Arizona Interagency Council on Long-Term Care annual report 2007

              INTERAGENCY COUNCIL ON
LONG- TERM CARE
2007 ANNUAL REPORT
Prepared by:
Interagency Council on Long- Term Care
November 15, 2007
Equal Opportunity EmployerlProgram
This document is available in alternative formats by contacting
The DES ADA Coordinator at 602.542.6572
..
Interagency Council 00 Long.. Term Care
2007 Annual Report
I. Background
In 2001, the Legislature passed Senate Bill 1196 and created the Interagency
Council on Long- Term Care ( Interagency Council). Pursuant to A. R. S. Â  41- 4102,
the purpose of the Interagency Council is " to help the state achieve a coordinated
long- term care services delivery system." Additionally, the Interagency Council is
required to " define this state's long- term care obligations by coordinating applicable
state and federal mandates that relate to long- term care services." This report is
prepared pursuant to A. R. S. Â  41- 4102( C).
II. Council Operating Guidance
Council Vision Statement
The Long- Term Care System in Arizona will be a family- friendly continuum
of services that is person- centered involving seamless partnerships of the
medical, social, physical, and mental health communities.
Council Mission Statement
Improve the quality of life for Arizona residents through a coordinated long term
care delivery system.
Council Purpose
The purpose ofthe Interagency Council is to help the state achieve a
coordinated long- term care services delivery system. Additionally, the
Interagency Council is required to define this state's long- term care services
including quality of care issues, access to services, and coordination!
integration of those services.
III. Membership
Arizona Revised Statute   41- 4101( A) mandates the Interagency Council's
representation be the directors or the designees of the following departments:
• Department of Health Services ( DHS)
• Department of Economic Security ( DES)
• Arizona Health Care Cost Containment System ( AHCCCS)
• Department of Commerce ( DOC)
• Department of Insurance ( DOl)
The following individual representation was made as appointments:
• Executive Director of the Governor's Advisory Council on Aging
• Executive Director ofthe Governor's Council on Developmental
Disabilities
• State Long- Term Care Ombudsman
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In addition, the following additional representation was made as three year
appointments:
• One representative from an Agency on Aging in an urban area
• One representative from an Agency on Aging in a rural area
• Two members of the House of Representatives ( nonvoting)
• Two members of the Senate ( nonvoting)
Appointments to the Interagency Council are for three- year terms. A roster ofthe
current appointments is attached as Appendix A.
IV. Meeting Dates
The Interagency Council on Long- Term Care ( Council) is required to meet four
times a year according tostatute. The Council met on the following dates:
January 3, 2007 - Strategic Planning meeting
February 7, 2007
April 4, 2007
July 11, 2007
September 5, 2007
October 6, 2007
The Council's January meeting was a strategic planning meeting devoted to
identifying Gap Areas within the long- term care system and Agency Activities for
the Council. It was the Council's intent to entertain presentations on Gap Areas
and Agency Activities at each of its 2007 meetings. Gap Areas were defined as
areas where more work needed to be done and the Council's membership could
consider additional strategies to address the needs. Agency Activities were
defined as new programs or initiatives that Council members were unaware of and
could benefit from learning more about. The attached meeting minutes
( Appendix B) describe presentations made to the Council.
Gap Areas
• How to better give people information about the long- term care system
and its options
• How to better integrate Adult Protective Services into the long- term care
system
• Education of healthcare professionals
• Nutrition and hydration of long- term care recipients
• Impact of " Choices" on home and community based services
• Lifespan respite care federal legislation, and the need for a statewide
coalition for information and coordination
• Utilizing retired physicians and other healthcare workers, i. e., dentists
• Older Americans Act caregiver language - caregivers of adult children
Page 3
Agency Activities
• Long- Term Care Insurance
• New Ombudsman training
• Dental coverage
• Falls prevention initiative
• Department of Insurance information on liability insurers
• Department ofEconomic Security Division ofDevelopmental Disabilities
senior- focused unit
• Consumer to consumer quality evaluation of services
• Better education of physicians
• Education practioners and workers with disabilities
• Consumer directed care
• Transitional services - 1 time only
• Putting information on nursing home and assisted home performance on
web
• Spouses as paid caregivers
• Consumer cooperatives
• Mature Workforce Imitative
• Aging 2020 Plan
v. Council Projects
The Council assumed responsibility for oversight of two major cross- agency,
long- tern care system coordination projects a year ago. The Council has
established working committees to manage both these projects.
AZ Links: the Aging and Disability Resource Center project.
In September of2005, the DES Division ofAging & Adult Services ( DAAS) was
notified by the federal Administration on Aging that it had been awarded an
Aging and Disability Resource Center ( ADRC) grant for $ 750,000 over three
years. DESIDAAS is partnering with AHCCCS, the Governor's Council on
Aging, the Governor's Council on Developmental Disabilities, DESlDivision of
Developmental Disabilities, Area Agencies on Aging, the Arizona Bridge to
Independent Living, community aging and disability groups, and the University of
Arizona in working toward creating a single, coordinated system of information,
assistance, and access for all persons seeking long- term care ( LTC) services. In
Arizona, this effort is known as the AZ Links Project.
Information about and access to LTC services must be available to all of
Arizona's citizens to plan for and make informed decisions about their future
needs in the most cost effective manner while choosing from a panoply of options
that promote choice, independence and dignity. Persons seeking services from
the state and its contractors need to have a system that allows them to proceed
from information and referral to eligibility application and determination to
service acquisition, and finally, to service coordination. To accomplish these
goals, the state is working toward developing a comprehensive, seamless
information, referral, and eligibility system along with the necessary data
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management infrastructure. A committee of the Interagency Council on Long Term
Care will serve as the advisory committee to this grant project.
AZ Links is being rolled out using two strategies:
Regional Collaboratives
Collaboratives consisting of staff from area agencies on aging, DES
Division of Developmental Disabilities, independent living centers, and
Arizona Health Care Cost Containment System ( AHCCCS) have been
formed in Mohave and Maricopa counties. Members are focusing on
cross- training within the system and common assessment and referral
protocols to provide a " no wrong door" for clients.
AZ Links Website
A beginning static website with pages of information and useful links
went live on August 1,2007 with the URL ofwww. azlinks. gov. Future
plans for the site include the opportunity for consumers to establish their
own accounts and for the site to have a common assessment, intake, and
referral capability.
The Direct Care Workforce Training effort.
