Did the [insert PP1] help explain what information concerning your finances and care needs might be needed 

to determine if you were eligible for federal assistance for healthcare and residential support services? 

Frequency Percentage 

Yes 60 94.91 

No 7 2.57 

Don’t Know 3 2.52 

Refused - -

Total * 70 100 

*This question was asked of all those who responded “Yes” to question E1.2.

E1.5 How long did you wait to find out if you/your [insert PP2] [are/is] eligible for financial assistance for 

healthcare and residential support services from the federal government? 

[DO NOT READ RESPONSES, CHECK APPROPRIATE RESPONSE] 

Frequency Percentage 

One day or less 10 15.75 

Two to six days 8 11.73 

One week 7 10.76 

More than one week but less than a month 18 28.36 

Over a month 5 6.69 

Still waiting 19 24.72 

Don’t Know 3 1.99 

Refused - -

Total * 70 100 

*This question was asked of all those who responded “Yes” to question E1.2.

E1.6 Did the [insert PP1] mention they were helping you to apply for Medicaid program, or did they use a different 

name to describe the financial assistance program? 

Frequency Percentage 

Yes, Medicaid 40 68.10 

No, Some other program 15 8.29 

Don’t Know 15 23.61 

Refused - -

Total 70 100 

*This question was asked of all those who responded “Yes” to question E1.2.

E1.6a. What was the name of this program? 

*Responses to this question are available in the appendix with supplemental questions. 

E1.7. Were you given information by the agency about other insurance, including private coverage and other types 

of government insurance, besides Medicaid/ [answer from E1.6a]? 

[PROGRAMMER NOTE: IF ANSWER TO E1.6a. Is “Don’t know OR “REFUSED”, SKIP TO E2.1] 

Frequency Percentage 

Yes 87 20.41 

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No 330 74.23 

Don’t Know 23 5.36 

Refused - -

Total* 440 100 

*This question was asked of all those who responded “Continue” to the Section E1 screener, and who did not answer “Don’t Know” 

or “Refused” to question E1.6a.

E1.7a Which other insurance resources were you given information on? 

*Responses to this question are available in the appendix with supplemental questions. 

Section E2. Assistance with One-on-One Options Counselling 

E2.1.Did you request a conversation with someone to talk with about understanding and selecting the long term 

services beyond information and referral, such as home delivered meals, personal care, help around the house, 

transportation, or similar kinds of services? 

Frequency Percentage 

Yes 126 20.11 

No 416 78.33 

Don’t Know 10 1.55 

Refused - -

Total 552 100 

E2.2. Did you have a conversation with someone about understanding and selecting the long term services beyond 

information and referral? 

Frequency Percentage 

Yes 65 53.12 

No 54 44.44 

Don’t Know 7 2.44 

Refused - -

Total * 126 100 

*This question was asked of all those who responded “Yes” to question E2.1.

E2.3. Did the person you talked to about understanding and selecting the long term services visit you at your 

home/your [PP2] s home? 

Frequency Percentage 

Yes 26 60.43 

No 38 39.35 

Don’t Know 1 0.22 

Refused - -

Total * 65 100 

*This question was asked of all those who responded “Yes” to question E2.2.

E2.4. Following the first conversation, did the person 

home visits? 

follow up with either by phone calls and/or additional in 

Frequency Percentage 

Yes 37 69.25 

No 25 27.03 

Page 516 
 

 

Don’t Know 2 3.51 

Refused 1 0.22 

Total * 65 100 

*This question was asked of all those who responded “Yes” to question E2.2.

Page 517 
 

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E2.5. Did the information and support from the person you talked to about understanding and selecting the long term services help you 

to:[READ CHOICES] [RANDOMIZE ITEMS] * 

Yes, definitely Yes, probably No, probably 

not 

No, definitely 

not Don’t Know Refused Total 

Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

Better understand 

your/your [insert 

PP2]’s long term 

service and 

support options? 

41 65.66 12 15.84 5 8.89 5 3.44 1 0.29 1 5.88 65 100 

Make a decision 

about long term 

support services? 

27 36.27 10 4.66 7 8.39 15 29.75 4 8.60 2 12.33 65 100 

Get in touch with 

public programs? 30 47.81 11 25.88 2 0.43 12 18.14 8 7.31 2 0.43 65 100 

Get in touch with 

private services 

including services 

that you have to 

pay for yourself? 

19 24.87 4 10.97 9 2.15 24 48.32 9 13.69 - - 65 100 

Obtain long term 

support planning 

or services that fit 

within your 

budget? 

24 50.61 8 9.61 7 6.09 14 20.07 10 12.83 2 0.79 65 100 

*This question was asked of all those who responded “Yes” to question E2.2. 

Page 518 
 

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E2.6. How satisfied or dissatisfied are you with the service you received from the person 

understanding and selecting the long term services?[READ CHOICES] 

you talked to about 

Frequency Percentage 

Very satisfied 38 68.53 

Somewhat satisfied 17 24.44 

Somewhat dissatisfied 4 1.08 

Very dissatisfied 5 3.44 

Don’t Know 1 2.51 

Refused - -

Total 65 100 

*This question was asked of all those who responded “Yes” to question E2.2.

Section E3. Care Transition Services 

E3.1. Based on your contact with [insert PP1], did you/your [insert PP2] receive services that helped you/your 

[insert PP2] to transition from a hospital or other acute care facility into the community? 

Frequency Percentage 

Yes 28 3.47 

No 516 95.73 

Don’t Know 8 0.80 

Refused - -

Total 552 100 

Page 519 
 

 

 

 

 

 

E3.2. Based on your contact with [insert PP1], did you/your [insert PP2] receive any of the following services? [READ CHOICES] 

Yes No Don’t Know Total 

Frequency Percentage Frequency Percentage Frequency Percentage Frequency Percentage 

A contract before 

discharge to assess 

your/your [insert PP2]’s 

discharge needs 

16 77.26 11 21.41 1 1.32 28 100 

An explanation of 

your/your [insert PP2]’s 

discharge instructions 

20 87.64 7 11.70 1 0.66 28 100 

Post discharge services 

such as transportation 

to the doctor, help 

filling prescriptions, or 

household help 

17 78.59 10 13.69 1 7.73 28 100 

Follow-up phone call or 

visit within 48 hours of 

discharge 

12 29.14 13 39.29 3 31.57 28 100 

*This question was asked of all those who responded “Yes” to question E3.1.

Page 520 
 

 

E3.3. How satisfied or dissatisfied are you with the transition service you/your [insert PP2] received? 

Frequency Percentage 

Very satisfied 22 72.41 

Somewhat satisfied 5 19.87 

Somewhat dissatisfied - -

Very dissatisfied - -

Don’t Know 1 7.73 

Refused - -

Total 28 100 

*This question was asked of all those who responded “Yes” to question E3.1.

Page 521 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section F. Services Received from the [insert PP1]
 

F.1. Did you/your [insert PP2] ever receive the service for [insert PES A.2 if answered; else insert PP6] that you 

were seeking based on your contact with [insert PP1]? [READ CHOICES] 

Frequency Percentage 

Yes, within one week of contact 151 31.95 

Yes, after more than a week 70 11.05 

No 311 52.65 

Don’t Know 20 4.35 

Refused - -

Total 552 100 

F.2. Why do you think you/your [insert PP2] have/has not received the services for [insert PES A.2 if answered; 

else insert PP6]? [READ CHOICES] [RANDOMIZE ORDER] [MULTIPLE SELECTION] [WAIT FOR 

RESPONSE AFTER EACH CHOICE]* 

Frequency Percentage ** 

The services were not available 47 14.81 

You/your [insert PP2] is on a waitlist 30 14.87 

You/your [insert PP2] could not get to the services 

(e.g., hours of operation, transportation barriers) 18 5.25 

The information/help received from [insert PP1] was 

not useful 33 9.91 

You/your [insert PP2] did not follow-up on the 

information and/or referral. 52 11.17 

You/your [insert PP2] no longer need the services 36 9.08 

Difficulties filling out paperwork 35 10.88 

Not being the right age for these services 17 5.27 

Some other reason, specify______________ *** 115 40.3 

Don’t Know 25 9.08 

Refused - -

* This question was asked of all those who responded “No” to question F.1.
 

**Percentages do not add up to 100% as respondents could select more than one option.
 

***Free text responses accompanying this question are available in the appendix with supplemental questions.
 

F.3. Since contacting the [insert PP1] on [insert PP5], have you been in touch with any other agencies similar to 

[insert PP1] to receive [insert PES A.2 if answered; else insert PP6]? * 

Frequency Percentage 

Yes 83 9.08 

No 463 89.22 

Don’t Know 6 1.7 

Refused - -

Total 552 100 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

F.3a. What other agencies or organizations were contacted? 

*Responses to this question are available in the appendix with supplemental questions. 

F.4 Were there any needs that this other agency or organization was able to meet that [insert PP1] was NOT able 

to meet? * 

Page 522 
 

 

 

 

 

 

 

Frequency Percentage 

Yes 30 26.50 

No 43 70.97 

Don’t Know 10 2.53 

Refused - -

Total** 83 100 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

** This question was asked of all those who responded “Yes” to question F.3.

F.4a What needs was this other agency or organization able to meet? 

*Responses to this question are available in the appendix with supplemental questions. 

F.5. As a result of your conversations with [insert PP1] staff, did you realize that you/your [insert PP2] had a need 

or concern that you did not know that you/your [insert PP2] had before contacting the [insert PP1]? 

Frequency Percentage 

Yes 84 15.48 

No 447 77.57 

Don’t Know 21 6.95 

Refused - -

Total 552 100 

F.6. Did the [insert PP1] follow up with you to find out how useful the information was or how the referral turned 

out? 

Frequency Percentage 

Yes 188 37.40 

No 336 59.63 

Don’t Know 28 2.97 

Refused - -

Total 552 100 

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F.7. On the following scale, as a result of your contact with [insert PP1], how satisfied or dissatisfied are you with... * [RANDOMIZE ORDER FOR ITEMS 1 7, 

ALWAYS ASK ITEM 8 LAST] 

Very Satisfied Somewhat 

Satisfied 

Somewhat 

Dissatisfied 

Very 

Dissatisfied N/A Don’t Know Refused Total 

Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

The services that 

you/your [insert 

PP2] received 

directly from 

[insert PP1] ** 

211 63.09 39 9.16 15 6.86 19 1.83 57 16.95 - - 17 2.12 358 100 

Comprehensiven 

ess of the 

information or 

services 

provided? 

339 67.37 112 15.14 31 8.39 40 4.47 28 4.44 2 0.20 - - 552 100 

The 

personalization 

or 

individualization 

of the services 

offered? 

315 61.53 119 18.11 36 5.50 50 10.46 32 4.40 - - - - 552 100 

The accuracy of 

the information 

provided? 

361 70.42 115 20.63 25 1.83 31 4.80 20 2.32 - - - - 552 100 

The support you 

received related 

to decisionmaking? 

292 54.69 107 16.14 32 2.67 39 5.97 81 20.47 1 0.06 - - 552 100 

The 

professionalism 

of the 

organization or 

staff? 

421 82.42 79 10.62 19 2.44 21 2.11 12 2.41 - - - - 552 100 

The ease of 

working with 

[insert PP1] to 

346 68.10 102 18.59 33 3.01 29 5.27 42 5.03 - - - - 552 100 

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F.7. On the following scale, as a result of your contact with [insert PP1], how satisfied or dissatisfied are you with... * [RANDOMIZE ORDER FOR ITEMS 1 7, 

ALWAYS ASK ITEM 8 LAST] 

Very Satisfied Somewhat 

Satisfied 

Somewhat 

Dissatisfied 

Very 

Dissatisfied N/A Don’t Know Refused Total 

Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % 

resolve the issue 

related to [insert 

PES A.2 if 

answered or PP6] 

The services that 

you/your [insert 

PP2] received 

from agencies 

you were 

referred to by 

[insert PP1]? *** 

111 43.92 45 14.59 9 4.86 22 7.39 38 15.84 - - 45 13.41 270 100 

*Free text responses accompanying this question are available in the appendix with supplemental questions.
 

** This question was only asked of those who responded “Directly ([insert PP1] provided the service)” or “Both/some services provided by [insert PP1] staff and some through
 

referrals” to question E.1.
 

*** This question was only asked of those who responded “Indirectly (you were referred elsewhere)” or “Both/some services provided by [insert PP1] staff and some through referrals” 

to question E.1. 

Page 525 
 

 

 

 

 

 

 

 

F.8. As a result of your contact with the [insert PP1], would you say that you 

CHOICES] 

are... [READ 

Frequency Percentage 

Much more certain about your/you [insert PP2]’s long term care 

options 179 37.14 

A little more certain 120 20.59 

About the same 145 25.80 

A little more confused 48 9.32 

Much more confused 30 4.56 

Don’t Know 29 2.53 

Refused 1 0.06 

Total 552 100 

F.9. To what degree has the information you received from [insert PP1] been useful to you as you 

select the long term care options that are best for you/your [insert PP2]? [READ CHOICES] 

Frequency Percentage 

Very Useful 247 45.43 

Somewhat useful 145 23.26 

Not too useful 36 5.46 

Not useful at all 71 14.18 

Don’t Know 52 10.64 

Refused 1 1.03 

Total 552 100 

F.10. Would you tell a friend or relative who needed help to contact the [insert PP1]? 

Frequency Percentage 

Yes 493 94.05 

No 53 5.24 

Don’t Know 6 0.71 

Refused - -

Total 552 100 

F.11. How likely is it that you would contact the [insert PP1] if you needed services in the future? 

[READ CHOICES] 

Frequency Percentage 

Very Likely 425 85.32 

Somewhat likely 64 6.39 

Somewhat unlikely 15 3.16 

Very unlikely 41 4.34 

Don’t Know 7 0.79 

Refused - -

Total 552 100 

Page 526 
 

 

 

 

 

 

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 ’

Section G. Heath and Demographic Information
 

G.1. Do/Does you/your [insert PP2] have any of the following types of health insurance? Record all that apply. 

[READ CHOICES] 

Yes No Don’t Know Refused TOTAL 

Freq. % Freq. % Freq. % Freq. % Freq. % 

Medicare 436 74.09 107 24.13 5 1.40 4 0.38 552 100 

Private Health 

Insurance 243 39.10 300 59.12 5 1.40 4 0.38 552 100 

Some other kind of 

health insurance 

(specify)___ * 

152 27.72 391 65.94 5 1.40 4 0.38 552 100 

No Insurance 24 7.19 519 91.03 5 1.40 4 0.38 552 100 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

G.2. At the present time, would you say your/your [insert PP2] s health is excellent, good, fair or poor? 

Frequency Percentage 

Excellent 36 4.83 

Good 117 25.39 

Fair 192 29.61 

Poor 194 37.55 

(VOL) [insert PP2] has passed 7 1.76 

Don’t Know 4 0.11 

Refused 2 0.74 

Total 552 100 

G.3. Have/has you/your [insert PP2] been admitted to a hospital in the past 6 months? 

Frequency Percentage 

Yes 208 34.23 

No 339 64.36 

Don’t Know 4 1.14 

Refused 1 0.27 

Total 552 100 

G.4. What is your date of birth? [month/day/year] 

*Data not included in dataset provided to IMPAQ 

G.5. What is the date of birth of the person for whom you contacted the agency? [month/day/year] 

*Data not included in dataset provided to IMPAQ 

G.6. What is your/your [insert PP2] s gender? [BY OBSERVATION UNLESS NEEDED] 

Frequency Percentage 

Male 160 29.84 

Female 391 69.90 

Don’t Know - -

Refused 1 0.27 

Page 527 
 

 

 

 

 

 

 

 

 

 ‘

 ’

 

 

 ’ 

 ’ 

 ’ 

 ’

 

Total 552 100 

G.7. What is the highest grade or year of school you/your [insert PP2] have/has completed? [READ AS NEEDED 

TO PROBE] 

Frequency Percentage 

No formal Schooling 8 1.39 

First through 7th grade 23 4.60 

8th grade 23 4.17 

Some high school 55 14.22 

High school graduate 208 38.35 

Some college 94 13.88 

Associates degree 29 4.04 

Four-year college graduate 49 7.08 

Some graduate school 9 2.17 

Graduate and professional degrees 24 4.53 

(VOL) Don’t Know 23 3.00 

(VOL) Refused 7 2.56 

Total 552 100 

G.8. Are you/ Is your [insert PP2] Hispanic, Latino, or of Spanish origin? 

[INTERVIEWER NOTE: IF RESPONDENT SAYS THEY ARE MEXICAN, MEXICAN 

CHICANO, PUERTO RICAN OR CUBAN, COUNT THEM AS A YES’.] 

AMERICAN, 

Frequency Percentage 

Yes 47 4.41 

No, not of Hispanic, Latino, or Spanish origin 501 94.98 

Don’t Know 2 0.29 

Refused 2 0.32 

Total 552 100 

G.9. What is your/your [insert PP2] s race? One or more categories may be selected. 

[READ LIST AND MULTIPLE RECORD] 

Frequency Percentage* 

White 465 94.25 

Black or African American 74 4.31 

American Indian or Alaska Native 20 3.35 

Asian or Asian American - -

Native Hawaiian or other Pacific Islander 1 0.27 

(VOL) Other (Specify)* 8 0.81 

(VOL) Don’t Know - -

(VOL) Refused 3 0.59 

* Percentages do not add up to 100% as respondents could select more than one option.
 

** Free text responses accompanying this question are available in the appendix with supplemental questions.
 

G.10a. And now, what was your/your [insert PP2] s total household income last year from all 

sources before taxes? Include your/your [insert PP2] s income and income from anyone else living 

in your/your [insert PP2] s household. Do not tell me the amount. Please just tell me the answer 

that best represents your/your [insert PP2] s household income. 

[CHECK APPROPRIATE RESPONSE] [READ CHOICES] [ PROBE: Your best estimate is fine.] 

82.91

Page 528 

Frequency Percentage 

Less than or equal to $40,000 454 
 

 ’ 

 ’ 

 ’ 

 ’

 

 

 ’ 

 

 

G.10a. And now, what was your/your [insert PP2] s total household income last year from all 

sources before taxes? Include your/your [insert PP2] s income and income from anyone else living 

in your/your [insert PP2] s household. Do not tell me the amount. Please just tell me the answer 

that best represents your/your [insert PP2] s household income. 

[CHECK APPROPRIATE RESPONSE] [READ CHOICES] [ PROBE: Your best estimate is fine.] 

Frequency Percentage 

More than $40,000 to $80,000 39 7.04 

More than $80,000 10 2.12 

(VOL) [insert PP2] has passed away 2 0.05 

(VOL) Don’t Know 27 4.85 

(VOL) Refused 20 4.85 

Total 552 100 

G.10b. Was that...? 

Frequency Percentage 

Less than or equal to $20,000 332 71.10 

More than $20,000 111 26.05 

(VOL) Don’t Know 10 2.82 

(VOL) Refused 1 0.03 

Total 454 100 

G.10c. Was that...? 

Frequency Percentage 

Less than or equal to $60,000 23 58.22 

More than $60,000 16 41.78 

(VOL) Don’t Know - -

(VOL) Refused - -

Total 39 100 

G.10d. Was that...? 

Frequency Percentage 

Less than or equal to $100,000 5 19.13 

More than $100,000 to $150,000 3 3.25 

More than $150,000 - -

(VOL) Don’t Know 2 77.62 

(VOL) Refused - -

Total 10 100 

G.11. What is your/your [insert PP2] s marital status? Are you/Is your [insert PP2]....? 

Frequency Percentage 

Married 140 26.75 

Living Together 4 0.85 

Widowed 178 30.78 

Divorced 134 26.89 

Separated 19 2.22 

Single, never married 60 11.07 

(VOL) Don’t Know 4 0.27 

(VOL) Refused 6 1.17 

Total* 545 100 

*This question was asked to all those not responding “(VOL) [insert PP2] has passed” to question G2.

Page 529 
 

 

 

 

 

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G.12. With whom, if anyone, do you/does your [insert PP2] live? 

Frequency Percentage 

Alone 236 40.86 

With a spouse or a partner 132 25.20 

With one or more family members 130 23.11 

With one or more friends/people who are not related to me 14 2.39 

Other residents (e.g., roommate) in a residential setting 26 7.00 

(VOL) Don’t Know 2 0.30 

(VOL) Refused 5 1.15 

Total* 545 100 

*This question was asked to all those not responding “(VOL) [insert PP2] has passed” to question G2.

G.13. Of the following choices, which one most closely describes your/your [insert PP2] s living situation? Do 

you/Does your [insert PP2] live in...[READ CHOICES[ 

[INTERVIEWER NOTE: SEE FAQ FOR DEFINITATIONS OF THESE ITEMS IF NEEDED] 

Frequency Percentage 

My own house or apartment (e.g., free-standing, row house, town house, 

apartment, etc.) 437 79.82 

Non-medical custodial housing (e.g., group home, congregate house, half-way 

house, safe-house, recovery house, board and care house, other residential nonmedical adult care facility) 

7 0.91 

In an assisted living setting 31 4.07 

In a nursing home 10 5.26 

In a continuing care retirement setting 4 0.34 

In some other setting, specify_____________ * 51 8.66 

(VOL) Don’t Know 1 0.02 

(VOL) Refused 4 0.91 

Total** 545 100 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

**This question was asked to all those not responding “(VOL) [insert PP2] has passed” to question G2.

G.14. Have you/ has your [insert PP2] ever lived in an assisted living setting? 

Frequency Percentage 

Yes 29 3.73 

No 485 95.14 

(VOL) Don’t Know 4 0.77 

(VOL) Refused 3 0.37 

Total* 521 100 

*This question was asked to all those who did not respond “In an Assisted Living Setting” to question G.13.

G.15. Have you/ has your [insert PP2] ever lived in nursing home? 

Frequency Percentage 

Yes 42 8.08 

No 495 91.46 

Don’t Know 2 0.09 

Refused 3 0.37 

Total* 542 100 

Page 530 
 

 

 

* This question was asked to all those who did not respond “In a Nursing Home” to question G.13.

Mean Median Mode Range 

Min Max 

G.14a. How long did you/your 

[insert PP2] live in the assisted 

living setting?_ / _ (months/years) * 

19.84 6 24 0 144 

G.15a. How long did you/your 

[insert PP2] live in the nursing 

home? _ / _ (months/years) 

6.96 2 1 0 120 

*Responses to these questions are available in the appendix with supplemental questions. 

Page 531 
 

 

 

 

APPENDIX U. OUTCOME EVALUATION ADRC SURVEY FREE TEXT RESPONSES 

Section PPS. Pre-Populated Information
 

PP2. Respondent Type : 

Responses for Those Answering “Other” 

Spouse 

Ssa 

Spouse 

Spouse 

Spouse 

Spouse 

Grandson 

Poa 

Partner 

Spouse 

Sister 

Spouse 

Friend Of Caregiver 

Spouse 

Spouse 

Payee Service 

Page 532 
 

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PP6. Other Reason for Contacting the agency (Client’s need at time of the time of contact) DC 8 

Assistance with air conditioner 

Assistance with scooter 

Financial support for health services needed 

VA paperwork 

Help writing monthly checks out 

Retirement, tax withholding income tax question 

Counseling 

To meet with ES 

Adult foster home 

Follow up on SNAP request 

Tax help resources 

Hospice 

Financial assistance for hearing aids 

Retirement/insurance questions 

XIX questions 

Medicaid/SNAP 

SNAP 

Program information/eligibility - if moves to OR 

Medicaid services 

Physician referrals 

Paid family caregiver 

Paid caregiver for mom 

Options for care such as assisted living 

Independent Choices 

Options for in home care for wife 

Independent Choices 

Options 

Independent Choices 

Help with deciding in home care vs. Nursing home 

Options In-home support 

Independent Choices 

Adult day training program 

Independent Choices 

Information about Independent Choices 

Workers w/ disabilities Medicaid 

Status on elderchoice application 

Resources for housing repairs 

Options 

Options counseling 

Options counseling for mom 

Options counseling/vehicle modification 

Page 533 
 

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PP6. Other Reason for Contacting the agency (Client’s need at time of the time of contact) DC 8 

Information on elder choices 

Assist with roof repair/replacement 

Medicaid for working disabled 

Options counseling 

Home Community-Based Services 

Moving assisstance 

Had been given number by attorney and was looking for more information 

Managed care 

Financial assistance to repair wheelchair lift in van 

Assistance with finding resources for finding medications 

Health insurance counseling-non-Medicare 

Financial assistance for supplies 

Free phone mn 

VCN, LTCOC 

Low cost dental care 

Verification code 

LTCOC, VN 

Tax assistance 

Lifeline (ERS) info 

Supports for reading mail 

Verification code 

Options counseling 

Verification code 

Visual services 

Dealing with forgetfulness 

Financial assistance 

Financial for trip to doctors in Denver 

Info on all programs 

Dental (title III grant) 

Dental (title III grant) 

Dental grant 

Dental 

Weatherization, free cell phone program 

Medical equipment diversion program 

Home repair/chore services 

Nursing home information 

Legal referral 

Legal question 

Long term planning for parent 

Chore services - snow removal 

Legal services 

Page 534 
 

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- 

PP6. Other Reason for Contacting the agency (Client’s need at time of the time of contact) DC 8 

