MEALS ON WHEELS: MORE THAN A MEAL

MEALSONWHEELS:MORETHANAMEAL

Creatiing an innovative and responsive system to deliver critical nutrition and social interaction

to vulnerable, isolated adultsintheJeffersonManagedCareServiceArea.

ABSTRACTMeals on Wheels America and Meals on Wheels Texas recognize a need to assure more eligible recipients are identified and served through a robust business plan and innovative practices. The following report details an analysis by home delivered meals (aka Meals on Wheels) providers, with the assistance of a consultant, in the Jefferson Managed Care Service Area, to consider how they may collaborate to accomplish these goals.

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ThisreportisfundedbyagrantfromMealsonWheelsAmericatoMealsonWheelsTexas.ThereportispartofanalysisandpreparationforthedevelopmentofapilotprojectintworegionsofTexasdesignatedforservicesfromManagedCareOrganizations(MCOs):theBexarManagedCareServiceArea,centeredaroundBexarCounty,Texas,andtheJeffersonManagedCareServiceArea,nearJeffersonCounty,Texas.

ThisreportisthepropertyofMealsonWheelsTexasandNutritionandServicesforSeniors,theleadagencyfortheprojectintheJeffersonManagedCareServiceArea.Thereportshouldnotbeshared

withoutthepermissionof:

ElaineShellenbergerExecutiveDirector

NutritionandServicesforSeniors4590Concord

BeaumontTX,77703Phone:409-892-4455Fax:409-892-0443

[email protected]

ThisreportwaspreparedbyMarthaSpinks,Ph.D.,consultingwithMealsonWheelsTexas.Dr.Spinkscanbecontactedat:

419StonewoodSanAntonio,TX78216

210.499.5175/[email protected]

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TableofContents

SUMMARYOFTHEMEETINGHELDJANUARY22,2016:....................................................................4

POINTSOFDISCUSSION....................................................................................................................4

INVITEES...........................................................................................................................................5

PILOTPROJECT.................................................................................................................................7

THEBUSINESSPLAN.........................................................................................................................7A. Goal...................................................................................................................................................7B. ManagementPlan..............................................................................................................................7C. OperatingPlan...................................................................................................................................8D. MarketingPlan..................................................................................................................................8E. FundingPlan......................................................................................................................................9F. ReturnonInvestment/SocialReturnonInvestment...........................................................................9

EnvironmentalConsiderationsforExpandingtheClientBaseintheJeffersonManagedCareServiceArea...............................................................................................................................................10

SWOTAnalysis...............................................................................................................................13STRENGTHS...............................................................................................................................................13WEAKNESSES............................................................................................................................................13OPPORTUNITIES........................................................................................................................................14THREATS...................................................................................................................................................14

FOLLOWUP....................................................................................................................................15FORMALIZEANAGREEMENT.....................................................................................................................15TODOLISTPREPARATORYTOTHENEXTMEETING....................................................................................16

APPENDICES...................................................................................................................................17APPENDIXA.Invitation/AgendaEmailedtoJeffersonManagedCareServiceAreaProviders...................18APPENDIXB.BexarandJeffersonManagedCareServicesAreas,byCountiesandPlaces..........................19APPENDIXC.KronkoskyFoundationResearchBrief:MealsonWheels....................................................21APPENDIXD.ProposedFlowChart,OperationandManagementoftheJeffersonManagedCareServiceArea..........................................................................................................................................................26APPENDIXE.ProposedCommunityCoalitionCharter................................................................................27APPENDIXF.DraftAgreementbetweenFiduciaryAgentandCoalitionMembers.....................................30APPENDIXG.OrganizationalCapacitySelfAssessment&CollaborativeSolutionsTool.............................32APPENDIXH.DualEligibleMedicaidEnrollment,byCounty......................................................................42APPENDIXI.Medicare-MedicaidRecipients,byCounty............................................................................43APPENDIXJ.Age,DisabilityandPovertyIndexbyCounty.........................................................................44APPENDIXK.Area2014CensusPopulationCharacteristicsforAge60+,byCounty,withComparisontoStateofTexas............................................................................................................................................50APPENDIXL.SelectedEconomicCharacteristics_14_5YR_DPO3.xls..........................................................51

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SUMMARYOFTHEMEETINGHELDJANUARY22,2016:FOCUSGROUP

FacilitatedbyMealsonWheelsTexas(Facilitator:MarthaSpinks,Ph.D.,MSW,Consultant)

forRegionalHomeDeliveredMealsProviders

ConcerningaPilotProjecttoImproveCoverageinUnservedorUnderservedAreas

HostedbyHollyAnderson,Director,AreaAgencyonAgingDeepEastTexasCouncilofGovernments(DETCOG),Jasper,Texas

POINTSOFDISCUSSION

• IdentifychallengestoMealsonWheelsprograms• Identifyopportunitiespresentedbythechallenges/currentenvironment• Makeaformalcommitmenttocollaboration• Developabusinessplan

GOALFORTHEPILOTPROJECT(Broadlydefinedbytheattendeesattheendofthemeetingandsubjecttoeditsoramendmentsbycollaboratingagencies):Throughacollaborativeeffortamongregionalhomedeliveredmealsproviders,developacooperativebusinessplanthatclosesthegapsinareasnotcurrentlyserved,orareunderserved,byindividualprograms.PROPOSEDNEXTSTEPS:

1. Facilitatorwillusecontentfromthefocusgroupmeetingtodraftacharteragreementandbusinessplanoutlineforthegrouptoreviewandmakecomment.

2. Followinggroupinputbyemail,groupwilldeterminewhethertohaveatelephoneconferenceand/ormeetingtofinalizedraftbusinessplanandcharter.

3. Collaboratingagencieswillsignacharter,designateaFiduciaryAgent,andapproveabusinessplanbyMarch2016.

4. Withformalizationoftherelationshipamongcollaborativemembers,theJeffersonManagedCareServiceAreawilloperationalizetocontractwithoneormoreManagedCareOrganizations(MCO)toprovideMealsonWheels/HomeDeliveredMealstoeligibleadultsinthedesignatedregion.(SeeAppendixBforamapofthepilotregions.)

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*NotincludedinemailinvitationforJanuary22,2016meeting.Theyshouldbeaddedtolistofinvitees.

INVITEES

Name MailingAddress

City/Town ZipCode

EmailAddress Phone Attending

MeetingVirgilAllen P.O.Box415 Coldspring 77331 [email protected] 936.653.4175 Y

BarbaraHayes 602E.ChurchStreet,Ste

145

Livingston 77351 [email protected] 936.327.6830 N

FrankIvory 340FHwy75North

Huntsville 77320 [email protected] 936.295.6151 N

BobbieBrodnax 109WestWaterSt

Jasper 75951 [email protected] 438.27280 Y

MaxineMorris P.O.Box1095

Cleveland 77328-1095

[email protected] 281.592.1174 Y

LindaHughes 103North5thSt.

Orange 77631 [email protected] 409.886.2186 Y

SandyVaughn Newton 75966 [email protected] 409.379.8083 Y

VickiSmith POBox3607 Victoria 77904 [email protected] 361.578.2989 NY-EttaMcBride POBox683 Anahuac 77514 [email protected] 409.267.3559 N

ElaineShellenberger

4590Concord

Beaumont 77703 [email protected] 409.892.4455 Y

HollyAnderson 210PremierDr.

Jasper 75951 [email protected] 409.384.5704 Y

BarbaraWilson P.O.Box1095

Cleveland 77328 [email protected] 936.509.6350 Y

TammyBlank 621Harris

Nacogdoches 75964

[email protected]

936.509.6350

Y

RayfieldJefferson

P.O.Box415 Coldspring 77331 [email protected] 936.653.4175 Y

*MitchMcMillon

409N.Fletcher

Jasper

75951

[email protected] 409.384.3701 Y

BobbieStott 210PremierDr.

Jasper 75951 [email protected] 409.384.5704ext5303

Y

DonnaSprouse 210PremierDr.

Jasper 75951 [email protected] 409.384.5704 Y

*KasieKroll 340-FHwy75North

Huntsville 77321 [email protected] 936.291.2868 N

*CharlesLee POBox1008 Groveton 75845

[email protected] 936.642.1541 N

*KatieJones POBox1008 Groveton 75845

[email protected] 936.642.1541 N

*DeaconGlendaHardin

2041TrinityAve.

Liberty 77575 [email protected] 936.336.3762 N

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ATTENDEESSIGNINGCOMMITMENTTOCOLLABORATEwithMealsOnWheelsTexasandOtherLocalHomeDeliveredMealsProviderstoDevelopaBusinessPlan:

Agency Representative Phone EmailEastTexasSupportServices,Inc. BobbieBroadnax 409.382.7280 [email protected]

SanAugustineCounty BridgetteBrown,forJudgeSaymeJohnson

936.201.3951 [email protected]

SeniorCitizensofSanJacintoCounty RayfieldJefferson 936.653.4175 [email protected] TammyBlank 936.569.6350 [email protected] LindaHughes 409.886.2186 [email protected],Beaumont,TX

ElaineShellenberger 409.892.4455

[email protected]

Note:Thisisanonbindingcommitmentbasedontheinitialmeetingofthegroupofpotentialcollaborators.OtherswhodidnotsignordidnotattendthemeetingonJanuary22,2016,haveanopportunitytocommittotheprojectbysigningtheproposedcharter.