In April 2005, the Citizens Workgroup on the Long- Term Care Workforce issued
their recommendations to Governor Napolitano in a report titled, " Will Anyone
Care? Leading the Paradigm Shift in Developing Arizona's Direct Care
Workforce." The report offered 10 recommendations to improve the direct care
workforce capacity and supply:
1. State agencies must establish and implement policies to support
informal/ family caregivers to ensure that the demand for professional
caregivers does not outweigh supply and thus exacerbate the financial
challenge already facing an overburdened system.
2. State agencies responsible for regulating oversight of direct care workers
must develop a standardized, uniform, and universal training curriculum.
3. Plans developed by state agencies that serve elders and people with
disabilities should be modeled on the concept of person- centered care.
4. One state agency should be identified as the focal point for resource
development for health care workforce initiatives, and designated to playa
proactive role in seeking state, federal, and private grants to further
develop Arizona's direct care workforce.
5. State policy must require and fund health insurance and benefits for direct
care workers in long term care settings.
6. Public and private sector employers must fundamentally re- evaluate the
wages paid to the direct care workforce and balance this with the value of
the services they provide.
7. Funding for pilot projects to enhance direct care workforce recruitment
and retention in long term care should be identified.
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8. The state should mount a public awareness campaign to promote the
image and profile ofthe direct care workforce.
9. The state should continue to support and develop preventative health care
programs.
10. Support the incorporation of long- term care workers into existing
professional associations, or the creation of an association dedicated to the
direct care worker in the long- term care setting.
The Citizens Workgroup on the Long- Term Care Workforce, Education and
Training subcommittee developed a training curriculum to provide the basis for a
standardized, universal, and uniform training. The core curriculum is 30 hours
and includes the following competencies: client's rights/ dignity, basics of
documentation, HIPPA/ confidentiality, stress and time management, basic
principles ofpersonal care, lifting, assistive devices, nutrition, and health and
safety. The core curriculum was piloted in June 2005 at Phoenix College. An
aging and physical disabilities module and developmental disabilities module
were reviewed by the curriculum development committee at Phoenix College, and
course competencies were established for the Maricopa County Community
College System. There are plans to pilot the core and two modules at Phoenix
College in the fall of2007. Pima Community College offered two courses in the
summer of2007 and is planning two additional courses in the fall of2007.
Building on the activities of the Citizens Workgroup on the LTC Workforce, the
Council has established a committee to direct the long- term care workforce effort.
As a result of Council discussion, DES, AHCCCS, and ADHS have come
together to jointly fund a Direct Care Workforce Specialist position within the
DESIDAAS to assist the subcommittee in the project's management, to serve as a
resource for direct care workforce initiatives, and to further develop Arizona's
direct care workforce.
DESIDAAS has directed $ 100,000 to train direct support professionals in
Maricopa, Pinal, and Pima counties using the standardized training curriculum
through the Maricopa and Pima Community College systems. As a result of a
Committee strategic planning meeting held on May 24th
, other project directions
for the current year include: ( l) The direct care worker training process should
initially focus on employees of state- funded agencies providing in- home services.
This should include both new and existing employees. ( 2) A subcommittee
should prepare a recommendation for the parameters of the training program,
including tiers of certification and a timeframe. ( 3) A subcommittee should
pursue the discussion of delivery methods and instruments for the assessment of
theoretical and practical knowledge.
Completed Project Activities
1. The Maricopa County Area Agency on Aging sent an invitation for
participation on January 22, 2007, to providers. It briefly described the
project and announced the training sessions for trainers.
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2. The training manuals for the Core, the Aging & Physical Disabilities, and the
Developmental Disabilities module were completed and printed by DES.
Toolkits with teaching materials and DVDs were assembled for all three
classes. Master trainers are:
Core: Susan Kilby ( FSL) and Diane Patton ( ABIL)
EIPD: Susan Kilby ( FSL) and Diane Patton ( ABIL)
DD: Wendy Ketterer ( AIRES)
3. The two trainings were conducted as planned in February and April. Forty one
individuals attended the Core and one ( or both) of the two modules.
• Trained instructors/ representatives of agencies: Core 41
• Trained instructors/ representatives of agencies: AginglPD 26
• Trained instructors/ representatives of agencies: DD 27
• Agencies represented: 27
• Agencies agreeing to test the curriculum ( or selections): 20
• Agencies that signed an agreement to train 10 direct care and support
professionals, ideally by June 30, 2007, received a toolkit.
4. Two instructors from Pima Health System attended the training in Phoenix
and will work with Pima Community College in Tucson to offer classes for
direct care and support professionals. The first class started May 12, 2007.
Over 30 individuals had signed up and 13 completed the course. Twenty- two
students completed the second class in July 2007. The college offers a
certificate and college credits to participants; tuition is paid from the funds
made available by DES to the Pima Council on Aging.
5. CJ 0' Connor of the Maricopa County Area Agency on Aging has developed a
plan for the evaluation of the project. She conducted telephone interviews
with participants of the February session, and she has developed
questionnaires for trainers and the direct care and support professionals
receiving the training.
Plans for the Future
1. Pima Community College is planning to offer two additional courses in the fall
of 2007. The college is also planning the development of a hybrid course.
The training project is expanding to Pinal/ Gila region, with Pinal/ Gila Council
for Seniors exploring implementation in rural areas. In " Maricopa, three
provider agencies will offer training through Phoenix College.
2. Project leaders and DES staffwill follow up with the agencies that attended the
trainings to promote the use of the curriculum in their training.
3. Through follow- up activities and formal evaluations, the acceptance of the
curriculum and details regarding implementation will be assessed.
4. Project leaders and DES staff will work with the Core Curriculum and
Expansion Committee to develop suggestions for further implementation and
revisions.
5. Work continues on the Alzheimer's Disease and Dementia module, and there
are plans for a module on behavioral health.
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Executive Order 2007- 01 on Ensuring Quality in Long Term Care
The Governor established an Executive Order to address quality in long term care.
The Departments of Realth Service, Economic Security, and ARCCCS and the
Governor's Interagency Council on Long- Term Care were specified to play key
roles in implementing the Order. The Executive Order specified a set ofeleven
Objectives for the next three years:
Objective 1: DRS, DES, and ARCCCS shall develop a comprehensive three year
strategy to improve quality in long term care, including focusing on
nursing homes in the first year, assisted living in the second year, and
community care in the third year.
