To: Board of Supervisors
Department or Agency Name(s): Human Services, Health Services, In-Home Supportive Services Public Authority
Staff Name and Phone Number: Paul Dunaway 565-3673, Tina Rivera 565-7901, Eric Glentzer 565-5952
Vote Requirement: 4/5th
Supervisorial District(s): Countywide
Title:
Title
Human Services Department Adult & Aging Division Expansion
End
Recommended Action:
Recommended action
A) Adopt a budget resolution to adjust revenue and expenditure appropriations to program additional funding in the amount of $152,800 from the California Department of Social Services and California Department of Aging for Adult Protective Services Expansion, Multipurpose Senior Services Program, In-Home Supportive Services Administration, and In-Home Supportive Services Public Authority for the Fiscal Year 2021-2022 budget.
B) Adopt a position resolution effective March 1, 2022 1) adding 9.0 new full-time equivalent (FTE) allocations, 2) converting 1.0 FTE time-limited allocation to a permanent allocation, 3) adding 4.0 FTE time-limited allocations through June 30, 2024 and 4) extending 2.0 FTE current time-limited allocations through June 30, 2024.
C) Authorize the Director of the Human Services Department to execute an agreement with Legal Aid of Sonoma County for legal services to older and dependent adult victims of abuse in the Adult Protective Services Home Safe Program for the period July 1, 2022 to June 30, 2023 in an amount not to exceed $139,000.
(4/5th Vote Required)
end
Executive Summary:
The Adult and Aging Division in the Human Services Department (HSD) 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.
New revenue from the California Department of Aging (CDA) and the California Department of Social Services (CDSS) provides the needed resources for the Adult and Aging Division to increase staffing by 12.0 FTE positions, extend 2.0 FTE time-limited positions, convert 1.0 FTE from time-limited to permanent, and add 1.0 FTE in partnership with the Department of Health Services (DHS). Additional staffing will address increased Adult Protective Services (APS) cases, housing needs for the APS Home Safe Program, increased case management demand in the Multipurpose Senior Services Program (MSSP), and increased caregiving needs for clients in the In-Home Supportive Services (IHSS) and In-Home Supportive Services - Public Authority (IHSS PA) program. These added positions are necessary to support the state mandated expansion of the APS program by lowering the eligible age of qualifying elders from 65 to 60 effective January 1, 2022, as well as supporting collaboration and operational efficiencies throughout the division and facilitating leadership capacity to focus on community partnerships and innovations.
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 aged 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.
Sonoma County has a significant lack of housing options for older adults and especially for those individuals who are low income. The number of older adults experiencing homelessness in Sonoma County increased by 42% from 2018 to 2020. More than half of older adults requesting assistance from Legal Aid of Sonoma County have needs related to housing. Since its first fiscal award in December 2018 for California’s new Home Safe Program pilot, Sonoma County has participated in this program designed to support the safety and housing stability of individuals involved in Adult Protective Services.
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 rather than the previous 65 years of age. As a result of this change and the ongoing impact of the pandemic, APS projects that reports could grow by 14% to about 6,400 reports per year by 2026, with the urgency and complexity growing as social workers assist victims of abuse who have also been impacted by the county’s collective trauma from fires, public safety power shutoffs, limited access to affordable housing, and the COVID-19 pandemic that disproportionately harmed older and other at-risk adults.
Authorized legislation, changes to the Welfare & Institutions code, and new funding from CDSS and CDA are supporting program expansions and additional services for older adults and people with disabilities in Sonoma County, all of which require additional staff. The additional staff will support increased caseloads, collaboration and operational efficiencies throughout the division, and facilitate capacity to focus on community partnerships and innovations.
The new funding, summarized below, will help to address the new mandates and increasing needs for older adults and people with disabilities.
Allocation from the California Department of Aging (CDA)
Multipurpose Senior Services Program (MSSP) ($107,104) HSD receives funds from CDA to operate the MSSP with the goals of preventing placement in nursing facilities and fostering independence and dignity for older adults. The program provides case management services to Medi-Cal eligible older adults who are frail and at risk of institutionalization. Effective March 1, 2022, new revenue will fund a Social Service Worker IV for MSSP (0.5 FTE) to serve an additional 40 MSSP clients, thus increasing the number of clients served each month from 160 to 200. A portion of the funding will also help pay for a Program Development Manager that will hold responsibility for administering MSSP. Existing ongoing MSSP funding supports conversion of a Social Work Assistant allocation from time-limited to permanent.
Allocations from the California Department of Social Services (CDSS)
In-Home Supportive Services (IHSS) and IHSS Public Authority ($305,362)
New revenue will fund a Program Development Manager (1.0 FTE) to provide increased management support to the Medi-Cal waiver programs in Adult and Aging, the MSSP and the Home and Community Based Alternatives (HCBA) Program, while also providing increased management to IHSS.
