Montgomery County Office of

Aging and Adult Services Public Hearing 2013 – 2014

CENTRAL OFFICE Human Services Center 1430 DeKalb Pike, Box 311 Norristown, PA 19404-0311 (610) 278-3601

Eastern Courthouse Annex Suite 303, 102 York Rd. Willow Grove, PA 19090-3283 (215) 784-5413

North Penn District Office 421 West Main St. Lansdale, PA 19446 (215) 361-7931

Pottstown District Office 260 High St. Pottstown, PA 19464 (610) 327-9203

MCAAS toll-free Protective Services Hotline : 1-800-734-2020 (24/7 reports on elder abuse, neglect, exploitation, or abandonment)

www.montcopa.org/mcaas

MCAAS Advisory Council

Council Chair Alma Jacobs Council Vice Chair Dene Liott

Thomas Biggar, Jr. Catherine Clark Lenore Forsted Hon. Kate Harper Miriam James

Rev. Martha Kreibel Dorothy McCabe Guy G. McGee Barbara Shotz Joanne Tierney Bernard Tompkin

MCAAS Value Statement: MCAAS reaches out into the community to improve lives and to promote independence for adults and families. We do this through a system of services and programs along a continuum of diverse needs, as our dedicated staff serve individuals and families across Montgomery County, respecting the dignity of all.

MCAAS Mission Statement:

Improving Lives, Mobilizing Supports

MCAAS Public Hearing 2013 -2014

Table of Contents

I. A Look at the Montgomery County Office of Aging and Adult Services

II. Yearly Review

III. MCAAS Plan Update

IV. Current Issues and Trends

MCAAS Administrative Staff

Executive Director Joanne Kline Clinical Deputy Linda Forest

Administrative Deputy Laura DeHope Fiscal Administrator Richard Swoger Office Manager Christine Hunsberger

The MCAAS Organizational Structure:

AGENCY STRUCTURE

The Montgomery County Office of Aging and Adult Services (MCAAS) is a public agency, operating as part of the Montgomery County government system for Human Services. The 100 MCAAS staff positions are currently part of the PA Civil Service system, yet are also employees of Montgomery County government, with the exception of the Executive Director, who has been appointed by the County Commissioners, in accordance with Department of Aging protocol.

An18-member Advisory Council assists in the oversight of MCAAS and its delivery of services and programs, as outlined by Pennsylvania statute. Advisory Council members are appointed by the Montgomery County Commissioners, and meet monthly with the MCAAS Executive Director to discuss issues related to the operation of the agency and the aging network, serving also as an independent advocacy group related to aging issues.

The Montgomery County Office of Aging and Adult Services is one of several county departments that comprise a Human Services Cabinet within county government. Other departments include: Behavioral Health/Developmental Disabilities/Drug & Alcohol, Health Department, Office of Children and Youth, Housing Services, Veteran's Affairs, and Child Care Information Services.

MCAAS Executive Director

MCAAS Advisory Council

Deputy Director for Clinical Services

Fiscal Administrator

MCAAS Executive Director

MCAAS Advisory Council

Montgomery County Human Services Cabinet

Montgomery County Commissioners

Deputy Director for Administrative Services

Office Manager

Data Unit, Monitoring and Contract Unit, ITST Support

All Clinical Programs, Clinical Supervisors, and Clinical Staff within 4 District Office Locations: Central (Norristown) Pottstown, Willow Grove, Lansdale

Fiscal Department Staff Office Support Staff

Improving Lives, Mobilizing Supports

For low-income indiv iduals , famil i es , the e lder ly and disabled within Montgomery County

