2022 FALL CONFERENCE

AGENDA

7:30-8:00: Check in & breakfast

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8:00-8:30: State of the Agency

• Gary Cook

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8:30-9:45: Closing the Gap: Senior Service Levies in Ohio

• Joe Rossi
• Ken Wilson

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9:45-10:00: BREAK

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10:00-11:15: The Next Generation: the future of Long-Term Services & Supports

• Ljudmila Burchfield
• Chris Fagerstrom
• Francine Chuchanis

2

11:15-12:30: Creative Partnerships for a New Reality: The impact of the pandemic on older adult supports

• Barb White
• Councilman Jeff Wilhite

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12:30-1:30: LUNCH

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1:30-2:45: PACE Panel

• Elizabeth Miller
• Ann Conn
• Shawn Bloom

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2:45-3:00: BREAK

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3:00-4:30: Age Friendly Panel

• Executive Ilene Shapiro
• Mayor Dan Horrigan
• Dr. Harvey Sterns
• Susan Sigmon

THANK YOU TO OUR CONTEMPORARY LEVEL SPONSORS

Schauer Group

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Akron Metropolitan Housing Authority

THANK YOU TO OUR PEER LEVEL SPONSORS

4

THANK YOU TO OUR SCHOLAR LEVEL SPONSORS

BUY YOUR TICKETS TODAY!

For details, purchase tickets or make tax-deductible donation, scan the QR code on your program or on this slide

$50 / ticket or �$200 / 5 tickets

Drawing date: November 17^th 

All proceeds benefit the Direction Home Akron Canton Foundation

BUY YOUR TICKETS TODAY!

For details, purchase tickets or make tax-deductible donation, scan the QR code on your program or on this slide.

Drawing date: November 17^th

$50 / ticket or �$200 / 5 tickets

All proceeds benefit the Direction Home Akron Canton Foundation

THANK YOU TO OUR LEADER LEVEL SPONSORS

AGENDA

7:30-8:00: Check in & breakfast

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8:00-8:30: State of the Agency

• Gary Cook

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8:30-9:45: Closing the Gap: Senior Service Levies in Ohio

• Joe Rossi
• Ken Wilson

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9:45-10:00: BREAK

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10:00-11:15: The Next Generation: the future of Long-Term Services & Supports

• Ljudmila Burchfield
• Chris Fagerstrom
• Francine Chuchanis

9

11:15-12:30: Creative Partnerships for a New Reality: The impact of the pandemic on older adult supports

• Barb White
• Councilman Jeff Wilhite

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12:30-1:30: LUNCH

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1:30-2:45: PACE Panel

• Elizabeth Miller
• Ann Conn
• Shawn Bloom

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2:45-3:00: BREAK

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3:00-4:30: Age Friendly Panel

• Executive Ilene Shapiro
• Mayor Dan Horrigan
• Dr. Harvey Sterns
• Susan Sigmon

THANK YOU TO OUR VISIONARY LEVEL SPONSORS

THANK YOU TO OUR PATHFINDER LEVEL SPONSORS

11

THANK YOU TO OUR LEADING SPONSORS

12

BUY YOUR TICKETS TODAY!

For details, purchase tickets or make tax-deductible donation, scan the QR code on your program or on this slide.

Drawing date: November 17^th

$50 / ticket or �$200 / 5 tickets

All proceeds benefit the Direction Home Akron Canton Foundation

BUY YOUR TICKETS TODAY!

For details, purchase tickets or make tax-deductible donation, scan the QR code on your program or on this slide.

Drawing date: November 17^th

$50 / ticket or �$200 / 5 tickets

All proceeds benefit the Direction Home Akron Canton Foundation

2022 �FALL CONFERENCE

16

Schauer Group

Akron Metropolitan

Housing Authority

Closing the Gap:

Senior Service Levies in Ohio

Joe Rossi, CEO

Direction Home of Eastern Ohio

Ken Wilson, Vice President of Program and Business Operations

Council on Aging of Southwestern Ohio

AGENDA

WHY DO WE NEED SENIOR SERVICE LEVIES?

WHY DO WE NEED SENIOR LEVIES?

THE GAP LEFT BY MEDICAID PROGRAMS IS HUGE!

LOCAL LEVIES IN SW OHIO

SUPPORT AND REVENUE�FISCAL YEAR ENDING SEPT. 30, 2021

Total Support/Revenue: $95 Million

Levies fund: ESP and FastTrack Home

Elderly Services Program:

• Long-Term chronic needs: 2+ years
• Primary aim: decreasing risk of nursing home placement
• 60+, chronic functional impairments, copayment requirement
• Full array of community services to maintain independence

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FastTrack Home:

• Short-Term acute needs: up to 60 days
• Primary aim: decreasing risk of re-hospitalization, and successful recovery at home
• Transitioning from a hospital or nursing facility, 60+ with acute functional impairments
• Short term services focused on patient transition, meals/nutrition, home care, medical devices, and transportation.

