Office for Aging Services, DARS Division for Community Living
Commonwealth Council on Aging2020 Annual Report with2021 Legislative RecommendationsDRAFTCommonwealth of VirginiaRichmondSeptember 16, 2020-1342819339700 September 16, 2020 DearHonorable Ralph S. Northam,Members of the General Assembly, and Members of the Public:-3422651261110Pursuant to § 51.5-127 of the Code of Virginia, the Commonwealth Council on Aging (“Council”) is charged with promoting an efficient, coordinated approach by state government to meeting the needs of older Virginians. This has been an unusual year for all of us. While the Council has monitored the COVID-19 pandemic and shifted to electronic meetings, the entire world has wrestled with trying to manage this crisis and mitigate its disproportionate impact it has on older adults. The Council commends the dedicated work of the Department for Aging and Rehabilitative Services (DARS), the 25 local Area Agencies on Aging, and the array of public and private service providers, all of which provide crucial support to older Virginians and their caregivers every day, but especially during the COVID-19 pandemic. The Council strongly encourages Virginia’s leadership not to lose sight of the importance of keeping the Commonwealth’s older adults safe, healthy, and engaged with their family, friends, and communities. The Council was pleased to celebrate its 2020 Best Practices Awards winners. The Best Practices Awards honor model aging programs that improve the lives of older Virginians and support caregivers. Although the Council could not hold its traditional in-person recognition ceremonies, with support from DARS, a webinar to acknowledge these ever vital programs is planned for September 24, 2020 from 2:00 to 3:00 pm.The Council has developed its 2021 legislative recommendations, many of which reflect the unprecedented times. The recommendations include: Restore the Currently Unallotted Medicaid Adult Dental Benefit;Provide Full Funding for the State Long-Term Care Ombudsman Program;Mandate Sick Leave for Direct Care Workers in Nursing Homes, Assisted Living Facilities, and Home and Community-Based Services; Restore the Currently Unallotted Funds for Dementia Specific Case Management;Restore the Currently Unallotted Funds for the Virginia Center on Aging;Require Training on LGBT Cultural Competency for Staff in Nursing Homes, Assisted Living, and Home and Community-Based Services; andAdd Report Language to the Council’s Duties.The Council is grateful for the opportunity to submit this report to you for your consideration. The Council looks forward to partnering with policymakers in advocating for older Virginians.Sincerely, DRAFT Beverley A. Soble, ChairCOMMONWEALTH COUNCIL ON AGING 2020 BEST PRACTICES AWARDS-2381256691630Third Place Award, tie ($1,000): In 2013, Volunteer Solutions created the Helping Hands (HH) Program to de-clutter, organize, and perform intensive yard work for older adults and adults with disabilities to allow for them to age in place safely and with dignity. The Fairfax clients served by the HH Program are unable to perform these tasks themselves due to physical limitations and are unable to afford the service if purchased privately. Many clients are at risk of eviction or are already involved in the eviction process due to the condition of their residences. Staff members conduct assessments, identify needs, and coordinate the work. Supplies and services are supported by donations from partnerships. To date, the HH program has created 37 partnerships with 757 volunteers giving 3,464 hours, valued at over $88,000. The HH program has served 112 clients and prevented evictions for 11 clients.00Third Place Award, tie ($1,000): In 2013, Volunteer Solutions created the Helping Hands (HH) Program to de-clutter, organize, and perform intensive yard work for older adults and adults with disabilities to allow for them to age in place safely and with dignity. The Fairfax clients served by the HH Program are unable to perform these tasks themselves due to physical limitations and are unable to afford the service if purchased privately. Many clients are at risk of eviction or are already involved in the eviction process due to the condition of their residences. Staff members conduct assessments, identify needs, and coordinate the work. Supplies and services are supported by donations from partnerships. To date, the HH program has created 37 partnerships with 757 volunteers giving 3,464 hours, valued at over $88,000. The HH program has served 112 clients and prevented evictions for 11 clients.