Cuyahoga CountyStatPreparation. Evaluation. Innovation.

Division of Senior and Adult Services (DSAS)

Date: 01/16/14, Presentation #12

Action Items

1. Break out medical/nursing home referral data. Are some institutions better or worse than others? Which ones are good at identifying problems? (See slide 12)

2. Begin to add more info to website that directs seniors and their caregivers to more resources, including for veterans, Affordable Care Act, etc. Do other counties do this? Check their sites. (See slide 7)

3. Provide more information on $700,000 variance in revenue. (See slide 24)

Other Discussion Items:1. Continue to benchmark all measures 2. Continue to track productivity3. Continue to identify best practices as appropriate4. Catalogue your internal promising practices

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Executive Debriefing: October 21, 2013

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Action Item-Records Retention InitiativeObjective: To effectively adhere to the state’s Public Records Law and manage and facilitate access to agency information in order to support and accelerate decision making and ensure accountability.

•Public Records Policy and RC-2 were completed in 2012; will be reviewed in 2014

•DSAS staff completed training on County Public Records Portal in July

•Reviews of agency records were processed in December by Records Managers and the Records Coordinator on the inventory of records submitted by all program areas

•DSAS staff conducting ongoing meetings to standardize process improvements for client record retention

•All DSAS Public Records Managers and relevant staff attended mandatory Sunshine Law training in September

•Need for records scanning system to address storage challenges and improve casework efficiency; New Case Management system will assist with this challenge

2014-2016 DSAS Strategic Plan Goals and ObjectivesCreate Programmatic Centers of Excellence to Foster Collaboration and Best Practices• Explore and implement models of care that empower clients to make individual choices that support their independence• Ensure customers have “no wrong door” access to services needed• Ensure that all programs are culturally and linguistically competent• Seek out expertise and integrate efforts with clinical and academic partners• Support families and caregivers by providing services including respite care and education

Raise the Public Profile for Multiple Audiences• Develop and implement an agency-wide marketing initiative• Expand public relations, marketing, and outreach efforts to promote and increase visibility• Create a system to educate the public about timely and relevant issues

Establish a Leadership Role in the Community• Advocate for seniors and adults with disabilities• Collectively address gaps in service: Transportation, Mental Health, and Housing• Engage in successful aging initiatives that foster volunteering, civic engagement, and lifelong learning opportunities

Strengthen Funding and Service Delivery Capacity• Eligibility Determination: Assess eligibility requirements for services and to communicate clear guidelines for eligibility• Maximize reimbursement for services• Service Delivery Capacity: Evaluate service capacity of programs and ensure financial accountability

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DSAS Strategic Plan-Key Western Reserve Plan Principles

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Goal 4 - Human Service Needs - Aligning and coordinating both public and private resources around our most pressing human service needs•Collaboration with community partners, such as United Way 211, and Health and Human Service agencies•Initiatives to obtain grants

Goal 5 - Education - Identifying education from early childhood forward, as the central factor in individual and community success•Expand education opportunities at Senior Centers•Explore collaborations with colleges to provide education opportunities for seniors

Goal 12 - Good Government - Creating a culture within county government which implements nationally-recognized good government practices and innovations•Create Centers of Excellence•Utilize technology to streamline case management and provide enriched data•Develop performance and process-based outcomes, comparing data to established benchmarks

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The mission of DSAS is to empower seniors and adults

with disabilities to age successfully by providing

resources and support that preserves their independence

Performance Measures-Process

Improvements

Performance Measures-Client

Outcomes

Centralized Intake Case Management System

Client Satisfaction Health and well-being outcomes

• New SMART Objectives in 2014 will include: Calls received through Centralized Intake (and measures associated with this); Services provided through Information and Outreach Unit (IOU)/Aging and Disability Resource Network (ADRN); Reduction in ER and Hospitalization (Home Support Unit)

• Complete analysis of more than 500 customer satisfaction surveys received in 2013 will be completed by March 2014

