COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Health Services Agency

DATE:

August 20, 2003

BOARD MEETING DATE:

September 9, 2003

TO:

Honorable Board of Supervisors

FROM:

Margaret Taylor, Director of Health Services
Charlene A. Silva, Director of Aging and Adult Services

SUBJECT:

Agreements with Various Providers of Older Americans Act (OAA) and Community- Based Services Program (CBSP) Funded Programs for Contract Term July 1, 2003 through June 30, 2005

Recommendation

Adopt a resolution:

1.

Authorizing the President of the Board of Supervisors to execute agreements with Alzheimer's Association, Avenidas, Catholic Charities, Center for Independence of the Disabled, City of Belmont, City of Daly City, City of Menlo Park, City of Millbrae, City of Pacifica, City of San Bruno, City of South San Francisco, Coastside Adult Day Health Center, Edgewood Center for Children and Families, Family Caregiver Alliance, Family Service Agency, Legal Aid Society, Mills-Peninsula Senior Focus, Inc., Ombudsman of San Mateo, Inc., Peninsula Volunteers, Inc., Self-Help for the Elderly, and Senior Coastsiders;

2.

Authorizing the County Manager to execute amendments and minor modifications to these agreements, not to exceed $100,000; and

3.

Authorizing the Director of Health Services to execute amendments and minor modifications to these agreements, not to exceed $25,000.

Background

Fiscal year 2003-04 is the third year of a four-year planning and funding cycle for OAA and CBSP funded programs initiated through a Request for Proposal (RFP) released by Aging and Adult Services (AAS) in FY 2000-01. Additionally, a second RFP was approved by the Commission on Aging (CoA) and released when the California Department of Aging (CDA) made funds available for the Title IIIE Family Caregiver Support Program. The agreements included here provide for the continuation of services established under both RFPs.

Funding for these services is a combination of federal, state, and county dollars; contributions from providers and the individuals served; and other grants and contributions from the community. Federal and state funding is provided through the Title III/VII, Title V, and CBSP agreements for 2003-04.

Discussion

Services to be funded through these provider agreements include Congregate Nutrition, Home-Delivered Meals, Adult Day Care/Adult Day Health Care, Assisted Transportation, Transportation, Senior Employment, Disease Prevention/Health Promotion, Legal Assistance and Ombudsman Programs, Health Insurance Counseling and Advocacy (HICAP), Family Caregiver Support Services and Alzheimer's Day Care Resource Centers (ADCRC). All service providers were selected through the approved RFP processes mentioned above, which were open to all interested providers and reviewed by evaluation teams approved by the CoA. This year's contracts have two-year terms to coincide with the end of the planning cycle in 2005.

This year budget deficits at the State level have resulted in reductions for some local programs. Though funding for Brown Bag, Foster Grandparents and Senior Companions programs was eliminated in the Governor's proposed budget, some of this funding was restored in the final approved budget. In any case San Mateo County's service providers will continue to operate these programs in FY 2003-2004 using direct federal funding supplemented by state funding if available. Despite reductions in funding for OAA nutrition programs, AAS, in consultation with CoA, has maintained units of service for meals to be served in FY 2003-2004 at levels equal to FY 2002-2003. Necessary reimbursement rate reductions to service providers have been offset by reduced costs for provider agencies which are now contracting with a new, less expensive caterer. The ombudsman program is the one program to receive a significant funding increase this year. These additional funds will be used to increase the number of trained volunteers who will monitor quality of life issues for residents of skilled nursing facilities.

Agreements with providers are reviewed quarterly to assess program performance for the purpose of redistribution of funds and to accommodate state allocations of one-time-only funds as they become available. We are requesting your Board's authorization to execute amendments and minor modifications as needed to these agreements as follows: County Manager not to exceed $100,000 and Director of Health Services not to exceed $25,000.

Performance Measures

The OAA and CBSP grants support a broad continuum of services, which can be grouped into three levels of care. At the primary level, Information and Assistance, Health Insurance Counseling, Congregate Nutrition, Transportation, Legal Assistance, Senior Employment, and Disease Prevention/Health Promotion serve the most able and independent individuals. At the prevention level, Home-Delivered Meals, Adult Day Care/Adult Day Health Care, Alzheimer's Day Care, Assisted Transportation, Family Caregiver Support Services, and Case Management ensure that severely impaired adults can remain in the community as long as possible and avoid premature institutionalization. At the protective level, the Ombudsman Program provides advocacy services for the severely impaired individuals who reside in institutions.

AAS has continued to make the provision of services that help maintain severely impaired individuals in independent settings a division-wide performance measure. With the assistance of the services provided through these agreements we have met this measure as a division. The following table shows performance measures for 2001-02, 2002-03, and projected outcomes for 2003-04 for contracted prevention and protection services funded through OAA and designed to serve San Mateo County's severely impaired clients.

CLIENTS SERVED BY CONTRACT PROVIDERS

2001-02 ACTUAL

2002-03 ACTUAL

2003-04 PROJECTED

TOTAL SEVERELY
IMPAIRED CLIENTS

3,272

3,462

3,478

SEVERELY IMPAIRED CLIENTS LIVING INDEPENDENTLY

2,024 (62%)

2,112 (61%)

2,156 (62%)

All of the providers comply with the Equal Benefits Ordinance except for the City of South San Francisco, who requested a waiver. A waiver was granted to this provider because there is no other compliant contractor able to provide services in this specific geographic area.

County Counsel has reviewed and approved these agreements.

Vision Alignment

These agreements keep the commitment of Ensuring Basic Health and Safety for All and goal number 8: Help vulnerable people - the aged, disabled, mentally ill, at-risk youth and others - achieve a better quality of life. The agreements contribute to this commitment and goal by providing services throughout the county designed to assist individuals with the greatest needs to maintain their independence and dignity within the least restrictive setting possible.

Fiscal Impact

The term of these agreements is July 1, 2003 through June 30, 2005. The total contracted program cost for this package of agreements for FY 2003-04 is $9,056,122. Of this amount, 31.2% or $2,828,064 is provided through state and federal funding (Title III/VII/V, CBSP, and United States Department of Agriculture), 46% or $4,169,329 represents the provider contribution, 19.4% or $1,754,782 represents anticipated client contributions, and 1.4% or $126,984 represents funding for the Supplemental Meals on Wheels (SMOW) program from the Meals on Wheels Trust Fund specifically for this purpose. The remaining $176,963 or 2% of the total program expense represents the county general fund contribution. These funds are included in the approved 2003-04 AAS budget.