I. A Look at the Montgomery County Office of Aging and Adult Services

The Montgomery County Office of Aging and Adult Services (MCAAS) serves as the designated area agency on aging for Montgomery County, mandated to develop and provide a comprehensive and coordinated system of services for older persons. As one of 52 area agencies on aging within Pennsylvania, MCAAS works with dozens of providers to serve over 40,000 older Montgomery County residents each year through a variety of services and programs which assist individuals and families in preventing premature institutionalization and to support the elderly and the disabled in living as independently as possible within the community. Responding to the increased needs of our aging and disabled county residents is an ongoing concern, as Montgomery County’s aging population has grown to make this county one of the “oldest” in the state and continuing to have the highest median age for this Southeast region of Pennsylvania. Whether provided directly by trained MCAAS staff, or through one of over 100 agency contracts, MCAAS offers in-home services, senior center services, comprehensive long term care assessment, care management, Information and Assistance, caregiver support programs, protective services, adult daily living centers, and other important services and programs to assist aging county residents as part of a continuum of care. Additionally, MCAAS is an integral part of a system of services assisting low-income adults and families, as well as many physically disabled adults, to achieve self-sufficiency. The adult services provided through the MCAAS system address individual and family needs for housing assistance, shelter services, case management, in-home services, nutrition, or other supportive programs for about 2,000 low-income county residents each year. In order to facilitate a timely response to low-income adults, families, and the elderly seeking assistance through the Montgomery County Office of Aging and Adult Services, over 100 agency staff persons have been located within local offices in four areas of Montgomery County since the 1980's. Community offices in Willow Grove, Norristown, Pottstown, and Lansdale provide direct access to any of the MCAAS services and programs, and together with a strong network of providers, our aging network provides a trained response to over 50,000 Information and Assistance contacts received each year from consumers and their families, assisting them with all long term care needs.

MCAAS Program Descriptions The Montgomery County Office of Aging and Adult Services (MCAAS) provides a wide array of programs and services to assist older adults, their families and caregivers, as well as low-income adults and the physically challenged along a continuum of care. The following program descriptions highlight many of the important program areas sponsored through MCAAS funding:

Adult Daily Living Centers : A supervised setting for disabled individuals during the day is provided as an assistance to families. Meals, activities, and transportation are provided to consumers attending their choice of over two dozen sites contracted to provide this important service through MCAAS. All Adult Daily Living Centers are also licensed through the Dept. of Aging. Care Management: Casework support to plan and monitor consumer services to meet individual and family needs, as mandated. Care plans are developed, and services ordered, to maintain consumer and family goals for quality care within a community setting. Family Caregiver Support Program: Community caregivers are assisted through a reimbursement program for supplies and services, as outlined in the federal and state Family Caregiver Acts, and operate on a sliding scale eligibility basis. Grandparents caring for their grandchildren may also be eligible under the National Family Caregiver Support Program for some monthly assistance. Home Care Services: Assistance with personal care, home delivered meals, and home support, is provided through MCAAS. Care managers assist with the development of a consumer care plan, and monitoring of the home care provided to meet individual needs. Housing and Homeless Programs:

Emergency Shelter Services: Provides emergency shelter to temporarily assist homeless individuals and families throughout Montgomery County. Rental Assistance: Assists low-income individuals and families, who qualify, with rental and mortgage assistance payments to prevent evictions; Includes funding available through HAP (state funding) Transitional Housing: Provides casework and financial assistance to individuals and families to meet their long-term goals through self-sufficiency programs, such as Bridge Housing.

Information and Assistance (I&A): MCAAS casework staff respond to over 25,000 requests for assistance and information annually, and assist in accessing community programs and resources for families and individuals seeking our help through four regional locations throughout Montgomery County, by phone, or over the web. Legal Services: Contracted legal assistance and referrals for low-income elderly available through senior centers, Legal Aid, and in conjunction with the Montgomery County Bar Association. Additionally, a collaborative pilot project is available to assist with elder mediation referrals for difficult consumer and family issues. Long Term Care Assessment: Trained assessors provide a determination for an appropriate level of care for consumers (for Community Services, Nursing Home Care, Personal Care Boarding Home Care, etc.), as required by the Departments of Aging and Welfare. These geriatric assessments assist families in making appropriate placements and ordering appropriate services to meet the needs of older and disabled individuals.