Resources to maintain current housing 

PP5. Date of Contact DC1 

18-Jun-13 

26-Jun-13 

24-Jun-13 

19-Jun-13 

29-Oct-13 

15-Nov-13 

9-Jul-13 

13-Aug-13 

11-Jul-13 

3-Jul-13 

17-Jul-13 

31-May-13 

14-Jun-13 

7-Jun-13 

3-Jun-13 

19-Jun-13 

18-Jul-13 

6-Jan-14 

6-Jan-14 

15-Jan-14 

12-Jun-13 

15-Jan-14 

12-Jun-13 

11-Jun-13 

13-Jun-13 

2-Jul-13 

18-Jul-13 

31-Jul-13 

28-Jun-13 

26-Jul-13 

19-Jun-13 

8-Aug-13 

5-Jul-13 

25-Jul-13 

13-Sep-13 

Page 535 
 

PP5. Date of Contact - DC1 

23-Sep-13 

19-Oct-13 

22-Oct-13 

21-Oct-13 

6-Nov-13 

26-Nov-13 

26-Nov-13 

18-Nov-13 

13-Nov-13 

18-Nov-13 

27-Jan-14 

5-Feb-14 

18-Jun-13 

19-Jul-13 

19-Aug-13 

22-Aug-13 

25-Oct-13 

10-Dec-13 

18-Dec-13 

23-Oct-13 

11-Feb-14 

27-Sep-13 

17-Oct-13 

6-Dec-13 

10-Oct-13 

18-Jun-13 

17-Jun-13 

17-Jun-13 

13-Jun-13 

28-Jun-13 

7-Jun-13 

11-Jun-13 

21-Jun-13 

9-Oct-13 

8-Oct-13 

10-Jul-13 

9-Jul-13 

9-Jul-13 

9-Jul-13 

9-Jul-13 

9-Jul-13 

Page 536 
 

PP5. Date of Contact - DC1 

8-Jul-13 

8-Jul-13 

23-Jul-13 

23-Jul-13 

30-Jul-13 

23-Jul-13 

8-Aug-13 

30-Jul-13 

24-Jul-13 

8-Aug-13 

9-Jul-13 

9-Jul-13 

23-Jul-13 

30-Jul-13 

30-Jul-13 

8-Aug-13 

15-Aug-13 

15-Aug-13 

9-Jul-13 

30-Jul-13 

15-Aug-13 

15-Aug-13 

15-Aug-13 

15-Aug-13 

15-Aug-13 

15-Aug-13 

24-Jul-13 

9-Jul-13 

15-Aug-13 

26-Jul-13 

22-Aug-13 

22-Aug-13 

22-Aug-13 

22-Aug-13 

9-Jul-13 

15-Aug-13 

22-Aug-13 

23-Jul-13 

30-Aug-13 

29-Aug-13 

30-Aug-13 

Page 537 
 

PP5. Date of Contact - DC1 

30-Aug-13 

30-Aug-13 

4-Sep-13 

29-Aug-13 

30-Aug-13 

8-Aug-13 

22-Aug-13 

22-Aug-13 

22-Aug-13 

17-Sep-13 

25-Sep-13 

10-Sep-13 

17-Sep-13 

10-Sep-13 

26-Sep-13 

1-Oct-13 

30-Jul-13 

8-Aug-13 

22-Aug-13 

1-Oct-13 

10-Sep-13 

15-Oct-13 

15-Oct-13 

14-Oct-13 

16-Oct-13 

4-Oct-13 

9-Oct-13 

18-Oct-13 

18-Oct-13 

15-Oct-13 

18-Oct-13 

18-Oct-13 

24-Jul-13 

8-Oct-13 

14-Jun-13 

14-Jun-13 

14-Jun-13 

10-Jun-13 

12-Jun-13 

12-Jun-13 

17-Jun-13 

Page 538 
 

PP5. Date of Contact - DC1 

17-Jun-13 

12-Jun-13 

11-Jun-13 

12-Jun-13 

11-Jun-13 

17-Jun-13 

11-Jun-13 

12-Jun-13 

12-Jun-13 

11-Jun-13 

14-Jun-13 

12-Jun-13 

12-Jun-13 

12-Jun-13 

11-Jun-13 

14-Jun-13 

21-Jun-13 

11-Jun-13 

24-Jun-13 

25-Jun-13 

28-Jun-13 

16-Jul-13 

28-Jun-13 

5-Jul-13 

16-Jul-13 

23-Jul-13 

28-Jun-13 

22-Jul-13 

25-Jul-13 

26-Jun-13 

25-Jun-13 

1-Jul-13 

17-Jul-13 

15-Jul-13 

24-Jun-13 

17-Jul-13 

22-Jul-13 

8-Jul-13 

28-Jun-13 

18-Jul-13 

24-Jul-13 

Page 539 
 

PP5. Date of Contact - DC1 

24-Jun-13 

13-Jun-13 

25-Jul-13 

28-Jun-13 

2-Aug-13 

20-Aug-13 

8-Aug-13 

1-Aug-13 

23-Aug-13 

29-Aug-13 

3-Jul-13 

3-Jul-13 

13-Aug-13 

22-Jul-13 

25-Jul-13 

31-Jul-13 

13-Aug-13 

28-Aug-13 

29-Aug-13 

10-Jun-13 

8-Aug-13 

8-Aug-13 

17-Jun-13 

25-Jun-13 

23-Aug-13 

22-Aug-13 

28-Jun-13 

23-Aug-13 

28-Aug-13 

21-Aug-13 

6-Sep-13 

10-Sep-13 

13-Sep-13 

9-Sep-13 

9-Sep-13 

20-Jun-13 

11-Sep-13 

10-Sep-13 

18-Sep-13 

8-Oct-13 

23-Sep-13 

Page 540 
 

PP5. Date of Contact - DC1 

8-Oct-13 

8-Oct-13 

4-Oct-13 

8-Oct-13 

9-Oct-13 

8-Oct-13 

18-Oct-13 

21-Oct-13 

10-Oct-13 

18-Oct-13 

21-Oct-13 

21-Oct-13 

17-Oct-13 

21-Oct-13 

23-Oct-13 

1-Nov-13 

4-Nov-13 

21-Oct-13 

4-Nov-13 

20-Sep-13 

31-Oct-13 

31-Oct-13 

21-Oct-13 

22-Oct-13 

30-Oct-13 

24-Sep-13 

9-Oct-13 

16-Oct-13 

21-Oct-13 

21-Oct-13 

7-Oct-13 

13-Jun-13 

21-Oct-13 

23-Oct-13 

4-Nov-13 

18-Oct-13 

6-Nov-13 

15-Nov-13 

4-Nov-13 

4-Nov-13 

5-Nov-13 

Page 541 
 

PP5. Date of Contact - DC1 

11-Oct-13 

25-Oct-13 

21-Oct-13 

19-Nov-13 

20-Nov-13 

21-Nov-13 

2-Dec-13 

23-Jan-14 

27-Nov-13 

20-Dec-13 

12-Nov-13 

20-Nov-13 

16-Dec-13 

9-Dec-13 

29-Jan-14 

2-Dec-13 

4-Dec-13 

27-Jan-14 

17-Dec-13 

21-Nov-13 

5-Dec-13 

6-Feb-14 

31-Jan-14 

7-Feb-14 

6-Mar-14 

31-Jan-14 

24-Feb-14 

18-Feb-14 

10-Feb-14 

20-Feb-14 

16-Jan-14 

13-Dec-13 

17-Dec-13 

31-Jan-14 

23-Jan-14 

24-Jun-13 

24-Jun-13 

27-Jun-13 

27-Jun-13 

27-Jun-13 

26-Jun-13 

Page 542 
 

PP5. Date of Contact - DC1 

27-Jun-13 

27-Jun-13 

27-Jun-13 

25-Jun-13 

25-Jun-13 

27-Jun-13 

26-Jun-13 

27-Jun-13 

20-Jun-13 

28-Jun-13 

5-Jul-13 

3-Jul-13 

2-Jul-13 

18-Jul-13 

5-Jul-13 

5-Jul-13 

3-Jul-13 

3-Jul-13 

2-Jul-13 

12-Jul-13 

10-Jul-13 

3-Jul-13 

1-Jul-13 

28-Jun-13 

24-Jun-13 

3-Jul-13 

1-Jul-13 

2-Jul-13 

8-Jul-13 

18-Jul-13 

16-Jul-13 

16-Jul-13 

26-Jul-13 

3-Jul-13 

21-Jun-13 

2-Jul-13 

1-Jul-13 

28-Jun-13 

1-Jul-13 

24-Jun-13 

1-Jul-13 

Page 543 
 

PP5. Date of Contact - DC1 

9-Jul-13 

15-Jul-13 

12-Jul-13 

8-Jul-13 

3-Jul-13 

16-Jul-13 

16-Jul-13 

25-Jun-13 

16-Jul-13 

28-Jun-13 

5-Jul-13 

11-Jul-13 

15-Jul-13 

15-Jul-13 

3-Jul-13 

10-Jul-13 

17-Jul-13 

8-Jul-13 

19-Jul-13 

25-Jul-13 

27-Jun-13 

24-Jun-13 

2-Jul-13 

19-Jul-13 

15-Jul-13 

12-Jul-13 

24-Jul-13 

10-Jul-13 

9-Jul-13 

15-Jul-13 

11-Jul-13 

13-Jul-13 

8-Jul-13 

13-Aug-13 

14-Aug-13 

16-Aug-13 

13-Aug-13 

12-Aug-13 

14-Aug-13 

26-Jul-13 

23-Jul-13 

Page 544 
 

PP5. Date of Contact - DC1 

26-Jul-13 

12-Aug-13 

15-Jul-13 

23-Jul-13 

5-Jul-13 

21-Aug-13 

28-Aug-13 

16-Aug-13 

22-Jul-13 

26-Aug-13 

11-Jul-13 

20-Aug-13 

19-Aug-13 

5-Sep-13 

4-Sep-13 

3-Sep-13 

12-Sep-13 

1-Jul-13 

24-Jul-13 

10-Sep-13 

27-Aug-13 

9-Jul-13 

9-Jul-13 

26-Jun-13 

10-Oct-13 

7-Oct-13 

11-Oct-13 

2-Oct-13 

5-Sep-13 

9-Oct-13 

22-Oct-13 

29-Oct-13 

29-Oct-13 

29-Oct-13 

29-Oct-13 

25-Oct-13 

28-Oct-13 

24-Oct-13 

19-Sep-13 

1-Oct-13 

30-Oct-13 

Page 545 
 

PP5. Date of Contact - DC1 

27-Jun-13 

29-Oct-13 

25-Jul-13 

17-Sep-13 

15-Jul-13 

1-Jul-13 

2-Aug-13 

26-Jun-13 

1-Jul-13 

26-Jul-13 

23-Jul-13 

30-Jul-13 

30-Jul-13 

8-Aug-13 

31-Jul-13 

1-Jul-13 

26-Aug-13 

27-Aug-13 

17-Sep-13 

4-Oct-13 

10-Oct-13 

10-Oct-13 

10-Oct-13 

3-Oct-13 

5-Nov-13 

10-Jun-13 

16-Jul-13 

12-Jun-13 

6-Sep-13 

3-Sep-13 

5-Sep-13 

9-Sep-13 

23-Sep-13 

24-Sep-13 

1-Oct-13 

1-Oct-13 

6-Nov-13 

15-Oct-13 

31-Oct-13 

8-Nov-13 

15-Oct-13 

Page 546 
 

PP5. Date of Contact - DC1 

10-Jan-14 

11-Feb-14 

3-Feb-14 

24-Jan-14 

29-Jan-14 

26-Jun-13 

26-Jun-13 

30-Jul-13 

20-Jun-13 

11-Sep-13 

30-Sep-13 

3-Oct-13 

4-May-13 

3-Jul-13 

22-Jul-13 

27-Aug-13 

3-Oct-13 

18-Nov-13 

18-Nov-13 

2-Dec-13 

20-Dec-13 

26-Jul-13 

26-Aug-13 

11-Sep-13 

20-Sep-13 

3-Oct-13 

27-Sep-13 

4-Nov-13 

23-Oct-13 

30-Dec-13 

13-Jan-14 

9-Jan-14 

15-Jan-14 

24-Jan-14 

29-Jan-14 

6-Feb-14 

19-Jun-13 

19-Jul-13 

15-Jul-13 

15-Jul-13 

16-Aug-13 

Page 547 
 

PP5. Date of Contact - DC1 

10-Aug-13 

26-Aug-13 

27-Aug-13 

24-Jan-14 

30-Jan-14 

28-Jan-14 

30-Jan-14 

30-Jan-14 

30-Jan-14 

28-Jan-14 

3-Feb-14 

5-Feb-14 

13-Feb-14 

19-Feb-14 

20-Feb-14 

13-Feb-14 

20-Feb-14 

31-Jan-14 

25-Feb-14 

26-Feb-14 

13-Jun-13 

Page 548 
 

 

 

 

 

 

 

 

 

Section A. Initial Contact
 

A.2. I’m sorry; please tell me, what was the main reason that you contacted [insert pp1] on [insert pp5]? 

Response: Other * 

Frequency** Percentage 

Other reason, Uncategorized 4 21 

Assisted Living 2 0.70 

Home healthcare 3 4.78 

Household assistance not relating to personal care (e.g., 

cooking, cleaning, paying bills) 2 15.99 

Medical assistance (unspec.) 2 0.70 

Medicaid (unspec.) 2 1.28 

Secondary/supplemental insurance coverage 4 1.4 

Assistance with medical bills 2 5.02 

Total 21 50.88 

*Responses to the option “Other” are coded and presented in this table. Verbatim responses to this question are available in 

the next table. 

A.2. I’m sorry; please tell me, what was the main reason that you contacted [insert pp1] on [insert pp5]? 

Response: Other 

I was trying to get information on a secondary insurance to help pay my medical bill because i just had some big ones. 

Looking for resources for long term health care for |my Father 

Medical assistance 

For Parent getting into Assistant living. 

Question on Supplementel infomation for Medicare |PART B. 

Supplemental insurance 

The call was about medicaid not medicare 

Assistant Living.for my daughter. 

It had to do with my WILL 

Also looking for houlsehold servuces and nursing services and anything else available to us 

Getting assistance for my friend. 

Hopice for my Mother 

Medicaire questions 

Getting info for my husband's grandmother, to get some kind of aide to help her at home 

In home health care 

Assistance w/our medical bills 

Medical assistance 

Perscription drugs. 

To get asistance in fillimg out a tax form 

Help with hospital bills 

Needed help processing Medicaid Application. 

Page 549 
 

 

 

 

 

 

 

 

 

 

 

 

 

A.3. From where did you first find out about [insert PP1]? Other 

I can't say for sure, but when i started getting meals on wheels i think someone there told me 

Local senior center 

Senior center 

A senior citizens newsletter 

A receptionist at a senior citizen housing complex 

A local community center 

Shared an office with the help line program 

The welfare board in my town 

Hospital 

Through assisted living where my mom is at 

Through our disability worker. We adopted an 8 year old boy last october...he has cerebral palsy 

Case was transfered automatically since i received food stamps 

I had used them in gresham, so i knew they were here when i needed assistance. 

Contractior from kaiseer permanente 

Mother's care-giver (in adult foster-home)\ 

Employed by them 

Walking through neighborhood 

Used them before 

I've dealt with them for about 10 years (i'm disabled) 

I worked for them years ago 

Welfare office 

I've worked in corrolary fields - i know about these agencies 

Earlier contact w/northwest, when i'd been awarded food stamps 

Where we get food stamps 

Through parent's insurance provider 

Attorney 

From various nursing homes 

From whoever i talked to when i called the governor's office 

Not sure..either from family member or someone in hosp{ital 

A friend told me to call the dept of human servces, and they gave me the number 

Department of human services 

Dept of human services 

It was listed on an application i had to fill oult 

From a hospital 

Requirement on application 

Lady came around to my house, telling about the agency 

Pamphlet found at the dhs office 

Advertising by carelink, and by step by step 

I drove by the office, just went in 

Nurse 

Looked up gov't services on the web - they were listed under "arkansas" 

Insurance 

Page 550 
 

 

 

 

 

 

 

A.3. From where did you first find out about [insert PP1]? Other 

Through my attorney 

From my social worker 

Social worker 

My attendant care nurse 

211 line info 

Veterans administration 

Social worker 

Medicare book 

Newsletter 

Place we lived 

Social security 

Social worker 

Center for placement for seniors 

Neighbor of my mother's 

County worker 

Care free center 

From my case worker 

Note in the back of a grocery store receipt 

Human resources 

Senior expo, got a magnet with their phone number on it 

My daughterin law contacted them and then she told me 

Radio ad 

I called the county 

Packet in mail, about senior placement 

Apartment complex that my parent was interested in moving into. 

Through my insurance 

Home health care 

Medical transportation co. 

Heard someone in drugstore talking about it 

Previous health agency i worked for 

I called human resources 

I had used area on ageing in olympia, washington, so i knew to call in here. 

Dentist 

Through unitedway helpline 

Saw their vehicles driving around 

She used to work as a substance abuse counselor 

University of iowa medical service 

Page 551 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section E. Assistance with Services
 

E.7. As a result of your contact with [insert PP1], to what supports and services were you transferred or referred? 

Other * 

Frequency** Percentage 

Other support or service, Uncategorized 3 21.77 

Food stamps/pantry/assistance services 4 5.83 

Home healthcare 5 2.06 

Hospice services 2 2.49 

Non-medical in home assistance (i.e., cooking, cleaning, paying 

bills) 13 8.68 

Medicaid 4 3.84 

Medicare 6 6.15 

Health insurance other than Medicaid/Medicare 2 7.65 

Department of Human Services/Health Services/DHS 15 5.48 

SSA/Social Security 5 0.53 

VA/Veterans Administration 4 0.46 

*Responses to the option “Other” are coded and presented in this table. Verbatim responses to this question are available in

the next table. 

** Total frequencies total more than the number of respondents who selected “Other” since some responses are coded as 2

different types of support. Percentages do not match up for the same reason. 

E.7. As a result of your contact with [insert PP1], to what supports and services were you transferred or referred? 

Other 

Signing up for medicare if you are still working/elab?/i was still confused, thought i needed to go to a medicare website, 

but you had to go to social security, but wading thru the data on socical security website was difficult to find medicare 

She sent me a whole bunch of them, she mailed them to me. /what?/other types of housing agencies. /other?/i think there 

was a brochure in there about what medicare services are covered, pertaining to home health aids and stuff like that. 

The va represntative that comes up here once a month: for the forms i got in the mail : i needed his help in filling out the 

forms from the va. 

Celine County health 

Medicare Supplement for insurance 

Health insurance 

Refered to someone who can help with house work and transportation 

The veterens admin. 

Veterans admin. 

Good Samaritan home healthcare 

Social security 

Services for helping around the house. Need maintenance|around my home. 

I was reffered to s.e.e.t.a: the idaho food assistance program; also to several community churches and the food bank. Also 

helped me set up an appointment for home help, a girl now comes in two hours a week, once a week. 

Elders Choice for living 

Medicaid worker for Marion County in Oregon 

Medicaid worker 

Dekota county health services 

To the welfare office 

Page 552 
 

 

 

 

E.7. As a result of your contact with [insert PP1], to what supports and services were you transferred or referred? 

Other 

Another agency, like a home health aide. 

Hospice 

Independant choices, Elder Care 

Meals on whheels 

To the case mgr and financial advisor at woodburn organ, whick is ther medicade dept 

Dept. Of Human Services 

Household services and reading services 

Alzheimners and dimentia support group, also an inhome person to assist in paying bills also we needed a sr advocate 

person to assess the stage of progression of dimentia 

A place called home instead,which is an agency that p|rovides home health care...another agency provided adult day 

care...i also contacted govt agencies to provide sr waiver programs 

D.H.S office 

Home health and personal care giver..i think it is called "elder care" 

Medicare 

Home health aide 

Elders' choice 

Veterans' administration, social security 

The dept. Of Health. In faulkner county. 

Hospice, in-home care 

Senior citizens' in-home care services 

Dhs 

Dep't. Of Human Services, Medicaid Section; an Alzheimers' office in Little Rock, AR (DK name) 

Part d, medicare 

Dhs office 

Dep't of Human Services 

Human service 

Dhs 

New Hampshire Dept. Of Health & Human Services; Meals On Wheels 

Meals On Wheels; Medical Assitance application 

Social security 

The elder choices program 

Medicare | 

Dk, something regarding Social Security benefits 

Social Security Administration; also Vocational Rehab Services 

Dhs 

Dhs. (dept. Of human services) 

Local DHS offices for various programs 

In home care services 

Elders' choice 

Harvard Pilgrim insurance (school system deals with this agency regarding Medicare) 

Page 553 
 

 

 

 

E.9. You said that you/your [insert PP2] did not receive the services through the referral; why do you think that is? 

Other 

Paperwork was not recieved. 

I thought I did everything I needed to do|for Meals on wheels,but haven't heard back from them 

Denied services. (ELAB) dk - I didn't go on the interview with them - my parents are older, and they didn't understand 

and they still don't understand why they were denied. 

rep. says I did not file the paper work. MY request|was denied. 

They'll meet with us tomorrow, my parent should receive these ser vices tomorrow 

I didn't follow up on it 

Page 554 
 

 

 

 

 

 

 

 

 

Section E1.Asistance with Medicaid Eligibility Determination
 

E1.2a Why not? 

Frequency Percentage 

Gave response 85 80.37 

DK 8 18.02 

REF 1 1.61 

Total 94 100.00 

E1.2a Why not? 

She gave me a list and i called, they never called me bac (spec) to do with glasses and dental work 

I dont qualify for medicaid 

I'm still working 

Didn't qualify 

Because i knew i wouldn't qualify and because it didn't apply to me./else/no 

We are not ready for it yet 

I don't need medicaid 

My income is more than the medicaid requirement 

Didn't know i could 

We were still gathering information at that time. 

My father is not eligible for service; has too much money to apply. 

Just needed info, so then i could go back & talk to the family 

Mother had too many assets at that time 

They're waitng for a medicaid worker to call me so i can get an app't w/them 

Just spent last 2 months preparing a wedding 

In the process of being taken care 

Been busy with other responsibilities concerning other relative medical care 

I made $30 too much 

Because of their social security income levels, i assume mom had to fill it out 

I haven't felt all that good yet... I have it started but i haven't finished it yet 

We withdrew, partly because of money our mother currently has 

He doesn't qualify 

Haven't pulled together all the documents necessary yet 

They haven't provided me that opportunity 

I had too many assets 

I didn't have prescriptions to pay for at that time 

Because he husband at the time alreadyk had 

I did not fully understand it and i will not fill it oult until i fully ulnderstand it plus i am waiting for an assessment of my 

father;s medical condfition 

I am already getting these benefits 

Me and my mother have had to read over it several times to really understand 

Just uncertain at that point. My relative was|too ill at that point. 

Page 555 
 

 

 

 

 

 

 

 

 

 

 

 

E1.2a Why not? 

Working on it now. 

My husband said if he was really able to choose the caregiver he wanted, he would want me (his wife)...my husband said 

that it was false advertising because it said he could choose whoever he wanted. But that was untru;e because he wanted 

me (h 

The grandmother just didn't want the government involved 

My brother has medicaid 

My mom was not given more than a few days to live 

I'm still in the process of doing it 

I'm the daughter who takes care of my mom, it's up to my dad to fill out papers like that, he has to make the decision on 

this 

It's on hold right now - my parents have the application but my mother hasn't filled it out yet 

We're still in the process of it (elab) mother just recently got out of the hospital - plus my own time constraints 

Parent already has medicaid 

We're disqualified - we didn't apply because we knew we're not eligible 

I haven't received the application 

Because my friend was not here with me that day to ask questions 

Father's health deteriorating and he was in a local state hospital, died on 11/30 

I ran out of time 

Already have medicaid, was interested in possibly keeping medicaid while going back to work 

I'd just received it now 

Mother was in & out of the hospital... She's had doctor follow up appt's after that... I've been out of work more than 

normal so we're still looking for that kind of information 

I dont remember if i i did it slip my memory 

My mother-in law finance's are such|that she would not qualify 

When we got to nurisng home we wer told |when my parent finaces run,then we can apply. 

I knew myk mom did not need it. She had enough fulnds 

Because i'm not eligible 

I think i am just to proud. 

My mother wants to be totally monetarily independent. 

We are working on that right now 

I was already on medicaid 

Income is a little to high. 

Do not need the service ylet 

We are not applying for any medical assistance. 

We are not eligible yet 

I did not qualify 

Parent has enough money for medical, just need caregiver support 

At this point, i don't know if we'll even need that in the next few months 

My relative has too much money to be eligible 

Already done 

I'm trying to make her daughter understand the medicaid service|\ 

We have an eldercare attorney that will handle this for us, the financial aspect. 

Page 556 
 

 

 

 

 

 

 

 

E1.2a Why not? 

I know i'm not eligible 

My siblings & i are still discussingh options, trying to decide what to do, keeping our mother in her home, or going to a 

longterm care facility 

He, my father, doesn't qualify for those benefits 

We're in the process of doing that 

I didn't need to - already applied and have coverage 

He wouldn't have qualified 

I was always getting disabiltiy. 

My mother's still is capable for paying, for the next couple of months 

The representative said i didn't qualify, i had too much money coming in 

We already gad federal assistance 

It's still in the envelope - it's hard for me to turn pages, deal with staples 

I'm able to provide the aide myself now 

If my mother's eligible, the money that comes from her social secuity at her nursing home, will be taken from her social 

security, a portion of it , and will go to pay for the hearing aid. Contingent on what her hearing test shows - we have to 

According to the standards of who we were talking to, we have too much income 

I didn't feel it was an issue 

E1.6a. What was the name of the program? 

Frequency Percentage 

Gave Response 8 84.80 

DK 7 15.20 

Total 15 100.00 

E1.6a What was the name of the program? 

Lifeline 

Not sure of the name 

Elder's choice independent choices 

Aapd waiver 

Aarp 

Not sure 

Dont recall 

Senior waiver program 

E1.7a. Which other insurance resources were you given information? 

Frequency Percentage 

Gave Response 61 66.23 

DK 26 33.77 

Page 557 
 

 

 

 

 

 

 

Total 87 100.00 

E1.7a. Which other insurance resources were you given information? 

I don't remember what kind it was 

Medicaid 

One was missouri health, and i think i have that, one was rx missouri, but i dont know what that is. Other/no 

Help with health insurance, gave info. 

Supplemental plans 

Medicare, advantage plans 

On helping to get commodities and payments on medicare 

For medicare supplemental insurance 

Medicare supplements, medicare hmos 

Medicare 

Aarp program 

Healthcare through midwise and health insurance program(hip) 

Veterans' aid 

Private insurabce 

S.s.i. 

Aarp, which my mom already has 

Ohp 

Workoregon, aflac 

Private insurance, dk name 

Blue cross 

None in p-articalur just let ,me know that she is eligible for that type of coverage 

Long term care insurance 

Aarp 

Humana, others as well but dk name 

Medicare 

Many follows the person 

Money follow the person 

Page of names and addresses for care 

Will not discuss 

Private insurance (name?) Dk 

Esate (else) no 

The different medicare programs it could be covered under 

Medicare 

Aarp 

The special needs program that i referred to earlier 

Medicare supplements 

Minnesoota care state funded healthcare program 

Everything i alreadty have 

Mille lacs county state or government insurance 

Page 558 
 

 

 

E1.7a. Which other insurance resources were you given information? 

Comprehensive heaath insurance 

Was given pasperwork about other private insurance 

My mom pays for her own long term care..no resources used at all 

Other low-income... Senior health partners, where you don't hacve to pay th e20% 

Health partners 

Nothing specific 

Representive went through a list of private |insurence and gov agency with me. 

Humana 

Elder waiver or sr waiver, a state run program 

My direct benefits from medicaire 

Elderly waiver 

Blue cross/blue shield, health partners, medica 

Minnesota care, humana 

Veterans' affairs assistance 

Medicare 

About medicaid 

Disability 

No other resources were available 

Medicare 

I don't recall 

Dental 

Medicare 

Page 559 
 Page 560 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section F. Services Received from the [insert PP1]
 

F.2. Why do you think you/your [insert PP2] have/has not received the services for [insert PES A.2 if answered; 

else insert PP6]? 

Some other reason [SPECIFY] * 

Responses Frequency Percentage 

Some other reason, Unclassified 24 10.11 

Not eligible 21 6.01 

Still in the planning/beginning stages 16 4.55 

Service provider did not follow-up with me/have not 

heard back from service provider 30 9.92 

Have not applied for services 7 2.40 

Too expensive/not affordable 8 5.05 

Waiting for evaluation/meeting 9 2.26 

Total 115 40.3 

*Responses to the option “Some other reason, specify” are coded and presented in this table. Verbatim responses to this

question are available in the next table. 

F.2. Why do you think you/your [insert PP2] have/has not received the services for [insert PES A.2 if answered; 

else insert PP6]? 

Some other reason [SPECIFY] 

Service was needed for emergency purposes. Reason was not on the list. 

I don't know, I have filled out all paper work. Have not had any follow-up. 

|We're still waiting for hearing test results 

Agency need's 3 pieces of info. (Bank Statment, Insurance, sale agreement on land that|had been sold). 

Applying for a "Grant". The paper work has to be sent, I have to get Three|different Quotes for a stair-Lift and a Ramp. 

