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  1. 1. SAN FRANCISCO STATISTICS By 2020, seniors will make up 21.3% of San Francisco’s population. 2007 136,369 Older Adults in San Francisco 2010 148,200 Growth of 9% 2020 174,000 Growth of 28%
  2. 2. SAN FRANCISCO STATISTICS 85 Years and Older Total growth: 10,373 2000 14,227 2010 22,600 Growth of 8,3373 2020 24,600
  3. 3. SAN FRANCISCO STATISTICS Younger Adults with Disabilities 2004 60,000 YAD 28,000 2 or more disabilities 2007 5,000 YAD in IHSS
  4. 4. 1996 AB1040 <ul><li>Long Term Care integration Pilot Program </li></ul><ul><li>To maximize independence for older adults and disabled adults </li></ul><ul><li>Improve availability and effectiveness of LTC Services </li></ul><ul><li>Integrate financing and administration of LTC Services </li></ul><ul><li>It required counties to establish a single LTC services agency </li></ul><ul><li>Consolidate and administer funding locally </li></ul><ul><li>Operate under capitated managed care </li></ul>
  5. 5. 2002 1 st Community Partnership Grant from Robert Wood Johnson - $175,000 to develop a strategic plan Living with Dignity in San Francisco to make improvement in community-based LTC and support services 2004 Received $750,000 Implementation Grant 2005 San Francisco Controller’s Office issues report Laguna Honda Replacement Program Where do we go from here? $11,500,000 Community Living Trust serve 575 people 2006 $3,000,000 Community Living Fund established
  6. 6. New $3 Million Community Living Fund (CLF) <ul><li>Purpose of Initiative : To reduce unnecessary institutionalization by providing older adults and adults with disabilities with options for how and where they receive services </li></ul><ul><li>No one willing and able to live in the community need be institutionalized because of a lack of community-based long-term care alternatives </li></ul><ul><li>IMPACT : CLF is now funding case management PLUS purchased services & equipment to help individuals currently in or at risk of being institutionalized. </li></ul>
  7. 7. The Following Groups of People Will Be Served: <ul><li>Top priority . Patients of Laguna Honda Hospital (LHH) and San Francisco General Hospital (SFGH) who are willing and able to be discharged to community living. </li></ul><ul><li>Nursing home eligible individuals on the LHH waiting list (some of whom are at SFGH and other hospitals) who are willing and able to remain living in the community. </li></ul><ul><li>Individuals who are at imminent risk fro nursing home or institutional placement, willing and able to remain living in the community with appropriate support. </li></ul>
  8. 8. Eligibility Criteria <ul><li>Be 18 years and older </li></ul><ul><li>Be a resident of San Francisco </li></ul><ul><li>Be willing and able to be living in the community with appropriate supports </li></ul><ul><li>Have income up to 300% of Federal poverty level for a single adult:: $31,200 plus savings/assets of $6,000 (Excluding assets allowed under Medi-Cal) </li></ul><ul><li>Have a demonstrated need for a service and/or resource that will serve to prevent institutionalization. </li></ul>
  9. 9. Eligibility Criteria cont. <ul><li>Be institutionalized or be deemed at assessment to be at imminent risk of being institutionalized. In order to be considered at “imminent risk”, an individual must have at a minimum, one of the following: </li></ul><ul><ul><li>A functional impairment in a minimum of two Activities of Daily Living (ADL): eating, dressing, transfer, bathing, toileting, and grooming; or </li></ul></ul><ul><ul><li>Having a medical condition to the extent requiring the level of care that would be provided in a nursing facility; or </li></ul></ul><ul><ul><li>Being unable to manage one’s own affairs due to emotional and/or cognitive impairment; and have a functional impairment in a minimum of 3 Instrumental Activities of Daily Living (IADL); taking medications, stair climbing, mobility, housework, laundry, shopping, meal preparation, transportation, using telephone and money management . </li></ul></ul>
  10. 10. CLF <ul><li>COSTS </li></ul><ul><li>Average total cost for Case management (CM) and Purchase of Service (POS) for all clients (not just those receiving POS), including all levels of case management: $534/month* </li></ul><ul><ul><li>Taken from FY 0708, 292 clients </li></ul></ul><ul><ul><li>Includes Intensive, stable and low-level CM needs </li></ul></ul><ul><li>Average cost of POS per client (all, not just those receiving POS) is approximately $185/month </li></ul><ul><li>Of all those who receive POS, 80% have an average cost of: below $500/month* </li></ul><ul><li>* Those over $3000/month are for large ticket items like a StairCarry </li></ul>
  11. 11. Electronic ROLODEX <ul><li>The Electronic ROLODEX is a web-based application developed by the Department of Public Health’s IT department for staff from community-based organizations participating in the Case Management Connect Pilot Project (CMCPP). CMCPP is a demonstration project in which selected case management programs are partnering to develop a formal organization through which they can coordinate case management services for the clients that they serve. </li></ul><ul><li>Electronic ROLODEX was developed to meet the following objectives: </li></ul><ul><li>Provide online tool for identifying and coordinating case management services. </li></ul>
  12. 12. The purpose of the Electronic Rolodex is to reduce duplication for both staff and clients, improve client outcomes, enable analyses of clients’ utilization across citywide services, and help evaluate and measure impact for San Francisco’s vulnerable older adults and adults with disabilities.
  13. 13. Diversion and Community Integration Program (DCIP) The DCIP Unit Purpose: To provide an integrated approach for individuals referred for admission to and diversion and discharge from Laguna Honda Hospital (LHH), with the goal of placing those individuals in the most integrated setting appropriate to their needs and preferences. DCIP makes decisions about LTC access to services, including LHH admissions and discharges, and access to housing and other community-based services. The Core Group of the DCIP is a decision making body capable of authorizing and committing to service needs.
  14. 14. DCIP TEAM INCLUDES <ul><li>The DCIP Coordinator – DAAS </li></ul><ul><li>The Core Group of the DCIP: (provides access to services) </li></ul><ul><ul><li>DAAS IHSS – Home Care Services </li></ul></ul><ul><ul><li>DPH Housing and Urban Health – Housing </li></ul></ul><ul><ul><li>DPH Behavioral/mental health services </li></ul></ul><ul><ul><li>Community Oriented Primary Care Clinics – Access to community primary care services </li></ul></ul><ul><ul><li>SF Behavioral Health Center – Behavioral/mental health </li></ul></ul><ul><ul><li>DAAS LTC Intake and Screening Unit – Community LTC services </li></ul></ul><ul><ul><li>LHH Administration: LHH Admissions, Eligibility and Screening Committee (A&E): </li></ul></ul><ul><ul><li>DPH Placement – short and long-term access to Residential Care For the Elderly, residential treatment etc. </li></ul></ul>
  15. 15. DCIP TEAM cont. <ul><li>LHH Admission, Eligibility and Screening (A&E) </li></ul><ul><li>DAAS Waiver Specialist </li></ul><ul><li>Discharge/Case Management Staff and Liaisons: </li></ul><ul><ul><li>Targeted Case Management staff at LHH and SFGH </li></ul></ul><ul><ul><li>DPH Placement staff at SFGH </li></ul></ul><ul><ul><li>LPHH Social Services </li></ul></ul><ul><ul><li>Community Living Fund, Community Case Management </li></ul></ul><ul><ul><li>Other community partners, as appropriate </li></ul></ul><ul><li>DAAS Director of Quality Management Services </li></ul>
  16. 16. DCIP Process Flow Chart