Objective 2: DRS, ARCCCS, and DES, in collaboration with program
contractors and the long term care industry, shall set goals and take measures
to reduce Arizona's rates of pressure ulcers and restraint use in nursing homes,
with a minimum goal of achieving and/ or sustaining rates well below the
national average.
Objective 3: ARCCCS, DRS, and DES shall work together with the Arizona
Long Term Care System program contractors to address and correct quality of
care deficiencies in long term care facilities.
Objective 4: Beginning in PY08, and as permitted by law, DRS shall develop
incentives for nursing homes that have achieved top quality care, based on criteria
set by the department and as measured and verified through the annual survey
and quality rating processes.
Objective 5: DRS, ARCCCS, and DES shall enter into intergovernmental
service agreements, using existing resources, to jointly staff a full- time
position within the DES Division of Aging and Adult Services to work with
community advocates, long term care providers, community colleges and
other entities as deemed necessary to address the shortage of long term care
direct care support professionals in Arizona.
Objective 6: DRS shall continue to take the lead in holding conferences to
educate direct care staff about how to prevent pressure ulcers and properly use
restraints, with the next such conference to occur before the end of 2007.
Objective 7: DRS shall post Quality Ratings of individual nursing homes on
the department's website by no later than July 2007.
Objective 8: DRS shall post regulatory surveys for nursing homes and
assisted living facilities on its website to provide consumers with quality
information about assisted living facilities beginning no later than January
2008.
Objective 9: DRS, ARCCCS, and DES shall collaborate to develop a
Consumer's Long Term Care Toolkit to provide Arizona families with the
information, resources and guidance needed to make informed decisions about
long term care.
Objective 10: DRS, during its survey process of nursing homes and assisted
living facilities, shall foster better understanding and compliance with federal
law regarding the provision and appropriate explanation ofthe Residents' Bill
of Rights to all residents.
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Objective 11: By July 2009, the Interagency Council on Long Term Care is
requested to recommend a Bill ofRights for consumers ofhome and
community- based long term care services.
VI. Listening Session
Pursuant to   A. R. S. 41- 3901( D), the Interagency Council must hold a public
meeting to solicit comments on ways to improve Arizona's Long- Term Care
delivery system from the community so that it:
• Ensures the dignity of consumers;
• Meets the individual needs of consumers;
• Provides high quality programs and services;
• Provides an opportunity for consumers to choose and have input in their
servIces;
• Enhances home and community- based care;
• Integrates funding sources to provide affordable services; and
• Coordinates state and federal mandates.
Every two years, the Governor's Advisory Council on Aging sponsors Senior Action Day
at the Legislature. Traditionally this was an event on the Capitol lawns where seniors
gathered for an opportunity to meet with their legislators and have some fun.
Unfortunately, that also meant that a lot of people didn't participate, because they could
not or would not drive to Phoenix. So this past year the Council decided to try something
different --- LOCAL Senior Action Days!
This past spring, the Council held a local Senior Action Day event in seven communities
across Arizona. The first event of the day was a luncheon for legislators and concerned
seniors from their respective legislative districts. The luncheons were designed to allow
legislators to participate and learn more about the issues that affect older Arizonans and
the role they can play in helping us all remain in our own homes and communities
throughout our lives.
Following the luncheons, public hearings were convened on- site to review the State Plan
on Aging. The hearings were 1 ~ hours long. The public hearings were facilitated and
generally were introduced by the host city Mayor and the legislators who stayed over
from the luncheon. Five of the Plan's eight Goals were covered and the main initiatives
planned for each Goal. Written and verbal input was then solicited for each Goal.
The Chair ofthe Interagency on Long- Term Care participated in each ofthe public
hearings. The broad scope of the State Plan on Aging allowed for consumer input across
the breath ofthe long term care continuum. Given the extensive input received from
these seven hearings across the state, they served as the Council's listening session for
2007.
Below is a listing of dates and locations of the Senior Action Days.
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SENIOR ACTION DAYS - 2007
Area & Districts/ Event Location
February 23rd Includes East Valley ( Maricopa) and Pinal districts of 8, 17, 18,
19,20,21,22, & 23. Event held in Mesa at East Valley Senior
Services Center.
March 16th Includes Mohave, La Paz, Yuma counties, districts 3 & 24. Event
held in Parker at the Parker Senior Center.
March 23rd Includes North Phoenix, Paradise Valley, Scottsdale, Cave
Creek/ Carefree districts of 6, 7, 8, 10, & 11. Event in Paradise
Valley Senior Center.
March 30th Includes Central Phoenix, West Valley & Pinal districts of9, 12,
13, 14, 15, 16, & 23. Event held in Avondale.
April 13th Includes upper northwest valley, Yavapai, & Coconino County
districts of 1, 2, & 4. Event held at the Prescott Community
Center.
April 20th Eastern & NE Arizona ( Coconino, Apache, Gila, Graham, Navajo
counties), including districts 2 & 5. Event held in Globe, at the
Globe City Hall.
April 27th Tucson and Southern AZ, ( Pima, Cochise, Santa Cruz, Greenlee
counties) including districts 25,26,27,28,29,30. Event held in
Tucson at a senior center.
VII. Next Steps
The Council will devote one of its first meetings in 2008 to a planning session to
determine priority projects, in addition to the AZ Links Project and Direct Care
Worker Training, with which the Council wants to become more involved. The
Council will also continue to remain involved in the critical projects mentioned
above to further the coordination, collaboration and improvement of Arizona's
Long Term Care System.
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APPENDIX A
INTERAGENCY COUNCIL ON LONG- TERM CARE
MEMBER ROSTER
Page 11
APPENDIXB
INTERAGENCY COUNCIL ON LONG- TERM CARE
MEETING MINUTES
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Interagency Council on Long Term Care ( IACLTC)
Planning Meeting Minutes
January 3, 2007
Committee Chair Rex Critchfield called the meeting to order at 1: 40 p. m. Quorum was
established. Rex announced Bob York, Assistant Director for the DES Division of Aging
and Adult Services, had tendered his resignation. Rex was assuming the Acting Assistant
Director's position.
Rex welcomed everyone and asked for introductions. Council members present were
Rex Critchfield, Mary Wiley, Kathleen Heard, Karen Duffy, Marian Lupu, Robert Nixon,
Alan Schafer, Jami Snyder, Sue Gerard and Melanie Starns.