PLACING THE LEVY ON THE BALLOT

RESEARCH, DATA COLLECTION, AND EDUCATION STAGE

2 WAYS TO GET A LEVY ON THE BALLOT

PETITION INITIATIVE IS THE MORE DIFFICULT WAY TO PLACE A LEVY ON THE BALLOT

• Requires gathering valid signatures of a number of local registered voters equal to 10% of those voting in the county in the prior election for governor
• Usually requires 20% because some will be disqualified for different reasons.

THE FIRST CAMPAIGN

• The last time we did an initial ballot initiative was in 2002
• We used the same template for all 4 first time ballot initiatives:
• County needs assessment conducted by Scripps Gerontology Center, Miami U
• Formed a campaign committee made up of committed volunteer advocates, local providers, etc.
• Petition signature drive
• Simultaneously gave the pitch to the Board of County Commissioners
• We passed each levy with the following margins: 57%, 58%, 60%, and 60%

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TAX AUTHORITY RESOLUTION��(COUNTY GOVERNMENT)

TYPES OF TAX SOURCES

Bond – Tax limited to capital improvements

Income – Tax based on an individuals income. Not yet attempted in Ohio.

Property – A tax based on real estate property value as determined by the county. Most traditional and only successful in the state.

THE REQUEST

The planning committee will have to go the County Board and ask them to place a levy on the ballot.

The request should include:

• What – What are you asking for
• Who – Who will get the service
• Why – Why are they need the service 
• How – How will the services be delivered

THE CAMPAIGN

CREATING A POLITICAL ACTION COMMITTEE (PAC)

THE FACES OF THE CAMPAIGN

CAMPAIGN MANAGER OR POLITICAL CONSULTANT

Campaign Manager

• Highly recommend hiring a professional campaign manager.
• Oversee all aspects of the campaign including day to day operations, the coordination and implementation of fundraising operations, coordinating media buys, assist in developing campaign materials and scheduling campaign events.

ORGANIZE A CAMPAIGN

CAMPAIGN COMMITTEES

Establish Subcommittees

• Levy Process: Ensure levy is on the ballot
• Finance and Fundraising: treasurer, budget, file, election reports, identify and contact donors, maintain records, fundraising events
• Grassroots: yard signs, speakers bureau, collateral materials, work events, allocate volunteers, kick off event(s)
• Media: messaging, photo shoots, “earned” media, purchased media, social media, mailings

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MODERN CAMPAIGN STRATEGIES THAT WORK FOR US

Every Campaign:

• Yard Signs
• 4x4 Large Signs (moved away from 4x8)
• Direct Mail to absentee and/or likely voters
• Social Media (Facebook and Google)
• Speaking engagements- local government, political clubs, Kiwanis, etc.
• Honk n Waves
• Poll workers

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MODERN CAMPAIGN STRATEGIES THAT WORK FOR US

Some Campaigns:

• Billboards
• Newspaper editorials, articles, ads.
• Radio
• Door to door canvassing
• Phone banks
• TV ads

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MESSAGING

• Develop One Message
• Stick to the message

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$52,638 Butler

$3,065 Clinton

$247,965 Hamilton

$28,122 Warren

$331,790 Total

TOTAL LEVY CAMPAIGN EXPENDITURES 2015-2017

Campaign Costs by County:

HAMILTON COUNTY�2017��ISSUE 5

$275K RAISED

HAMILTON COUNTY�2017��ISSUE 5

$248K EXPENSED

MAHONING COUNTY EXPERIENCE

MAHONING COUNTY EXPERIENCE

LESSONS�LEARNED

LEVY�AGREEMENT

LEVY�AGREEMENT

COMMON MISCONCEPTIONS

SENIOR SERVICE LEVY PASSAGE RATES�*ALL RENEWALS EXCEPT CLINTON & HAMILTON COUNTY

COMMON MISCONCEPTIONS

COMMON MISCONCEPTIONS

COMMON MISCONCEPTIONS

�HAMILTON COUNTY �1992 - 2017

SOME TRUTHS-

THE BENEFITS OF LEVIES

• Great community impact- large numbers of older adults and family caregivers benefit

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• Opportunities for innovation, change, improvement. Much more flexible.

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• Ability to be responsive to changing needs, and to solve problems.

