The Changing Landscape of Aging Services

Health care reform, market pressures and demographic shift are changing the familiar landscape of Long Term Services and Supports, requiring consumers, healthcare providers and community based organizations to adapt. How can stakeholders shape new policies and service delivery models that are person-centered? How will providers of health and supportive services interact in this new landscape? How can community based organizations engage to become the change? These questions might best be answered through an exploration of possibilities, innovation and recent developments.

Local Groundbreakers

Collaborative MHSA Innovation Project

May 23, 2018 – Alameda County has the highest rate of 5150 holds in California. People who do not qualify for 5150 holds are not successfully linked to services and continue to use emergency services. First responders spend many hours addressing behavioral health related 911 calls that could be addressed more effectively with a different system. A collaboration between core Alameda County Health Care Services Agency programs – Alameda County Care Connect (AC3), Emergency Medical Services and Behavioral Health Care Services – is addressing the problem with the launch of the Community Assessment & Transport Teams (CATT) Project.  

The project is a test of a new concept for improving the mobile crisis system through a collaborative approach and a change in staffing models paired with new technology support.

Here’s a nutshell description of the project design:

  • A mobile crisis team – comprised of an emergency medical technician (EMT) and a behavioral health provider in an unmarked non-emergency vehicle – will respond to crisis calls and transport clients to the most appropriate services;
  • Clients do not need to meet 5150 criteria to be assisted and transported;
  • To start, two teams will run 7am to midnight 7 days/week in the cities of San Leandro and Hayward;
  • After 18 months if the project is successful it will expand to Oakland;
  • Teams will use the Reddinet software in order to see crisis bed availability and utilize the community health record designed under Whole Person Care (AC3).

Collaborative partners include 911 dispatch, County Sheriff’s Office, city police departments, city health and human services, and other relevant services.

The 5-year project cost of $14.8 million is being covered with Mental Health Services Act Innovations funding, BHCS’s Medi-Cal Federal Financial Participation ($3.4 million), and County Measure AA ($1.8 million). To learn more, click here to check out the Innovative Project Plan Description.

Collaborative Recommendations re: Homeless Older Adults

July 25, 2017  – For the past 9 months SSC has partnered with Health Care Services Agency to convene meetings with Alameda Health System and the other systems, agencies and CBOs. We recently convened a facilitated discussion focused on homeless older adults and encampments. Here are some of the take-aways from that discussion and follow-up work.

Health Care for the Homeless estimates that 33% of the homeless people that their street medicine teams treated last year were over age 55. People ages 55+ account for 27% of the HomeStretch registry.

Older adults may present an additional set of factors that, if ignored, set them up to “fall through the cracks”. These include needing assistance with activities of daily living, cognitive deficits, multiple medications, grief and loss, multiple EMS contacts and hospital admissions, and the potential to reunite with family caregivers.

Solutions identified include:

  • On-call access to geriatric and dementia expertise, as well as training in working effectively with people with cognitive impairment, for the staff of housing resource centers, shelters, Permanent Supportive Housing, and emergency services)
  • Identify and implement funding mechanisms to cover post-acute transitional care beyond 30 days when needed.
  • Provide public health, nursing and hygiene services at homeless encampments.
  • Expedite proactive IHSS eligibility to qualify people for housing or reunify with family caregivers (Adult & Aging Services is starting up a pilot to do just that).
  • Reconfigure shelters so that they are viable options for older adults.
  • Develop relationships and systematic connections between case managers and housing services to facilitate continuity of care through transitions and help older adults stay in long-term housing.

The full report will be out soon. The recommendations are being shared with the multiple workgroups within county agencies and cities that are focusing on addressing homelessness.

Recent Developments

Medi-Cal RX to Launch on January 1, 2022

November 26, 2021 – On or about December 1, all Medi-Cal beneficiaries will receive a 30-day notice regarding the implementation of Medi-Cal Rx on January 1, 2022. This is part of a broader outreach campaign by DHCS to educate Medi-Cal beneficiaries about the pharmacy carve out.