MSSP and HCBA provide case management to older adults and people with disabilities who meet nursing facility level of care, but are able to remain safely in the community. These are both highly regulated, complex programs that require strict adherence to Department of Healthcare Services (DHCS) and California Department of Aging (CDA) regulations and protocols. Additionally, the Program Development Manager will provide management support to the IHSS program which is growing in complexity and size and requires similar adherence to regulations from the California Department of Social Services.
New revenue will also fund a new Social Service Worker III position (0.5 FTE) and a new Home Care Support Specialist position (1.0 FTE). The 0.5 FTE Social Service Worker III position will be combined with a current, unfilled 0.5 FTE Social Service Worker III position so the program can fill a single, full-time position. The 1.0 FTE Home Care Support Specialist position will be responsible for recruiting new IHSS providers to the IHSS Public Authority Registry.
Effective July 1, 2019, SB 80 (Chapter 27, Statutes of 2019) modified the previously existing County IHSS Maintenance of Effort (MOE) structure and implemented a new statewide County IHSS MOE base that includes modified cost sharing arrangements between the state and the counties. As part of the changes, IHSS administration is no longer a component of the IHSS MOE. Instead, counties receive a State General Fund allocation for the IHSS administration activities which will be used as a match to draw down federal Title XIX funds for eligible costs.
Adult Protective Services (APS) Expansion ($1,359,013)
New revenue is being allocated due to the change in the age of eligibility for the APS program, which recognizes a growing older adult demographic, and the California Department of Social Services’ expectation that APS will provide longer term case management support to those with complex needs. The Adult Protective Services program is growing to more than 50 staff with three distinct program areas comprised of Intake, Investigations and the Home Safe Program. This new revenue will fund a new Human Services Section Manager (1.0 FTE) to provide the leadership capacity to oversee the day-to-day operations of the three distinct program areas as well as APS community engagement efforts, grants and contracts.
New revenue will also fund a Social Service Supervisor II (1.0 FTE), Social Service Worker IVs (3.0 FTE), and a Social Work Assistant (1.0 FTE). Funding these six new positions, the California State Budget includes an ongoing year-to-year statewide $70 million State General Fund for Adult Protective Services Expansion.
Effective January 1, 2022, AB 135 (Chapter 85, Statutes of 2021) lowers the eligible age to meet the statutory definition of “elder” from 65 to 60 years old, allowing APS to investigate and provide services to vulnerable adults five years earlier than previously permissible. AB 135 also makes changes to the Welfare & Institutions code and amends WIC Section 15763 by expanding Multidisciplinary Teams to include housing representatives and WIC Section 15630 to include IHSS agency employees as mandated reporters. AB 135 also adds WIC Section 15651 allowing APS to refer clients with intensive needs to appropriate agencies to support their safety goals. These changes address the state’s growing aging population and expands case management for those with more complex needs.
APS Home Safe Program ($1,341,275)
The number of older adults becoming homeless or facing homelessness is reaching disproportionate numbers. New time-limited revenue will support the addition of Social Service Worker IVs (3.0 FTE), extension of a Social Service Worker IV (1.0 FTE), extension of a Social Work Assistant (1.0 FTE), and addition of a Senior Public Health Nurse (1.0 FTE - DHS) to support the Home Safe Program through June 30, 2024.
Home Safe assists APS clients who are experiencing homelessness or are at imminent risk of homelessness due to elder or dependent adult abuse, neglect, self-neglect or financial exploitation. The Budget Act of 2021 (SB 129, Chapter 69, Statutes of 2021) appropriated a total of $92.5 million for Home Safe for Fiscal Year 2021-2022 to be expended through June 30, 2024. AB 135 (Chapter 85, Statutes of 2021) and amendments to WIC (Sections 15770-15771) includes an additional $92.5 million General Fund for Fiscal Year 2022-23 that can also be expended through June 30, 2024.
AB 135 (Chapter 85, Statutes of 2021) and amendments to WIC (15770) include case management and housing assistance to those who are homeless or at risk of becoming homeless, including those in unsafe living conditions and those individuals who have not yet received an eviction notice. The Home Safe Program works to enhance health, safety, and housing supports for individuals receiving services through APS. This funding will also support an elder law attorney with Legal Aid of Sonoma County to respond to housing related issues. This is time-limited funding available through June 30, 2024.
Strategic Plan:
This item directly supports the County’s Five-year Strategic Plan and is aligned with the following pillar, goal, and objective.
Pillar: Healthy and Safe Communities
Goal: Goal 1: Expand integrated system of care to address gaps in services to the County’s most vulnerable.
Objective: Objective 2: Identify gaps in the Safety Net system of services and identify areas where departments can address those gaps directly, and seek guidance from the Board when additional resources and/or policy direction is needed.