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PILOTPROJECT1. Thefirsthourofthemeetingwasapresentationfromthefacilitatoraboutthepilotprojectledby

MealsonWheelsAssociationofTexas,fundedbyMealsonWheelsofAmerica.MealsonWheelsAmericaandMealsonWheelsTexasrecognizeaneedtoexpandservicestoassuremoreeligiblerecipientsareidentifiedandserved.ThechallengesofreachingmoreeligiblerecipientswillrequirecollaborationamongproviderstodevelopabusinessplanthatallowsthevarioushomedeliveredmealsprogramstoidentifyA. theirrespectivestrengthsB. waysinwhichtheprogramscanaligntheirstrengthsandhelpeachotherto—

i. createefficienciesthatresultinmoreclientsbeingservedii. sustainindividualHDMprogramsiii. sustainthetraditionalmodelofalocalHDMprogramthatdelivers“morethana

meal”byengaginginfrequentface-to-facecontactwithclientsiv. collaboratetodevelopinnovativesolutionsthataddressthebarriersdescribedin

itemsi-iiiabove2. Attendeesweregivensummarystatisticsfromanonlinesurveythatwascompletedbythemin

NovemberandDecember.Theresultswereusedtoleadadiscussionaboutthecharacteristicsandcapacityoftheprogramscollectively.

3. Thefacilitatordiscussedtheoutlineofabusinessplan:

A. GoalB. OperatingPlanC. ManagementPlanD. FundingPlanE. ReturnonInvestment/SocialReturnonInvestment

THEBUSINESSPLAN4. Attendeesbegandiscussionsonthebusinessplanasfollows:

A. Goal“Throughacollaborativeeffortamongregionalhomedeliveredmealsproviders,developacooperativebusinessplanthatclosesthegapsinareasnotcurrentlyserved,orthatareunderserved,byindividualprograms.”B. ManagementPlan

1) Designateallpartiestotheagreementasacoalitionandadvisorycommitteetothecoalition

2) Designatealeaderforthegroup,who,ataminimum,willa. Beapointofcontactformembersofthecoalitionb. Beapointofcontactforbusinesspartnersorpotentialbusinesspartners

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c. Organize,atminimum,routinequarterlymeetingsd. Callothermeetingsasneedede. Beonthealertforfundingopportunitiesf. Organizeworkgroupsoridentifyspecialistswithinthegroupwhocanwrite

grants,negotiatecontracts,etc.3) Formalizeanagreementtocollaborateandimplementabusinessplanandregional

operatingnetwork(SeeAppendixEfordraftcharter.)4) Reviewtypescollaborativearrangements,including,butnotlimitedto:

a. Considerorganizingavoluntarycoalition,andthecriteriaformembership.b. Considertheefficacyoforganizingasa501(c)(3)c. PerDETCOGAAAstaff,considerapproachingtheregionalcoalitionofArea

AgenciesonAgingtodiscussexpandingthemembershipofthatexistingorganizationtohomedeliveredmealsproviders.(PersuggestionfromDETCOGAAAstaff.)

5) DesignateaFiduciaryAgentforthecollaborative.(SeeAppendixFfordraftofFiduciaryAgentagreement.)

C. OperatingPlan

1) SeeAppendixDforschematicofproposedoperatingprocedure2) Identifyalliesofthehomedeliveredmealsprograms3) Shareinformation4) Sharegoodideas5) Standardizecoreprogramstothedegreepossible,withtheunderstandingthat

agenciesvarytosomedegreeintheirresourcesaswellastheiradditiveprogramsandwillcontinuetodoso

6) CreateaformalagreementamongareahomedeliveredmealsproviderstoactasacollaborativetocontractwithMCOsandaddressothermutualinterests

7) Createamorecoordinatedandreliableinformationandreferralsystemforclientsandproviders

8) Joinand/orworkwiththeregionalcoalitionofAreaAgenciesonAging9) Developpartnershipsamonghomedeliveredmealsproviderstoassisteachothertofill

respectivegaps

D. MarketingPlan1) Usethecurrentthreatfromnewcompetitorsasanopportunitytorevivemarketing

materialsanddevelopaconsistentstrategythatindividualHDMproviderscanshare,e.g.,

a. WriteabusinesscaseforthesuperiorityoflocalHDMprogramsthatallHDMprovidersuseinprintmaterials,presentations,contactswithofficials,communityleaders,DADS,etc.

b. Designamarketingstrategyforcoreservicesofferedbyallprovidersthatresultsini. Abrochure,postersandotherprintmaterialssharedbyallproviders

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ii. Ascriptedpresentationthatallmemberscanuseincontactswithofficials,themedia,andpotentialbusinesspartners

c. Notdiscussed,butfacilitatorrecommends:i. Astandardizedstyleinlogos,colors,print,signageetc.(Considerusing

thenewMealsonWheelsAmericalogoandcolors.)ii. Apresskitthatrepresentsthecoalitionasanextensivenetworkacross

theregioniii. Contactswithmediaoutletsusingthepresskit,askingforregional

coverageofthecoalitioniv. AdedicatedwebsitetopromoteallregionalHDMprograms(See

exampleatwww.callarideforseniors.org)tosupportersaswellasconsumers.

v. Sampleletterstouseincontactswithofficials,businesses,volunteers,etc.

vi. Amapforwho,bypositionortitle,tocontactineachlocalcommunityvii. Schedulemeetingswithallcountyandstateofficials,community

leaders,communityvolunteersandbusinessestotellthemaboutHDMandtheroleitplaysinthehealthofthecommunityandcontainmentofhealthcrisesandhealthcosts,aswellasthepotentialthreattotraditionalHDM.

E. FundingPlan1) Attendeesaretentativelywillingtodiscussthepossibilityofconsolidating

administrativeactivities,whichmayincludeappointingaFiduciaryAgentfromwithintheagenciesthataremembersofthecollaborative.

2) AttendeesdiscussedthepossiblebenefitofcollaborationwouldbetheabilitytocontractwithMCOsandandotherstogenerateadditionalrevenue

F. ReturnonInvestment/SocialReturnonInvestment

1) ReturnonInvestment(ROI)a. Efficienciesofscaleresultingfromconsolidatingadministrationand

managementofseveralHDMprovidersforcontracting,billing,reporting,etc.b. Efficienciesfromrealigningserviceareasandreferringclientsbetween

providerswithintheserviceareatoallowmoreflexibilitybasedoncapacityandgeographicreachofcollaboratingHDMprograms

c. Savingstoindividuals,insurancecompaniesandlocalhealthcaresystemsthroughearlyidentificationofclienthealthrisksthati. Preventsrecidivism/readmissionofrecentlydischargedindividuals,for

whichhealthcaresystemsnowarepenalizedundertheAffordableCareAct

ii. Preventsordelaysclientmorbidityandmortality,promptinghealthcaretreatmentatanearlierornon-emergencyandlessexpensivestage

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d. Leveragesrelationshipsinthecommunitytoprovideadditionalsocialservicesupportorinterventionthatpreventsmorbidityandmortality

e. IncreaseinunitratesthroughcollaborativeeffortsoflocalHDMprovidersandlocalofficialstoleveragepoliticalinfluenceatthestatelevel

f. IncreaseinfundingsourcesthroughagreementswithManagedCareOrganizations,healthcaresystemsandothers

g. PotentialforMedicaidreimbursementsforotherprogramservices,e.g.,caretransitions,adultdaycare,transportationtomedicalappointments

2) SocialReturnonInvestment(SROI)a. Strengthensthesocialsafetynetforconsumersbykeepingalocalprogramin

placethati. Providessocialinteractiontoisolatedclientsalmostdaily,whichhas

beendocumentedtoimprovementalhealthii. Insuresfrequentface-to-faceobservationandcomparisonofclient

statusovertimeiii. Notifiesfamilycaregivers,healthcareproviders,adultprotective

servicesorothersofconcernsiv. Hasdetailedknowledgeofthewholeperson,e.g.,secondaryhealthor

socialproblems,relationships,isolation,orchangeinstatusthatmaypromptorpreventdecompensationandmaybeunknowntofamilycaregivers,healthcareprovidersorpublicsafetyofficials

v. Canleveragerelationshipsinthecommunitytoprovideadditionalformalandinformalresourcesorinterventionwithat-riskclientswhoareunservedorunderservedbysocialservicesorhealthcaresystems

b. MakesHDMacomponentofbroaderpublichealthconsciousnessofthelocalcommunity,ratherthanisolatingitasacommercialenterprise

c. Educateslocalagencies,officials,businessesandindividualsaboutHDMandthevalueandimpactsaccruingtothecommunityfromlocalHDMproviders,comparedtocommercialproviders

EnvironmentalConsiderationsforExpandingtheClientBaseintheJeffersonManagedCareServiceArea

1. Forthepurposesofthisreport,thetermHomeDeliveredMeals(HDM)referstoallprogramsthat

delivermealstoadultsintheirhomes.HDMisthetermusedbythemajorfunderofmostoftheseprograms,thefederalOlderAmericansAct.MealsonWheelsoftenisusedinterchangeablywithHDM,butforthepurposesofthisreport,MOWisusedtorefertoMealsonWheelsTexas(MOWT),anassociationofHDMprovidersfromacrosstheStateofTexas,ortoorganizationsthataremembersofMOWT.MOWTistherecipientofagrantfromMealsonWheelsAmericaforthepurposeofdevelopingcoalitionsamongHDMproviders—notjustMOWTmembers.

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2. AttendeesatthefocusgroupinthislargelyruralareaparticipatedinaSWOTanalysis,whichprovidesimportantinsightsintotheenvironmentinwhichtheyhaveoperatedfordecades.TheSWOTanalysisisprovidedbelow.

3. ThemajorityofdirectorsofHDMprogramsinthisareahaveatleast10yearsofexperience,andmanyhave20ormoreyearsofexperiencemanagingandsustainingtheircurrentprograms.

4. ThesedirectorshavesignificantexperiencefundraisingandhabituallyovermatchtheOAAgrant,asdomostoftheHDMprogramsthroughoutTexas.AbriefpreparedbytheKronkoskyFoundationatAppendixCdescribestheMOWprogramintheBexarManagedCareServiceArea,yetisinstructiveaboutMOWprogramsmoregenerally,andisfittingasageneraldescriptionoftheJeffersonManagedCareServiceArea.