• 2013 Statistical Performance Report will be completed by March 2014

DSAS Strategic Plan Phase 3-Performance Measurement

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Action Item-Website ImprovementsMeeting held with DSAS Office on Aging and County DOIT on 12/9/13

•Website will be re-designed to be more interactive and user-friendly

•Links to County social media sites, including You Tube and Twitter , with DSAS media, will be available

•Website landing pages will be redesigned to make them more "senior-friendly”▫ Options for enlarging the type size▫ Minimizing the use of jargon and technical terms▫ Providing a speech function to hear text, functions to minimize scrolling, and bilingual scripts

•A searchable database of services and resources will be created

•A series of videos will be produced and uploaded to website and will include:▫ An introduction to DSAS video▫ A "Call to Action" video about Adult Protective Services and other policy issues relevant to seniors▫ A video announcing our new Centralized Intake number (“One Call Does it All” campaign); and

videos highlighting signature events

•A portal for Advisory Committee Members to log-in to for special updates will be developed

Adult Protective Services Unit

SMART ObjectiveBy 12/31/2013, APS will reduce the rate of recidivism of reported cases of alleged abuse, neglect, self-neglect, and/or exploitation to 25%.

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Adult Protective Services (APS) is mandated to protect and assist adults who may be victims of abuse, neglect, self-neglect, and financial exploitation.

* Data through 09/30/2013

Adult Protective Services Unit

Description 2010 2011 2012 2013 YTD**

Alleged Abuse 472 425 403 343

Alleged Neglect 914 849 824 682

Alleged Self-Neglect 1,513 1,440 1,461 1,131

Alleged Exploitation 609 582 579 412

Alleged Hoarding* 1 103 178 153

Total Allegations 3,509 3,399 3,445 2,721

Validated Abuse 171 152 158 167

Validated Neglect 344 344 303 350

Validated Self-Neglect 1,066 1,022 1,023 864

Validated Exploitation 213 174 205 188

Validated Hoarding* 0 72 106 79

Total Validations of Allegations

1,794 1,764 1,795 1,648

Allegations and Validations

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*Hoarding Allegations and Validations were tracked beginning in mid-2011.

** 2013 Data through 9/30/2013

Adult Protective Services Unit-Benchmarking Data

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CuyahogaMontgomery

CountyFranklin County

Ohio (2012) Texas (2012)County* Ohio (2012) Ohio (2012)

SMART Objective 28% Data not available Data not available Data not available 16.3%

Allegations validated 61% 36% 64% 52% 68%

Investigations completed

1,382 234 366 3,744 21,877

Investigations occurred within

timeframe85%

Data not available Data not available Data not available91%

Cases closed withservices in place

85%Data not available Data not available Data not available

89%

Customer Satisfaction 75% Data not available

 Data not available

 Data not available

 98% 

Highlights

New reports to provide better statistical information and supervisory oversight have been developed

* Data as of 9/30/13

Adult Protective Services Unit

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Referral Sources1) Mandated reporters2) Non-Mandated reporters3) Self referrals4) After hours hotline referrals 696-KIDS

Abuse /Neglect /

ExploitationValidated?

CaseTerminated

No:Protective

Not Needed

Adultwilling toaccept

services?

Yes:ProtectiveNeeded

No

Yes

Educate theadult and/or

familymembers

Implementsafety plan –

servicereferrals &linkages

Alleviaterisk toclient

Doesadult havecapacity?

No

Yes

Non-voluntary intervention:APS involves

Assistant Prosecuting Attorney (APA)

Probate Court Hearings:Protective Service Orders

ConservatorshipsGuardianships

Case assigned for an APS Investigation

APS initiates the Investigation

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Action Item-Adult Protective Services (APS)-Source of Referrals

• Data based on 1,593 referrals from January through September 2013

• 10% of APS clients are veterans

Information Outreach Unit

SMART Objective By 12/31/2013, Information Outreach will link clients with a total of $500,000 in cost-saving benefits.