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QUESTIONS

We will resume at 10:00 am

The Next Generation: the future of

Long-Term Services and Supports

Ljudmila Burchfield

Sr. VP Compliance, Legal Affairs, Data Protection & Privacy

Chris Fagerstrom

Sr. VP of HCBS

Francine Chuchanis

Director of Entitlement Rights

Payors and Services

Waivers Age Groups

Dual Eligible for Medicare and Medicaid

Managed Care Products Available to Dual Eligible

Medicare, Medicaid, Waiver and Duals: Managed and non-Managed

Traditional Medicare

Medicare Advantage

D-SNP

Medicaid

Managed Medicaid

LTSS

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Managed LTSS (MLTSS)

MyCare

MyCare: aligned Medicaid

MyCare aligned all Medicaid funded services:

• Requires all Medicaid services to be provided by one entity including LTSS (THIS IS US), but not Medicare (opt out)
• Can elect to receive Medicare through the same entity.

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Medicare

Non-MyCare Regions  

While MyCare aligned Medicaid service, non-MyCare regions are very unaligned. A person can receive:

• Primary, acute, and post-acute services through Medicaid directly
• Medicare services from a Managed Care Organization
• Waiver from Ohio Department of Aging  

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Medicare

Medicaid

ODA

Next Generation Medicaid: primary, acute and post-acute

• Aligning: By December 1, all recipients of Medicaid primary, acute, and post-acute services will be moved to managed care in one of the Next Generation Plans. 
• Does not include Waivers or Dual Eligible Home and Community Based Services at this time; does NOT include LTSS right now.    
• But, MyCare is a demonstration
• ending in 2022...unless not ending in 2022...

Future of MyCare: Options

MLTSS

• An arrangement between state Medicaid programs and managed care plans through which the managed care plans receive capitated payments for long term services and supports (LTSS), including both home- and community-based services (HCBS) and/or institutional-based services.
• Fully Intergraded Medicaid: One plan manages all the beneficiary’s Medicaid services including LTSS. Very similar to MyCare for Medicaid services.  

Option for MyCare: MLTSS

MLTSS Option for MyCare

• Fully Integrated MLTSS Partially Integrated MLTSS

MLTSS

Next Gen. Medicaid Plan

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One Plan Manages all Medicaid Services: Primary, Acute, Post-Acute & LTSS

Medicare

MLTSS Example

• Dan: 64-year old Medicaid recipient 
• Primary, acute, and post-acute services through Next Generation Medicaid Plan provided by Best Health 
• Due to functional limitations, Dan is now eligible for LTSS 
• Best Health also offers LTSS (MLTSS)
• In fully integrated MLTSS, he would receive his LTSS from Best Health as well
• Once he turns 65, he will be eligible for Medicare
• Could receive Medicare services from Best Health if Best Health has Medicare Advantage, another Medicare Advantage Plan, or traditional Medicare 

Option for MyCare: D-SNP: Medicare Product

D-SNP

• Fully Integrated (FIDE) Highly Integrated (HIDE)

One Plan Manages all Medicaid and Medicare  Services: Primary, Acute, Post-Acute & LTSS

MLTSS

or

LTSS

Medicaid and Medicare Primary Acute and Post-Acute

D-SNP Example

• Sam: 65 year-old needs LTSS; has been receiving Medicaid Services from Next Generation Best Health and LTSS from State Department on Aging 
• Eligible for Medicare 
• Best Health also offers FIDE SNP 
• At 65, he is enrolled into Best Health FIDE SNP and now receives all his Medicare, Medicaid, and LTSS care through Best Health
• In HIDE SNP, Sam’s LTSS could be carved out and he would have the option to continue to receive LTSS from State Department of Aging, Best Health or another MCO, depending on the design 

MyCare Conversion: Plan Required

Option for MyCare: Something Else

HIDE SNP

FIDE SNP

LTSS

MLTSS

Fully Integrated Medicaid

Our Role �

“WE ARE THE ONLY COMMON DENOMINATOR FOR TRANSITION OF CARE AND TRANSITION OF PLANS” �      - Gary L. Cook

Current LTSS Offerings

DIRECTION HOME AKRON CANTON �PROGRAM ENROLLEES

MyCare Ohio

CURRENT MYCARE OHIO REGIONS

AAA roles in MyCare Ohio 

AAA roles in MyCare Ohio 

AAA roles in MyCare Ohio 

AAA MyCare Ohio Successes

AAA MyCare Ohio Successes

Shift from Institutional to Home & Community Based Care�

Member Transitions

Area Agencies on Aging

Using data to maximize performance

Member Satisfaction Scores

Overall ODM Audit Performance

This score was reached by averaging the plan’s compliance over each of the nine performance measures.

80.0

70.0

60.0

50.0

40.0

30.0

20.0

10.0

0.0

90.0

100.0

CareSource

Plan 1

UnitedHealthcare

Plan 3

Plan 4

State Average

Compliance Percentage

94

CMS Minimum Requirement - 86%

Paving the future LTSS path forward

Area Agencies on Aging:��A Bright Spot in the MyCare Ohio Demonstration

During a presentation for the Health Policy Institute of Ohio titled Care Coordination in Managed LTSS: Ohio Case Study, former Ohio Department of Medicaid Director, John McCarthy stated, 

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“…requiring MCO contracts with Ohio AAAs was the best decision made”. 