5. SeeAppendixBforamapoftheareasthatwillbethesitesofthepilotprojects.WhileSanAntonioandBeaumontaresizablemunicipalities,formuchoftheJeffersonandBexarManagedCareServiceAreas,themapshowslargegeographicalexpanseswithfewmajorhighwaysandalimitednumberoftownsorvillages,suggestingthedistancesthatHDMprovidersmayberequiredtodrivetoreachmanyruralclients.Geographyisakeychallengetoexpandingthenumberofclientsserved.

6. TheHDMprogramswereestablishednearly40yearsagowhenthefederalOlderAmericansAct(OAA)addedfundingfornutritionservicesforpeople60andolder.OAAfundingisawardedtostates,andinTexasthosefundsarepassedtoAreaAgenciesonAgingin28designatedregionsthatmanagemostofthefederalandstatefundingforpeople60andolder.Inadditiontonutritionalfunding,theOAAalsoprovidescasemanagement,informationandreferral,benefitscounseling,incomesupport,familycaregiversupport,andotherrelatedsocialservicesprograms.

7. TheOAArequiresproviderstoputupmatchingfunds,whichtheHDMprogramssolicitfromthestate,othergovernmentagencies,andcharitableandcivicorganizations,addingasmuchasmuchas40%-60%tothetotalprogramfunding.HDMtypicallyhavesubstantialvolunteersupport,therecruitmentandmanagementofwhichaddsfurtherin-kindcontributionsfromtheproviders.(SeeAppendixCformoredetailontheimpactofthenonprofitproviders.)

8. ConversationswithmembersofMealsonWheelsTexasindicatedthatMOWprovidershavedifficultyestimatinghowmanyeligibleparticipantsresideintheirareasandwhatpercentageofeligibleclientsarenotserved.Forthisreason,AppendicesHthroughLhavebeenincludedfortheconvenienceofHDMprovidersintheJeffersonManagedCareServiceAreasotheycanextrapolatethenumberofeligibleclientswhoare60andolder,andalsoconsiderthenumbersandcategoriesofnewclientsthatmightbeofferedtothembycontractswithaManagedCareOrganizations,whichprovidecommunity-basedservicestoMedicaid-eligibleadultsunderitsStar+PluscontractwiththeStateofTexas.

9. ContractingwithManagedCareOrganizationsorotherscouldexpandHDMs’traditionalclientbasefrompeople60andovertoanyone18andolderwhomeetsqualificationsforcommunity-basedservices.

10. Star+PlusisaMedicaidManagedCareprogramoftheTexasHealthandHumanServicesCommission(HHSC)foradultswhoarenotreceivingMedicare.Theterm"ManagedCare"meanstheStateofTexashiresmanagedcareorganizations(MCOs)tomanagerecipients’healthcare,includingcommunity-basedservices,suchasHDM,thatpreventadmissionorreadmissiontohospitalsandlongtermcarefacilities.ThoseeligibleforStar+Plusinclude:

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• IndividualswhodoNOThaveMedicarecoverageAND• IndividualswithIntellectualorDevelopmentalDisabilities(IDD),whoreceiveservicesinan

intermediatecarefacility,• IndividualswithanIntellectualDisabilityorRelatedConditions(ICD-IID),• OrIndividualswithoneormoreofthefollowingIDDWaivers:

o CommunityLivingAssistanceandSupportService(CLASS)o DeafBlindandMultipleDisabilities(DBMD)o HomeandCommunity-basedServices(HCS)o TexasHomeLiving(TxHmL)1

11. ThepilotprojectandthedatainthisreportwerepromptedbyrecentchangestothewaytheOlderAmericansActnutritionprogramhasoperatedforthepast40years.TheStateofTexashasbeenapproachedbycommercialprovidersclaimingthattheycanreachisolatedseniorsandmeetthegoaloftheStatetoassureHDMareprovidedtoallseniorsinTexas,regardlessoflocation.WhileHDMprovidershaveprovidedexceptionalservice,reachingallisolatedseniorsinthevast,openareasofTexashasalwaysbeenachallengefornonprofitHDM,duetolimitationsininfrastructureandfunding.

12. ThecommercialprovidershavecontactedstatelegislatorsandTexas’DepartmentofAgingandDisabilityServices(DADS)fortheirsupportinchangingtheTexasAdministrativeCode(TAC)toallowthemtocompetewithnonprofitHDMproviders.

13. Todate,thecommercialprovidershavemadeinroadsintwoareas:1)someAreaAgenciesonAginghavecontractedwithcommercialproviderstodelivermealstoseniorsforemergenciesand/orroutineneeds,and2)ManagedCareOrganizations,chargedbytheStateofTexasStar+Plusprogramtoprovidecommunity-basedservicestoMedicaidrecipients,havecontractedwithbothcommercialandnonprofitHDMproviderstoprovidenutritionservicestotheirclients.

14. TheMealsonWheelsAssociationofAmericahasidentifiedcommercialprovidersasathreattothetraditionalMealsonWheelsprovidersnationally.Asaresult,MOWAawardedMOWTa$10,000granttodeveloptwopilotprojectsinTexasbetweenNovember2015andAugust2016totestwhetherHDMproviderscancollaboratetocreateandoperationalizeabusinessplanthatwillmakethembetterabletomaximizetheirreachtoisolatedseniors,servingmoreseniorsinmorediverseways,tomeetthegoaloftheStatetoserveeveryeligiblesenior,wherevertheymaybe.

1 - For more detail see http://www.starplustx.com/#sthash.0bWe5nz0.dpuf For MCOs assigned to each county and contact information for those MCOs, see http://www.starplustx.com/Counties.) For more information on community-based services funded by Texas Department of Aging and Disability Services, go to http://www.dads.state.tx.us/providers/.)

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SWOTAnalysisSTRENGTHS

1. ThemajorityofHDMarepreparedfreshdaily,withoutadditives/preservatives2. HDMhasfirsthandknowledgeofclientsindetail,e.g.,daytodaycomparisonofphysicaland

cognitivefunction,preferences,supportsystems,families,socialhistory,levelofisolation,idiosyncrasiesthatcouldputthematrisk

3. HDMstaffhavetrustedface-to-facerelationshipswithclientswhomaynotrespondtopeopletheydon’tknow

4. HDMintegratesmanyotherserviceswithmealdelivery,e.g.,SeniorCompanions,AdultDayCare,SeniorCenters,CongregateMeals,SpecialEvents

5. HDMstaffrecognizebarrierstonutrition,particularlyforchilledorfrozenmeals,suchasa. Lackofelectricityb. Lackofrefrigerationc. Lackofcooking/heatingdevicesd. Lackofphysicalorcognitiveabilitytoreceive,store,orpreparemeals

6. HDMsupportsthemissionofAreaAgenciesonAgingbydailyobservingclientsmostatrisk7. HDMhasthecapacitytoprovideclienttrackingtoMCOs8. RecognitionofMOWand/orlocalHDMprovideragenciesasatrustedbrand9. HDMstaffandvolunteerspossess

a. Firsthandknowledgeoftheenvironmentandpeopleb. Decadesofexperiencebystaffc. Personalconnectionsatthelocallevelwith

i. Clientsii. Familycaregiversiii. Communitymembersiv. Governmentofficialsv. Businessesvi. Civicorganizationsvii. Religiousorganizationsviii. Educationalinstitutions

10. VolunteersoffsetexpensesoftraditionalHDMprograms11. HDMprogramsraisefundstomatchandsometimesexceedgovernmentnutritionfunding12. HDMprogramsreceivefinancialcontributionsfromlocalgovernmentsandagenciesto

supplementgovernmentnutritionfundingWEAKNESSES

1. Limitedfunding2. Lackofstaff3. Lackofvolunteers4. Lackoftime5. Relianceondeclininggovernmentfunding

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6. Overtaxedlocaldonors,especiallyinsmallercommunities,whichhavefewercharitableorcivicorganizationsorphilanthropists

7. ManagingthetransitiongapfromoldestoldagingoutofHDMordyingwhiletotryingtoengageBoomers.(ThismayresultinashorttermdipindemandservicesthatwillincreaseasBoomersbecomeolder.)

8. Needtoimprovemarketing9. Lackofmediaexposureinruralareas10. Needtoidentifyallpeoplewhoneedhelp11. HDMstaffagingout,i.e.,staffstaywithHDMprogramformanyyears,oftentillretirement;

limitedfundspreventhiringnewstaffforoverlapandtraining;substantialinstitutionalknowledgeislost

12. DADSpoliciesprevent(ormakedifficult)collaboration/clientsharing/gapcoverage.Example:individualassignedtooneserviceareathatcannotreachfarenoughtoassistcouldbeassistedbyHDMinanotherarea,butassignmentandfundingrulespreventassistance

13. SPURS/HarmonysystemisproblematicforbothHDMprovidersandAAAsOPPORTUNITIES

1. Requestsfromcommercialproviderstoprovideahigherrateformealdeliveryhasopenedadiscussionatstatelevelthatwasnotencouragedinthepast

2. RequestsfromcommercialproviderstochangeTexasAdministrativeCode(TAC)toallowthemmoreflexibilitymayproducemoreflexibilityfortraditionalHDMprograms

3. Thepilotprojectcanbeusedtomountawellintegrated,welldefinedmarketingcampaignthathelpsprovidersengagestakeholders,includingMCOs,consumers,otherhelpingagencies,officials,andbusinesses