In 2019, Governor Gavin Newsom issued Executive Order (EO) N-01-19, requiring, among other things, that all Medi-Cal pharmacy services be transitioned from managed care to the fee-for-service delivery system by January 1, 2021 (full implementation was lengthened to January 1, 2022). This transition is considered a critical step for the success of the CalAIM, the state’s sweeping reforms to improve life and health outcomes for Medi-Cal beneficiaries. Medi-Cal Rx will:

  • Standardize the Medi-Cal pharmacy benefit under one statewide delivery system. This means that no matter what county a person lives in, the same access to their prescriptions is possible.
  • Improve access to pharmacy services.
  • Centralize pharmacy policy, transactions, and reimbursements, leading to greater efficiency for pharmacies and the Medi-Cal program.
  • Strengthen California’s ability to negotiate state supplemental drug rebates with drug manufacturers as the largest Medicaid program in the nation, with more than 14 million beneficiaries.

Go to for more information, materials and links.

NCLER Tips re Medicare Coverage for Home Health Aide
August 5, 2021 – National Center on Law & Elder Rights has released a Practice Tip to help navigate Medicare coverage for medically necessary home care. When individuals meet the home health benefit criteria, Medicare-covered care can include home health aide services such as hands-on personal care and assistance with the activities of daily living. This care is often critical to beneficiaries’ health, safety, and ability to remain at home. Click here to read NCLER’s Practice Tip.

OIG Report Shows Impact of COVID-19 on Nursing Home Residents

June 24, 2021 – This week, the U.S. Department of Health and Human Services Office of Inspector General (OIG) released a report that demonstrated the devastating impact of COVID-19 on people with Medicare who reside in nursing homes. While it was clear from early in the public health emergency that older adults and people with disabilities were disproportionately harmed by COVID-19 and that nursing homes were particularly dangerous, some of the data had not been compiled and available until now.

The OIG found that 42% of Medicare beneficiaries who resided in nursing homes were diagnosed with COVID-19 or likely COVID-19 in 2020. Over half of Black beneficiaries and nearly half of Hispanic and Asian beneficiaries in nursing homes had or likely had COVID-19. At the height of the pandemic, over 6,600 beneficiaries were being diagnosed with COVID-19 or likely COVID-19 per day. The infection rate was the same across age groups and genders, but it was higher for people who are dually eligible for both Medicare and Medicaid.

The staggering numbers of infections in nursing homes took a huge toll, increasing the mortality rate for beneficiaries across age groups and genders in nursing homes by 32% over 2019, with Asian, Hispanic, and Black beneficiaries seeing the largest increases. These data demonstrate the urgent need to increase the pandemic readiness of nursing homes, reduce the number of people in nursing homes through better at-home supports, and better prepare the national infrastructure for future public health emergencies. They also show that COVID-19 disproportionately affects communities of color.

Read the full OIG report.

Read the OIG summary.

From the American Society on Aging: In Their Own Words: How Nursing Home Residents Feel About Lock-Down

October 12, 2020 – A new report drawn from an online survey taken between July and August 2020 that tracked nursing home resident’s live brings into clear relief the stark realities of living in a nursing home during the pandemic. Click here to read more.

California’s LTSS Feasibility Study Final Report

September 25, 2020 – On September 11th, DHCS released the study of long-term services and supports (LTSS) financing and services options per the Budget Act of 2019.

Click here for the Final Report of the LTSS Feasibility Study prepared by Milliman. The report includes background information, stakeholder findings, a list of benefit options for a public LTSS insurance program, actuarial analysis, and fiscal estimates. DHCS has noted that “the analysis, model, design, and fiscal estimates were prepared independently by Milliman, and do not reflect proposal or commitments by the Administration.” This report has been submitted to the Legislature and is now public.