Area IV said they don't do this kind of service, washing down walls on a trailer home 

Because she's in that loophole of being on Medicare, what Medicare covers and what they don't cover... Guess it has to do 

with her financials 

Because there is a lot|of paper work,just getting started on filling out apps. 

Called about |issue with guardianship,but didn't get answer. 

Case hasnt started yet 

Currently waiting 

DHS hasn't finished processing the paperwork she needs as yet 

Did not qualify|based on my age 

Didnot qualify 

Didn't get the information I needed, that they said they would send 

Doctor wanted hin to try to walk first 

Don't really know,|being told they have to do NEW paper work and starting with|the older paper work first. Keep 

calling,and left messages. 

Dr. Has to evaluate|my mother first. 

Everything is still in the process stage right hnow 

Expecting in-house|evaluation is tomorrow. 

Father is deceased 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

F.2. Why do you think you/your [insert PP2] have/has not received the services for [insert PES A.2 if answered; 

else insert PP6]? 

Some other reason [SPECIFY] 

Going through|the info now. 

Have an appointment in a month. 

Have not |recieved paper work as yet. 

Have not filled out application 

Have to determined|since I just moved. 

Have to finish |filling out paper work. 

He has not been at home..since the phone call he has been back and forth between a hospital & senior care center 

He lived with me at home & i was able to cook and prepare the meals 

I already had been in contact with the facility we ended up placing my mother in 

I already have a job; i was trying to find out what i needed to do for applying for m.a.p.d. 

I am not qualified because I am able to dress myself and cook and feed myself,bath my |self. Therefore I am not qualified 

for the service. 

I am waiting to |see if my husband keep his license 

I couldn't reach the at the other number - the phone rang and rang 

I decided to hold off because I wasn't sure if I had a choice in who would be here |to help me. I didn't want a stranger in 

my house. 

I did not really go after the services 

I didn't call for the service yet because I have glaucoma 

I didn't complegte the paperwork... I was told she wasn't at a stage where she would qualify for the services she'd need 

I didn't follow up because it was just too expensive. 

I didn't understand the person - their accent, they couldn't speak English properly -

I don't need it right now 

I don't qualify 

I don't remember which agency provided the service 

I got a call today.|the Rep. Will contact me a few days for an appointment for an|evaluation. 

I had to cancel the evaluation because i was sick all night long, and they never contacted me back; i asked them to contact 

me, and i'm pissed off because it took me forever to talk to a supervisor to get a 

I hadn't talked it over w/my son just yet... Transporation would have been a problem... Also, I wasn't sure yet if it would 

be suitable for my son, being 30 years old and the types of problems he has. I did 

I have a plan in place for her now - her children, we take of her 

I have an appointment this coming tuesday and i will bring the application then 

I have not had my meetintg yet 

I haven't applied for them 

I haven't filled out the papers as yet 

I haven't finished the application as yet 

I have'nt follow-up.|My sister was the one taking care of my mother. We will leave it up|to my sister,we will discuss it 

what options for mother. Gave info|to my sister for my mother to look at. 

I haven't put it in the mail, but i will tomorrow morning! 

I haven't received papers they sent. 

I just called for information about Part D - I have no idea about these types of coverage 

I just were getting information for the future, 

I lost the referal number they provided, and i've been thinking of doing it this week, but i fell, so i will try next week 

I made the|phone calls to Mesa County arch,but one has called back or|sent info. 

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F.2. Why do you think you/your [insert PP2] have/has not received the services for [insert PES A.2 if answered; 

else insert PP6]? 

Some other reason [SPECIFY] 

I made too much money 

I really don't know most of this - I wasn't contacted at all yet 

I talked to them at the facility last week, the admistrator said she'd get back to me, tomorrow. 

I temporarily left the county 

I think they are not doing their job,it's taking too long. 

I was not given all the paperwork needed 

I was previously dropped from medicade 

I was told by choices in living they don't do these kinds of repairs, I was referred to another agency I don't remember, they 

said they didn't give that of service either 

I was told i made too much money in social seculrity 

I wasn't here when the information arrived in the mail 

If I had Medicaid I could get the services, I have Medicare 

I'm just waiting for their decision 

I'm not old enough, & I'm working, covered by insurance 

I'm not yet disabled enough to receive Medicaid benefits. 

I'm waiting on estimates to get back to the agency (WVA&D), and get everything into the mail on Monday, to get the ball 

rolling 

It costed money; it was not affordable. 

It was something they didn't offer - she told me to call White County aging, but she didn't offer to give me the number 

It was turned back to his case worker at the disability office that we were previously deasling with. They confirmed that 

he was already on medicaod 

It's only been 7 days and this takes up to 45 days to recieve. 

Its too soon just filled out application 

Just had recent contact about this 

Just interviewed yesterday with rep. From northwest. 

Just recieved paper|work from another program this week. 

Lack of availability of the housing i requested 

Mail is slow 

Money issue|is holding me back. 

My appointment in 2 days 

My husband said if i can not give him the personal care, he does not want anyone else. He feels he is not given his 

personal choice 

My son made an|appointment for me, No one ever contact me. I have called a few|times,No one has come out to my house 

yet. I have contacted|different numbers Northwest gave me,still no answ. 

My step dad didn't fill out the papers needed 

Needed Electric |Wheel chair and was told that "we would have wait a few more|yrs". (wife had manuel chair). 

Needed paper work from Social Security, it would take 6 wks. I was not able to follow|through on my paperwork. 

Needed to wait one more month - she's paying privzately for carde she's gettign now, tyoo many assets for Medicaid 

Never got to apply for Medicaid or follow up because of my mother's medical emergency 

NEVER H,AD ANY folowups EITHER BY PHONE OR PERSONAL VISIT OR BY EMAIL 

No Funding for the Energy program until January, and IF there is enough funding|there is a Wait List. 

No funds available 

No one ever called back 

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F.2. Why do you think you/your [insert PP2] have/has not received the services for [insert PES A.2 if answered; 

else insert PP6]? 

Some other reason [SPECIFY] 

None of the abovde 

None of these - my parent is receiving services 

Not eligible yet. 

Not sure of|the reason. I think i was not clear of services that i needed. 

Paperwork is in process of being completed|\ 

Reason were financial, my friend chose not to pursue 

Relative passed away within 5 days of contact 

Said income was too high 

She couldn't get it, she didn'thave the insurance for it 

She got lost in the shuffel? We never received the information packet they told us about 

She has medicaid and medicaree so the state programs take care of her services 

She makes too much money and does not live in a nursing home....she lkives with me 

She transferred property but they told us it would have to be 5 years before she'd be cdovered, or, transfer the proerty back 

into her name, then she'd be eligible for Medicaid 

She went to the nursing home and we didn't have time to wait for their response 

She's still in the skilled nursing facility - not ready to go back to her home 

Still evaluating her parent's needs. And she got ill again 

Still waiting for medicaid approval 

Still waiting for northwest to contact me 

Still waiting to find out if my mom is eligible for the program 

The assistant living|was for my daughter,she is too young right now. 

The only thing my|friend has is a nurse that comes to the house 2 hrs per day. I do all|the bathing and shaving of my 

friend. 

The papers haven't been filled out yet 

The reason service |recieved is because my Partner needs help. Social security would be|taken away from her. 

The reason they gave was, my income was too high, with me & my husband's income 

The respresentative |did not understand what I needed. 

The surgeon dragged his feet, as far as sending the paperwork oking it, this & that. 

There were no vacancies 

They are still checking on my financial situation 

They contacted her but my mother wasn't able to answer the phone - she was unable to answer 

They couldn't get assistance from Veterans' benefits, you have to have a very low income 

They did not have any sercvices that covered what I was looking for 

They don't pay family members, I had wanted to be paid for taking care of my wife who had a stroke - I couldn't even 

work 

They don't pay for false teeth, but the representative didn't tell me that. The dentist told me they'd pay $44 out of a bill of 

$1,000. 

They have to qualify for the services, my mother has to go through DHS for these services 

They helped with Electric bill and gas bill in the winter 

They just thought I wanted Medicare, didn't talk to me about Personal Care 

They never gave us information about it, not that i can recall 

They said she had another bank accountj in another state and that is why they refused the mnedicaid 

They said they'd send me a form to fill out for my son, to put him into the system. I never received that, never got a phone 

Page 563 
 

 

 

 

 

 

 

 

 

 

 

F.2. Why do you think you/your [insert PP2] have/has not received the services for [insert PES A.2 if answered; 

else insert PP6]? 

Some other reason [SPECIFY] 

call 

They told me I had to spend certain amount of moeny first 

They took too long & by the time they got back to me, my husband died 

They wanted me to let them do whatever, and do the rest myself and I'm 83 years old. They wouldn't plow around my car, 

or clean my little concrete stoop. 

They're under new management... She said whenever they get to my father's file they'll start the process 

This agency does not|do anything with "walk in bathtubs" 

Too many medical bills. Just can't afford it. 

Too soon.Just|submitted the paperwork. 

Waiting for the papewrwork to go through 

We are in the process of recieveing the info now. 

We did not request it...i just wanted to get some information on that 

We don't know|how to approach the subject with my Mother-in law. She lives alone|and seems to be doing well right now. 

We filled it out and we're still waiting to hear 

We have not been out with my parent to see housing because of the waethe conditions. 

We haven't completely gone through everything yet (SPEC) forms we have to fill out for income management 

We haven't requested any services, there hasn't been a need for these services; there hasn't been a need 

We never recieved|any information for housing (7/24/2013). The first contact said 

We spoke with several agencies, I can't really talk about seniorlinkage's role in any of this 

We were given info to help us get into program 

We were looking for meals, but they're only offering 2 meals, and we needed 3. 

We were told to call only on Monday, they only dealt w/energy assistance only on Mondays... That Monday there was a 

snowstorm and we couldn't get out of our driveway. 

We withdrew because of money our mother has 

Would like vouchers,|and Savings (income) is running out. 

Because you have to qualify for medicaid 

Explained it takes from 30-45 days to get set up, and that was the last i heard from her 

Financial reasons 

His medical condition is still being defined. I am trying to get through his cancer treatment before future assessment on 

needs can be defined. 

I come to the conclusion that we weren't eligible 

I do everything to take care of his needs, so i dont need services from them 

I'm not having the surgery until next year and i won't qualify for the medicaid until next year 

It was my choice - ididnt choose to change what he had 

They didnt get back to me with information 

They told me i would have to wait for a nurse to come to my home to evaluiate me but so far, they have not sent a nurse. 

They were not interested in helping 

We're just filling out the paperwork right now, we havne't gotten started yet with her care 

Page 564 
 

 

 

 

F.3.a What other agencies or organizations were contacted? 

Frequency Percentage 

Gave Response 74 86.08 

DK 9 13.92 

Total 83 100 

F.3.a. What other agencies or organizations were contacted? 

Just the va 

Older americans transportation act 

No other but i asked my h.r. guy at work and he told me to contact the area counsel on aging area 6. Funny part area six 

suggested i contact my company h.r. guy because we have a company insurance plan and they felt that they could answer 

som 

Home health care agency (Lake County Home Health Care) 

Helpline 

Medicare. 

I couldn't tell you. I have a case manager that's working on them 

Access 

I contacted the B.R.S. state agency. 

Various energy assistance agencies but i do not know their names 

Sunnyside care center in salem, oregon 

Victim assistance. V.A. office to see|if we could get assistance from them. IF she was still|eligible for help through them 

for counseling and any other |help they may have . The woman gave us phone #'s and we|followed throught with phone 

#'s. 

The free clinic and THE organ HEALTH CARE PLAN 

Loving care 

None 

P.R.N and Aging America 

Dept of human services 

I contacted a home health nurse, also the dept of human services 

Independent choice 

Commission for the blind 

The d.h.s. office - the department of health and human services 

Pine bluff daycare. 

Absolute 

Area Agency on Aging. 

Easter seals 

Medicaid to get me to my appointments. 

Independent choices. 

Harris home health 

Area agency on Aging. 

Easter seals; pathfinders 

Independent care; resource living 

Page 565 
 

 

 

F.3.a. What other agencies or organizations were contacted? 

Care links 

Arkansas rehabilitation 

Alternative living 

Area Of? On? Aging; spoke to Meals On Wheels 

Service from a law school (legal services for those who can't afford it, but R was told he's making too much money) 

Social security administration, vocational rehab 

Elders at home 

Division of aging 

Independent Choice and Healthy Choice 

Tri-care, senior ciizens' living facilities 

Elder choice 

Fresenises medical care 

Home health 

360 community, churches, dept of human services, first call for help 

Cancer care,Coney Heath. 

Churches and volunteer services, and numbers i was given from 211 

The county|\ 

Faith and Action agency. 

A place for mom. 

Chicago county/ family pathways 

Faith in action which is an all volunteer orgabnization made up if members of different churches 

Veterans' admistration 

County health & human services 

Medicare 

Minnesota seniors 

St louis countyk 

7 county senior citizen federation 

Human resources of the county 

Home instead, a non medical organization that does things that give companionship, take people to dr;s office, go 

shopping| 

County social worker 

Ramsey county public health 

Trans tek mobility from "equip-life". 

Social security to help get relief from my high medical expenses 

Attic 

Adaptive home services 

Social Security office. 

Va 

G s i l (granite state independent living). 

Va 

Archuleta county community center 

Page 566 
 

 

 

 

 

F.3.a. What other agencies or organizations were contacted? 

Hhr 

A place for mom 

The administration on aging 

F.4.a What needs was this other agency or organization able to meet? 

Frequency Percentage 

Gave Response 30 100 

DK - -

Total 30 100 

F.4.a. What needs was this other agency or organization able to meet? 

A tombstone for my husbands grave, finished payment on his cremation and the cemetary lot/else/no 

Yes. This agency is for personal transportation. 

Social security website. I'm trying to sign up without leaving my office and travelling an hour and a half away from my 

hometown, by using the social security website. 

Resource options to help mother stay in her home (SPEC) Equipment we could get that would help her stay in her home... 

Also Meals On Wheels 

Clear information on my account. They were|able to provide info. On Medicare info.that I could not |get form Nevada 

County. 

I signed up for oil assistance 

Face to face contact 

Arches supplys a lunch and they supplied info. For|my niece to call that would be helpful. 

Residential light cleaning in the house 

I won't know till after tomorrow, they are meeting me in my home 

Transportation (else) no 

Medical 

Medicaid need and also assisted living in my relative's home, not a nursing home. 

I don't remember if the first agency did or not but Easter Seals has classes and language therapy that sounds right for my 

son 

Short term personal care & therapy (SPEC therapy?) Therapy on my legs 

Home Healthcare,House keeping services. Home delivered|meals. Risk accessments. 

Got a response from Pathfinders - felt my son wasn't suitable for Pathfinders 

They said they'll send somebody out 

They help with Hrs. For my mom. (taking care|of my parent). 

On SSI, you're required to fill out certain paperwork that onl y they have 

Tri-Care provides a sitter for after-hours sitter in the home. 

It was faster service. 

Page 567 
 

 

 

 

 

 

 

 

 

F.4.a. What needs was this other agency or organization able to meet? 

During call the represeantative referred my to Family Pathways - home health aides, occuipational therapy 

I got a little money for some care 

A food program in which you applied for a card which can be used in grocerty stores 

They helped me and point me to the right directions 

Ramsey County Public Health was able to do the evaluation to get to the next step - this was the step that's needed to say 

"your level of care is "B", which means she can't stay in her home 

We were abel to Electric Wheel Chair for my Wife. 

Representative at social security helped|me signe up for part "A" & "B" 

Someone to help deal with new colostomy (ELSE) None 

F.7.a.1 Please tell me why you were [somewhat or very] dissatisfied with the services that you/your [insert PP2] 

received directly from [insert PP1]? 

He never got the services requested 

Just that I never received the assistance for utilities forms they said they'd send 

Lack of help 

They never got back to me 

I'm still in flux - they have not followed through with contacting either myself or my relative 

I didn't receive any services from them 

I didn't receive any services 

She hasn't received any 

I still have nort resolved the issue. 

They did not explain anything to me. I'd ask a question and neverjh get a direct answer. Maykbe they just didn't know. 

Because they didnt explain it to me in the right way 

I didn't recieve any services 

It's been almost 4 months and we haven't heard from a nurse 

Because she didn't get any help; no one helping me to help her 

She did not receive any services 

She never received anything from them..she already had to services...i just wanted to get more info on attendant care 

Didn't receive any services 

I never got a follow up call about my case 

Because he did not receive the services he wanted 

Still waiting to receive paperwork 

She didnt receive any 

I received none 

They have not done anything 

Because i couldnt go further with the conversation, it wasnt thrie fault - it was my fault because i didnt have time to 

continue with them 

He hadn't received any services 

I didn't receive any serviecs from them 

Because i didnt receive anything 

Didnot receive any services there was no info to help me 

There were too many foreigh reps i couldnot understand 

Nothing happened 

I did nbot receive any servuices 

I didn't receive the money I thought I would 

The phone call - I called them 3 times and finally left a message there, name address and phone number, they never called 

Page 568 
 

 

 

 

 

 

 

 

 

F.7.a.1 Please tell me why you were [somewhat or very] dissatisfied with the services that you/your [insert PP2] 

received directly from [insert PP1]? 

back 

They sent a letter saying I wasn't eligible for Part D Medicare. 

F.7.a.2. Please tell me why you were [somewhat or very] dissatisfied with the completeness of the information that 

you received? 

They just kept me on a waiting list 

I don't have an answer from medicare website, or maybe its the social security website, i have no idea: they seem to be 

linked at the hip, but i don't know. 

It was Difficult recieving services from|Nevdad county. Nevada County was contact 11/4/2013|and then no action I called 

December 4th again called|Jan.4....end of January my app. Was accepted.When|I recieved my BIC card Inncorrect info on 

my I.D 

They mentioned it but no one ever followeed up or gave us direction 

Never got information from them 

They are not studying what they are suppose to be doing; they give it to the people who don't need it and the people who 

work don't receive nothing. 

That i didn't recieve the form they said they'd send|\|\ 

Was not looking for services for my self.|need info and services for my partner. (we're not married) 

I was lied to from the beginning 

No followulp or help hatsoever 

I did not get any information 

They did not provide any info. That we needed at all.|we are here just to do medical cards and food stamps. They don't do 

housing, they don't do couseling and they don't give referrals. 

Because my dad lost part of his medical and |I did not know. 

I didn't receive enough, and nobody cared where i was coming from or what my intentions were. /elab?/i can't get an 

answer from people who are aware of what my needs are. 

I felt the information wasn't accurate, in terms of the Medicaid eligiblity 

I haven't received any information 

I did not understand that I could have been |too young, they thought I was not in the right age |group. 

Didn't get enough informkation 

They haven't don anything either/explain?/they cannot do anything: he's not homebound; they took him off hospice 

because of his heart rate went down. 

I DIDN'T RECEIVE ANY SERVICES 

Cause we haven't received any/other/no 

Because the DH office in ft smith are very rude and also very ignorant; like whenever i call and ask questions they just say 

i don't know 

Because they weren't helpful to me at all 

They didn't give me any information i needed, they didn't help me neither 

I can't understand why it's taking so long. 

Have not recieved the paper work as yet. 

Did not get much. Was supposed to get|that form representative. 

I didn't receive all the information that I needede, to know what THEY needed 

It could have been better explaining who|could be here to help me. 

I just didnt' get information I needed 

They said within two weeks we would |have someone come out and do an evaluation. We have|not heard from anyone. It's 

3 months. 

Nobody helped me, they didn't send me to an organization that could help me 

They never came to the house, and phone call. 

We are not receiving the service and i do not feel we were given enoughinformation 

I think since I'm the one that called in for the information, they should have got back in touch with me and tell me why 

Page 569 
 

 

 

 

 

 

 

 

 

 

 

 

F.7.a.2. Please tell me why you were [somewhat or very] dissatisfied with the completeness of the information that 

you received? 

they'be being slow about responding to me 

Received no information 

Because they didn't answer the question I asked. They gave me phone numbers and I called them and told the person my 

idea about going out to where he is, and making sure he takes his medications (CLAR "Question"?) He needs help, he's 

forgetful, 

Have not yet received the necessary paperwork 

Because i still dont know any more today than the day i called them 

I thought they could help. They never told me |that I could try to get Medicaid...Medicare. I did not|know that I could 

apply NOW for it. 

I got information but it didn't help me 

You don't hear anything after that phone call... I had to start at the beginning and go again re-applying 

I felt like I didn't get any information or any help 

I feel I did not recieve the info. I needed|to get my parent sign up for a program and could not|find out what the options 

were. 

It wasn't any completeness - like filling out an applicatioln and having them trash it when you leave 

I never received the information 

Their inability to provide any kind of service 

There was not enough of info. To help us. 

I did not get my alert system 

Do not feel like I got anywhere; (probe) do not feel like I got the help I needed. 

Did not receiving any information and still waiting 

There's no start or finish, no follow up with my father or wtih me 

The entire thing - they didn't seem to be familiar with the program at all, they thought I was after Medicaid 

Because i wasnt referred to any agancies 

Had to explain over and over what i needed to each agency i was referred to 

They couldnt help me 

I got no help at all 

The information i was given most didnt understand because it was foreign reps they were lack of english when explaining 

to me 

No one ever contacted us 

They did not provide anything 

They only said "Call Good Will" maybe|be able to get the wheelchair there. 

They really didn't do anything 

My neighbor gets it and i don't: they are not old. 

They need to take more things into consideration than they do (SPEC) You almost have to be bedfast before you get any 

help, or dead before you can go to the hospital 

Because no one has followed up to see|If I qualify for the services. 

Because I haven't heard anything 

Because no info and no phone has been recieved. 

They didn't provide the services I wanted 

If they don't call you back, you can't find out anything 

It was unfair that I'm not eligible for Part D, when the government is saying everyone has to have insurance. 

They didnt do anything 

F.7.a.3. Please tell me why you were [somewhat or very] dissatisfied with the degree to which their services met 

your specific needs ? 

I had no confidence that the case worker on |my case was actully on my case. 

If there's something she, my nmother could use, we never heard from them 

They never met my needs 

Page 570 
 

 

 

 

 

 

 

 

 

 

 

 

They are not taking time to get to the person to see what the person need; they need to have more personal connection. 

Did not get the service realted "Walk in Bathtubs" 

I had cotacted them and wanted counseling |directly from them,not a referral to another agency. 

At that time I was dissatisfied, with their not being able to wash down the trailer walls 

Did not help with services to my partner. 

Haven't recieved any calls for follow-up 

I do not drive, so i have trouble going to my doctors; i can't seem to get transportation from their services. Portland has a 

lift program, but there doesnt' seem to be a lift program here (monmouth). 

I've not had a lot of contact with them 

They did not meet the needs at all 

Their parameters financially make it difficult for people to get he;lp nowadasyh 

There was no guidance or services offered. They just wanted me to fill out the forms 

Beacuse they did not have any info what so ever.|"we don't do housing, they just do medical cards and food|stamps for 

seniors with disabilities. 

Still can't get answer for personal care. 

I will see waht happens when I visit their office|this wk. 

I need some help with other resources and I need|to talk with representative. I have been playing "telephone tag" 

Level of knowledge related to Medicaid eligibility was less than what I would expect 

They did not do anything at that point. Spoke|with them recently and I am not going to deal with them. 

I couldn't understand them 

I was told I didn't qualify for anything 

I'm not receiving the contact back, as I was told I would 

F.7.a.3. Please tell me why you were [somewhat or very] dissatisfied with the degree to which their services met 

your specific needs ? 

I didn't receive any services 

Cause i actually thought theyd call back and give me more details and information on what she approved or disapporoved. 

I'd like to know where i stand. 

I just felt like maybe the individual should have provided more resources 

When i would ask something, i would never get a direct answer 

Because i dont think the services provided were good enough 

Define what you mean by comprehensive 

I didn't understand, and they didn't help me understand the stiutation/explain?/situation of the things i needed to get some 

help for my mother, help with bathing, medicine scheduling, that's about it. 

They said or did nothing useful. They did not show any concern 

Tghey didn't do nothing, didn't get in tohuch with me, kept saying someone would but no one did|\ 

Didn't get the information I needed 

Thy have not done anything for me 

All I did was fill out paper work. Nothing|has been done for the agency. 

I didn't get no help 

My husband was dissatisfied...if they would not llet me be the caregiver, my husband is not interested in anyone e;se 

We did not receive any services 

Their qualifications, my parents qualifitaction, are the same for inhome care as it is for a nursing home, except for one 

thing, they have to show why you can't take care of yourselves - one has Alzheimers;, the other has dementia. 

They couldn't help me with what I neeeded (SPEC) With the home health aide 

They didn't answer my question - they kept on insisting to take him to a nursing home 

Therhe are no beeds to be met 

Because i still don't know if my parent qualifies or where i can inquire about it 

I feel they could sugguested somplace where|I could have gotten the help. 

Because it just seems like everything just goes |nowhere. It's just a bunch of talk. When you get into the |program for 

Home Care it's to suited for your loved one.|We don't want back in the facility because there is abuse|and neglect. We are 

Page 571 
 

 

 

 

 

 

 

 

 

 

 

 

g 

Paperwork, re-apply... I just get "Re-apply." They say I'm ambulatory, and I wouldn't say walking 3 steps is ambulatory 

I didn't get any information, it just wasn't what I was expecting the way it was phrased in the paper 

Never could connect to get the options OR even|apply. We should be able to go the local DHS office |and get info there 

instead of contacting someone by phone. 

I was expecting more from them (SPEC?) Expecting to hear from them, someone to come out for a visit to find out what I 

needed, see that child 

They really didn't hel{p me with what I needed 

They didn't know what they were talking about, didn't have any information for me 

Still have not received any help 

They did not seem they did not have knowledge|of anything,info to help. 

I was not approved 

I did not get what i needed 

They did not meet my needs. 

At this point she doesn't qualify for the services 

The way I was answreed as far as having to wait til October, which is when they re-evaluate letting people in on thge list. 

They look at the applicatiuon then, then determine if you should be helped 

F.7.a.3. Please tell me why you were [somewhat or very] dissatisfied with the degree to which their services met 

your specific needs? 

The info I rewceived i got from DHS, NOT from this agency... They're going thorough a mgmt change and if they told me 

that then I'd knopw if I could qualtify for this, or should I look somewhere else 

It was confusing... Something went wrong, I don't know what. 

The service was not available in my area. 

I couldnt afford the services that i was eligible for 

They couldnt help me at all 

Have not heard anything from them as yet. 

They did not help me at all 

Because of staff following up. 

Couldnot understand them languauage barrier 

Never contacted 

Amleady mentioned reason and it is not their fault 

Still have not had a follow-up call. 

They did not meet any of my needs 

I thought the services were not complete...there were some grey areas (elab) they were giving me info about hobbies as 

opposed to giving me business contacts... 

Needs were not met. Bascially we had a chair for three|yrs,and we had to wait and that was Not correct. 

Did not receive any services 

I had been previously been told that t hey would help with my personal needs but i was told they did not take care of the 

things i;' needed such as a lift chair, help cleaning my house, amnd relief from medical bills 

Because they haven't met it. I had no problem getting services for mom, but they have changed proceedures. I never 

thought i'd need services, but it came down to it. 

They wouldn't help me, and they didn't suggest anything. She just called and told me "you're not eligible." 

Still have'nt found out if I qualify for Medicaid. 