Nursing Home Transition: This program is designed to provide outreach, counseling and assistance toward community placement services for nursing home residents who may be able to transition back into the community. Ombudsman Services: The investigation of complaints and conflicts within over 150 licensed long term care facilities in Montgomery County, including nursing homes, personal care homes, and domiciliary care, are handled through the Ombudsman Program, as mandated in Department of Aging Regulations. In addition to the staff ombudsman, a dozen trained ombudsman volunteers assist in this important work. OPTIONS Services: This important program, supported through Lottery funding, provides care management oversight, planning, and assistance to those consumers and their families requiring in-home services, such as home delivered meals, personal care, and home support. This program is available to consumers on a cost-sharing basis, with consumers contributing toward the cost of their care, according to income guidelines. Protective Services: Intervention and assistance is provided in cases of abuse, neglect, exploitation and abandonment for those at risk over age 60, as outlined in the Protective Services Act. This critical program is available 24 hours a day, 7 days a week, and reports can be made by contacting the toll-free, elder abuse hotline, at 1-800-734-2020. Over 100 reports were taken monthly during the past year. Senior Community Center Services: Preventive programs to promote involvement, support positive health and wellness goals, and enhance independence for older adults, including good nutrition, activities and daily programs, are provided through 8 county-funded senior community center programs throughout Montgomery County, as well as 3 part-time centers. Transportation Services: Older consumers and low-income individuals who meet the basic eligibility guidelines may be eligible for assistance with transportation. Transportation is available through a shared-ride program to go to senior centers, adult daily living centers, medical appointments, shopping, and for other important needs. Volunteer Services: Volunteer placements for older adults exist throughout the County to assist with insurance counseling (APPRISE), ombudsman activities, in-home support, and a variety of community programs to assist the older adult volunteer as well as the community they seek to serve. Aging Waiver Program: This important program is funded through the Office of Long Term Living (DPW) with Medicaid funding to allow elderly individuals, who are financially and medically eligible, to remain at home within the community through a variety of extensive in-home services, instead of paying a nursing home to provide comparable care within an institutional setting.

Contact MCAAS to receive further information on any of the programs described above.

CENTRAL OFFICE Human Services Center 1430 DeKalb Pike, Box 311 Norristown, PA 19404-0311 (610) 278-3601

Eastern Courthouse Annex Suite 303, 102 York Rd. Willow Grove, PA 19090-3283 (215) 784-5413

North Penn District Office 421 West Main St. Lansdale, PA 19446 (215) 361-7931

Pottstown District Office 260 High St. Pottstown, PA 19464 (610) 327-9203

www.montcopa.org/mcaas

MCAAS reaches out into the community to improve lives and promote independence for adults and families. We do this through a responsive system of care designed to meet an individual’s changing needs, respecting the dignity of all.

State/Federal Grants administered through AAS AAS has administrative responsibility for the following grants which provide a variety of services to meet the needs of County residents who are either older adults (including family members) or low-income adults. In some cases, these grants are pass-through funding, with planning provided through the Montgomery County Human Services Cabinet.

GRANT NAME FUNDING SOURCE – STATE LEVEL

Aging Block Grant (ABG)

Aging (PDA)*

Homeless Assistance Programs (HAP)

Public Welfare (DPW)*

Human Services Development Fund (HSDF)

Public Welfare (DPW)

Medical Assistance Transportation Program (MATP)

Public Welfare (DPW)

Title XIX - Aging Waiver and Long Term Care Assessment, Nursing Home Transition

Office of Long Term Living- Public Welfare (DPW)

State Food Purchase Program (SFPP) Agriculture

Temporary Emergency Food Assistance Program (TEFAP)

Agriculture

* PDA – Pennsylvania Department of Aging * DPW – (PA) Department of Public Welfare

FY 2012 and FY2013 MCAAS Budgets

Revenues: FY  2012 FY2013Grants  and  other  governmental  support 18,262,100                 15,970,779                Program  generated  revenue 300,000                             330,000                            Fee  for  Service  revenues 1,430,000                    

Total  revenues 18,562,100         17,730,779        

ExpensesHome  Delivered  Meals 1,704,421                     1,676,660                    Congragate  Meals 570,242                             554,555                            Senior  Centers 900,398                             859,600                            Assessments 1,428,098                     1,321,335                    Care  Management 2,766,109                     1,681,551                    Information  and  Referral 972,836                             997,743                            Protective  Services 455,539                             536,002                            Personal  Care  and  other  community  based  services 1,709,887                     1,785,269                    Ombudsman 313,029                             344,757                            Transportation   313,477                             305,955                            Adult  Day  Care 326,248                             325,287                            Other  Consumer  Services 557,749                             481,479                            Caregiver  Reimbursements 347,415                             378,003                            HSDF  and  HAP  services  (Human  Services  Block  Grant) 1,019,847                     938,263                            Pass  Thru  Programs

State  Farmers  Nutrition  Program 3,354                                     3,354                                    MATP 3,335,654                     3,335,654                    TEFAP 40,000                                 40,000                                

Medicaid  Waiver  Service  Coordination 460,607                             921,215                            Total  Program  Related  Expenses 17,224,910                 16,486,682                Agency  Administration 1,337,190                     1,244,097                    