Public in attendance were Leona Goldfarb, Angela Arens, Kathleen Pagels, Dick White,
Karla Avery, Kim Simmons, Robin Jordan, Lynn Larson, Allie Masters, Randy Scott and
Pat Talcott.
Chair Rex Critchfield began the meeting with discussion ofAZ Links Proj, ect. He stated
that the morning's Steering Committee had decided upon a regional collaborative
approach where multiple agencies will work together to assist individuals and families
through the long term care system. The AZ Links Project Manager will assist agencies in
Maricopa and Mohave counties to formulate regional collaborations. Rex stated there is
nothing for the Council to approve today and there would be more to share at the next
meeting in March.
Vice- Chair Mary Wiley provided the purpose oftoday's meeting along with the
background of the Council, a review of the Council's authorizing legislation, and a
review ofthe Council's vision, mission, and purpose statement.
Vice- Chair Mary Wiley summarized the background of the Council's beginnings from 6Â 7
years ago, which grew from a grievous episode in a nursing home and the death of a
woman from a severe sunburn in a nursing home. Sue Gerard brought numerOl, lS
individuals together to determine what could be done with the long- term care system,
including legislation, and thus the IACLTC came into being. Vice- Chair Mary Wiley
reviewed the seven legislative intents for the Council, its Vision, Mission Statement, and
Purpose.
Mary stated the 7 Legislative points:
1. Ensures the dignity of consumers of long- term care services.
2. Is designed to meet the individual needs ofconsumers.
3. Provides services and programs that are of the highest quality.
4. Promotes consumer self- determination by providing an opportunity for
consumer choice and input.
S. Enhances appropriate alternatives to institutional care such as home and
community based long- term care services.
6. Integrates various funding sources to provide affordable services at the highest
quality.
7. Coordinates applicable state and federal mandates that relate to long- term care
services.
Mary proceeded to read the Council Vision Statement, which the Council changed to
reflect the changing of " mental" health to " behavioral" health.
The Council Mission Statement was changed to add, " this entity was designed to be
a high level dialog vehicle for state policy makers to ensure coordination and to
prevent duplication of resources".
Rex stated the Council has two standing sub- committees, AZ Links Committee and the
Direct Workforce Committee, which report to the Council and they are important when
looking at planning activities for the year. The three committees spoke about their future
plans and matched their plans to the Council's seven legislative intents.
The Council, with public participation, identified initiatives for 2007 that will address
each of the Council's seven legislative intents by its two standing committees, by the
State Committee for the Reduction of Pressure Ulcers and Restraints ( SCRPUR), and
then initiatives for each ofthe member agencies.
1. Ensures the dignity of consumers of long- term services.
Committee Plans
Direct Care Worker ( DCW) delivery of standardized curriculum
Statewide Coalition on Restraints and Pressure Ulcer Reduction
( SCRPUR) activities
2. Is designed to meet the individual needs of consumers.
Committee Plans
AZ Links website
AZ Links Uniform Assessment Instrument ( UAI)
SCRPUR activities
Agency Activities
Long Term Care Insurance ( AHCCCS)
New Ombudsman training - ( DAAS- DES)
Dental coverage - GCDD
Falls prevention initiative - GACA
Gap Areas
How to better give people information/ respond
How to better integrate Adult Protective Services into the LTC system
2
3. Provides services and programs that are ofthe highest quality
Committee Plans
AZ Links website
DCW delivery of standardized curriculum
SCRPUR activities
Agency Activities
Department of Insurance information on liability insurers
New Ombudsman training ( DAAS- DES)
DDD senior- focused unit
Consumer to consumer quality evaluation of services ( DDD)
Better education of physician ( UofA)
Gap Areas
Education of healthcare professionals
Nutrition & hydration ofLTC recipients
4. Promotes consumer self- determination by providing an opportunity for
consumer choice and input.
Committee Plans
AZ Links website
AZ Links outreach and education
SCRPUR activities
Agency Activities
Education practioners re: disabled workers ( AHCCCS)
Consumer directed care ( AHCCCS, EPD)
Spouses as paid caregiver ( AHCCS)
Transitional services - 1 time only ( AHCCS)
Putting information on nursing home and assisted living home
performance on web
Consumer cooperatives ( DDD)
Mature Workforce Initiative ( GACA)
Gap Areas
Impact of " Choices" on Home & Community Based Services
3
5. Enhances appropriate alternatives to institutional care such as home and
community based long- term care services.
Committee Plans
AZ Links website
AZ Links outreach and education
DCW delivery of standardized curriculum
DCW staff to coordinate and explore incentives (" operationalizing
curriculum")
SCRPUR activities
Gap Areas
Lifespan respite care federal legislation, need a statewide coalition for
information and coordination.
6. Integrates various funding sources to provide affordable services at the highest
quality.
Committee Plans
DCW exploring/ coordinating incentives, resources, and more affordable
services.
Gap Areas
Utilizing retired physicians and other health care workers, i. e., dentists.
7. Coordinates applicable state and federal mandates that relate to long- term care
servIces.
Committee Plans
AZ Links regional collaborations
AZ Links UAI
DCW - hiring jointly funded position
SCRPUR activities
Agency Activities
Aging 2020 Plan
Gap Areas
Older Americans' Act Caregiver language - caregivers of adult children
Discussion was exchanged that the Council needed more legislative and agency director
participation. This topic will be an agenda item at a future meeting.
It was agreed the Council would meet next month on February 7th
. The meeting was
adjourned at 3: 55 p. m.
4
Interagency Council on Long Term Care ( IACLTC)
Meeting Minutes
February 7, 2007
Committee Chair Rex Critchfield called the meeting to order at 1: 36 p. m. Quorum was
established.
A. Welcome and Introductions
Committee Members Present: Mary Wiley, Kathleen Heard, Marian Lupu, Melanie
Starns, Uta Brotherton, Jami Snyder, Robert Nixon,
Public in Attendance: Kathleen Pagels, Angela Arens, Lynn Larson, Robin Jordan,
Dick White, Karla Averill, Kim Simmons, Robin Coulon and Pat Talcott.
B. Approval of Minutes
Meeting minutes from January 3, 2007 were approved as submitted.
C. AZ Links Project Update
Robin Jordan stated there were two meetings scheduled for the regional
collaboratives on February 9th for Mohave County and February 13th for Maricopa
County. Work is moving forward on the IT Charter Agreement with AHCCCS and a
meeting was held with DES IT to start building the content for the website.
