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The 2010 Census showed that every day for the ensuing five years, 8,000 people would turn 65. How are counties in North Carolina preparing for this “Silver Tsunami?” Orange County and its aging services providers have embarked on a unique partnership to develop coordinated community support for older adults and adults with disabilities. The program is having a remarkable impact by helping citizens age successfully and reducing re-hospitalizations for those with complex hospital transitions. What is your county doing to prepare? This workshop, held during the NCACC's 2012 Annual Conference, highlighted a successful public-private partnership of community support designed to teach attendees how to approach their county’s Silver Tsunami with a spirit of discovery.
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GROWING OLDER IN NORTH CAROLINA:
Helping Seniors Navigate Transitions
North Carolina Association of County Commissioners Annual Conference
August 17, 2012
The Silver Tsunami
Every day for the next five years, 8000 people are turning 65
2
New
Alexander
AlleghanyAshe
Avery
BuncombeBurke
Cabarrus
Caldwell
Catawba
CherokeeCleveland
Davie
GastonGraham
Haywood
Henderson
Iredell
Jackson
McDowell
Macon
Madison
Mecklenburg
Mitchell
Polk
Rowan
Rutherford
Surry
Swain
Union
Watauga WilkesYadkin
Yancey
ClayTransylvania
Lincoln
Granville
NashAlamance
Anson
Bladen
Caswell
Chatham
Columbus
Cumberland
Davidson
Durham
Forsyth FranklinGuilford
Harnett
Hoke
JohnstonLee
Montgomery Moore
Orange
Person
Randolph
Richmond
Robeson
Rockingham
Sampson
Scotland
Stanly
StokesVance
Wake
Warren
Beaufort
Bertie
Carteret
Chowan
Craven
Dare
Duplin
Edgecombe
Gates
Greene
Halifax Hertford
Hyde
Jones
Lenoir
Martin
Hanover
Northampton
Onslow
Pamlico
Pasquotank
Pender
Perquimans
Pitt
Tyrrell
Brunswick
Washington
Wayne
Wilson
CamdenCurrituck
Percent of Population 65 and Over in NC 2010
11% to 20%
21% to 30%
Source: US Census 2010
10% or less
North Carolina – 13%
New
Alexander
AlleghanyAshe
Avery
BuncombeBurke
Cabarrus
Caldwell
Catawba
CherokeeCleveland
Davie
GastonGraham
Haywood
Henderson
Iredell
Jackson
McDowell
Macon
Madison
Mecklenburg
Mitchell
Polk
Rowan
Rutherford
Surry
Swain
Union
Watauga WilkesYadkin
Yancey
ClayTransylvania
Lincoln
Granville
NashAlamance
Anson
Bladen
Caswell
Chatham
Columbus
Cumberland
Davidson
Durham
Forsyth FranklinGuilford
Harnett
Hoke
JohnstonLee
Montgomery Moore
Orange
Person
Randolph
Richmond
Robeson
Rockingham
Sampson
Scotland
Stanly
StokesVance
Wake
Warren
Beaufort
Bertie
Carteret
Chowan
Craven
Dare
Duplin
Edgecombe
Gates
Greene
Halifax Hertford
Hyde
Jones
Lenoir
Martin
Hanover
Northampton
Onslow
Pamlico
Pasquotank
Pender
Perquimans
Pitt
Tyrrell
Brunswick
Washington
Wayne
Wilson
CamdenCurrituck
Percent of Population 65 and Over in NC2030
11% to 20%
21% to 30%
Source: NC State Data Center, April 2012
10% or less
31% or more
North Carolina – 19%
New
Alexander
AlleghanyAshe
Avery
BuncombeBurke
Cabarrus
Caldwell
Catawba
CherokeeCleveland
Davie
GastonGraham
Haywood
Henderson
Iredell
Jackson
McDowell
Macon
Madison
Mecklenburg
Mitchell
Polk
Rowan
Rutherford
Surry
Swain
Union
Watauga WilkesYadkin
Yancey
ClayTransylvania
Lincoln
Granville
NashAlamance
Anson
Bladen
Caswell
Chatham
Columbus
Cumberland
Davidson
Durham
Forsyth FranklinGuilford
Harnett
Hoke
JohnstonLee
Montgomery Moore
Orange
Person
Randolph
Richmond
Robeson
Rockingham
Sampson
Scotland
Stanly
StokesVance
Wake
Warren
Beaufort
Bertie
Carteret
Chowan
Craven
Dare
Duplin
Edgecombe
Gates
Greene
Halifax Hertford
Hyde
Jones
Lenoir
Martin
Hanover
Northampton
Onslow
Pamlico
Pasquotank
Pender
Perquimans
Pitt
Tyrrell
Brunswick
Washington
Wayne
Wilson
CamdenCurrituck
The Graying of North Carolina
Counties with more 60+ than 0-17 (43)
Counties with more 0-17 than 60+ (57)
Source: US Census 2010
• NC in the midst of significant demographic change• The state’s 2.4 million baby boomers are entering retirement age
• NC has the highest percentage of older adults living in rural areas among
the most populous states
2010
New
Alexander
AlleghanyAshe
Avery
BuncombeBurke
Cabarrus
Caldwell
Catawba
CherokeeCleveland
Davie
GastonGraham
Haywood
Henderson
Iredell
Jackson
McDowell
Macon
Madison
Mecklenburg
Mitchell
Polk
Rowan
Rutherford
Surry
Swain
Union
Watauga WilkesYadkin
Yancey
ClayTransylvania
Lincoln
Granville
NashAlamance
Anson
Bladen
Caswell