-2381254872355Third Place Award, tie ($1,000): The Arlington Agency on Aging (AAA) partnered with the Arlington’s Addiction and Recovery Initiative (AARI) to deliver drug deactivation kits for older adults in the community to safely dispose medications. While exploring potential opportunities to expand the program and provide information about medication safety and drug deactivation kits, Arlington AAA partnered with Arlington Virginia Insurance and Counseling Assistance Program (VICAP) to offer Medication Safety for Older Arlingtonians. VICAP achieves this goal through community events where older adults receive medication safety education, assistance with Medicare and Medicare Part D prescription coverage and signup, information on the safe disposal of medications, and drug deactivation kits. The Medication Safety for Older Arlingtonians program advances the Arlington County’s efforts toward realizing its Age Friendly Plan.00Third Place Award, tie ($1,000): The Arlington Agency on Aging (AAA) partnered with the Arlington’s Addiction and Recovery Initiative (AARI) to deliver drug deactivation kits for older adults in the community to safely dispose medications. While exploring potential opportunities to expand the program and provide information about medication safety and drug deactivation kits, Arlington AAA partnered with Arlington Virginia Insurance and Counseling Assistance Program (VICAP) to offer Medication Safety for Older Arlingtonians. VICAP achieves this goal through community events where older adults receive medication safety education, assistance with Medicare and Medicare Part D prescription coverage and signup, information on the safe disposal of medications, and drug deactivation kits. The Medication Safety for Older Arlingtonians program advances the Arlington County’s efforts toward realizing its Age Friendly Plan.-2381252567305Second Place Award ($3,000): Jimmy’s PetPals is a companion pet program developed at Sentara Martha Jefferson Hospital to help patients with dementia have a better hospital experience. The PetPals are Hasboro? “Joy for all Companion Pets,” life-like robotic dogs and cats that exhibit animal-like behaviors. Abby Denby, Director of Patient Care Services, initially provided a robotic companion pet to her father who was struggling while hospitalized. The program was then expanded with financial support from the hospital’s foundation and a grant from the Patient and Family Advisory Council. Now, any hospital staff member caring for a patient with dementia who is agitated, combative or depressed can obtain a companion pet for the patient. Jimmy’s PetPals have benefited 30 patients at the hospital so far. Clinicians and hospital staff express that Jimmy’s PetPals has reduced the use of patient restraints and improved patients’ demeanors. Denby is beginning a study measuring patients’ agitation levels, and restraint and antipsychotic use before and after receiving a PetPal, as well as analyzing feedback from clinical staff about their experiences caring for patients before and after receipt of a PetPal.00Second Place Award ($3,000): Jimmy’s PetPals is a companion pet program developed at Sentara Martha Jefferson Hospital to help patients with dementia have a better hospital experience. The PetPals are Hasboro? “Joy for all Companion Pets,” life-like robotic dogs and cats that exhibit animal-like behaviors. Abby Denby, Director of Patient Care Services, initially provided a robotic companion pet to her father who was struggling while hospitalized. The program was then expanded with financial support from the hospital’s foundation and a grant from the Patient and Family Advisory Council. Now, any hospital staff member caring for a patient with dementia who is agitated, combative or depressed can obtain a companion pet for the patient. Jimmy’s PetPals have benefited 30 patients at the hospital so far. Clinicians and hospital staff express that Jimmy’s PetPals has reduced the use of patient restraints and improved patients’ demeanors. Denby is beginning a study measuring patients’ agitation levels, and restraint and antipsychotic use before and after receiving a PetPal, as well as analyzing feedback from clinical staff about their experiences caring for patients before and after receipt of a PetPal.-235585796593First Place Award ($5,000): Staples for Seniors and Fido’s Pantry offers food assistance to homebound seniors and their cats or dogs. Seniors in rural areas expressed difficulty with affording and accessing grocery items, and many would give their food to their pets who also needed a reliable food source. Since launching the program, New River Valley Agency on Aging (NRVAOA) served 248 seniors each month with necessary groceries throughout all of Planning District Four. Fido’s Pantry provides monthly pet food assistance and supplies to 87 of the households who access the food assistance. Volunteers assisting with the delivery process provide social interaction for isolated older adults, and also help identify additional needs and services for the clients. The program has a 96% client satisfaction rate, and has also been made available to seniors not affiliated with NRVAOA, but who are in the midst of a food crisis. 020000First Place Award ($5,000): Staples for Seniors and Fido’s Pantry offers food assistance to homebound seniors and their cats or dogs. Seniors in rural areas expressed difficulty with affording and accessing grocery items, and many would give their food to their pets who also needed a reliable food source. Since launching the program, New River Valley Agency on Aging (NRVAOA) served 248 seniors each month with necessary groceries throughout all of Planning District Four. Fido’s Pantry provides monthly pet food assistance and supplies to 87 of the households who access the food assistance. Volunteers assisting with the delivery process provide social interaction for isolated older adults, and also help identify additional needs and services for the clients. The program has a 96% client satisfaction rate, and has also been made