“I want to thank Governor DeSantis for his support and for his unparalleled commitment to Florida seniors,” said Department of Elder Affairs Secretary Richard Prudom. “With the changing demographics and increasing elder population, it is important that we are continuously adapting and improving to best serve our seniors. Governor DeSantis is engaged on aging issues that affect so many families across Florida, whether it is combatting dementia, increasing funding for essential home and community-based services, or making our state more age-friendly. Governor DeSantis continues to set the example and establish the framework for our success, and I am grateful for his leadership and commitment to our elders.”
2019 Accomplishments for the Department of Elder Affairs
Florida Achieves Age-Friendly Designation: Livable Florida
In April, Florida became the fourth state in the nation to join the AARP Network of Age-Friendly States and Communities, an announcement that was jointly made by Governor DeSantis, Department of Elder Affairs (DOEA) Secretary Richard Prudom, and AARP’s national CEO, JoAnn Jenkins. Establishing a Florida that allows people of all ages and abilities to live well and age well is the ultimate goal of the initiative. Called Livable Florida, the goal of the efforts is to engage communities across the state to be more inclusive, accessible, safe, respectful, and engaging of older residents so that all can live well and age well. Everything points to the fact that the communities that will fare best in the 21st century will be those that both tackle the challenges and embrace the positive possibilities that an aging population creates. These Livable Communities will help maximize the independence and quality of life of older adults, while also enhancing the economic, civic, and social vitality of the community.
Since the designation announcement, Livable Florida has gained momentum, and Florida now has 34 Age-Friendly Communities. The Department created a bi-monthly Livable Florida newsletter that is being distributed to public and private partners and the public to increase awareness and encourage new communities to join. Governor DeSantis has recommended more than $440,000 in next year’s budget to support this initiative.
Secretary Prudom Highlights Florida’s Strong Aging Network in Testimony Before United States Senate
During Older Americans Month this year (May), Secretary Richard Prudom was invited to present before the U.S. Senate Select Committee on Aging to discuss Florida’s strong Aging Network. The purpose of the committee hearing was to discuss reauthorization of the federal Older Americans Act, which most do not realize is the primary funder of older adult services across the country, and to highlight all that Governor DeSantis is doing to make Florida the best place for older adults and their families. Florida was selected for our many innovative ways to serve the growing and increasingly diverse senior population and the Department was highlighted as model for other states to follow. The Committee was especially interested in our Age-Friendly efforts, Governor DeSantis’ efforts to combat dementia, and DOEA’s Dementia Care and Cure Initiative.
DOEA Expands Efforts to Make Florida Dementia Caring
To improve the lives of millions of Floridians affected by dementia, Governor DeSantis announced his Dementia Action Plan in March. With more than 560,000 residents living with Alzheimer’s disease, the most well-known form of dementia, tens of thousands more affected by other forms of dementia, and more than 1.1 million caregivers of those with Alzheimer’s Disease or Related Dementias (ADRD), Governor DeSantis has made combatting dementia and supporting affected Floridians a top priority.
As part of his initiative to fight dementia, Governor DeSantis challenged the Department to expand the Dementia Care and Cure Initiative (DCCI) by the end of the year. As of November, the Department met this challenge, as DCCI now has active task forces in all of Florida’s 11 Planning and Service Areas (PSAs). The Department continues to work with communities currently participating to develop and implement solutions that are dementia-sensitive and caring for those affected by dementia. While all PSAs are now active, DOEA is working to increase the number of participating cities and counties within each PSA as the number of those affected by or diagnosed with dementia continues to rise.
In support of these Floridians, Governor DeSantis secured a funding increase for the Department’s Alzheimer’s Disease Initiative (ADI) in the 2019 Bold Vision for a Brighter Future budget. An additional $3.1 million was provided to serve additional elders with Alzheimer’s disease and provide relief, respite care, and counseling for their caregivers. For next year’s budget, Governor DeSantis has recommended additional funding increases of more than $3.6 million to serve more individuals.
DOEA Makes Significant Changes to State Guardianship Program
To further ensure that the best interests of Florida residents under the Guardian Program are respected and protected, the Legislature expanded the authority of the DOEA guardianship office, the Office of Public and Professional Guardians (OPPG), to include regulating more than 550 professional guardians statewide. This includes the investigation and, if appropriate, discipline of the guardians found in violation of laws and rules. In July, Secretary Prudom took direct control of the OPPG and asked for the resignation of its Executive Director after discovering inefficiencies in the program. In less than a month, Secretary Prudom cleared a backlog of approximately 80 cases that had been investigated but final decisions and appropriate administrative discipline had not yet been implemented.
