Two Public Hearings were held:

• Henderson County Health Department, Gladstone, IL – May 19, 2008
• Henry County Senior Citizens’ Center, Kewanee, IL – May 20, 2008

The hearings were opened by Deb Castillo, Information and Planning Manager and Maxine Marchese, Board of Directors member for Western Illinois Area Agency on Aging (WIAAA). Introductions of the WIAAA staff, Board members, Advisory council members and all other participants followed the opening statements. Janice Stille, the Executive Director of WIAAA and Deb Castillo gave brief explanations of the 2009 Public Information Document (PID) which was made available to all who attended the hearings. The PID serves as an official summary of our 2009 amendment to the 2008-2010 Area Plan. It describes in brief who our agency is, what it does and addresses majors issues facing seniors in western Illinois today. This document details our service priorities under the Older Americans Act and other activities undertaken by the agency. It contains our 2009 budget, requests for our waivers and our vision for the 2008-2010. The Public Hearing participants were asked for comment or questions regarding the PID but none were forthcoming. This is a brief summary of the issues, concerns and resolutions discussed at the two Public Hearings.

Gloria Short – Director of Senior Services at Henderson County Health Department – Gladstone, IL. – Gloria commented on how it seems there is always a need for more money for Home Delivered Meals as it is getting more difficult to provide this service to seniors with the increase in costs of food and fuel. She also indicated that providing transportation services continues to be a problem as fuel costs continue to increase and their old, worn out vehicles continue to deteriorate. Gloria intimated that transportation is a critical need for seniors in a rural area but it is a known fact that there is never enough funding to support the program as it should be operated. Seniors in rural areas, with little or no family are hit particularly hard when it comes to getting to medical and dental appointments which often require a trip to the larger cities.

Connie Shinberger – Henderson County Health Department, Gladstone, IL – Connie testified to the need for more funding for the respite program. Respite is a service which is in great demand for caregivers who are trying to maintain the care of their loved one at home for the maximum benefit of the care recipient.

Michelle Jech, Chief Executive Officer and Julie Farmer, Program Director, for Alternatives for the Older (AFOA) – Both Michelle and Julie testified that AFOA sees the increased need for assisting frail and chronically ill seniors and their caregivers. The Comprehensive Care Coordination (CCC) program was implemented by Illinois Department on Aging (IDOA) approximately a year and one half ago. This initiative allows for an assessment by trained and certified staff that addresses physical, functional, nutritional, environmental, social, financial, medical psychological issues as well as many other areas of need. The IDOA provides funding for this evaluation, care planning and monitoring. However, they stated, the funding is not adequate to cover the additional time spent and the additional paperwork involved to provide this service. An assessment now takes 5.75 average hours compared to 2 hours previously. In addition, the amount of paperwork created by the new assessment has increased by 50%. It was stated by both parties that AFOA is currently $20,000 in deficit for this program and they are not fully staffed for the number of referrals they receive.

Another service provided by AFOA is Respite assessment and administration of the program. AFOA is $10,000 in deficit for this program.

AFOA provides Money Management, Ombudsman, Self-Neglect and Medication Management which continue to operate without enough funding.

AFOA, like transportation providers, is feeling the crunch in their budget due to the travel distances spanned by their case managers. Case managers must often travel great distances in order to see homebound seniors for assessment and follow-up.

Margaret Bent, Director of VNA Senior Services in Knox County – Galesburg, IL. (as read by Janice Stille, Executive Director of WIAAA) Margaret wrote that her monthly cost of gasoline for the VNA transportation program increased from $885 in October of 2007 to $1,585 in April of 2008. This increase in cost affects congregate meals, home delivered meals and transportation programs. The agency has no recourse but to increase the suggested donation to $2.00 per ride causing seniors to take the Handi-van which costs just $1.00 per ride. Over 3,000 rides per year were lost over this decision and while the City is recouping 80% of their deficit from federal funds VNA is forced to pass on their deficit to the consumer.

Margaret expressed appreciation regarding the additional community focal points funds and SHAP funds. She stated that seniors continue to need centers where they can go to receive health information, socialization, entertainment and a nutritional meal. Margaret said that the additional SHAP funds will enable VNA to employ a worker for 32 weeks of the year during the critical times for both Medicare D and Illinois Cares Rx enrollments.

Skipper Snow – Caregiver - expressed appreciation for services she has received while caring for her husband. She also posed questions regarding nutrition and dietary choices at the meal sites and received answers from Virginia Nelson, the Director of the Henry County Senior Center who oversees the nutrition programs in Henry County. The director quoted budget concerns and a shortage of volunteers to help keep costs in line which often hinder the types of foods made available for seniors who partake of the nutrition services.

1. Home Delivered Meals

Several of the providers at both of the public hearings made comment that there is never enough funding for the Home Delivered meal program but now that the cost of fuel has risen so drastically they don’t know how they are going to continue to serve their seniors the meals they critically need. With aging vehicles and fewer volunteers able to assist due to increased fuel costs, the providers are struggling to find alternate methods of providing service. In some cases they have had to increase the suggested donation while in other cases they are considering cutting back on the number of delivery days during the week. Some are considering delivering frozen meals along with hot meals so that shortened delivery hours won’t mean decreased nutrition provision.