THREATS1. RequestsfromcommercialproviderstochangeTexasAdministrativeCode(TAC)toallowthem

moreflexibilitycouldgivethemadvantagesincompetingwithHDMprograms2. Commercialcompetitorswithsubstantialfinancial,marketingandpoliticalresourcescould

poseathreattocontinuingtraditionalHDMprograms3. Thelongtermeffectofcompetitionfromcommercialproviderscouldbethat1)HDM

programscouldnotsustainthecompetition,and2)withthedemiseofHDMprogramscommercialproviderswouldraiserateswiththeeventualresultthat3)fewerclientswouldbeservedthanarecurrentlyserved,because4)theprogrambecomesmoreexpensive

4. Withdrop-shipservicesandmoreflexiblefunding,commercialproviderscanprovidemealssevendaysaweek

5. CommunicationgapswithManagedCareOrganizationsa. DelayedresponsefromMCOstoHDMs’inquiriesaboutclients,includingnotificationof

continuationinthehealthplanb. Delayedreimbursementofprovidersforservicesc. Non-reimbursementwhenservicesareprovidedafterclientdropshealthplanwithout

provider’sknowledge

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6. LackofknowledgebyMCOsreHDMs7. MCOstafflackknowledge/experiencedealingwithclientpopulation,connectingclientsto

resources,includingHDM8. Declineincharitablefunding9. Lackofempathyforagingpopulationsamongfunders10. Logistics

a. Ruralisolation—deliveryoftraditionalHDMtoonepersonatagreatdistancefromothersisnotcosteffective

b. ExtendedserviceareasbeyondabilityofHDMstafforvolunteerstodeliverc. Poorcountryroads—wearandtearonvehicles,poorsignage,addtocomplexityof

deliveryd. Poor9/11networkinruralareasinhibitscommunicatione. Poorinformationandreferralinruralareasf. Clientsmayhavelimitedcapacityforselfcare,e.g.,

i. followingstaffinstructionsii. recognizingwhomtheycantrustiii. havingutilityservice

g. Clientsatriskforhealthcrises,selfneglect,exploitation

FOLLOWUPItemsthatneedtobeaddressedinordertoformacollaboration,signacharter,andcreateandimplementthebusinessplan.FORMALIZEANAGREEMENT

1. ReviewthisreportofthemeetingonJanuary22,20162. Submitquestionsandcommentstothefacilitatorand/orElaineShellenberger,Executive

DirectorofNutritionforSeniorsandMore,whoseagencyreceivedthegrantforthisproject3. HDMprovidersintheJeffersonHealthServiceAreawhowishtoproceedwitharegional

collaborationshoulda. Reviewthedraftcharter(AppendixE),providecomments,recommendmodifications,

andadvisethefacilitatoriftheprovideriswillingtosignthecharterb. ReviewthedraftFiduciaryAgentAgreement(AppendixF),providecomments,

recommendmodifications,andadvisethefacilitatoriftheprovideriswillingtosignthecharter

c. IndicateavailabilityforparticipationonanAdvisoryCommitteethatwillcommunicatefrequentlytoimplementtheoperationalplan

d. Bepreparedtoattendafollowupmeetingtofinalizedetailsofthecollaborationandsignthecharter

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TODOLISTPREPARATORYTOTHENEXTMEETING1. ElaineShellenbergerwillforwardinformationtoattendeesaboutacquiringaMedicaid

numberforbilling.2. IndividualorganizationsshouldcompletetheOrganizationalAssessment(SeeAppendixG)and

submittothefacilitatoralongwiththefollowinginformation:a. Identifywhateachcollaboratorcancontributetothecollaborationb. Identifywhateachcollaboratorneedsfromothercollaboratorsc. Identifyareaswherecollaboratorsmayneedtocreateanewsystemorprocessto

makethebusinessplanwork3. ProviderswithanMCOcontractemailacopyofthecontracttothefacilitator,alongwith

contactinformationforMCOstaffpersonresponsibleforsettingupormanagingthecontract.4. Eachattendeesubmitoneormorestories,nottoexceed250words,thatillustratetheimpact

oftheHDMprogram5. EachattendeesubmitanyinformationaboutoperationsofMom’sMealsorothercommercial

providers,intheirareathatcanbedocumented,e.g.,a. AclientrequestingMom’sMealsinplaceoftraditionalHDMb. AclientbeingreassignedbyanMCOfromHDMtoMom’sMealsc. AnAreaAgencyonAgingthatisusingdropshipproviders

17

APPENDICES

APPENDIXA.Invitation/AgendaEmailedtoJeffersonManagedCareServiceAreaProviders........................18

APPENDIXB.BexarandJeffersonManagedCareServicesAreas,byCountiesandPlaces..............................19

APPENDIXC.KronkoskyFoundationResearchBrief:MealsonWheels.........................................................21

APPENDIXD.ProposedFlowChart,OperationandManagementoftheJeffersonManagedCareServiceArea

..........................................................................................................................................................................26

APPENDIXE.ProposedCommunityCoalitionCharter......................................................................................27

APPENDIXF.DraftAgreementbetweenFiduciaryAgentandCoalitionMembers..........................................30

APPENDIXG.OrganizationalCapacitySelfAssessment&CollaborativeSolutionsTool.................................32

APPENDIXH.DualEligibleMedicaidEnrollment,byCounty............................................................................42

APPENDIXI.Medicare-MedicaidRecipients,byCounty..................................................................................43

APPENDIXJ.Age,DisabilityandPovertyIndexbyCounty...............................................................................44

APPENDIXK.Area2014CensusPopulationCharacteristicsforAge60+,byCounty,withComparisontoState

ofTexas.............................................................................................................................................................50

APPENDIXL.SelectedEconomicCharacteristics_14_5YR_DPO3.xls...............................................................51

18

APPENDIXA.Invitation/AgendaEmailedtoJeffersonManagedCareServiceAreaProviders

MeetingAgendaFriday,January22,2016

10a.m.-2p.m.MealsonWheelsAssociationofTexas(MOWAT)

&HomeDeliveredMealsProvidersoftheDeepEastTexasArea

LOCATION:DeepEastTexasAreaAgencyonAging

210PremierDriveJasper,Texas75951

ExecutiveDirectorsofareaHomeDeliveredMeals(HDM)ProgramsareinvitedtoattendameetingwithrepresentativesofMealsonWheelsAssociationofTexas(MOWAT)onFriday,January22,2016,from10a.m.to2p.m.Lunchwillbeprovidedbythemeetinghost,DeepEastTexasAreaAgencyonAging.ThepurposeofthismeetingistodiscussbuildingacollaborationamongHDMproviderstoexpandandimproveHDMservices,withaspecialfocusonreachingunservedorunderservedareas.AllHDMproviders—notjustmembersofMOWAT,andnotjustrecipientsofstateorfederalfunding—arestronglyencouragedtoattend.WeareawarethatthereareHDMprogramsthataredoingimportantworkwithouttheseconnections,andwewouldliketoknowaboutyouandhowyoumightbepartofthisproject.SeveralHDMprovidersthatwerepreviouslyidentifiedreceivedsurveysfromMOWATinNovemberandDecemberaskingabouttheircapacity,theirconcerns,andtheirinterestincollaboratingtostrengthentheirorganizationsandexpandservices.Ifyouwanttoknowmoreaboutthesurvey,gotohttps://www.surveymonkey.com/r/attachmentDETCOGtoviewand/orcompletethesurvey.Thegoalsofthemeetingare:

1.DiscussMOWAT’spilotprojecttoassistHDMprogramsinDeepEastTexastocreateandtestanewcollaborativebusinessmodel.2.SharewhathasbeenlearnedfromtheMOWATsurveyabouttheStrengths/Weaknesses/Opportunities/ThreatsrelatedtotheareaHomeDeliveredMealsprograms.3.WiththeinputofHDMprovidersinattendance,fillininformationthatthesurveymaynothavecaptured.4.WiththeinputofHDMprovidersinattendance,outlineaplanabouthowHDMproviderscancollaboratetocreatearobustprogramthatexpandsmealservicestomoreconsumersandopensnewopportunitiestoprovidersthatwillstrengthentheiroperations.5.Draftatentativeagreementtocollaborateandpilotthedevelopmentandimplementationofanewbusinessplan.IfyouhavequestionsabouttheMOWATpilotproject,pleasefeelfreetocontactMarthaSpinks,Ph.D.,MSW,[email protected].

HollyAnderson,CIRS-ADirector,AreaAgencyonAgingDirector,211/AreaInformationCenter210PremierDriveJasper,Texas75951409-384-7614,409-384-5704,ext5258(office)409-384-6177(fax)

19

APPENDIXB.BexarandJeffersonManagedCareServicesAreas,byCountiesandPlaces

Note:SanAugustineandTrinityCountiesarenotnormallypartoftheJeffersonManagedCareServiceArea,buthavebeenaddedforthepurposesofthepilotprojectduetointerestfromthosecounties.UvaldeisnotnormallypartoftheBexarManagedCareServiceArea,butisbeingconsideredforadditiontothepilotproject.

20

Withthedesignationofplacesandmajorhighwaysineachcounty,thismapillustratestherelativeisolationofareasinTexas.SeebelowfortheCensusBureaudefinitionof“Places,”whicharerepresentedonthismap.GeographicTermsandConcepts-PlaceIncorporatedPlacesarethosereportedtotheCensusBureauaslegallyinexistenceasofJanuary1,2010,asreportedinthelatestBoundaryandAnnexationSurvey(BAS),underthelawsoftheirrespectivestates.Anincorporatedplaceisestablishedtoprovidegovernmentalfunctionsforaconcentrationofpeopleasopposedtoaminorcivildivision,whichgenerallyiscreatedtoprovideservicesoradministeranareawithoutregard,necessarily,topopulation.Placesalwaysarewithinasinglestateorequivalententity,butmayextendacrosscountyandcountysubdivisionboundaries.Anincorporatedplaceusuallyisacity,town,village,orborough,butcanhaveotherlegaldescriptions.