available to seniors not affiliated with NRVAOA, but who are in the midst of a food crisis. Established in 2006, the Best Practices Awards recognize and encourage the replication of model programs, particularly those that foster aging in place, livable communities and home and community-based services. With financial support from Dominion Energy, the Council encourages the development of these innovative programs. COMMONWEALTH COUNCIL ON AGING -266700307975The Council gave Honorable Mentions to the following organizations:Longevity Project for a greater Richmond for its Housing Stability Learning Labs, which equips providers across the sectors of human services with increased knowledge applied to their professional roles, as well as bridge building and relationship strengthening across sectors.Senior Connections, the Capital Area Agency on Aging for its Ride Connection program, which ensures older adults and persons with disabilities have knowledge and access to transportation to age in place and live a healthy, socially connected life.Central Virginia Alliance for Community Living, Inc. for its TAKE CHARGE: Care Transitions Intervention, a partnership with Centra Foundation, supports older adults who are transitioning from hospital to home with coaching services focused on managing medical conditions and reducing hospital readmissions. 00The Council gave Honorable Mentions to the following organizations:Longevity Project for a greater Richmond for its Housing Stability Learning Labs, which equips providers across the sectors of human services with increased knowledge applied to their professional roles, as well as bridge building and relationship strengthening across sectors.Senior Connections, the Capital Area Agency on Aging for its Ride Connection program, which ensures older adults and persons with disabilities have knowledge and access to transportation to age in place and live a healthy, socially connected life.Central Virginia Alliance for Community Living, Inc. for its TAKE CHARGE: Care Transitions Intervention, a partnership with Centra Foundation, supports older adults who are transitioning from hospital to home with coaching services focused on managing medical conditions and reducing hospital readmissions. 2020 BEST PRACTICES AWARDSThe Council, DARS, and Dominion Energy cordially invite you to join us as we celebrate the Council’s 2020 Best Practices Award Winners! The Best Practices Awards serve to encourage organizations across the Commonwealth to develop and support programs and services that assist older adults to age in their community. The upcoming webinar will highlight this year’s amazing winners: First Place: Staples for Seniors & Fido’s Pantry, a program of New River Valley Agency on AgingSecond Place: Jimmy’s PetPals, a program of Sentara Martha Jefferson HospitalThird Place (tie): Medication Safety for Older Arlingtonians, a program of Arlington Agency on AgingThird Place (tie): Volunteer Solutions’ Helping Hands Program, a program of Fairfax County Area Agency on Aging-Volunteer SolutionsWebinar attendees will have the chance to learn more about these award winning programs, how the programs can be replicated, and how programs can be nominated for the Council’s 2021 Best Practices Awards. To Register: COUNCIL ON AGING -152400316865Restore the Currently Unallotted Medicaid Adult Dental Benefit020000Restore the Currently Unallotted Medicaid Adult Dental Benefit2021 LEGISLATIVE RECOMMENDATIONS Access to dental care is one of the greatest health care challenges facing older adults, especially those with low incomes and without dental insurance. According to the U.S. Centers for Disease Control and Prevention, a decline in oral health – such as gum disease, missing teeth, and dental cavities – can affect nutritional status, behavior, sleep, self-esteem, communication with others, and overall quality of health and life for older people. Individuals may lose dental insurance when they retire, and Medicare does not cover oral health. Currently, Virginia Medicaid covers dental services for adults only for emergency extractions, when medically necessary, as well as some initial services provided through Commonwealth Coordinated Care Plus (CCC Plus) Medicaid plans, which is insufficient to meet the needs. According to the Virginia Health Catalyst, poor oral health is associated with diabetes, high blood pressure, heart disease, and stroke. Medicaid coverage for adults will not only improve health, but save funds due to improved chronic disease management and reduced inappropriate use of emergency departments. The 2020 General Assembly provided funding for a Medicaid Adult Dental Benefit from the general fund and federal funds for both years of the biennium. In response to the COVID-19 pandemic, the 2020 Budget unallotted these funds (Item 313 #46c). The Council seeks their restoration. -167640386715Provide Full Funding for the State Long-Term Care Ombudsman Program020000Provide Full Funding for the State Long-Term Care Ombudsman ProgramThe State Long-Term Care Ombudsman Program (“Program”) acts as a voice for nursing home and assisted living residents as well as those who receive home and community-based services. The Program helps to resolve care problems and issues of basic resident rights. Individuals who are denied care may experience