‘Lessons Learned’ Report from COVID-19 CBO Senior Food Delivery Group

September 14, 2020 – In March, as California issued stay at home orders in response to the Coronavirus crisis, the California Department of Aging and the California Department of Social Services recognized the unprecedented need to address the food security implications for older adults sheltering in place. They formed a COVID-19 CBO Senior Food Delivery Local Operations Work Group with representatives from a diverse set of community based organizations to identify how local CBOs could coordinate and get support for food delivery, both grocery and meal, especially for aging and at risk adults, and how the state departments could best and quickly support that critical work.

The group’s report on Lessons Learned highlights policy and operational take-aways from the first several months of food assistance response. It represents a practical lesson in what helps or hinders disaster food response for older adults. Click here for the report.  

As Coronavirus cases continue to rise throughout the state, older adults and others at high risk will continue to need to shelter in place. These lessons can support state departments, AAAs, and CBOs to offer the best possible support to food insecure vulnerable populations.

Study finds Food Insecurity and Physical Functioning Limitations are Linked

August 31, 2019 – Physical functioning limitations — including those related to food intake — are associated with food insecurity among older adults in the U.S., according to research in Preventive Medicine Reports

Physical limitations were defined based on reported difficulty in performing 19 activities without the aid of special equipment. Having four or more physical limitations increased the likelihood of marginal, low, and very low food security, compared to having no physical limitations. The 19 activities were further categorized into five domains: activities of daily living (e.g., dressing oneself, using a fork or knife), instrumental activities of daily living (e.g., managing money, preparing meals), leisure and social activities (e.g., attending social events), general physical activities (e.g., grasping small objects), and lower extremity mobility (e.g., walking up 10 steps). All five functional limitation domains were associated with marginal, low, and very low food security, but additional analyses demonstrated that the strongest associations with food insecurity were for instrumental activities of daily living, leisure and social activities, and general physical activities. 

The findings, based on national survey data, demonstrate the need to screen for physical functioning limitations and food insecurity among older adults. Click here for the article.

ACL Tool Helps CBOs Prepare for Contracting

A significant challenge experienced by community-based organizations in contracting with healthcare entities is healthcare partners’ reluctance to share data on the outcomes of CBO services. In response, the health plans workgroup of the Administration on Community Living’s Trailblazers Learning Collaborative developed a standard long-term services and supports care management client experience survey. The tool was based on CMS’s new Consumer Assessment of Healthcare Providers and Systems (CAHPS) for LTSS and on measures used by top agencies across the country. If broadly used by aging and disability CBOs, this survey and other tools developed by the health plans workgroup will enhance readiness to partner by providing CBOs with data to demonstrate their value and by allowing CBOs to benchmark and improve the quality of their services.

The Aging and Disability Institute (a collaboration of National Association of Area Agencies on Aging and American Society on Aging) is giving a webinar on the tool on August 22 at 1 pm ET, where they will describe the care management experience survey, explain how to use it, and why it’s important. Click here to register.

To learn more about the Institute, click here.

Analysis Confirms Senior Meals Programs Improve Outcomes

November 9, 2018 – The Administration on Community Living recently released a Mathematica Policy Research report evaluating the impact of Older Americans Act-funded congregate meal programs on participants’ health outcomes, utilization and costs.

The evaluation results suggest that those that participated in the congregate meal program had lower health care expenditures. Key findings for congregate meal participants include:

  • Congregate meal participants were more able to remain living in their home. When compared to nonparticipants, congregate meal participants were 2.3 percentage points less likely to be admitted into a nursing care facility.
  • For lower-income congregate meal participants, the rate of nursing home admissions was 8.5 percentage points lower than the rate for nonparticipants.
  • Congregate meal participants who lived alone were less likely than nonparticipants to have a hospital admission or have an emergency department visit that led to a hospital admission.

Click here to download a copy of the full report.

Early Use of Home & Community-Based Services is Effective!

June 1, 2018 – The Centers for Medicare & Medicaid recently released “Money Follows the Person Report from the Field” by Mathematica Policy Research, which found that early access to home and community based services leads to reduced reliance on institutional care. Click here for the report.