CensusDesignatedPlaces(CDPs)arethestatisticalcounterpartsofincorporatedplaces,andaredelineatedtoprovidedataforsettledconcentrationsofpopulationthatareidentifiablebynamebutarenotlegallyincorporatedunderthelawsofthestateinwhichtheyarelocated.Theboundariesusuallyaredefinedincooperationwithlocalortribalofficialsandgenerallyupdatedpriortoeachdecennialcensus.Theseboundaries,whichusuallycoincidewithvisiblefeaturesortheboundaryofanadjacentincorporatedplaceoranotherlegalentityboundary,havenolegalstatus,nordotheseplaceshaveofficialselectedtoservetraditionalmunicipalfunctions.CDPboundariesmaychangefromonedecennialcensustothenextwithchangesinthesettlementpattern;aCDPwiththesamenameasinanearliercensusdoesnotnecessarilyhavethesameboundary.CDPsmustbecontainedwithinasinglestateandmaynotextendintoanincorporatedplace.TherearenopopulationsizerequirementsforCDPs.(Retrievedfromhttps://www.census.gov/geo/reference/gtc/gtc_place.html,February22,2016)

21

APPENDIXC.KronkoskyFoundationResearchBrief:MealsonWheels

Exhibit on following page

26

APPENDIXD.ProposedFlowChart,OperationandManagementoftheJeffersonManagedCareServiceArea

27

APPENDIXE.ProposedCommunityCoalitionCharterArticleI–NameThenameofthisCoalition(“Coalition”)shallbe<insertname>.ArticleII–Mission&VisionThemissionofthe<coalitionname>is:Throughacollaborativeeffortamongregionalhomedeliveredmealsproviders,developacooperativebusinessplanthatclosesthegapsinareasnotcurrentlyserved,orthosethatareunderservedbyindividualprograms.Thecoalitionwillstrivetoincreasethenumberofeligibleadultsreceivingservicesby10%inthenext12months.ArticleIII–Purpose1. Tobuildandsustainacommunitycoalitionwithafocusonthedeliveryofnutritionservicesand

associatedsupporttovulnerableadults2. Toprovidemutualsupporttocoalitionmemberstoassuretheirprogramsaresustainableandresponsive

totheneedsofeligibleadultsintheirrespectivecommunities3. Todevelopandoperationalizeabusinessplanthanidentifiesopportunitiesforexpansion,improvement

andinnovationofnutritionprograms4. Tocollaborateandencourageeffortsoforganizationswithasharedpurposeofimprovingcare5. ToadvancecommunityengagementthatfurthersthemissionandvisionoftheCoalition.

ArticleIV–ParticipationSectionI–CollaborationParticipationinthe<coalitionname>isopentoorganizationsandindividualsinterestedinfosteringthevisionbyactivelyengagingintheplanningandworkoftheCoalition.Chartermembersshouldjoininacommitmentto:• Sharebestpracticesandknowledge• Mentorpartnersandproviders• Requestandprovideassistancewhereneeded• Sharedataandsupportanalyses• Promoteimplementationofevidence-basedinterventions

Participantcategoriesmayinclude:• Providersofhomedeliveredmeals• Providersofothernutritionalservicestovulnerableadults(e.g.,congregatemeals,foodbanks,

governmentcommoditiesprograms,etc.)• ManagedCareOrganizations

28

• HealthcareProvidersacrossthecontinuumofcare• ProviderAssociations• ConsumerAdvocacyOrganizations• GovernmentOrganizations(DepartmentofAgriculture,MunicipalOfficials,HealthDepartment,Area

AgencyonAging,etc.)• QualityImprovementOrganizations• EducationalandFundingOrganizations• Consumers

The<coalitionname>,hasreceiveda$10,000grantfromMealsonWheelsAmericatoconductapilotprojectdemonstratingtheabilityof<coalitionname>tocreatearegionalcollaborationthataccomplishesthepurposesdescribedherein.SectionII–CoalitionParticipantResponsibilitiesMeetingAttendance.CoalitionMembersagreetoattendinpersonorbyteleconferenceaminimumof70%ofscheduledmeetingseachyearwithnotmorethantwo(2)consecutiveunexcusedabsences.Committees.CoalitionMembersagreetoactivelyparticipateincommitteework,andareexpectedtovolunteertheirservicesforCoalitionprojects.ArticleV–CommitteesSection1.TheactivitiesoftheCoalitionwilltakeplacewithinitscommitteesandallActiveParticipantsareexpectedtoselectthecommitteeorcommitteesonwhichtheywishtoserveduringanygivenyear.Section2.ThestandingcommitteesoftheCoalitionare:

1. ManagementAdvisoryCommittee2. MarketingCommittee3. EducationandCommunicationCommittee4. TechnicalSupport

OtherTaskForcesmaybeformedonanadhocbasisasneeded.Section3.CommitteesarechairedbyActiveParticipants,chosenbytheCoalition.Section4.Thetermofserviceforthecommitteechairsshallbeoneyear.Section5.Nomembershallholdmorethanonecommitteechairmanshipatatime.ArticleVI–MeetingsSection1.AnnualMeetingThereshallbeanAnnualMeetingoftheCoalition,atwhichtimetheCoalitionwillreviewmembership,committeereports,developannualgoals,andconductotherbusinessasappropriate.

29

Section2.RegularMeetingsMeetingsoftheCoalitionshallbeheldatleastquarterly.Meetingsmaytakeplaceinpersonorremotely.ArticleVII–ProceduralPoliciesSection1.ConflictsNoonemayprofitfinanciallyfrommembershipintheCoalitionbysalesorsolicitationatmeetingsorworkshops.ParticipantswilldiscloseanyactualorpotentialconflictsofinteresttotheActiveMembers.Section2.DecisionMakingInthespiritofthe<coalitionname>vision,allCoalitionbusinessshallbeconductedbasedonthephilosophyofmutualrespect.Simplemajorityruleswillapply.CoalitionParticipantsareentitledtoonevotepermember.Section3.VotingVotingonthebusinessoftheCoalitionmaybeconductedbythoseinattendanceatthemeetingeitherinpersonorbyteleconference.Proxyvotingviaemailispermissible.CharterMembers.Signaturesbelowconfirmtheintentofthesigneetoparticipateinthe<coalitionname>inaccordancewiththeconditionsofthischarteragreement.SIGNATURE ORGANIZATION DATE

30

APPENDIXF.DraftAgreementbetweenFiduciaryAgentandCoalitionMembers

AgreementtoActasFiduciaryAgentonBehalfofaPrincipalof<nameofcoalition>

Thisdocumentisanagreementbetween________________________________(“FiduciaryAgent(FA)”)and_____________________________(“Principal”),amemberof<nameofcoalition>.TheFiduciaryAgentwillberesponsibleforthesolicitationandmanagementoffundingawardedtoPrincipalthroughthe<nameofcoalition>.TheFiduciaryAgentisrequiredtoactforthebenefitofthePrincipal,withthedutiesofgoodfaith,trust,confidence,reasonablecareanddiligence,loyalty,disclosure,accounting,andcandor.A. ThisdutyobligatestheFAtoactinthebestinterestofthePrincipal.Specificdutiesinclude:

1. AdministeringtheprojectasdirectedbytheManagementAdvisoryCommitteeof<nameofcoalition>andrespectivefunders,includingorganizationsawardinggrantsorcontractsto<nameofcoalition>.

2. Actingasthepointofcontactonbehalfof<nameofcoalition>forapplication,management,reportingandadministrationofcontractsandgrantsintendedtobenefitmembersofthecoalition.

3. Establishingandmaintainingaccountingsystemsandfinancialrecordstoaccuratelyaccountforinvoicing,reporting,andreimbursementfromorganizationscontractingwith<nameofcoalition>.

4. Monitoringthemanagementandoperationsoftheprojectarereviewedassessinginformationgatheredfromprogramandfinancialreports,routinecommitteemeetings,sitevisits,teleconferences,andothermeans.

5. Ensuringthatprojectobjectivesaremetandfundsarespentandaccountedforproperly.6. AssuringtheFAmanagementsystemsaresufficienttomeetprojectobjectives,complywithaward

termsandconditions,andaccountforfunds.

B. ThedutiesofthePrincipalinclude:1. FollowingthefinancialmanagementrequirementsimposedbytheFA,whomustcomplywiththe

requirementsthatcontractingorganizationsimposeontheFA.2. ProperaccountingandfinancialrecordkeepingandtimelyreportingtotheFAofbothperformanceand

financialdataandanyotherinformationpertinenttothemanagementoftheprojectandreimbursementforservicesrendered.

3. Accountingofreceiptsandexpenditures,cashmanagement,maintenanceofadequatefinancialrecords,andrefundingexpendituresdisallowedbyfundingorganizations.

C. SharedFAandPrincipalResponsibilities:

1. FAandPrincipalwillensurethattherequirements,limitations,andregulationspertinenttocontractsandgrantsareapplied.

2. Attentionshouldbedirectedtothemaintenanceofcurrentfinancialdata.3. ReviewingFinancialOperations

a. FAshouldbefamiliarwithPrincipal’sfinancialoperations,records,systems,andprocedures.b. PrincipalshouldbefamiliarwithFA’sfinancialoperations,records,systems,andprocedures.

31

4. RecordingFinancialActivitiesa. FAinvoicesandreceiptsshouldbesupportedbyreportformsdulyfiledbytheFA.Allfinancial

recordsmustvalidateinvoicesandreceiptsrelatedtotherespectivecontract(s).b. PrincipalexpendituresshouldbeevidencedbyreportformsdulyfiledbythePrincipal.All

financialrecordsmustvalidateexpendituresrelatedtotherespectivecontract(s).5. AuditRequirements-FAmustmeet,andmustensurethatPrincipalhasmet,thenecessaryaudit

requirements.6. ReportingIrregularities-FAandPrincipalshallpromptlynotifythecontractingorganizationofany

illegalactsorirregularitiesandofproposedandactualactions,ifany.Illegalactsandirregularitiesincludeconflictsofinterest,falsificationofrecordsorreports,andmisappropriationoffundsorotherassets.