preventable complications and hospitalizations, costing taxpayer dollars and inflicting unnecessary suffering on a vulnerable population. Early intervention by an ombudsman representative can save money, prevent harm, and maintain dignity.The General Assembly adopted the recommended national standard of one ombudsman representative for every 2,000 long-term care beds (Code of Virginia § 51.5-135), but has never funded the Program at the level necessary to achieve that ratio. In some areas of the state, coverage is as low as one ombudsman representative per 5,000 beds. A fully funded Program will be better equipped to respond to the needs. The Council recommends fully funding the State Long-Term Care Ombudsman Program. COMMONWEALTH COUNCIL ON AGING -123825311702Mandate Sick Leave for Direct Care Workers in Nursing Homes, Assisted Living Facilities, and Home and Community-Based Services 020000Mandate Sick Leave for Direct Care Workers in Nursing Homes, Assisted Living Facilities, and Home and Community-Based Services 2021 LEGISLATIVE RECOMMENDATIONS (continued)Providing paid sick leave to direct care workers in nursing homes and assisted living is a major public health issue. Such workers have very low wages; some live in poverty and/or rely on public assistance. They often go to work when they are sick to continue to earn their meager incomes to support themselves and their families, thus exposing those in their care and others to grave illness. Some must work more than one job due to the low wages, carrying infection directly from one long-term care facility to another.Home care workers provide quality, hands-on care to maximize the well-being of older adults and people with disabilities and help them to live with dignity. Home care workers are essential to enable those they serve to live independently in the community, often keeping them out of institutional settings where COVID-19 is more prevalent. When sick, home care workers can spread illness to their clients as well as other staff and families. -1238251235710Restore the Currently Unallotted Funds for Dementia Specific Case Management (DSCM)020000Restore the Currently Unallotted Funds for Dementia Specific Case Management (DSCM)Direct care workers in all of these settings are essential to the welfare of older adults and people with disabilities, providing personal care and help with activities of daily living. They should have paid sick leave during and after the pandemic. Eleven states now protect at least some direct care workers through broader sick leave employment policies that vary in their requirements, but Virginia offers no such option. Paid sick leave will not only protect the health and safety of people needing assistance, but also their families, their caregivers, and their communities.? Caring for an individual with Alzheimer’s disease or other dementias poses unique challenges. According to the U.S. Centers for Medicare and Medicaid Services (CMS), more than 95% of individuals with dementia have one or more other chronic conditions, such as hypertension, heart disease, and diabetes. Further, a person with dementia is 4.4 times more likely to have six or more other chronic conditions than someone without dementia. Many of these conditions and consequent costs could be avoided with proper care management and assistance in navigating our health care system. The DSCM program would provide better care coordination, seamless navigation across the multitude of providers, and timely access to interventions. The 2020 General Assembly initially provided $150,000 in the first year of the biennium and $150,000 in the second year to support DSCM (Item 340#1c). These funds were unallotted due to the COVID-19 pandemic, and the Council seeks their restoration. COMMONWEALTH COUNCIL ON AGING 2021 LEGISLATIVE RECOMMENDATIONS (continued)-152400172720Restore the Currently Unallotted Funds for the Virginia Center on Aging (VCOA)020000Restore the Currently Unallotted Funds for the Virginia Center on Aging (VCOA) VCOA develops the skills and capacities of the gerontological and geriatric workforce throughout the Commonwealth. VCOA supports training initiatives focused on areas such as dementia, advance care medical planning, caregiving, mental health, and other best care practices. Current capacity falls far short of the need. The 2020 General Assembly provided $100,000 in the first year of the biennium and $100,000 in the second year to support VCOA training (Item 214#3c). These funds were unallotted due to the COVID-19 pandemic. The Council seeks their restoration. -153670216535Require Training on LGBT Cultural Competency for Staff in Nursing Homes, Assisted Living, and Home and Community-Based Services020000Require Training on LGBT Cultural Competency for Staff in Nursing Homes, Assisted Living, and Home and Community-Based ServicesRecent research shows that some LGBT older adults encounter violations of their rights when seeking long-term care services and supports; and that many are uneasy about acceptance, concerned about how they might be treated, or fear they might be subject to neglect, abuse or verbal or physical harassment. The federal 1987 Nursing Home Reform Law and federal regulations require nursing facilities to “protect and promote the rights of each resident” (42 CFR 483.10). The Code