Total  Agency  Expenses 18,562,100         17,730,779        

MCAAS Service Delivered

Current Waiting List = 178

 TYPE OF SERVICE

 

 UPS

Unduplicated Persons Served    Adult Day Service

  187 individuals

 Care Management

  2,451 individuals

Environmental Modifications

200 individuals

Family Caregivers Support

104 individuals

Home Delivered Meals

302,484 meals served 1,332 individuals served

Information and Referral

54,300 (duplicated-system wide contacts)

Personal Care

1026 individuals

Protective Service

440 Investigations 1083 Reports of Need (RON) 16 Court Petitions

Senior Center Attendance

9156 individuals served (327,969 visits)

Legal Services

1208 (Individual and group settings)

LTC Assessments

3397 (+ 833 Reassessments)

Nursing Home Transition

44 (cases transitioned from NH)

Transportation

539 individuals (Senior Centers/ Adult Day)

Transportation – Shared Ride / MATP

155,631 Shared Ride Trips 118,896 Medical Asst. Trips

Volunteer Hours (RSVP, Other Aging)

159,303 hours Provided by 1,337 volunteers

Volunteer Hours (Senior Centers)

75,088 Hours Provided by 1306 volunteers

Current Issues and Trends for FY 2013/2014

Although these remain uncertain financial times, a positive trend may be found in some new systems of care which are shaping new opportunities for a transition into newer and hopefully more effective ways to address growing and complex needs during these times of shrinking resources. The following points outline a few of the difficult issues, as well as trends to watch as we move through this new fiscal year: State Trends to Watch During This Fiscal Year • Human Services Block Grant Development Although Montgomery County was not one of the original counties opting to accept a change to a Human Services Block Grant for certain state funding streams, the Human Services Cabinet in Montgomery County proceeded with planning to collaborate and share funding among various human service departments in order to provide a new “Community Connections” model for serving the county residents. Continued meetings with the members of the Human Services Cabinet are working to establish a strong interconnected system of support for human service priorities in Montgomery County, and examining the funding priorities among all County human service departments and not just those affected by the state’s Human Services Block Grant. Montgomery County is working with the state closely in planning as we move toward sharing funding and a stronger collaboration, perhaps as a HS Block Grant county in the future. • Department of Aging / Office of Long Term Living A formal restructuring is still underway, separating the programs and functions under the responsibility of the Department of Aging and the Office of Long Term Living (DPW). The Aging Waiver and the long term care assessment programs (among other Medicaid-funded programs) are now part of the Title XIX funding received through OLTL and no longer under the direction of the PA Department of Aging. • Aging Waiver Changes Last year, substantial changes to the Aging Waiver Program significantly affected care management and service delivery to Aging Waiver consumers, changing the existing care management role to a service coordination function, and not covering certain important functions within this vital program: RN nursing visits, supervision, transportation, and interpretation for non-English speaking consumers. The effect during FY2012/2013 was the change to a reimbursement billing system for service coordination, lower provider rates, less home visits to consumers, a reduction of 12 positions at MCAAS, reduction in nursing staff to visit Waiver consumers, and the changes will continue into the new fiscal year as well. While we have changed our service delivery model to fit DPW’s new regulations, we have seen a shifting in Waiver resources and quality service delivery as a result and so discussions at the state level with P4A (state association) will continue to work toward improving this important program for older persons choosing to age at home. • Growth of Waiting Lists Due to essentially flat funding over the past several years, waiting lists for OPTIONS are continuing to grow throughout the state. In Montgomery County about 200 persons are waiting for basic in-home care, while across the state the waiting lists total close to 7,000. This could potentially be eased somewhat by passing the current budget plan which has funding available to area agencies on aging for the first new money to address waiting lists in several years. Local Collaborative Trends to Note • Community Connections Community Connections is an initiative developed to change the way in which Montgomery County serves county residents, building a stronger partnership between government and community organizations, and focusing on the use of “Navicates” (Navigator/Advocates) to assist in guiding families and individuals toward