7. DebarredandSuspendedOrganizations-FAandPrincipalmustnotcontractatanyleveltoanypartythatisdebarredorsuspendedfromparticipationinFederalassistanceprograms.

8. TheFAandPrincipalmusthavesufficientinsurance,bondorothercoveragetoprotecttheFA,thePrincipal,the<nameofcoalition>andcontractingorganizations.

7. MonitoringProjectPerformancea. TheFAandPrincipalhavefullresponsibilityfortheconductoftheprojectoractivitysupported

andfortheresultsachieved.b. TheFAandPrincipalmustmonitortheperformanceoftheprojectandcommunicateregularly

toassureadherencetoperformancegoals,timeschedulesorotherrequirementsasappropriatetotheprojectorthetermsoftheagreement.

8. ContractingOrganizationResponsibilities:a. TheContractingOrganizationroleisthatofapartner,wheretheContractingOrganization

reimbursesthe<nameofcoalition>tocarryouttheprojectactivities.b. Acontractingorganizationshouldlimitinvolvementbetweenitself,theFA,andPrincipalinthe

performanceofaprojecttotheminimumnecessarytoachieveprogramobjectivesandtoensureconformancewithrequirementsofthecontract.

c. TheFAistheprimarypointofcontactwiththeContractingOrganization,representingtheinterestsofPrincipalasindividualsandasacollaborativewhole,the<nameofcoalition>.

d. TheFAisresponsibleforsharingcommunicationsfromtheContractingAgencywiththePrincipal,anddeterminingwiththePrincipalwhatisinthebestinterestofthePrincipalandthe<nameofcoalition>.

ThesignaturesbelowconstituteanagreementbetweentheFiduciaryAgentandthePrincipaltotheenterintotherelationshipdefinedabove.Thisagreementcanbecancelledbyeitherpartywithtwoweeksnoticeinwriting.FiduciaryAgent Organization Date___________________________________________________________________________________________Principal Organization Date

32

APPENDIXG.OrganizationalCapacitySelfAssessment&CollaborativeSolutionsToolUsethisasaself-assessmenttooltodetermineyourorganization’sorganizationalcapacityandtoconsiderhowyouragencymaycontributetoorbenefitfromthecollaborativeeffortsofotherMealsonWheelsorHomeDeliveredMealsproviders.Circleeachelementthatmostcloselydescribesyourorganization.Thisinformationwillguideconversationsamongcollaboratorsonhowtostructurethecollaborationtofillgapsinservicestoclients,andhoworganizationsmightcollaboratetoaddressareasforimprovement.Pleasecompleteandreturntotheconsultantbyemailorpostalmail.

CapacityElements LEVELONE LEVELTWO LEVELTHREE LEVELFOUR

Notehereifyoucanassistorwouldliketohave

assistancefroma

collaboratorto

strengthenyour

agency’scapacitywithanelement.

1 StaffingLevels Somepositionswithinandperipheraltoorganization(e.g.,staff,volunteers,board,seniormanagement)areunfilled,inadequatelyfilled,orexperiencehighturnoverand/orpoorattendance

Criticalpositionswithinandperipheraltoorganizationarestaffed,thoughsomeinappropriately;attendanceproblemsarelimited;highturnoverissometimesachallenge

Criticalpositionswithinandperipheraltoorganizationareadequatelyandappropriatelystaffed;attendanceproblemsarerare;turnoverislimited

Allpositionswithinandperipheraltoorganizationareadequatelyandappropriatelystaffed;attendanceproblemsareextremelyrare;turnoverislimited;vacanciesfilledimmediately

2 Skills,Abilities,&CommitmentofVolunteers

Volunteersnotworkinguptotheirpotentialorill-equippedforworkwithorganization;maybeunreliableorhavelowcommitment

Manyvolunteersworkinguptotheirpotential;mostlyreliable,loyal,andcommittedtoorganization’ssuccess

Capablesetofindividualsthatbringrequiredskillstoorganization;culturallycompetent,reliable,loyal,andgenerallycommittedtoorganization’ssuccessandto

Extremelycapablesetofindividualsthatbringcomplementaryskillstoorganization;culturallycompetent,reliable,loyal,highlycommittedto

33



assistancefroma

collaboratorto

strengthenyour


“makingthingshappen”;workeasilywithmoststaff,butdonotgenerallyplaycoreroleswithoutstaffsupervision

organization’ssuccessandto“makingthingshappen”;oftengobeyondcallofduty;abletoworkeasilywithwiderangeofstaffandplaycoreroleswithoutspecialsupervision

3 Fundraising Generallyweakfundraisingskillsandlackofexpertise(eitherinternallyoraccessibleexternally)

Mainfundraisingneedscoveredbysomecombinationofinternalskillsandexpertise,andaccesstoexternalfundraisingassistance(if/whenneeded)

Fundraisingneedsadequatelycoveredbywell-developedinternalfundraisingskills;occasionalaccesstosomeexternalfundraisingexpertise(if/whenneeded)

Highlydevelopedinternalfundraisingskillsandexpertiseinallfundingsourcetypestocoverallneeds;accesstoexternalfundraisingexpertiseforadditionalextraordinaryneeds

4 BoardInvolvement&ParticipationinFundraising

Mostmembersdonotrecognizefundraisingasoneoftheboard'srolesandresponsibilities;nogoalsorplansforboard-

Membersacceptthattheboardhassomefundraisingresponsibilities,butsomeconcernsexistregardingabilityofboardtobesuccessfulinthisarea;board

Manymembersembracefundraisingasoneoftheboard'scorerolesandresponsibilities,andparticipatewithfundraisingendeavors;

Allmembersembracefundraisingasoneoftheboard'scorerolesandresponsibilities;realisticandappropriateboard

34



assistancefroma

collaboratorto

strengthenyour


drivenfundraisingactivitiesexist;membersdonotgenerallymakefinancialcontributionstoorganization

fundraisingactivitiesarelimited;somemembersmakeapersonallysignificantannualfinancialcontributiontoorganizationbasedontheirindividualmeans

realisticandappropriateboardfundraisinggoalsandplansexist;fundraisingactivitiesareunderway;mostmembersmakeapersonallysignificantannualfinancialcontributiontoorganizationbasedontheirindividualmeans

fundraisinggoalsandplansinplace;boardactivelyfundraisesandhasachievedmeasurableprogresstowardsgoals;allmembersmakeapersonallysignificantannualfinancialcontributiontoorganizationbasedontheirindividualmeans,andsomecontributemorefrequently

5 RevenueGeneration

Nointernalrevenue-generationactivities;conceptssuchascause-relatedmarketing,fee-for-services,andretailingareneitherexplorednorpursued

Someinternalrevenuegenerationactivities,howeverfinancialnetcontributionismarginal;revenuegenerationactivitiesmaydistractfromprogrammaticworkandoftentieupseniormanagementteam

Someproveninternalrevenuegenerationactivities:theseactivitiesprovidesubstantialadditionalfundsforprogramdelivery,butoccasionallydistractfromprogrammaticworkandrequire

Significantinternalrevenuegeneration;experiencedandskilledinareassuchascause-relatedmarketing,fee-for-services,andretailing;revenue-generatingactivitiessupport,butdon’tdistract

35



assistancefroma

collaboratorto

strengthenyour


extensiveseniormanagementattention

from,focusoncreatingsocialimpact

6 CommunicationsStrategy

Nocommunicationsplanorarticulatedcommunicationsstrategyinplace;keymessagesnotdefinedorarticulated;stakeholdersnotidentified;informationmessagesaboutorganizationareinconsistent

Nocommunicationsplanorarticulatedcommunicationsstrategyinplace,butkeymessagesdefinedandstakeholdersidentified;communicationstostakeholdersarefairlyinconsistent

Communicationsplanandstrategyinplace;keymessagesdefinedandstakeholdersidentified;communicationstostakeholdersaregenerallyconsistentandcoordinated

Communicationsplanandstrategyinplaceandupdatedonafrequentbasis;stakeholdersandtheirvaluesidentified,andcommunicationstoeachofthosestakeholderscustomized;communicationsalwayscarryaconsistentandpowerfulmessage

36



assistancefroma

collaboratorto

strengthenyour


7 Communications&Outreach

Nomarketingmaterials,oroutdatedmaterials;strictlyinternally-focusedandlittletonooutreachtostakeholders;anymaterialsthatexistareunprofessionalinpresentation

Loosecollectionofmaterialsusedformarketing;genericdocumentsandnotalwaysupdatedtoreflectcurrentprograms,activities,andoutcomes;materialshaveaminimaldegreeofprofessionalismorconsistentlookandfeel;afewkeymaterialsareprovidedinmultiplelanguagesasneeded

Packetofmarketingmaterialsusedonaconsistentbasis;informationcontainedinthematerialsisuptodateandreflectscurrentprograms,activities,andoutcomes;materialsreasonablyprofessionalinpresentationandalignedwithestablishedstandardsforfont,color,logoplacement,etc.;mostmaterialsareprovidedinmultiplelanguagesasneeded

Packetofmarketingmaterialsusedconsistentlyandeasilyupdatedonaregularbasis;materialsextremelyprofessionalinappearanceandappealtoavarietyofstakeholders;allmaterialsconsistentlyadheretoestablishedstandardsforfont,color,logoplacement,etc.;allmaterialsareprovidedinmultiplelanguagesasneeded

8 Telephone&Fax

Workingstatus,lackofsophistication,orlimitednumberoftelephoneandfaxfacilitiesareanimpedimenttoday-to-day