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Planning for an aging Ohio: Exploring policy options for investing in prevention and quality care - Health Policy Institute of Ohio (healthpolicyohio.org)

Finding Success by Building Upon the Existing Infrastructure

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"Ohio requires that MCOs participating in its demonstration program for dual-eligible beneficiaries partner with AAAs.

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These and other aging- and disability-focused community-based organizations have critical links to the community and understand the populations they serve."

NGA-Improving-the-Health-and-Well-Being-of-the-Nations-Aging-Population.pdf

History of success in managing long-term services & supports

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"the AAA coordinators tended to have a better understanding of the different needs of the younger populations with disabilities."��

AAA Critical Priorities

Dual Plans

Role of Ombudsman Now and in the Future

Ombudsman Role in My Care

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• Specifically addressed in the 3-Way contract
• Outreach & consumer empowerment through education
• Person centered investigation and complaint resolution
• Reporting of casework data to CMS quarterly
• Provides access to member advisory councils
• Specifies participation in all stakeholder & oversight activities

CMS Funding in Dual Demonstrations

Specific Duties of My Care Ombudsman

• Assure access to services including adequate provider networks
• Coordinate with Automated Health Services to resolve enrollment issues
• Assure person centered care plans
• Uphold consumer rights including choice, written notices, right to copies of care plans & any information used affecting consumer services
• Assist members with grievances & appeals
• Attend Member Advisory Councils

Coordination with Local Stakeholders

Common Issues in My Care

• Transportation services – no accountability
• Reductions in home care services and DME denials
• Minimal coordination in the nursing home setting
• Workforce shortages/lack of home care availability
• Confusing appeals process
• Home modifications process and workforce
• Difficulty comparing benefits between My Care & D-SNP plans
• Poor information exchange between plans 
• Demonstration evaluation not yet released

Statewide Ombudsman Activity  �Data as of 8-31-22

Important Future Considerations

Additional Future Considerations

• Allow for consumer choice in enrollment, clear default notices, change periods
• Tailor services to characteristics & needs of dual population including social determinants of health
• Incorporate  AAA extensive knowledge of Medicaid, expertise with My Care opt-in populations, other community- based programs including caregiver programs and transitions 
• Maintain AAA role in assessment, care management, waiver service delivery
• Fund & continue Ombudsman role in consumer advocacy & expansion in home and community- based services

QUESTIONS???

Thank you

Creative Partnerships for a New Reality: �The Impact of the Pandemic on Older Adult Supports

Jeff Wilhite�Summit County Council Member�District 4

Barb White�Deputy Director�Akron-Summit County �Public Library

Summit County Nursing Homes & Facilities Task Force

Community Report

Development of NH Task Force

112

Summit County LTC Profile

Task Force Initial Membership

• Jeff Wilhite, Council President
• Aimee Weekley
• Beth Burch
• Cari Templeton
• Carrie Carney
• Doug Kohl
• Judge Elinore Marsh Stormer
• Erika Witherspoon
• G. Felicia Miller
• Greg Ackerman
• Jennifer Yozwiak
• Jessica Burns
• Joe Altieri
• Cathi Rufener Freeland
• Kim Hone-McMahan
• Matthew Pool
• May Chen
• Mike Conley
• Needa Moore
• Nora Stadler
• Olivia Roberts
• Rebecca Sandholdt
• Sam McCoy
• Sue Augustine
• Susan Wong
• Tammy Denton
• Dr. Mary Dee
• Tonia Burford
• Victoria Schafer
• Whitney Spencer

Staffing

Digital Media

24 hour access to best-selling ebooks, digital audiobooks, digital magazines,

and streaming movies and music with your ASCPL card

Operations

Visiting

Pandemic Impact

(Inter)Personalized Service

Summary

Dr. Harvey Sterns

80 years young

to our sponsor

Program of All-Inclusive Care for the Elderly and Ohio: Providing for the enhanced needs of older adults

Ann Conn, CEO & President, MgGregor Foundation

Shawn Bloom, CEO, National PACE Association

Elizabeth Miller, Quality Director, McGregor PACE

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Understanding the PACE Model of Care

By:

Elizabeth Miller

Quality Director

McGregor PACE

Objectives

• What is PACE?
• History of PACE
• Define the IDT
• How is PACE different?
• Clinical Care at PACE
• Participant Centered Care

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What is PACE?

History of PACE

• The PACE Model of Care was created in 1973 to help the Asian-American community in San Francisco care for its elders in their own homes. Placing elders in nursing homes was not a culturally acceptable solution for their families.
• In order to meet this community need, On Lok Senior Services (“On Lok” is Cantonese for “peaceful, happy abode”) created an innovative way to offer care.
• This included an array of medical care, physical and occupational therapies, nutrition, transportation, respite care, socialization and other needed services using homecare and an adult day setting.