the right type of care and support needed. Montgomery County’s Human Service Cabinet is committed to building collaborative partnerships that will offer many opportunities for all local organizations and residents to be engaged in the process, while also streamlining the response for those in need. This initiative gets off the ground in June 2013 in four areas of the county and plans to expand into the future. • Innovations Home Care (IHC) A discretionary grant was received in 2011from the Dept. of Aging to allow the development of a nonprofit operation to support four area agencies on aging in the greater Philadelphia region: Bucks, Chester, Delaware, and Montgomery counties. While still awaiting nonprofit status, Innovations has an expanded Board developed and is operating in conjunction with a provider network to market a private pay “concierge” service to assist individuals requesting long term planning, home care, and home maintenance activities. A similar model in a single, smaller nonprofit county is already operational and doing well, and it is hoped that this larger model of county-based AAA’s will do the same by funneling “profits’ back to the area agencies on aging (AAA) to assist older adults on the AAA waiting lists by 2015. • Housing Resource Centers – “Your Way Home Montgomery County” MCAAS has been a partner with this new initiative to redesign the continuum of housing resources, to address the changing needs of the homeless and near-homeless, and to build a more coordinated system of housing assistance to those in need of safe, stable, and affordable housing in to the future. Soon, housing resource centers will be established and connecting with local resources to serve as an improved response to the growing numbers of families and individuals with housing needs. • Human Service Cabinet The Montgomery County Human Services Cabinet brings together the county human service departments to enhance the health, security and financial stability of all residents in Montgomery County, Pennsylvania by providing community-based access to consumer-driven, coordinated and exceptional quality human services. To achieve that mission, the HS Cabinet meets weekly to collaborate on projects such as Community Connections, Your Way Home Montgomery County, the Human Services Block Grant, information sharing, and other projects to support the needs of County residents.

• Aging and Disability Resource Centers (ADRC) Continuing in this region and across Pennsylvania, is dedicated funding to flow through area agencies on aging to support a better coordinated system of response for aging and (physical) disability resources and services for consumers. ADRC development is now established in each county within Southeastern Pennsylvania, and hoping to form a regional presence here soon. • Nutrition Services and Programs MCAAS is working collaboratively toward a public/private partnership to examine the most effective possibilities related to the food security system in Montgomery County, in order to adapt to changing needs and trends for the years ahead. • Care Transitions Project Montgomery County will be exploring Care Transitions work, similar to the projects initiated between hospitals and area agencies on aging to lower the re-admission rates for older and disabled patients. Already this effort is growing, with several models to be explored with local hospitals and community agencies to support older and disabled adults needing follow up to ensure positive aging in the community.

UPDATING THE FOUR YEAR PLAN (2012 – 2016)

The following goals from the most recent four year plan are helping to shape a future course for the Montgomery County Office of Aging and Adult Services (MCAAS). There are unique strategies outlined within the complete Four Year Plan 2012-2016 to achieve the goals defined, leading to outcomes which will be measured in an ongoing way over the years ahead. As MCAAS completes the first year of operation under this current plan, the following areas of progress have been noted:

GOAL #1 MCAAS will work collaboratively to enhance the existing system of coordinated and comprehensive services and programs to support stronger communities for older and disabled adults who choose to age at home in a community setting.

a) MCAAS partnered with Temple University’s Planning Department to support a study of the county needs in creating a more “Aging Friendly Montgomery County”.

b) MCAAS continues to work with the United Way on the Communities That Care project and other projects which build strong community-based supports and foster aging-friendly community models.

c) MCAAS continues to support existing collaborations with municipalities, foundations, county government, and other groups to engage in planning for the aging needs of Montgomery County residents.

d) MCAAS continues to participate as a member of the Human Services Cabinet to ensure that aging issues are woven into the larger human services fabric of Montgomery County.

e) MCAAS has requested funding for a feasibility study to consider the possibility of a county-based LIFE (Living Independence for the Elderly) model of care within the county.

f) MCAAS continues to collaborate to address unmet housing needs for older and disabled adults, especially in the areas of affordable and accessible housing options, nursing home transition needs, and rehab programs available to maintain existing housing while aging in place.

g) MCAAS is also continuing to work collaboratively in the public/private partnership of “Your Way Home” to improve to continuum of housing options available for all ages.

GOAL #2 MCAAS will provide enhanced access to information, benefits, and programs for older and disabled adults seeking to make informed choices regarding their options along the long term care continuum.

a) MCAAS has worked with the Human Services Cabinet and the County Commissioners in developing “Community Connections” to connect individuals and families with benefits and services to meet their needs, and co-locating with new “Navicate” positions to navigate and advocate for county residents in need.

b) MCAAS continues to support and expand efforts made through APPRISE and other volunteer efforts to assist older adults in making choices related to benefits and insurance coverage. Likewise, support of the VNA Personal Navigator Program has continued to grow and is utilized as a resource to connect older and disabled residents with benefits and services.

c) MCAAS works closely with other regional area agencies on aging and their advisory councils to strengthen advocacy efforts and improve communication to the public and to policymakers, thus improving the continuum of services available to support older persons.

d) MCAAS has worked toward the development of a plan to cross-train County Human Services staff in an ongoing way.