of Virginia sets out residents’ rights, and specifies that nursing facilities must provide staff training to implement these rights (§ 32.1-138). Virginia regulations provide specific requirements for nursing facility staff training (12VAC5-371-260). Additionally, the Code of Virginia sets out residents’ rights in assisted living (§ 63.2-1808), and regulations provide requirements for initial staff training (22VAC40-73-120). Models of long-term care staff training on LGBT cultural competency exist. For example, the U.S. Administration for Community Living and the HHS Office of the Assistant Secretary for Public Affairs have collaborated to develop an online training tool for staff of long-term care facilities.In 2020, Virginia enacted legislation prohibiting discrimination on the basis of sexual orientation and gender identity in housing, employment, public places and credit applications. In alignment with these new protections, the Council recommends that LGBT cultural competency be listed as required training for staff in nursing homes, assisted living, and home and community-based services. COMMONWEALTH COUNCIL ON AGING -153670338455Add Report Language to the Council’s Duties020000Add Report Language to the Council’s Duties2021 LEGISLATIVE RECOMMENDATIONS (continued) Every year the Council produces an Annual Report with Legislative Recommendations. The Annual Report is not automatically sent to the General Assembly because the Code of Virginia provisions describing the Council’s duties do not include the language that would authorize this to occur. By comparison, the Alzheimer’s Disease and Related Disorders Commission statutory duties includes such language (Code of Virginia § 51.5-154(D)(5)), ensuring that all members of the General Assembly will receive the Commission’s Report. The Council duties include a mandate to “advise the Governor and General Assembly on aging issues and aging policy.” The lack of statutory report language impedes the implementation of this duty. The proposed language would be a new subdivision ((A)(6)) in Code of Virginia § 51.5-128 as provided below: “Submit to the Governor, General Assembly, and Department by October 1 of each year an electronic report regarding the activities and recommendations of the Council, which shall be submitted for publication as a report document as provided in the procedures of the Division of Legislative Automated Systems for the processing of legislative documents and reports and shall be posted on the General Assembly's website and the Department's website.”COMMONWEALTH COUNCIL ON AGING MEETINGS, PRESENTATION TOPICS, AND ACTIVITIESFor this reporting period, the Commonwealth Council on Aging met on: December 18, 2019, and June 17, August 11, and September 16, 2020. The Council’s meetings featured educational presentations and discussions on: 685800532447500Looking ahead, the Commonwealth Council on Aging will meet on January 27, April 28, July 28, and September 22, 2021. Educational presentations and topics planned for the upcoming year so far include: The Council also anticipates it will finalize updates to the Council bylaws. During the COVID-19 pandemic and Virginia’s state of emergency, the Council has shifted from hosting in-person meetings to hosting electronic meetings. Live public access to the Council meetings has been provided through the DARS YouTube page (). COMMONWEALTH COUNCIL ON AGING MEMBERSThe purpose of the Commonwealth Council on Aging shall be to promote an efficient, coordinated approach by state government to meeting the needs of older Virginians. (Code of Virginia § 51.5-127)Council Members Beverley A. Soble, Chair, of RichmondTerm ends 6/30/24Kathryn B. Reid, PhD, RN, Vice-Chair, 5th DistrictTerm ends 6/30/21David Broder, of ViennaTerm ends 6/30/24Tresserlyn L. Kelly, 3rd DistrictTerm ends 6/30/21Harvey E. Chambers, CSA, of Glen AllenTerm ends 6/30/24Diana Paguaga, 11th DistrictTerm ends 6/30/20Deborah Davidson, RN, 7th DistrictTerm ends 6/30/22Debbie Preston, MS, of ChesterfieldTerm ends 6/30/24Jennifer L. Disano, 10th DistrictTerm ends 6/30/22J. Tina Savla, PhD, of BlacksburgTerm ends 6/30/24Amy Duncan, 9th DistrictTerm ends 6/30/2021Michael Wampler, of Big Stone GapTerm ends 6/30/24Joni Goldwasser, DNP, NP, 6th DistrictTerm ends 6/30/21John “Jay” White, EdD, MSG, 4th DistrictTerm ends 6/30/22Carter R. Harrison, of PowhatanTerm ends 6/30/22Roland Winston, of RichmondTerm ends 6/30/20Carla Hesseltine, of Virginia BeachTerm ends 6/30/22Erica Wood, Esq., 8th DistrictTerm ends 6/30/20Ex Officio MembersThe Honorable Daniel Carey, MDSecretary of Health and Human ResourcesKathryn Hayfield, CommissionerVirginia Department for Aging and Rehabilitative ServicesTara Davis-RaglandVirginia Department of Social ServicesDeborah SilvermanRepresentative, Virginia Association of Area Agencies on AgingTerry A. SmithDepartment of Medical Assistance Services356679580067151610 Forest Avenue, Suite 100Henrico, Virginia 23229PHONE: (804) 662-9333FAX: (804) 662-9354dars@dars.001610 Forest Avenue, Suite 100Henrico, Virginia 23229PHONE: (804) 662-9333FAX: (804) 662-9354dars@dars.Council Staff MembersCharlotte Arbogast, MSPolicy Analystcharlotte.arbogast@dars. Cecily SlasorAdministrative Supportcecily.slasor@dars.08010525 ................
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