Secretary Prudom also made other operational and personnel changes to improve the effectiveness of the office. This included changing the process to increase transparency and accountability by making investigative reports available at the completion of the investigation rather than waiting for the Department’s response in action to the findings. Now, the reports are made available at their completion while DOEA notifies complainants timelier of the investigation findings and enacts appropriate administrative discipline. Further, the Secretary modified the processes to ensure appropriate resources are spent on investigations, including confirming that only legally sufficient complaints are referred for investigation.
In his Bolder, Brighter, Better Future Budget Recommendations, Governor DeSantis has recommended approximately $6.5 million in funding increases for OPPG, including an additional $455,000 for guardianship complaint investigations, $500,000 for the development and implementation of a monitoring tool to ensure guardians’ compliance with established standards of practice, and more than $5.5 million in recurring funding to serve more needing public guardianship services.
Secretary Prudom worked closely with Governor DeSantis and his team, as well as Florida legislative leadership on legislation aimed at making improvements to the guardianship program. The legislation addresses issues of conflicts of interest, compensation, and strengthening and formalizing the process by which a professional guardian obtains a Do-Not-Resuscitate (DNR) order on a ward.
DOEA Expands Efforts to Stop Abuse, Neglect, and Exploitation of Elders
Stopping abuse, neglect, and exploitation (ANE) of seniors and vulnerable adults is an integral part of Livable Florida and DOEA’s statewide efforts to make Florida a place where seniors can live well and age well safely and free from abuse. Social isolation is a major factor that can increase the vulnerability of an elder. DOEA has been working with communities through the Livable Florida initiative to help prevent social isolation and, therefore, reduce exploitation. DOEA has expanded its focus on World Elder Abuse Awareness Day, recognized internationally each year on June 15. The Department is now partnering with the Consumer Financial Protection Bureau to plan for and host an Elder Fraud Prevention and Response Network training event in the spring of 2020. In his Bolder, Brighter, Better Future Budget Recommendations, Governor DeSantis has recommended $160,000 in increases to fight abuse, neglect, and exploitation through Livable Florida and the expansion of our Elder Abuse Awareness Day activities and outreach.
DOEA Partners with DOH on State Health Improvement Plan
At the direction of Governor DeSantis, the Department partnered with the Alzheimer’s Association and the Department of Health to add Alzheimer’s Disease and Related Dementias (ADRD) to the State Health Improvement Plan (SHIP). Florida is the only state in the nation to have ADRD has its own priority area in the SHIP. The subcommittees of the new priority area workgroup have implemented the strategies and objectives in the SHIP to ensure that Florida is a place where all Floridians, including individuals living with ADRD, their families, and caregivers, can live and live well. The SHIP subcommittees have already met several of their goals or objectives, including implementing mobile outreach efforts through the Alzheimer’s Association Brain Bus.
Earlier this year, DOEA included in the new ADRD priority area in the SHIP a strategy that each of the hospitals and universities that house the state’s Memory Disorder Clinics (MDCs) answer Governor DeSantis’ challenge to provide matching funding annually to the clinics to allow for an increase in the number of individuals they serve with evaluation and diagnostic testing for dementia. The 16 contracted MDCs are working to meet Governor DeSantis’ challenge to serve more people through a variety of ways, including increased funding, expansion of clinic staff and doctors, and reprioritizing resources to ensure increased service delivery.
DOEA Prioritizes and Advocates for Florida’s Caregivers
This year, Secretary Prudom updated the mission and vision of the Department of Elder Affairs to increase awareness of the importance of Florida’s caregivers.
The new mission is to promote the health, safety, and independence of Florida’s seniors, their families, and caregivers. The updated vision is for all Floridians to live well and age well. The intention of this change was to more formally declare DOEA’s commitment to supporting the millions of important and selfless caregivers and care partners across Florida – more than 2.9 million – who make numerous sacrifices to care for others. One of the most important things the Department is working on is how to make Florida more age-friendly, and a significant part of that is ensuring that communities are livable, accessible, and supportive of caregivers.
One of the most important trends affecting home and community-based long-term care is the growing recognition of the burden borne by family caregivers and of their needs. Caregivers have been and will continue to be the backbone of long-term care, so prioritizing their wellness is critical to ensure the needs of seniors continue to be met.