D. Direct Care Work Committee Update
Jami Snyder stated they are working on the first round of training here inc Maricopa
County on the Disability Module. Many providers are interested in having their
employees take the training. Lynn Larson is contacting Ted Rausch at Pima College
regarding the manuals. Curriculum for Pima College could be approved at the
College Committee's March meeting. Jami stated they are working with the local
Area Agency to evaluate the training programs.
E. Review of the Executive Order 2007- 01 on Ensuring Quality In Long- Term Care
Melanie Starns distributed a copy of the executive order issued January 2006 by the
Governor. The purpose of this order is to focus on ensuring quality in long- term care
through strategies in a 3- year Plan. Item # 11 of the Executive Order asked the
IACLTC to recommend a Bill of Rights for consumers of home and community based
long term care services by July 2009. Chair Rex Critchfield called for a
motion to undertake this request. Melanie Starns made the motion, Mary Wiley
seconded the motion. There was no discussion and everyone was in agreement.
This issue will be brought to a future meeting. Many issues were brought up
regarding the executive order, such as licensing issues, discharging plan/ basic
services, quality of services monitoring, surveys, complaint driven system, incentives
for nursing homes with help from the council, toolkits through AZ Links, partners,
colleges, libraries, faith based organizations, area agencies and the Ombudsman
Program. Mary Wiley, DHS, stated that facility surveys are being redesigned for
Internet use and s; he would bring copies to group for testing in May.
Interagency Council on Long Term Care ( IACLTC)
Meeting Minutes
February 7, 2007
Page 2
F. Follow- up to January's Planning Session/ Review and Prioritization of Planned
Activities/ Review and Prioritization of Gaps for presentations and discussion
at future meetings Chair Rex Critchfield asked everyone to prioritize agency
activities for future presentations to and discussions by council. The activities were
prioritized as the following:
1. Dental Coverage
2. Consumer Direct Care
Dept. of Insurance Information on Liability Insurers
3. Long- term Care Insurance
Consumer Cooperatives
Falls Prevention Initiative
4. New Ombudsman Training ( DAAS- DES)
DDD senior- focused unit
Spouse as paid caregiver ( AHCCCS)
Aging 2020 Plan
5. Consumer to consumer quality evaluation of services ( DDD)
Better education of physician ( UofA)
Transitional Services - 1time only ( AHCCCS)
Putting information on nursing home and assisted home performance on
web ( EO, DHS)
Mature Workforce Initiative ( GACA)
The Gaps were prioritized as following:
1. Integrate APS with Long- Term Care System, central registry, investigation
of facilities and AG central registry to give better information and
response.
Older American Act Caregiver language- caregivers of adult children.
Coordinating OAA regulations with state appropriation. Still a gap - DD
adult children with parents caring for them.
2. Education of Healthcare Professionals
3. Nutrition & Hydration of LTC recipients - DHS, CMS, Feeding Assistance
Program
4. Utilizing retired physicians.
2
Interagency Council on Long Term Care ( IACLTC)
Meeting Minutes
February 7,2007
Page 3
These topics will be slated for future meetings.
G. Member Announcements
Melanie gave an update on the 7 Senior Action Days, which will consist of a
legislative luncheon and a public forum where the State Plan on Aging will be
presented.
Chair Rex Critchfield stated the " draft" Plan on Aging was currently being
reviewed by Deputy Director Nelba Chavez and will eventually be posted on the
Division of Aging and Adult Services website. The State Plan was very
comprehensive.
Chair Rex Critchfield stated the next meeting is scheduled for Wednesday,
March 7, 2007. Many stated they would be unable to attend on this date so
March 14th was selected for the next meeting. Rex stated everyone would be
contacted bye- mail to find out if there would be a quorum for March 14th
.
H. Call for Agenda Items
No additional agenda items were identified.
I. Call to the Public
Kathleen Pagels stated her thanks to the Governor Napolitano for her leadership
and the Executive Order. She further reviewed for the Council the concerns that
she and the provider community had with the interpretation of the Executive
Order.
J. Adjournment
With no other items, Chair Rex Critchfield adjourned the meeting at 3: 27 p. m.
3
Governor's Interagency Council on Long- Term Care
Council Minutes
April 4, 2006
Council Members Present:
Council Member Absent:
Staff Present:
Guests Present:
Rex Critchfield, Chairperson
Mary Wiley, Vice- Chairperson
Robert Nixon
Jami Snyder
Christina Urias
Alan Schafer
Kathleen Heard
Marian Lupu
Melanie Starns
Uta Brotherton
Senator Carolyn Allen
Representative Bob Stump
Robin Jordan
Lynn Larson
Pat Talcott
Jutta Ulrich
Erin Klug
Dick White
Kim Simmons
Call to Order
Introductions
Minutes Approved
AZ Links Project
Update
Call to Order: The meeting was called to order at 1: 08 p. m. by Rex Critchfield,
Council Chairperson.
Introductions: All individuals who were in attendance introduced themselves. It
was noted a quorum of the council members was present for the meeting.
Approval of the February 7, 2007 Meeting Minutes: The members of the
Council reviewed and approved the minutes.
The minutes were approved without objection.
AZ Links Project: Rex Critchfield asked Robin Jordan to present this report.
Ms. Jordan reported on the two subcommittees of the Project's Steering
Committee. The Customer Assistance subcommittee is working on the
development of a training manual to use for Project partners across the state,
which would contain a core set of information on the long term care system. The
Uniform Assessment Instrument subcommittee is working on a common
assessment form for use by all Project partners.
Ms. Jordan then spoke about the two regional collaboratives that have begun
Governor's Interagency Council on Long- Term Care
April 4, 2006 meeting minutes
1
Direct Care Workforce
Committee Report
Executive Order 2007Â 01
on Ensuring Quality
in Long Term Care
Update
Dental Coverage  Agency
Activity
Department of
meeting. The Mohave County Collaborative is working on a common referral
form, an MOU/ agreement to be signed by all partners, and a client screening
tool. The Maricopa County Collaborative is also working on an
MOU/ agreement for all partners as well as cross- training needs for all partners.
Project staff are working with DES IT staff to establish a static web page for the
project. The estimated date for the web page to go live is 5/ 1.