Chatham
Columbus
Cumberland
Davidson
Durham
Forsyth FranklinGuilford
Harnett
Hoke
JohnstonLee
Montgomery Moore
Orange
Person
Randolph
Richmond
Robeson
Rockingham
Sampson
Scotland
Stanly
StokesVance
Wake
Warren
Beaufort
Bertie
Carteret
Chowan
Craven
Dare
Duplin
Edgecombe
Gates
Greene
Halifax Hertford
Hyde
Jones
Lenoir
Martin
Hanover
Northampton
Onslow
Pamlico
Pasquotank
Pender
Perquimans
Pitt
Tyrrell
Brunswick
Washington
Wayne
Wilson
CamdenCurrituck
2025
Counties with more 60+ than 0-17
Counties with more 0-17 than 60+
(85)
(15)
Source: NC State Data Center
• Our 65 and older population will double in the next 20 years from 1.2 to 2.4 million.
• While NC is 10th nationally in size of total population, we are 9th in those 60 +.• By 2025, 85 of NC 100 counties are projected to have more people over age 60 than under age 17 and one in four NC citizens will be 60 and older.
7
The Long-Term Services and Supports LandscapeIn North Carolina long-term services and supports are funded by numerous sources, administered by multiple agencies, and have complex, fragmented, and often duplicative intake, assessment, and eligibility functions.
7
8
Determining how to obtain services is difficult both for persons who qualify for publicly funded support and for those who can pay privately.
A uniform, coordinated system of information and access for all persons seeking long-term support will minimize confusion, enhance individual choice, be cost efficient, and support informed decision-making.
Recent Milestones For American Health Care
• Medicare Modernization Act (2003)
• Deficit Reduction Act (2005)• Medicare Improvement for
Patients and Providers Act (2008)
• Affordable Care Act (2010)
10
http://www.kff.org/medicare
11
• In 2003, the US Administration on Aging (AoA) launched the federal Aging and Disability Resource Center (ADRC) initiative, which began with three core functions– Awareness, Assistance, and Access
• The set of core expectations has grown over time– Information, referral, and awareness– Options counseling, advice, and assistance– Streamlined eligibility determinations for public programs– Person-centered transitions– Quality assurance and continuous improvement
• Since 2009 AoA and CMS are viewing ADRCs as the platform to:– Intervene during care transitions– Promote consumer direction– Implement new initiatives (e.g., Veteran Directed Home and Community Based
Services)– Catalyze broader systems change
12
Anson
Beaufort
Bertie
Brunswick
Camden
Carteret
Columbus
Craven
Currituck
Duplin
Edgecombe
Gaston
Gates
Halifax
Harnett
Hertford
Hoke
HydeJohnston
Jones
Lee
Lenoir
Lincoln
Martin
Moore
Nash
Northampton
Onslow
Pamlico
Pasquotank
Pender
Perquimans
Pitt
Richmond
Robeson
Sampson
Scot-land
Tyrrell
Union
Washington
Wayne
Wilson
Alam
ance
Alexander
Alleghany
Ashe
Caldwell
Caswell
Catawba
ChathamDavidson
Davie
ForsythFranklinGuilford
Gra
nvil l
e
Iredell
Person
Randolph
RockinghamStokes
Surry
Vanc
e
Warren
WataugaWilkes
Yadkin
Wake
Avery
Cherokee
Clay
Graham Henderson
BuncombeMcDowell
MaconPolk
RutherfordSwain
Madison
HaywoodN
ew
Hanover
Chowan
Cumber-land
MontgomeryStanly
Mecklenbu rg
Cabarrus
Rowan
Cleveland
Burke
Orange
Durham
Jackson
Bladen
Dare
Transylvania
Yancey
Greene
Cabarrus CRC (Cabarrus )Chatham-Orange CRC [Chatham and Orange]Eastern Carolina CRC -Developing [Carteret, Craven, Duplin, Greene, Jones, Lenoir, Onslow, Pamlico, Wayne]Forsyth CRC [Forsyth]Great Smokies CRC [Haywood, Jackson, Macon]High Country CRC [Ashe, Alleghany, Avery, Watauga, Wilkes]Isothermal CRC - Developing [Cleveland, McDowell, Polk, Rutherford]Land of Sky CRC [Buncombe, Henderson, Madison, Transylvania]Lumber River CRC - Developing [Bladen, Hoke, Richmond, Robeson, Scotland]Mecklenburg CRC [Mecklenburg]Northwest Piedmont CRC [Davie, Stokes, Surry, Yadkin]Piedmont Triad CRC [Alamance, Caswell, Davidson, Guilford, Montgomery, Randolph, Rockingham]Pitt-Beaufort CRC [Pitt, Beaufort]Wake CRC [Wake]Western CRC [Cherokee, Clay, Graham, Swain]
March 2012
North Carolina Community Resource Connections (CRCs)
In 2009 NC was one of 9 states to be awarded a CMS Person-
Centered Hospital Discharge Model Grant (PCHDM)
• The over arching goal for this grant was to provide states the opportunity to develop effective care transitions models that integrated community-based services with hospital discharge planning as a means for preventing avoidable hospital re-admissions.