I called in July and I have not heard anything|for Mesa County arch since. 

Because if you make too much money you can't get help and if you make too little you can't get help and i have 6 people 

to support and i'm in the margin where i can 't get help, but its not all their fault, i'm 70 yrs old and cant walk hardly b 

Small amount of money 

They didn't pay what I thought they were going to. 

I called three times, nobody called back 

Didnt provide services 

Page 572 
 

 

 

 

 

 

 

 

 

 

Out of everything I was looking for,|I only got a "elderly wavier".
 

Ifeel like there was something lacking in the|system now,I don't feel there is enough to offer since|there are older people.
 

F.7.a.4. Please tell me why you were [somewhat or very] dissatisfied with the accuracy of the information 

provided? 

My issues: signing up for medicare only seemed somewhat out of the ordinary for the troubleshooting tools that they are 

provided. 

Because I only got info on my own and then|call Nevada County,and when asked about is available|they never bothered to 

take action. 

I'm sure it exists but we have no evidence of that 

They never gave me information 

Work since 14 years old until 70 years old; and took the medicaid away from me; charging high prices for medication and 

cannot afford this. 

Staff did not spend much time talking |with me. Nothing through the mail. 

It wasn't a representative, and i havent talked to a caseworker yet because i haven't mailed back the forms. 

Ot was lies 

They did niot explain anything to me...they jusst dumped forms and other info on me..they told me to fill out the forms 

without telling me about any of the options...i recently had a struck and have difficulty filling out the forms and they did 

No contact when I called back. Can not|get through to representive. 

Medicaid criteria was not accurate 

It left me more confused about what |they offer. 

I couldnt' understand a word they were telling me 

I didn't get enough information 

I haven't gotten any services 

I called her back with the medicad number and she hasn't called me back or anything 

Because i didn't really get anything from them 

Cause i didn't get no information,no help, we still need help/ 

The person seemed to think it was a game in which they were ib charge of all the rules. 

Because i have not gotten any results 

No follow up for info. 

I went through the pamphlet, did what I was supposed to, but the favor wasn't returned (CLAR) I read this stuff but no one 

got in touch and said what was expectged of me - I more or less felt written off 

Didn't gjet the process done 

They should have contacted me by now to let me know something 

Didn't help me 

You've got to be interested and try to understand what they're saying -

They didn't send any information on this. 

They refered me to the internet and once i did i didn't know what do do with it 

The person at Choices said there was not a program like I wanted but there were programs where you could get home 

nursing 

It seemed like I got the run around when|I went to get the Application from Choices In Living for|Long term care (elder 

choices). 

They didn't day exactly why I could NOT |get someone to sweep and mop. I am not supposed to|sweping and moping 

because of the disability with|my back. I can't stand for very long and when I sweep|it takes about an hr. To do it. 

I didn't get any information 

Because I felt like I was getting the run-around.|Was not able to talk to a person for Information, 

They really didn't give me anything, no help 

Beacuse Respresentative was supposed to send |parperwork via E-mail, It can not access the email sent.|She never 

followed-up to see weather or not I recieved the|info. 

They didn't provide accurate information - they referred me to somebody else and when I call the number I hear a message 

saying the number is no longer in use, or another one, I got somebody that said they didn't know anything about it and that 

Page 573 
 

 

 

 

 

 

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F.7.a.4. Please tell me why you were [somewhat or very] dissatisfied with the accuracy of the information 

provided? 

It was kind of "IFFY" on everything. "IF|they have any ifo, I could get it".... 

I expected a little more useful information (SPEC) I asked abourt physical therapy problems - the rep suggested alternate 

programs,they weren't really helpful 

No one returned my phone call 

There's no accuracy - they didn't ask about the service, offer follow up with me 

The reactions that I got - they were not helpful at all. 

They just couldnt help me 

Have not recieved musch on info. 

Because when the social worker came,she asked|all question about my mother's health...total waste|of time. Needed help 

on HOUSING. 

Didbot tell you enough 

We were never contacted about anything 

They did not help me with anything 

Info not helpful. 

They were wrong. "said we were not eligeble for|services,and that was wrong. 

I don't know, because there has been no results 

Not info. Provided for me. 

No info given,no one followed up with me. 

She should have said "We don't cover dentures." 

They didnt do anything to help us. 

It wasn't what I wanted - I just wanted a referral, a list of names of people I could hire - it wasn't long-term, I needed the 

list 

It wasn't helpful (ELAB) The presentation of it - how they had to call my mother, and she couldn't answer 

F.7.a.5. Please tell me why you were [somewhat or very] dissatisfied with the support you received related to 

decision making? 

The long waiting list i was on and no help reveived 

I felt like she just handed me some panmplets, and I was on my own. She didn't ask me questions, to encourage the 

sharing of ideas (SPEC) she didn't tell me about options instead of medicaid-eligible or private pay. 

We're lost in the shuffle, no one ever contacted us 

No support 

I could not get no results. 

Do you know what kind of support that would be? I don't feel it was ever brought up. 

They werhe no help at all 

Their was no support 

They did give some support but not alot.. 

No support form the person I spoke with.|No referrals or anything. 

When I called,It was like talking to a secretary.|she was going to make the appointment,and they would call|back and set 

up appoinment. No One called. 

They wer telling me what they could & couldn't do, but didn't tell me if they couldn't, who could, or what other 

information was available 

Couldn't understand the person 

They haven't got back to me 

I havnee't gotten any services, all i got is a packet, my needs have not been met. 

Well, because i think they should get information from someone else but i never got it 

They did not explain anything to me. They just sent a form and told me to fill it out...they would not explain anything 

until the nurse came. 

Because i didn't get any information 

Because i didn't get the information i needed/elab?/how do i go about getting her some help with her medicine, helping 

Page 574 
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F.7.a.5. Please tell me why you were [somewhat or very] dissatisfied with the support you received related to 

decision making? 

her do things around the house. 

They were accurate in that they said they could not or would not help me 

No results as yet. 

Was no follow up. The rep. Never came|to my house. Canceled first appointment. 

I didn't understand what they told me 

They didn't support me - what i got was my hospice, they too care of it all 

I didn't get the process done, I didn't get anywhere 

It was the options that were offered. The options|were not for me. 

I didn't get hlep 

They never tried to send anyone evaluate |my relative. 

It seems like no one is paying attention to me, no one has ever gotten back to me 

They did not give me enough info 

Even after they talked to me, they said they'd send him the information in the mail but he hasn't received it, so they haven't 

kept their word 

I heard nothing more from them, after that one conversation 

Because I didn't get the answers to my question, about helping my brother in the family home, rather than putting him in a 

nursing home 

I did not receive what i was suppose to. His only suppirt is family.. 

There was no personal communication, all they did was refer me to the internet 

They refferred to Dept. Of human Services,I went to|wrong dept. Department,need to be in the Aging Dept. It |was a long 

process. Got the application and fill it out|and have not heard anything from Choices In Living. 

Because when aasked if I could have someone|clean my house at twice a week...I was told I can feed myself and|feed and 

cloth my self,I ma not able to get this service. 

When I called, she automatically brought up Medicaid. Not everyone qualifies for Medicaid and I don't like that this is 

something she automatically brought up 

I didn't receive any support 

I didn't get any help 

I was not given options to make a decision.|Whenever I called area Agency on aging,and they told me|to contact the DHS 

office. Contacted DHS on the phone,|DHS refeered me to Choices in Living...Never could get|a response. Called DHS 

back,they s 

I received none, didn't get any anyway 

They didn't know what they were doing, didn't seem to care 

Parent has not recieved any help yet. 

I am running out of money to pay for bills and care 

I don't feel like they helped me. 

I feel that if someone needs help they should be able to contact the person. 

Letting people on the list once a year - taht's kind of strange. I called in december and i have to wait a year to find out if i 

can be helped 

I haven't seen any support - they said they're sending someone out to do an evaluation and they never came - bad I not 

called yesterday, I wouldn't have known they have a backlog 

I didn't get anything from them 

There was no information provided 

They didnt help me decide anything. Just gave me referrals 

Didnot receive services and in the same boat nothing has changed 

The did not give me anyk help at all nor did they offer a referral for help. 

Because already figured out where the housing|was going to be. 

Didnot recieive right info 

We were never contacted 

I could not get the help that i need...the help that i needed was not available in the remote area where i live 

Don't think they offered waht I was looking for, the ser vices i needed\ 

Page 575 
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F.7.a.5. Please tell me why you were [somewhat or very] dissatisfied with the support you received related to 

decision making? 

Until I find out about my issue. 

They did not make any decisions. I made all the decisions 

They didnt answer my question and didnt seem to understand what i was talking about 

It was decided that i was making too much for a program 

The General conversation was "your not eligbel".|and that was all. Had to contact some agency out of town. 

I thought that they could have called and turned me to a different direction for help 

There was no support, just saying "you are not eligible". 

Because I didn't get what I was after. 

They didnt provide any services 

Because there was not alot of follow through 

I didn't feel the person I spoke with, was real receptive. I don't know whether they understood what I asked them. 

F.7a.6. Please tell me why you were [somewhat or very] dissatisfied with the professionalism of the staff? 

Because i still don't have answers : am i signed up for medicare only, i've got my confirmation number from the website, 

haven't heard from medicare; area six can't do anything about that. 

No attention is being giving to my|account. 

Cause i was not given any support related to decision-making. 

It seems phony, because they tell us all this stuff and no one ever cdame through 

Language barrier, sometimes they didn't know how to communicate with her and she's still in the same situation. She 

needs help with some that can speak spanish. 

They don't know what they are doings. 

Never got to talk futher with staff. 

They were liarhs 

They just gave me the run around 

Very unprofessional 

She was very blunt,and to the point. She said|I would have to make an appointment with her,and she would|have them 

(mcmiville office) to contact me. 

They didn't speak English 

I didn't receive any help for him/she talked about nursing homes and other places i couldn't afford; i was very dissatisfied. 

I haven't received any support 

I haven't received any support 

They would not tell me anykthing.. Theyk sai/d i/ woul/ld have to wait til the nurse came out and she still has not come. 

Due to the fact i didn't get any support from them in making a decision 

They didn't give me none 

There was no help 

The lady I spoke with was ok,but it is not working out|the way she said it would. 

Didnot get all the information i needed and no one followed up with me 

I felt if they thought she (mother) or I was important they wouldv'e got back in touch with me 

They should've known someone to call or to refer me to somebody 

I called for a specific thing. Even though they suggested the nursing home, I kept going back to my question about my 

being a caregiver for my brother 

I;f it was rtheir dad, they would have sent the papers i need 

They were very pleasent but didnt follow through 

The lady was very nice,but I did not recieve the |info. Or direction where I need to go. Every I called,I |could NOT get 

anyone on the line. 

There wasn't professionalism at all (SPC) They didn't listen at all 0- as you rattle on, they finally say they're not the right 

person 

They didn't know what they were doing 

Page 576 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

F.7a.6. Please tell me why you were [somewhat or very] dissatisfied with the professionalism of the staff? 

They did not try help or Resolve the issue |for parent with Energy Assistance. Dad is a Senior Citizen|and does'nt have 

much money. 

I've been calling and leaving messages and no one has returned my phone call. 

The rep I spoke with had a horrible attitude, she spoke horrible... She was really rude. 

I didnt receive no support 

Need to have more contact with staff. 

Sometimes the were foreigners and i couldnt understand 

We were never contacted 

I only spoke to someone once and it just didnt work 

Rep. Acted like there was Nothing they could do 

She was never available, and nobody else could do it 

I don't think the girl knew age elegibility. 

F.7a.7. Please tell me why you were [somewhat or very] dissatisfied with the ease of working with [insert PP1] to 

resolve the issue related to [insert PES A.2 if answered or PP6]? 

They sd they were going to process my|app. And then they Did NOT. 

We only had that one initial meeting on the phone, we never received the information they said we would 

They never called me back 

They do not know what they are doing. Seems to have things all backwards. 

Have not contacted about services 

There was no resolution 

I talkd w/them 7/30, but Icalled them at least 10 days before and I had to leave a messaage on a voicemail. It took at least 

10 days for them to call me and just gettign this startecd, getting an interview stgarted - nothing had been sent in t 

No help whatspever 

They were not helpful. They did not give any|resources. They only told me what they supplied. 

It wasn't as easy as i thought it should be/elab?/i would like to have been in touch who knew what i was looking for and 

help me find what i was looking for. /looking for?/affordable housing, something we could handle./else?/no 

I needed paper work from social Secutiy,and called |the rep again,she was on vacation. I will go their office again|this wk. 

When I talked to them she explained everything very clear - she said she would send out a packet with an application for 

Medicaid and I haven't received anything 

I really did not understand what the program was.|I wanted to talk about other avenues for care. They did not|understand 

my request. I wanted info. On home health care. 

I know a little about the aging network... I didn't feel like it was very user-friendly (SPEC) A really complicated phone 

tree when you call... Get referred to the wrong person; it took me 3 times to get to someone who'd talk to me. My situatio 

I couldn't understand them 

I've been trying to move this thing forward, and it's been since the 15th, that's 13 days - it's been a slow follow-up 

I don't think they understood what I was looking for. I think THEY think I make a lot of money but I don't. 

From the lack of communication back from them 

I believe they should have called me back/purpose?/to give me more information on where we stand, do something else, 

give them more information, you know? 

I felt like they really wasn't listening when i talked to them 

All we did was talk to a representative, all they tell me is, "When she gets to you, she gets to you." 

Because they didn't try to help me./else/didn't refer me to someone else to get some help 

My questions were not something to play about. The life of my daughter and granddaughter were at stake 

It just takes too long. 

Didn't really get the service my parent needed. 

No one cared enough to get b ack in contact w/me about what I needed to do 

Didn't get the process done 

Page 577 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

F.7a.7. Please tell me why you were [somewhat or very] dissatisfied with the ease of working with [insert PP1] to 

resolve the issue related to [insert PES A.2 if answered or PP6]? 

They have not resolved my issue or called me back so i am still in the dark 

The application was difficult to understand 

I thought someone would call me by now. I have a nuber to|call someone,I am trying to figure out what I need and i 

don't|need from info. They provided. 

They didn't help me. They said I need Medicaid, but I have Medicare 

I am having to stay home to care for my relative. 

Their was no followup from choices to see if we got the services 

Lack of contact 

They really didnt answer any medicaid questions - they just referred me to the internet 

I feel like they could have told me alot more|of why they could not help me. They could have told me|of a place where I 

could get help,BUT they did not do|that. 

You get the same thing, over and over... Like pulling teeth. Fill out papers and wait. 

It didn't fill my needs. 

Was unable to speak with someone who could|give info. On a program for my parent. 

I'm listening but I really don't hear you, that was the feeling I got about them when I talked to them 

Seeming lack of knowledge and lack of interest 

Parent still has not recieved any help for energy assistance. 

No one has returned my phone call 

I jsutr think that if a person's trying to take care of his wife, that tghe government should have some program to help the 

husband - I couldn't work 

It was just confusing, I'm still confused about it, why they thought I just wanted Medicaid 

Not in the area,disappointed. 

Purpose for timing. Needed info faster. 

They didnot return callls right away 

We were never contacted 

As mentioned b efiore, i did not get the help needed 

Because ther has been no Follow-up. 

I did not get any answers or any help with anything 

Because when I try, I make too much money. 

I only spoke to one person and they didnt understand me 

Because just kinda "belw me off"...didn't have time|for me. 

I couldn't get to the right person, i finally got to a supervisor, but they never followed up, and i could really use the 

service. 

Because my neighbors get generations and they are not old, they are just disabled, and i was told i would get help because 

i am disabled. I felt i was discrimated against, because they get help and i don't. The girl who came to the house was a 

Because there has not been any follow-up to see|IF I was eligilbel for the service for personal care. 

No info, staff has not gotten back to me. 

They didnt give the equiment because they think he could walk 

Because of the amount of money that I had to pay. They coiuldn't find a volunteer to come over here and plow. 

I didn't feel like it wasn't the biggest interest for them, for the day. 

F.7a.8. Please tell me why you were [somewhat or very] dissatisfied with the quality of the services that you/your 

[insert PP2] received from agencies you were referred to by [insert PP1]? 

People didnt deal with her wheelchair because she didn't buy the wheelchair from them. 

I don't know if i'm signed up or not at this late date. And this has nothing to do with area six 'because/ive gone thru the 

website but they haven't commented on whether it is successful. They don't contact me, but i have to go back into their 

I have not got any connections with any organizations yet. 

Page 578 
 

 

 

 

 

 

 

 

 

F.7a.8. Please tell me why you were [somewhat or very] dissatisfied with the quality of the services that you/your 

[insert PP2] received from agencies you were referred to by [insert PP1]? 

They did not provide the service we needed. 

Because I am on a waiting list. 

It was too long in coming, and it was not very personal/elab?/it seems i get left behind/example?/i don't think i can do that 

When i told her what i need, she said we dont do that, and that was it. 

They haven't resolved the problem, all they did was send me a packet, i have not filled out the packet. 

I haven't worked with them on anything./other/no 

I didn't feel they were interested in talking to me 

Cause they didn't solve nothing, things are still the same before i even called them, is still need those things and i'm doing 

it by myself 

They were not interested in helping me. It ehy could not help me, they should of at least had a suggestion as to who might 

be able to help 

No contact with any referral agency yet. 

Only services she received was from health department 

We submitted application for Medicaid for my mom - they went into the interview and were told "You just don't qualify. 

You don't need these services." Mom said after this interview, they stopped services they'd been getting, like meals, and 

hou 

Didn't get any, never received any 

Nothing has been done. No follow up with agency so far. 

I was not referred to any services 

I haven't received anything 

They referred me to someone else again, they said "we don't know anything about that, try this other person." 

I haven't heard anything yet| 

They never got any help from anyone or any contact from anyone. 

Have not received any information from any other agencies 

Because the couldnt help me or refer to anyone 

They couldnt help me with my needs and they didnot have any other referrals for me 

There was no info to get help elsewhere 

They asked and i answered many questions and they misinterpreted some of my answers. 

I was turned down 

They weren't as helpful as this guy, the guy at Senior Linkage. (ELAB) It's hard to get through, it's a state office. If you do 

get through, they give you these short answers, they don't really explain it. 

There is no assistance for her for legal refferal |right now. 

Page 579 
 

 

 

 

 

 

 

 

Section G. Health and Demographic Information
 

G.1. Do you/Does your [insert PP2] have any of the following types of health insurance? 

Some other kind of health insurance [specify] * 

Frequency Percentage 

Some other kind of health insurance, Uncategorized 35 8.04 

Medicaid 94 15.48 

State/County medical assistance program 11 0.54 

TriCare/Champ/Veterans/Military coverage 6 1.15 

Supplemental coverage 10 2.64 

Total ** 152 27.72 

*Responses to the option “Some other kind of health insurance, specify” are coded and presented in this table. Verbatim

responses to this question are available in the next table.
 

** Total frequencies total more than the number of respondents who selected “Some other reason, specify” since some 

responses are coded as 2 different types of insurance. Percentages do not match up for the same reason.
 

G.1. Do you/Does your [insert PP2] have any of the following types of health insurance? 

Some other kind of health insurance [specify] 

Medicaid 

Medicade 

Medicade 

Medicaid 

Indigent care 

Medicaid 

QMB, type of Medicaid 

State farm; va 

Vision and dental 

Blue cross blue shield supplement, and humana for perscriptions 

C.m.sp (county health care which is niot medicaid 

Tri-care 

A smnall long term care policy 

Medicaid 

Medicaid 

Medicade 

Low-income subsidy, similar to Medicare, goes with Medicare 

United health care 

Medicaid 

Medicaid 

United Health Care, for prescriptions 

Organ health care provided through the adoption service and that is medicaid 

Medicaid 

Hmo..used to|called marion polk county. 

State medical, ohp 

Medicaid 

Medicaid 

|Some kind of secondary insurance..not sure what it is 

Has Medical card|from Seniors and disabilities. 

Medicaid 

Medicaid 

Page 580 
 

 

G.1. Do you/Does your [insert PP2] have any of the following types of health insurance? 

Some other kind of health insurance [specify] 

Paying for COBRA 

Prescription Drug coverage 

Medical 

Humana drug coverage 

Medicare part d thru blue cross/blue shield 

Medicaid 

Extra help from tjhe dept of human services 

Medicaid 

Medicaid 

Medicaid 

Humana plus 

Medicaid 

Medicaid 

MEDICAID AND ANOTHER INSURANCE THAT PAYS MY CO-PAYS BECAUSE MY COPAYS COME TO $120-

130 A month 

Medicaid 

Medicaid 

Medicaid 

Medicaid 

Medicaid 

Medicad 

Medicaid 

Medicaid 

Tricare for life 

Medicaid 

Medicaid 

Medicaid 

Medicaid (my Dad has it but Mom doesn't) 

Medicaid 

Medicaid 

Medicaid 

Man handler's insurance. 

Medicaid 

Medicaid 

Medicaid 

Medicaid 

Medicaid 

Medicaid 

Medicaid 

Medicaid 

Medicaid 

Medicaid 

Medicaid 

Medicaid 

Q.m.b./ that is a medicaire supplement 

Supplemental coverage 

Medicaid 

Medicaid 

Care improvement 

Medicaid 

Page 581 
 

 

 

 

 

G.1. Do you/Does your [insert PP2] have any of the following types of health insurance? 

Some other kind of health insurance [specify] 

Medicaid 

Medicaid 

Medicaid 

Small policy from AARP, pays me so much a day if I'm in the hospital 

Care Improvement Plus (affiliated with United Health) 

Medicaid 

He is deceased 

Medicaid 

Medicaid 

Tri-care 

Bluecross/blueshield supplement 

Long term care 

Medicaid 

Medicaid (elder's choice) 

Medicade 

Not sure of kind/name 

Medicaid 

Medicaid 

Medicaid 

Medicaid 

Medicaid 

Medicaid 

Medicaid 

Medicaid 

Teacher retirement insurance 

No 

Medicaid 

Medicade 

Medicare supplement 

Medicaid 

Medicaid 

Medical assistance 

State health insurance 

Silver script and that's for meds 

Medicaid 

V.a. 

Minnesota care, tefra 

Minessotta care healthcare state program 

County medica 

Medi caid 

Humana 

Long term care insurance 

Postal Worker coverage, V-A 

Medical assistance insurance (m.a.) 

M.a. medical asssitance 

Medical assistance through the state 

Medicaid 

Medicaid 

Minnesota care, a state program of medical assistance 

Medi ca 

Page 582 
 

 

G.1. Do you/Does your [insert PP2] have any of the following types of health insurance? 

Some other kind of health insurance [specify] 

Military coverage, Tri-Care For Life 

V-a 

Nursing home insurance 

Supplemental health policy; as well as long term care 

Welfare 

Blue cross 

Minnesota Health Care program 

Medicaid 

Medicaid 

Medicaid 

Medicaid 

Indiana medicaid 

Medicaid 

Medicaid 

Medicade 

Anthem blue cross/blue shield 

Drug insurance 

Gha 

Medicaid; also, Part D 

HMO plan 

Medicaid 

Va 

Humana 

Medicaid 

Supplements 

Private supplemental care to Medicare 

Medicaid 

Medicaid 

Medicaid 

Medicaid 

I have a supplement 

Page 583 
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G.13. Of the following choices, which one most closely describes your/your [insert PP2] s living situation? Do 

you/Does your [insert PP2] live in....... 

Some other setting, specify * 

Frequency Percentage 

Some other setting, Uncategorized 15 2.32 

With Family/Friend/Partner 36 6.33 

Total 51 8.66 

*Responses to the option “Some other setting, specify” are coded and presented in this table. Verbatim responses to this

question are available in the next table. 

G.13. Of the following choices, which one most closely describes your/your [insert PP2] s living situation? Do 

you/Does your [insert PP2] live in....... 

Some other setting, specify 

I rent a trailer 

Live with my son & his family in his mother in law's house 

My home 

Her own house on her son's property 

Guest at friend's house 

I'm living in a motel 

Lives with resp (daughter in law) 

Senior citizen housing 

Mobile home 

Certidied adult foster home 

Live with parents, husb and, and grandmother 

Boards with friends 

Skilled bnursing facility 

Bounces around.|place to place,sometimes friends or family. 

Rent a room at sister-in-law's home 

In daughter's home 

Lives with her daughter 

In family member's home 

My own trailerhome 

She lives with her daughter in the daughter's home 

House that her son owns, but does not live with her 

My house, i am her daughter 

In a 30 foot travel trailer 

Parnet lives with me, I rent. 

Lives with parents 

Respondent's (granddaughter's) house or apartment 

In my home 

In a friend's home 

Lives in my house 

Lives in home of niece 

In my sister's house 

Living w/Respondent 

Independent senior living 

In friend's home 

Lives w/Resp 

She with Mother-in-law 

Lives with care giver. 

Page 584 
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G.13. Of the following choices, which one most closely describes your/your [insert PP2] s living situation? Do 

you/Does your [insert PP2] live in....... 

Some other setting, specify 

Elderly subsidized housing 

Currently resident in a hospital 

Duplex apartment, my own 

In my home 

Live with a friend 

With family members 

Living with 2 friends in their home 

Has a trailer|on Son's property 

Independent living|apartment 

Senior housing, not assisted living 

Living with friend in their home 

Living with other family members in their home 

Group facility 

My mobile home 

Her daughter's trailer 

Independent senior living 

My mother's home 

HUD Housing apartments 

Brother's mobile home 

My brother's trailer 

Senior park (mobile homes) 

Living with daughter in daughter's home 

Son's home 

Senior hud housing 

Relatives' house 

Lives with family 

In a mobile home 

My father's home 

Apartment in a nursing home setting 

Page 585 
 

 

G.14.a How long did you/your [PP2] live in the assisted living setting? * 

Frequency Percentage 

Gave Response 42 61.98 

DK 15 36.60 

REF 3 1.42 

Total 60 100 

G.14.a. How long did you/your [insert PP2] live in the assisted living setting? 

6 Months 

4 Years 

1 Months 

2 Months 

12 Years 

2 Years 

5 Months 

1 Months 

6 Months 

1 Months 

10 Years 

2 Months 

1 Months 

2 Years 

9 Months 

8 Months 

3 Months 

2 Years 

Years 

1 Months 

6 Months 

2 Months 

2 Years 

2 Years 

1 Months 

0 Months 

2 Years 

2 Months 

9 Months 

6 Years 

1 Months 

4 Months 

1 Months 

Page 586 
 

 

G.14.a. How long did you/your [insert PP2] live in the assisted living setting? 

1 Months 

1 Months 

1 Months 

1 Months 

5 Months 

1 Months 

1 Months 

3 Months 

1 Months 

1 Months 

1 Months 

3 Years 

8 Months 

1 Months 

1 Years 

0 Months 

13 Months 

1 Years 

0 Months 

5 Months 

0 Months 

0 Months 

3 Months 

5 Years 

10 Years 

G.15.a How long did you/your [PP2] live in the nursing home? * 

Frequency Percentage 

Gave Response 38 70.18 

DK 10 29.27 

REF 3 0.55 

Total 51 100 

Page 587 
 

 

G.15.a. How long did you/your [insert PP2] live in the nursing home? 