Direct Care Workforce Committee: Jami Snyder stated that the Core
Curriculum Committee has been meeting. The Committee is considering the
best use of the funding provided through the DES Division of Aging & Adult
Services ( DAAS) to continue to promote the curriculum. One train- the- trainer
course has been conducted. A second session is planned and has approximately
37 individuals signed up to attend. The Region One Area Agency on Aging is
working on the evaluation portion of the project. Jutta Ulrich was introduced as
the new DAAS staff assigned to the Direct Care Workforce issue. Jami also
mentioned that Phoenix College has indicated that they will no longer be able to
provide the coordination of the curriculum for college credits due to the decrease
in the Full Time Student Equivalent funds they receive for each student. Several
members ofthe Core Curriculum and Expansion Committee will be
meeting with Rio Salado College to coordinate the delivery of the curriculum for
college credits.
Ensuring Quality Care in Long Term Care: Mary Wiley on behalf of
Melanie Starns that meetings have been scheduled for the state agencies
referenced in the Executive Order. Activities in progress to meet the Executive
Order include: a 2007 Reducing Pressure Ulcers Summit on 5/ 23; a 2007
Reducing Restraints Summit on 6/ 27; the Department ofHealth Services ( DHS)
is revising their web site with nursing horne and assisted living facility
information to immediately reflect any change in the horne or facility score
based on a visitation or inspection; a Took Kit is being worked on by GACA;
DHS and AHCCCS will be meeting to find a way not to duplicate surveys of
facilities; and the IACLTC will be developing a Patient's Bill of Rights by 2009.
Dental Coverage: Jami Snyder stated that the Governor's Council on
Developmental Disabilities ( GCDD) had identified dental coverage as a number
one need as part of their planning process for their 5- Year Plan. They had put
together a workgroup on this issue. Alan Schafer reported that this year,
AHCCCS proposed a budget issue that became part of the Governor's budget for
capped dental coverage for aging, physically disabled and developmentally
disabled long- term care eligible individuals, up to $ 1,000 per person. S. B. 1488
limited coverage to the aging and physically disabled long- term care eligible.
While optimism is not high on funding for this issue, the 68% match available to
AHCCCS for such a program is appealing.
Director of the Department of Insurance ( Dol), Christina Urias, gave a short
Governor's Interagency Council on Long- Term Care
April 4, 2006 meeting minutes
2
Insurance Information
on Liability Insurers  Agency
Activity
Member
Announcements
Call for Agenda Items
Call to the Public
presentation. The Nursing Home liability market is experiencing problems
nationwide and insurers in Arizona are finding it particular difficult. Dol
conducts marketing surveys. They found that of 184 licensed companies
responding to their survey, only 3 were writing new business. The average claim
against nursing homes has risen from $ 72,000 in 1993 to $ 176,000 in 2004 - a
144% increase in 11 years. Between 1996 and 2000, 15% of all claims exceeded
$ 250,000 per claim. Carriers are aware of the severity of these claims, making it
difficult to find re- insurers. This forces some nursing homes to turn to the non admitted
market, which is not subject to the same oversight as the admitted
insurers. Dol just sent out their 2007 survey and the preliminary returns are
indicating a similar situation.
A Report on Arizona Health Insurers was issued in May of 2006. It listed the
top 25 insurers doing business in Arizona. It further disclosed that about 50% of
the time, insurers will overturn their original decision on payment of claims if it
is appealed.
Christina mentioned a New York Times article that was a scathing review of
Long Term Care Insurance. One of its main criticisms was that, since it was a
new type policy, many insurers originally set their premiums too low and
policyholders are now experiencing 35% and 25% yearly increases. She
reminded the Council that Dol can approve or disapprove rates on individual
Long Term Care policies. However, only 15 complaints had been received by
Dol in 2005 and 8 complaints in 2006 about Long Term Care policies.
Jami Snyder - Announced that she was leaving the GCDD as their Executive
Director and was taking a position with DHS.
Alan Schafer - AHCCCS' contract to develop a consumer directed care model
was moving forward and was basically on schedule, as was another initiative to
pay spouses as caregivers up to 40 hours per week, another initiative moving into
place is to provide funding for transition services to move from a nursing home
back into the person's home, and they have received a half- million dollar grant
to assist persons with a disability obtain employment to move off Medicaid.
Rex suggested that for the next meeting, the Council receive presentations on the
Falls Prevention Initiative ( an Agency Activity) and on DD Adult Children with
Parents Caring for Them ( a Gap).
The next meeting will be July 11 - not July 4 th
, the traditional meeting date
because it is the first Wednesday in July. Notification will be sent to members to
determine availability.
Dick White - The National Life Span Respite Care bill has made it to the
negotiation stage at the federal level. S. B. 1317, the state level counterpart, is
doing well and has passed out of the Appropriations Committee by a unanimous
vote. Dick also mentioned that there are ongoing discussions with DES to
integrate or coordinate a statewide Caregivers Coalition with a statewide Respite
Governor's Interagency Council on Long- Term Care
April 4, 2006 meeting minutes
3
Adjournment
Care Coalition.
Kim Simmons - Asked Director Urias' whether the liability insurers for DDD
group homes were the same insurers for nursing horne. Director Urias
responded in the affirmative.
The Chairperson adjourned the meeting at 3: 02 p. m.
Governor's Interagency Council on Long- Term Care
April 4, 2006 meeting minutes
4
Interagency Council on Long- Term Care
Council Minutes
July 11, 2007
Council Members Present:
Council Member Absent:
Staff Present:
Guests Present:
Rex Critchfield, Chairperson
Mary Wiley, Vice- Chairperson
Uta Brotherton
Alan Schafer
Erin Klug
Robert Nixon
Cynthia Gafford
Kathleen Heard
Melanie Starns
Senator Carolyn Allen
Representative Bob Stump
Lynn Larson
Pat Talcott
Jutta Ulrich
GretaMang
Kim Simmons
Kathleen Pagels
Genny Rose
Karen Barno
Call to Order
Introductions
Minutes Approved
AZ Links Project
Update
Direct Care Workforce
Committee Report
Call to Order: The meeting was called to order at 1: 10 p. m. by Rex Critchfield,
Council Chairperson.
Introductions: All individuals who were in attendance introduced themselves. It
was noted a quorum of the council members was present for the meeting.
Approval of the April 4, 2007 Meeting Minutes: The members of the Council
reviewed and approved the minutes. The minutes were approved without
objection.
AZ Links Project: See attached report.