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PACE services include but aren’t limited to the following: �

• Primary Care (including doctor and nursing services)
• Hospital Care
• Medical Specialty Services
• Prescription Drugs
• Nursing Home Care
• Emergency Services
• Home Care
• PT/OT
• Recreational therapy

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• Meals
• Dentistry
• Nutritional Counseling
• Social Services
• Laboratory / X-ray Services
• Social Work Counseling
• Transportation
• Adult Day Care
• Respite Care

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PACE also includes all other services determined necessary by the IDT to improve and maintain the participant’s overall health

IDT: �Interdisciplinary Team

• Each participant is assigned to a team. The team meets regularly (weekly) to review assessments, exchange information, and solve problems as conditions and needs of participants change.
• Through the IDT, viewpoints of different disciplines are brought together, and information gained through interaction with PACE participants over time and in different settings is shared.
• This approach empowers those involved and allows more information to be available at the critical points when decisions are being made.

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Coordination of Care

How PACE is different…

Payment

Day Center

Transportation

PACE in Action

Consider the example of a patient who has frequent ED visits to be treated for skin infections caused by flea bites.

The traditional, fragmented care delivery system would have trouble addressing the root cause of the condition and might just keep treating the patient’s flea bites.

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Clinical Care at McGregor PACE

• In the first month of enrollment, participants are assigned to a transition team including a social worker and RN.
• During this time, the initial care plan is developed detailing what services the participant will receive.
• They are then transitioned to one of 12 IDT teams based on where they live.

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• Participants are assessed at minimum on a semiannual basis by the core members of the IDT (primary care provider, RN, master’s level social worker).
• Comprehensive assessments are completed annually to redetermine program eligibility with approval of the Ohio Department of Aging.

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Day to Day Clinical

Participant Centered Care

• The participant care plan is a living document that is individualized with the participant’s goals at the forefront.
• The needs of the participant, family/caregivers are an integral part of goals and are supported and honored by all team members.
• The team communicates regularly with the participant and family and involves them in decision making processes.
• The team is knowledgeable about and respects various cultural, religious and other considerations in caring for and working with participants and families.
• The team is informed and respectful of each participant’s end of life decisions such as resuscitation orders and other related issues affecting their care.

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National PACE Stats

• 95% live in the community
• Average age 77
• 69% women, 31% men
• States pay PACE programs 13% less than the cost of other Medicaid services
• PACE participants have less than 1 ED visit per member per year
• A 24% lower hospitalization rate than dually-eligible beneficiaries who receive Medicaid nursing home services
• 46% participants have dementia

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• Top 5 conditions:
• Vascular Disease
• Major Depression/Bipolar/Paranoid Behaviors
• Diabetes w/ Chronic Complications
• CHF
• COPD
• 17 trips per month per participant
• PACE participants average 6 prescriptions per month
• ADL assistance:
• 26% need help with 1-2 ADL’s
• 24% need help with 3-4 ADL’s
• 33% need help with 5-6 ADL’s

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PACE featured in the New York Times

https://www.nytimes.com/2022/03/12/health/elderly-health-care-pace.html

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Agenda

• PACE in Ohio
• History
• Participant Eligibility
• Services
• The PACE Revenue Model
• Current statistics, census
• Strategic Advantages
• Challenges

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McGregor Foundation

• Established in 1877
• Nursing: The Gardens
• Skilled & Long-term Care
• Residential Care:
• Assisted Living
• Affordable Senior Living
• Home and Community Based Care
• McGregor PACE
• McGregor Hospice
• Grantmaking – Northeast Ohio

PACE History in Ohio

Status of PACE Development �(as of January 2022)

McGregor PACE Center Locations

154

McGregor PACE Centers

BASIC REVENUE MODEL

156

Three main revenue streams:

• Medicare - Risk-adjusted, per member per month capitated payment from Medicare ~$3,400 PMPM
• Medicaid – fixed monthly payment regardless of living in community or nursing facility ~ $3,280 PMPM dual
• Medicare Part D - pharmacy benefits included in PMPM payment ~ $1,040 PMPM

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Managed Care Model: surplus from healthier participants offsets deficit from those more needy

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2021 PACE Enrollee Payer Distribution

McGregor PACE�Historical Average Census Growth

158

Successful Program Attributes

Physician commitment to business model

Sufficient local need to maximize census

Interdisciplinary team management

Community recognition and support

Service delivery model – location, timing, need

Healthcare community engagement

Reserve management

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Risk Management

• Two sources of participant risk:
• Extended institutionalization
• “Catastrophic” healthcare needs

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• “Stop loss” (reinsurance) available for

catastrophic healthcare

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• Delivery of all services regardless of need

Strategic Advantages

1. Aligns with McGregor’s Mission
• Supporting Seniors in Need and those who serve them
2. Strong demand for PACE services – Not reliant on a bed or a room
3. Broadens opportunities for McGregor colleagues
4. Licensure follows program and allows for flexibility to meet need through coordination of services versus moving to a new living environment
5. Leverages management strengths

161

Challenges

• Policy - “MyCare Ohio” integrated care delivery system
• Confusion about service options
• Growth
• Staffing
• Space
• Commitment of hospital partner
• Participant Risk

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PACE Expansion Coalition

Session Outline

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• PACE Strategies to Mitigate COVID Impact on Participants
• Confidence Survey of PACE leaders
• PACE growth trends and factors
• Significant issues impacting future of PACE
• Closing

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Support. Innovate. Lead.