Adequatebasictelephoneandfaxfacilitiesaccessibletomoststaff;maybemoderatelyreliableoruser-friendly,ormaylackcertainfeaturesthatwouldincrease

Solidbasictelephoneandfaxfacilitiesaccessibletoentirestaff(inofficeandoutinthefield);catertoday-to-daycommunicationneedswith

Sophisticatedandreliabletelephoneandfaxfacilitiesaccessiblebyallstaff(inofficeandoutinthefield),includesaround-the-clock,individual

37



assistancefroma

collaboratorto

strengthenyour


effectivenessandefficiency

effectivenessandefficiency(e.g.,individualvoice-mail),ormaynotbeeasilyaccessibletosomestaff(e.g.,fieldstaff);mostfrequentusersreceivetrainingonphonesystemfeatures

essentiallynoproblems;includesadditionalfeaturescontributingtoincreasedeffectivenessandefficiency(e.g.,individual,remotelyaccessiblevoice-mail);moststaffreceivetrainingonphonesystemfeatures

voice-mail;supplementedbyadditionalfacilities(e.g.,pagers,cellphones)forselectedstaff;effectiveandessentialinincreasingstaffeffectivenessandefficiency;allstaffreceivetrainingonphonesystemfeatures

9 Computers,Applications,Network,&Email

Limited/nouseofcomputersorothertechnologyinday-to-dayactivityand/orlittleornousagebystaffofexistingITinfrastructure

Adequatelyequippedatcentrallevel;incomplete/limitedinfrastructureatlocationsasidefromcentraloffices;equipmentsharingmaybecommon;satisfactoryuseofITinfrastructurebystaff;periodictrainingprovidedtosomestaffmembers

Solidhardwareandsoftwareinfrastructurethatcontributestoincreasedefficiency;noorlimitedsharingofequipmentisnecessary;regularuseofITinfrastructurebystaff,thoughsomeaccessibilitychallengesforfront-lineprogramdeliverersmayexist;periodictraining

State-of-the-art,fullynetworkedcomputinghardwarewithcomprehensiverangeofup-to-datesoftwareapplications;greatlyenhancesefficiency;allstaffhaveindividualcomputeraccessande-mail;highusagelevelofITinfrastructurebystaff;regulartraining

38



assistancefroma

collaboratorto

strengthenyour


providedtoallstaffmembers

providedtoallstaffmembers

10

Website Noindividualwebsite

Basicwebsitecontaininggeneralinformation,butlittleinformationoncurrentdevelopments;sitemaintenanceisaburdenandperformedonlyoccasionally

Comprehensivewebsitecontainingbasicinformationonorganizationaswellasup-to-datelatestdevelopments;mostinformationisorganization-specific;easytomaintainandregularlymaintained

Sophisticated,comprehensive,andinteractivewebsite,regularlymaintainedandkeptuptodateonlatestareaandorganizationdevelopments;praisedforitsuser-friendlinessanddepthofinformation;includeslinkstorelatedorganizationsandusefulresourcesontopicaddressedbyorganization

39



assistancefroma

collaboratorto

strengthenyour


11

Databases/ManagementReportingSystems

Nosystemsfortrackingclients,staffvolunteers,programoutcomesandfinancialinformation

Electronicdatabasesandmanagementreportingsystemsexistinonlyfewareas;systemsperformonlybasicfeatures,areawkwardtouse,orareusedonlyoccasionallybystaff

Electronicdatabaseandmanagementreportingsystemsexistinmostareasfortrackingclients,staff,volunteers,programoutcomes,andfinancialinformation;commonlyusedandhelpincreaseinformationsharingandefficiency

Sophisticated,comprehensiveelectronicdatabaseandmanagementreportingsystemsexistfortrackingclients,staff,volunteers,programoutcomes,andfinancialinformation;widelyusedandessentialinincreasinginformationsharingandefficiency

12

Buildings&OfficeSpace

Inadequatephysicalinfrastructure,resultinginlossofeffectivenessandefficiency(e.g.,unfavorablelocationsforclientsandemployees,nopossibilityofconfidentialdiscussions,insufficientworkspaceforindividuals,no

Physicalinfrastructurecanbemadetoworkwellenoughtosuitorganization’smostimportantandimmediateneeds;anumberofimprovementscouldincreaseeffectivenessandefficiency

Fullyadequatephysicalinfrastructureforthecurrentneedsoftheorganization;infrastructuredoesnotimpedeeffectivenessandefficiency;decorpartiallyreflectsculturaltraditionsofconstituents

Physicalinfrastructurewell-tailoredtoorganization’scurrentandanticipatedfutureneeds;well-designedtoenhanceorganization’seffectivenessandefficiency;favorablelocationsforclientsandemployees;plentifulspace

40



assistancefroma

collaboratorto

strengthenyour


spaceforteamwork)

encouragesteamwork;layoutincreasescriticalinteractionsamongstaff;decorclearlyreflectsandaffirmsculturaltraditionsofconstituents

13

ManagementofLegal&LiabilityMatters

Legalissuesnotanticipated;issuesaddressedindividuallywhentheyarise;propertyinsuranceincludessomeliabilitycoverage

Legalsupportresourcesidentified,readilyavailable,andemployedon"asneeded"basis;majorliabilityexposuresmanagedandinsured(includingpropertyliabilityandworkerscompensation)

Legalsupportregularlyavailableandconsultedinplanning;routinelegalriskmanagementandoccasionalreviewofinsurance

Well-developed,effective,andefficientinternallegalinfrastructureforday-to-daylegalwork;additionalaccesstogeneralandspecializedexternalexpertisetocoverpeaksandextraordinarycases;continuouslegalriskmanagementandregularadjustmentofinsurance

41



assistancefroma

collaboratorto

strengthenyour


Comments:

Note:ThisassessmentisadaptedfromtheMargueriteCaseyFoundationOrganizationalCapacityAssessmentTool,self-assessmentinstrumentthathelpsnonprofitsidentifycapacitystrengthsandchallengesandestablishcapacitybuildinggoals.Retrievedfromhttp://caseygrants.org/resources/org-capacity-assessment/,February24,2016.

42

APPENDIXH.DualEligibleMedicaidEnrollment,byCounty

FinalCount-MedicaidEnrollmentbyCounty-October2013

Total

Enrollment

TotalEnrollment

inChildren'sMedicaid

TotalChildrenUnderAge19

Enrolledin

Medicaid

Aged

Disa

bled

&Blind

TAN

FAd

ults

TAN

FCh

ildren

FosterC

are

Children

Pregnan

tWom

en

New

borns

Children

Age1-5

Med

icallyNeedy

Chambers 3,216 2,326 2,430 170 470 114 354 30 136 215 733 -

Hardin 6,194 3,939 4,189 459 1,219 265 736 43 312 403 1,089 -Jasper 5,855 3,701 3,983 475 1,223 250 769 38 206 341 1,057 -

Jefferson 40,933 26,501 28,720 2,508 8,698 1,651 4,918 280 1,574 2,259 7,778 1Liberty 11,827 8,195 8,562 617 1,959 586 1,662 148 469 689 2,249 1Newton 2,187 1,279 1,384 190 539 104 294 6 73 91 296 2Orange 11,862 7,588 8,130 558 2,515 690 1,785 128 511 692 2,053 -

Polk 7,415 4,524 4,865 600 1,610 412 1,055 90 269 371 1,161 -San

Augustine 1,642 952 1,008 228 356 58 217 17 48 67 244 -San

Jacinto 4,147 2,692 2,832 250 810 250 653 39 145 209 623 -Trinity 2,263 1,342 1,451 210 524 103 272 22 84 88 354 -Tyler 2,838 1,747 1,856 246 607 115 308 66 123 165 461 -

Walker 6,122 4,195 4,468 345 1,098 227 654 118 256 344 1,259 1DataSource:TexasHealthandHumanServicesCommission.MonthlyMedicaidEligiblesFileExtractandTexasMedicaidHistorical(8-Month)EnrollmentFile.TablePreparedby:ResearchandEvaluationDepartment,StrategicDecisionSupport,TexasHealthandHumanServicesCommission.(Retrievedfrom:http://www.hhsE.state.tx.us/research/MedicaidEnrollment/ME/201212.html)

43

APPENDIXI.Medicare-MedicaidRecipients,byCountyCounty-LevelDualStatusCodes,March2015Medicare-MedicaidEnrolleeStateandCountyEnrollmentSnapshots,UpdatedQuarterly(March2015)

CountyofBeneficiary

Qua

lifiedMed

icare

Bene

ficiarie

s(QMB)-only

QMBplusFull

Med

icaidBe

nefits

Specified

Low

-incomeMed

icare

Bene

ficiarie

s(SLM

B)-only

SLMBplusFull

Med

icaidBe

nefits

Qua

lifying

Individu

als(QI)

OtherDua

lFull

Med

icaidBe

nefit

Qua

lifiedDisabled

an

dWorking

Individu

als(QDW

I)

Total

CHAMBERS 89 161 59 14 35 53 0 411

HARDIN 276 470 206 48 115 182 0 1297

JASPER 295 519 204 37 116 120 0 1291

JEFFERSON 1864 4083 1025 252 481 868 0 8573

LIBERTY 618 917 343 38 191 161 0 2268

NEWTON 128 276 69 20 40 60 0 593

ORANGE 545 851 348 73 171 249 0 2237

POLK 417 697 257 52 147 153 0 1723 SANAUGUSTINE 87 210 40 14 31 38 0 420

SANJACINTO 165 298 98 * 50 43 0 654

TRINITY 140 274 122 19 43 53 0 651

TYLER 174 285 92 21 66 77 0 715

WALKER 268 496 190 20 73 88 0 1135

(Retrievedfromhttps://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/Analytics.html,February27,2016.)