Direct Care Workforce Committee: Jutta Ulrich reported on the progress of
the project and the recommendations from the Core Curriculum and Expansion
Committee's strategic planning meeting, which included a direct care workforce
training, parameters of the training program including tiers of certification,
explore delivery methods, curriculum pilot in a rural area, continued training
activities and evaluation in Maricopa and Pima counties, and subcommittees to
implement the recommendations. The committee also advised the IACLTC that
Interagency Council on Long- Term Care
July 11,2007 meeting minutes
1
Executive Order 2007Â 01
on Ensuring Quality
in Long Term Care
Update
Ombudsman Training
State Plan on Aging
Member
Announcements
a public policy plan is needed to address the larger issues surrounding the direct
care workforce in Arizona. Jutta advised that the project's planned activities for
FY2008 include expansion of the curriculum into Pinal- Gila region, continued
training and evaluation in Maricopa and Pima counties, and the development of a
' hybrid" web- based course.
The Council asked the committee to come back to the next Council meeting with
an agreed upon name for the committee, a membership list, and a work plan.
Alan Schafer agreed to become the new committee chair.
Uta Brotherton recommended that the committee check out collaboration
possibilities with the Department of Commerce's Apprenticeship Program.
Ensuring Quality Care in Long Term Care: No report on this activity.
Ombudsman Training: Â  Bob Nixon advised there would be new Ombudsman
training through out the state to all volunteers which would lead to certification
and everyone would be provided with an updated manual. Also at their request,
this training would included the Native Americans tribes.
State Plan on Aging. Lynn Larson provided a handout on the State Plan Goals
and Objectives and reported the State Plan on Aging was approved by the
Governor's Advisory Council on Aging. The next steps would be approval by
DES management and the Governor.
Member Announcements. Rex announced that the Legislature had
appropriated $ 500,000 in state funds to the DES Division of Aging and Adult
Services for the development of a statewide respite coalition and for the
provision of respite care services.
Erin Klug advised the long- term care insurance brochure provided to the Council
a few meetings back by the Department of Insurance is now on their website and
to contact her if there was any questions or concerns regarding long term care
insurance.
Alan Schafer reported on the state appropriation to AHCCCS of $ 1 ,000 per
person for non- emergency Adult Dental Care, which does not include dentures.
Alan stated a policy is being drafted to be provided to AHCCCS management
regarding payment to caregiver spouses who provide healthcare 7 days a week.
Also in the works is a Community Reintegration Program to assist someone
moving from a nursing home back into their own home, which would provide
$ 2,000 per member within a 5 year period for utility deposits and basic
furnishings.
Interagency Council on Long- Term Care
July 11,2007 meeting minutes
2
Alan stated that AHCCCS will launch a Consumer Directed Care program
targeted to start October 1, 2007. This program will allow the consumer to
delegate service tasks. Implementation issues are still being worked through,
such as fiscal agent unemployment insurance.
AHCCCS has received a $ 500,000 Medicaid grant in collaboration with
Medicaid Freedom to initiate an Arizona Health and Disability Partnership
program to assist members who are working or wanting to go back to work. It is
designed to better link the independent living systems with the employment
network. Derek Johnson is Project Manager of the 3- year grant.
Call for Agenda Items Agenda Items. Rex advised at the next IACLTC meeting on September 5, 2007
the Council will receive a draft of the Annual Report so it could be approved at
the October 3,2007 meeting instead of waiting until the November 7,2007
meeting for approval.
Call to the Public No comments.
Adjournment The Chairperson adjourned the meeting at 3: 00 p. m.
Interagency Council on Long- Term Care
July 11,2007 meeting minutes
3
AZ Links Update JULY 1, 2007
Regional Collaboratives
Cross Training Materials have been developed by the CAC Committee.
• Finalization of those materials will be determined at the July 18th Meeting.
• A contractor will compile all materials into an instructional manual and desk
reference.
Cross Training -
• Mohave Regional Network have developed training outlines and set three
training days - 2 in September and one in October. Staff participating in the
cross trainings have also been identified.
• Maricopa Regional Network has determined their regional training format and will
determine dates for those cross trainings at their JUly meeting. They expect to
hold the trainings in October/ November timeframe.
Website Development-
• AZ Links website is expected to go live the last week in July. It is being
developed by the PIO office. It will be located on the DMS website and will also
have a separate URL: www. azlinks. gov.
• This site will have links to various websites arranged by topic. However it will not
be interactive. Topics include: Aging and Other Resources; Caregiver
Resources; Employment; Financial Help; Fitness, Health & Nutrition; Fraud,
Scams & Legal Matters; Housing Options; Independent Living Supports;
Insurance, Medicare & Other Benefits; Long Term Care Choices; Personal
Safety; Socialization/ Recreation; Transportation; Tribal Resources; Volunteering.
• Website Continuing Development - Interactivity will be built as this website is
developed to include the Screening Tool and a Common Intake.
Background: Following the formal agreement between AHCCCS and DAAS,
AHCCCS has appointed Linda Schwank to work with us to develop the website
connection with AHCCCS.
• Linda Schwank is currently developing a work plan to develop the functionality of
the website and proposes to launch a Pilot with functionality.
Focus groups are being assembled to give feedback on both the Screening Tool and
the Website once the website is launched.
• The Governor's Council on Developmental Disabilities has identified persons with
developmental disabilities, persons with physical disabilities in both Pilot regions.
• The Area Agency on Aging in Region One and Region 4 are providing
participants representing the aging community.
Screening Tool- is currently being tested for validity in Mohave and Maricopa
Counties.
• It has been installed on the WACOG AM Region 4 website ( English and
Spanish translations).
• Installation of the Screening Tool on the AAA, Region One website is expected
any day.
Background: The Screening Tool is designed to be a self- help tool. Following data
entry, it is sent to an Information Specialist who then calls the person and assists in
locating the services they are requesting, or referring to the most appropriate agency.
Common Intake Matrix - A Common Intake is being developed by the Uniform
Assessment Instrument committee. Kris Bursae has incorporated committee
recommendations, and will present a Final Draft at the UAI Meeting on July 18th
. If
approved, it will be forwarded for Steering Committee approval on August 1.
Triggers - Identifying the elements that determine where the consumer should be
directed.
• Expected Completion: August, 2007.
Background: The UAI committee members have submitted the triggers and are now
creating a decision tree to determine which of their respective agencies are the most
appropriate to handle the specific individual's needs. This will guide IT development,
to provide the information on agencies that will most likely provide the services
needed.