What if Health Care Providers Could Diagnose Food Insecurity!

February 7, 2018 – The Food Research & Action Center and AARP Foundation have released a free, online course to educate health care and community-based providers around the country about the extent of senior hunger and the solutions that exist to solve it. Titled “Screen & Intervene: Addressing Food Insecurity Among Older Adults,” the course provides training on how to screen patients 50 and older for food insecurity, and information on how to connect food-insecure patients to key nutrition resources, including the Supplemental Nutrition Assistance Program (known as CalFresh in California). Nationally, 2.8 million households with at least one adult age 65 or older struggled against hunger in 2016. Click here for more information.  Register for the course at

Congress Passes Bipartisan Legislation
on Family Caregiving

February 6, 2018 – The Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers passed Congress with bipartisan support and has been signed into law. A broad coalition of aging and disability organizations advocated for passage, working closely with Sens. Collins (R-ME) and Baldwin (D-WI) and Reps. Harper (R-MS) and Castor (D-FL).

The legislation requires the Secretary of Health and Human Services to develop, maintain, and update a strategy to recognize and support family caregivers. An advisory council will be formed to develop the strategy with public input. The development of the initial strategy will take up to 18 months, followed by biennial updates. Click here to read the text of RAISE ACT.

Dementia Resource Guides

January 21, 2018 – The CMS Medicare-Medicaid Coordination Office (MMCO) has three new resource guides intended to support providers and health plans serving older adults and caregivers. These two resource guides, one created for caregivers and the other for healthcare professionals, include training and toolkits, fact sheets, publications, and information resources from various organizations and health plans.

To view these guides, click here.

Gerontologist Study on Adult Day Programs 

September 6, 2017 – A new article in Gerontologist, The Effect of Adult Day Program Attendance on Emergency Room Registrations, Hospital Admissions, and Days in Hospital: A Propensity-Matching Study, looked at people age 65+ who also had home care. It reports that Adult Day Program attendees had significantly lower rates of emergency room registrations, hospital admissions, and days in hospitals for attendees, compared to matched non-attendees.

The findings replicate and extend results from previous research that reported a decreased reliance on costly health care services by seniors who attend adult day programs. Click here to go to the article.

Medicare Begins Covering Care Planning for Cognitive Impairments

May 22, 2017 – As of January 1, 2017, Medicare will now pay for care planning services for beneficiaries experiencing cognitive impairment, including Alzheimer’s disease. Under new billing code G0505, health care providers can be reimbursed for providing a comprehensive set of care planning services that includes a cognition-based evaluation, functional assessment, and caregiver identification and interview. Click here for information on the new billing code from the Alzheimer’s Association, and click here to go to the Alzheimer’s Association page on approved cognitive assessment tools.

State Wins CalFresh Waivers to Benefit Seniors

April 21, 2017 – The USDA has approved two waiver requests submitted by California’s Department of Social Services to streamline enrollment and increase benefits for CalFresh households with seniors and/or disabled members.

The Elderly Simplified Application Project (ESAP) and Standard Medical Deduction (SMD) demonstration project will be implemented simultaneously beginning October 1, 2017. The ESAP is designed to simplify the application and recertification processes by making three significant changes to the application and recertification requirements for households with only elderly (age 60 or older) and/or disabled household members with no earned income. The SMD simplifies the CalFresh application process for CalFresh by reducing the paperwork burden and the time that eligibility workers must spend verifying every expense.

These changes to can help increase older adult participation in CalFresh.

Click here to go to California Food Policy Advocate’s summary of the new waivers and download their fact sheet and report.

Managed Care 101

The SCAN Foundation’s January 8, 2013 webinar helped community-based service providers and advocates understand the fundamentals of managed care, and what is involved in integrating long-term services and supports into a managed care model. The Webinar will orient you to the brave new world of managed care, and is an essential start in preparing your organization for the 2014 launch of the Coordinated Care Initiative in Alameda County.

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