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North Carolina Division of Aging and Adult Services

Governor's Advisory Council on Aging

Recommendations for 2012

General principles—The Council:

  1. understands and supports the Governor’s efforts to assure government effectiveness and efficiency—demonstrated in her “setting government straight” reorganization and regulatory reform activities;
  2. recognizes and appreciates the Governor’s leadership in elevating the importance of preparing for our aging population—evidenced through her Living Wise and Aging Well initiative;
  3. recognizes the seriousness of the state budget situation and the difficult decisions facing the Governor, the General Assembly, and other state leaders;
  4. is concerned about how significant budget reductions can adversely affect vulnerable seniors, younger adults with disabilities, and their families and undermine the advances North Carolina has made in providing cost-effective home and community care options;
  5. appreciates the importance of meeting the needs of our most vulnerable citizens through a combination of targeting those with the greatest needs; raising awareness about valued services; encouraging contributions and cost sharing for the services; strengthening partnerships, including those with the faith and business communities; better integrating health and social services; and encouraging and supporting families in their caregiving; and
  6. hopes that all involved in developing the State budget will consider a balanced approach pertaining to budget reductions and revenue maintenance and enhancements to protect essential services and supports for an aging population.

Recommendations involving funding:

In offering these recommendations affecting State funding, the Council remains respectful of the State budget constraints while also seeing the importance of maintaining sufficient capacity to meet the vital service needs of our aging population. Although there are far more services and initiatives that the Council values, our short list of funding recommendations is meant to emphasize their priority. These recommendations are of equal significance.

  1. The Council shares the Governor’s interest in continuing support for Medicaid optional services. The Council is impressed with how services such as in-home care, P.A.C.E., CAP, and therapies have helped frail elderly continue to live in their homes and communities. The Council is concerned that reducing the availability of these services will not only limit options for living and care arrangements but may well result in cost-shifting to more expensive services as individuals and family caregivers lose critical supports. The Council is also concerned about the health and well-being of at-risk individuals who could lose their dental, eye, mental health and hospice care, as well as other optional but vital services.
  2. The Council also supports the Home and Community Care Block Grant, Project C.A.R.E., and Adult Protective Services as core aging and adult services that are essential to vulnerable seniors and younger adults with disabilities—many of whom have low incomes but are not eligible for Medicaid. Some background information and specific recommendations are offered for each of the three services below: :

    1. Protect current State and Federal funding for the Home and Community Care Block Grant (HCCBG). The HCCBG provides essential support to all counties to enable them to provide home-delivered and congregate meals, in-home aide services, transportation, adult day services, and other core assistance to seniors. Current State funding for HCCBG is about $31.6 million, which represents nearly 51% of HCCBG funding, including local match. Most of the balance comes from the federal Older Americans Act, which could be subject to a reduction. Many HCCBG providers are already reporting decreased funding from other sources such as United Way, county and municipal support, private and corporate donations, and consumer contributions. The current waiting list for HCCBG services totals about 18,800 (largely home-delivered meals and in-home aide). These services are critical to helping seniors remain in their homes and communities at a lower cost to their families and the State. Failure to sustain, if not increase, the HCCBG could have a serious adverse domino-effect on the well-being of frail elderly and the public cost of caring for them.
    2. Restore $500,000 in State funding for Project C.A.R.E. (Caregiver Alternatives to Running on Empty). The Council continues its support of Project C.A.R.E. as a key investment in North Carolina’s families who are caring for persons with Alzheimer’s disease and other dementia-related illnesses. While the Governor’s Recommended Budget for State Fiscal Years 2011-2013 proposed maintaining the $500,000 for Project C.A.R.E. and making it recurring, the General Assembly ended this State support June 30, 2011. This resulted in a reduced amount of respite care available for each caregiver (from $2,500 to $1,800) and halted expansion into additional counties (currently in 40). Project C.A.R.E. is now almost entirely dependent on federal grants that are set to expire September 2013. While continuing to pursue other sources of support, there is a sense of urgency for State funding of this cost-effective service that reduces caregiver stress, depression, chronic health issues, and the need for institutional care by keeping persons with Alzheimer’s disease at home longer. With over 170,000 older North Carolinians currently suffering from Alzheimer’s or other dementia—projected to grow to 288,000 by 2030—dementia care is a looming crisis and the State benefits greatly when families can continue their caregiving at home. Adequate, recurring support for Project C.A.R.E. is needed so that Alzheimer’s families in all NC counties can count on it.
    3. Reestablish and restore full funding ($2 million) to the State Adult Protective Services (APS) Fund to Meet Growing Service Need, to Pilot Important Reforms, and to Increase Awareness about This Vital Service. As the need for APS grows with increasing numbers of older and disabled adults at risk of abuse, neglect, and exploitation, county departments of social services continue to struggle with staffing to meet the need. The number of APS reports to county DSSs has increased steadily, moving from about 14,200 in 2006-07 to more than 19,600 in 2010-11. State Law (Article 6, Chapter 108A) requires all persons to report suspected cases of abuse, neglect and exploitation to their county DSS, which is required to respond within certain time-frames to determine the need for protective services. With the loss of $2 million in State funding for this critical service in the last legislative session and the absence of targeted federal support, the pressure to respond has placed untold burdens on county funding. While about 60% of the funds for the State APS Fund were replaced with support from the Social Services Block Grant (SSBG), the loss of this special fund for APS has had symbolic consequences as well. First established in 1999, the State APS Fund had strengthened awareness among state and local policymakers about the importance of this service for assisting frail elderly and younger adults with disabilities. Adult abuse, neglect and exploitation are very serious issues. According to national research: (a) nearly 11% of people ages 60 and older report suffering from some form of abuse each year; (b) elder victims have three times the risk of dying prematurely; and (c) billions in dollars are lost each year to financial abuse and exploitation. An original leader among states in its APS law and practices, North Carolina’s approach to protecting seniors and adults with disabilities requires substantial reform. A State APS Task Force offered recommendations that were endorsed by the former Aging Study Commission on Aging. Funding for piloting and then implementing these reforms was never provided. Seeing the increasing importance of this service, the Council recommends reestablishing and funding the State APS Fund to support county DSSs in their efforts to meet the current demand and to pilot some of the reforms that can help prepare North Carolina for the likely future service demand that will come with our aging population.