164

Support. Innovate. Lead.

 This presentation is for general informational purposes only and does not constitute business or legal advice by NPA or any of its participating members. 

PACE Flexibly Adapted to COVID

• Reduce Center Access (Not Clinic)
• Reduce Access to Clinic
• Expand Health Svcs in the Home
• IDT Use of Remote Tech. for Assessments
• IDT Use of Remote Tech. for Monitoring, Care Planning
• Other IDT modifications
• Modified Intake Process
• 24-Hour Center Use
• Use Vans as Mobile Health Clinic
• Regular Telephone Check-ins
• Modified Enrollment Process

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Support. Innovate. Lead.

165

Support. Innovate. Lead.

 This presentation is for general informational purposes only and does not constitute business or legal advice by NPA or any of its participating members. 

PACE Rates Compared to SNFs

166

Support. Innovate. Lead.

 This presentation is for general informational purposes only and does not constitute business or legal advice by NPA or any of its participating members. 

PACE Rates Compared to SNFs

• Overall, PACE participants have throughout the pandemic and continue to be at approximately one-third the risk of nursing home residency for contracting or dying from COVID-19
• This is a testament of the flexibility and effectiveness of the PACE model of care, and a direct reflection of the tremendous resilience of the PACE community!

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Support. Innovate. Lead.

167

Support. Innovate. Lead.

 This presentation is for general informational purposes only and does not constitute business or legal advice by NPA or any of its participating members. 

94%

OVERALL SATISFACTION

Overall satisfaction with care and services provided during the pandemic

168

Support. Innovate. Lead.

 This presentation is for general informational purposes only and does not constitute business or legal advice by NPA or any of its participating members. 

SATISFACTION AND LOYALTY

169

Support. Innovate. Lead.

 This presentation is for general informational purposes only and does not constitute business or legal advice by NPA or any of its participating members. 

BURDEN DECREASED

68%

During COVID

170

Support. Innovate. Lead.

 This presentation is for general informational purposes only and does not constitute business or legal advice by NPA or any of its participating members. 

Despite (or perhaps because of) Pandemic Challenges PACE Leaders are Confident About the Future

171

Support. Innovate. Lead.

 This presentation is for general informational purposes only and does not constitute business or legal advice by NPA or any of its participating members. 

2022 CONFIDENCE SURVEY RESPONDENTS

74 PACE Leaders provided feedback, the majority of whom have been Directors for more than 3 years.

172

Support. Innovate. Lead.

 This presentation is for general informational purposes only and does not constitute business or legal advice by NPA or any of its participating members. 

CONFIDENCE OVERALL CONTINUES TO RISE

PACE Leaders have the highest confidence level recorded

2016

64

61

2019

62

2021

2017

60

2018

60

65

2022

173

Support. Innovate. Lead.

 This presentation is for general informational purposes only and does not constitute business or legal advice by NPA or any of its participating members. 

EXCELLENT/VERY GOOD GROWTH PROSPECTS

63% of leaders project excellent/very good growth prospects in the next year.

174

Support. Innovate. Lead.

 This presentation is for general informational purposes only and does not constitute business or legal advice by NPA or any of its participating members. 

FISCALLY HEALTHY

Fiscal health ratings of excellent/very good remain high.

175

Support. Innovate. Lead.

 This presentation is for general informational purposes only and does not constitute business or legal advice by NPA or any of its participating members. 

Future Growth of PACE

176

Support. Innovate. Lead.

 This presentation is for general informational purposes only and does not constitute business or legal advice by NPA or any of its participating members. 

�Historical PACE Organization Growth

Support. Innovate. Lead.

177

Support. Innovate. Lead.

 This presentation is for general informational purposes only and does not constitute business or legal advice by NPA or any of its participating members. 

Number of New PACE Organizations

Support. Innovate. Lead.

178

Support. Innovate. Lead.

 This presentation is for general informational purposes only and does not constitute business or legal advice by NPA or any of its participating members. 

Growth Environment – Current PACE states

Growing Existing PACE Organizations

• Expediting Enrollment
• Service Area Expansions

Adding New PACE Organizations

• RFPs Seeking New POs
• Fill-in unserved and underserved areas

FL

MA

NC

MD

LA

NJ

VA

OH

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Support. Innovate. Lead.