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The Information Outreach Unit improves the economic well-being of seniors and disabled adults by helping them to navigate through, link with, and enroll in the complex network of social service benefits.

Target 2013

Target in 2012 was $350,000. Due to additional staff and planned events, goal was raised for 2013

Target number of clients served in 2013 is 5,000; Through 3Q 2013, IOU has served 3,784 clients

* YTD as of 9/30/13

Home Support Unit

SMART ObjectiveBy 12/31/2013, 90% of clients will have a completed home assessment within 10 days of referral.

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Home Support provides home-based personal care (such as assistance with bathing, dressing, and grooming) and homemaking (such as light housekeeping and laundry) to high-need clients.

Home Support UnitBenchmarking Data

Cuyahoga County*Ohio

Average (2012)**National

Average (2012)**

Visiting NurseAssociation-

Cleveland (2012)**

SMART Objective 67% 91% 91% 87%

Client Satisfaction (2013)

93% 82% 84% 84%

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New measures to be collected and benchmarked will include:•How often clients receiving home health care need any unplanned ER care•How often home health clients had to be admitted to the hospital•Falls screen (individual client information and aggregate data)•Depression screen (individual client information and aggregate data)

* Cumulate YTD Data as of 9/30/13** Source Data: http://www.medicare.gov/HomeHealthCompare

Options Unit

SMART ObjectiveBy 12/31/2013, the Options Unit will increase the number of clients who report being linked to additional (non-Options) services to 90%.

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Options serves seniors with limited income who need help coordinating and financing their multiple home care needs, but are not eligible for PASSPORT services or Medicaid reimbursements for services to assist in maintaining independence.

* Data as of 9/30/13

Options UnitBenchmarking Data

Cuyahoga County*Midwest RegionAverage (2012)**

NationalAverage (2012)**

Franklin CountyOhio (2012)

SMART Objective 83% 80.1% 71.4% Data not available

90% of home visits completed within 10 days

96%Data not available

Data not availableRequired visit within

3-4 weeks; compliance not tracked

Caseload (2013)81 per case manager

(ILOC & PLOC***)Data not available

Data not available40-45 per case manager

(ILOC)

Client Satisfaction (2013)  88% 79.6% 78.1% 96%

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* YTD Data as of 9/30/13

** Source Data: http://agidnet.org/CustomTables/NPS/Data/ (Aging Integrated Database)

***ILOC (Intermediate Level of Care) and PLOC (Protective Level of Care)

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DSAS Client Count

2010 2011 2012 2013 YTD*

Adult Protective Services 2,182 2,003 1,975 1,499

Information Outreach 2,516 2,187 3,965 3,784

Options 1,480 1,497 1,438 1,263

Home Support 650 550 546 484

Intake 11,713 13,008 13,540 10,983

Community Social Services Program (CSSP) 1,076 1,057 1,114 1,264

Total Clients 19,935 20,616 22,889 19,277

CSSP Units Provided

Adult Development (Hours of service) 146,482 140,944 149,038 122,824

Transportation (Number of 1-way rides) 53,614 90,826 95,784 90,384

Congregate Meals (Number of Meals) 25,301 28,399 27,494 27,369

DSAS Overview

* 2013 YTD as of 9/30/13

Universal Measure - Staff Accountability

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Activity Frequency

Direct Service Accountability Measures

Review of Home Health Aide GPS reports (selected randomly) 40 per month (2 per day)

Social workers submit calendars for monitoring Weekly

Supervisors complete home visits with social workersOne visit per worker per

month

Quality Assurance case reviews 30 per month

Travel Accountability Measures

Supervisors review travel reimbursement reports submitted by workers Average of 100 per month

Financial unit checks all travel reimbursement reports before processing Average of 100 per month

Travel reimbursement reports audited to verify accuracy (selected randomly) 10 per month

Division Organizational Structure

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168 FTEs

Administrator( 2 FTEs)

Deputy DirectorClinical(2 FTEs)