Recommendations not requiring funds:

Given these difficult budgetary times, the Council continued its consideration of items that should not require additional resources to address and could, in some areas, increase available resources to meet the needs of seniors and organizations serving them. The Council also wants to affirm what it sees as important to preparing for the future.

  1. The Council supports maintaining the mission of the Home and Community Care Block Grant in terms of supporting local planning and providing counties with discretion and authority in determining services, service levels, and providers tied to eligible services. For 18 years, counties, with citizen input and the support of area agencies on aging, have made good decisions in effectively using the HCCBG funds to support frail elderly at home and helping other seniors remain as healthy and active as possible.
  2. The Council continues to value its participation as a member of the Aging Assessment Team as identified in Executive Order No. 54. We support ongoing efforts to strengthen the Corps of Aging Liaisons across state government to promote ongoing interagency planning, communications, and collaboration. The Council also supports efforts to assist local communities in assessing their readiness for the aging population. The experience of Henderson and Orange counties provide examples that other counties can emulate.
  3. The Council encourages further consideration of the recommendations of the North Carolina Public Policy Research Center in its studies of the aging population, to include examining: (1) how the Commissioner of Banks, the financial management industry, and law enforcement can further partner to prevent fraud against the elderly; and (2) the merits of giving the Attorney General the power to prosecute fraud against the elderly. The Council will be participating on the task force on fraud against older adults that the Governor helped establish in signing Senate Bill 449; S.L. 2011-189.
  4. The Council remains concerned about the availability of professional and paraprofessional direct care workers to meet the needs of an aging population and encourages the university and community college systems to take further steps to meet these needs. The Council is tracking the progress associated with the three-year federal Personal and Home Care Aide State Training Program (PHCAST) grant that North Carolina received to develop, pilot test, implement, and evaluate the impact of a comprehensive training and competency program for direct care workers.
  5. The Council supports the efforts underway tobetter connect existing health and social resources to create a more effective, efficient and person-centered system to facilitate access to services and supports and to reduce costs. Efforts that we are tracking include the growth of PACE (Programs of All-Inclusive Care for the Elderly), the Dually Eligible project, and the Partnership for Patients initiative. The Council had members attend the recent Partnership for Patients Summit in Greensboro, where about 300 persons came together to discuss person-centered hospital discharges, transitional care, health literacy and many other important topics. Those attending included physicians, hospital representatives, community service providers, and consumer advocates.
  6. The Council is concerned about the diminished legislative attention being given to identifying and discussing issues vital to North Carolina’s aging population as a result of the elimination of the Legislative Study Commission on Aging. As an interim measure, the Council is proposing to hold several forums across North Carolina to gather public input and highlight key issues and learn of effective and innovative local strategies to address them.
  7. The Council hopes that North Carolina’s Congressional Delegation will help assure adequate federal resources to support North Carolina’s efforts to meet the critical service needs of our growing older population. This would include:
    • reauthorizing the federal Older Americans Act and providing adequate funding for all of the related services;
    • sustaining funding for the Social Services Block Grant which is the primary source of federal support for the adult services programs provided through the county departments of social services (e.g., adult protective services, guardianship);
    • appropriating the authorized funds for the Elder Justice provisions of the federal Affordable Care Act that would strengthen Adult Protective Services and the Long-Term Care Ombudsman Program; and
    • assuring a more equitable distribution of funding under the Senior Farmers’ Market Nutrition Program.

 

Last updated February 28, 2012