DOEA Increases Financial Support for Caregivers Through HCE Program
In July, Elder Affairs increased the basic subsidy for caregivers each month through the Home Care for the Elderly (HCE) Program. The subsidy had not been updated in more than 20 years and is essential to offset expenses for providing support and maintenance of the elder for whom they care. The Department went through the rule promulgation processes to increase the payment. Additionally, DOEA changed its policy to allow clients to be dually enrolled in HCE and the Statewide Medicaid Managed Care Long-term Care Program (SMMC LTC), which now permits existing HCE clients who are released for SMMC enrollment to also keep their basic subsidy caregiver benefit if they choose.
Department Modifies Community Care for the Elderly (CCE) Program
CCE is a general revenue program that provides an array of community-based services to meet the needs of functionally impaired elders. These services are most needed to prevent unnecessary nursing home placement and meets immediate crisis-resolving needs of elders. Following a program evaluation, it was determined that some clients were terminating their services due to the inability to pay co-payments established in the program. In order to better serve seniors, DOEA updated the co-pay policy for CCE clients to ensure continued services to clients who are unable to pay. Effective July 2019, no co-payments are assessed on any CCE client whose income is at or below the federal poverty level. Additionally, no CCE client may have their services terminated for inability to pay their co-pay.
DOEA Builds Long-Term Feeding and Nutrition Partnerships
DOEA worked to expand a partnership with Feeding Florida that began after Hurricane Michael to identify and resolve immediate food assistance needs following the storm. While many partnerships and project occur before, during, and immediately after an emergency event, DOEA staff worked this year to continue, on a long-term basis, a partnership with Feeding Florida, DOEA, the Florida Department of Agriculture and Consumer Services, and the Department of Children and Families (DCF).The purpose of the efforts is to unite all programs that can provide assistance to prevent and resolve senior hunger throughout the year.
DOEA’s Adult Care Food Program (ACFP) Sees Tremendous Growth
Florida continues to successfully administer the nation’s only bifurcated Child and Adult Care Food Program. The separation of the child and adult portions into two individual programs administered through two distinct state agencies allows for a more focused approach to serving elders. ACFP supports the provision of nutritious meals and/or snacks for community-based adults attending adult care centers. These important meals support the client’s nutrition status and enables them to prolong living independently in their communities rather than in a nursing home. ACFP has grown by adding 26 new providers, which is a 75% increase since 2015. With the increase in providers comes an increase in US Department of Agriculture (USDA) funding allocated to DOEA. Additionally, unused funds from the Florida Department of Health (DOH), which administers the Child Care Food Program, have been reallocated to DOEA to serve more seniors in need of food assistance. The additional funding has also supported program efforts to have fully bilingual program administration. USDA often highlights the accomplishments of Florida’s ACFP and has been encouraging other states to consult with DOEA regarding successful administration of the program.
DOEA Expands Advocacy Activities at Florida Senior Day
At this year’s Florida Senior Day event, DOEA expanded programming to include a new Senior Day Forum with a panel led by Secretary Prudom to discuss issues facing Florida’s seniors, their families, and the Aging Network. At this year’s event, topics discussed included the state’s Age-Friendly efforts; Governor DeSantis’ initiatives to combat dementia and support affected residents; preventing abuse, neglect, and exploitation; funding for senior services and the growing demographics, and the unique needs of Florida’s senior veteran population, to name a few. Also new to the enhanced program this year was the Florida Senior Day dinner at which the highest-ranking senior services and advocacy official, the U.S. Assistant Secretary for Aging and Administrator for ACL – Lance Robertson, provided the keynote and highlighted the many ways Florida is a model for other states in service to seniors.
DOEA Bureau Utilizes Mapping to Locate and Serve Seniors Needing Assistance
The Bureau of Planning & Evaluation (P&E) created and utilizes custom client-based and population-based ArcGIS maps to help the Department and Florida’s Aging Network achieve its mission and goals. The population-based maps allow DOEA and partners to locate concentrations of seniors needing assistance and also provide population statistics for all 67 counties. The Elder Needs Index (ENI) ranks geographical areas according to the characteristics of the resident elder population. This mapping allows DOEA to follow the expressed intent of the Older Americans Act, the Department’s primary federal funding source, to target senior populations that are socially, racially, or culturally isolated; in poverty, or have a disability. While the maps are used to identify areas of need, this year they were also utilized to support the Alzheimer’s Disease and Related Dementias (ADRD) new priority area workgroup in the State Health Improvement Plan.