4 Years 

1 Months 

6 Months 

2 Months 

0 Months 

1 Months 

2 Months 

2 Years 

2 Months 

1 Months 

1 Months 

3 Years 

2 Months 

3 Months 

4 Months 

3 Months 

10 Months 

6 Months 

Years 

4 Months 

3 Months 

2 Months 

2 Months 

1 Months 

5 Years 

1 Years 

10 Years 

2 Months 

2 Months 

0 Months 

10 Months 

1 Months 

1 Months 

0 Months 

1 Months 

1 Months 

2 Months 

2 Months 

2 Years 

1 Years 

0 Months 

3 Months 

Page 588 
G.15.a. How long did you/your [insert PP2] live in the nursing home? 

0 Months 

1 Years 

1 Months 

1 Months 

1 Years 

0 Months 

1 Months 

Page 589 
 

 

 

 

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APPENDIX V. OUTCOME EVALUATION AAA SURVEY RESPONSE TABLES 

The following tables contain tabulations of responses to the Participant Experience Survey questions. 

Frequencies indicate the number of respondents selecting each response, while percentages are weighted 

following the methodology outlined in section 1.4 of the Outcome Evaluation Analysis Report. The final 

sampling weight is a combination of a base weight and an adjustment for nonresponse at the agencylevel. 

Section PPS. Pre-Populated Information Based on the Client Screening Tool (ES) and 

Data Collection (DC) Tools
 

Agency Type ES2 

Frequency Percentage 

AAA Rural 11 23.39 

AAA Urban 62 76.61 

Total 73 100 

Needs Spanish Interpreter DC6 

Frequency Percentage 

Yes 71 95.08 

No 2 4.92 

Total 73 100 

Need TRS service DC 7 

Frequency Percentage 

Yes 72 97.54 

No 1 2.46 

Total 73 100 

Preferred Call Time DC5 

No Data Available 

Page 590 
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PP1. Agency Name ES 1 

Frequency Percentage 

Aging Partners AAA 10 14.27 

Albemarle Commission Area Agency on Aging 2 2.70 

Area Agency on Aging of the Permian Basin 18 44.25 

Area IX Area Agency on Aging 9 20.70 

Cape Fear Council of Governments 7 3.33 

Southwest 8 Senior Services, Inc. 2 2.85 

WPCOG Area Agency on Aging 25 11.90 

Total 73 100 

PP2. Respondent Type ES3 

Frequency Percentage 

Self 51 69.31 

Parent 13 19.75 

Child - -

Other Relative 3 1.43 

Friend 3 4.20 

Neighbor - -

Client/Patient 1 2.46 

Other* 2 2.86 

Total 73 100 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

PP3. Study Type ES 5/ES 6 

Frequency Percentage 

Older Adult 33 34.18 

Disability 3 5.15 

Older Adult and Disability 35 58.76 

Neither Older Adult nor Disability 1 0.48 

No Response 1 1.43 

Total 73 100 

Page 591 
 

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PP4. Result of Contact ES7 

Yes No No Response Total 

Frequency Percentage Frequency Percentage Frequency Percentage Frequency Percentage 

Information Assistance 

and/or Referral(s) (not 

including options counseling) 

42 71.53 30 26.17 1 2.30 73 100 

Options Counseling or Peer 

Support/Peer Counseling 4 7.77 68 89.93 1 2.30 73 100 

Benefits Counseling or 

Eligibility Determination 40 39.41 32 58.29 1 2.30 73 100 

Transition Assistance - - 71 96.27 2 3.73 73 100 

Crisis Intervention - - 72 97.70 1 2.30 73 100 

Life skills training or support - - 72 97.70 1 2.30 73 100 

Page 592 
 

 

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 –

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PP5. Date of Contact – DC1 * 

*Responses to this question are available in the appendix with supplemental questions. 

PP6. Reason for Contacting the Agency (Client s Need at Time of the Time of Contact) 

Frequency Percentage 

Income Assistance 7 16.26 

Energy Assistance 3 7.38 

Medicare Questions 3 7.38 

Medicaid Questions (Including Questions About HCBS 

Waivers) 9 13.88 

Housing 3 3.25 

Personal Care - -

Transportation 2 2.78 

Nutrition 1 2.46 

Chronic Health Conditions 1 1.43 

Employment - -

Support Groups - -

Recreation Opportunities - -

Caregiver/Respite Support 5 5.23 

Home Modification 3 5.23 

Attendant Care Services - -

Advocacy - -

Education - -

Services for Emergent Cares/Crisis Intervention - -

Preventative Health Services - -

Ombudsman/Abuse or Neglect Issues - -

Advanced Directives - -

Transition Services - -

Other Independent Living Supports or Services - -

Other 36 34.73 

Total 73 100 

PP7. Mode of Contact DC 10 

Frequency Percentage 

In-person visit 32 27.20 

Telephone call 41 72.80 

Total 73 100 

PP8. Respondent Name DC2 

No Data Available 

PP9. Respondent Age ES5 

Respondent Age 

Page 593 
 

 

Frequency Percentage 

Less than 18 - -

18-45 - -

46-59 3 4.28 

60-84 60 80.01 

85 and above 9 15.15 

No Response 1 0.48 

Total 73 100 

Min 52 

Max 101 

Mean 74.74 

Median 76 

Mode 66 

I.1 Is now a good time for the interview about your experiences? 

Frequency Percentage 

Yes 73 100 

No, this is a bad time - -

No, I don’t remember calling agency - -

Refused, no I don’t want to do an interview - -

Total 73 100 

I.2 When would be a better time to call back to do the interview? 

Frequency Percentage 

Not Applicable 73 100 

Don’t Know - -

RF - -

Total 73 100 

I.3 Can I ask you why are you not interested in participating? 

Frequency Percentage 

Not Applicable 73 100 

Don’t Know - -

RF - -

Total 73 100 

Page 594 

I.4 Do you agree to participate in this research study and begin study procedures as we have? discussed? 
-

 

 

 

 

Frequency Percentage 

Yes 73 100 

No - -

Total 73 100 

I.5 Can you tell me why you don’t wish to participate in the interview? 

Frequency Percentage 

Not Applicable 73 100 

Don’t Know - -

Refused - -

Total 73 100 

CP1. Is this number that I called you on a cell phone? 

(If asked why: I just want to offer to call you on a land line phone, or at a time when you are not 

driving if this is a cell phone) 

Frequency Percentage 

Yes 17 29.42 

No 56 70.58 

Refused (Soft) - -

Refused (Hard) - -

Total 73 100 

CP2. Is there a land line where you would prefer me to call to conduct the interview? 

Frequency Percentage 

Yes - -

No, continue on cell phone 17 100 

Refused (Soft) - -

Refused (Hard) - -

Total * 17 100 

* This question was only asked of those who responded “Yes” to question CP1.

CP3. Are you currently driving, or someplace else where it IS NOT safe to talk on your cell phone? 

Frequency Percentage 

Yes/Call me later - -

No, respondent can talk now 17 100 

Refused (Soft) - -

Refused (Hard) - -

Total * 17 100 

* This question was only asked of those who responded “No, continue on cell phone” to question CP2.

CP4. Is now a good time to talk? 

(Interviewer: IF EVENINGS/WEEKENDS ARE BETTER BECAUSE RESPONDENT IS NOT CHARGED FOR 

Page 595 
 

CELL USAGE, SCHEDULE CALLBACK AND RECORD COMMENTS) 

Frequency Percentage 

Yes, now is fine 17 100 

No, another time is better - -

Refused (Soft) - -

Refused (Hard) - -

Total 17 100 

* This question was only asked of those who responded “No, respondent can talk now” to question CP3.

Page 596 
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Section A. Initial Contact
 

A.0. Was the initial contact with [insert PP1] a telephone call or in person visit? * 

Frequency Percentage 

In-Person Visit - -

Telephone call - -

Don’t Know - -

RF - -

Not Applicable 73 100 

Total 73 100 

* This question was only asked if PP7 was blank. 

A.0b. I just need to verify your current age to be sure you are eligible for the study. Are you 60 years of age or 

older? * 

Frequency Percentage 

Yes 1 0.48 

No - -

Don’t Know - -

RF - -

No Response 72 99.52 

Total 73 100 

* This question was only asked if QES6 had the value “Neither Older Adult nor Disability.”

A.1 When you contacted the [insert PP1], you said that the main reason for your [insert PP7] was insert [PP6]. Is 

that correct? 

Frequency Percentage 

Yes 72 99.52 

No 1 0.48 

Don’t Know - -

Refused - -

Total 73 100 

Page 597 
A.2. I’m sorry; please tell me, what was the main reason that you contacted [insert PP1] on [insert PP5] ? *

Frequency Percentage 

Safe and affordable 

housing options - -

Peer support 

services/groups - -

HCBS Medicaid Waiver 

Programs - -

Caregiver Support (i.e. 

respite program, support 

groups, or counseling) 

- -

Nutrition Programs - -

Employment Services - -

Education services - -

Opportunities to develop 

advanced directives - -

Transportation services - -

Opportunities for 

socialization/recreation - -

Mental health services - -

Ombudsman services - -

Health prevention and 

screening services - -

Emergency services/crisis 

intervention - -

Transition programs 

(from hospitals, nursing 

homes etc.) 

- -

Nursing home 

(institutional) diversion 

program 

- -

Nursing home/residential 

beds - -

Income Assistance - -

Energy assistance - -

Personal Care services - -

Independent living 

services (e.g., home 

modification, attendant 

care) 

1 100 

Independent Living 

Skills training - -

Other, please specify - -

(VOL) DK - -

(VOL) REF - -

Page 598 
 

 

 

 

 

A.2. I’m sorry; please tell me, what was the main reason that you contacted [insert PP1] on [insert PP5]? * 

Frequency Percentage 

Total 1 100 

*Responses to this question are available in the appendix with supplemental questions. 

A.3. From where did you first find out about [insert PP1]? [CHECK MOST APPROPRIATE RESPONSE] 

Frequency Percentage 

Family member, friend or other acquaintance 13 22.44 

Hospital/Clinic/Doctor 2 4.92 

Nursing home/Assisted Living - -

Phone Book 2 3.73 

Brochure/Flyer 1 1.43 

Referral from Senior Center 4 5.71 

Referral from another agency/organization 26 31.96 

Through work 1 0.48 

Internet/Website 6 7.61 

Media/Newspaper/TV/Radio 13 15.54 

Other* 2 1.90 

Don’t Know 3 4.28 

Refused - -

Total 73 100 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

Page 599 
A.4. Was [insert PP1] the first organization that you contacted about [insert PES A.2 if answered OR PP6] 

Frequency Percentage 

Yes 57 78.03 

No 15 20.62 

Don’t Know 1 1.35 

Refused - -

Total 73 100 

Page 600 
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Section B. Agency Efficiency
 

B.1.[ASK ONLY IF PP7 IN PERSON VISIT; ELSE SKIP TO B.2] When you contacted the [insert PP1], how 

long did you wait during the initial contact to talk with someone who could help you with [insert PES A.2 If 

answered OR PP6]? [DO NOT READ RESPONSES, PLEASE CHECK APPROPRIATE RESPONSE] 

Frequency Percentage 

Minimal wait (less than five minutes) 16 58.31 

Five to 10 minutes 6 20.99 

10 minutes to 20 minutes 7 12.24 

Over 20 minutes 1 1.75 

Don’t Know 2 6.71 

Refused - -

Total 32 100 

B.2. Were you able to talk to a representative during your first [insert PP7] with [insert PP1]? 

Frequency Percentage 

Yes 66 87.79 

No 6 11.74 

Don’t Know 1 0.48 

Refused - -

Total 73 100 

B.3. Do you recall how many additional contacts you had to make before you were able to talk with a 

representative, including calls where you left a message on a machine? [DO NOT READ RESPONSES] [PROBE: 

IF NOT SURE, PROBE FOR BEST ESTIMATE AND READ CHOICES] 

Frequency Percentage 

None - -

One 1 20.13 

Two 3 35.71 

Three 2 40.26 

Four or more - -

Don’t Know 1 3.90 

Refused - -

Total * 7 100 

*This question was asked to all those not responding “Yes” to question B2.

B.4. Including the contact that you made [insert PP1] on [insert PP5], how many times have you had to describe 

your request for services to [insert PP1], or explain what you needed? [DO NOT READ RESPONSES] 

Frequency Percentage 

One time 47 57.81 

Two times 15 22.28 

Three or four times 8 15.54 

Five or more times 1 1.43 

Don’t Know 2 2.93 

Refused - -

Page 601 
 

Total 73 100 

Page 602
 
 

 

 

 

 

B.5 Throughout your contact with [insert PP1] did any of the following circumstances reduce or prevent your ability to resolve your issue? [READ 

EACH ITEM TO GET A YES/NO ANSWER] 

Yes No Don’t Know Refused Total 

Frequency Percentage Frequency Percentage Frequency Percentage Frequency Percentage Frequency Percentage 

[insert PP1]’s 

hours of 

operation 

2 4.92 69 90.17 2 4.92 - - 73 100 

Difficulty 

reaching the 

[insert PP1]’s 

staff 

7 12.21 65 85.33 1 2.46 - - 73 100 

Language or 

communication 

problems 

1 2.46 70 94.61 2 2.93 - - 73 100 

Lack of staff 

professionalism 2 2.93 69 94.13 2 2.93 - - 73 100 

Lack of staff 

knowledge 3 7.38 67 87.23 3 5.39 - - 73 100 

Lack of staff 

follow through 7 12.21 61 82.63 5 5.15 - - 73 100 

Page 603 
 

 

 

 

Section C: Effectiveness of Agency Representative
 

C.1. Did you feel the representative at [insert PP1] paid close attention to what you were saying? [READ 

CHOICES] 

Frequency Percentage 

Yes, definitely 65 86.28 

Yes, probably 6 8.80 

No, probably not - -

No, definitely not - -

Don’t Know 2 4.92 

Refused - -

Total 73 100 

C.2. In your opinion, how knowledgeable was the representative at [insert PP1] about the reason you contacted 

them, that is [insert PES A.2 if answered; else insert PP6] ? Were they ..[READ CHOICES] 

Frequency Percentage 

Very knowledgeable 58 74.23 

Somewhat knowledgeable 10 15.46 

Not very knowledgeable - -

Not at all knowledgeable - -

Don’t Know 4 7.85 

Refused 1 2.46 

Total 73 100 

C.3. When you had [insert PP7] with [insert PP1] on [insert PP5], was the information you received from the 

representative at [insert PP1]......? [READ CHOICES] 

Frequency Percentage 

Very clear and understandable 64 85.01 

Somewhat clear and understandable 7 12.05 

Not very clear or understandable 1 0.48 

Not at all clear or understandable - -

Don’t Know 1 2.46 

Refused - -

Total 73 100 

Page 604 
 

 

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C.4. Based on your request for help with [insert PES A.2 if answered; else insert PP6] when you contacted [insert 

PP1], did the representative ask questions that made you feel that your needs for which you initially contacted the 

agency were being correctly assessed? 

Frequency Percentage 

Yes 66 87.79 

No 3 6.34 

Don’t Know 4 5.87 

Refused - -

Total 73 100 

C.5. If the assistance was requested, did the representative at [insert PP1] work with you to develop a plan 

outlining your next steps in meeting your/your [insert PP2] s ongoing need for services or supports? 

[INTERVIEWER NOTE: IF RESPONDENT IS UNCLEAR AS TO WHAT YOU MEAN BY SERVICES AND 

SUPPORTS’, YOU MAY OFFER THIS DECRIPTION: “SERVICES AND SUPPORTS ARE THE THINGS 

YOU MAY NEED TO MEET YOUR HEALTH OR PERSONAL CARE NEEDS AND TO ASSIST YOU WITH 

THE BASIC PERSONAL TASKS OF EVALUATION”.] 

Frequency Percentage 

Yes 45 52.50 

No 16 31.25 

No assistance requested for long term 

care needs 10 13.32 

Don’t Know 2 2.93 

Refused - -

Total 73 100 

C.6. Does the plan accurately reflect your/your [insert PP2] s needs and preferences for resolving the issue that you 

called about, that is [insert PES A.2 if answered; else insert PP6]? [READ CHOICES] 

Frequency Percentage 

Yes, definitely 36 77.49 

Yes, probably 4 10.57 

No, probably not 2 5.44 

No, definitely not 2 1.81 

Don’t Know 1 4.68 

RK - -

Total * 45 100 

*This question was asked to all those who responded “Yes” to question C5.

Page 605 
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Section D. Institutional Diversion
 

D.1. When you contacted [insert PP1], were you considering a move to a long term care facility, such as a nursing 

home, for yourself/your [insert PP2]? 

Frequency Percentage 

Yes 7 9.20 

No 66 90.80 

Don’t Know - -

Refused - -

Total 73 100 

D.2. Did the representative you talked to at the [insert PP1] on [inset PP5] help you to understand other choices for 

staying in the community to avoid or delay moving to a nursing home or other long term care facility? 

Frequency Percentage 

Yes 25 24.19 

No 46 73.04 

Don’t Know 2 2.78 

Refused - -

Total 73 100 

D.3. How likely is it that you/your [insert PP2] will have to move into a nursing home within the next five years? 

Would you say that it is..... [READ CHOICES] 

Frequency Percentage 

Very likely 6 9.67 

Somewhat likely 11 15.54 

Somewhat unlikely 5 6.19 

Very unlikely 42 57.57 

Don’t Know 8 8.56 

Refused 1 2.46 

Total 73 100 

Page 606 
 

 

 

 ’

 

Section E: Assistance with Services
 

E.1. Did you receive access to the service that you/your [insert PP2] needed directly from them or indirectly 

[INSERT PP1] or indirectly by a referral to another agency? 

Frequency Percentage 

Directly ([insert PP1] provided the service) 48 65.82 

Indirectly (you were referred elsewhere) 12 14.43 

Both/some services provided by [insert PP1] staff and some 

through referrals 5 6.03 

Don’t Know 8 13.72 

Refused - -

Total 73 100 

E2. Did the representative of the [insert PP1] help you/your [insert PP2] to connect with the services you/your 

[insert PP2] needed? 

Frequency Percentage 

Yes 16 58.93 

No 9 41.07 

Don’t Know - -

Refused - -

Total * 25 100 

*This question was asked of all those who did not respond “Directly ([insert PP1] provided the service)” to question E1.

E.3 Did the representative of the [insert PP1] transfer your call to an agency or organization that provided 

you/your [insert PP2] with your/your [insert PP2] s needed or requested services? 

Frequency Percentage 

Yes 3 21.65 

No 12 75.98 

Don’t Know 1 2.36 

Refused - -

Total* 16 100 

*This question was asked of all those who responded “Yes” to question E2.

Page 607 
 

 

 

 

 

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E.4. Did the representative of [insert PP1] give you contact information (telephone number, address, web address) 

of an agency or organization that provided you/your [insert PP2] with needed or requested services? 

Frequency Percentage 

Yes 11 87.94 

No 2 12.06 

Don’t Know - -

Refused - -

Total * 13 100 

*This question was asked of all those who did not respond “Yes” to question E3.

E.5 Did the representative of [insert PP1] contact the service provider and arrange for them to contact you? 

Frequency Percentage 

Yes - -

No 2 100 

Don’t Know - -

Refused - -

Total * 2 100 

*This question was asked of all those who responded “No” to question E4.

E.6. When you contacted the provider about the services you were seeking, did that provider already have the 

information that you gave to [insert PP1] or did you have to explain your/you [insert PP2] s need again? [READ 

CHOICES] 

Frequency Percentage 

Provider had the information 4 47.39 

Provider had the information but it was not correct or it was incomplete 

and you had to start the process again 2 10.43 

Provider did not have the information – had to start the process again 8 42.17 

Don’t Know - -

Refused - -

Total * 14 100 

*This question was asked of all those who responded “Yes” to any of questions E3, E4, and E5. 

Page 608 
 

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E.7. As a result of your contact with [insert PP1], to what supports and services were you transferred or referred? 

[RECORD RESPONSE BELOW (CODING WILL BE DONE IN POST PRODUCTION)] * 

Frequency Percentage ** 

Safe and affordable housing options 2 15.22 

Peer support services/groups - -

HCBS Medicaid Waiver Programs - -

Caregiver Support (i.e. respite program, support groups, or counseling) - -

Nutrition Programs 1 13.48 

Employment Services - -

Education services - -

Opportunities to develop advanced directives - -

Transportation services 1 2.61 

Opportunities for socialization/recreation - -

Mental health services 1 7.83 

Ombudsman services - -

Health prevention and screening services 1 13.48 

Emergency services/crisis intervention - -

Transition programs (from hospitals, nursing homes etc.) - -

Nursing home (institutional) diversion program - -

Nursing home/residential beds - -

Income Assistance - -

Energy assistance - -

Personal Care services - -

Medicaid Waiver Assistance - -

Independent living services (e.g., skills training, peer support) - -

Other, please specify * 4 31.74 

None 1 2.61 

DK 1 2.61 

REF - -

* This question was asked of all those who responded “Yes” to any of questions E3, E4, and E5. Responses to this question are 

available in the appendix with supplemental questions.
 

**Percentages do not add up to 100% as respondents could select more than one option.
 

Page 609 
 

 

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E.8. What was the result of the referral? [READ FROM THE FOLLOWING LIST AND CHECK THE MOST 

APPROPRIATE RESPONSE] 

Frequency Percentage 

You/your [insert PP2] received services 3 23.91 

You/your [insert PP2] did not receive services 4 36.52 

It’s too soon to tell 7 39.57 

Don’t Know - -

Refused - -

Total* 14 100 

*This question was asked of all those who responded “Yes” to any of questions E3, E4, and E5.

E.9. You said that you/your [insert PP2] did not receive the services through the referral; why do you think it is? 

[RECORD RESPONSE; CODING WILL BE DONE IN POST PRODUCTION] 

Frequency Percentage 

The services were not what [insert PP2] 

wanted/needed - -

The service/program is not accepting 

applications/there is a waitlist - -

It is too expensive 1 36.9 

There is no transportation - -

The service or program is not available at times 

needed - -

[insert PP2] is not eligible - -

I tried to contact the service or program that was 

referred, but was busy/unavailable - -

Line was busy - -

Wait time was too long - -

Other, ______________ 1 34.52 

Have not yet contacted, but plan to 2 28.57 

Have no plans to contact the service or program 

Please specify ______________________ - -

DK - -

REF - -

Total 4 100 

*Responses to this question are available in the appendix with supplemental questions. 

**This question was asked of all those who responded “You/your [insert PP2] did not receive services” to question E8.

Page 610 
 

 

 

 

 

 

 

 

 

 

Section E1. Assistance with Medicaid Eligibility Determination
 

E1. The next set of questions has to do with information and help that you may have received from [insert PP1] on 

whether or not you/your [insert PP2] are/is eligible for the Medicaid program in this state. 

Frequency Percentage 

Continue 56 71.77 

(VOL) Already receive Medicaid benefits 2 3.73 

(VOL) Did not talk about being eligible for Medicaid 

benefits 15 24.50 

Total 73 100 

E1.1 Did you receive specific information on applying for financial assistance for healthcare and residential 

support services from the federal government? 

Frequency Percentage 

Yes 19 32.60 

No 33 61.99 

Don’t Know 4 5.41 

Refused - -

Total * 56 100 

*This question was asked of all those who responded “Continue” to the Section E1 screener.

E1.2 Did you complete an application for financial assistance for healthcare and residential support services from 

the federal government? 

Frequency Percentage 

Yes 7 40.70 

No 15 50.87 

Don’t Know 1 8.43 

Refused - -

Total 23 100 

*This question was asked of all those who did not respond “No” to question E1.1.

E1.2a Why not? 

*Responses to this question are available in the appendix with supplemental questions. 

E1.3 Were you provided with the help by the [insert PP1] in completing the application for financial assistance for 

healthcare and residential support services from the federal government? 

Frequency Percentage 

Yes 4 70.00 

No 3 30.00 

Don’t Know - -

Refused - -

Total * 7 100 

*This question was asked of all those who responded “Yes” to question E1.2.

E1.4 Did the [insert PP1] help explain what information concerning your finances and care needs might be needed 

to determine if you were eligible for federal assistance for healthcare and residential support services? 

Frequency Percentage 

Page 611 
 

 

 

 

 

 

 

 

 

 

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Yes 7 100 

No - -

Don’t Know - -

Refused - -

Total * 7 100 

*This question was asked of all those who responded “Yes” to question E1.2.

E1.5 How long did you wait to find out if you/your [insert PP2] [are/is] eligible for financial assistance for 

healthcare and residential support services from the federal government? [DO NOT READ RESPONSES, 

CHECK APPROPRIATE RESPONSE] 

Frequency Percentage 

One day or less 1 4.29 

Two to six days 1 12.86 

One week - -

More than one week but less than a 

month 1 12.86 

Over a month 1 22.14 

Still waiting 3 47.86 

Don’t Know - -

Refused - -

Total * 7 100 

*This question was asked of all those who responded “Yes” to question E1.2.

E1.6 Did the [insert PP1] mention they were helping you to apply for Medicaid program, or did they use a different 

name to describe the financial assistance program? 

Frequency Percentage 

Yes, Medicaid 4 42.86 

No, some other program 2 35.00 

Don’t Know 1 22.14 

Refused - -

Total 7 100 

*This question was asked of all those who responded “Yes” to question E1.2.

E1.6a. What was the name of this program? 

*Responses to this question are available in the appendix with supplemental questions. 

E1.7. Were you given information by the agency about other insurance, including private coverage and other types 

of government insurance, besides Medicaid/ [answer from E1.6a]? [PROGRAMMER NOTE: IF ANSWER TO 

E1.6a. IS “DON T KNOW” OR “REFUSED”, SKIP TO E2.1] 

Frequency Percentage 

Yes 10 13.73 

No 42 81.35 

Don’t Know 3 4.92 

Refused - -

Total 55 100 

*This question was asked of all those who responded “Continue” to the Section E1 screener, and who did not answer 

“Don’t Know” or “Refused” to question E1.6a.

Page 612 
 

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E1.7a Which other insurance resources were you given information on? 

*Responses to this question are available in the appendix with supplemental questions. 

Section E2. Assistance with One-on-One Options Counselling 

E2.1.Did you request a conversation with someone to talk with about understanding and selecting the long term 

services beyond information and referral, such as home delivered meals, personal care, help around the house, 

transportation, or similar kinds of services 

Frequency Percentage 

Yes 15 21.33 

No 58 78.67 

Don’t Know - -

Refused - -

Total 73 100 

E2.2. Did you have a conversation with someone about understanding and selecting the long term services beyond 

information and referral? 

Frequency Percentage 

Yes 8 70.63 

No 6 17.84 

Don’t Know 1 11.52 

Refused - -

Total * 15 100 

*This question was asked of all those who responded “Yes” to question E2.1.

E2.3. Did the person you talked to about understanding and selecting the long term services visit you at your 

home/your [PP2] s home? 

Frequency Percentage 

Yes 3 46.84 

No 5 53.16 

Don’t Know - -

Refused - -

Total * 8 100 

*This question was asked of all those who responded “Yes” to question E2.2.

E2.4. Following the first conversation, did the person follow up with either by phone calls and/or additional in 

home visits? 

Frequency Percentage 

Yes 2 31.58 

No 5 53.16 

Don’t Know 1 15.26 

Refused - -

Total 8 100 

*This question was asked of all those who responded “Yes” to question E2.2.