 This presentation is for general informational purposes only and does not constitute business or legal advice by NPA or any of its participating members. 

New PACE Organizations in Current PACE States�

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 This presentation is for general informational purposes only and does not constitute business or legal advice by NPA or any of its participating members. 

Expanding the PACE Map

• District of Columbia (not shown) – Working with one provider
• Missouri – Working with two providers. A program in the St. Louis area opened in May of 2022 another in the Kansas City area should open in Q4 of 2022.
• Kentucky – The state is supporting PACE development in 3 areas across the state, one of which opened in August 2022
• Illinois – Released an RFP in December, 2021. Eight new POs awarded markets in August, 2022.

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 This presentation is for general informational purposes only and does not constitute business or legal advice by NPA or any of its participating members. 

��PACE is Growing�Added 2020-21 and Projected 2022-2023

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 This presentation is for general informational purposes only and does not constitute business or legal advice by NPA or any of its participating members. 

PACE Census Growth

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 This presentation is for general informational purposes only and does not constitute business or legal advice by NPA or any of its participating members. 

What are the Factors Supporting Rapid PACE Growth?

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 This presentation is for general informational purposes only and does not constitute business or legal advice by NPA or any of its participating members. 

Pandemic Impact on Institutional Service Options

• 327 SNFs closed during the pandemic
• Another 400 expected to close in 2022 according to AHCA
• April 22, 2022, McNight’s LTC News
• Occupancy declined 13.3% since February 2020, ending 2021 at 70.1%
• NIC May, 2022 Newsletter
• Staffing challenges have limited nursing home capacity
• 90% of nursing home residents became infected with COVID during the pandemic

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 This presentation is for general informational purposes only and does not constitute business or legal advice by NPA or any of its participating members. 

Consumer Opinion

• 62% of consumers over the age of 62 indicated their opinion of nursing homes had worsened during the pandemic
• Statista - https://www.statista.com/statistics/1139773/changing-perceptions-of-us-nursing-home-during-pandemic-by-age/
• Research by The Associated Press National Opinion Research Center shows that, more than a year into the pandemic, 88% of Americans say they would rather care for elderly relatives in their own home instead of moving them into a facility.
• ABC News May 6, 2021

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 This presentation is for general informational purposes only and does not constitute business or legal advice by NPA or any of its participating members. 

Bottled Up Ambition for System Reforms

• 1999 - Olmstead Decision mandate to have access to community-based services
• 2001 - New Freedom Initiative established to remove barriers to community living for people with disabilities
• 2005 - Deficit Reduction Act make several changes to enable and promote opportunities to receive care in the community
• 2010 – ACA established several initiatives to both integrate care and expand community-based options
• 2019 – 59% of Medicaid LTSS expenditures, compared to 20% in 1995

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 This presentation is for general informational purposes only and does not constitute business or legal advice by NPA or any of its participating members. 

States Need to Rebuild Capacity and Were Provided Federal Incentives

• Recognizing diminished SNF capacity and closures, and to incentivize expanded community-based options:
• American Rescue Plan Act of 2021 (ARPA) included a 10% enhanced Medicaid match for HCBS expenditures from April 2021 through March of 2022 (total = $12.7B)
• State SNF expenditures dropped 9.8% in 2020 compared to 2.2% average annual increases between 2013-2019 (Health Affairs, 12/16/20)
• Reductions in 2020 (and likely beyond) State Medicaid SNF expenditures offer opportunities for reinvest in community-based service options

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 This presentation is for general informational purposes only and does not constitute business or legal advice by NPA or any of its participating members. 

Factors Potentially Impacting PACE Moving Forward

• Consumer opinion – should we change our messaging?
• State HCBS expansions and relief funds – are we included in plans?
• Market competition – what’s the right balance for PACE sponsors and consumers?
• Staffing challenges – impact on growth during a time of unprecedented expansion?
• Operational flexibilities – can we retain some of our innovations?
• Capital markets – are they sufficient to support growth?
• Leadership – how to train and support new leaders?
• Linkages to other services and models – what about Greenhouses, senior housing and CCRCs?
• New state environments – how will expanding HCBS options impact PACE competition and rate setting?
• PACE audit protocol – Is it time to consider a new federal regulatory framework and audit?

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 This presentation is for general informational purposes only and does not constitute business or legal advice by NPA or any of its participating members. 

PACE is Finally Getting the Attention is Deserves!

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 This presentation is for general informational purposes only and does not constitute business or legal advice by NPA or any of its participating members. 

Questions?

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 This presentation is for general informational purposes only and does not constitute business or legal advice by NPA or any of its participating members. 