• Projected Outcomes-• Improve quality of care for Medicare beneficiaries through a
comprehensive community effort• Reduce preventable hospital re-admissions • Increase discharge from Hospital to Home for target populations
Resources and Milestones
• CRC Care Transition Projects– Forsyth County– Chatham-Orange Counties– Rockingham County– Land of Sky
• PASSPORT• Area Agencies on Aging• NC Alliance for Care Transition (NC ACT)
– NC Hospital Association Quality Center– Community Care of NC– Carolinas Center for Medical Excellence
Transitions of Care
• Definition: The movement of persons from one health care practitioner or setting to another as their condition and care needs change
• Poor Transitions… – Compromise clients safety & quality of care– Burden clients and their families– Increase costs to clients, payers, providers & employers
20% Medicare Beneficiaries readmitted within 30 Days
33% readmitted within 90 Days
Hospitalizations account for 33% of total Medicare $
Readmissions result in $17.4 Billion annually
76% of Medicare readmissions potentially avoidable
Estimated $12 Billion Preventable Expenditures
Readmissions: By the Numbers
The Challenge
“If re-hospitalizations are frequent, costly, and able to be reduced,
why haven’t they been?”
Hospital-level barriersCommunity-level barriers
State-level barriers
New Models of Care
There are a number of proven & promising models to improve outcomes during transitions:
Common Elements:Interdisciplinary Communication/Collaboration Transitional Care Staff Patient Activation Enhanced Follow-up (by phone / home visit)
For more resources: www.cfmc.org/integratingcare
NCMJ: Care Transitions
www.ncmedicaljournal.com
How does our community navigate this transition?
Nursing Home
Assisted Living
RehabilitationContinuing Care
Retirement Community
Home
County Council/Department on
Aging
Area Agency on
Aging
Cooperative Extension
Mental Health
Provider
Community Resource Connection
Home Health Care
Senior Center
Adult Day ServicesFaith Community
County Social
Services
?
Community Engagement Event
• Plan WITH Not FOR Community• Power of Consumers• Map Current Reality• Assess Beliefs• Build Common Vision • Set Priorities• Define Action Steps
Local Core Collaborators
Consumers Aging Services Agencies Disability Services Agencies In-Home services Senior Centers Community Organizations Dept. of Social Services Area Agencies on Aging Community Health Centers Hospitals
Community-Based Approach
“Communities across the US are beginning to consider transitions of care as a community–based challenge that requires shared ownership and close collaboration across settings.”
(Institute for Healthcare Improvement)
Local Level Planning
• How to get started?• What has been done?
Orange County Is Now In It’s Third Master Aging Plan (MAP)
•Objectives for Developing MAP
•Input
•Process
•Plan
Objectives For Developing MAP
• Citizen Engagement
• A plan for the whole county
• Sustainability
• Accountability
Citizen Engagement
• Focus Groups• Community Forums• Work Groups
– Housing– Navigation and Transportation– Health and Wellness– Community Engagement– Aging in Place
Integrated Countywide Plan
• Government Readiness Survey• Personal Interviews with County Dept. Heads.
• Steering Committee– Key County Department Heads, citizen
representation, community organizations, BOCC Representatives
– Increased buy-in and commitment agencies across the county – Personal interviews
Sustainability and Accountability
• Economic context requires creativity
• Public Private Partnerships
• Built-in indicators of success
• MAP Evaluation Committee
How Can You Begin In Your Community?
• Contact your local Dept. or Council on Aging• Find out if they have a strategic plan• Is it time to update the plan and you like what
you have heard today visit us at www.orangecountync.gov/aging
• We have created an on-line MAP toolkit
Most Important Role For You
• Get involved and stay involved!
• If your community does not have an Aging Plan, advocate that they get started planning.
• The Silver Tsunami is going to have a dramatic impact on you and your community.
Our Contact Information
Bernadette PelissierOrange County Board of [email protected]
Heather AltmanCarol Woods Retirement [email protected]
Sabrena LeaNorth Carolina Division of Aging & Adult [email protected]
Janice Tyler Orange County Department on [email protected]