Program staff have created an annual disaster event mapping exercise to determine which clients could be most seriously affected by emergency events, to effectively plan for their relocation before an event, and to arrange for possible extended care or support after an event. Many Aging Network and DOEA clients are uniquely vulnerable, disoriented, and/or displaced during natural disasters, especially during the hurricanes that have hit Florida in recent years. Many, if not most, of these individuals are dependent upon supervision or require hands-on help to perform basic self-care and are homebound. Often times, elders are unable to evacuate without transportation and personal care or attendant support. This year, DOEA was awarded a TaxWatch Productivity Team Award for the disaster-mapping activities and Bureau staff were also selected to present these innovations at various conferences, including the esteemed Gerontological Society of America’s (GSA) Annual Scientific Meeting. Further, Secretary Prudom highlighted these technological innovations during his U.S. Senate testimony in May and was asked to share with other states.
Planning & Evaluation Unit Modify DOEA County Profiles with Enhanced Demographic and Research Features
The Department’s Profiles of Older Floridians (available by county, Planning and Service Area (PSA) and statewide) have been used by DOEA and partners for more than a decade, and, over time, they have grown to be a touchstone for various publications and work products. The Profiles provide an extensive range of data on older adults that are organized at the state, regional, and county levels. This year’s Profiles have been enhanced with significant updates. New features include a complete organizational change in the document, more graphics, new maps with evacuation zones, new information on topics like hurricane preparedness, and the creation of a user guide. Information in the Profiles are now divided into different sections organized around the following key themes: demographics, finances, Livability Index; health and medical resources, and disaster preparedness. In addition, the Profiles are now available as a new subset based on the Legislative District level.
DOEA Awarded Grants and Funding to Serve Additional Older Adults
This year, the Department of Elder Affairs was awarded two significant grants from the U.S. Administration for Community Living (ACL) for capacity development of falls prevention in rural areas and chronic disease self-management education in underserved areas. These funds will provide $150,000 for each program over a three-year period to reach individuals in counties that currently have no access to falls prevention programs and no access to chronic disease self-management programs. Falls are the leading cause of fatal and non-fatal injuries among people age 65 or older in Florida, causing 2,884 deaths, 57,862 non-fatal hospitalizations, and 185,447 non-fatal emergency room visits in 2018. Many falls can be prevented through home-safety education, strength and balance exercises, and improved doctor-patient communication.
DOEA was also awarded the Medicare Improvements for Patients and Providers Act (MIPPA) grant from ACL. With this funding, DOEA will enhance state efforts to assist Medicare beneficiaries through a statewide partnership with Florida’s 11 Area Agencies on Aging (AAAs).
DOEA also received the Senior Companion Program (SCP) grant from the Corporation for National and Community Service (CNCS). This grant renewal enables the Department to continue SCP services to older adults at risk of nursing home placement due to chronic illnesses, disabilities, or isolation.
In addition to the increases in funding for the Alzheimer’s Disease Initiative (ADI) mentioned earlier, DOEA received $2.1 million in increased funding to serve more seniors through the Community Care for the Elderly (CCE) Program, the Department’s flagship home and community-based services program to help keep seniors living independently in their homes rather than being institutionalized in a nursing home.
DOEA Fights Senior Exploitation Through Senior Medicare Patrol (SMP)
In June 2018, the Department of Elder Affairs SHINE (Serving Health Insurance Needs of Elders) Program was awarded the five-year Senior Medicare Patrol (SMP) grant from the Administration for Community Living within the U.S. Health and Human Services (HHS) Department. The mission of SMP is to help prevent, detect, and report suspected Medicare fraud, waste, and abuse. The director of the DOEA’s SHINE (Serving Health Insurance Needs of Elders) Program has assumed control as Director over this initiative as well and has expanded the reach and effect in 2019. A statewide SMP Task Force was created, made up of SHINE volunteers and staff. At the SHINE leadership meeting in May, HHS Office of Inspector General representatives spoke on trends in Medicare fraud, including genetic testing as one of the most prevalent and newest forms of fraud. As a result, SMP leadership increased marketing efforts to spread the word about SMP and to educate the public about the genetic testing scams. This included articles, op-eds, and press releases, as well as social media efforts.
Medicare beneficiaries and the general public flooded SMP with complaints about the genetic testing scam happening to them. SMP staff compiled all of the information and began reporting it federally. They also shared it with the HHS OIG reps in Florida to expand those collaborations. Because of DOEA’s increased partnership and information sharing with federal authorities, they provided significant contributions that led to the Department of Justice announcing statewide arrests of the scammers. Following the arrest, the SMP Director was contacted by the Assistant Special Agent in Charge of the HHS OIG Miami Office. He and the newly appointed Special Agent in Charge over the State of Florida wanted to meet her because of the success occurring under her leadership of the SHINE/SMP Program. They asked to increase our partnership and will now co-present at SHINE outreach events statewide, which will further increase the legitimacy and awareness of the program.