We will resume at 3:00 pm

AGE FRIENDLY PANEL

FACILITATOR: SUSAN SIGMON

• CO-CHAIR AGE FRIENDLY AKRON, CO-CHAIR AGE FRIENDLY SUMMIT

DAN HORRIGAN

• MAYOR OF AKRON

ILENE SHAPIRO

• SUMMIT COUNTY EXECUTIVE

DR. HARVEY STERNS

• PROFESSOR EMERITUS, THE UNIVERSITY OF AKRON DEPT. OF PSYCHOLOGY, CO-CHAIR AGE FRIENDLY AKRON, CO-CHAIR, AGE FRIENDLY SUMMIT

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HOUSING

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OUTDOOR SPACES AND BUILDINGS

TRANSPORTATION

COMMUNICATION AND INFORMATION

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CIVIC PARTICIPATION AND EMPLOYMENT

RESPECT AND SOCIAL INCLUSION

SOCIAL PARTICIPATION

HEALTH SERVICES AND COMMUNITY SUPPORTS

AKRON SUMMIT AGE FRIENDLY TASK FORCE

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EDUCATE AND EMPOWER

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Selected Actions and Key Considerations:

1. Develop a “positive aging campaign” featuring older adults in the County that shines a positive light on aging and involves all residents.
1. Shifting perceptions of “older adults” to 50+, using “Age-Friendly” labels on certain programs or services as well as a #AgeFriendly on social media (but more of an umbrella or category than a separate entity).
2. Highlighting the diverse ways people can age healthily and happily, and having age-friendly role models in our communities.

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• Increase awareness and promotion of aging resources including United Way 211, Job and Family Services, and Direction Home as three primary entry points to obtain services for older adults.
• Show people “this service is for you”
• Make sure people know that these entities do more than just essential services but also fun activities,
• Connecting the dots between serving older adults and serving the greater community.

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• Develop multi-generational mentorship programs and engagement opportunities to advance senior skills with tech, etc. add higher ed and local school systems
• Volunteer yard work, recipe sharing between older and younger folks, technology training with college students, and community history, book clubs and story sharing.

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EDUCATE AND EMPOWER

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“Envision” a community where intergenerational activities are the norm.

COMMUNICATE BROADLY

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Selected Actions and Key Considerations:

1. Develop specific strategies for communicating and reaching out to different populations throughout the County. Use and evaluate created strategies to provide the greatest level of effectiveness.
1. Timely information sharing.
2. Social media is important, but so is word of mouth.
3. Increase awareness of collaboration among service providers, let people know we all talk.
4. Age-Friendly Ambassador program.

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• Evaluate the success of printed directories vs. online databases and promote one or both. Use the best methods that will serve the Summit County community.
• Need to utilize printed and digital resources.
• Leverage Getting Wiser magazine pilot.

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• Partner with libraries, senior centers, healthcare, cities, faith community, specific neighborhoods and communities and the County to create a coordinated communications policy. These policies should be made available to the public to increase awareness and access.
• Added faith community involvement.

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INCREASE CONNECTIONS

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Selected Actions and Key Considerations:

1. Support neighborhood-level community events through small grant funding opportunities and coordinated promotion of information on County communication channels.
• Utilize feedback from the focus groups, survey to make sure we fund the most relevant events. Listening sessions indicated that people want to socialize, and that these community events are sorely needed because of the pandemic.
• Folks need to be able to get to and engage with these events in a meaningful way, though if they can’t get there they can’t engage at all.
2. Develop long-term communication structures to improve Senior awareness of local issues, events, meetings, and activities.
• What information or lists are out there now? How effective are they?
• Is there a point of contact that can direct people to the many key organizations that have events and resources? Is 211 this contact, and if so, how can we let people know that it offers resources and services AND events and engagement information?
• Physical material, digital material, word of mouth, pros and cons to all.

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3. Identify funding to develop pilot projects for senior cultural, educational and artistic events.

• Current events that could be enhanced or organized more often: bus rides to fun places, such as the West Side Market, First Fridays, Museums for All, Senior Tea at Stan Hywet, intergenerational book club, etc.

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ENHANCE LIVABILITY

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Selected Actions and Key Considerations:

1. Develop a countywide home improvement and maintenance program that offers services regardless of homeownership status.

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• Identify additional funding sources for the modification of older housing. This would reduce blight and empower neighborhood renewal while protecting housing values and neighborhoods.

REMOVE BARRIERS/IMPROVE COMMUNITY SERVICES

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Selected Actions and Key Considerations:

1. Create an “Age-Friendly Seal of Approval” Program aimed at businesses, service providers, transit options and public spaces to improve the County’s “age-friendliness.”

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• Coordinate transportation services among providers to better meet the transportation needs of everyone in the County.

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• Expand housing counseling services to identify loans, grants, or other financial tools that will assist property owners and homeowners to encourage and support affordable Aging-in-Place.

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2022 FALL CONFERENCE