Inventory of Services - The Customer Assistance Committee has agreed on a list of
40 service categories and 143 services available from the partner agencies, state and
federal programs. This inventory will help I & R staff in directing consumers to the correct
agency. The value of this Inventory:
1) Helps staff from other agencies know what each agency provides;
2) Provides easy location of services based on a category of services;
3) Illustrates if there are gaps in services;
4) Using AIRS taxonomy as well as other agreed upon service categories, facilitates
search capabilities when a database is developed on the website.
Inventory of Sites - A complete list of locations ( 365) throughout the state has been
compiled. Agencies include DES, AHCCCS, DOD, AAA offices. Other service locations
include Benefits Check Up, AZ Secure, and SHIP sites.
Interagency Council on Long- Term Care
Council Minutes
September 5, 2007
Council Members Present:
Council Member Absent:
Staff Present:
Guests Present:
Rex Critchfield, Chairperson
Mary Wiley, Vice- Chairperson
Alan Schafer
Erin Klug
GretaMang
Melanie Starns
Franc Kahn
Jan Lesher/ Uta Brotherton
Senator Carolyn Allen
Representative Bob Stump
Lynn Larson
Pat Talcott
Robin Jordan
Allie Masters
Kim Simmons
John Linda
Fran Atkinson
Jana Bertucci
Andy Weiler
Call to Order
Introductions
Minutes Approved
Update on Council
Membership
Call to Order: The meeting was called to order at I : 33 p. m. by Rex Critchfield,
Council Chairperson.
Introductions: All individuals who were in attendance introduced themselves. It
was noted a quorum of the council members was present for the meeting.
Approval of the July 11,2007 Meeting Minutes: The members of the Council
reviewed the minutes and Melanie Starns asked for removal of " Governor's"
before Interagency Council on Long Term Care title. Alan Schafer moved to
approve the minutes. Greta Mang seconded the motion and the minutes were
approved without objection.
Update on Council Membership: Rex Critchfield, Council Chairperson, stated
that Senator Meg Cahill would be the new representative for the Senate. Area
Agency on Aging urban and rural representatives have been accepted and the
Council is awaiting their signed Oaths of Office. Greta Mang, new supervisor
over the Ombudsman Program, replaces Bob Nixon the Council. The Council
roster will be updated to reflect the changes.
Interagency Council on Long- Term Care
September 5, 2007 meeting minutes
I
AZ Links Project
, Update
Direct Care Workforce
Committee Update
Executive Order 2007Â 01
on Ensuring Quality
in Long Term Care
Update
Falls Prevention
Initiative
Draft Annual Report
AZ Links Project: Allie Masters reported the launching of the website, through
DES and stated the site provides a plethora of levels of information for aging,
developmental disabled, and disabled. She stated the website is a work in
progress and welcomes suggestions. A project manager from AHCCCS has
been assigned to help develop the AZ Links web application. Regional networks
have been established in Mohave and Maricopa counties, bringing together Area
Agencies on Aging, the Division of Developmental Disabilities, AHCCCS, and
the independent living agency. Staff cross trainings will occur from September
through December. Chairperson Critchfield stated there had been coordination
with the Governor's Council on DD to have focus groups evaluate the
maneuverability, accessibility, assessments, and improvements to the AZ Links
website.
Direct Care Workforce Committee: Alan Schafer stated they have been
meetings through the first part of the year establishing 3 sub committees on
curriculum, training, implementation, and marketing aspects. Chairperson
Critchfield clarified that the Governor's Advisory Council on Aging ( GACA) is
forming a caregiver coalition group focused on the unpaid caregiver. Lynn
Larson further clarified that the DAAS is developing a Lifespan Respite Care
Program, through a $ 500,000 state appropriation, which will assist individuals
who do not qualify for current respite programs. Criteria are in development for
those who will be serviced.
Ensuring Quality Care in Long Term Care: Melanie Starns reported that half
of the objectives of a work plan to accomplish the Executive Order have been
accomplished. Accomplishments have included a Conference on the Use of
Restraints by ADHS ( 250 attendance) and ADHS has on- line survey results for
nursing homes and childcare which are more user friendly. A press release about
a Tool Kit for use in facilities was issued last week and is a good resource for the
ombudsmen. Next year's work will include a Consumer Bill ofRights for Home
Based Care.
Falls Prevention Initiative: Andrew Weiler stated he is developing a track on
Falls Prevention for the Governor's Conference on Aging for May 2008 in
Tucson. Mr Weiler stated that he was also working to develop a survey tool to
detect the likelihood of a person falling. Chairperson Critchfield suggested that
APS workers would benefit from having such a survey to administer to their
clients. Free standing tools are available now. Co- chair Mary Wiley stated
cards on the signs of abuse are currently being given to paramedics.
Draft Annual Report. Chair Critchfield stated that the Council's Annual
Report is due to the Governor and the Legislature on the 15th ofNovember.
This year's draft Report includes a section on results of the Council's strategic
planning session in January, reports on the three committees, and uses the seven
public meetings that DAAS used around the state to collect input on their State
Plan on Aging. Comments on the draft Annual Report are needed within 2
weeks. Changes will be incorporated and sent back out to the Council in a week.
Next meeting will be on Wednesday, October 17, 2007 @ 2: 30 p. m.
Interagency Council on Long- Term Care
September 5, 2007 meeting minutes
2
, Member
Announcements
Alan Schafer announced that dental services with a one time authorization for
$ 1,000 through the ALTCS Program would now be available from October 1,
2007 through September 30,2008. Also starting October 1st is a payment for up
to 40 hours of in- home service in a 7 day period for caregiver spouses.
Community Integration payments will be available for settling into one's own
home/ apt., to include furniture, utility deposits, etc. The $ 2,000 allowance is
available every 5 years. The Self Directed Care project is delayed until April
2008.
Greta Mang reported that on October 18,2007, an Ombudsman Quarterly
Meeting will be held and include APS and the AG's office. The meeting will
have a legal theme. Greta, as the new Ombudsmen Program supervisor, will be
making statewide visits, is in the process of planning a two day annual meeting,
is working on the Nursing Home Resident Rights Brochure, and will be re designing
and updating current booklets and posters. Greta advised that October
7- 14 is Residents Rights Week.
Call for Agenda Items None
Call to the Public John Linda stated that although his office has moved, their e- mail and phone
number have not changed.
Adjournment The Chairperson adjourned the meeting at 2: 57 p. m.
Interagency Council on Long- Term Care
September 5, 2007 meeting minutes
3