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E2.5. Did the information and support from the person you talked to about understanding and selecting the long term services help you to: 

[READ CHOICES] [RANDOMIZE ITEMS] * 

Yes, definitely Yes, probably No, probably 

not No, definitely not Don’t Know Refused Total 

Freq. % Freq 

. % Freq . % Freq. % Freq. % Freq. % Freq. % 

Better 

understand 

your/your 

[insert PP2]’s 

long term 

service and 

support 

options? 

6 75.26 - - - - 1 9.47 - - 1 15.26 8 100 

Make a 

decision about 

long term 

support 

services? 

3 35.26 1 15.26 - - 2 24.74 2 24.74 - - 8 100 

Get in touch 

with public 

programs? 

5 65.79 1 9.47 - - 2 24.74 - - - - 8 100 

Get in touch 

with private 

services 

including 

services that 

you have to pay 

for yourself? 

2 18.95 1 15.26 1 9.47 - - 4 56.32 - - 8 100 

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E2.5. Did the information and support from the person you talked to about understanding and selecting the long term services help you to: 

[READ CHOICES] [RANDOMIZE ITEMS] * 

Yes, definitely Yes, probably No, probably 

not No, definitely not Don’t Know Refused Total 

Freq. % Freq 

. % Freq . % Freq. % Freq. % Freq. % Freq. % 

Obtain long 

term support 

planning or 

services that fit 

within your 

budget? 

3 28.42 1 15.26 - - 2 30.53 2 25.79 - - 8 100 

*This question was asked of all those who responded “Yes” to question E2.2.

Page 615 
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E2.6. How satisfied or dissatisfied are you with the service you received from the person you talked to about 

understanding and selecting the long term services? [READ CHOICES] 

Frequency Percentage 

Very satisfied 8 100 

Somewhat satisfied - -

Somewhat dissatisfied - -

Very dissatisfied - -

Don’t Know - -

Refused - -

Total 8 100 

*This question was asked of all those who responded “Yes” to question E2.2.

Section E3. Care Transition Services 

E3.1. Based on your contact with [insert PP1], did you/your [insert PP2] receive services that helped you/your 

[insert PP2] to transition from a hospital or other acute care facility into the community? 

Frequency Percentage 

Yes 4 7.61 

No 67 91.44 

Don’t Know 2 0.95 

Refused - -

Total 73 100 

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E3.2. Based on your contact with [insert PP1], did you/your [insert PP2] receive any of the following services? [READ CHOICES] * 

Yes No Don’t Know Refused Total 

Freq. % Freq. % Freq. % Freq. % Freq. % 

A contract before discharge to assess your/your [insert 

PP2]’s discharge needs 3 69.79 - - 1 30.21 - - 4 100 

An explanation of your/your [insert PP2]’s discharge 

instructions 2 51.04 1 30.21 1 18.75 - - 4 100 

Post discharge services such as transportation to the doctor, 

help filling prescriptions, or household help 2 48.96 2 51.04 - - - - 4 100 

Follow-up phone call or visit within 48 hours of discharge 2 51.04 2 48.96 - - - - 4 100 

*This question was asked of all those who responded “Yes” to question E3.1.

Page 617 
 

 

E3.3. How satisfied or dissatisfied are you with the transition service you/your [insert PP2] received? [READ 

CHOICES] 

Frequency Percentage 

Very satisfied 1 18.75 

Somewhat satisfied 2 62.50 

Somewhat dissatisfied - -

Very dissatisfied - -

Don’t Know 1 18.75 

Refused - -

Total * 4 100 

*This question was asked of all those who responded “Yes” to question E3.1.

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Section F. Services Received from the [insert PP1]
 

F.1. Did you/your [insert PP2] ever receive the service for [insert PES A.2 if answered; else insert PP6] that you 

were seeking based on your contact with [insert PP1]? [READ CHOICES] 

Frequency Percentage 

Yes, within one week of contact 36 45.68 

Yes, after more than a week 10 11.42 

No, have not yet received the service 26 41.55 

Don’t Know 1 1.35 

Refused - -

Total 73 100 

F.2. Why do you think you/your [insert PP2] have/has not received the services for [insert PES A.2 if answered; 

else insert PP6]? [READ CHOICES] [RANDOMIZE ORDER] [MULTIPLE SELECTION] [WAIT FOR 

RESPONSE AFTER EACH CHOICE] * 

Frequency Percentage ** 

The services are not available 3 10.5 

You/your [insert PP2] are/is on a waitlist 1 5.92 

You/your [insert PP2] could not get to the services (e.g., hours of operation, 

transportation barriers) 1 1.15 

The information and help received from [insert PP1] was not useful 2 7.06 

You/your [insert PP2] did not follow-up on the information and/or referral. 6 15.65 

You/your [insert PP2] no longer need the services 2 6.87 

Difficulties filling out paperwork 2 7.06 

Not being the right age for these services 2 6.87 

Some other reason, specify______________ *** 12 53.63 

Don’t Know 1 1.15 

Refused - -

* This question was asked of all those who responded “No” to question F.1

**Percentages do not add up to 100% as respondents could select more than one option.
 

***Free text responses accompanying this question are available in the appendix with supplemental questions.
 

F.3. Since contacting the [insert PP1] on [insert PP5], have you been in touch with any other agencies similar to 

[insert PP1] to receive [insert PES A.2 if answered; else insert PP6]? * 

Frequency Percentage 

Yes 10 10.55 

No 63 89.45 

Don’t Know - -

Refused - -

Total 73 100 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

F.3a. What other agencies or organizations were contacted? 

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*Responses to this question are available in the appendix with supplemental questions. 

F.4 Were there any needs that this other agency or organization was able to meet that [insert PP1] was NOT able 

to meet? * 

Frequency Percentage 

Yes 3 22.56 

No 5 59.40 

Don’t Know 2 18.05 

Refused - -

Total ** 10 100 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

** This question was asked of all those who responded “Yes” to question F.3.

F.5. As a result of your conversations with [insert PP1] staff, did you realize that you/your [insert PP2] had a need 

or concern that you did not know that you/your [insert PP2] had before contacting the [insert PP1]? 

Frequency Percentage 

Yes 13 13.72 

No 58 81.52 

Don’t Know 2 4.76 

Refused - -

Total 73 100 

F.6. Did the [insert PP1] follow up with you to find out how useful the information was or how the referral turned 

out? 

Frequency Percentage 

Yes 16 26.96 

No 49 61.62 

Don’t Know 8 11.42 

Refused - -

Total 73 100 

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F.7. On the following scale, as a result of your contact with [insert PP1], how satisfied or dissatisfied are you with... * [RANDOMIZE ORDER 

FOR ITEMS 1 7, ALWAYS ASK ITEM 8 LAST] 

Very Satisfied Somewhat 

Satisfied 

Somewhat 

Dissatisfied 

Very 

Dissatisfied N/A Don’t Know Refused Total 

Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq 

. % 

The services that 

you/your [insert 

PP2] received 

directly from 

[insert PP1] ** 

44 79.94 1 1.91 2 3.93 1 0.64 5 8.39 1 1.91 1 3.29 55 100 

Completeness of 

the information 

that you received? 

55 74.78 10 12.53 3 5.39 2 2.93 3 4.36 - - - - 73 100 

The degree to 

which their 

services met your 

specific needs? 

55 71.69 6 7.77 3 6.34 5 8.33 4 5.87 - - - - 73 100 

The accuracy of 

the information 

provided? 

57 79.54 8 8.72 3 5.39 3 5.39 2 0.95 - - - - 73 100 

The support you 

received related to 

decision-making? 

54 71.45 6 8.64 3 3.41 5 6.34 5 10.15 - - - - 73 100 

The 

professionalism of 

the staff? 

62 81.92 4 6.82 2 2.93 - - 4 5.87 1 2.46 - - 73 100 

The ease of 

working with 

[insert PP1] to 

resolve the issue 

related to [insert 

PES A.2 if 

answered or PP6] 

57 74.78 7 11.02 2 4.92 5 6.34 2 2.93 - - - - 73 100 

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F.7. On the following scale, as a result of your contact with [insert PP1], how satisfied or dissatisfied are you with... * [RANDOMIZE ORDER 

FOR ITEMS 1 7, ALWAYS ASK ITEM 8 LAST] 

Very Satisfied Somewhat 

Satisfied 

Somewhat 

Dissatisfied 

Very 

Dissatisfied N/A Don’t Know Refused Total 

Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq. % Freq 

. % 

The quality of the 

services that 

you/your [insert 

PP2] received from 

agencies you were 

referred to by 

[insert PP1]? *** 

14 59.07 2 8.60 - - - - 3 9.53 - - 6 22.79 25 100 

*Free text responses accompanying this question are available in the appendix with supplemental questions.
 

** This question was only asked of those who responded “Directly ([insert PP1] provided the service)” or “Both/some services provided by [insert PP1] staff and some through
 

referrals” to question E.1.
 

*** This question was only asked of those who responded “Indirectly (you were referred elsewhere)” or “Both/some services provided by [insert PP1] staff and some through
 

referrals” to question E.1.
 

Page 622 
 

 

 

 

 

F.8. As a result of your contact with the [insert PP1], would you say that you are... [READ CHOICES] 

Frequency Percentage 

Much more certain about your/your [insert PP2]’s long term care options 35 47.26 

A little more certain 16 20.94 

About the same 14 20.22 

A little more confused about your/your [insert PP2]’s long term care options - -

Much more confused 1 0.48 

Don’t Know 7 11.10 

Refused - -

Total 73 100 

F.9. To what degree has the information you received from [insert PP1] been useful to you as you select the long 

term care options that are best for you/your [insert PP2]? [READ CHOICES] 

Frequency Percentage 

Very useful 45 54.88 

Somewhat useful 10 14.43 

Not too useful 3 3.41 

Not useful at all 9 14.99 

Don’t Know 6 12.29 

Refused - -

Total 73 100 

F.10. Would you tell a friend or relative who needed help to contact the [insert PP1]? 

Frequency Percentage 

Yes 68 93.66 

No 4 5.87 

Don’t Know 1 0.48 

Refused - -

Total 73 100 

F.11. How likely is it that you would contact the [insert PP1] if you needed services in the future? [READ 

CHOICES] 

Frequency Percentage 

Very likely 56 76.21 

Somewhat likely 4 5.87 

Somewhat unlikely 3 3.25 

Very unlikely 6 8.80 

Don’t Know 4 5.87 

Refused - -

Total 73 100 

Page 623 
 

 

 

 

 

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Section G. Heath and Demographic Information
 

G.1. Do/Does you/your [insert PP2] have any of the following types of health insurance? Record all that apply. 

[READ CHOICES] 

Yes No Don’t Know Refused TOTAL 

Freq. % Freq. % Freq. % Freq. % Freq. % 

Medicare 66 91.83 5 4.28 2 3.89 - - 73 100 

Private Health Insurance 34 39.02 37 57.03 2 3.89 - - 73 100 

Some other kind of health 

insurance (specify)___ * 10 11.58 61 84.53 2 3.89 - - 73 100 

No Insurance 2 1.90 69 94.21 2 3.89 - - 73 100 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

G.2. At the present time, would you say you/your [insert PP2] s health is excellent, good, fair or poor? 

Frequency Percentage 

Excellent 10 11.50 

Good 23 27.99 

Fair 23 36.72 

Poor 13 19.90 

(VOL) [insert PP2] has passed away - -

Don’t Know 2 2.93 

Refused 2 0.95 

Total 73 100 

G.3. Have/has you/your [insert PP2] been admitted to a hospital in the past 6 months? 

Frequency Percentage 

Yes 18 29.90 

No 55 70.10 

Don’t Know - -

Refused - -

Total 73 100 

G.4. What is your date of birth? [month/day/year] 

*Data not included in dataset provided to IMPAQ 

G.5. What is the date of birth of the person for whom you contacted the agency? [month/day/year] 

*Data not included in dataset provided to IMPAQ 

G.6. What is your/your [insert PP2] s gender? [BY OBSERVATION UNLESS NEEDED] 

Frequency Percentage 

Male 26 28.79 

Female 47 71.21 

Don’t Know - -

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Refused - -

Total 73 100 

G.7. What is the highest grade or year of school you/your [insert PP2] have/has completed? [READ AS NEEDED 

TO PROBE] 

Frequency Percentage 

No formal schooling - -

First through 7th grade 7 12.21 

8th grade 1 2.46 

Some high school 10 16.18 

High school graduate or high school equivalency (GED) 24 31.64 

Some college 13 13.88 

Associates degree 7 7.06 

Four-year college graduate 2 2.93 

Some graduate school - -

Graduate and professional degrees 5 7.93 

(VOL) Don’t Know 3 5.23 

(VOL) Refused 1 0.48 

Total 73 100 

G.8. Are you/ Is your [insert PP2] Hispanic, Latino, or of Spanish origin? 

[INTERVIEWER NOTE: IF RESPONDENT SAYS THEY ARE MEXICAN, MEXICAN AMERICAN, 

CHICANO, PUERTO RICAN OR CUBAN, COUNT THEM AS A YES’.] 

Frequency Percentage 

Yes 12 22.44 

No, not of Hispanic, Latino, or Spanish origin 60 76.13 

Don’t Know - -

Refused 1 1.43 

Total 73 100 

G.9. What is your/your [insert PP2] s race? One or more categories may be selected? [READ LIST AND 

MULTIPLE RECORD] 

Frequency Percentage * 

White 51 69.15 

Black or African American 10 10.47 

American Indian or Alaska Native 2 2.78 

Asian or Asian American - -

Native Hawaiian or other Pacific Islander - -

(VOL) Other (Specify) ** 5 12.29 

(VOL) Don’t Know 1 2.46 

(VOL) Refused 4 2.86 

*Percentages do not add up to 100% as respondents could select more than one option.
 

**Free text responses accompanying this question are available in the appendix with supplemental questions.
 

Page 625 
 

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G.10a. And now, what was your/your [insert PP2] s total household income last year from all sources before taxes? 

Include your/your [insert PP2] s income and income from anyone else living in your/your [insert PP2] s household. 

Do not tell me the amount. Please just tell me the answer that best represents your/your [insert PP2] s household 

income. 

[CHECK APPROPRIATE RESPONSE] [READ CHOICES] [PROBE: Your best estimate is fine.] 

Frequency Percentage 

Less than or equal to $40,000 62 82.08 

More than $40,000 to $80,000 3 5.23 

More than $80,000 - -

(VOL) [insert PP2] has passed away - -

(VOL) Don’t Know 7 12.21 

(VOL) Refused 1 0.48 

Total 73 100 

G.10b. Was that...? 

Frequency Percentage 

Less than or equal to $20,000 44 71.79 

More than $20,000 15 19.42 

(VOL) Don’t Know 2 5.80 

(VOL) Refused 1 3.00 

Total 62 100 

G.10c. Was that...? 

Frequency Percentage 

Less than or equal to $60,000 3 100 

More than $60,000 - -

(VOL) Don’t Know - -

(VOL) Refused - -

Total 3 100 

G.10d. Was that...? 

Frequency Percentage 

Less than or equal to $100,000 - -

More than $100,000 to $150,000 - -

More than $150,000 - -

(VOL) Don’t Know - -

(VOL) Refused - -

Total - -

G.11. What is your/your [insert PP2] s marital status? Are you/Is your [insert PP2]....? 

Frequency Percentage 

Married 25 25.30 

Living Together - -

Widowed 31 47.5 

Divorced 12 20.06 

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Separated - -

Single, never married 4 6.66 

(VOL) Don’t Know - -

(VOL) Refused 1 0.48 

Total * 73 100 

*This question was asked to all those not responding “(VOL) [insert PP2] has passed” to question G2.

G.12. With whom, if anyone, do you/does your [insert PP2] live? [READ LIST; SELECT ONE] 

Frequency Percentage 

Alone 37 60.75 

With a spouse or a partner 21 18.56 

With one or more family members 12 17.37 

With one or more friends/people who are not related to me 1 0.48 

Other residents (e.g., roommate) in a residential setting 2 2.85 

(VOL) Don’t Know - -

(VOL) Refused - -

Total * 73 100 

*This question was asked to all those not responding “(VOL) [insert PP2] has passed” to question G2.

G.13. Of the following choices, which one most closely describes your/your [insert PP2] s living situation? Do 

you/Does your [insert PP2] live in...[READ CHOICES] 

[INTERVIEWER NOTE: SEE FAQ FOR DEFINITIONS OR THESE ITEMS IF NEEDED] 

Frequency Percentage 

My/His or her own house or apartment 64 84.30 

Non-medical custodial housing 1 1.43 

In an assisted living setting 1 1.43 

In a nursing home 3 5.31 

In a continuing care retirement setting - -

In some other setting, specify_____________ * 3 7.06 

Refused 1 .48 

Total ** 73 100 

*Free text responses accompanying this question are available in the appendix with supplemental questions. 

**This question was asked to all those not responding “(VOL) [insert PP2] has passed” to question G2.

G.14. Have you/ has your [insert PP2] ever lived in an assisted living setting? 

Frequency Percentage 

Yes 1 1.45 

No 68 93.24 

(VOL) Don’t Know 2 4.83 

(VOL) Refused 1 0.48 

Total * 72 100 

* This question was asked to all those who did not respond “In an Assisted Living Setting” to question G.13.

G.15. Have you/ has your [insert PP2] ever lived in nursing home? 

Page 627 
 

 

 

 

 

Frequency Percentage 

Yes 5 6.62 

No 63 90.45 

Don’t Know 1 2.43 

Refused 1 0.50 

Total * 70 100 

* This question was asked to all those who did not respond “In a Nursing Home” to question G.13.

Mean Median Mode Range 

Min Max 

G.14a. How long did you/your 

[insert PP2] live in the assisted 

living setting?_ / _ (months/years) * 

19.5 19.5 - 18 21 

G.15a. How long did you/your 

[insert PP2] live in the nursing 

home? _ / _ (months/years) ** 

16.91 4 1 1 48 

*Only two responses were given for question G.14.a, both of which were equally likely to occur. 

**Responses to both questions are available in the appendix with supplemental questions. 

Page 628 
 

 

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APPENDIX W. OUTCOME EVALUATION AAA SURVEY FREE TEXT RESPONSES
 

Section PPS. Pre-Populated Information
 

PP2. Respondent Type : 

Responses for Those Answering “Other” 

Spouse 

Spouse 

PP6. Other Reason for Contacting the Agency (Client s Need at Time of the Time of Contact) DC 8 

Medical equipment 

Home improvement 

Window repair 

Incontinence supplies 

Cashed check she didn't do 

Walk-in shower 

Emergency response 

Emergency response button 

Emergency response & raised commode 

Transportation 

Reverse mortgage counseling 

Reverse mortgage counseling 

Reverse mortgage counseling 

Reverse mortgage counseling 

Reverse mortgage counseling 

Home delivered meals information 

Reverse mortgage counseling 

Reverse mortgage counseling 

Reverse mortgage counseling 

Reverse mortgage counseling 

Reverse mortgage counseling 

Reverse mortgage counseling 

Reverse mortgage counseling 

Reverse mortgage counseling 

Reverse mortgage counseling 

Reverse mortgage counseling 

Reverse mortgage counseling 

Reverse mortgage counseling 

Reverse mortgage counseling 

Reverse mortgage counseling 

Reverse mortgage counseling 

Page 629 
 

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 –

PP6. Other Reason for Contacting the Agency (Client s Need at Time of the Time of Contact) DC 8 

Reverse mortgage counseling 

Reverse mortgage counseling 

Reverse mortgage counseling 

Reverse mortgage counseling 

Restart meals on wheels 

PP5. Date of Contact DC1 

14-Jun-13 

21-Jun-13 

14-Jun-13 

12-Jul-13 

24-Jul-13 

19-Jul-13 

12-Jul-13 

1-Aug-13 

19-Jul-13 

1-Aug-13 

10-Jun-13 

2-Jul-13 

9-Sep-13 

2-Oct-13 

9-Sep-13 

1-Jul-13 

28-Jun-13 

28-Jun-13 

1-Jul-13 

1-Jul-13 

1-Jul-13 

1-Jul-13 

8-Jul-13 

9-Jul-13 

8-Jul-13 

8-Jul-13 

19-Aug-13 

13-Aug-13 

15-Aug-13 

5-Aug-13 

6-Aug-13 

4-Sep-13 

12-Feb-14 

11-Feb-14 

Page 630 
 

PP5. Date of Contact –DC1 

20-Jun-13 

16-Jul-13 

9-Aug-13 

20-Nov-13 

22-Jul-13 

30-Jul-13 

13-Aug-13 

17-Jun-13 

12-Jun-13 

21-Jun-13 

18-Jul-13 

30-Aug-13 

9-Sep-13 

16-Sep-13 

25-Sep-13 

24-Sep-13 

29-Oct-13 

14-Nov-13 

12-Nov-13 

31-Oct-13 

18-Nov-13 

12-Dec-13 

18-Dec-13 

9-Jan-14 

22-Jan-14 

17-Jan-14 

17-Feb-14 

20-Feb-14 

4-Feb-14 

21-Nov-13 

31-Oct-13 

31-Dec-13 

27-Jan-14 

3-Feb-14 

24-Jan-14 

24-Jan-14 

25-Feb-14 

17-Jan-14 

Page 631 
 

 

 

 

 

Section A. Initial Contact
 

A.3. From where did you first find out about [insert PP1]? Other 

Mailings from aaa 

Know them from my community 

Home care|(nurse) 

Elderly fair for seniors at the coleseum: there were several booths and i found out there. 

Lady from meals-on-wheels told me 

Texas opportunity 

Local meeting in my community 

On tv, someone named fred thompson 

At a financial institution, was given a list of agencies 

Liberty mutual 

From credit union 

I sell avon at the senior center 

Page 632 
 

 

 

 

 

 

 

 

Section E. Assistance with Services
 

E.7. As a result of your contact with [insert PP1], to what supports and services were you transferred or referred? 

Other * 

Frequency** Percentage 

Home healthcare 1 13.48 

Non-medical in home assistance (i.e., cooking, cleaning, paying 

bills) 1 7.83 

Medicaid 1 7.83 

Health insurance other than Medicaid/Medicare 1 2.61 

Total 4 31.74 

*Responses to the option “Other” are coded and presented in this table. Verbatim responses to this question are available in 

the next table. 

E7. As a result of your contact with [insert PP1], to what supports and services were you transferred or referred? 

Other 

I believe they called it "chores" 

Community services such as home healthcare. 

Humana 

Medicaid 

E.9.You said that you/your [insert PP2] did not receive the services through the referral; why do you think that is? 

Other 

Applied for SNAP...they want more Documentation. 

Section E1. Assistance with Medicaid Eligibility Determination
 

E1.2a Why not? 

Frequency Percentage 

Gave response 13 86.86 

DK 1 3.43 

REF 1 9.71 

Total 15 100.00 

E1.2a. Why not? 

Because i have not yetk given all the information they need 

Because she didn't move here 

I never spoke to an actual rep..just someone that answered the phone 

Problems with the hospital bills 

I did not want it at th.is point. 

I have money saved. Once is has run out,|i will qualify. 

I have veterans benefits, i am a veteran, so i do not need medicaid. 

Page 633 
 

 

 

 

 

 

E1.2a. Why not? 

That's not why i contacted them 

I just had so much going on, it has to be one thing at a time 

We had too much income 

We don't qualify for it. 

Just haven't got to it yet. 

We were looking for information an ddecied to make a decision later 

E1.6a. What was the name of the program? 

Frequency Percentage 

Gave Response 1 36.73 

DK 1 63.27 

Total 2 100.00 

E1.6a What was the name of the program? 

Elderly waiver 

E1.7a. Which other insurance resources were you given information on? 

Frequency Percentage 

Gave Response 4 30.00 

DK 6 70.00 

Total 10 100.00 

E1.7a Which other insurance resources were you given information on? 

Medicaid (else) the snap program (else) that's all we were eligible for 

I don't rememember/any/no, i've already got veterans benefits thru the va, so i don't need anything else 

Fha 

Other agencies like ssi 

Section F. Services Received from the [insert PP1] 

F.2. Why do you think you/your [insert PP2] have/has not received the services for [insert PES A.2 if answered; 

else insert PP6]? 

Some other reason [SPECIFY] * 

Frequency Percentage 

Some other reason, Unclassified 2 11.83 

Page 634 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Not eligible 3 15.27 

Still in the planning/beginning stages 1 3.44 

Service provider did not follow-up with me/have not heard back 

from service provider 4 13.74 

Have not applied for services - -

Too expensive/not affordable 1 3.44 

Waiting for evaluation/meeting 1 5.92 

Total 12 53.63 

*Responses to the option “Some other reason, specify” are coded and presented in this table. Verbatim responses to this

question are available in the next table. 

F.2. Why do you think you/your [insert PP2] have/has not received the services for [insert PES A.2 if answered; 

else insert PP6]? 

Some other reason [SPECIFY] 

Everybody was sick - first the representatives got sick, then I did 

got discouraged with medicare 

Have filled paper work. Not enough volunteers. 

I got 3 signatures out of the four that I needed - so I couldn't get the deed put back in my name 

I never received the list of different service that i was told I would get, on which there are services for housekeeping, 

someone statying in the house w/my mother, just to find out what was available 

It came down to finances. Your parent did not realiz there was fee that was required.|it was 10% total cost. She is on a 

fixed income and couldn't afford it. 

My telephone|number was recored wrong, now the representive from "Life|alert" will call me to set appointment. 

never spoke to an actual rep...the neverh returned my call 

NOT QUALIFIED BECAUSE OF THE INSURANCE HE'S ON 

Paper Work!!! 

PArent still|has money to support herslef,when she runs out of money,then|we will contact Aging Partners again. 

she is over qualified for the services 

The agency sd it will|be 3 more months. 

They weren't interested, when I presented them with the information I found out 

Told to call|in OCtober for the Walk-in shower. 

because we are still completing the steps of selecting the facility 

moved from a residence ot community living 

F.3.a What other agencies or organizations were contacted? 

Frequency Percentage 

Gave Response 9 95.49 

DK 1 4.51 

Total 10 100 

F.3.a. What other agencies or organizations were contacted? 

Page 635 
 

 

 

 

 

 

no others 

PEOPLE CITY MISSION AND THE HOPE PROGRAM 

v.A. 

Easter Day 

Columbus County Senior Center, Housing for Seniors 

U.S.D. rual developement. Columbus county agency. 

WEST TEXAS OPPORTUNITY ONC 

Senor security advisors 

AAG 

F.4.a What needs was this other agency or organization able to meet? 

Frequency Percentage 

Gave Response 3 100 

DK - -

Total 3 100 

F.4.a. What needs was this other agency or organization able to meet? 

to take care of the medication he was taking 

Columbus county will put in the|ramps. 

they told us what we were eligible for as far as $87K - we were eligible for the first six months, $47k. 

F.7.a.1 Please tell me why you were [somewhat or very] dissatisfied with the services that you/your [insert PP2] 

received directly from [insert PP1]? [ONLY ASK IF E.1 = 1 OR 3] 

Because i didnt receive any srevices 

Never received anything 

Electric company is contacting me about|payment. 

F.7.a.2 Please tell me why you were [somewhat or very] dissatisfied with the completeness of the information that 

you received? 

Because i have not got her needs met yet 

They didn't follow up with the information they told me; i never got a phone call. 

They didn't tell me about support and|no follow-up, 

Never received any information 

No info received 

F.7.a.3 Please tell me why you were [somewhat or very] dissatisfied with the degree to which their services met 

your specific needs ? 

