To: Board of Supervisors
Department or Agency Name(s): Human Services
Staff Name and Phone Number: Paul Dunaway (707) 565-3673
Vote Requirement: 4/5th
Supervisorial District(s): Countywide
Title:
Title
Human Services Department Adult & Aging Services Position Conversion and Expansion
End
Recommended Action:
Recommended action
A) Adopt a position resolution effective December 13, 2022 to
i) Convert 2.0 Full Time Equivalent time-limited Adult and Aging Social Workers, 1.0 Full Time Equivalent time-limited Senior Office Assistant position and 1.0 Full Time Equivalent time-limited Adult and Aging Supervisor allocations to permanent allocations in the Human Services Department; and
ii) Add 1.0 new Full Time Equivalent Adult and Aging Social Worker allocation in the Human Services Department to support the Home and Community Based Alternatives program.
B) Adopt a budget resolution to modify the Human Services Department Fiscal Year 2022-2023 budget to increase appropriations in the amount of $240,500. (4/5 vote)
(4/5th Vote Required)
end
Executive Summary:
The Adult and Aging Division in the Human Services Department provides safety net services to veterans, older adults, people with disabilities and their caregivers. Since its creation in 1996, the Adult and Aging Division has expanded direct services and community partnerships to meet the needs of the growing older adult population in Sonoma County.
Ongoing revenue from the California Department of Aging and the California Department of Social Services provides the needed resources for the Adult and Aging Division to increase staffing by 1.0 FTE Adult and Aging Social Worker, convert 2.0 FTE time-limited Adult and Aging Social Worker positions to permanent positions, convert 1.0 FTE time-limited Adult and Aging Social Work Supervisor position to a permanent position, and convert 1.0 FTE time-limited Senior Office Assistant position to a permanent position. This staffing will address increasing client needs in Linkages and the Home and Community Based Alternatives Programs.
Discussion:
California’s over-60 population is projected to diversify and grow faster than any other age group, increasing from 16% in 2010 to 25% of the population by 2030. Older adults age 60+ account for 27% of Sonoma County’s total population, a number that is projected to increase to 33% by 2030. The economic profile of the county’s older adult population reflects growing financial challenges. Older adults tend to become poorer as they age and their economic status is linked to social determinants such as ethnicity, education, and employment history.
Effective January 1, 2022, AB 135 (Chapter 85, Statutes of 2021) and a change to the Welfare and Institutions code (Sec. 15750) defines an “elder” as a person who is 60 or older rather than the previous 65 years of age. Authorized legislation, changes to the Welfare and Institutions code, and ongoing and guaranteed funding from the California Department of Social Services (CDSS) and the California Department of Aging (CDA) are supporting program expansions and additional services for older adults and people with disabilities in Sonoma County, all of which require committed permanent and additional staff. These staff members will support increasing caseloads, case management demands and collaboration and operational efficiencies throughout the division.
The programs and staff, summarized below, will help address the new mandates and increasing needs for older adults and people with disabilities.
Home and Community Based Alternatives
The California Department of Health Care Services (DHCS) began funding the Home and Community Based Alternatives (HCBA) Waiver program in 2018 and has renewed the HCBA Waiver through 2026 with the expectation that this funding will continue with renewal every five years. The Centers for Medicare and Medicaid Services (CMS) continue to approve extensions and the DHCS has amended the HCBA Waiver to integrate Assisted Living Waiver (ALW) services. HCBA is a Medicaid Federal waiver program that is protected by legislation.
The HCBA program enables Sonoma County to provide case management services to older adults and people with disabilities who would otherwise receive care in an intermediate care facility, skilled nursing facility, subacute facility or an acute care hospital. To be eligible for enrollment in a 1915(c) waiver, a person must require at least skilled nursing level of care and otherwise need institutional care if not for the services provided through the Waiver. The HCBA Waiver provides long-term supports and services to eligible Medi-Cal beneficiaries in their home or community residence of choice. The goal is to facilitate the transition of institutionalized beneficiaries to a less-restrictive, community-based setting and to prevent individuals who are at imminent risk of institutionalization from being admitted.
This is a highly regulated, complex program requiring strict adherence to Department of Healthcare Services (DHCS) and California Department of Aging (CDA) regulations and protocols. HCBA services are integral to Adult and Aging services and require confidentiality and an understanding of the unique needs and challenges of its client base. This work cannot be contracted out into the community.
Conversion of 2.0 FTE Adult and Aging Social Workers and 1.0 FTE Senior Office Assistant position from time-limited (expiring April 16, 2023) to permanent will ensure HCBA can continue to meet its expanded mandate. The urgency and complexity of these cases is growing and social workers have expanded their scope of work into disaster related services and supports as well. This level and scope of services requires the unique support provided by the program’s Senior Office Assistant. Conversion of the SOA will ensure the needed support for HCBA to meet the County’s contractual obligation to the State, address workload demands, meet timelines, and most importantly, enable HCBA Social Workers to prioritize client health and safety.