Goal #3 MCAAS will support health and wellness programs for older and disabled adults to enhance each person’s mental and physical wellbeing within their communities.

a) MCAAS is working with Montgomery County Office of Behavioral Health to focus outreach and case management services targeting isolated, elderly individuals with behavioral health issues, and drug and alcohol concerns.

b) MCAAS has begun discussions with hospitals and long term care facilities to promote supportive care transitions, reduce hospital readmissions, and strengthen health promotion efforts for those aging residents of the county.

c) MCAAS is partnering with foundation support to examine the nutritional needs of individuals and families and to consider how a future system may prove more responsive to the growing needs that exist.

d) MCAAS has partnered with the Drug and Alcohol Department for educational outreach programs regarding gambling and other addiction issues.

e) MCAAS is supporting the Aging and Disability Resource Centers, on a county-wide and regional basis, in order to enhance collaboration and improve service delivery.

f) MCAAS has expanded senior community center and nutrition services in Eastern Montgomery County to better respond to the gaps that have existed in that heavily populated region of the county, and are working with local centers elsewhere through technical assistance to support their growth and development as community centers.

Goal #4 MCAAS will support efforts to enhance the quality of life for older residents who are most at risk.

a) MCAAS now partners with Orphan’s Court, the DA’s Office, the Domestic Violence network, law enforcement, community and advocacy groups to support a coordinated response to vulnerable elderly in need through the newly created Elder Justice Roundtable.

b) MCAAS continues to support an expansion of volunteer efforts related to the Ombudsman Program to protect those with care concerns in the county.

c) MCAAS has dedicated staff time to expand efforts to better communicate, educate, and coordinate in meeting the safety and emergency preparedness needs of older, isolated adults who may be at risk.

d) MCAAS is collaborating with other advocates and collaborative projects to address growing food insecurity issues among the elderly, and to ensure better nutritional outcomes for those at risk.

GOAL #5 MCAAS will continue to support an individual’s right to choose home and community-based options, despite shrinking public resources available in this current economic environment.

a) MCAAS is partnering with Bucks, Chester, and Delaware County area agencies on aging, on a new private-pay, home care business model called “Innovations Home Care”, supporting residents as they age within the four suburban counties. This model will assist the counties in meeting growing local service demands while also addressing the growing waiting lists across the region as Innovations seeks to funnel funds back to area agencies on aging to address their growing needs and waiting list by the year 2015.

b) MCAAS Advisory Council and the regional AAA’s continue to promote advocacy and outreach efforts in support of home and community based services for older and disabled adults.

FINAL THOUGHTS HEADING INTO FY 2013/2014 MCAAS will continue to expand collaborative efforts within our southeast regional aging network, and in the local collaborative networks within Montgomery County, to build a more effective advocacy presence as it may relate to legislative and budgetary issues of concern to the aging network. Recent years have challenged the aging network and weakened its infrastructure, but not its resolve. Together, MCAAS will work with its partners to build a stronger economic road for the aging network moving forward, through advocacy and innovative planning, in order to sustain priority programs and services along a continuum of aging needs. Already partnerships exist between MCAAS and other County human service departments, the United Ways, local community health foundations, and other foundation and grant avenues, and yet these avenues will need to be strengthened to create a stronger combined impact on the communities we all serve and support. Expanded partnerships with businesses, nonprofits, local municipalities, diverse cultures and community groups to continue to build our service system in a more responsive way to meet ever changing demands and challenges will be vital to future planning. Likewise, building new and creative collaborative funding opportunities will assist MCAAS and its providers to respond beyond the surveyed needs and work toward preparing to meet the growing needs as our county ages in the years ahead. As we near our 40th anniversary of service to the older residents of Montgomery County, MCAAS is proud to have built a system of quality community partnership with so many along the way, yet it will take an even more dedicated effort to meet the future challenges from an increasingly complex population to be served, and a renewed spirit of advocacy and community will require the involvement from each of us in order to achieve a truly Aging Friendly Montgomery County for the future.