2. Transportation

The need for increased funding for transportation continues to be a heavy burden for providers. Several stated that their vehicles are old and requiring many repairs throughout the year. One provider indicated she had an increase in her monthly fuel bill in the amount of $700 which is creating tremendous strain on her budget. Many providers talked of raising the suggested donation or cutting days that van rides will be available to the seniors. When seniors are unable to leave their homes without assistance from the transportation program it often leads to depression, isolation, and other physical and psychological ramifications

3. Case Management

Representatives from our Case Coordination Unit (CCU) expressed great concern about the cost of services they are providing through the Comprehensive Care Coordination (CCC) program. The Illinois Department on Aging funds this program but staff at the CCU stated they are overwhelmed by the expenses incurred while providing the additional assessment process, the extra paperwork and the cost of case managers traveling to appointments all over the ten county PSA. They commented that they are currently $20,000 in deficit with this program. They ask that WIAAA reinstate some case management funding to help offset the debt they are incurring within the inadequately funded CCC program.

4. Respite, Money Management, Ombudsman, Self-Neglect and Medication Management.

Representatives from our CCU stated that these programs which they also provide are under funded as well. They are seeing a deficit of $10,000 in the assessment and administration of the Respite program and would like to see adequate funds provided for this and all of these programs. Alternatives representatives stated that they are aware that making funding decisions is always difficult especially in these lean times of governmental funding and they applaud WIAAA for looking at the needs of the community when doing so.

1. Home Delivered Meals

Recommendation:

WIAAA recognizes that the increased costs of food and fuel are causing a strain on the providers’ budgets in regard to the Home Delivered Meal program. It is vital that seniors continue to receive the nutrition they need in order to sustain their health and live independently. In addition, more seniors are retiring and beginning contact the providers in need of these services. If it becomes no longer feasible to deliver meals five days per week to homebound seniors WIAAA recommends that individual providers seek ways to cut costs. It may be possible to deliver five meals on three trips per week or deliver five frozen meals out to seniors one time per week. WIAAA encourages providers to look at all options available to them, including the possibility of contracting with organizations such as "Mom’s Meals", which delivers five refrigerated meals one time per week.

Rationale:

This problem of continuing to deliver meals to homebound seniors on less funding with increased demand will only continue to worsen. Providers must look at how they have always done things down through the years and begin to seek out alternate ways of providing this service. While WIAAA is aware that the ideal way to deliver meals is with a daily visit, helping to keep an eye on the senior and assure he or she is doing all right, this way of doing things may become a thing of the past. There may be other ways to check on that senior by phone while making sure that they still get the nutrition they need each day.

2. Transportation

Recommendation:

WIAAA acknowledges that the transportation budget has never been solvent and the cost of providing this service continues to increase annually for its providers. WIAAA will continue to seek solutions and share alternate methods with providers that might help curb the cost for providing this service. Ultimately, it may be necessary to cut the amount of transportation offered, providing rides three days per week as opposed to five. Providers may need to take a look at the types of transportation they are offering and consider consolidating and prioritizing what they can offer to seniors. And without a doubt, all providers of transportation should be actively participating in Human Service Transportation Planning Committees as Federal dollars are available and none of us want to see seniors kept away from the bargaining table to obtain the services they so desperately need.

Rationale:

WIAAA is aware that transportation is a vital link in helping seniors live independently in their homes and in their communities. We also acknowledge that the number of seniors retiring and utilizing this service is growing. Because transportation funding will most likely never be provided at the level that is needed, the time to start making adjustments in how we view the provision of this service is now. Participating in regional transit meetings and on their committees will enable providers to seek workable solutions to transportation problems. Providers may also collaborate with other transportation providers within the network, seeking ways to combine resources when possible. Providers should also participate in all Human Service Councils, Elderly Consortiums and other membership entities which promote the health and welfare of senior citizens to address the possibilities of addressing issues such as transportation.

3. Case Management

Recommendation:

WIAAA understands the concern of Alternatives for the Older Adult, its Case Coordination Unit (CCU), regarding the increased work load they are experiencing under the Comprehensive Care Coordination (CCC) program. It is our hope that the Illinois Department on Aging will take consideration of their concerns, looking at the increased work load and paper work to determine what might be done. Seniors continue to have a multitude of needs as they age and WIAAA regularly tries to determine what would be in the best interest for the majority of its seniors in the way of services.

Rationale:

The needs of seniors continue to increase and evolve. The seniors of today want information made available to them in the form of educational events, computer classes and trainings. They desire more challenging volunteer opportunities, programs that will stimulate their mental and physical health and access to services at their fingertips. WIAAA sees a real need for implementing new programs to meet these growing demands and feels funds must also be diverted to innovative programs which help meet the needs of the "new" younger seniors while also being of great value to all seniors we serve. If we can’t meet them on their level of interest we can’t help provide the services they are seeking.

4. Respite, Money Management, Ombudsman, Self-Neglect and Medication Management

Recommendation:

WIAAA received a funding cut for 2009 as a result of the State using the Intra-state funding formula to re-apportion funds throughout the state. Many of our funded programs could most likely continue running at a deficit or remain under funded for some time to come. Because this funding formula uses criteria, such as must be 60 years of age or older, or rural, living alone, minority, and non-English speaking, it is critical that all providers make every effort to collect the appropriate data during assessment and intake processes. It is one way that we can all work together to ensure that we receive the maximum funding for the seniors we serve.

Rationale:

WIAAA acknowledges that its providers work hard, always seeking ways to provide services to the majority of seniors with a minimal amount of funding. If there is anything that can be done at the provider level to help alleviate this ongoing problem of under funded programs, it is to make a concerted effort to collect accurate data to start with, showing those funding our programs the numbers of seniors and caregivers we are reaching throughout our PSA. This information should also be shared with state and local legislators, making them aware of the difficulties of providing adequate services to seniors and caregivers with insufficient funds.

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