COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Health Services Agency

DATE:

August 10, 2004

BOARD MEETING DATE:

August 31, 2004

TO:

Honorable Board of Supervisors

FROM:

Charlene A. Silva, Director of Health Services
Lisa L. Mancini, Director of Aging and Adult Services

SUBJECT:

Amendments to 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 Authorizing the President of the Board of Supervisors to execute:

1.

Amendment I to the Agreements with Avenidas, City of Menlo Park, City of Pacifica, City of San Bruno, City of South San Francisco, Second Harvest Food Bank and Senior Coastsiders; and

2.

Amendment II to the Agreements with Alzheimer’s Association of Northern California, Catholic Charities CYO, Center for Independence of the Disabled, City of Belmont, City of Daly City, City of San Mateo, 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., and Self-Help for the Elderly

Background

Fiscal Year 2004-05 is the final 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. A second RFP was approved by the Commission on Aging (CoA) and released in October 2001 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, Community-Based Services Programs (CBSP) and Health Insurance Counseling and Advocacy Program (HICAP) agreements with CDA for 2004-05.

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. The Commission on Aging has approved these categorical allocations.

Discussion

Services to be funded through these provider agreements include Congregate Nutrition, Home-Delivered Meals, Brown Bag, Adult Day Care/Adult Day Health Care, Transportation, Senior Employment, Disease Prevention/Health Promotion, Legal Assistance, Ombudsman Programs, HICAP, Family Caregiver Support Services and Alzheimer’s Programs. 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. These amendments reflect funding allocations for the second year of the two-year terms for these agreements that coincide with the end of the planning cycle, June 30, 2005.

The amendment with Second Harvest Food Bank adds funding for FY 2004-05 and extends the original term through June 30, 2005, to match the terms of the other provider agreements.

Budget shortfalls at State and County levels necessitated funding reductions to many of these providers. Except for HICAP funds that were allocated separately, CDA block granted Title III/VII and CBSP funds to allow more flexibility in program planning at the local level while implementing a five percent reduction in funds. Aging and Adult Services (AAS) has minimized the impact of these reductions on services to vulnerable seniors and adults with disabilities through prioritization and targeting of resources to programs serving those in greatest social and economic need. Funding reductions were applied by reducing the AAS administrative allocation, the Brown Bag Program and eliminating the Senior Companion Program as prescribed by the State, and reducing allocations to other programs according to performance and the aforementioned prioritization strategy.

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.

Consistent with contract approval level limitations in County Administrative Memorandum B-1, the Director of Health Services will be authorized to execute amendments and modifications to these agreements, not to exceed $25,000 in aggregate.

The Commission on Aging and County Counsel have reviewed and approved these amendments to the provider agreements as to form and content.

Performance Measures

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 2002-03 and projected outcomes for 2003-04 and 2004-05 for contracted primary and prevention services funded through OAA and designed to serve San Mateo County’s severely impaired clients.

Clients served
by Contract Providers

2002-03 Actual

2003-04 Projected

2004-05 Projected

Total Severely Impaired Clients

3,339

3,605

3,641

Severely Impaired Clients living independently

2,764
(83%)

2,884
(80%)

2,949
(81%)

All of the providers comply with the Equal Benefits Ordinance except for the City of South San Francisco, which 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.

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 remains the same, July 1, 2003 through June 30, 2005. The total contracted amount for these amendments to the agreements for FY 2004-05 is increased by $2,910,733 for a total obligation of $6,153,014 for the term of these agreements. This amount reflects a 1.9% decrease of $52,947 in State and Federal funding (Title III/VII/V, CBSP, and United States Department of Agriculture). The County General Fund contribution to these agreements is $69,765, which is the Net County Cost. Funding available for the Supplemental Meals on Wheels program from the Meals on Wheels Trust Fund is $87,240. These funds are included in the AAS 2004-05 adopted budget.