The addition of 1.0 FTE Adult and Aging Social Worker will help HCBA to continue to meet its contractual obligations of maintaining the staff to client ratios required by DHCS. Currently there are 150 active clients and there are 35 community members on the wait list. This position provides person-centered care management services to individuals enrolled in the HCBA program, which assists them to remain safe in the community and out of skilled nursing facilities. This position also allows the HCBA program to continue to outreach to more diverse communities and respond more effectively to increasingly complex client needs.
Linkages and Information and Assistance program
The Linkages/Information and Assistance program is funded through the County’s Area Agency on Aging (AAA) Public Service Area (PSA) 27, which is funded directly by the CDA. The AAA receives a combination of federal and state funding, and the Federal Older Americans Act requires there to be planning service areas to receive guaranteed funding. This funding is guaranteed through Sonoma County’s AAA PSA-27 status. Additional funding is received through In-Home Supportive Services and the Mental Health Services Act’s Prevention and Early Intervention grant.
The Linkages program is intended to prevent premature or inappropriate institutionalization of frail, at-risk older adults and adults with disabilities by providing care management as well as comprehensive information and assistance services. The Information and Assistance program provides person centered services to older adults, people with disabilities, and their caregivers through a public hotline (707-565-INFO) staffed by trained Adult and Aging Social Workers. The Linkages/Information and Assistance unit requires a dedicated Adult and Aging Supervisor to oversee the work of 10.0 FTE Adult and Aging Social Workers.
Conversion of 1.0 FTE Adult and Aging Supervisor from time-limited (expiring April 16, 2023) to permanent is essential to the provision of services in which this position monitors compliance, determines client eligibility, assigns cases to social workers, and monitors and approves case actions and closures. The supervisor provides critical case consultation and reviews time sensitive reports. Stability of this supervisor resource means social workers will have increased access to clinical consultation and support.
Strategic Plan:
N/A
Prior Board Actions:
03.01.2022 Human Services Department (HSD) Adult & Aging Division Expansion
08.31.2021 Adult and Aging Division Position Changes
12.14.2021 HSD Revenue Contract Amendment with DHCS
04.17.2018 Authorized HSD to accept funding and execute a contract with DHCS for the HCBA program and added time-limited allocations.
Fiscal Summary
|
Expenditures |
FY 22-23 Adopted |
FY23-24 Projected |
FY 24-25 Projected |
|
Budgeted Expenses |
521,100 |
868,900 |
903,800 |
|
Additional Appropriation Requested |
240,500 |
|
|
|
Total Expenditures |
$761,600 |
$868,900 |
$903,800 |
|
Funding Sources |
|
|
|
|
General Fund/WA GF |
|
|
|
|
State/Federal |
761,600 |
868,900 |
903,800 |
|
Fees/Other |
|
|
|
|
Use of Fund Balance |
|
|
|
|
Contingencies |
|
|
|
|
Total Sources |
$761,600 |
$868,900 |
$903,800 |
Narrative Explanation of Fiscal Impacts:
The Human Services Department’s Fiscal Year 2022-23 Adopted Budget includes $521,100 for the 4.0 time-limited positions supporting the Home and Community Based Alternatives and Linkages programs through 4/16/2023. HSD requests approval to add $139,800 in appropriations for the 4.0 time-limited positions to cover the time period of 4/16/2023 to 6/30/2023. In addition, HSD requests approval to add $100,700 in appropriations for a permanent 1.0 FTE Adult & Aging Social Worker as of Board date 12/13/2022 through the end of the fiscal year.
The cost of the existing 2.0 FTE Adult & Aging Social Worker and 1.0 FTE Senior Office Assistant positions will continue to be 100% funded with Medicaid Federal waiver programs under HCBA. HCBA waiver revenue will vary as it is based on reimbursement from the number of clients.
The cost of the existing 1.0 FTE Adult and Aging Social Work Supervisor will continue to be 100% funded with ongoing funding for Linkages through the AAA, Mental Health Services Act Prevention and Early Intervention, and In-Home Supportive Services.
The cost of the new 1.0 FTE Adult & Aging Social Worker will be 100% funded using projected caseload revenue of approximately $215,000 provided through Medicaid Federal waiver programs under HCBA. HCBA waiver revenue will vary as it is based on reimbursement from the number of clients.
|
Staffing Impacts: |
|
|
|
|
Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
|
Adult and Aging Social Worker |
$6,567-7,983 |
1.00 |
|
|
Adult and Aging Social Work Supervisor |
$7,357-8,943 |
0.00 |
|
|
Senior Office Assistant |
$3,916-4,760 |
0.00 |
|
Narrative Explanation of Staffing Impacts (If Required):
The Adult and Aging Social Worker reports to the Adult and Aging Social Work Supervisor and does not supervise any staff. The Adult and Aging Social Work Supervisor position under the Linkages program reports to the Community Services Section Manager and will supervise full-time Adult and Aging Social Workers. The Senior Office Assistant reports to the Adult and Aging Social Work Supervisor as well as the Office Support Supervisor (OSS) and does not supervise any staff.
Attachments:
Attachment 1 Position Resolution
Attachment 2 Budget Resolution
Related Items “On File” with the Clerk of the Board:
None