Deputy DirectorCommunity-Based

(2 FTEs)

Adult ProtectiveServices Unit

(41 FTEs)

Information Outreach Unit

(9 FTEs)

Professional Development Unit

(0 FTE)

Home Support Unit

(70 FTEs)

Options Unit(19 FTEs)

Office on Aging &Operations

(7 FTEs)

Financial Services(5 FTEs)

Procurement & Contractual Services

(8 FTEs)

RecordsManagement

(1 FTE)

Performance Management (2 FTEs)

Program/Area Staff Vacancies

Administrator's Office 9 0

Financial Services 5 1

Procurement & Contract Svcs. 8 1

Adult Protective Services Unit 43 0

Information Outreach Unit 9 1

Professional Development Unit 0 1

Home Support Unit 73 5

Options Unit 19 0

Performance Management 2 0

Total* 168 9

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Universal Measure - Personnel

* Staff totals through November 2013

Disciplinary Action* 2010 2011 2012 2013(through November)

Verbal Counseling NR* NR* 8 14

Written Reprimand 1 NR* 2 5

Suspension 2 6 2 1

Termination 3 2 2 1

Pre-Disciplinary Conference 2 1 0 4

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Universal Measure - Personnel

Staff Attrition 2010 2011 2012 2013(through November)

Disability  2 4 2 4

Retired 21 4 4 2

Resigned 8 11 11 7

Laid-off 1 1 0 0

Eliminated Positions 0 2 3 0

Transferred to CJFS orout of the Division 0 67 0 0

Total 32 89 20 13

*Data not available from Human Resources.

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Universal Measure - Productivity

Data obtained from: http://intranet.cuyahoga.cc/en-US/CountyStat.aspx

Division of Senior and Adult Services

2013 Q3 2012 Q3

Staff 166 172

DSAS Total Hours

DSAS Average

Hours

County Average

Hours

DSAS Total Hours

DSAS Average

Hours

County Average

Hours SICK Usage 4,758.59 28.66 23.64 3,812.27 22.16 23.39FMLA Usage 989.33 5.96 5.21 608.35 3.53 4.30COMP Usage 12.67 0.08 4.83 12.50 0.07 4.78 Total hours of Absence 5,760.59 34.70 33.68 4,433.12 25.77 32.47 Total Hours of Overtime 6.42 0.04 16.75 19.25 0.11 15.62

2012 ACTUAL 2013 ACTUAL 2014 BudgetGROWTH/REDUCTION over 2012 REVENUE

Operating Revenue $4,235,979 $2,758,263 $2,329,478 -45.0%

HHS Subsidy $12,735,396 $11,631,351 $15,067,720 18.3%

Total Revenue $16,971,375 $14,389,614 $17,397,198 2.5%

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Universal Measure - Budget

Budget assumes the following revenue sources:

2013 Actual 2014 BudgetHome Support Fees $ 96,415 $ 113,417

Options Program Fees $ 142,189 $ 147,744

Federal Social Services $ 1,468,260 $ 1,268,034

Social Services Operating $ 191,212 $ 191,212

Medicaid Core Waiver $ 24,897 $ 28,874

Adult Protective Services $ 17,544 $ 17,535

Transfer from Probate Court $ 201,000 $ 201,000

Private Grants $ 324,091 $ 282,882

Other $ 292,655 $ 78,780

Total $ 2,758,263 $ 2,329,478

* Action Item #3, Provide more information on $700,000 variance in revenue was based on a 2013 projection and is not shown in the above chart

• The decrease in 2010 and 2011 was due to staff participation in the Early Retirement Program (ERIP), in which 55 staff participated. The budget was also reduced due to drops in State funding.

• The decrease in 2011 and 2012 is due to the transfer of the Medicaid Benefits unit to Cuyahoga Job and Family Services.

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Universal Measure - BudgetHHS Senior and Adult Services History

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Universal Measure - BudgetHHS Senior and Adult Services by Expense Category