Never received it 

They never got back in contact with me 

All the bases were not covered 

Page 636 
 

 

 

 

 

 

- 

 

 

 

 

 

 

 

F.7.a.3 Please tell me why you were [somewhat or very] dissatisfied with the degree to which their services met 

your specific needs ? 

Have not recieved the services yet. 

They were unable to find something affordable to us. 

Never spoke to a professional 

Because there was no mention of a fee up front. 

They did not meet my needs at all 

F.7.a.4 Please tell me why you were [somewhat or very] dissatisfied with the accuracy of the information provided? 

Because it did not meet her needs 

With all the information they gave, they didn't do anything, they didn't follow up on it 

Have not had anything done as yet. 

Because nothing was resolved 

A professional never called me back 

They did not give any information 

F.7.a.5 Please tell me why you were [somewhat or very] dissatisfied with the support you received related to 

decision making? 

Because i was passed from one person to another and it hasn't happened yet 

I thought someone would come out,look|at the leak. It's just a little spot,not the whole|roof. They cut me short about that 

information. 

Some of the places they offered were in the Project, and she just came out of the Project and didn't want to go back to it 

Same answer - never received anything, had nothign to choose from 

I never got an answer ; i never heard from them, the didn't do nothing. 

It seems like there has not been any|decision making on what they are going to ddo. 

Got no support 

They did not help at all...they never re-contacted me 

F.7a.6 Please tell me why you were [somewhat or very] dissatisfied with the professionalism of the staff? 

Never received what I was told I would receive 

The lady who answered the phone said it wasn't her department 

F.7a.7 Please tell me why you were [somewhat or very] dissatisfied with the ease of working with [insert PP1] to 

resolve the issue related to [insert PES A.2 if answered or PP6]? 

I have not had anyone come by to look and|give an "yes OR no". 

Never received anything 

Taking a longer time than expected. 

I fjelt that my questions were not answered 

They have not contacted me, I have given them my phone number, and no follow-up phone call. I |do all the phone 

calls,they never call me. 

Should have more concern about the family 

Did nothing 

Page 637 
 

 

 

 

 ’

 

Section G. Heath and Demographic Information
 

G.1. Do you/Does your [insert PP2] have any of the following types of health insurance? 

Some other kind of health insurance [specify] * 

Frequency Percentage 

Some other kind of health insurance, Uncategorized 3 1.43 

Medicaid 4 6.74 

State/County medical assistance program - -

TriCare/Champ/Veterans/Military coverage 3 3.41 

Supplemental Coverage - -

Total 10 11.58 

*Responses to the option “Some other kind of health insurance, specify” are coded and presented in this table. Verbatim

responses to this question are available in the next table. 

G.1. Do you/Does your [insert PP2] have any of the following types of health insurance? 

Some other kind of health insurance [specify] 

MEDICAID 

Medicaid 

Medicaid 

long term health care program 

Champ. V.A. 

MEDICADE 

Tri-care 

Military coverage 

VETERANS ADMINISTRATION 

Prescription 

conventry insurance 

mediciad 

G.13. Of the following choices, which one most closely describes your/your [insert PP2] s living situation? Do 

you/Does your [insert PP2] live in....... 

Some other setting, specify * 

Responses Frequency Percentage 

Some other setting, Uncategorized 2 4.60 

With Family/Friend/Partner 1 2.46 

Total 3 7.06 

*Responses to the option “Some other setting, specify” are coded and presented in this table. Verbatim responses to this

question are available in the next table. 

Page 638 
 ’

 

 

G.13. Of the following choices, which one most closely describes your/your [insert PP2] s living situation? Do 

you/Does your [insert PP2] live in....... 

Some other setting, specify 

Mobile home 

Daughter's house 

Senior citizen apartment, called a "Secure Building" 

Renting 

G.14.a How long did you/your [PP2] live in the assisted living setting? * 

Frequency Percentage 

Gave Response 2 100 

DK - -

Total 2 100 

G.14.a. How long did you/your [insert PP2] live in the assisted living setting? 

18 Months 

21 Months 

G.15.a How long did you/your [PP2] live in the nursing home? * 

Frequency Percentage 

Gave Response 5 54.11 

DK 2 24.66 

REF 1 21.23 

Total 8 100 

G.15.a. How long did you/your [insert PP2] live in the nursing home? 

18 Months 

4 Years 

2 Months 

3 Years 

4 Months 

1 Months 

3 Months 

Page 639 
 

 

 

 

 

 

APPENDIX X. OUTCOME EVALUATION SUBGROUP ANALYSIS BY CLIENT 

GENDER
 

Exhibit 1: Information Assistance as Result of Contact 

Information Assistance Female Male Total 

No 18.31 5.65 14.52 

Yes 81.69 94.35 85.48 

Total 100 100 100 

*Reported results are weighted percentages 

p < .001 

Exhibit 2: Benefits Counseling as Result of Contact 

Benefits Counseling Female Male Total 

No 54.32 34.99 48.53 

Yes 45.68 65.01 51.47 

Total 100 100 100 

*Reported results are weighted percentages 

p < .05 

Exhibit 3: Transition Assistance as Result of Contact 

Transition Assistance Female Male Total 

No 97.27 99.92 98.06 

Yes 2.73 0.08 1.94 

Total 100 100 100 

*Reported results are weighted percentages 

p < .001 

Page 640 
 

 

 

 

 

 

APPENDIX Y. OUTCOME EVALUATION SUBGROUP ANALYSIS BY CLIENT AGE
 

Exhibit 1: Counseling or Peer Support Options as Result of Contact 

Counseling or Peer 

Support ≤60 >60 Total 

No 80.38 69.10 72.21 

Yes 19.62 30.90 27.79 

Total 100 100 100 

*Reported results are weighted percentages 

p < .10 

Exhibit 2: Satisfaction with Ease of Resolving the Issue 

Level of Satisfaction ≤60 >60 Total 

Very Dissatisfied 13.37 2.50 5.55 

Somewhat Dissatisfied 3.77 2.94 3.17 

Somewhat Satisfied 9.52 23.50 19.58 

Very Satisfied 73.35 71.07 71.71 

Total 100 100 100 

*Reported results are weighted percentages 

p < .001 

Page 641 
 

 

 

 

 

 

 

APPENDIX Z. OUTCOME EVALUATION SUBGROUP ANALYSIS BY CLIENT 

EDUCATION
 

Exhibit 1: Top Five Reasons for Contact 

Reason Less than High 

School Education 

High School 

Education 

Greater than 

High School 

Education 

Total 

Medicare Questions 21.75 26.39 40.66 30.40 

Medicaid Questions 24.37 47.60 23.49 32.54 

Housing 12.07 4.40 14.79 10.27 

Personal Care 14.27 14.52 15.13 14.68 

Nutrition 27.55 7.09 5.924 12.11 

Total 100 100 100 100 

*Reported results are weighted percentages 

p < .10 

Exhibit 2: Satisfaction with Degree to which Services Met Needs 

Level of Satisfaction Less than High 

School Education 

High School 

Education 

Greater than High 

School Education Total 

Very Dissatisfied 28.47 4.53 6.80 11.53 

Somewhat Dissatisfied 1.04 5.53 9.80 5.74 

Somewhat Satisfied 9.69 26.14 19.79 19.77 

Very Satisfied 60.80 63.80 63.61 62.95 

Total 100 100 100 100 

*Reported results are weighted percentages 

p < .01 

Exhibit 3: Satisfaction with Support Received for Decision-Making 

Level of Satisfaction Less than High 

School Education 

High School 

Education 

Greater than High 

School Education Total 

Very Dissatisfied 19.45 3.35 4.32 7.73 

Somewhat Dissatisfied 1.16 5.43 2.60 3.40 

Somewhat Satisfied 17.26 22.75 21.54 20.96 

Very Satisfied 62.14 68.48 71.54 67.92 

Total 100 100 100 100 

*Reported results are weighted percentages 

p < .10 

Page 642 
 

 

 

 

 

 

 

Exhibit 4: Satisfaction with Quality of Services 

Level of Satisfaction Less than High 

School Education 

High School 

Education 

Greater than High 

School Education Total 

Very Dissatisfied 27.01 3.68 1.84 10.62 

Somewhat Dissatisfied 0.24 17.05 1.31 6.97 

Somewhat Satisfied 19.63 20.26 22.03 20.58 

Very Satisfied 53.12 59.00 74.83 61.83 

Total 100 100 100 100 

*Reported results are weighted percentages 

p < .05 

Exhibit 5: Client Recommendation to Others in Need 

Client Would Tell Friends or 

Relatives to Contact Agency 

Less than High 

School Education 

High School 

Education 

Greater than High 

School Education Total 

No 3.74 3.25 9.65 5.54 

Yes 96.26 96.75 90.35 94.46 

Total 100 100 100 100 

*Reported results are weighted percentages 

p < .05 

Page 643 
 

 

 

 

 

 

 

 

 

 

APPENDIX AA. OUTCOME EVALUATION SUBGROUP ANALYSIS BY CLIENT 

INCOME
 

Exhibit 1: Information Assistance as Result of Contact 

Information Assistance Income Less than or Equal 

to $40,000 

Income Greater than 

$40,000 Total 

No 15.77 3.094 14.51 

Yes 84.23 96.91 85.49 

Total 100 100 100 

*Reported results are weighted percentages 

p < .001 

Exhibit 2: Transition Assistance as Result of Contact 

Transition Assistance Less than or Equal to 

$40,000 Greater than $40,000 Total 

No 97.70 99.75 97.9 

Yes 2.30 0.25 2.10 

Total 100 100 100 

*Reported results are weighted percentages 

p < .05 

Exhibit 3: Satisfaction with Services 

Level of Satisfaction Income Less than or Equal 

to $40,000 

Income More than 

$40,000 Total 

Very Dissatisfied 2.11 4.09 2.35 

Somewhat Dissatisfied 4.82 24.80 7.27 

Somewhat Satisfied 13.51 1.40 12.02 

Very Satisfied 79.56 69.71 78.35 

Total 100 100 100 

*Reported results are weighted percentages 

p < .10 

Page 644 
 

 

 

 

 

 

 

 

 

APPENDIX BB. OUTCOME EVALUATION SUBGROUP ANALYSIS BY CLIENT 

HEALTH
 

Exhibit 1: Top Five Reasons for Contact 

Reason Good Health Poor Health Total 

Medicare Questions 45.86 13.82 33.73 

Medicaid Questions 24.81 37.82 29.73 

Housing 10.08 9.93 10.02 

Personal Care 12.13 18.89 14.69 

Nutrition 7.12 19.54 11.82 

Total 100 100 100 

*Reported results are weighted percentages 

p < .05 

Exhibit 2: Crisis Intervention as Result of Contact 

Life Skills Training or 

Support Good Health Poor Health Total 

No 99.50 99.94 99.67 

Yes 0.50 0.06 0.33 

Total 100 100 100 

*Reported results are weighted percentages 

p < .10 

Exhibit 3: Services Were Not Available 

Services Not Available Good Health Poor Health Total 

No 91.34 76.61 84.71 

Yes 8.66 23.39 15.29 

Total 100 100 100 

*Reported results are weighted percentages 

p < .10 

Exhibit 4: Did not Receive Service Because They Were on a Waitlist 

Did Not Receive Services 

Because of Waitlist Good Health Poor Health Total 

No 78.32 92.27 84.60 

Yes 21.68 7.73 15.4 

Total 100 100 100 

*Reported results are weighted percentages 

p < .10 

Exhibit 5: Could Not Get to Services 

Could Not Get To Services Good Health Poor Health Total 

Page 645 
 

 

 

 

 

 

 

 

 

 

No 91.15 98.73 94.56 

Yes 8.85 1.27 5.44 

Total 100 100 100 

*Reported results are weighted percentages 

p < .01 

Exhibit 6: Information Was Not Useful 

Information Was Not Useful Good Health Poor Health Total 

No 85.37 95.28 89.83 

Yes 14.63 4.72 10.17 

Total 100 100 100 

*Reported results are weighted percentages 

p < .10 

Exhibit 7: Client Did Not Follow Up 

Client Did Not Follow Up Good Health Poor Health Total 

No 83.78 94.11 88.43 

Yes 16.22 5.89 11.57 

Total 100 100 100 

*Reported results are weighted percentages 

p < .05 

Exhibit 8: No Longer in Need of Services 

No Longer in Need of 

Services Good Health Poor Health Total 

No 95.48 84.94 90.73 

Yes 4.52 15.06 9.27 

Total 100 100 100 

*Reported results are weighted percentages 

p < .05 

Exhibit 9: Satisfaction with Completeness of Information 

Level of Satisfaction Good Health Poor Health Total 

Very Dissatisfied 1.54 10.02 4.79 

Somewhat Dissatisfied 6.37 7.95 6.98 

Somewhat Satisfied 13.84 20.20 16.27 

Page 646 
 

 

 

 

 

 

 

 

 

 

Very Satisfied 78.25 61.82 71.96 

Total 100 100 100 

*Reported results are weighted percentages 

p < .05 

Exhibit 10: Satisfaction with Degree to which Services Met Needs 

Level of Satisfaction Good Health Poor Health Total 

Very Dissatisfied 2.63 24.80 11.20 

Somewhat Dissatisfied 7.79 2.17 5.62 

Somewhat Satisfied 16.28 19.80 17.64 

Very Satisfied 73.29 53.23 65.54 

Total 100 100 100 

*Reported results are weighted percentages 

p < .001 

Exhibit 11: Satisfaction with Support Received for Decision-Making 

Level of Satisfaction Good Health Poor Health Total 

Very Dissatisfied 1.36 17.37 7.68 

Somewhat Dissatisfied 4.07 2.51 3.45 

Somewhat Satisfied 21.56 19.86 20.89 

Very Satisfied 73.02 60.26 67.98 

Total 100 100 100 

*Reported results are weighted percentages 

p < .01 

Exhibit 12: Satisfaction with Professionalism of the Staff 

Level of Satisfaction Good Health Poor Health Total 

Very Dissatisfied 1.62 3.17 2.19 

Somewhat Dissatisfied 0.62 5.88 2.57 

Somewhat Satisfied 12.15 7.31 10.35 

Very Satisfied 85.62 83.64 84.88 

Total 100 100 100 

*Reported results are weighted percentages 

p < .05 

Page 647 
 

 

 

 

 

Exhibit 13: Satisfaction with Ease of Resolving the Issue 

Level of Satisfaction Good Health Poor Health Total 

Very Dissatisfied 1.26 12.64 5.65 

Somewhat Dissatisfied 3.32 3.06 3.22 

Somewhat Satisfied 18.87 20.89 19.68 

Very Satisfied 76.55 63.32 71.45 

Total 100 100 100 

*Reported results are weighted percentages 

p < .05 

Exhibit 14: Satisfaction with Quality of Services 

Level of Satisfaction Good Health Poor Health Total 

Very Dissatisfied 0.67 29.76 10.62 

Somewhat Dissatisfied 10.12 0.91 6.97 

Somewhat Satisfied 26.02 11.19 20.95 

Very Satisfied 63.19 58.14 61.46 

Total 100 100 100 

*Reported results are weighted percentages 

p < .001 

Page 648 
 

 

 

 

 

 

 

 

 

APPENDIX CC. OUTCOME EVALUATION SUBGROUP ANALYSIS BY CLIENT 

DISABILITY STATUS
 

Exhibit 1: Top Five Reasons for Contact 

Reason Adult without Disability Adult with Disability Total 

Medicare Questions 58.41 24.69 32.83 

Medicaid Questions 30.06 31.88 31.44 

Housing 5.15 11.22 9.75 

Personal Care 0.69 18.86 14.47 

Nutrition 5.69 13.35 11.50 

Total 100 100 100 

*Reported results are weighted percentages 

p < .01 

Exhibit 2: Transition Assistance as Result of Contact 

Transition Assistance Adult without Disability Adult with Disability Total 

No 99.91 97.45 98.07 

Yes 0.09 2.55 1.93 

Total 100 100 100 

*Reported results are weighted percentages 

p < .001 

Exhibit 3: Crisis Intervention as Result of Contact 

Crisis Intervention Adult without Disability Adult with Disability Total 

No 93.57 99.63 98.1 

Yes 6.43 0.37 1.90 

Total 100 100 100 

*Reported results are weighted percentages 

p < .01 

Exhibit 4: Could Not Get to Services 

Could Not Get To Services Adult without Disability Adult with Disability Total 

No 98.96 93.72 94.75 

Yes 1.04 6.28 5.25 

Total 100 100 100 

*Reported results are weighted percentages 

p < .01 

Exhibit 5: Information Was Not Useful 

Information Was Not Useful Adult without Disability Adult with Disability Total 

Page 649 
 

 

 

 

 

 

 

 

No 97.47 88.30 90.09 

Yes 2.53 11.70 9.91 

Total 100 100 100 

*Reported results are weighted percentages 

p < .01 

Exhibit 6: Did Not Receive Services Because of Difficulty Filling Out Paperwork 

Difficulty Filling Out 

Paperwork Adult without Disability Adult with Disability Total 

No 99.55 86.58 89.12 

Yes 0.45 13.42 10.88 

Total 100 100 100 

*Reported results are weighted percentages 

p < .001 

Exhibit 7: No Longer in Need of Services 

No Longer in Need of 

Services Adult without Disability Adult with Disability Total 

No 98.14 89.16 90.92 

Yes 1.86 10.84 9.08 

Total 100 100 100 

*Reported results are weighted percentages 

p < .01 

Exhibit 8: Did Not Receive Services Because of Age 

Not the Right Age for 

Services Adult without Disability Adult with Disability Total 

No 99.70 93.52 94.73 

Yes 0.30 6.48 5.27 

Total 100 100 100 

*Reported results are weighted percentages 

p < .001 

Exhibit 9: Satisfaction with Support Received for Decision-Making 

Level of Satisfaction Adult without Disability Adult with Disability Total 

Very Dissatisfied 0.22 10.06 7.52 

Somewhat Dissatisfied 4.89 2.82 3.35 

Somewhat Satisfied 12.32 23.09 20.31 

Very Satisfied 82.56 64.04 68.82 

Page 650 
 

 

Total 100 100 100 

*Reported results are weighted percentages 

p < .05 

Page 651
 
 

 

 

 

 

 

 

 

 

 

APPENDIX DD. OUTCOME EVALUATION SUBGROUP ANALYSIS BY AGENCY
 

LOCATION
 

Exhibit 1: Top Five Reasons for Contact 

Reason Rural Urban Total 

Medicare Questions 34.50 33.04 33.51 

Medicaid Questions 26.98 35.51 32.76 

Housing 0.00 13.87 9.41 

Personal Care 19.96 8.45 12.15 

Nutrition 18.56 9.13 12.17 

Total 100 100 100 

*Reported results are weighted percentages 

p < .10 

Exhibit 2: Information Assistance as Result of Contact 

Information Assistance Rural Urban Total 

No 21.43 8.72 12.19 

Yes 78.57 91.28 87.81 

Total 100 100 100 

*Reported results are weighted percentages 

p < .10 

Exhibit 3: Counseling or Peer Support Options as Result of Contact 

Counseling or Peer 

Support Rural Urban Total 

No 49.49 84.11 74.62 

Yes 50.51 15.89 25.38 

Total 100 100 100 

*Reported results are weighted percentages 

p < .001 

Exhibit 4: Benefits Counseling as Result of Contact 

Benefits Counseling Rural Urban Total 

No 66.13 38.96 46.38 

Yes 33.87 61.04 53.62 

Total 100 100 100 

*Reported results are weighted percentages 

p < .01 

Exhibit 5: Respondent Requested Options Counseling 

Requested Options 

Counseling Rural Urban Total 

Page 652 
 

 

 

 

 

 

No 68.78 83.78 79.72 

Yes 31.22 16.22 20.28 

Total 100 100 100 

*Reported results are weighted percentages 

p < .05 

Exhibit 6: Agency Follow-up about Usefulness of Information 

Agency Followed Up Rural Urban Total 

No 48.46 66.13 61.18 

Yes 51.54 33.87 38.82 

Total 100 100 100 

*Reported results are weighted percentages 

p < .10 

Exhibit 7: Information Was Not Useful 

Information Was Not 

Useful Rural Urban Total 

No 99.60 87.27 90.18 

Yes 0.40 12.73 9.82 

Total 100 100 100 

*Reported results are weighted percentages 

p < .001 

Page 653 
 

 

 

 

 

 

 

APPENDIX EE. OUTCOME EVALUATION SUBGROUP ANALYSIS BY REASON
 

FOR CONTACT
 

Exhibit 1: Services Were Not Available 

Services Not 

Available Medicare Medicaid Housing Personal Nutrition Total 

No 89.84 92.32 41.61 85.29 100 85.40 

Yes 10.16 7.68 58.39 14.71 0 14.60 

Total 100 100 100 100 100 100 

*Reported results are weighted percentages 

p < .05 

Exhibit 2: Could Not Get to Services 

Could Not Get 

to Services Medicare Medicaid Housing Personal Nutrition Total 

No 100 82.22 99.33 97.35 100 92.24 

Yes 0.00 17.78 0.67 2.66 0.00 7.76 

Total 100 100 100 100 100 100 

*Reported results are weighted percentages 

p < .10 

Exhibit 3: Other Reason for Not Receiving Services 

Had Other 

Reason Medicare Medicaid Housing Personal Nutrition Total 

No 98.78 35.37 78.97 70.35 77.46 63.45 

Yes 1.22 64.63 21.03 29.65 22.54 36.55 

Total 100 100 100 100 100 100 

*Reported results are weighted percentages 

p < .001 

Page 654 
 

 

 

 

 

 

 

 

APPENDIX FF. OUTCOME EVALUATION SUBGROUP ANALYSIS BY AGENCY
 

COVERAGE 

Exhibit 1: Representative Developed Plan for Next Steps for Services 

Representative Developed a 

Plan for Next Steps Local Statewide Total 

No 73.57 58.71 72.52 

Yes 16.12 22.18 16.55 

Not Applicable 10.31 19.11 10.93 

Total 100 100 100 

*Reported results are weighted percentages 

p < .05 

Exhibit 2: Top Five Reasons for Contact 

Reason Local Statewide Total 

Medicare Questions 33.51 21.60 32.83 

Medicaid Questions 32.76 9.88 31.44 

Housing 9.41 15.43 9.75 

Personal Care 12.15 52.47 14.47 

Nutrition 12.17 0.62 11.50 

Total 100 100 100 

*Reported results are weighted percentages 

p < .001 

Exhibit 3: Method Services Were Received (Directly or Indirectly) 

Method Services Were 

Received Local Statewide Total 

Directly 66.18 51.30 65.17 

Indirectly 29.54 43.12 30.47 

Both 4.28 5.58 4.36 

Total 100 100 100 

*Reported results are weighted percentages 

p < .05 

Exhibit 4: Information Assistance as Result of Contact 

Information Assistance Local Statewide Total 

Page 655 
 

 

 

 

 

 

 

 

 

No 12.19 45.48 14.48 

Yes 87.81 54.52 85.52 

Total 100 100 100 

*Reported results are weighted percentages 

p < .001 

Exhibit 5: Counseling or Peer Support Options as Result of Contact 

Counseling or Peer Support Local Statewide Total 

No 74.62 39.60 72.21 

Yes 25.38 60.40 27.79 

Total 100 100 100 

*Reported results are weighted percentages 

p < .001 

Exhibit 6: Benefits Counseling as Result of Contact 

Benefits Counseling Local Statewide Total 

No 46.38 75.84 48.40 

Yes 53.62 24.16 51.60 

Total 100 100 100 

*Reported results are weighted percentages 

p < .001 

Exhibit 7: Where Client First Heard About Agency 

How Client First Heard About Agency Local Statewide Total 

Family, Friend or other Acquaintance 38.9 28.42 38.16 

Hospital/Clinic/Doctor 6.30 5.61 6.25 

Nursing Home/Assisted Living 2.09 5.61 2.34 

Phone Book 4.44 .35 4.15 

Brochure/Flyer .44 5.61 2.34 

Referral from Senior Center 1.61 2.46 1.67 

Referral from another Agency/Organization 28.63 29.82 28.72 

Work 2.78 4.21 2.88 

Internet/Website 4.66 10.18 5.04 

Media/Newspaper/TV/Radio 8.78 4.56 8.49 

Other 1.38 3.16 1.51 

Total 100 100 100 

*Reported results are weighted percentages 

p < .001 

Exhibit 8: Services That Were Sought After Were Received 

Services Received Local Statewide Total 

Yes, within one week of contact 34.21 22.68 33.40 

Yes, after more than a week 11.37 14.09 11.56 

Page 656 
 

 

 

 

 

 

 

 

 

 

 

No, have not received the service 54.43 63.23 55.04 

Total 100 100 100 

*Reported results are weighted percentages 

p < .10 

Exhibit 9: Did not Receive Service Due to Waitlist 

Did not Receive Service due 

to Waitlist Local Statewide Total 

No 84.54 91.85 85.13 

Yes 15.46 8.15 14.87 

Total 100 100 100 

*Reported results are weighted percentages 

p < .10 

Exhibit 10: Reduction in Ability to Resolve Issue as Result of Difficulty Reaching Staff 

Reduction in Ability to 

Resolve Issue Local Statewide Total 

No 82.72 89.30 83.18 

Yes 17.28 10.70 16.82 

Total 100 100 100 

*Reported results are weighted percentages 

p < .10 

Exhibit 11: Satisfaction with Services 

Level of Satisfaction Local Statewide Total 

Very Dissatisfied 1.75 10.79 2.26 

Somewhat Dissatisfied 8.55 7.19 8.47 

Somewhat Satisfied 10.97 17.27 11.32 

Very Satisfied 78.74 64.75 77.95 

Total 100 100 100 

*Reported results are weighted percentages 

p < .01 

Exhibit 12: Satisfaction with Completeness of Information 

Level of Satisfaction Local Statewide Total 

Very Dissatisfied 4.28 10.10 4.68 

Somewhat Dissatisfied 9.09 4.88 8.80 

Somewhat Satisfied 15.30 23.69 15.88 

Very Satisfied 71.33 61.32 70.64 

Total 100 100 100 

*Reported results are weighted percentages 

Page 657 
 

 

 

 

 

 

 

 

 

 

 

 

p < .01 

Exhibit 13: Satisfaction with Support Received for Decision-Making 

Level of Satisfaction Local Statewide Total 

Very Dissatisfied 7.30 10.15 7.52 

Somewhat Dissatisfied 2.91 8.65 3.35 

Somewhat Satisfied 19.81 26.32 20.31 

Very Satisfied 69.98 54.89 68.82 

Total 100 100 100 

*Reported results are weighted percentages 

p < .05 

Exhibit 14: Satisfaction with Professionalism of the Staff 

Level of Satisfaction Local Statewide Total 

Very Dissatisfied 1.99 4.44 2.16 

Somewhat Dissatisfied 2.36 4.44 2.50 

Somewhat Satisfied 10.48 16.38 10.89 

Very Satisfied 85.17 74.74 84.45 

Total 100 100 100 

*Reported results are weighted percentages 

p < .05 

Exhibit 15: Satisfaction with Ease of Resolving the Issue 

Level of Satisfaction Local Statewide Total 

Very Dissatisfied 5.56 5.46 5.55 

Somewhat Dissatisfied 2.83 8.00 3.17 

Somewhat Satisfied 19.34 22.91 19.58 

Very Satisfied 72.28 63.64 71.71 

Total 100 100 100 

*Reported results are weighted percentages 

p < .05 

Exhibit 16: Client Recommendation to Others in Need 

Client Would Tell Friends 

or Relatives to Contact 

Agency 

Local Statewide Total 

No 4.82 11.49 5.28 

Yes 95.18 88.51 94.72 

Total 100 100 100 

*Reported results are weighted percentages 

p < .01 

Page 658 
 

 - -

 

 

- -

 

 

APPENDIX GG. OUTCOME EVALUATION SUBGROUP ANALYSIS BY NUMBER
 

OF CONSUMERS SERVED
 

Exhibit 1: Counseling or Peer Support as Result of Contact 

Counseling or Peer 

Support 0 500 Consumers 500 2500 Consumers Greater than 2500 Consumers Total 

No 26.42 68.73 83.91 72.21 

Yes 73.58 31.27 16.09 27.79 

Total 100 100 100 100 

*Reported results are weighted percentages 

p < .001 

Exhibit 2: Benefits Counseling as Result of Contact 

Benefits Counseling 0 500 Consumers 500 2500 Consumers Greater than 2500 

Consumers Total 

No 94.81 41.06 47.55 48.40 

Yes 5.19 58.94 52.45 51.6 

Total 100 100 100 100 

*Reported results are weighted percentages 

p < .001 

Page 659 
 

 - - 

 

 

- - 

 

 

 

- - 

 

 

- - 

 

 

APPENDIX HH. OUTCOME EVALUATION SUBGROUP ANALYSIS BY NUMBER
 

OF FTES IN ADRC
 

Exhibit 1: Counseling or Peer Support as Result of Contact 

Counseling or Peer 

Support 0 5 FTEs 5 15 FTEs Greater than 15 FTEs Total 

No 72.76 52.06 79.28 72.21 

Yes 27.24 47.94 20.72 27.79 

Total 100 100 100 100 

*Reported results are weighted percentages 

p < .05 

Exhibit 2: Benefits Counseling as Result of Contact 

Benefits Counseling 0 5 FTEs 5 15 FTEs Greater than 15 FTEs Total 

No 21.34 96.38 48.21 48.4 

Yes 78.66 3.62 51.79 51.6 

Total 100 100 100 100 

*Reported results are weighted percentages 

p < .001 

Exhibit 3: Reduction in Ability to Resolve Issue as Result of Hours of Operation 

Reduction in Ability 

to Resolve Issue 0 5 FTEs 5 15 FTEs Greater than 15 FTEs Total 

No 88.44 85.22 97.46 92.35 

Yes 11.56 14.78 2.54 7.65 

Total 100 100 100 100 

*Reported results are weighted percentages 

p < .05 

Exhibit 4: Client Recommendation to Others in Need 

Client Would Tell 

Friends or Relatives 

to Contact Agency 

0 5 FTEs 5 15 FTEs Greater than 15 FTEs Total 

No 0.00 10.52 6.79 5.28 

Yes 100 89.48 93.21 94.72 

Total 100 100 100 100 

*Reported results are weighted percentages 

p < .01 

Page 660 
 

 

 

 

 

 

 

 

 

 

 

APPENDIX II. OUTCOME EVALUATION REGRESSION COVARIATES
 

The following is the list of variables used as covariates in the outcome evaluation regression models. A sub-set 

of these variables were used for sub-group analysis. 