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APPENDIXJ.Age,DisabilityandPovertyIndexbyCounty

ChambersCounty HardinCounty JeffersonCounty JasperCountyJEFFERSON

MANAGEDCARESERVICEAREA

Estimate MarginofError




Total: 36,155 +/-171 54,652 +/-251 34,797 +/-182 236,106 +/-1,256

Under18years: 10,089 +/-145 13,842 +/-93 8,815 +/-121 59,029 +/-273

Withadisability: 571 +/-226 770 +/-253 602 +/-223 2,648 +/-443

Incomeinthepast12-monthsbelowpovertylevel

200 +/-185 214 +/-160238 +/-147 952 +/-219

Incomeinthepast12-monthsatorabovepovertylevel

371 +/-189 556 +/-193364 +/-150 1,696 +/-400

Nodisability: 9,518 +/-279 13,072 +/-260 8,213 +/-253 56,381 +/-492


889 +/-401 2,058 +/-4382,063 +/-503 18,231 +/-1,122


8,629 +/-504 11,014 +/-5256,150 +/-560 38,150 +/-1,048

18to64years: 22,461 +/-171 33,166 +/-125 20,089 +/-169 145,535 +/-1,174

Withadisability: 2,838 +/-483 4,786 +/-501 3,695 +/-426 17,820 +/-930


622 +/-193 976 +/-201780 +/-194 5,104 +/-504


2,216 +/-449 3,810 +/-4692,915 +/-398 12,716 +/-783

Nodisability: 19,623 +/-498 28,380 +/-489 16,394 +/-454 127,715 +/-1,520


1,778 +/-317 2,671 +/-3982,518 +/-615 22,062 +/-1,418


17,845 +/-594 25,709 +/-61113,876 +/-675 105,653 +/-1,623

65yearsandover: 3,605 +/-123 7,644 +/-177 5,893 +/-144 31,542 +/-279

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ChambersCounty HardinCounty JeffersonCounty JasperCountyJEFFERSON

MANAGEDCARESERVICEAREA







216 +/-115 328 +/-151493 +/-144 2,223 +/-300


1,423 +/-189 2,851 +/-3132,817 +/-317 12,318 +/-569

Nodisability: 1,966 +/-174 4,465 +/-313 2,583 +/-298 17,001 +/-571


242 +/-133 369 +/-146121 +/-60 1,756 +/-317


1,724 +/-198 4,096 +/-3142,462 +/-301 15,245 +/-531

JEFFERSONMANAGEDCARESERVICEAREA

LibertyCounty NewtonCounty OrangeCounty PolkCounty





Total: 70,612 +/-595 13,956 +/-184 81,682 +/-297 41,370 +/-875

Under18years: 19,096 +/-98 3,192 +/-35 20,128 +/-174 9,168 +/-122

Withadisability: 822 +/-231 228 +/-168 1,355 +/-319 753 +/-219


226 +/-140 36 +/-35 435 +/-197 247 +/-164


596 +/-182 192 +/-163 920 +/-268 506 +/-160

Nodisability: 18,274 +/-263 2,964 +/-178 18,773 +/-365 8,415 +/-263


4,135 +/-651 674 +/-266 3,297 +/-515 2,203 +/-363


14,139 +/-681 2,290 +/-297 15,476 +/-595 6,212 +/-438

46


LibertyCounty NewtonCounty OrangeCounty PolkCounty





18to64years: 42,567 +/-589 8,335 +/-189 49,958 +/-251 23,630 +/-855



2,150 +/-410 319 +/-138 2,439 +/-429 1,540 +/-356


5,175 +/-503 1,110 +/-224 5,607 +/-536 3,754 +/-391

Nodisability: 35,242 +/-702 6,906 +/-307 41,912 +/-708 18,336 +/-858


5,514 +/-821 884 +/-212 4,892 +/-542 2,745 +/-492


29,728 +/-980 6,022 +/-389 37,020 +/-862 15,591 +/-929

65yearsandover: 8,949 +/-193 2,429 +/-55 11,596 +/-167 8,572 +/-175



464 +/-126 98 +/-50 548 +/-147 401 +/-133


4,217 +/-352 1,140 +/-168 4,511 +/-269 3,857 +/-315

Nodisability: 4,268 +/-296 1,191 +/-153 6,537 +/-265 4,314 +/-335


445 +/-136 68 +/-49 443 +/-133 312 +/-96


3,823 +/-297 1,123 +/-152 6,094 +/-305 4,002 +/-334


SanAugustineCounty

SanJacintoCounty

TrinityCounty TylerCounty





Total: 8,554 +/-122 26,659 +/-120 14,330 +/-86 19,040 +/-462

47


SanAugustineCounty

SanJacintoCounty






Under18years: 1,732 +/-74 6,215 +/-36 2,874 +/-122 4,024 +/-148

Withadisability: 89 +/-47 467 +/-177 112 +/-84 400 +/-112


32 +/-41 259 +/-142 71 +/-63 197 +/-114


57 +/-46 208 +/-120 41 +/-45 203 +/-75

Nodisability: 1,643 +/-74 5,748 +/-179 2,762 +/-135 3,624 +/-189


636 +/-283 1,433 +/-355 659 +/-230 765 +/-208


1,007 +/-271 4,315 +/-398 2,103 +/-267 2,859 +/-289

18to64years: 4,847 +/-98 15,588 +/-137 7,848 +/-183 10,818 +/-421



493 +/-205 841 +/-239 409 +/-159 731 +/-211


765 +/-214 1,510 +/-368 1,566 +/-309 1,359 +/-219

Nodisability: 3,589 +/-318 13,237 +/-399 5,873 +/-380 8,728 +/-441


531 +/-201 2,295 +/-489 771 +/-252 862 +/-235


3,058 +/-306 10,942 +/-603 5,102 +/-448 7,866 +/-446

65yearsandover: 1,975 +/-95 4,856 +/-131 3,608 +/-144 4,198 +/-97

Withadisability: 924 +/-164 2,086 +/-223 1,507 +/-194 1,943 +/-241


169 +/-69 328 +/-153 198 +/-89 290 +/-94

48


SanAugustineCounty

SanJacintoCounty







755 +/-172 1,758 +/-267 1,309 +/-196 1,653 +/-221

Nodisability: 1,051 +/-159 2,770 +/-255 2,101 +/-210 2,255 +/-245


170 +/-83 220 +/-96 191 +/-103 172 +/-76


881 +/-168 2,550 +/-250 1,910 +/-203 2,083 +/-244

JEFFERSONMANAGEDCARESERVICEAREAWalkerCounty


Total: 47,998 +/-1,577

Under18years: 10,707 +/-151

Withadisability: 458 +/-200

Incomeinthepast12-monthsbelowpovertylevel 223 +/-134

Incomeinthepast12-monthsatorabovepovertylevel 235 +/-145

Nodisability: 10,249 +/-245

Incomeinthepast12-monthsbelowpovertylevel 3,005 +/-550

Incomeinthepast12-monthsatorabovepovertylevel 7,244 +/-631

18to64years: 30,496 +/-1,559

Withadisability: 2,648 +/-392



Nodisability: 27,848 +/-1,533

49

JEFFERSONMANAGEDCARESERVICEAREAWalkerCounty


Incomeinthepast12-monthsbelowpovertylevel 7,403 +/-719

Incomeinthepast12-monthsatorabovepovertylevel 20,445 +/-1,239

65yearsandover: 6,795 +/-234

Withadisability: 2,001 +/-256



Nodisability: 4,794 +/-279



50

APPENDIXK.Area2014CensusPopulationCharacteristicsforAge60+,byCounty,withComparisontoStateofTexas

ExhibitFollowsonNextPages,K.1-K.25StateofTexas………………………………………………………………………………………………………………………………….K.1HardinCounty………………………………………………………………………………………………………………………….........K.4JasperCounty…………………………………………………………………………………………………………………………..….....K.7JeffersonCounty…………………………………………………………………………………………………………………………....K.10LibertyCounty………………………………………………………………………………………………………………………………...K.13OrangeCounty………………………………………………………………………………………………………………………………..K.16PolkCounty…………………………………………………………………………………………………………………………………….K.19SanJacintoCounty…………………………………………………………………………………………………………………….…...K.22WalkerCounty………………………………………………………………………………………………………………………………..K.25

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APPENDIXL.SelectedEconomicCharacteristics_14_5YR_DPO3.xlsNote:Duetolimitedpopulationsize,identicalCensusBureaudatafor2014CensusPopulationCharacteristicsAge60+isnotavailableforthefollowingcounties:Chambers,Newton,SanAugustine,Trinity,andTyler.Similar,butnotidentical,dataforthosecountiesareavailableintheseries.Forconsistency,all12countiesplusthestateofTexasareincludedinthefollowingseries.

ExhibitFollowsonNextPages,L.1-L.14StateofTexas…………………………………………………………………………………………………………………………….L.1ChambersCounty……………………………………………………………………………………………………………………….L.2HardinCounty………………………………………………………………………………………………………………..…………..L.3JasperCounty……………………………………………………………………………………….........................................L.4JeffersonCounty……………………………………………………………………………………………………………….………..L.5LibertyCounty………………………………………………………………………………………………………………….…………L.6NewtonCounty……………………………………………………………………………………………………………………..……L.7OrangeCounty……………………………………………………………………………………………………………………….…..L.8PolkCounty………………………………………………………………………………………………………………………………...L.9SanAugustine…………………………………………………………………………………………………………………………...L.10SanJacintoCounty………………………………………………………………………………………………………………….…L.11Trinity……………………………………………………………………………………………………………………………………..…L.12Tyler…………………………………………………………………………………………………………………………………..……..L.13WalkerCounty…………………………………………………………………………………………………………………………..L.14…

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