Prior Board Actions:
08.31.2021 Adult and Aging Division (A&A) Position Changes
01.26.2021 Human Services Department Adult Protective Services Budget Amendment and Position Allocation
08.04.2020 Multipurpose Senior Services Program (MSSP) Revenue Contract for Fiscal Year 2021-22
Fiscal Summary
|
Expenditures |
FY 21-22 Adopted |
FY 22-23 Projected |
FY 23-24 Projected |
|
Budgeted Expenses |
$0 |
$3,316,700 |
$3,336,440 |
|
Additional Appropriation Requested |
$152,800 |
$0 |
$0 |
|
Total Expenditures |
$152,800 |
$3,316,700 |
$3,336,440 |
|
Funding Sources |
|
|
|
|
General Fund/WA GF |
$0 |
$0 |
$0 |
|
State/Federal |
$152,800 |
$3,316,700 |
$3,336,440 |
|
Fees/Other |
$0 |
$0 |
$0 |
|
Use of Fund Balance |
$0 |
$0 |
$0 |
|
Contingencies |
$0 |
$0 |
$0 |
|
Total Sources |
$152,800 |
$3,316,700 |
$3,336,440 |
Narrative Explanation of Fiscal Impacts:
The Human Services Department requests an adjustment to the FY 2021-22 budget to increase appropriations in the total amount of $152,800.
FY 2021-22 increased appropriations totaling $152,800 will be funded by a revenue increase of $30,200 received by the California Department of Aging as part of the Multipurpose Senior Services Program, $41,300 received from the California Department of Social Services for In-Home Supportive Services (IHSS) and IHSS Public Authority, and $81,300 received for Adult Protective Services Expansion.
FY 2022-23 expenses of $3,316,700 will be funded by a revenue increase of $96,300 received by the California Department of Aging as part of the Multipurpose Senior Services Program, $264,000 received from the California Department of Social Services for In-Home Supportive Services (IHSS) and IHSS Public Authority, $100,000 from the Area Agency on Aging, $1,277,700 from the Adult Protective Services Expansion, $242,000 from 2011 Realignment, and $1,336,700 from the Adult Protective Services Home Safe Program.
FY 2023-24 expenses of $3,336,440 will be funded by a revenue increase of $101,100 received by the California Department of Aging as part of the Multipurpose Senior Services Program, $305,300 received from the California Department of Social Services for In-Home Supportive Services (IHSS) and IHSS Public Authority, $100,000 from the Area Agency on Aging, $1,359,013 from the Adult Protective Services Expansion, $254,200 from 2011 Realignment, and $1,216,827 from the Adult Protective Services Home Safe Program.
Please see Attachment 4 for a funding source comparison by each fiscal year.
|
Staffing Impacts: |
|
|
|
|
Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
|
Senior Public Health Nurse |
$8,405.88-$10,218.19 |
1.0 |
0.0 |
|
Human Services Section Manager |
$8,473.71-$10,301.68 |
1.0 |
0.0 |
|
Program Development Manager |
$7,964.10-$9,679.02 |
1.0 |
0.0 |
|
Social Service Supervisor II |
$6,621.39-$8,047.59 |
1.0 |
0.0 |
|
Home Care Support Specialist |
$3,838.56-$4,666.45 |
1.0 |
0.0 |
|
Social Service Worker IV |
$5,922.20-$7,198.82 |
6.5 |
0.0 |
|
Social Service Worker III |
$5,308.24-$6,452.68 |
0.5 |
0.0 |
|
Social Work Assistant |
$3,821.17-$4,643.84 |
1.0 |
0.0 |
Narrative Explanation of Staffing Impacts (If Required):
Thirteen (13) new allocations will be added as indicated in the table above. The department will work with Human Resources on recruitments to fill the positions. The extension of the time-limited positions will prevent the department from having to initiate layoff proceedings for those time-limited positions that are currently filled and previously set to expire on June 30, 2022.
The Adult Protective Services program is growing to more than 50 staff with three distinct program areas: Intake, Investigations and the Home Safe Program. Adding a dedicated Section Manager will provide the leadership capacity to oversee the day-to-day operations of the three program areas as well as APS community engagement efforts, grants and contracts.
The Program Development Manager is being added to provide increased management support to the Medi-Cal waiver programs in Adult and Aging: the MSSP and the HCBA programs, as well as additional support to IHSS. These programs are highly regulated, complex programs requiring strict adherence to DHCS, CDS and CDSS regulations and protocols.
Attachments:
Attachment 1 Budget Resolution
Attachment 2 Position Resolution
Attachment 3 Legal Aid Contract
Attachment 4 Funding Sources by Fiscal Year
Related Items “On File” with the Clerk of the Board:
None