Type* # Variable Source 

Individual 

Characteristics 

1 Older Adult (60 years or above) 

Participant 

Experience 

Survey 

2 Individual with disability 

3 Gender (Male=1) 

4 Race (White, non-Hispanic compared to all others) 

5 Less than High School Education 

6 High School Education 

7 More than High School Education 

8 Income Less than or equal to $40,000 

9 Marital Status 

10 Age 

11 Poor health 

12 Living alone 

13 Reason for contact: Medicare, Medicaid, Personal care 

ADRC 

Characteristics 

14 Rural or urban ADRC 

Process 

Evaluation 

Survey 

15 Number of consumers 

16 Number of FTEs 

17 Number of partners 

18 Statewide vs Local ADRCs ACL 

Community -

Population, 

Race 

18 # Population 60+ years American 

Community 

Survey (ACS) 

5-year 2012 

19 # White 

20 # Hispanics 

Community –

Education, 

Resources 

21 # 25+ yrs with Less than High School Education 

ACS 5-year 

2012 

22 # 25+ yrs with High School Education 

23 # 25+ yrs with More than High School Education 

24 # in poverty 

25 # Individuals with any Disability ACS 5-year 

2012 

26 # of Home Health Agency per 1000 60+years population 

Area Resource 

File, 2013 

27 # of Nursing home beds per 1000 60+ years population 

*All the community-level variables are at the ADRC service area level 

Page 661 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The following is a summary of variables from the regression analysis. 

Independent Variables Obs. Mean Standard 

Deviation Min Max 

Client Characteristics 

Age 541 68.73 15.73 7 99 

Married (1=Yes) 541 0.26 0.44 0 1 

Education (1=High School) 541 0.43 0.50 0 1 

Education (1=More than High School) 541 0.37 0.48 0 1 

Income less than or equal to $40,000 (1=Yes) 541 0.91 0.29 0 1 

Poor health (1=Yes) 541 0.35 0.48 0 1 

Older (1=Yes) 541 0.74 0.44 0 1 

Disabled (1=Yes) 541 0.82 0.39 0 1 

Gender (1=Male) 541 0.29 0.46 0 1 

White, Non-Hispanic (1=Yes) 541 0.77 0.42 0 1 

Living Alone (1=Yes) 541 0.42 0.49 0 1 

ADRC Controls 

Rural ADRC (1=Yes) 541 0.14 0.35 0 1 

Statewide ADRC (1=Yes) 541 0.55 0.50 0 1 

Community Characteristics 

# Home health agencies (per 10,000 60 years and above) 541 21.27 9.33 0 72.12 

# Nursing home beds (per 1000 60 years and above) 541 1.23 1.33 0 6.53 

# 60 years and older population (in 1000s) 541 445.0 369.1 0.15 962.9 

# Whites in ADRC service area (in 1000s) 541 1920.9 1701.6 0.65 4524.1 

# Hispanics in ADRC service area (in 1000s) 541 139.0 92.9 0.08 250.3 

# Poverty in ADRC service area (in 1000s) 541 342.9 263.3 0.12 617.2 

# Disability in ADRC service area (in 1000s) 541 294.6 227.0 0.08 524.1 

# Less than High school Degree (>25 years, in 1000s) 541 180.8 138.3 50 320.6 

# High school Degree (>25 years, in 1000s) 541 469.5 379.4 116 955.8 

# More than High school Degree (>25 years, in 1000s) 541 1318.8 1289.6 589 3420.7 

Page 662 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

APPENDIX JJ. OUTCOME EVALUATION REGRESSION FINDINGS
 

Exhibit 1: Efficiency and Effectiveness of ADRCs
 

Representative Paid Close 

Attention 

Representative Explained 

Choices 

b/se b/se 

Age 0.000 0.004 

(0.001) (0.003) 

Married (1 = Yes) -0.079** 0.014 

(0.029) (0.066) 

60+ or Disabled 60+ (1=Yes) 0.054 0.062 

(0.030) (0.107) 

Disabled or Disabled 60+ (1=Yes) -0.049*** 0.195*** 

(0.013) (0.055) 

Male (1=Yes) 0.005 0.021 

(0.020) (0.056) 

White, Non-Hispanic (1 = Yes) 0.02 0.103* 

(0.018) (0.052) 

High School Degree (1=Yes) 0.070** 0.096 

(0.025) (0.131) 

More than High School (1=Yes) 0.014 0.083 

(0.022) (0.106) 

Income Less than or equal 40K (1=Yes) 0.083 -0.023 

(0.047) (0.065) 

Poor Health (1=Yes) -0.034* 0.196*** 

(0.017) (0.052) 

Living Alone (1 = Yes) -0.016 -0.113* 

(0.020) (0.050) 

Rural (1 = Yes) 0.119*** 0.212* 

(0.002) (0.101) 

Statewide ADRC (1=Yes) 0.112*** -0.318*** 

(0.001) (0.010) 

# HHA per 10,000 60+ population 0.177*** 0.01 

(0.021) (0.006) 

# of Nursing Home Beds per 1000 60+ population -0.541*** 0.002 

(0.063) (0.012) 

# Less than HS (in 1000s) -0.001*** 0.000* 

(0.000) (0.000) 

# of HS Graduates (in 1000s) 0.000*** -0.000*** 

(0.000) (0.000) 

# More than HS (in 1000s) 0.000*** -0.000** 

(0.000) (0.000) 

Page 663 
 

 

 

 

 

 

 

 

Representative Paid Close 

Attention 

Representative Explained 

Choices 

# of Whites (in 1000s) -0.070*** 0.067*** 

(0.010) (0.020) 

# of Hispanics (in 1000s) -0.040*** -0.002 

(0.005) (0.001) 

# of Individuals in Poverty (in 1000s) 0.086*** -0.015*** 

(0.010) (0.004) 

# of Individuals with Disability (in 1000s) 0.014*** 0.026* 

(0.002) (0.012) 

# of Individuals over 60+ years (in 1000s) 0.288*** -0.052** 

(0.037) (0.016) 

N 532 527 

* p<0.10, ** p<0.05, *** p<0.01 

**Average Marginal Effect calculated from probit regressions are provided above with standard errors in parenthesis. 

Page 664 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Exhibit 2: Reasons for Contact
 

Medicare Medicaid Personal 

Care 

Age 0.001 0.001 0.000 

-0.002 -0.002 -0.001 

Married (1 = Yes) 0.128** -0.148** 0.048* 

(0.040) (0.046) (0.021) 

60+ or Disabled 60+ (1=Yes) -0.056 0.059 0.007 

(0.052) (0.083) (0.027) 

Disabled or Disabled 60+ (1=Yes) -0.008 0.093 0.103*** 

(0.114) (0.051) (0.014) 

Male (1=Yes) -0.044 0.085 -0.019 

(0.096) (0.067) (0.019) 

White, Non-Hispanic (1 = Yes) 0.06 0.176*** -0.079* 

(0.092) (0.017) (0.034) 

High School Degree (1=Yes) -0.002 0.019 -0.011 

(0.049) (0.065) (0.034) 

More than High School (1=Yes) -0.031 -0.009 0.008 

(0.111) (0.086) (0.042) 

Income Less than or equal 40K (1=Yes) -0.247 -0.08 0.028 

(0.127) (0.158) (0.024) 

Poor Health (1=Yes) -0.155 0.06 -0.003 

(0.087) (0.080) (0.015) 

Living Alone (1 = Yes) 0.105*** -0.033 -0.026 

(0.019) (0.058) (0.016) 

Rural (1 = Yes) 0.09 0.07 0.420*** 

(0.293) (0.098) (0.084) 

Statewide ADRC (1=Yes) 0.725*** 0.749*** -0.039 

(0.022) (0.030) (0.607) 

# HHA per 10,000 60+ population -0.004 0.001 -0.012*** 

(0.007) (0.004) (0.003) 

# of Nursing Home Beds per 1000 60+ population -0.072 -0.048* 0.031** 

(0.038) (0.022) (0.012) 

# Less than HS (in 1000s) -0.000* 0.000 0.000 

(0.000) (0.000) (0.000) 

# of HS Graduates (in 1000s) 0.000 0.000 0.000 

(0.000) (0.000) (0.000) 

# More than HS (in 1000s) -0.000* 0.000 0.000 

(0.000) (0.000) (0.000) 

# of Whites (in 1000s) 0.003 0.007 -0.004 

(0.024) (0.015) (0.012) 

# of Hispanics (in 1000s) 0.009 -0.003** 0.003*** 

(0.006) (0.001) (0.001) 

# of Individuals in Poverty (in 1000s) 0.013 0.001 0.003 

(0.009) (0.004) (0.003) 

# of Individuals with Disability (in 1000s) 0.091 -0.016 0.030*** 

(0.054) (0.008) (0.009) 

# of Individuals over 60+ years (in 1000s) -0.026 0.014* -0.021** 

(0.020) (0.007) (0.008) 

N 541 541 541 

Page 665 
 

 

Medicare Medicaid Personal 

Care 

* p<0.10, ** p<0.05, *** p<0.01 

**Average Marginal Effect calculated from probit regressions are provided above with standard errors 

in parenthesis. 

Page 666 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Exhibit 3: Challenges Faced in Resolving Issues
 

Difficulty Reaching Staff Lack of Staff Follow Through 

Age 0.004 -0.002* 

(0.003) (0.001) 

Married (1 = Yes) -0.022 0.007 

(0.058) (0.040) 

60+ or Disabled 60+ (1=Yes) -0.212 0.041 

(0.115) (0.048) 

Disabled or Disabled 60+ (1=Yes) -0.09 0.095* 

(0.115) (0.037) 

Male (1=Yes) -0.013 -0.001 

(0.038) (0.042) 

White, Non-Hispanic (1 = Yes) -0.114 0.017 

(0.125) (0.060) 

High School Degree (1=Yes) 0.016 0.012 

(0.054) (0.037) 

More than High School (1=Yes) 0.137* 0.047 

(0.054) (0.052) 

Income Less than or equal 40K (1=Yes) 0.102 -0.03 

(0.071) (0.059) 

Poor Health (1=Yes) 0.035 -0.002 

(0.058) (0.039) 

Living Alone (1 = Yes) 0.008 0.011 

(0.070) (0.026) 

Rural (1 = Yes) -0.142** -0.178 

(0.054) (0.110) 

Statewide ADRC (1=Yes) -0.231*** -0.057 

(0.010) (0.583) 

# HHA per 10,000 60+ population 0.011* 0.009 

(0.005) (0.006) 

# of Nursing Home Beds per 1000 60+ population -0.024 -0.018 

(0.019) (0.022) 

# Less than HS (in 1000s) 0.000 0.000 

(0.000) (0.000) 

# of HS Graduates (in 1000s) -0.000* 0.000 

(0.000) (0.000) 

# More than HS (in 1000s) 0.000 -0.000* 

(0.000) (0.000) 

# of Whites (in 1000s) 0.003* 0.003 

(0.001) (0.001) 

# of Hispanics (in 1000s) -0.003 -0.001 

Page 667 
 

 

 

 

 

Difficulty Reaching Staff Lack of Staff Follow Through 

(0.004) (0.005) 

# of Individuals in Poverty (in 1000s) -0.002 -0.008 

(0.011) (0.011) 

# of Individuals with Disability (in 1000s) -0.021 -0.013 

(0.015) (0.030) 

# of Individuals over 60+ years (in 1000s) 0.022 0.028 

(0.016) (0.017) 

N 536 518 

* p<0.10, ** p<0.05, *** p<0.01 

**Average Marginal Effect calculated from probit regressions are provided above with standard errors in parenthesis. 

Page 668 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Exhibit 4: Satisfaction with Services Received
 

Comprehensiveness of 

Information 

Personalization of 

Services 

Accuracy of 

Information 

Support in Decision 

Making 

Age 0.002 0.000 0.000 0.000 

(0.002) (0.002) (0.001) (0.002) 

Respondent Type (1=Self) (0.007) -0.124*** -0.053 -0.057* 

(0.049) (0.033) (0.028) (0.023) 

Married (1 = Yes) 0.007 0.036 -0.05 -0.100** 

(0.036) (0.062) (0.037) (0.036) 

60+ or Disabled 60+ (1=Yes) 0.02 -0.08 0.053 0.088 

(0.050) (0.084) (0.049) (0.072) 

Disabled or Disabled 60+ (1=Yes) 0.025 -0.056 -0.043 0.07 

(0.081) (0.082) (0.027) (0.052) 

Male (1=Yes) -0.015 0.008 -0.01 0.059** 

(0.037) (0.055) (0.023) (0.022) 

White, Non-Hispanic (1 = Yes) 0.08 0.059 0.049 -0.027 

(0.102) (0.055) (0.045) (0.037) 

High School Degree (1=Yes) 0.086 0.150*** 0.093** 0.111 

(0.075) (0.032) (0.032) (0.066) 

More than High School (1=Yes) 0.057 0.054 0.064* 0.131* 

(0.058) (0.057) (0.028) (0.053) 

Income Less than or equal 40K (1=Yes) 0.306* 0.052 0.081 0.036 

(0.126) (0.112) (0.044) (0.034) 

Poor Health (1=Yes) -0.066* -0.101 -0.034 -0.107*** 

(0.034) (0.068) (0.019) (0.024) 

Living Alone (1 = Yes) -0.141** 0.059 -0.037 -0.121** 

(0.045) (0.068) (0.027) (0.041) 

Rural (1 = Yes) 0.122** 0.171** 0.065 -0.008 

(0.041) (0.059) (0.035) (0.129) 

Page 669 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Comprehensiveness of 

Information 

Personalization of 

Services 

Accuracy of 

Information 

Support in Decision 

Making 

Statewide ADRC (1=Yes) -0.653 -0.506 0.122*** 0.164*** 

(0.756) (0.894) (0.002) (0.003) 

Reason for contact: Medicare -0.105** 0.070** -0.033 -0.039 

(0.035) (0.024) (0.033) (0.035) 

Reason for contact: Medicaid 0.003 0.107 0.058* 0.093*** 

(0.080) (0.060) (0.023) (0.022) 

Reason for contact: Personal Care -0.142 0.085 -0.002 0.050*** 

(0.114) (0.069) (0.020) (0.008) 

# HHA per 10,000 60+ population 0.008** 0.018*** 0.015*** 0.035*** 

(0.003) (0.005) (0.004) (0.007) 

# of Nursing Home Beds per 1000 60+ population -0.004 -0.020 -0.058*** -0.159*** 

(0.019) (0.023) (0.014) (0.026) 

# Less than HS (in 1000s) -0.000*** -0.000* -0.000** -0.000*** 

(0.000) (0.000) (0.000) (0.000) 

# of HS Graduates (in 1000s) 0.000** 0.000 0.000** 0.000*** 

(0.000) (0.000) (0.000) (0.000) 

# More than HS (in 1000s) -0.000* 0.000* 0.000 -0.000* 

(0.000) (0.000) (0.000) (0.000) 

# of Whites (in 1000s) -0.003*** -0.006* -0.003* -0.011*** 

(0.001) (0.003) (0.001) (0.002) 

# of Hispanics (in 1000s) 0.004* 0.007 0.011*** 0.033*** 

(0.002) (0.005) (0.003) (0.004) 

# of Individuals in Poverty (in 1000s) 0.009 0.005 0.001 0.002 

(0.006) (0.007) (0.003) (0.009) 

# of Individuals with Disability (in 1000s) 0.002 0.038* 0.014 0.014 

(0.008) (0.015) (0.009) (0.021) 

# of Individuals over 60+ years (in 1000s) 0.014 0.003 -0.002 0.029 

(0.009) (0.010) (0.005) (0.024) 

Page 670 
 

Comprehensiveness of 

Information 

Personalization of 

Services 

Accuracy of 

Information 

Support in Decision 

Making 

N 511 510 522 463 

* p<0.10, ** p<0.05, *** p<0.01 

**Average Marginal Effect calculated from probit regressions are provided above with standard errors in parenthesis. 

Page 671 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Exhibit 5: Usefulness of Information Provided by ADRC
 

Degree of Usefulness of Information 

Age -0.007** 

(0.002) 

Married (1 = Yes) 0.062 

(0.082) 

60+ or Disabled 60+ (1=Yes) 0.123 

(0.108) 

Disabled or Disabled 60+ (1=Yes) 0.017 

(0.095) 

Male (1=Yes) -0.009 

(0.037) 

White, Non-Hispanic (1 = Yes) 0.068 

(0.058) 

High School Degree (1=Yes) 0.05 

(0.113) 

More than High School (1=Yes) -0.117 

(0.081) 

Income Less than or equal 40K (1=Yes) 0.146 

(0.179) 

Poor Health (1=Yes) -0.084 

(0.048) 

Living Alone (1 = Yes) -0.011 

(0.085) 

Rural (1 = Yes) -0.017 

(0.063) 

Statewide ADRC (1=Yes) -0.697*** 

(0.186) 

Reason for contact: Medicare -0.079 

(0.045) 

Reason for contact: Medicaid 0.033 

(0.084) 

Reason for contact: Personal Care 0.047 

(0.025) 

# HHA per 10,000 60+ population 0.014*** 

(0.004) 

# of Nursing Home Beds per 1000 60+ population 0.007 

(0.014) 

# Less than HS (in 1000s) -0.000** 

(0.000) 

# of HS Graduates (in 1000s) 0.000 

Page 672 
 

 

 

 

 

 

 

 

 

 

 

 

Degree of Usefulness of Information 

(0.000) 

# More than HS (in 1000s) 0.000 

(0.000) 

# of Whites (in 1000s) -0.002* 

(0.001) 

# of Hispanics (in 1000s) 0.001 

(0.003) 

# of Individuals in Poverty (in 1000s) 0.005 

(0.006) 

# of Individuals with Disability (in 1000s) 0.005 

(0.009) 

# of Individuals over 60+ years (in 1000s) 0.023 

(0.012) 

N 490 

* p<0.10, ** p<0.05, *** p<0.01 

**Average Marginal Effect calculated from probit regressions are provided above with standard errors 

in parenthesis. 

Page 673 
 

 

 

 

 

 

 

 

 

 

 

APPENDIX KK. OUTCOME EVALUATION SURVEY DISTRIBUTION OF ADRC
 

CHARACTERISTICS
 

Exhibit 1: Distribution of Characteristics of ADRCs Participating in the Outcome 

Evaluation Survey
 

Agency Number of 

Consumers 

Number 

of FTEs 

Number of 

Partners 

Percentage 

in Poverty 

Percentage 

60+ 

Percentage 

Disabled 

Percentage 

White 

Ability Resources 684 18 8 14.57% 18.06% 14.11% 70.99% 

Adult Resources for 

Care and Help 

(ARCH): Larimer 

County 

1339 2 5 13.74% 17.43% 8.88% 90.53% 

Aging Partners Area 

Agency on Aging 12000 137 33 12.88% 17.35% 9.46% 88.82% 

Albemarle 

Commission Area 

Agency on Aging 

1000 4 17 16.73% 22.04% 15.12% 71.32% 

Appalachian Agency 

for Senior Citizens 1513 7 13 20.27% 23.83% 27.24% 96.62% 

Area Agency on 

Aging of the Permian 

Basin 

3211 10 11 15.61% 15.71% 13.55% 77.03% 

Area IV Agency on 

aging and 

Community Action 

Programs (Area 4) 

6468 31 19 16.69% 17.39% 11.68% 89.02% 

Area IX Area Agency 

on Aging 6743 31.15 78 12.24% 21.13% 11.23% 95.46% 

Area V - Southeast 

Idaho 1180 19 8 16.38% 16.95% 12.91% 87.58% 

Area VI Agency on 

Aging 685 4 11 21.24% 27.27% 16.87% 83.17% 

Cape Fear Council of 

Governments 391 23 23 18.43% 23.29% 14.50% 77.30% 

Choices in Living 

Resource Center 726 7 11 18.86% 20.13% 16.45% 77.00% 

Community Choices: 

North Central Region 993 53.1 31 11.36% 19.85% 10.78% 74.94% 

Concho Valley 

ADRC 141 10.8 23 17.69% 25.44% 13.07% 85.11% 

Coos County 

ServiceLink 2354 5 20 13.78% 26.82% 18.49% 96.94% 

Essex County ADRC 1032 4 2 16.84% 16.49% 10.64% 42.59% 

Generations 465 9 21 13.50% 21.13% 13.27% 96.07% 

Kiamichi Economic 

Development District 

of Oklahoma 

(KEDDO) Area 

85 9 9 21.88% 23.10% 21.94% 72.06% 

Page 674 
 

 

 

 

 

 

 

 

 

 

 

Agency Number of 

Consumers 

Number 

of FTEs 

Number of 

Partners 

Percentage 

in Poverty 

Percentage 

60+ 

Percentage 

Disabled 

Percentage 

White 

Agency on Aging 

LifeLong Links 

ADRC Heritage AAA 3076 6 10 12.00% 17.69% 9.83% 90.78% 

Mesa County ADRC 1331 38 3 11.21% 18.11% 10.75% 88.38% 

Nevada County 

ADRC 1023 8.67 8 12.00% 28.35% 12.61% 91.36% 

North West Senior 

and People with 

Disabilities 

5414 61 12 17.76% 19.65% 13.90% 82.03% 

Northwest Missouri 

Area Agency on 

Aging (NWAAA) 

386 5 5 14.01% 21.25% 13.77% 94.55% 

San Juan Basin 

ARCH 1105 6 9 17.74% 21.75% 10.87% 92.56% 

Senior Linkage Line 39606 95 20 11.64% 18.15% 9.88% 85.30% 

Southwest 8 Senior 

Services Inc. 636 7.5 16 12.92% 22.52% 14.35% 94.94% 

WPCOG Area 

Agency on Aging 2324 9.5 13 17.40% 21.48% 15.29% 85.12% 

West Virginia Aging 

and Disability 

Resource Center -

Fairmont Site 

687 4 9 17.48% 19.97% 15.31% 93.32% 

Summary Statistics Based on PES Participant Sites 

Minimum 85 2 2 11.21% 15.71% 8.88% 42.59% 

25th Percentile 684.5 5.5 8.5 12.90% 17.88% 10.83% 77.17% 

Mean 3449.93 22.31 16 15.60% 20.80% 13.81% 84.68% 

Median 1068.5 9 11.5 16.00% 20.63% 13.41% 87.98% 

75th Percentile 2715 27 20 17.72% 22.81% 15.20% 92.94% 

Maximum 39606 137 78 21.88% 28.35% 27.24% 96.94% 

Summary Statistics Based on Process Evaluation Participant Sites 

Minimum 7 0.75 1 

25th Percentile 717 6.12 7 

Mean 4365.31 22.23 13.65 

Median 1729 13.25 12 

75th Percentile 4448 26.5 19 

Maximum 59366 283.25 41 

Exhibit 2: Comparison of Characteristics of ADRCs Participating in the Process and 

Outcome Evaluation Surveys
 

Measures ADRCs from Process 

Evaluation Survey 

ADRCs from Participant 

Experience Survey 

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Number of FTEs Frequency Percentage Frequency Percentage 

0-5 86 18.22 6 28.57 

6-15 138 29.24 8 38.10 

>15 172 36.44 7 33.33 

Missing data 76 16.10 - -

Number of Consumers Frequency Percentage Frequency Percentage 

0-500 84 17.80 4 19.05 

501-2500 171 36.23 13 61.90 

>2500 147 31.14 4 19.05 

Missing data 70 14.83 - -

Number of Partners Frequency Percentage Frequency Percentage 

0-8 125 26.48 7 33.33 

9-15 131 27.75 8 38.10 

>15 143 30.29 6 28.57 

Missing data 73 15.48 - -

Type of ADRC* Frequency Percentage Frequency Percentage 

Urban 332 70.49 11 52.38 

Rural 129 27.39 8 38.10 

Statewide 10 2.12 2 9.52 

* Excludes West Virginia Aging and Disability Resource Center - State ADRC Office which participated in the Local 

ADRC survey; this ADRC was not coded as a rural, urban or statewide ADRC. 

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